|
1
|
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.
Collapse
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,
| |
Collapse
|
|
2
|
Biagi D, Fantozzi ET, Campos-Oliveira JC, Naghetini MV, Ribeiro AF, Rodrigues S, Ogusuku I, Vanderlinde R, Christie MLA, Mello DB, de Carvalho ACC, Valadares M, Cruvinel E, Dariolli R. In Situ Maturated Early-Stage Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes Improve Cardiac Function by Enhancing Segmental Contraction in Infarcted Rats. J Pers Med 2021; 11:jpm11050374. [PMID: 34064343 PMCID: PMC8147857 DOI: 10.3390/jpm11050374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
The scant ability of cardiomyocytes to proliferate makes heart regeneration one of the biggest challenges of science. Current therapies do not contemplate heart re-muscularization. In this scenario, stem cell-based approaches have been proposed to overcome this lack of regeneration. We hypothesize that early-stage hiPSC-derived cardiomyocytes (hiPSC-CMs) could enhance the cardiac function of rats after myocardial infarction (MI). Animals were subjected to the permanent occlusion of the left ventricle (LV) anterior descending coronary artery (LAD). Seven days after MI, early-stage hiPSC-CMs were injected intramyocardially. Rats were subjected to echocardiography pre-and post-treatment. Thirty days after the injections were administered, treated rats displayed 6.2% human cardiac grafts, which were characterized molecularly. Left ventricle ejection fraction (LVEF) was improved by 7.8% in cell-injected rats, while placebo controls showed an 18.2% deterioration. Additionally, cell-treated rats displayed a 92% and 56% increase in radial and circumferential strains, respectively. Human cardiac grafts maturate in situ, preserving proliferation with 10% Ki67 and 3% PHH3 positive nuclei. Grafts were perfused by host vasculature with no evidence for immune rejection nor ectopic tissue formations. Our findings support the use of early-stage hiPSC-CMs as an alternative therapy to treat MI. The next steps of preclinical development include efficacy studies in large animals on the path to clinical-grade regenerative therapy targeting human patients.
Collapse
Affiliation(s)
- Diogo Biagi
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Evelyn Thais Fantozzi
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Julliana Carvalho Campos-Oliveira
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Marcus Vinicius Naghetini
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Antonio Fernando Ribeiro
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Sirlene Rodrigues
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Isabella Ogusuku
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
- Gene Center and Department of Biochemistry, Ludwig-Maximilians-Universität München, 81377 München, Germany
| | - Rubia Vanderlinde
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Michelle Lopes Araújo Christie
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (M.L.A.C.); (D.B.M.); (A.C.C.d.C.)
| | - Debora Bastos Mello
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (M.L.A.C.); (D.B.M.); (A.C.C.d.C.)
| | - Antonio Carlos Campos de Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (M.L.A.C.); (D.B.M.); (A.C.C.d.C.)
| | - Marcos Valadares
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Estela Cruvinel
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
| | - Rafael Dariolli
- PluriCell Biotech, São Paulo 05508-000, Brazil; (D.B.); (E.T.F.); (J.C.C.-O.); (M.V.N.); (A.F.R.J.); (S.R.); (I.O.); (R.V.); (M.V.); (E.C.)
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence:
| |
Collapse
|
|
3
|
Leong YY, Ng WH, Ellison-Hughes GM, Tan JJ. Cardiac Stem Cells for Myocardial Regeneration: They Are Not Alone. Front Cardiovasc Med 2017; 4:47. [PMID: 28770214 PMCID: PMC5511846 DOI: 10.3389/fcvm.2017.00047] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/29/2017] [Indexed: 12/17/2022] Open
Abstract
Heart failure is the number one killer worldwide with ~50% of patients dying within 5 years of prognosis. The discovery of stem cells, which are capable of repairing the damaged portion of the heart, has created a field of cardiac regenerative medicine, which explores various types of stem cells, either autologous or endogenous, in the hope of finding the “holy grail” stem cell candidate to slow down and reverse the disease progression. However, there are many challenges that need to be overcome in the search of such a cell candidate. The ideal cells have to survive the harsh infarcted environment, retain their phenotype upon administration, and engraft and be activated to initiate repair and regeneration in vivo. Early bench and bedside experiments mostly focused on bone marrow-derived cells; however, heart regeneration requires multiple coordinations and interactions between various cell types and the extracellular matrix to form new cardiomyocytes and vasculature. There is an observed trend that when more than one cell is coadministered and cotransplanted into infarcted animal models the degree of regeneration is enhanced, when compared to single-cell administration. This review focuses on stem cell candidates, which have also been tested in human trials, and summarizes findings that explore the interactions between various stem cells in heart regenerative therapy.
Collapse
Affiliation(s)
- Yin Yee Leong
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Wai Hoe Ng
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Georgina M Ellison-Hughes
- Centre for Human and Aerospace Physiological Sciences, King's College London, London, United Kingdom.,Centre for Stem Cells and Regenerative Medicine, King's College London, London, United Kingdom
| | - Jun Jie Tan
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia.,Centre for Human and Aerospace Physiological Sciences, King's College London, London, United Kingdom.,Centre for Stem Cells and Regenerative Medicine, King's College London, London, United Kingdom
| |
Collapse
|
|
4
|
Suss PH, Capriglione LGA, Barchiki F, Miyague L, Jackowski D, Fracaro L, Schittini AV, Senegaglia AC, Rebelatto CLK, Olandoski M, Correa A, Brofman PRS. Direct intracardiac injection of umbilical cord-derived stromal cells and umbilical cord blood-derived endothelial cells for the treatment of ischemic cardiomyopathy. Exp Biol Med (Maywood) 2015; 240:969-78. [PMID: 25576340 DOI: 10.1177/1535370214565077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/12/2014] [Indexed: 01/09/2023] Open
Abstract
The development of new therapeutic strategies is necessary to reduce the worldwide social and economic impact of cardiovascular disease, which produces high rates of morbidity and mortality. A therapeutic option that has emerged in the last decade is cell therapy. The aim of this study was to compare the effect of transplanting human umbilical cord-derived stromal cells (UCSCs), human umbilical cord blood-derived endothelial cells (UCBECs) or a combination of these two cell types for the treatment of ischemic cardiomyopathy (IC) in a Wistar rat model. IC was induced by left coronary artery ligation, and baseline echocardiography was performed seven days later. Animals with a left ventricular ejection fraction (LVEF) of ≤40% were selected for the study. On the ninth day after IC was induced, the animals were randomized into the following experimental groups: UCSCs, UCBECs, UCSCs plus UCBECs, or vehicle (control). Thirty days after treatment, an echocardiographic analysis was performed, followed by euthanasia. The animals in all of the cell therapy groups, regardless of the cell type transplanted, had less collagen deposition in their heart tissue and demonstrated a significant improvement in myocardial function after IC. Furthermore, there was a trend of increasing numbers of blood vessels in the infarcted area. The median value of LVEF increased by 7.19% to 11.77%, whereas the control group decreased by 0.24%. These results suggest that UCSCs and UCBECs are promising cells for cellular cardiomyoplasty and can be an effective therapy for improving cardiac function following IC.
Collapse
Affiliation(s)
- Paula H Suss
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| | | | - Fabiane Barchiki
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| | - Lye Miyague
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| | - Danielle Jackowski
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| | - Letícia Fracaro
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| | - Andressa V Schittini
- Carlos Chagas Institute, Oswaldo Cruz Foundation, FIOCRUZ/PR, Curitiba 81.350-010, Brazil
| | - Alexandra C Senegaglia
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| | - Carmen L K Rebelatto
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| | - Márcia Olandoski
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| | - Alejandro Correa
- Carlos Chagas Institute, Oswaldo Cruz Foundation, FIOCRUZ/PR, Curitiba 81.350-010, Brazil
| | - Paulo R S Brofman
- Core for Cell Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80.215-901, Brazil
| |
Collapse
|
|
5
|
Ali-Hasan-Al-Saegh S, Mirhosseini SJ, Lotfaliani MR, Dehghan HR, Sedaghat-Hamedani F, Kayvanpour E, Rezaeisadrabadi M, Ghaffari N, Vahabzadeh V, Jebran AF, Sabashnikov A, Popov AF. Transplantation of bone marrow stem cells during cardiac surgery. Asian Cardiovasc Thorac Ann 2014; 23:363-74. [PMID: 25281762 DOI: 10.1177/0218492314553251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND This systematic review with meta-analysis sought to determine the efficacy and safety of intramyocardial transplantation of bone marrow stem cells during coronary artery bypass graft surgery on postoperative cardiac functional parameters such as left ventricular ejection fraction and left ventricular end-diastolic volume. METHODS Medline/PubMed, Embase, Elsevier, Sciences online database, and Google Scholar literature search were searched. The effect sizes measured were risk ratio for categorical variables and weighted mean difference with 95% confidence interval for calculating differences between mean values of baseline and follow-up cardiac functional parameters. A value of p < 0.1 for Q test, or I(2 )> 50%, indicated significant heterogeneity among studies. The literature search retrieved 2900 studies from screened databases, of which 2866 (98.6%) were excluded and 34 (619 patients) were included for scoping review. The final analysis included 9 studies (335 patients). RESULTS Pooled effects estimates of left ventricular ejection fraction and left ventricular end-diastolic volume showed that bone marrow stem cell transplantation had a weighted mean difference of 4.06 (95% confidence interval: 0.41-7.72; p = 0.02) and 7.06 (95% confidence interval: -8.58-22.7; p = 0.3), respectively. CONCLUSIONS Intramyocardial transplantation of bone marrow stem cells improves cardiac functional parameters, significantly increasing left ventricular ejection fraction with a nonsignificant reduction in left ventricular end-diastolic volume. Also, this therapeutic method has no life-threatening complications and was therefore found to be an effective and safe method.
Collapse
Affiliation(s)
- Sadeq Ali-Hasan-Al-Saegh
- Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Jalil Mirhosseini
- Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad-Reza Lotfaliani
- Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamid Reza Dehghan
- Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Elham Kayvanpour
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Mohammad Rezaeisadrabadi
- Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Naser Ghaffari
- Department of Cardiovascular Surgery, Herzchirurgie Klinikum, Karlsruhe, Germany
| | - Vahid Vahabzadeh
- Department of Cardiovascular Surgery, Herzchirurgie Klinikum, Karlsruhe, Germany
| | - Ahamd Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, University Hospital Goettingen, Goettingen, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| |
Collapse
|
|
6
|
Gowdak LHW, Schettert IT, Rochitte CE, Lisboa LAF, Dallan LAO, César LAM, de Oliveira SA, Krieger JE. Early increase in myocardial perfusion after stem cell therapy in patients undergoing incomplete coronary artery bypass surgery. J Cardiovasc Transl Res 2011; 4:106-13. [PMID: 21061106 DOI: 10.1007/s12265-010-9234-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/22/2010] [Indexed: 11/29/2022]
Abstract
Incomplete revascularization is associated with worse long-term outcomes. Autologous bone marrow cells (BMC) have recently been tested in patients with severe coronary artery disease. We tested the hypothesis that intramyocardial injection of autologous BMC increases myocardial perfusion in patients undergoing incomplete coronary artery bypass grafting (CABG). Twenty-one patients (19 men), 59 ± 7 years old, with limiting angina and multivessel coronary artery disease (CAD), not amenable to complete CABG were enrolled. BMC were obtained prior to surgery, and the lymphomonocytic fraction separated by density gradient centrifugation. During surgery, 5 mL containing 2.1 ± 1.3 × 108 BMC (CD34+ = 0.8 ± 0.3%) were injected in the ischemic non-revascularized myocardium. Myocardial perfusion was assessed by magnetic resonance imaging (MRI) at baseline and 1 month after surgery. The increase in myocardial perfusion was compared between patients with <50% (group A, n = 11) with that of patients with >50% (group B, n = 10) of target vessels (stenosis ≥ 70%) successfully bypassed. Injected myocardial segments included the inferior (n = 12), anterior (n = 7), and lateral (n = 2) walls. The number of treated vessels (2.3 ± 0.8) was significantly smaller than the number of target vessels (4.2 ± 1.0; P < 0.0001). One month after surgery, cardiac MRI showed a similar reduction (%) in the ischemic score of patients in group A (72.5 ± 3.2), compared to patients in group B (78.1 ± 3.2; P = .80). Intramyocardial injection of autologous BMC may help increase myocardial perfusion in patients undergoing incomplete CABG, even in those with fewer target vessels successfully treated. This strategy may be an adjunctive therapy for patients suffering from a more advanced (diffuse) CAD not amenable for complete direct revascularization.
Collapse
Affiliation(s)
- Luís Henrique Wolff Gowdak
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, 05403-000 São Paulo, SP, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
|
7
|
Brandão SMG, Schettert IT, César LAM, Krieger JE, de Oliveira SA, Stolf NAG, Gowdak LHW. Clinical profile of patients enroled in a cell therapy trial for severe coronary artery disease. J Clin Nurs 2010; 19:440-6. [PMID: 20500284 DOI: 10.1111/j.1365-2702.2009.03045.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To compare the clinical profile of patients included in a clinical trial of autologous bone marrow cells as an adjunctive therapy to coronary artery bypass grafting with that of patients undergoing routine coronary artery bypass grafting. BACKGROUND The therapeutic potential of autologous bone marrow cells has been explored in the treatment of severe coronary artery disease. There are few data regarding the clinical and socio-economic profile of patients included in clinical trials using bone marrow cell. DESIGN Case-control study. METHOD Sixty-seven patients (61 SD 9) years, 82% men) with multivessel coronary artery disease were divided into two groups: patients in the bone marrow cell group (n = 34) underwent incomplete coronary artery bypass grafting + intramyocardial injection of autologous bone marrow cells (lymphomonocytic fraction -2.0 (SD 0.2 x 10(8)) cells/patient) in the ischaemic, non-revascularised myocardium, whereas patients in the coronary artery bypass grafting group (n = 33) underwent routine bypass surgery. Demographics, socio-economic status, clinical and echocardiographic data were collected. Statistical analysis included the Fisher's exact test (categorical variables) and the Student's t-test (continuous variables). RESULTS There were no significant differences between groups regarding age, gender, BMI, heart rate, blood pressure and echo data. There was a greater prevalence of obesity (65 vs. 33%; OR = 3.7 [1.3-10.1]), of previous myocardial infarction (68 vs. 39%; OR = 3.2 [1.2-8.8]) and prior revascularisation procedures (59 vs. 24%; OR = 4.5 [1.6-12.7]) in the autologous bone marrow cells group and of smokers in the coronary artery bypass grafting group (51 vs. 23%; OR = 3.5 [1.2-10.4]). CONCLUSIONS Patients included in this clinical trial of autologous bone marrow cells for severe coronary artery disease presented a greater prevalence of myocardial revascularisation procedures, indicating a more severe clinical presentation of the disease. Fewer smokers in this group could be attributable to life style changes after previous cardiovascular events and/or interventions. RELEVANCE TO CLINICAL PRACTICE The knowledge of the clinical profile of patients included in cell therapy trials may help researchers in the identification of patients that may be enroled in future clinical trials of this new therapeutic strategy.
Collapse
Affiliation(s)
- Sara M G Brandão
- Heart Institute (InCor), University of São Paulo Medical School-Av. Dr. Enéas de Carvalho Aguiar, São Paulo/SP, Brazil.
| | | | | | | | | | | | | |
Collapse
|
|
8
|
Muellner A, Glazer GM, Reiser MF, Bradley WG, Krestin GP, Hricak H, Thrall JH. Advancing radiology through informed leadership: summary of the proceedings of the Seventh Biannual Symposium of the International Society for Strategic Studies in Radiology (IS(3)R), 23-25 August 2007. Eur Radiol 2009; 19:1827-36. [PMID: 19277668 PMCID: PMC2705708 DOI: 10.1007/s00330-009-1370-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 01/18/2009] [Indexed: 01/21/2023]
Abstract
The International Society for Strategic Studies in Radiology (IS3R) brings together thought leaders from academia and industry from around the world to share ideas, points of view and new knowledge. This article summarizes the main concepts presented at the 2007 IS3R symposium, providing a window onto trends shaping the future of radiology. Topics addressed include new opportunities and challenges in the field of interventional radiology; emerging techniques for evaluating and improving quality and safety in radiology; and factors impeding progress in molecular imaging and nanotechnology and possible ways to overcome them. Regulatory hurdles to technical innovation and drug development are also discussed more broadly, along with proposals for addressing regulators’ concerns and streamlining the regulatory process.
Collapse
Affiliation(s)
- Ada Muellner
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, room C-278, New York, NY 10065, USA
| | | | | | | | | | | | | |
Collapse
|