Early Tissue Distribution of Bone Marrow Mononuclear Cells After Transcoronary Transplantation in a Patient With Acute Myocardial Infarction
2005; Lippincott Williams & Wilkins; Volume: 112; Issue: 4 Linguagem: Inglês
10.1161/circulationaha.104.496133
ISSN1524-4539
AutoresMartin Pěnička, Petr Widimský, Petr Kobylka, Tomáš Kozák, Otto Lang,
Tópico(s)Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
ResumoHomeCirculationVol. 112, No. 4Early Tissue Distribution of Bone Marrow Mononuclear Cells After Transcoronary Transplantation in a Patient With Acute Myocardial Infarction Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBEarly Tissue Distribution of Bone Marrow Mononuclear Cells After Transcoronary Transplantation in a Patient With Acute Myocardial Infarction Martin Penicka, MD, PhD, Petr Widimsky, MD, PhD, Petr Kobylka, MD, PhD, Tomas Kozak, MD and Otto Lang, MD, PhD Martin PenickaMartin Penicka From the III Internal-Cardiological Clinic, (M.P., P.W.), Department of Hematology (T.K.), and Department of Nuclear Medicine (O.L.), III Medical Faculty, Charles University, Prague, Czech Republic; and the Institute of Hematology and Blood Transfusion (P.K.), Prague, Czech Republic. , Petr WidimskyPetr Widimsky From the III Internal-Cardiological Clinic, (M.P., P.W.), Department of Hematology (T.K.), and Department of Nuclear Medicine (O.L.), III Medical Faculty, Charles University, Prague, Czech Republic; and the Institute of Hematology and Blood Transfusion (P.K.), Prague, Czech Republic. , Petr KobylkaPetr Kobylka From the III Internal-Cardiological Clinic, (M.P., P.W.), Department of Hematology (T.K.), and Department of Nuclear Medicine (O.L.), III Medical Faculty, Charles University, Prague, Czech Republic; and the Institute of Hematology and Blood Transfusion (P.K.), Prague, Czech Republic. , Tomas KozakTomas Kozak From the III Internal-Cardiological Clinic, (M.P., P.W.), Department of Hematology (T.K.), and Department of Nuclear Medicine (O.L.), III Medical Faculty, Charles University, Prague, Czech Republic; and the Institute of Hematology and Blood Transfusion (P.K.), Prague, Czech Republic. and Otto LangOtto Lang From the III Internal-Cardiological Clinic, (M.P., P.W.), Department of Hematology (T.K.), and Department of Nuclear Medicine (O.L.), III Medical Faculty, Charles University, Prague, Czech Republic; and the Institute of Hematology and Blood Transfusion (P.K.), Prague, Czech Republic. Originally published26 Jul 2005https://doi.org/10.1161/CIRCULATIONAHA.104.496133Circulation. 2005;112:e63–e65A 57-year-old man with no history of coronary artery disease was admitted for acute anterior ST-segment–elevation myocardial infarction caused by an occlusion of the proximal left anterior descending (LAD) coronary artery. The culprit artery was recanalized with direct stenting with an optimal result. Left ventricular ejection fraction was 40% with anteroapicoseptal akinesia. A positron-emission tomography study demonstrated reduced perfusion and borderline fluorine-18-fluorodeoxyglucose uptake in apical segments and adjacent anterior and septal wall, suggesting reduced viability in the distal LAD territory. Nine days after infarction, the patient underwent autologous bone marrow stem cell transplantation as a part of a research protocol. Bone marrow blood was aspirated under local anesthesia from both iliac crests. A total of 27.4×108 of mononuclear bone marrow cells (BMCs; 1.45×107 of CD34+ cells) were processed into a volume of 24 mL. Six milliliters of the cell suspension were separated, radiolabeled by 0.65 mL of 99mTc hexamethylpropylene amine oxime (Medi-Radiopharma LTD; radioactivity 700 MBq, physical half-life 6 hours), and mixed into a nonlabeled cell suspension. The BMC transplantation was performed on the same day. In brief, catheterization started with left ventricular and coronary angiography, which confirmed anterolateral akinesia with a left ventricular ejection fraction of 41% and no in-stent restenosis, respectively. Then, an over-the-wire balloon (same balloon diameter as implanted stent, shorter balloon length) was inflated in the proximal LAD inside the stent, and 4.5- to 5-mL portions of the cell suspension were injected through the central lumen. The balloon remained inflated for 3 minutes and then deflated for another 3 minutes to allow reflow. This maneuver was repeated 5 times. To monitor the fate of transplanted BMCs, nuclear imaging studies were performed at 2 and 18 hours after transplantation. The majority of transplanted BMCs were accumulated in spleen (Figure 1). The estimated radioactivity uptake by the heart was 5% of the injected radioactivity at 2 hours and 1% at 18 hours after transplantation. At 2 hours, transplanted cells occupied the whole LAD territory (Figure 2). At 18 hours, radioactivity was observed only in the apex and adjacent segments (Figure 3); in other words, in the region with reduced hypoperfusion and viability at PET. Download figureDownload PowerPointFigure 1. Early tissue distribution of radiolabeled BMCs. Left, whole body scans at 2 h post-transplantation in anterior (A) and posterior (P) views. Right, distribution at 18 hours. Heart indicated by arrow. On both 2- and 18-h scans, significant radioactivity was noted in spleen, urinary bladder, and circulating blood pool including LV cavity. At 2 h, considerable radioactivity also observed in anterolateral and apical myocardial segments corresponding to LAD perfusion territory. At 18 h, heart was hardly distinguishable on whole body scan and radioactivity remained restricted to apical region.Download figureDownload PowerPointFigure 2. SPECT of thorax at 2 h post-transplantation. Upper, middle, and lower, left ventricular cuts in the transverse, frontal, and sagittal planes, respectively. Heart indicated by arrows. Radioactivity distributed within whole LAD territory involving anterior, anterolateral, septal, and apical myocardial segments. Another large pool of radioactivity represents spleen.Download figureDownload PowerPointFigure 3. Thorax planar spot view in left anterior oblique (45°) projection at 18 h post-transplantation. Heart indicated by arrow. At 18 h, radioactivity observed only in apical area of left ventricle. Nevertheless, majority of transplanted cells located in spleen.This case points out the potential limitations of the transcoronary BMC transplantation in the setting of infarcted myocardium in humans. Additional research to increase the rate of cell engraftment and survival within the infarcted myocardial tissue is warranted.DisclosureDr Penicka is the recipient of a research grant from the Czech Society of Cardiology.FootnotesCorrespondence to Martin Penicka, MD, PhD, III Internal-Cardiological Clinic, Charles University, Srobarova 50, 100 34 Prague, Czech Republic. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Alnasser S, AL-Rasheedi M, Alreshidi M, Alqifari S and Haider K (2022) Augmenting Mesenchymal Stem Cell-Based Therapy of the Infarcted Myocardium with Statins Handbook of Stem Cell Therapy, 10.1007/978-981-16-6016-0_20-1, (1-34), . 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