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(Circulation. 2004;110:II-213 – II-218.)
© 2004 American Heart Association, Inc.

Cell Transplantation and Tissue Engineering

Improved Exercise Capacity and Ischemia 6 and 12 Months After Transendocardial Injection of Autologous Bone Marrow Mononuclear Cells for Ischemic Cardiomyopathy

Emerson C. Perin, MD PhD^*; Hans F.R. Dohmann, MD^*; Radovan Borojevic, PhD; Suzana A. Silva, MD; Andre L.S. Sousa, MD; Guilherme V. Silva, MD; Claudio T. Mesquita, MD PhD; Luciano Belém, MD; William K. Vaughn, PhD; Fernando O.D. Rangel, MD; Joao A.R. Assad, MD; Antonio C. Carvalho, MD PhD; Rodrigo V.C. Branco, MD; Maria I.D. Rossi, PhD; Hans J.F. Dohmann, MD PhD; James T. Willerson, MD

From the Texas Heart Institute at St. Luke’s Episcopal Hospital (E.C.P., G.V.S., W.K.V., R.V.C.B., J.T.W.), Houston, Tex; Hospital Procardiaco (H.F.R.D., S.A.S., A.L.S.S., C.T.M., L.B., F.O.D.R., J.A.R.A., H.J.F.D.), Rio de Janeiro, Brazil; Federal University (R.B., A.C.C., M.I.D.R.), Rio de Janeiro, Brazil.

Correspondence to Emerson C. Perin, MD, PhD, 6624 Fannin, Suite 2220, Houston, TX 77030 (E-mail eperin{at}crescentb.net), or Hans F.R. Dohmann, MD, Rua General Polidoro, 192, CEP 22080-000 Botafogo, Rio de Janeiro, Brazil (E-mail hemodinamica@procardiaco.com.br).

Background— We recently reported the safety and feasibility of autologous bone marrow mononuclear cell (ABMMNC) injection into areas of ischemic myocardium in patients with end-stage ischemic cardiomyopathy. The present study evaluated the safety and efficacy of this therapy at 6- and 12-month follow-up.

Methods and Results— Twenty patients with 6- and 12-month follow-up (11 treated subjects; 9 controls) were enrolled in this prospective, nonrandomized, open-label study. Complete clinical and laboratory evaluations as well as exercise stress (ramp treadmill), 2-dimensional Doppler echocardiography, single-photon emission computed tomography (SPECT) perfusion scanning, and 24-hour Holter monitoring were performed at baseline and follow-up. Transendocardial delivery of ABMMNCs was performed with the aid of electromechanical mapping to identify viable myocardium. Each patient received 15 ABMMNC injections of 0.2 mL each. At 6 and 12 months, total reversible defect, as measured by SPECT perfusion scanning, was significantly reduced in the treatment group as compared with the control group. At 12 months, exercise capacity was significantly improved in the treatment group. This improvement correlated well with monocyte, B-cell, hematopoietic progenitor cell, and early hemapoietic progenitor cell phenotypes.

Conclusions— The 6- and 12-month follow-up data in this study suggest that transendocardial injection of ABMMNCs in patients with end-stage ischemic heart disease may produce a durable therapeutic effect and improve myocardial perfusion and exercise capacity.

Key Words: cells • heart failure • ischemia • revascularization • gene therapy