Intramyocardial implantation of CD133(+) stem cells improved cardiac function without bypass surgery

Introduction. Cell transplantation for myocardial regeneration has been shown to have beneficial effects on cardiac function after myocardial infarction. Most clinical studies of intramyocardial cell transplantation were performed in combination with coronary artery bypass grafting (CABG). The contribution of implanted stem cells could yet not be clearly distinguished from the effect of the CABG surgery. Our current phase 1 clinical study has focused on the safety and feasibility of CD133(+)-enriched stem cell transplantation without CABG and its potential beneficial effect on cardiac function. Method and Results. Ten patients with end-stage chronic ischemic cardiomyopathy (ejection fraction < 22%) were enrolled in the study. Bone marrow (up to 380 mL) was harvested from the iliac crest. CD133(+) cells were purified from bone marrow cells using the CliniMACS device with purities up to 99%. Autologous bone marrow CD133(+) cells (1.5-9.7 x 10(6) cells) were injected into predefined regions. Cardiac functions prior to and 3, 6, and 9 months after cell transplantation were assessed by cardiac magnetic resonance imaging. Stem cell transplantation typically improved the heart function stage from New York Heart Association/Canadian Cardiovascular Society class III-IV to I-II. The mean preoperative and postoperative ventricular ejection fractions were 15.8 +/- 5% and 24.8 +/- 5%, respectively. Conclusion. CD133(+) injection into ischemic myocardium was feasible and safe. Stem cell transplantation alone improved cardiac function in all patients. This technique might hold promise as an alternative to medical management in patients with severe ischemic heart failure who are ineligible for conventional revascularization.