Bone marrow cells and ejection fraction improvements in the human heart

ejection fractionThe crucial question of every stem cell transplantation whether the cellular incorporation or other happenings (paracrine effects) results in any functional improvement. In heart it was showed that functional and metabolic regeneration of infarcted and chronically avital tissue can be achieved in humans using transplantation of bone-marrow-derived cells {Brehm and Strauer, 2006, Nat Clin Pract Cardiovasc Med, 3 Suppl 1, S101-4} {Nyolczas et al., 2007, Am Heart J, 153, 212.e1-7}. Ejection fraction (Ef) is the fraction of blood pumped out of a ventricle with each heart beat so it is an excellent physiologic parameter to measure with echocardiography.

In the case of patients with chronic myocardial infarction both global left ventricular ejection fraction (LVEF) and infarction wall-movement velocity were increased significantly (15% and 57%, respectively) after 3 months {Brehm and Strauer, 2006, Nat Clin Pract Cardiovasc Med, 3 Suppl 1, S101-4}. In the case of acute myocardial infarction, implanted autologous BMDCs both improved LVEF from (50 +/- 10% to 58 +/- 10% at 4-month follow-up in one study, and in another study the combined stem cell injection (intramyocardial and intracoronary) resulted in an increase in global EF, (from 34.8 to 39.5 percent), as well as a significant increase in wall motion at the six-month follow up {Schachinger et al., 2004, J Am Coll Cardiol, 44, 1690-9} {Nyolczas et al., 2007, Am Heart J, 153, 212.e1-7}

Figure: Left ventricular ejection fraction, measured by quantitative left ventricular angiography initially and at four-month follow-up for patients receiving bone marrow-derived progenitor cells (BMC). Bars represent mean ± SD. From Schachinger et al., 2004

Literature:

1. Brehm, M. & Strauer, B. E. Stem cell therapy in postinfarction chronic coronary heart disease. Nat Clin Pract Cardiovasc Med 3 Suppl 1, S101-4 (2006).
2. Nyolczas, N. et al. Design and rationale for the Myocardial Stem Cell Administration After Acute Myocardial Infarction (MYSTAR) Study: a multicenter, prospective, randomized, single-blind trial comparing early and late intracoronary or combined (percutaneous intramyocardial and intracoronary) administration of nonselected autologous bone marrow cells to patients after acute myocardial infarction. Am. Heart J. 153, 212.e1-212.e7 (2007).
3. Schachinger, V. et al. Transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction: final one-year results of the TOPCARE-AMI Trial. J. Am. Coll. Cardiol. 44, 1690-1699 (2004).