Autologous mesenchymal stem cells produce reverse remodelling in chronic ischaemic cardiomyopathy

• Published in: European heart journal Vol. 30; no. 22; pp. 2722 - 2732
• Main Authors: Schuleri, Karl H., Feigenbaum, Gary S., Centola, Marco, Weiss, Eric S., Zimmet, Jeffrey M., Turney, Jennifer, Kellner, Joshua, Zviman, Menekhem M., Hatzistergos, Konstantinos E., Detrick, Barbara, Conte, John V., McNiece, Ian, Steenbergen, Charles, Lardo, Albert C., Hare, Joshua M.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.11.2009
• Subjects: Animals; Balloon Occlusion; Biological and medical sciences; Biomarkers - metabolism; Cardiology. Vascular system; Clinical Research; Coronary heart disease; Cytokines - metabolism; Double-Blind Method; Female; Heart; Heart Failure - etiology; Heart Failure - pathology; Heart Failure - therapy; Magnetic Resonance Angiography; Magnetic resonance imaging; Medical sciences; Mesenchymal Stem Cell Transplantation - methods; Mesenchymal stem cells; Myocardial Contraction; Myocardial infarction; Myocardial Infarction - pathology; Myocardial Infarction - therapy; Myocardial Reperfusion; Myocardial Reperfusion Injury - etiology; Myocardial Reperfusion Injury - pathology; Myocardial Reperfusion Injury - therapy; Myocarditis - blood; Myocarditis. Cardiomyopathies; Random Allocation; Remodelling; Swine; Transplantation, Autologous; Ventricular Dysfunction, Left - pathology; Ventricular Dysfunction, Left - therapy; Ventricular Remodeling; Myocardial infarction; Remodelling; Magnetic resonance imaging; Mesenchymal stem cells; Cardiomyopathy; Stem cell; Cardiovascular disease; Coronary heart disease; Myocardial disease; Nuclear magnetic resonance imaging; Autograft; Chronic; Ischemia; Graft; Medical imagery; Circulatory system; Cardiology
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehp265

Aims The ability of mesenchymal stem cells (MSCs) to heal the chronically injured heart remains controversial. Here we tested the hypothesis that autologous MSCs can be safely injected into a chronic myocardial infarct scar, reduce its size, and improve ventricular function. Methods and results Female adult Göttingen swine (n = 15) underwent left anterior descending coronary artery balloon occlusion to create reproducible ischaemia–reperfusion infarctions. Bone-marrow-derived MSCs were isolated and expanded from each animal. Twelve weeks post-myocardial infarction (MI), animals were randomized to receive surgical injection of either phosphate buffered saline (placebo, n = 6), 20 million (low dose, n = 3), or 200 million (high dose, n = 6) autologous MSCs in the infarct and border zone. Injections were administered to the beating heart via left anterior thoracotomy. Serial cardiac magnetic resonance imaging was performed to evaluate infarct size, myocardial blood flow (MBF), and left ventricular (LV) function. There was no difference in mortality, post-injection arrhythmias, cardiac enzyme release, or systemic inflammatory markers between groups. Whereas MI size remained constant in placebo and exhibited a trend towards reduction in low dose, high-dose MSC therapy reduced infarct size from 18.2 ± 0.9 to 14.4 ± 1.0% (P = 0.02) of LV mass. In addition, both low and high-dose treatments increased regional contractility and MBF in both infarct and border zones. Ectopic tissue formation was not observed with MSCs. Conclusion Together these data demonstrate that autologous MSCs can be safely delivered in an adult heart failure model, producing substantial structural and functional reverse remodelling. These findings demonstrate the safety and efficacy of autologous MSC therapy and support clinical trials of MSC therapy in patients with chronic ischaemic cardiomyopathy.