TY - JOUR
T1 - Adult bone marrow cell therapy improves survival and induces long-term improvement in cardiac parameters
T2 - A systematic review and meta-analysis
AU - Jeevanantham, Vinodh
AU - Butler, Matthew
AU - Saad, Andre
AU - Abdel-Latif, Ahmed
AU - Zuba-Surma, Ewa K.
AU - Dawn, Buddhadeb
PY - 2012/7/31
Y1 - 2012/7/31
N2 - Background-Despite rapid clinical translation and widespread enthusiasm, the therapeutic benefits of adult bone marrow cell (BMC) transplantation in patients with ischemic heart disease continue to remain controversial. A synthesis of the available data is critical to appreciate and underscore the true impact of this promising approach. Methods and Results-A total of 50 studies (enrolling 2625 patients) identified by database searches through January 2012 were included. Weighted mean differences for changes in left ventricular (LV) ejection fraction, infarct size, LV end-systolic volume, and LV end-diastolic volume were estimated with random-effects meta-analysis. Compared with control subjects, BMC-treated patients exhibited greater LV ejection fraction (3.96%; 95% confidence interval, 2.90-5.02; P<0.00001) and smaller infarct size (-4.03%, 95% confidence interval,-5.47 to-2.59; P<0.00001), LV end-systolic volume (-8.91 mL; 95% confidence interval,-11.57 to-6.25; P<0.00001), and LV end-diastolic volume (-5.23 mL; 95% confidence interval,-7.60 to-2.86; P<0.0001). These benefits were noted regardless of the study design (randomized controlled study versus cohort study) and the type of ischemic heart disease (acute myocardial infarction versus chronic ischemic heart disease) and persisted during long-term follow-up. Importantly, all-cause mortality, cardiac mortality, and the incidence of recurrent myocardial infarction and stent thrombosis were significantly lower in BMC-treated patients compared with control subjects. Conclusions-Transplantation of adult BMCs improves LV function, infarct size, and remodeling in patients with ischemic heart disease compared with standard therapy, and these benefits persist during long-term follow-up. BMC transplantation also reduces the incidence of death, recurrent myocardial infarction, and stent thrombosis in patients with ischemic heart disease.
AB - Background-Despite rapid clinical translation and widespread enthusiasm, the therapeutic benefits of adult bone marrow cell (BMC) transplantation in patients with ischemic heart disease continue to remain controversial. A synthesis of the available data is critical to appreciate and underscore the true impact of this promising approach. Methods and Results-A total of 50 studies (enrolling 2625 patients) identified by database searches through January 2012 were included. Weighted mean differences for changes in left ventricular (LV) ejection fraction, infarct size, LV end-systolic volume, and LV end-diastolic volume were estimated with random-effects meta-analysis. Compared with control subjects, BMC-treated patients exhibited greater LV ejection fraction (3.96%; 95% confidence interval, 2.90-5.02; P<0.00001) and smaller infarct size (-4.03%, 95% confidence interval,-5.47 to-2.59; P<0.00001), LV end-systolic volume (-8.91 mL; 95% confidence interval,-11.57 to-6.25; P<0.00001), and LV end-diastolic volume (-5.23 mL; 95% confidence interval,-7.60 to-2.86; P<0.0001). These benefits were noted regardless of the study design (randomized controlled study versus cohort study) and the type of ischemic heart disease (acute myocardial infarction versus chronic ischemic heart disease) and persisted during long-term follow-up. Importantly, all-cause mortality, cardiac mortality, and the incidence of recurrent myocardial infarction and stent thrombosis were significantly lower in BMC-treated patients compared with control subjects. Conclusions-Transplantation of adult BMCs improves LV function, infarct size, and remodeling in patients with ischemic heart disease compared with standard therapy, and these benefits persist during long-term follow-up. BMC transplantation also reduces the incidence of death, recurrent myocardial infarction, and stent thrombosis in patients with ischemic heart disease.
KW - bone marrow cells
KW - myocardial infarction
KW - myocardial ischemia
KW - stem cells
KW - ventricular remodeling
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U2 - 10.1161/CIRCULATIONAHA.111.086074
DO - 10.1161/CIRCULATIONAHA.111.086074
M3 - Review article
C2 - 22730444
AN - SCOPUS:84864453582
SN - 0009-7322
VL - 126
SP - 551
EP - 568
JO - Circulation
JF - Circulation
IS - 5
ER -