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| Myotissue implants into myocardial infarct zone decreases infarct size and improves left ventricular function in infarct scar. |
| 광주기독병원 순환기내과¹, Division of cardiology, Beth Israel Deaconees Medical Center, Harvard Medical School² |
| 윤성훈¹, 이광욱¹ , 박오성¹, 김종환¹ , 강동구¹ , 이승욱¹ , 조상기¹, Roger J. Laham² |
Background:Cellular therapy has been used to prevent post-infarction myocardial dysfunction, a major cause of mortality and morbidity. This, however,is limited by poor cell survival.
Methods: Twelve Yorkshire pigs underwent myocardial infarction via balloon occlusion for one hour. Two weeks after the initial infarct, animals were randomized to 1. treatment group (n=6) undergoing septal biopsies via the right ventricle and implantation of 6-8 biopsies in the left ventricular anterior wall or 2. control group (n=6) undergoing septal biopsies and sham injections. All animals were sacrificed four weeks after the infarction. Left ventricular function was assessed at both 2 weeks and 4 weeks with echocardiography and hemodynamic measurements. At sacrifice gross infarct size was assessed by tetrazolium (TTC) staining. Histological analysis was performed to assess myocardial and myotissue viability.
Results: TTC staining demonstrated significantly smaller infarcts in the left ventricular anterior wall in treated animals vs controls (21.4% ± 11.3% versus 33.4% ± 7.7%, p=0.006). There was a significant difference in the infarct size in the untreated septum (16.2. % ± 11.3 and 27.1% ± 10.4, p-value=0.024) suggesting a global effect. TTC staining assessment was consistent between two independent observers (corr coeff=0.819; p=0.0005). Ejection fraction (EF) remained the same in the treated animals between weeks 2 and 4 (49% ± 6.5% vs 46% ± 7.4%; p=0.52). In contrast, EF decreased significantly in untreated animals (50% ± 10.4% vs 36% ± 8.7%; p=0.038). On gross pathology and H&E staining myocardial implants were viable with nearly 100% engraftment within the scar area at 4 weeks post infarction.
Conclusion: This novel method of implanting autologous adult myocardial cells is safe and efficacious in limiting left ventricular dysfunction in the setting of infarction. Implanting myocardial tissue in its entirety with preserved extracellular matrix milieu may have enhanced its viability. Implanted tissue contained cardiac stem cells that may have contributed to preservation of myocardial function.
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