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VIEWPOINT

Promise of Blood- and Bone Marrow-Derived Stem Cell Transplantation for Functional Cardiac Repair

Putting It in Perspective With Existing Therapy

Thorsten Reffelmann, MD^_*,,,_*, Stephanie Könemann, MD^_* and Robert A. Kloner, MD, PhD, FACC^,

^_* Klinik und Poliklinik für Innere Medizin B, Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany
The Heart Institute, Good Samaritan Hospital, Los Angeles, California
Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California

Manuscript received June 20, 2008; revised manuscript received October 9, 2008, accepted October 13, 2008.

^_* Reprint requests and correspondence: Dr. Thorsten Reffelmann, Klinik und Poliklinik für Innere Medizin B, Universitätsklinikum der Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Löffler Str. 23 a, 17475 Greifswald, Germany (Email: ThorstenReffelmann{at}web.de).

Intracoronary transplantation of peripheral blood- or bone marrow-derived cells, as tested in several recent trials, is associated with moderate increases in left ventricular (LV) ejection fraction (EF) and a small reduction of LV end-systolic volumes. Substantial variability exists between trials, and most of them are based on a small number of patients. Meta-analyses estimated an increase in EF of 3% to 4% more in comparison with control patients. In this review, the effects are put into perspective with established treatment options for acute myocardial infarction (AMI), such as thrombolysis and acute percutaneous interventions or pharmacotherapy aimed at favorably influencing the cardiac remodeling process. Changes in functional and morphometric parameters of LV performance after cell therapy appear to be in the range of effects observed with reperfusion therapy, pharmacotherapeutic interventions influencing the renin-angiotensin-aldosterone pathway, and beta-blockers after AMI.

Key Words: cell transplantation • acute myocardial infarction • remodeling • thrombolysis • immediate coronary angioplasty

Abbreviations and Acronyms   AMI = acute myocardial infarction   EF = ejection fraction   LV = left ventricular   MI = myocardial infarction

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