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Patient receives infusion of own cardiac cells to repair damage from MI
Cardiac stem cells grown from the patient’s own tissue were reintroduced successfully.
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The first procedure in which a patient’s own cardiac stem cells are used to repair the patient’s injured heart muscle has been completed at Cedars-Sinai Medical Center as part of a clinical trial.
Physicians at the medical center in Los Angeles announced that they had successfully used a patient’s own heart tissue, taken from a small biopsy, to culture and grow heart stem cells that were then re-introduced into the patient’s coronary arteries following an MI. The patient is a 39-year-old man who had an MI due to a 99% blockage of the left anterior descending artery.
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“This procedure signals a new and exciting era in the understanding and treatment of heart disease,” said Eduardo Marbán, MD, PhD, director of the Cedars-Sinai Heart Institute, in a press release. “Five years ago, we did not even know the heart had its own distinct type of stem cells. Now we are exploring how to harness such stem cells to help patients heal their own damaged hearts.”
All patients to be included in the study (n=24) will have had MI within four weeks prior to enrollment. Four of the patients are scheduled to receive 12.5 million stem cells with two patients to serve as controls. According to the press release, 12 more patients are expected to receive 25 million stem cells each by the end of the summer, with six additional patients to serve as controls. Patients will be followed for six months, and the study results are scheduled to be reported in late 2010.
“If successful, we hope the procedure could widely be available in a few years and could be more broadly applied to cardiac patients,” Marbán said. “For example, if patients are able to re-grow damaged heart muscle via stem cell therapy, there could be lesser demand for expensive and risk treatments such as heart transplants.”
Raj R. Makkar, MD, director of interventional cardiology and the cardiac catheterization laboratory at Cedars-Sinai Medical Center, was the interventionalist who performed the transplantation of the stem cells. Makkar also sees potential for the wider application of the technique.
“The use of these cells is exciting because there is the potential for real cardiogenesis,” Makkar told Cardiology Today. “If this pans out and if there is improvement in cardiac function from the use of these cells, then these cells become a very viable therapy and we are talking about a much wider application of these cells in the setting of acute MI or recent MI.”
The study is being conducted in collaboration with Johns Hopkins University. – by Eric Raible
I am familiar with the cardiospheres that Dr. Marbán pioneered while working at Johns Hopkins. It is known that the human adult has a limited number of resident cardiac stem cells. He has been successful in culturing these resident cardiac stem cells from the patient's endomyocardial biopsy, and the resulting cell product can then be stored or reintroduced. Dr. Marbán and his group had done this in experimental models. It is exciting to learn they are actually doing this now in patients with acute MI, so we will see how the results play out. It is not possible to say much more at this point other than if this is successful, a faster and less costly method to process these cells will be essential for its commercial development. The whole field of cell therapy in patients is extraordinarily exciting and moving at a rapid pace. This is the first time that anybody has delivered these specifically-designed cardiac cells back to the same patient. There is a depression or depletion of bone marrow stem cells that occurs in and around an acute MI, so I am wondering how that may impact these cells which reside outside of bone marrow. Theoretically, it may not impact them at all, but on the other hand, their success in repair may actually depend on bone marrow for recruitment of more cells to the treated region. Perhaps this is the ideal cell type - we really do not know at this point. Everybody is searching for the optimal cell type, and so far, nobody has really nailed it.
Cardiology Today Chief Medical Editor
This is an extremely important field. When we look back over the last nine to ten years, the two most common cells used in cardiology have been the skeletal myoblast-derived stem cell and bone marrow-derived stem cell. The bone marrow could be mononuclear or it could be mesenchymal. If you transplanted this human myoblast iinto the human heart, the myoblast survives and makes a new myofiber, and they do appear to reverse the enlargement of the heart. However, they do not do gap junction to transmit electricity exactly as one would like.
There are limitations. To my understanding, one limitation is growing the exact number of the cells that needed to repair severely damaged hearts from MI. One gram of the cardiac muscle has about 20 million cells. So far, it seems like you need every patient to have a sample taken from their heart muscle, then have the stem cells isolated and then have them transplanted to the heart. There is a major limitation here. Number one, the way that the method is done is analogous. The other point to consider is that the number of the cells that they can generate from that biopsy is still a very limited number. Scientists will need to work very hard on upscaling the number of cells.
– Nabil Dib, MD
Director, Clinical Stem Cell Therapy Program, University of California, San Diego