CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Bodo-Eckehard Strauer, MD*,
Michael Brehm, MD,
Christiana Mira Schannwell, MD and
Muhammad Yousef, MD
* Department of Medicine, Division of Cardiology, Pneumology, and Angiology, Heinrich-Heine-University of Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany (Email: strauer{at}med.uni-duesseldorf.de).
The letter by Drs. Thum and Anker touches various aspects of cardiac stem cell therapy (e.g., mortality, paracrine effects, and inflammation), all of which may be briefly addressed as follows.
Intracoronary stem cell therapy seems to represent a safe and effective regimen for treatment of heart failure after acute myocardial infarction (1,2), in an old myocardial infarction ( 8 years) with ischemic cardiomyopathy (3), and in advanced dilated cardiomyopathy (4). Our study (5) did not aim to speculate (Drs. Thum and Anker) on stem cell-induced inflammation (which has not yet been documented in the overwhelming majority of studies) and on possible paracrine effects by stem cells, but fortunately was able to analyze the different parameters of ventricular performance and potential effects on cardiac mortality in large patient groups, treated and untreated, in long-term follow-up after myocardial infarction.
When carefully reading our paper (5), the BALANCE (Clinical Benefit and Long-Term Outcome After Intracoronary Autologous Bone Marrow Cell Transplantation in Patients With Acute Myocardial Infarction) study showed that mortality, as a consequence of stem cell therapy, is significantly reduced; in a median follow-up time of 4.6 ± 2.1 years in the bone marrow cell group 1 patient died, and in 4.8 ± 2.2 years, 7 patients in the control group died (p = 0.03).
Mortality is dependent on both the degree of ventricular impairment and the amount of arrhythmogenicity. Dependent on the multifactorial mode of action of stem cells, systolic function (e.g., ejection fraction, stroke volume, contractility) and diastolic performance are improved; infarct size, end-systolic volume, and systolic wall stress decrease; and the arrhythmogenicity of the heart is presumably reduced. Thus, several of the main myocardial determinants of cardiac mortality are influenced in favor of reduced mortality by stem cell treatment in chronically ill cardiac patients.
Undoubtedly, further large studies are needed to analyze the action of stem cells on ventricular performance and cardiac mortality in different stages of chronic cardiac failure, especially with regard to the distinct origin of this chronic disease.
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1. Strauer BE, Brehm M, Zeus T, et al. [Intracoronary, human autologous stem cell transplantation for myocardial regeneration following myocardial infarction] Dtsch Med Wochenschr 2001;126:932-938.[CrossRef][Medline]2. Strauer BE, Brehm M, Zeus T, et al. Repair of infarcted myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans Circulation 2002;106:1913-1918.[Abstract/Free Full Text] 3. Strauer BE, Brehm M, Zeus T, et al. Regeneration of human infarcted heart muscle by intracoronary autologous bone marrow cell transplantation in chronic coronary artery disease: the IACT study J Am Coll Cardiol 2005;46:1651-1658.[Abstract/Free Full Text] 4. Strauer BE, Brehm M, Schannwell CM. The therapeutic potential of stem cells in heart disease Cell Prolif 2008;41(Suppl 1):126-145.[Web of Science][Medline] 5. Yousef M, Schannwell CM, Köstering M, Zeus T, Brehm M, Strauer BE. The BALANCE study: clinical benefit and long-term outcome after intracoronary autologous bone marrow cell transplantation in patients with acute myocardial infarction J Am Coll Cardiol 2009;53:2262-2269.[Abstract/Free Full Text]
Related Article
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The BALANCE Study: Too Early to Speculate on Mortality Effects
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J. Am. Coll. Cardiol. 2010 55: 263-264.
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