Stem cells intracoronary infusion

Most of the clinical experience gained with stem cells has involved therapy for AMI, particularly intracoronary infusion of bone marrow cells since skeletal myoblasts are too large for this purpose [133]. Table 7.2 summarizes the experience to date. In all of these trials, revascularization was performed promptly after the index myocardial infarction, and left ventricular systolic compromise was minor (in the BOOST trial, the baseline left ventricular ejection fraction [LVEF] was 50%). 

The feasibility and efficacy of granulocyte-colony stimulating factor (G-CSF) therapy and subsequent intracoronary infusion of collected peripheral blood stem cells were prospectively investigated in the MAGIC randomized clinical trial [137], which showed improved cardiac function and promotion of angiogenesis in myocardial infarction patients. 

However, the trial raised important safety questions. Intracoronary infusion of G-CSF-stimulated peripheral-blood stem cells apparently aggravated restenosis after coronary stenting, leading to early termination of the trial. Meanwhile, no temporal association between increased restenosis rate and stenting near the time of intracoronary cell administration has been noted in other studies that have not used G-CSF stimulation. 

Kang HJ, Kim HS, Zhang SY, Park KW, Cho HJ, Koo BK, Kim YJ, Soo Lee D, Soon DW, Han KS, Oh BH, Lee MM, Park YB. Effects of intracoronary infusion of peripheral blood stem-cells mobilised with granulocyte-colony stimulating factor on left ventricular systolic function and restenosis after coronary stenting in myocardial infarction the MAGIC cell randomised clinical trial. Lancet 2004 363 751-756. 

Tendera, M., Wojakowski, W., Ruzyllo, W., Chojnowska, L., Kepka, C., Tracz, W., Musialek, P. et al. 2009. Intracoronary infusion of bone marrow-derived selected Cd34-l- Cxcr4-l- cells and non-selected mononuclear cells in patients with acute Stemi and reduced left ventricular ejection fraction Results of randomized, multicentre myocardial regeneration by intracoronary infusion of selected population of stem cells in acute myocardial infarction (Regent) trial. Eur. Heart 30, 1313-1321. 

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