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| J Korean Med Assoc > Volume 49(11); 2006 > Article |
Abstract
Several randomized placebo controlled clinical trials, which were based on the solid data from cell biologic, animal, and phase 1 clinical trials, have been published to demonstrate the efficacy of cell therapy to improve the contractility of myocardium in patients with myocardial infarction. Intracoronary infusion of the bone marrow mononuclear cells into infarct territory proved to be effective in improving coronary flow and contractility of the damaged myocardium in patients with AMI or OMI. Intracoronary infusion of the mobilized peripheral blood mononuclear cells with G-CSF also proved to be effective in induction of angiomyogenesis in infarct territory of patients with AMI. Intramyocardial injection surgically or through catheter of autologous skeletal myoblast expanded ex vivo provided gain of LV contractility with possible side effect of arrhythmogenecity. From these trials we got the insight regarding the limitation and the solution to overcome it. In order to introduce cell therapy in the daily clinical practice, we have to find out the best protocol to ensure the reproducible and remarkable efficacy from active communication between basic and clinical researches. The limitation of efficacy in cell therapy may be overcome in two ways. One is to enhance the number and vitality/function of the cells for therapy. The other is to improve the homing/integration rate of transplanted cells to infarct territory after intracoronary infusion or intramyocardial injection.Stem cell therapy for angiomyogenesis in infarcted myocardium of patients proved to be effective. Future studies should be focused on to improve the limited efficacy and then to test the new protocols in large clinical trials.
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Table 1
Randomized controlled trials to test the efficacy of bone marrow mononuclear cells to improve the contractility of myocardium in patients with myocardial infarction (Rosenzweig A. 2006)
BOOST=Bone Marrow Transfer to Enhance ST-Elevation Infarct Regeneration, PCI: percutaneous coronary intervention, MRI magnetic resonance imaging,
TOPCARE-CHD=Transplantation of Progenitor Cells and Recovery of LV Function in Patients with Chronic Ischemic Heart Disease, CPC progenitor cells derived from circulating blood,
ASTAMI=Autologous Stem-Cell Transplantation in Acute Myocardial Infarction, SPECT single-photon-emission computed tomography, and
REPAIR-AMI=Reinfusion of Enriched Progenitor Cells and Infarct Remodeling in Acute Myocardial Infarction.
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