Intrakoronare, humane autologe Stammzelltransplantation zur Myokardregeneration nach Herzinfarkt

Autor: N. Gattermann, P. Wernet, M. Brehm, Tobias Zeus, R. V. Sorg, G. Kögler, B. E. Strauer, A. Hernandez
Rok vydání: 2004
Předmět:
Zdroj: DMW - Deutsche Medizinische Wochenschrift. 126:932-938
ISSN: 1439-4413
0012-0472
DOI: 10.1055/s-2001-16579
Popis: Hintergrund: Das regenerative Potential humaner autologer adulter Stammzellen auf die Kardiomyogenese und Angiogene- se nach Herzinfarkt konnte zur Infarktheilung beitragen, ist al- lerdings klinisch nicht untersucht. Vorgeschichte und Befund: Ein 46-jahriger Patient wurde 14 Stunden nach Einsetzen von linksthorakalen Schmerzen zur inva- siven Diagnostik und Therapie zugewiesen. Die Herzkatheterun- tersuchung zeigte einen Verschluss des Ramus interventricularis anterior der linken Kranzarterie, der durch Ballondilataion und Stentimplantation behandelt wurde. Wir haben erstmals die In- dikation zur intrakoronaren Transplantation humaner autologer Stammzellen gestellt. Objektive: The regenerative potential of human autologous adult stem cells on myocardial regeneration and neovascularisa- tion after myocardial infarction may contribute to healing of the infarction area. But no clinical application has previously been reported. We here describe for the first time the results of this method applied in a patient who had sustained an acute myo- cardial infarction. History and clinical findings: 14 hours after the onset of left precordial pain a 46-year-old man was admitted to our hospital for interventional diagnosis and treatment. Coronary angiogra- phy demonstrated occlusion of the anterior descending branch of the left coronary artery with transmural infarction. This was treated by percutaneous transluminal catheter angioplasty and stent placement. Therapy and results: Mononuclear bone marrow cells of the pa- tient were prepared and 6 days after infaction 1,2 × 10 7 cells were transplanted at low pressure via a percutaneous transluminal ca- theter placed in the infarct-related artery. Before and 10 weeks af- ter this procedure left ventricular function, infarct size, ventricular geometry and myocardial perfusion were measured by 201 thallium SPECT both at rest and on exercise, together with bull's-eye analysis, dobutamine stress echocardiography, right heart catheterisation and radionuclide ventriculography. At 10 weeks after the stem cell transplantation the transmural infarct area had been reduced from 24.6% to 15.7% of left ventricular cir- cumference, while ejection fraction, cardiac index and stroke vo- lume had increased by 20-30%. On exercise the enddiastolic volu- me had decreased by 30% and there was a comparable fall in left ventricular filling pressure (mean pulmonary capillary pressure). Conclusion: These results for the first time demonstrate that selective intracoronary transplantation of human autologous adult stem cells is possible under clinical conditions and that it can lead to regeneration of the myocardial scar after transmural infarction. The therapeutic effects may be ascribed to stem cell- associated myocardial regeneration and neovascularisation.
Databáze: OpenAIRE
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