Intramyocardial transplantation of autologous CD34+ stem cells for intractable angina : A phase I/IIa double-blind, randomized controlled trial

• Published in: Circulation (New York, N.Y.) Vol. 115; no. 25; pp. 3165 - 3172
• Main Authors: LOSORDO, Douglas W, SCHATZ, Richard A, BURG, Aaron, EATON, Liz, HEYD, Lindsay, THORNE, Tina, SHTURMAN, Leon, HOFFMEISTER, Peter, STORY, Ken, ZAK, Victor, DOWLING, Douglas, TRAVERSE, Jay H, WHITE, Christopher J, OLSON, Rachel E, FLANAGAN, Janice, SODANO, Donata, MURAYAMA, Toshinori, KAWAMOTO, Atsuhiko, FUKUSHIMA KUSANO, Kengo, WOLLINS, Jill, WELT, Frederick, SHAH, Pinak, SOUKAS, Peter, UDELSON, James E, ASAHARA, Takayuki, HENRY, Timothy D, VEERESHWARAYYA, Vimal, DURGIN, Michelle, KIAN KEONG POH, WEINSTEIN, Robert, KEARNEY, Marianne, CHAUDHRY, Muqtada
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 26-06-2007
• Subjects: Aged; Aged, 80 and over; Angina Pectoris - chemically induced; Angina Pectoris - diagnostic imaging; Angina Pectoris - drug therapy; Angina Pectoris - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood vessels and receptors; Cardiology. Vascular system; Cardiovascular Agents - therapeutic use; Cardiovascular system; Cell Count; Combined Modality Therapy; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Double-Blind Method; Electric Countershock; Electrocardiography, Ambulatory; Exercise Tolerance; Female; Fundamental and applied biological sciences. Psychology; Granulocyte Colony-Stimulating Factor - adverse effects; Granulocyte Colony-Stimulating Factor - pharmacology; Humans; Injections; Male; Medical sciences; Middle Aged; Myocardium; Peripheral Blood Stem Cell Transplantation - methods; Pharmacology. Drug treatments; Quality of Life; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Vasodilator agents. Cerebral vasodilators; Vertebrates: cardiovascular system; Angiogenesis; stem cells; Ischemia; Stem cell; angina; Phase I trial; Cardiovascular disease; Autologous system; Angina pectoris; Coronary heart disease; Endothelium
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.687376

A growing population of patients with coronary artery disease experiences angina that is not amenable to revascularization and is refractory to medical therapy. Preclinical studies have indicated that human CD34+ stem cells induce neovascularization in ischemic myocardium, which enhances perfusion and function.
Twenty-four patients (19 men and 5 women aged 48 to 84 years) with Canadian Cardiovascular Society class 3 or 4 angina who were undergoing optimal medical treatment and who were not candidates for mechanical revascularization were enrolled in a double-blind, randomized (3:1), placebo-controlled dose-escalating study. Patients received granulocyte colony-stimulating factor 5 microg x kg(-1) x d(-1) for 5 days with leukapheresis on the fifth day. Selection of CD34+ cells was performed with a Food and Drug Administration-approved device. Electromechanical mapping was performed to identify ischemic but viable regions of myocardium for injection of cells (versus saline). The total dose of cells was distributed in 10 intramyocardial, transendocardial injections. Patients were required to have an implantable cardioverter-defibrillator or to temporarily wear a LifeVest wearable defibrillator. No incidence was observed of myocardial infarction induced by mobilization or intramyocardial injection. The intramyocardial injection of cells or saline did not result in cardiac enzyme elevation, perforation, or pericardial effusion. No incidence of ventricular tachycardia or ventricular fibrillation occurred during the administration of granulocyte colony-stimulating factor or intramyocardial injections. One patient with a history of sudden cardiac death/ventricular tachycardia/ventricular fibrillation had catheter-induced ventricular tachycardia during mapping that required cardioversion. Serious adverse events were evenly distributed. Efficacy parameters including angina frequency, nitroglycerine usage, exercise time, and Canadian Cardiovascular Society class showed trends that favored CD34+ cell-treated patients versus control subjects given placebo.
A randomized trial of intramyocardial injection of autologous CD34+ cells in patients with intractable angina was completed that provides evidence for feasibility, safety, and bioactivity. A larger phase IIb study is currently under way to further evaluate this therapy.