10 Years of Intracoronary and Intramyocardial Bone Marrow Stem Cell Therapy of the Heart

J Am Coll Cardiol, 2011; 58:1095-1104, doi:10.1016/j.jacc.2011.06.016
© 2011 by the American College of Cardiology Foundation
STATE-OF-THE-ART PAPER

10 Years of Intracoronary and Intramyocardial Bone Marrow Stem Cell Therapy of the Heart

From the Methodological Origin to Clinical Practice

Bodo-Eckehard Strauer, MD*, and Gustav Steinhoff, MD,,*
* Heinrich-Heine University of Duesseldorf, Duesseldorf, Germany
Reference and Translation Center for Cardiac Stem Cell Therapy (RTC), Biomedical Research Center Rostock, Rostock, Germany
Department for Cardiac Surgery, University Rostock, Rostock, Germany
Manuscript received March 4, 2011; revised manuscript received April 6, 2011, accepted April 7, 2011.
* Reprint requests and correspondence: Dr. Gustav Steinhoff, Reference and Translation Center for Cardiac Stem Cell Therapy, Biomedical Research Center Rostock, Department for Cardiac Surgery, University Rostock, Schillingallee 68, Rostock D-18057, Germany (Email: strauer@med.uni-duesseldorf.de or gustav.steinhoff@med.uni-rostock.de ).
Intracoronary and intramyocardial stem cell therapy aim at therepair of compromised myocardium thereby—as a causal treatment—preventingventricular remodeling and improving overall performance. Sincethe first-in-human use of bone marrow stem cells (BMCs) afteracute myocardial infarction in 2001, a large number of clinicalstudies have demonstrated their clinical benefit: BMC therapycan be performed with usual cardiac catheterization techniquesin the conscious patient as well as also easily during cardiosurgicalinterventions. New York Heart Association severity degree ofpatients as well as physical activity improve in addition to(“on top” of) all other therapeutic regimens. Stem cell therapyalso represents an ultimate approach in advanced cardiac failure.For acute myocardial infarction and chronic ischemia, long-termmortality after 1 and 5 years, respectively, is significantlyreduced. A few studies also indicate beneficial effects forchronic dilated cardiomyopathy. The clinical use of autologousBMC therapy implies no ethical problems, when unmodified primarycells are used. With the use of primary BMCs, there are no majorstem cell-related side effects, especially no cardiac arrhythmiasand inflammation. Various mechanisms of the stem cell actionin the human heart are discussed, for example, cell transdifferentiation,cell fusion, activation of intrinsic cardiac stem cells, andcytokine-mediated effects. New techniques allow point-of-carecell preparations, for example, within the cardiac interventionor operation theater, thereby providing short preparation time,facilitated logistics of cell transport, and reasonable costeffectiveness of the whole procedure. The 3 main indicationsare acute infarction, chronic ischemic heart failure, and dilatedcardiomyopathy. Future studies are desirable to further elucidatethe mechanisms of stem cell action and to extend the currentuse of intracoronary and/or intramyocardial stem cell therapyby larger and presumably multicenter and randomized trials.