Feasibility of trans-endocardial cell transplantation in chronic ischaemia

Cell transplantation is currently being explored as a novel therapeutic option for patients with chronic myocardial ischaemia. The main goal of bone marrow cell transplantation is to augment blood flow in ischaemic myocardium through induction of angiogenesis. Improved collateral perfusion and enhanced left ventricular function have already been documented in animal models with chronic myocardial ischemia.1 Until now, most clinical studies were carried out in patients with acute myocardial infarction. Only two studies containing ⩽10 patients assessed the safety and feasibility of autologous bone marrow cell transplantation in patients with angina and ischaemia.2,3 Further studies are needed to confirm the safety, feasibility and effectiveness reported in these pilot trials. The present phase I/II study tested the feasibility, safety and clinical effects of trans-endocardial transplantation of autologous bone marrow-derived mononuclear cells in patients with drug-refractory angina and myocardial ischaemia. Moreover, we aimed to determine whether cell transplantation is associated with improved myocardial function and perfusion by means of technetium-99m tetrofosmin gated single photon emission computed tomography (SPECT). Patients with ischaemia on technetium-99m tetrofosmin SPECT and with Canadian Cardiovascular Society (CCS) class III or IV angina pectoris (despite maximal tolerated medical treatment) without options for conventional revascularisation were included in the study. An independent expert panel that reviewed the angiograms determined the ineligibility for surgical or percutaneous revascularisation. Seventeen patients fulfilled the inclusion criteria and were considered for inclusion. Exclusion criteria were acute myocardial infarction