A Study of Intracoronary Injection of Hematopoietic Stem Cells in Pediatric Dilated Cardiomyopathy: Is It an Applicable Solution for Critically Ill Patients? (original) (raw)
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Study of peripheral stem cells mobilization as a treatment line of pediatric dilated cardiomyopathy
Stem cell investigation, 2015
Mobilizing hematopoietic stem cells may be a promising intervention for the treatment of idiopathic dilated cardiomyopathy (IDCM) in infant and children. So the aim of the work is to evaluate the efficacy of granulocyte-colony stimulating factor (G-CSF) as a therapeutic modality in pediatric IDCM. A randomized clinical trial was conducted on 40 pediatric patients with IDCM. They were subjected to history taking, clinical examination, serum lactate dehydrogenase (LDH), total creatinine phosphokinase (CPK), creatinine phosphokinase isoenzyme B (CK-MB) isoenzyme, and peripheral blood CD34(+) cell assessment before and at day 7 after subcutaneous G-CSF injection for 5 consecutive days. Echocardiography was done before and 1, 3 and 6 months after therapy. Clinical improvement in the form of regression of patients Modified Ross heart failure (MRHC) classification classes. Increased percentage of CD34(+) mobilized cells from the bone marrow, and significant increase in blood counts especia...
Therapeutic Role of Mobilized Bone Marrow Cells in Children with Nonischemic Dilated Cardiomyopathy
ISRN Pediatrics, 2012
Dilated cardiomyopathy is an important cause of congestive cardiac failure in infants and children. Mobilizing hematopoietic progenitor cells is a promising intervention to this deadly disease. Aim. Evaluate granulocyte colony stimulating factor (GCSF) as therapeutic modality in children with idiopathic dilated cardiomyopathy (IDCM). Subjects and Methods. This case-control prospective study was conducted on 20 children with IDCM following up at Cardiology Clinic Children's Hospital, Ain Shams University (group 1) who were compared to another 10 age-, sex-, duration-of-illness-, and systolic-function-matched children with IDCM as control (group 2). They were subjected to history taking, clinical examination, echocardiography, and peripheral blood CD34+ cell assessment before and one week after GCSF intake for 5 consecutive days (by group 1 but not group 2). Results. A significant improvement in echocardiographic data and CD34+-T-cell increase was found in group 1 one week after GCSF intake and for the next 6 months CD34+ T cells percentage of change showed no significant correlation with the that of the left ventricular dimensions and systolic function. Conclusion. Administration of GCSF to children with IDCM resulted in clinical and echocardiographic improvement not correlated to mobilized CD34+ T cells, implying involvement of additional mechanisms over simple stem cell mobilization.
Acta Chirurgica Latviensis, 2010
Introduction. Dilated cardiomyopathy is a serious disorder of the myocardium in pediatric age. Conservative therapy is limited and lethal outcome observed in one third of patients within a year. Bone marrow derived progenitor cell transplantation is becoming a promising method of treatment in adult population and there is ground to believe there are perspectives in pediatric cardiology. Aim of the Study. We present the first results of bone marrow cell transplantation in case of dilated cardiomyopathy for six patients at age four months to seventeen years. Materials and methods. We did the six Bone marrow derived progenitor cell (BMCs) intramycardial transplantations. Five to 30 mililiters of bone marrow were aspirated from iliac bone. Seventeen to 90 million BMCs were isolated and as suspension of physiologic saline given to patients by intramyocardial punction. Every patient underwent repeated examination every two month. Results. Six months following bone marrow derived progenitor stem cell intramyocardial transplantation we observed increase of ejection fraction in 4 patients, decrease of dilatation echocardiographycally and cardiothoracic ratio (CTR) at chest x-ray; decrease of the stage of heart insufficiency clinically from class IV to I-II(NYHA). Conclusions. We see the intramyocardial administration of bone marrow cells proved to be technically feasible and safe, also the procedure does not need for expensive technical equipment. The bone marrow transplantation improves the patients clinical situation and physical measurements. Our method might be used for the stabilization of the patient to get the time for further treatment.
2012
Copyright © 2012 Nevin M. Habeeb et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dilated cardiomyopathy is an important cause of congestive cardiac failure in infants and children. Mobilizing hematopoietic progenitor cells is a promising intervention to this deadly disease. Aim. Evaluate granulocyte colony stimulating factor (GCSF) as therapeutic modality in children with idiopathic dilated cardiomyopathy (IDCM). Subjects and Methods. This case-control prospective study was conducted on 20 children with IDCM following up at Cardiology Clinic Children’s Hospital, Ain Shams University (group 1) who were compared to another 10 age-, sex-, duration-of-illness-, and systolic-function-matched children with IDCM as control (group 2). They were subjected to history taking, clinical examination, echocardiography, and per...
Science Journal of Clinical Medicine, 2013
This retrospective report presents findings on 7 patients with idiopathic dilated cardiomyopathy who underwent transplantation of autologous bone marrow derived mononuclear cells (BMSC) after failed routine conservative treatment, and were on a waiting list for cardiac transplantation. In two out of seven patients, we performed intramyocardial delivery of BMSC twice, 22 and 24 months respectively after the first transplant. All patients received anti-congestive therapy by diuretics, ACE inhibitors, carvedilol, digitalis and aspirin. We discuss potential disadvantages of intracoronary injections of autologous bone marrow stem cells. We believe that our BMSC transplantation method as opposed to intravascular input is the method of choice, particularly in children with idiopathic dilated cardiomyopathy because it is safe, gentle and is not associated with risks for coronary circulation.
Stem Cells as A Possible Treatment for Pediatric Cardiomyopathy
Stem cell and regenerative medicine, 2020
Pediatric cardiomyopathies are a collection of diseases that deal with improper formation of the ventricular myocardium in infants and children. These cardiomyopathies are split into dilated, hypertrophic, restrictive, and left ventricular noncompaction cardiomyopathy; classified by the exact irregularity that is present. This analysis dives into the use of stem cells to help correct the abnormalities that occur. There are currently two methods utilizing stem cells with one being the creation of an in vitro model that replicates the problematic tissue and then using stem cells as a means of replacing the defective cells. The other method is finding animals with or generating animals with cardiomyopathies and then introducing stem cells into the organism. To date, in rat and pig models, mesenchymal stem cells derived from cord blood and bone marrow show immense promise as the results indicate increased cardiac efficiency. A decrease in cardiomyocyte apoptosis, an increase in left ventricular fraction shortening levels, and an increase in cardiac contractile function have been observed in these animal models. Mesenchymal stem cells have shown their massive capabilities in early animal models, however; more studies need to be conducted to transition to the next stage and eventually to human clinical trials. That being said, stem cells appear to be a viable solution to pediatric cardiomyopathies in the future.
Arquivos Brasileiros de Cardiologia, 2014
Background: Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even under optimal medical treatment. Autologous infusion of bone marrow adult stem cells has shown promising preliminary results in these patients. Objective: Determine the effectiveness of autologous transplantation of bone marrow adult stem cells on systolic and diastolic left ventricular function, and on the degree of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Methods: We administered 4.54 x 10 8 ± 0.89 x 10 8 bone marrow adult stem cells into the coronary arteries of 24 patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Changes in functional class, systolic and diastolic left ventricular function and degree of mitral regurgitation were assessed after 3 months, 6 months and 1 year. Results: During follow-up, six patients (25%) improved functional class and eight (33.3%) kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after 3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no significant changes neither in diastolic left ventricular function nor in mitral regurgitation degree. A combined cardiac resynchronization and implantable cardioversion defibrillation was implanted in two patients (8.3%). Four patients (16.6%) had sudden death and four patients died due to terminal cardiac failure. Average survival of these eight patients was 2.6 years. Conclusion: Intracoronary infusion of bone marrow adult stem cells was associated with an improvement or stabilization of functional class and an improvement in left ventricular ejection fraction, suggesting the efficacy of this intervention. There were no significant changes neither in left ventricular diastolic function nor in the degree of mitral regurgitation. (Arq Bras Cardiol. 2014; 103(6):521-529)
Journal of US-China Medical Science, 2013
We report 7 pediatric patients with idiopathic dilated cardiomyopathy who underwent autologous bone marrow derived mononuclear cells intramyocardial delivery as a final option after unsuccessful routine conservative treatment and have real perspective for cardiac transplantation in childhood in our country at new time. For two patients intramyocardial delivery was performed repeatedly 22 and 24 months respectively after first repair. All patients received massive anti-congestive therapy by diuretics, ACE inhibitors, carvedilol, digitalis and aspirin.
2014
An increasing understanding of the nature and processes of idiopathic dilated cardiomyopathy in children, as well as the limited treatment options have led several researchers to use stem cell transplantation in management of these patients. Study results suggest that homing of transplanted cells varies significantly using different techniques for their delivery to the target area. We will describe in detail the technique for transdermal intramyocardial implantation of bone marrow derived progenitor cells. This innovative technique if combined with ultrasound monitoring offers the possibility for delivery of stem cells right into the target area in a safe and effective way.