This Article Full Text Full Text (PDF) All Versions of this Article: 116/4/366    most recent CIRCULATIONAHA.106.671545v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Erbs, S. Articles by Schuler, G. Search for Related Content PubMed PubMed Citation Articles by Erbs, S. Articles by Schuler, G. Related Collections Acute myocardial infarction Coronary circulation Catheter-based coronary and valvular interventions: other

(Circulation. 2007;116:366-374.)
© 2007 American Heart Association, Inc.

Coronary Heart Disease

Restoration of Microvascular Function in the Infarct-Related Artery by Intracoronary Transplantation of Bone Marrow Progenitor Cells in Patients With Acute Myocardial Infarction

The Doppler Substudy of the Reinfusion of Enriched Progenitor Cells and Infarct Remodeling in Acute Myocardial Infarction (REPAIR-AMI) Trial

Sandra Erbs, MD; Axel Linke, MD; Volker Schächinger, MD; Birgit Assmus, MD; Holger Thiele, MD; Klaus-Werner Diederich, MD; Christina Hoffmann, MD; Stefanie Dimmeler, PhD; Torsten Tonn, MD; Rainer Hambrecht, MD; Andreas M. Zeiher, MD; Gerhard Schuler, MD

From the University of Leipzig, Heart Center, Department of Cardiology, Leipzig (S.E., A.L., H.T., K.-W.D., R.H., G.S.); J.W. Goethe University Frankfurt, Departments of Cardiology (V.S., B.A., S.D., A.M.Z.) and Transfusion Medicine (T.T.), Frankfurt; and Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen (C.H.), Germany.

Correspondence to Sandra Erbs, MD, University of Leipzig, Heart Center, Department of Internal Medicine/Cardiology, Struempellstrasse 39, 04289 Leipzig, Germany. E-mail Sandra.Erbs{at}medizin.uni-leipzig.de

Received November 3, 2006; accepted May 3, 2007.

Background— The Doppler Substudy of the randomized, double-blind, placebo-controlled Reinfusion of Enriched Progenitor Cells and Infarct Remodeling in Acute Myocardial Infarction (REPAIR-AMI) trial aimed to investigate the effects of intracoronary infusion of bone marrow–derived progenitor cells (BMCs) on coronary blood flow regulation in patients with reperfused acute myocardial infarction.

Methods and Results— In a total of 58 patients (BMC group, n=30; placebo group, n=28), coronary flow reserve (CFR) in the infarct artery and a reference vessel was assessed by intracoronary Doppler at the time of study therapy (4.2±0.1 days after acute myocardial infarction) and at the 4-month follow-up. Initial CFR was reduced in the infarct artery compared with the reference vessel in both groups (BMC: 2.0±0.1 versus 2.9±0.2, P<0.05; placebo: 1.9±0.1 versus 2.8±0.2; P<0.05). At the 4-month follow-up, CFR in the infarct artery had slightly improved in the placebo group (+0.88±0.18; P<0.001 versus initial) but was markedly increased by 90% (+1.80±0.25; P=0.005 versus placebo) in BMC-treated patients, resulting in a normalization of CFR (3.8±0.2; P<0.001 versus initial and placebo at 4 months). In the infarct vessel, adenosine-induced minimal vascular resistance index declined slightly in the placebo group (from 1.77±0.12 to 1.52±0.15 mm Hg · s/cm; P<0.05) but considerably decreased by –29±6% in the BMC group (from 1.86±0.19 to 1.20±0.12 mm Hg · s/cm; P<0.05 versus initial and placebo at 4 months).

Conclusions— Intracoronary BMC therapy after acute myocardial infarction restores microvascular function of the infarct-related artery, which is associated with a significant improvement in maximal vascular conductance capacity. These data provide clinical proof of concept that progenitor cell transplantation promotes vascular repair.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				A. Surdacki, E. Marewicz, E. Wieteska, G. Szastak, T. Rakowski, E. Wieczorek-Surdacka, D. Dudek, J. Pryjma, and J. S. Dubiel Association between endothelial progenitor cell depletion in blood and mild-to-moderate renal insufficiency in stable angina Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2265 - 2273. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				G. Gerosa and C. d'Agostino Cell therapy in ischemic settings: Fact and fiction. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 986 - 990. [Full Text] [PDF]

				R. K. Burt, Y. Loh, W. Pearce, N. Beohar, W. G. Barr, R. Craig, Y. Wen, J. A. Rapp, and J. Kessler Clinical Applications of Blood-Derived and Marrow-Derived Stem Cells for Nonmalignant Diseases JAMA, February 27, 2008; 299(8): 925 - 936. [Abstract] [Full Text] [PDF]

				S. Dimmeler, J. Burchfield, and A. M. Zeiher Cell-Based Therapy of Myocardial Infarction Arterioscler. Thromb. Vasc. Biol., February 1, 2008; 28(2): 208 - 216. [Abstract] [Full Text] [PDF]