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Gowdak LHW, Schettert IT, Rochitte CE, de Carvalho LP, Vieira MLC, Dallan LAO, de Oliveira SA, César LAM, Brito JOR, Guarita-Souza LC, de Carvalho ACC, Krieger JE. Additional improvement in regional myocardial ischemia after intracardiac injection of bone marrow cells during CABG surgery. Front Cardiovasc Med 2023; 10:1040188. [PMID: 36824456 PMCID: PMC9941147 DOI: 10.3389/fcvm.2023.1040188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background Post-procedure residual ischemia is associated with worse prognosis in patients with coronary artery diasease (CAD). Objective We evaluated whether autologous bone marrow-derived cells (BMC) contribute to additional reduction in regional stress-induced myocardial ischemia (SIMI) in patients undergoing incomplete coronary artery bypass graft surgery (CABG). Methods In a double-blind, randomized, placebo-controlled trial, we enrolled 143 patients (82% men, 58 ± 11 years) with stable CAD and not candidates for complete CABG. They received 100 million BMC (n = 77) or placebo (n = 66) injected into ischemic non-revascularized segments during CABG. The primary outcome was improvement on SIMI quantified as the area at risk in injected segments assessed by cardiovascular magnetic resonance (CMR) 1, 6, and 12 months after CABG. Results The reduction in global SIMI after CABG was comparable (p = 0.491) in both groups indicating sustained beneficial effects of the surgical procedure over 12 month period. In contrast, we observed additional improvement in regional SIMI in BMC treated group (p = 0.047). Baseline regional SIMI values were comparable [18.5 (16.2-21.0) vs. 18.5 (16.5-20.7)] and reached the lowest values at 1 month [9.74 (8.25; 11.49) vs. 12.69 (10.84; 14.85)] for BMC and placebo groups, respectively. The ischemia's improvement from baseline represented a 50% difference in regional SIMI in favor of the BMC transplanted group at 30 days. We found no differences in clinical and LVEF% between groups during the 12 month follow-up period. The 1 month rate of major adverse cerebral and cardiovascular events (MACCE) (p = 0.34) and all-cause mortality (p = 0.08) did not differ between groups 1 month post intervention. Conclusion We provided evidence that BMC leads to additional reduction in regional SIMI in chronic ischemic patients when injected in segments not subjected to direct surgical revascularization. This adjuvant therapy deserves further assessment in patients with advanced CAD especially in those with microcirculation dysfunction. Clinical trial registration https://clinicaltrials.gov/, identifier NCT01727063.
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Affiliation(s)
- Luís Henrique Wolff Gowdak
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil
| | - Isolmar Tadeu Schettert
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos Eduardo Rochitte
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil
| | - Leonardo P. de Carvalho
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Luiz Campos Vieira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil
| | - Luís Alberto Oliveira Dallan
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil
| | - Sérgio Almeida de Oliveira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Antonio Machado César
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil
| | - José Oscar Reis Brito
- Department of Cardiovascular Surgery, National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Luiz César Guarita-Souza
- Department of Cardiovascular Surgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Antonio Carlos Campos de Carvalho
- Cell Technology Center, National Institute of Cardiology, Rio de Janeiro, Brazil,Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil,*Correspondence: Jose Eduardo Krieger,
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Combined Coronary Artery Bypass Surgery With Bone Marrow Stem Cell Transplantation: Are We There Yet? Ann Thorac Surg 2019; 108:1913-1921. [PMID: 31398356 DOI: 10.1016/j.athoracsur.2019.05.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 04/11/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although the safety and feasibility of combined coronary artery bypass grafting (CABG) and bone marrow stem cell (BMSC) transplantation have been proven, the efficacy of this approach remains controversial. Therefore, we conducted an updated meta-analysis of randomized controlled trials to evaluate the efficacy of this procedure. METHODS Electronic databases were systematically searched for randomized trials comparing 4-month to 6-month follow-up outcomes in patients who underwent isolated CABG (CABG group) and patients who received BMSC transplantation with CABG (BMSC group). A random-effects meta-analysis was conducted across eligible studies. Meta-regression and subgroup analyses were utilized to identify sources of data heterogeneity. RESULTS Thirteen trials were eligible, with a total number of 292 patients in the BMSC group and 247 patients in the CABG group. Compared with the CABG group, the BMSC group showed significant improvement of follow-up left ventricular ejection fraction (n = 539, 4.8%; 95% confidence interval [CI], 2.3%-7.3%; P = .001). The analyzed data showed significant heterogeneity (I2 = 74.2%, P < .001). The reduction in scar size (n = 120; -2.2 mL; 95% CI, -18.2 mL to 13.7 mL; P = .44) and the improvement in the 6-minute walk test (n = 212; 41 m; 95% CI, -13 m to 95 m; P = .10) did not reach statistical significance. No significant correlation was found between the number of the injected BMSCs or the method of injection and the change in ejection fraction. CONCLUSIONS The present evidence suggests that combined CABG and BMSC transplantation is associated with improvement of left ventricular ejection fraction. However, the heterogeneity in the data suggests variations in patient response to this therapy. Further studies are required to understand these variations.
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Wu S, Yao L, Yan P, Bao Q, Dong X, Liu X, Zhu Y, Su X, Wang A, Duan Y, Yang K, Zhang M, Cao Y. Autologous bone marrow stem cell therapy for patients undergoing coronary artery bypass grafting: A meta-analysis of 14 randomized controlled trials. Exp Ther Med 2019; 17:2985-2994. [PMID: 30906476 PMCID: PMC6425237 DOI: 10.3892/etm.2019.7283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/24/2019] [Indexed: 01/01/2023] Open
Abstract
Autologous bone marrow stem cell (BMSC) therapy is a novel option for regenerative therapy in patients with ischemic heart disease. The aim of the present meta-analysis was to evaluate the effectiveness of BMSCs combined with coronary artery bypass grafting (CABG). The PubMed, Cochrane Library, EMBASE and Web of Science databases were searched from inception to November 22, 2017 for randomized controlled trials on BMSC therapy combined with CABG. Finally, 14 trials with a total of 596 participants were included. Data were analyzed using a random-effects model. Compared with the control group, the BMSC therapy group exhibited an improvement in the left ventricular (LV) ejection fraction from baseline to follow-up [mean difference (MD)=4.36%; 95% confidence interval (CI): 1.90–6.81%; P<0.01]. Analysis of the pooled results revealed non-significant differences in the LV end-diastolic volume (MD=−6.27 ml; 95% CI: −22.34 to 9.80 ml; P=0.44), LV end-diastolic volume index (MD=−15.11 ml/m2; 95% CI: −31.53 to 1.30 ml/m2; P=0.07), LV end-systolic volume (MD=−11.52 ml; 95% CI: −26.97 to 3.93 ml; P=0.14) and LV end-systolic volume index (MD=−16.56 ml/m2; 95% CI: −37.75 to 4.63 ml/m2; P=0.13) between the BMSC and CABG alone groups. Therefore, autologous BMSC therapy for patients undergoing CABG appears to be associated with an improvement in LV function compared with CABG alone.
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Affiliation(s)
- Shanlian Wu
- Department of Pathology, School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu 730000, P.R. China.,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China.,Institute of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China.,Department of Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Liang Yao
- Institute of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Peijing Yan
- Institute of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Qiangwei Bao
- Department of Pathology, School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu 730000, P.R. China.,Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Xin Dong
- Department of Ultrasound, The Third Hospital of Gansu Province, Lanzhou, Gansu 730020, P.R. China
| | - Xingguang Liu
- Department of Cardiac Surgery, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Yan Zhu
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Xin Su
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China.,Department of Cardiology, School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu 730000, P.R. China
| | - Aqian Wang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China.,Department of Cardiology, School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu 730000, P.R. China
| | - Yichao Duan
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Kehu Yang
- Institute of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China.,Department of Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Min Zhang
- Department of Pathology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
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