Combined treatment of intractable ischemic heart disease with TML and endothelial progenitor cells-preliminary results of a therapeutic concept

摘要

Ischemic heart disease as the most frequentcardiovascular disease still implies a majorhealth burden to western countries. In a certainamount of patients, conventionalrevascularization therapy is unsuccessfulleaving these patients with disabling anginapectoris or congestive heart failure.Theoretically combining TMLR for signallinginduction and pain relief and stem cellinjection for regeneration support offers apromising treatment strategy for thereotherwise intractable patient suffering fromischemic heart disease.Methods:Five patients with TML and stem cell therapywere evaluated. The pelvic bone waspunctured and 300 ml of crude bone marrowwere aspirated. Patients were operated "offpump". Between 11 and 25 laser channelswere created. In between the channels thestem cells were applied with 6 to 12 injections.Cell selection was carried out using magneticcell separation. The patient followup was 14.2+6.9 (mean+SEM).Results:NYAH classification improved significantlybetween preoperatively (mean 3.4) and three(mean 1.,8) and six month (mean 1.8)postoperatively. When patients were asked torank their complains on a scale from 1 to 10,all patients described an immediateimprovement postoperatively(7.4preoperatively, 3.6 at three month and 3.2 atsix month). An improvement in left ventricularejection fraction was as well observed(48.8+13 preoperatively, 59.6+13 at threemonth (p=0.028) and 61.6+17 at six month(p=0.038 to preoperatively). The effect onLVEDV varied between the patients and didnot reach statistic significance.Conclusions:In summery, the presented investigationdemonstrated an increase in LVEF and betterclinical performance by intramyocardial CD133+ stem cells injection and TML therapy.The reason remains uncertain and may beexplained by paracrine mechanism. It is stilluncertain how long the observed effect willlast, or if the better cardiac performance willlead to better life expectancy.