Document Detail

Global contractility increment in nonischemic dilated cardiomyopathy after free wall-only intramyocardial injection of autologous bone marrow mononuclear cells: an insight over stem cells clinical mechanism of action.
MedLine Citation:
PMID:  20546674     Owner:  NLM     Status:  MEDLINE    
Bone marrow mononuclear cells (BMMC) effects have been investigated in small series of nonischemic dilated cardiomyopathy (NIDC). Left ventricular myocardial contractility improvements occur, but doubt remains about their mechanism of action. We compared contractility changes in areas treated (free wall) and nontreated (septal wall) with BMMC, in selected patients who have showed significant ventricular improvement after free wall-only intramyocardial stem cells injection. From 15 patients with functional class III/IV (NYHA) and LVEF inferior to 35%, who received 9.6 ± 2.6 × 10(7) BMMC divided into 10 points over the left ventricular free wall, 7 (46.7%) showed LVEF relative improvement greater than 15%. Those patients were selected for further contractility study. BMMC were collected from iliac bone and isolated with Ficoll-Hypaque. Magnetic resonance imaging was used to measure the systolic thickening of the septal (nontreated) and free wall (treated) before injection and 3 months postoperatively. Mean systolic septal wall thickening increased from 0.46 to 1.23 mm (an absolute 0.77 ± 1.3 mm and relative 167.4% increase) and in the free wall from 1.13 to 1.87 mm (an absolute 0.74 ± 1.5 mm and relative increase of 65.5%). There was no difference in the rate of absolute or relative systolic thickening between the two walls (p = 0.866 and 1.0, respectively), when cells were injected only in the left ventricular free wall. BMMC transplantation in nonischemic dilated cardiomyopathy can improve ventricular function by an overall effect, even in areas that are not directly injected. This finding favors the existence of a diffuse mechanism of action, rather than a local effect, and should be reminded when the pathophysiology of stem cells is considered.
Roberto T Sant'anna; Renato A K Kalil; Angelo S Pretto Neto; Fernando Pivatto Júnior; James Fracasso; João R M Sant'anna; Maurício Marques; Melissa Markoski; Paulo R Prates; Nance B Nardi; Ivo A Nesralla
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-06-11
Journal Detail:
Title:  Cell transplantation     Volume:  19     ISSN:  1555-3892     ISO Abbreviation:  Cell Transplant     Publication Date:  2010  
Date Detail:
Created Date:  2010-11-09     Completed Date:  2011-03-01     Revised Date:  2011-03-09    
Medline Journal Info:
Nlm Unique ID:  9208854     Medline TA:  Cell Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  959-64     Citation Subset:  IM    
Instituto de Cardiologia do Rio Grande do Sul/FUC, Porto Alegre, RS, Brazil.
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MeSH Terms
Bone Marrow Transplantation*
Cardiomyopathy, Dilated / radionuclide imaging,  therapy*
Cross-Sectional Studies
Magnetic Resonance Imaging
Middle Aged
Myocardial Contraction / physiology
Stem Cell Transplantation
Time Factors
Transplantation, Autologous
Ventricular Function, Left

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