Specially prepared stem cells derived from patientsâ€™ own bone marrow appear to be safe, feasible and a potentially effective treatment for chronic heart failure, a small study has shown.
Forty eight patients with heart failure caused by a heart attack were involved in the trial led by Dr Andre Terzic from the Mayo Clinic in America and Dr Jozef Bartunek from the Aalst Cardiovascular Centre in Belgium.
The patients were all on standard treatments for heart failure but 32 also had stem cells, cultivated from their bone marrow, injected into their hearts via a vein in their thighs.
They received their stem cells an average of 1,540 days after having a heart attack. After excluding patients for reasons such as insufficient bone marrow being harvested and failure to meet criteria, 21 patients (65.6%) received the full cell therapy and completed a two-year follow-up.
Complications due to the procedure were rare, said the study being reported in the Journal of the American College of Cardiology. One patient suffered a ventricular tachycardia (a fast, potentially dangerous heart rhythm) and was given a shock (cardioversion) to get it back in a normal rhythm and one patient who suffered from severe migraine had blurred vision after treatment.
After six months, patients who received stem cells experienced greater improvement in their left ventricular ejection fraction (LVEF), a measure of heart function. In those who had standard treatment only, LVEF remained very similar but in those who had had the stem cell therapy, LVEF had typically risen from 25.7 per cent to 34.5 per cent.
Cell therapy patients also did better in 6-minute walk tests, while the others did less well. There were no signs of increased cardiac or systemic toxicity with cell therapy.
Reviewers said the results suggest that treatment is safe and feasible and also shows signs of providing enhanced cardiac performance. They said the gain in LVEF was dramatic particularly given the duration between the heart attack and cell therapy. It compared favourably with the most potent therapies in heart failure.â€ť
But they said that the path from harvesting bone marrow to treatment was far from simple.
â€śHarvesting marrow locally, shipping it to a central lab for processing, and returning the expanded cells for injection is not a trivial undertaking,â€ť they said. They remarked that 30 per cent of patients had been excluded from further analysis which may have biased results in favour of cell therapy.
But Dr Terzic said that follow-up of patients who did not meet the criteria showed no difference in outcomes. He said the next-generation stem cell technologyâ€™s LVEF improvement was the most exciting finding.
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