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Kologrivova I, Shtatolkina M, Suslova T, Ryabov V. Cells of the Immune System in Cardiac Remodeling: Main Players in Resolution of Inflammation and Repair After Myocardial Infarction. Front Immunol 2021; 12:664457. [PMID: 33868315 PMCID: PMC8050340 DOI: 10.3389/fimmu.2021.664457] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/16/2021] [Indexed: 12/13/2022] Open
Abstract
The burden of heart failure (HF), developing after myocardial infarction MI, still represents a major issue in clinical practice. Failure of appropriate resolution of inflammation during post-myocardial injury is associated with unsuccessful left ventricular remodeling and underlies HF pathogenesis. Cells of the immune system have been shown to mediate both protective and damaging effects in heart remodeling. This ambiguity of the role of the immune system and inconsistent results of the recent clinical trials question the benefits of anti-inflammatory therapies during acute MI. The present review will summarize knowledge of the roles that different cells of the immune system play in the process of post-infarct cardiac healing. Data on the phenotype, active molecules and functions of the immune cells, based on the results of both experimental and clinical studies, will be provided. For some cellular subsets, such as macrophages, neutrophils, dendritic cells and lymphocytes, an anti-inflammatory activity has been attributed to the specific subpopulations. Activity of other cells, such as eosinophils, mast cells, natural killer (NK) cells and NKT cells has been shown to be highly dependent of the signals created by micro-environment. Also, new approaches for classification of cellular phenotypes based on the single-cell RNA sequencing allow better understanding of the phenotype of the cells involved in resolution of inflammation. Possible perspectives of immune-mediated therapy for AMI patients are discussed in the conclusion. We also outline unresolved questions that need to be solved in order to implement the current knowledge on the role of the immune cells in post-MI tissue repair into practice.
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Affiliation(s)
- Irina Kologrivova
- Department of Clinical Laboratory Diagnostics, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russia
| | - Marina Shtatolkina
- Department of Emergency Cardiology, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russia
| | - Tatiana Suslova
- Department of Clinical Laboratory Diagnostics, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russia
| | - Vyacheslav Ryabov
- Department of Emergency Cardiology, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russia.,Division of Cardiology, Department of Professional Development and Retraining, Siberian State Medical University, Tomsk, Russia
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2
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Dorobantu M, Popa-Fotea NM, Popa M, Rusu I, Micheu MM. Pursuing meaningful end-points for stem cell therapy assessment in ischemic cardiac disease. World J Stem Cells 2017; 9:203-218. [PMID: 29321822 PMCID: PMC5746641 DOI: 10.4252/wjsc.v9.i12.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/08/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
Despite optimal interventional and medical therapy, ischemic heart disease is still an important cause of morbidity and mortality worldwide. Although not included in standard of care rehabilitation, stem cell therapy (SCT) could be a solution for prompting cardiac regeneration. Multiple studies have been published from the beginning of SCT until now, but overall no unanimous conclusion could be drawn in part due to the lack of appropriate end-points. In order to appreciate the impact of SCT, multiple markers from different categories should be considered: Structural, biological, functional, physiological, but also major adverse cardiac events or quality of life. Imaging end-points are among the most used - especially left ventricle ejection fraction (LVEF) measured through different methods. Other imaging parameters are infarct size, myocardial viability and perfusion. The impact of SCT on all of the aforementioned end-points is controversial and debatable. 2D-echocardiography is widely exploited, but new approaches such as tissue Doppler, strain/strain rate or 3D-echocardiography are more accurate, especially since the latter one is comparable with the MRI gold standard estimation of LVEF. Apart from the objective parameters, there are also patient-centered evaluations to reveal the benefits of SCT, such as quality of life and performance status, the most valuable from the patient point of view. Emerging parameters investigating molecular pathways such as non-coding RNAs or inflammation cytokines have a high potential as prognostic factors. Due to the disadvantages of current techniques, new imaging methods with labelled cells tracked along their lifetime seem promising, but until now only pre-clinical trials have been conducted in humans. Overall, SCT is characterized by high heterogeneity not only in preparation, administration and type of cells, but also in quantification of therapy effects.
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Affiliation(s)
- Maria Dorobantu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest 014461, Romania
| | | | - Mihaela Popa
- Carol Davila, University of Medicine, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest 020022, Romania
| | - Iulia Rusu
- Carol Davila, University of Medicine, "Carol Davila" University of Medicine and Pharmacy Bucharest, Bucharest 020022, Romania
| | - Miruna Mihaela Micheu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest 014461, Romania.
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Brooks A, Futrega K, Liang X, Hu X, Liu X, Crawford DHG, Doran MR, Roberts MS, Wang H. Concise Review: Quantitative Detection and Modeling the In Vivo Kinetics of Therapeutic Mesenchymal Stem/Stromal Cells. Stem Cells Transl Med 2017; 7:78-86. [PMID: 29210198 PMCID: PMC5746161 DOI: 10.1002/sctm.17-0209] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/02/2017] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stem/stromal cells (MSCs) present a promising tool in cell‐based therapy for treatment of various diseases. Currently, optimization of treatment protocols in clinical studies is complicated by the variations in cell dosing, diverse methods used to deliver MSCs, and the variety of methods used for tracking MSCs in vivo. Most studies use a dose escalation approach, and attempt to correlate efficacy with total cell dose. Optimization could be accelerated through specific understanding of MSC distribution in vivo, long‐term viability, as well as their biological fate. While it is not possible to quantitatively detect MSCs in most targeted organs over long time periods after systemic administration in clinical trials, it is increasingly possible to apply pharmacokinetic modeling to predict their distribution and persistence. This Review outlines current understanding of the in vivo kinetics of exogenously administered MSCs, provides a critical analysis of the methods used for quantitative MSC detection in these studies, and discusses the application of pharmacokinetic modeling to these data. Finally, we provide insights on and perspectives for future development of effective therapeutic strategies using pharmacokinetic modeling to maximize MSC therapy and minimize potential side effects. Stem Cells Translational Medicine2018;7:78–86
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Affiliation(s)
- Anastasia Brooks
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia.,School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Kathryn Futrega
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Brisbane, Australia
| | - Xiaowen Liang
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Xiaoling Hu
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Xin Liu
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Darrell H G Crawford
- School of Clinical Medicine, The University of Queensland, Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Australia
| | - Michael R Doran
- Mater Research Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Brisbane, Australia.,Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, Australia
| | - Michael S Roberts
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Basil Hetzel Institute, Adelaide, Australia
| | - Haolu Wang
- Therapeutics Research Centre, The University of Queensland Diamantina Institute, Brisbane, Australia.,Department of Biliary-Pancreatic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Ryabov V, Gombozhapova A, Rogovskaya Y, Kzhyshkowska J, Rebenkova M, Karpov R. Cardiac CD68+ and stabilin-1+ macrophages in wound healing following myocardial infarction: From experiment to clinic. Immunobiology 2017; 223:413-421. [PMID: 29179985 DOI: 10.1016/j.imbio.2017.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 01/01/2023]
Abstract
Myocardial infarction (MI) remains the leading cause of mortality and morbidity throughout the world. Macrophages are key innate immune cells that play a significant role in transition from the inflammatory to the regenerative phase during wound healing following MI. The scavenger receptor stabilin-1 is one of the most interesting macrophage biomarkers. This receptor contributes to wound healing, angiogenesis, and tissue remodeling. We suggested a research protocol using macrophage biomarkers to study the cellular basis of cardiac remodeling and healing in patients with acute MI. The purpose of the research was to translate experimental knowledge regarding macrophage subsets and their biomarkers in post-infarction myocardial regeneration into results observed in clinical settings. The study included 41 patients with fatal MI type 1. All patients were divided into four groups according to the timeline of MI histopathology. In addition to routine histopathological analysis, macrophage infiltration was assessed by immunohistochemistry. We used CD68 as a marker for the cells of the macrophage lineage and stabilin-1 as an M2-like macrophage biomarker. The number of CD68+ and stabilin-1+ macrophages in the infarct area increased and peaked in the regenerative phase and did not decrease in the late stage of MI. In the peri-infarct area, the number of CD68+ macrophages increased in the inflammatory phase, peaked during the reparative phase, and did not decrease in the late phase, while the number of stabilin-1+ macrophages increased in the regenerative phase and remained unchanged. Additionally, in the reparative phase, we observed increase in the number of CD68+ and stabilin-1+ macrophages in the non-infarct area. The research protocol suggested allowed us to translate experimental knowledge regarding macrophage subsets and their biomarkers in post-infarction myocardial regeneration into clinical data. Taken together, these results demonstrated biphasic cardiac macrophage response following acute MI somewhat similar to that in a murine model. The increase in stabilin-1+ macrophage infiltration noticed in the myocardium during the regenerative phase and the strong positive correlation between the number of these cells and timeline of MI histopathology enabled us to propose stabilin-1 as a diagnostic macrophage biomarker in myocardium wound healing in patients with acute MI.
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Affiliation(s)
- Vyacheslav Ryabov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk, 634012, Russian Federation; National Research Tomsk State University, 36 Lenin Avenue, Tomsk, 634050, Russian Federation; Siberian State Medical University, 2 Moskovsky Trakt, Tomsk, 634055, Russian Federation.
| | - Aleksandra Gombozhapova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk, 634012, Russian Federation; National Research Tomsk State University, 36 Lenin Avenue, Tomsk, 634050, Russian Federation.
| | - Yuliya Rogovskaya
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk, 634012, Russian Federation; National Research Tomsk State University, 36 Lenin Avenue, Tomsk, 634050, Russian Federation.
| | - Julia Kzhyshkowska
- National Research Tomsk State University, 36 Lenin Avenue, Tomsk, 634050, Russian Federation; University of Heidelberg, 1-3 Theodor-Kutzer Ufer, Mannheim, 68167, Germany.
| | - Mariya Rebenkova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk, 634012, Russian Federation; National Research Tomsk State University, 36 Lenin Avenue, Tomsk, 634050, Russian Federation.
| | - Rostislav Karpov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk, 634012, Russian Federation; Siberian State Medical University, 2 Moskovsky Trakt, Tomsk, 634055, Russian Federation.
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Mazza M, Lozano N, Vieira DB, Buggio M, Kielty C, Kostarelos K. Liposome-Indocyanine Green Nanoprobes for Optical Labeling and Tracking of Human Mesenchymal Stem Cells Post-Transplantation In Vivo. Adv Healthc Mater 2017; 6. [PMID: 28777501 DOI: 10.1002/adhm.201700374] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/25/2017] [Indexed: 01/09/2023]
Abstract
Direct labeling of human mesenchymal stem cells (hMSC) prior to transplantation provides a means to track cells after administration and it is a powerful tool for the assessment of new cell-based therapies. Biocompatible nanoprobes consisting of liposome-indocyanine green hybrid vesicles (liposome-ICG) are used to safely label hMSC. Labeled hMSC recapitulating a 3D cellular environment is transplanted as spheroids subcutaneously and intracranially in athymic nude mice. Cells emit a strong NIR signal used for tracking post-transplantation with the IVIS imaging system up to 2 weeks (subcutaneous) and 1 week (intracranial). The transplanted stem cells are imaged in situ after engraftment deep in the brain up to 1 week in living animals using optical imaging techniques and without the need to genetically modify the cells. This method is proposed for efficient, nontoxic direct cell labeling for the preclinical assessment of cell-based therapies and the design of clinical trials, and potentially for localization of the cell engraftment after transplantation into patients.
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Affiliation(s)
- Mariarosa Mazza
- Nanomedicine Lab; Faculty of Biology, Medicine and Health; University of Manchester; Manchester M13 9PT UK
| | - Neus Lozano
- Nanomedicine Lab; Faculty of Biology, Medicine and Health; University of Manchester; Manchester M13 9PT UK
| | - Debora Braga Vieira
- Nanomedicine Lab; Faculty of Biology, Medicine and Health; University of Manchester; Manchester M13 9PT UK
| | - Maurizio Buggio
- Nanomedicine Lab; Faculty of Biology, Medicine and Health; University of Manchester; Manchester M13 9PT UK
| | - Cay Kielty
- Wellcome Trust Centre for Cell-Matrix Research; Faculty of Biology, Medicine and Health; University of Manchester; Manchester M13 9PT UK
| | - Kostas Kostarelos
- Nanomedicine Lab; Faculty of Biology, Medicine and Health; University of Manchester; Manchester M13 9PT UK
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Vo D, Nguyen PK. Multimodality molecular imaging in cardiac regenerative therapy. J Nucl Cardiol 2017; 24:1803-1809. [PMID: 28185234 DOI: 10.1007/s12350-017-0785-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 01/01/2023]
Abstract
Stem cell therapy holds great promise for the repair and regeneration of damaged myocardium. Disappointing results from recent large-scale randomized trials using adult stem cells, however, have led some to question the efficacy of this new therapeutic. Because most clinical stem cell trials have not incorporated molecular imaging to track cell fate, it may be premature to abandon this approach. Herein, we will review how multimodality imaging can be incorporated into cardiac regenerative therapy to facilitate the translation of stem cell therapy.
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Affiliation(s)
- Davis Vo
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Cardiology Section, Department of Medicine, Veterans Affairs, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA.
- Cardiology Section, Department of Medicine, Veterans Affairs, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
- Stanford University, 300 Pasteur Drive, Grant Building, S114, Stanford, CA, 94305-5208, USA.
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Ryabov VV, Kirgizova MA, Suslova TE, Karas SI, Markov VA, Karpov RS. Relationships of growth factors, proinflammatory cytokines, and anti-inflammatory cytokines with long-term clinical results of autologous bone marrow mononuclear cell transplantation in STEMI. PLoS One 2017; 12:e0176900. [PMID: 28558042 PMCID: PMC5448725 DOI: 10.1371/journal.pone.0176900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 04/19/2017] [Indexed: 01/16/2023] Open
Abstract
AIM The aim of the study was to test the hypothesis suggesting that the pre-intervention levels of proinflammatory cytokines, anti-inflammatory cytokines, and angiogenic growth factors predict the long-term clinical results of autologous bone marrow-derived mononuclear cell (ABMMC) transplantation in patients with primary ST elevation myocardial infarction (STEMI). METHODS AND RESULTS From 2003 to 2006, a total of 62 patients with primary STEMI were enrolled in an open randomized study registered under the title ESTABOMA. Patients were randomized into two groups: group 1 included patients treated with percutaneous coronary intervention (PCI) and ABMMC transplantation (n = 28); group 2 comprised patients treated only with PCI (n = 34). Follow-up study was performed 7.96 ± 0.96 years after STEMI and involved physical examination, six-minute walk test, echocardiography, and determination of brain natriuretic peptide (BNP) levels. The total and cardiovascular mortality rates were higher in group 1 compared with group 2: 36% (n = 10) vs. 12% (n = 4) (p = 0.02) and 29% (n = 8) vs. 6% (n = 2) (p = 0.03), respectively. Lower levels of proinflammatory cytokines were observed in group 1 after PCI and ABMMC transplantation. Serum levels of FGF, VEGF, and IL-10, determined before PCI and ABMMC transplantation were prognostically significant long-term indicators of unfavorable course of CAD after STEMI.
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Affiliation(s)
- Vyacheslav V. Ryabov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russian Federation
- Siberian State Medical University, Department of Cardiology at the Faculty of Continuous Medical Education, Tomsk, Russian Federation
- National Research Tomsk State University, Laboratory of Translational Cellular and Molecular Biomedicine, Tomsk, Russian Federation
- * E-mail:
| | - Marina A. Kirgizova
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russian Federation
| | - Tatiana E. Suslova
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russian Federation
- National Research Tomsk State University, Laboratory of Translational Cellular and Molecular Biomedicine, Tomsk, Russian Federation
| | - Sergei I. Karas
- Siberian State Medical University, Department of Cardiology at the Faculty of Continuous Medical Education, Tomsk, Russian Federation
| | - Valentin A. Markov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russian Federation
- Siberian State Medical University, Department of Cardiology at the Faculty of Continuous Medical Education, Tomsk, Russian Federation
| | - Rostislav S. Karpov
- Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russian Federation
- Siberian State Medical University, Department of Cardiology at the Faculty of Continuous Medical Education, Tomsk, Russian Federation
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Xu JY, Cai WY, Tian M, Liu D, Huang RC. Stem cell transplantation dose in patients with acute myocardial infarction: A meta-analysis. Chronic Dis Transl Med 2016; 2:92-101. [PMID: 29063029 PMCID: PMC5643746 DOI: 10.1016/j.cdtm.2016.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate whether stem cell transplantation improves global left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction (AMI), and to determine the appropriate stem cell therapy dose as well as the effective period after stem cell transplantation for therapy. METHODS A systematic literature search included Pubmed, MEDLINE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Cochrane Evidence-Based Medicine databases. The retrieval time limit ranged from January 1990 to June 2016. We also obtained full texts through manual retrieval, interlibrary loan and document delivery service, or by contacting the authors directly. According to our inclusion and exclusion criteria, data were extracted independently by two evaluators. In case of disagreement, a joint discussion occurred and a third researcher was utilized. Data were analyzed quantitatively using Revman 5.2. Summary results are presented as the weighted mean difference (WMD) with 95% confidence intervals (CIs). We collected individual trial data and conducted a meta-analysis to compare changes in global left ventricular ejection fraction (ΔLVEF) after stem cell therapy. In this study, four subgroups were based on stem cell dose (≤1 × 107 cells, ≤1 × 108 cells, ≤1 × 109 cells, and ≤1 × 1010 cells) and three subgroups were based on follow-up time (<6 months, 6-12 months, and ≥12 months). RESULTS Thirty-four studies, which included 40 randomized controlled trials, were included in this meta-analysis, and 1927 patients were evaluated. Changes in global LVEF were significantly higher in the stem cell transplantation group than in the control group (95% CI: 2.35-4.26%, P < 0.01). We found no significant differences in ΔLVEF between the bone marrow stem cells (BMCs) group and control group when the dose of BMCs was ≤1 × 107 [ΔLVEF 95% CI: 0.12-3.96%, P = 0.04]. The ΔLVEF in the BMCs groups was significantly higher than in the control groups when the dose of BMCs was ≤1 × 108 [ΔLVEF 95% CI: 0.95-4.25%, P = 0.002] and ≤1 × 109 [ΔLVEF 95% CI: 2.31-4.20%, P < 0.01]. In addition, when the dose of BMCs was between 109 and 1010 cells, we did not observe any significant differences [ΔLVEF 95% CI: -0.99-11.82%, P = 0.10]. Our data suggest stem cell therapy improves cardiac function in AMI patients when treated with an appropriate dose of BMCs. CONCLUSION Stem cell transplantation after AMI could improve global LVEF. Stem cells may be effectively administered to patients with AMI doses between 108 and 109 cells.
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Affiliation(s)
- Jia-Ying Xu
- The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Wen-Yuan Cai
- The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Ming Tian
- The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Dai Liu
- The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Rong-Chong Huang
- The Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
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Lee SH, Hong JH, Cho KH, Noh JW, Cho HJ. Discrepancy between short-term and long-term effects of bone marrow-derived cell therapy in acute myocardial infarction: a systematic review and meta-analysis. Stem Cell Res Ther 2016; 7:153. [PMID: 27765070 PMCID: PMC5072331 DOI: 10.1186/s13287-016-0415-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/18/2016] [Accepted: 09/27/2016] [Indexed: 12/11/2022] Open
Abstract
Background Bone marrow-derived cell therapy has been used to treat acute myocardial infarction. However, the therapeutic efficacy of this approach remains controversial. Here, we performed a systematic review and meta-analysis to evaluate short-term and long-term effectiveness of bone marrow-derived therapy. Methods We searched eight databases (Ovid-Medline, Ovid-EMBASE, Cochrane Library, KoreaMed, KMBASE, KISS, RISS, and KisTi) up to December 2014. Demographic characteristics, clinical outcomes, and adverse events were analyzed. We identified 5534 potentially relevant studies; 405 were subjected to a full-text review. Forty-three studies with 2635 patients were included in this review. Results No safety issues related to cell injection were reported during follow-up. At 6 months, cell-injected patients showed modest improvements in left ventricular ejection fraction (LVEF) compared with the control group. However, there were no differences between groups at other time points. In the cardiac MRI analysis, there were no significant differences in infarct size reduction between groups. Interestingly, mortality tended to be reduced at the 3-year follow-up, and at the 5-year follow-up, cell injection significantly decreased all-cause mortality. Conclusions This meta-analysis demonstrated discrepancies between short-term LV functional improvement and long-term all-cause mortality. Future clinical trials should include long-term follow-up outcomes to validate the therapeutic efficacy of cell therapy.
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Affiliation(s)
- Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Seoul, South Korea
| | - Jin Hyuk Hong
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Kyoung Hee Cho
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
| | - Jin-Won Noh
- Department of Healthcare Management, Eulji University, 212 Yangji-dong, Sujeong-gu, Seongnam-si, Gyeonggi, 461-713, South Korea.
| | - Hyun-Jai Cho
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Nadlacki B, Suuronen EJ. Biomaterial strategies to improve the efficacy of bone marrow cell therapy for myocardial infarction. Expert Opin Biol Ther 2016; 16:1501-1516. [DOI: 10.1080/14712598.2016.1235149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Fisher SA, Zhang H, Doree C, Mathur A, Martin‐Rendon E. Stem cell treatment for acute myocardial infarction. Cochrane Database Syst Rev 2015; 2015:CD006536. [PMID: 26419913 PMCID: PMC8572033 DOI: 10.1002/14651858.cd006536.pub4] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cell transplantation offers a potential therapeutic approach to the repair and regeneration of damaged vascular and cardiac tissue after acute myocardial infarction (AMI). This has resulted in multiple randomised controlled trials (RCTs) across the world. OBJECTIVES To determine the safety and efficacy of autologous adult bone marrow stem cells as a treatment for acute myocardial infarction (AMI), focusing on clinical outcomes. SEARCH METHODS This Cochrane review is an update of a previous version (published in 2012). We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 2), MEDLINE (1950 to March 2015), EMBASE (1974 to March 2015), CINAHL (1982 to March 2015) and the Transfusion Evidence Library (1980 to March 2015). In addition, we searched several international and ongoing trial databases in March 2015 and handsearched relevant conference proceedings to January 2011. SELECTION CRITERIA RCTs comparing autologous bone marrow-derived cells with no cells in patients diagnosed with AMI were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently screened all references, assessed the risk of bias of the included trials and extracted data. We conducted meta-analyses using random-effects models throughout. We analysed outcomes at short-term (less than 12 months) and long-term (12 months or more) follow-up. Dichotomous outcomes are reported as risk ratio (RR) and continuous outcomes are reported as mean difference (MD) or standardised MD (SMD). We performed sensitivity analyses to evaluate the results in the context of the risk of selection, performance and attrition bias. Exploratory subgroup analysis investigated the effects of baseline cardiac function (left ventricular ejection fraction, LVEF) and cell dose, type and timing of administration, as well as the use of heparin in the final cell solution. MAIN RESULTS Forty-one RCTs with a total of 2732 participants (1564 cell therapy, 1168 controls) were eligible for inclusion. Cell treatment was not associated with any changes in the risk of all-cause mortality (34/538 versus 32/458; RR 0.93, 95% CI 0.58 to 1.50; 996 participants; 14 studies; moderate quality evidence), cardiovascular mortality (23/277 versus 18/250; RR 1.04, 95% CI 0.54 to 1.99; 527 participants; nine studies; moderate quality evidence) or a composite measure of mortality, reinfarction and re-hospitalisation for heart failure (24/262 versus 33/235; RR 0.63, 95% CI 0.36 to 1.10; 497 participants; six studies; moderate quality evidence) at long-term follow-up. Statistical heterogeneity was low (I(2) = 0% to 12%). Serious periprocedural adverse events were rare and were generally unlikely to be related to cell therapy. Additionally, cell therapy had no effect on morbidity, quality of life/performance or LVEF measured by magnetic resonance imaging. Meta-analyses of LVEF measured by echocardiography, single photon emission computed tomography and left ventricular angiography showed evidence of differences in mean LVEF between treatment groups although the mean differences ranged between 2% and 5%, which are accepted not to be clinically relevant. Results were robust to the risk of selection, performance and attrition bias from individual studies. AUTHORS' CONCLUSIONS The results of this review suggest that there is insufficient evidence for a beneficial effect of cell therapy for AMI patients. However, most of the evidence comes from small trials that showed no difference in clinically relevant outcomes. Further adequately powered trials are needed and until then the efficacy of this intervention remains unproven.
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Affiliation(s)
- Sheila A Fisher
- NHS Blood and TransplantSystematic Review InitiativeLevel 2, John Radcliffe HospitalHeadingtonOxfordOxonUKOX3 9BQ
| | - Huajun Zhang
- PLA General Hospital, Institute of Cardiac SurgeryDepartment of Cardiovascular Surgery28 Fuxing RoadBeijingChina100853
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeLevel 2, John Radcliffe HospitalHeadingtonOxfordOxonUKOX3 9BQ
| | - Anthony Mathur
- William Harvey Research InstituteDepartment of Clinical PharmacologyCharterhouse SquareLondonUKEC1M 6BQ
| | - Enca Martin‐Rendon
- NHS Blood and TransplantStem Cell Research DepartmentJohn Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
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12
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Abstract
The field of regenerative medicine has experienced considerable growth in recent years as the translation of pre-clinical biomaterials and cell- and gene-based therapies begin to reach clinical application. Until recently, the ability to monitor the serial responses to therapeutic treatments has been limited to post-mortem tissue analyses. With improvements in existing imaging modalities and the emergence of hybrid imaging systems, it is now possible to combine information related to structural remodeling with associated molecular events using non-invasive imaging. This review summarizes the established and emerging imaging modalities that are available for in vivo monitoring of clinical regenerative medicine therapies and discusses the strengths and limitations of each imaging modality.
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Affiliation(s)
- Mitchel R. Stacy
- Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, Dana-3, New Haven, CT 06520 USA
| | - Albert J. Sinusas
- Departments of Internal Medicine & Diagnostic Radiology, Yale University School of Medicine, P.O. Box 208017, Dana-3, New Haven, CT 06520 USA
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13
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Abstract
Although cellular therapies hold great promise for the treatment of human disease, results from several initial clinical trials have not shown a level of efficacy required for their use as a first line therapy. Here we discuss how in vivo molecular imaging has helped identify barriers to clinical translation and potential strategies that may contribute to successful transplantation and improved outcomes, with a focus on cardiovascular and neurological diseases. We conclude with a perspective on the future role of molecular imaging in defining safety and efficacy for clinical implementation of stem cell therapies.
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14
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Katsikis A, Koutelou M. Cardiac Stem Cell Imaging by SPECT and PET. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9265-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Gili M, Orsello A, Gallo S, Brizzi MF. Diabetes-associated macrovascular complications: cell-based therapy a new tool? Endocrine 2013; 44:557-75. [PMID: 23543434 DOI: 10.1007/s12020-013-9936-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/20/2013] [Indexed: 01/01/2023]
Abstract
Diabetes mellitus and its ongoing macrovascular complications represent one of the major health problems around the world. Rise in obesity and population ages correlate with the increased incidence of diabetes. This highlights the need for novel approaches to prevent and treat this pandemic. The discovery of a reservoir of stem/progenitors in bone marrow and in mesenchymal tissue has attracted interest of both biologists and clinicians. A number of preclinical and clinical trials were developed to explore their potential clinical impact, as target or vehicle, in different clinical settings, including diabetes complications. Currently, bone marrow, peripheral blood, mesenchymal, and adipose tissues have been used as stem/progenitor cell sources. However, evidences have been provided that both bone marrow and circulating progenitor cells are dysfunctional in diabetes. These observations along with the growing advantages in genetic manipulation have spurred researchers to exploit ex vivo manipulated cells to overcome these hurdles. In this article, we provide an overview of data relevant to stem-progenitors potential clinical application in revascularization and/or vascular repair. Moreover, the hurdles at using progenitor cells in diabetic patients will be also discussed.
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Affiliation(s)
- Maddalena Gili
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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16
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Chen IY, Wu JC. Molecular imaging: the key to advancing cardiac stem cell therapy. Trends Cardiovasc Med 2013; 23:201-10. [PMID: 23561794 DOI: 10.1016/j.tcm.2012.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/10/2012] [Accepted: 12/11/2012] [Indexed: 12/30/2022]
Abstract
Cardiac stem cell therapy continues to hold promise for the treatment of ischemic heart disease despite the fact that early promising pre-clinical findings have yet to be translated into consistent clinical success. The latest human studies have collectively identified a pressing need to better understand stem cell behavior in humans and called for more incorporation of noninvasive imaging techniques into the design and evaluation of human stem cell therapy trials. This review discusses the various molecular imaging techniques validated to date for studying stem cells in living subjects, with a particular emphasis on their utilities in assessing the acute retention and the long-term survival of transplanted stem cells. These imaging techniques will be essential for advancing cardiac stem cell therapy by providing the means to both guide ongoing optimization and predict treatment response in humans.
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Affiliation(s)
- Ian Y Chen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA; Department of Radiology, Molecular Imaging Program at Stanford, Stanford, CA 94305-5454, USA
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17
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Abstract
The past decade has witnessed a marked increase in the number of clinical trials of cardiac repair with adult bone marrow cells (BMCs). These trials included patients with acute myocardial infarction (MI) as well as chronic ischemic heart disease (IHD) and utilized different types of BMCs with variable numbers, routes of administration, and timings after MI. Given these differences in methods, the outcomes from these trials have been often disparate and controversial. However, analysis of pooled data suggests that BMC injection enhances left ventricular function, reduces infarct scar size, and improves remodeling in patients with acute MI as well as chronic IHD. BMC therapy also improves clinical outcomes during follow-up without any increase in adverse effects. Although the underlying mechanisms of heart repair are difficult to elucidate in human studies, valuable insights may be gleaned from subgroup analysis of key variables. This information may be utilized to design future randomized controlled trials to carefully determine the long-term safety and benefits of BMC therapy.
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18
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Steinhoff G, Strauer BE. Heart. Regen Med 2013. [DOI: 10.1007/978-94-007-5690-8_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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19
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Alvarez PA, Schwarz ER, Ramineni R, Myatt P, Barbin C, Boissonnet C, Phan A, Maggioni A, Barbagelata A. Periprocedural adverse events in cell therapy trials in myocardial infarction and cardiomyopathy: a systematic review. Clin Res Cardiol 2012; 102:1-10. [PMID: 23052331 DOI: 10.1007/s00392-012-0508-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 09/11/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND Cell therapy (CTh) is a promising novel therapy for myocardial infarction (MI) and ischemic cardiomyopathy (iCMP). Recognizing adverse events (AE) is important for safety evaluation, harm prevention and may aid in the design of future trials. OBJECTIVE To define the prevalence of periprocedural AE in CTh trials in MI and iCMP. METHODS A literature search was conducted using the MEDLINE database from January 1990 to October 2010. Controlled clinical trials that compared CTh with standard treatment in the setting of MI and/or iCMP were selected. AE related to CTh were analyzed. RESULTS A total of 2,472 patients from 35 trials were included. There were 26 trials including 1,796 patients that used CTh in MI and 9 trials including 676 patients that used CTh in iCMP. Periprocedural arrhythmia monitoring protocols were heterogeneous and follow-up was short in most of the trials. In MI trials, the incidence of periprocedural adverse events (AE) related to intracoronary cell transplantation was 7.5 % (95 % CI 6.04-8.96 %). AE related to granulocyte colony-stimulating factor (GCS-F) used for cell mobilization for peripheral apheresis was 16 % (95 % CI 9.44-22.56 %). During intracoronary transplantation in iCMP, the incidence of periprocedural AE incidence was 2.6 % (95 % CI 0.53-4.67 %). There were no AE reported during transepicardial transplantation and AE were rare during transendocardial transplantation. CONCLUSIONS The majority of periprocedural AE in CTh trials in MI occurred during intracoronary transplantation and GCS-F administration. In iCMP, periprocedural AE were uncommon. Avoiding intracoronary route for CTh implantation may decrease the burden of periprocedural AE. Standardization of AE definition in CTh trials is needed.
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Affiliation(s)
- Paulino A Alvarez
- Hospital de Clínicas José de San Martin, Universidad de Buenos Aires, Buenos Aires, Argentina
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20
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Exercise capacity, arrhythmic risk profile, and pulmonary function is not influenced by intracoronary injection of Bone Marrow Stem Cells in patients with acute myocardial infarction. Int J Cardiol 2012; 159:134-8. [DOI: 10.1016/j.ijcard.2011.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 02/10/2011] [Indexed: 11/18/2022]
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21
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Clifford DM, Fisher SA, Brunskill SJ, Doree C, Mathur A, Clarke MJ, Watt SM, Martin-Rendon E. Long-term effects of autologous bone marrow stem cell treatment in acute myocardial infarction: factors that may influence outcomes. PLoS One 2012; 7:e37373. [PMID: 22655042 PMCID: PMC3360027 DOI: 10.1371/journal.pone.0037373] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 03/28/2012] [Indexed: 12/16/2022] Open
Abstract
Aims To investigate whether there are important sources of heterogeneity between the findings of different clinical trials which administer autologous stem cell treatment for acute myocardial infarction (AMI) and to evaluate what factors may influence the long-term effects of this treatment. Methods and Results MEDLINE (1950-January 2011), EMBASE (1974-January 2011), CENTRAL (The Cochrane Library 2011, Issue 1), CINAHL (1982-January 2011), and ongoing trials registers were searched for randomised trials of bone marrow stem cells as treatment for AMI. Hand-searching was used to screen recent, relevant conference proceedings (2005–2010/11). Meta-analyses were conducted using random-effects models and heterogeneity between subgroups was assessed using chi-squared tests. Planned analyses included length of follow-up, timing of cell infusion and dose, patient selection, small trial size effect, methodological quality, loss of follow-up and date of publication. Thirty-three trials with a total of 1,765 participants were included. There was no evidence of bias due to publication or time-lag, methodological quality of included studies, participant drop-out, duration of follow-up or date of the first disclosure of results. However, in long-term follow-ups the treatment seemed more effective when administered at doses greater than 108 cells and to patients with more severe heart dysfunction. Conclusions Evaluation of heterogeneity between trials has not identified significant sources of bias in this study. However, clinical differences between trials are likely to exist which should be considered when undertaking future trials.
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Affiliation(s)
- David M. Clifford
- Stem Cell Research Laboratory, NHS-Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, United Kingdom
| | - Sheila A. Fisher
- Systematic Review Initiative, Clinical Research Group, NHSBT-Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Susan J. Brunskill
- Systematic Review Initiative, Clinical Research Group, NHSBT-Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Carolyn Doree
- Systematic Review Initiative, Clinical Research Group, NHSBT-Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Anthony Mathur
- Department of Clinical Pharmacology, William Harvey Research Institute, London, United Kingdom
- Barts and the London NIHR Biomedical Research Unit, London, United Kingdom
| | - Mike J. Clarke
- All-Ireland Hub For Trials Methodology Research, Queen’s University, Belfast, United Kingdom
| | - Suzanne M. Watt
- Stem Cell Research Laboratory, NHS-Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, United Kingdom
| | - Enca Martin-Rendon
- Stem Cell Research Laboratory, NHS-Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
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22
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Zhang WY, Ebert AD, Narula J, Wu JC. Imaging cardiac stem cell therapy: translations to human clinical studies. J Cardiovasc Transl Res 2011; 4:514-22. [PMID: 21538182 PMCID: PMC3657500 DOI: 10.1007/s12265-011-9281-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/14/2011] [Indexed: 12/21/2022]
Abstract
Stem cell therapy promises to open exciting new options in the treatment of cardiovascular diseases. Although feasible and clinically safe, the in vivo behavior and integration of stem cell transplants still remain largely unknown. Thus, the development of innovative non-invasive imaging techniques capable of effectively tracking such therapy in vivo is vital for a more in-depth investigation into future clinical applications. Such imaging modalities will not only generate further insight into the mechanisms behind stem cell-based therapy, but also address some major concerns associated with translational cardiovascular stem cell therapy. In the present review, we summarize the principles underlying three major stem cell tracking methods: (1) radioactive labeling for positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging, (2) iron particle labeling for magnetic resonance imaging (MRI), and (3) reporter gene labeling for bioluminescence, fluorescence, MRI, SPECT, and PET imaging. We then discuss recent clinical studies that have utilized these modalities to gain biological insights into stem cell fate.
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Affiliation(s)
- Wendy Y. Zhang
- Department of Medicine (Division of Cardiology), Stanford University School of Medicine
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
| | - Antje D. Ebert
- Department of Medicine (Division of Cardiology), Stanford University School of Medicine
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
| | - Jagat Narula
- Division of Cardiology, UC Irvine Medical Center, Orange, California, USA
| | - Joseph C. Wu
- Department of Medicine (Division of Cardiology), Stanford University School of Medicine
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
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23
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Affiliation(s)
- Ian Y Chen
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305-5111, USA
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24
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Another possible cell source for cardiac regenerative medicine: Reprogramming adult fibroblasts to cardiomyocytes and endothelial progenitor cells. Med Hypotheses 2011; 76:365-7. [DOI: 10.1016/j.mehy.2010.10.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 10/26/2010] [Indexed: 12/18/2022]
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25
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Jiang M, He B, Zhang Q, Ge H, Zang MH, Han ZH, Liu JP, Li JH, Zhang Q, Li HB, Jin Y, He Q, Gong XR, Yin XY. Randomized controlled trials on the therapeutic effects of adult progenitor cells for myocardial infarction: meta-analysis. Expert Opin Biol Ther 2010; 10:667-80. [PMID: 20384520 DOI: 10.1517/14712591003716437] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We performed a systematic meta-analysis to assess the therapeutic effects of progenitor cell therapy after myocardial infarction (MI). RESEARCH DESIGN/METHODS Randomized controlled trials of progenitor cell therapy for MI were extracted from MEDLINE. We performed a prospective comparison of progenitor cell therapy versus placebo after acute or chronic MI, with changes in left ventricular ejection fraction (LVEF) as the primary endpoint. We conducted random-effects meta-analyses to pool these outcomes across the studies. RESULTS A total of 980 patients from 18 studies were analysed. Seventeen trials used bone marrow-derived cells (BMCs). Overall, BMCs significantly increased LVEF, left ventricular end systolic volume and left ventricular end diastolic volume within six months of treatment, and the effect was sustained one year later. Following BMC transplantation regional myocardial anatomy displayed statistically and clinically significant improvements compared with controls, albeit without functional changes. Similar results were observed in the subgroup of patients with impaired LVEF at the baseline. The subgroup analysis suggested a benefit of BMCs on LVEF in acute but not chronic MI. LVEF enhancement seemed to correlate positively with dose and inversely with the storage duration of the BMCs. CONCLUSIONS BMC transplantation for MI was able to deliver benefits over regular therapy even at an 18-month follow-up, particularly when used to treat acute MI. CD34(+) cell therapy holds promise for MI treatment in the future.
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Affiliation(s)
- Meng Jiang
- Department of Cardiology, Shanghai Jiaotong University, Renji Hospital, School of Medicine, Shanghai 200001, China.
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26
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Abstract
The therapeutic potential of 'adult' or at least non-embryonic stem cells and their progeny has developed gradually over the past half century as a consequence of the wealth of knowledge derived from stem cell research. Translational research coupled with clinical trials and derived from basic research has led the way to the clinic. This commenced with the use of haematopoietic stem cell transplantation (HSCT), to treat haematological malignancies, to be followed by the most recent clinical trials to treat a variety of coronary and peripheral artery diseases. Stem cells and their progeny isolated from bone marrow or blood appear to exert an ameliorating effect in certain vascular disorders. Although promising, some of these treatments remain controversial and further research and, where indicated, appropriately powered trials are required to confirm the safety and determine the efficacy of these novel therapies.
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Affiliation(s)
- E Martin-Rendon
- Stem Cell Research Laboratory, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
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27
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Brunskill SJ, Hyde CJ, Doree CJ, Watt SM, Martin-Rendon E. Route of delivery and baseline left ventricular ejection fraction, key factors of bone-marrow-derived cell therapy for ischaemic heart disease. Eur J Heart Fail 2009; 11:887-96. [PMID: 19654139 DOI: 10.1093/eurjhf/hfp101] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS Previous evaluation of autologous bone-marrow stem-cell (BMSC) therapy following acute myocardial infarction (AMI) suggests that cell dose and timing of stem-cell administration post-MI are important factors in the efficacy of cellular therapy. This study aimed to assess whether route of delivery and baseline left ventricular ejection fraction (LVEF) of the participants may also affect the outcome of BMSC treatment in patients with AMI and ischaemic heart disease (IHD). METHODS AND RESULTS Randomized controlled trials of BMSCs as treatment for AMI and IHD were identified by searching MEDLINE, EMBASE, the Cochrane Library, and the Current Controlled Trials Register through to November 2008. Twenty-one trials (25 comparisons) with a total of 1091 participants were eligible. Data were analysed using a random-effects model. Improvement in LVEF in favour of the control was observed when BMSC were administered by intracoronary infusion [-0.19% (95% CI, -0.24 to -0.14; P < 0.00001)] in IHD patients. However, the effect on LVEF was statistically significant and in favour of BMSC when cells were delivered by intra-myocardial injection [5.85% (95% CI, 2.50-9.19; P = 0.0006)]. The significant improvement in LVEF observed in AMI patients was independent from the baseline LVEF of the participants. However, in patients suffering from chronic IHD, increase in LVEF was significant only in the group with lower LVEF at baseline [4.42% (CI, 1.87-6.96; P = 0.0007)]. CONCLUSION Clinical evidence suggests that route of delivery and baseline LVEF influence the effect of BMSC therapy in treating AMI and chronic IHD.
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Affiliation(s)
- Susan J Brunskill
- Systematic Reviews Initiative, Clinical Research Group, NHSBT-Oxford, John Radcliffe Hospital, Oxford, UK
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28
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Dawn B, Abdel-Latif A, Sanganalmath SK, Flaherty MP, Zuba-Surma EK. Cardiac repair with adult bone marrow-derived cells: the clinical evidence. Antioxid Redox Signal 2009; 11:1865-82. [PMID: 19203221 PMCID: PMC2848520 DOI: 10.1089/ars.2009.2462] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
On the basis of strong evidence from animal studies, numerous clinical trials of cardiac repair with adult bone marrow-derived cells (BMC) have been completed. These relatively smaller studies employed different BMC types with highly variable numbers, routes, and timings of transplantation, and included patients with acute myocardial infarction (MI), chronic ischemic heart disease (IHD), as well as ischemic cardiomyopathy. Although the outcomes have been predictably disparate, analysis of pooled data indicates that BMC therapy in patients with acute MI and chronic IHD results in modest improvements in left ventricular function and infarct scar size without any increase in untoward effects. However, the precise mechanisms underlying these benefits remain to be ascertained, and the specific advantages of one BMC type over another remain to be determined. The long-term benefit and safety issues with different BMC types are currently being evaluated critically in larger randomized controlled trials with a view to applying this novel therapeutic strategy to broader patient populations. The purpose of this review is to summarize the available clinical evidence regarding the efficacy and safety of therapeutic cardiac repair with different types of adult BMCs, and to discuss the key variables that need optimization to further enhance the benefits of BMC therapy.
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Affiliation(s)
- Buddhadeb Dawn
- Division of Cardiovascular Medicine and the Institute of Molecular Cardiology, University of Louisville, Louisville, Kentucky 40292, USA.
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29
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Intracoronary delivery of stem cells in patients with acute myocardial infarction. The clinical experience obtained to date and prospects. COR ET VASA 2009. [DOI: 10.33678/cor.2009.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Möbius-Winkler S, Höllriegel R, Schuler G, Adams V. Endothelial progenitor cells: implications for cardiovascular disease. Cytometry A 2009; 75:25-37. [PMID: 19009636 DOI: 10.1002/cyto.a.20669] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endothelial progenitor cells (EPCs) reside in the bone marrow and are mobilized into the circulation by specific stimuli such as certain drugs, ischemia, and exercise training. Once in the circulation EPCs are thought to participate in the maintenance of the endothelial cell layer. Recently it was clearly demonstrated that the amount and function of EPCs is significantly impaired in different cardiovascular diseases. Furthermore, the level of circulating EPCs predicts the occurrence of cardiovascular events and death from cardiovascular causes and may help to identify patients at increased cardiovascular risk. After demonstrating the beneficial effect of applied EPCs in several animal experiments, these cells were also used to treat humans with different cardiovascular diseases. This review will focus on the characterization and liberation of EPCs from the bone marrow, as well as on the most important clinical cardiovascular diseases for which EPCs were used therapeutically.
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Affiliation(s)
- Sven Möbius-Winkler
- Department of Cardiology and Internal Medicine, University Leipzig - Heart Center Leipzig, Leipzig, Germany
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31
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Martin-Rendon E, Brunskill SJ, Hyde CJ, Stanworth SJ, Mathur A, Watt SM. Autologous bone marrow stem cells to treat acute myocardial infarction: a systematic review. Eur Heart J 2008; 29:1807-18. [PMID: 18523058 DOI: 10.1093/eurheartj/ehn220] [Citation(s) in RCA: 419] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AIMS To provide systematic assessment of the safety and efficacy of autologous bone marrow-derived stem cell (BMSC) transplantation in acute myocardial infarction (AMI) based on clinical evidence. METHODS AND RESULTS The search strategy included MEDLINE, EMBASE, the Cochrane Library, and Current Controlled Trials Register through to August 2007 for randomized controlled trials of BMSC treatment for AMI. Thirteen trials (14 comparisons) with a total of 811 participants were included. Data were analysed using a random effects model. Overall, stem cell therapy improved left ventricular ejection fraction (LVEF) by 2.99% [95% confidence interval (CI), 1.26-4.72%, P = 0.0007], significantly reduced left ventricular end-systolic volume (LVESV) by 4.74 mL (95% CI, -7.84 to -1.64 mL, P = 0.003), and myocardial lesion area by 3.51% (95% CI, -5.91 to -1.11%, P = 0.004) compared with controls. Subgroup analysis revealed that there was statistical significant difference in LEVF in favour of BMSCs when cells were infused within 7 days following AMI and when the BMSC dose administered was higher than 10(8) BMSCs. In addition, there were trends in favour of benefit for most clinical outcomes examined, although it should be acknowledged that the 95%CI included no significant difference. CONCLUSION Stem cell treatment for AMI still holds promise. Clinically, these data suggest that improvement over conventional therapy can be achieved. Further, adequately powered trials using optimal dosing, longer term outcome assessments, more reliable, and more patient-centred outcomes are required.
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Affiliation(s)
- Enca Martin-Rendon
- Stem Cell Research Laboratory, NHS-Blood and Transplant, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, UK.
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