Stem Cells in Myocardial Infarction Repair

Mechanism of restoration of cardiac function after stem cell transplantation remains unclear. Apoptosis of transplanted cells seems to modulate local tissue reaction that can repress myocardial apoptosis and lead to improved cardiac outcome. In the BOOST trial (Wollert et al. Lancet. 2004;364[9429]:141), intracoronary infusion of bone marrow cells (BMC) into the infarct-related artery resulted in improved left ventricular ejection fraction at 6 months. Selective intracoronary transplantation of autologous, mononuclear BMC positively impacted myocardial regeneration and neovascularization and postinfarction remodelling processes (Strauer et al. Circulation. 2002;106[15]:1913). At the present time, it appears that BMC transplantation can lead to (1) metabolic regeneration of infarcted myocardial tissue in humans with an increase in maximum oxygen uptake; (2) improvement in perfusion in the ischemic region; and (3) improvement in exercise capacity in patients with end-stage ischemic cardiomyopathy, improved ejection secondary to a reduction in infarct size, and better recovery of regional systolic function.

Future goals for BMC studies will be to identify therapeutic cell population, determine the efficacy, and prevent atherosclerosis or restenosis in remodelling myocardium after myocardial infarction.

Dr. Roberto Carbone, FCCP,
Steering Committee Member
Dr. Alberto Ballestrero
Dr. Vincenzo Savarino