Myocardial regeneration after intracoronary transplantation of human autologous stem cells following acute myocardial infarction

Objective:The regenerative potential of human autologous adult stem cells o n myocardial regeneration and neovascularisation after myocardial infarctio n may contribute to healing of the infarction area. But no clinical applica tion has previously been reported. We here describe for the first time the results of this method applied in a patient who had sustained an acute myoc ardial infarction. History and clinical findings: 14 hours after the onset of left precordial pain a 46-year-old man was admitted to our hospital for interventional diag nosis and treatment. Coronary angiography demonstrated occlusion of the ant erior descending branch of the left coronary artery with transmural infarct ion. This was treated by percutaneous transluminal catheter angioplasty and stent placement. Therapy and results: Mononuclear bone marrow cells of the patient were prep ared and 6 days after infaction 1,2 x 10(7) cells were transplanted at low pressure via a percutaneous transluminal catheter placed in the infarct-rel ated artery. Before and 10 weeks after this procedure left ventricular func tion, infarct size, ventricular geometry and myocardial perfusion were meas ured by (201)thallium SPECT both at rest and on exercise, together with bul l's-eye analysis, dobutamine stress echocardiography, right heart catheteri sation and radionuclide ventriculography. At 10 weeks after the stem cell t ransplantation the transmural infarct area had been reduced from 24.6% to 1 5.7% of left ventricular circumference, while ejection fraction, cardiac in dex and stroke volume had increased by 20-30%. On exercise the enddiastolic volume had decreased by 30% and there was a comparable fall in left ventri cular filling pressure (mean pulmonary capillary pressure). Conclusion: These results for the first time demonstrate that selective int racoronary transplantation of human autologous adult stem cells is possible under clinical conditions and that it can lead to regeneration of the myoc ardial scar after transmural infarction. The therapeutic effects may be asc ribed to stem cell-associated myocardial regeneration and neovascularisatio n.