Cellular cardiomyoplasty

pp 138-145

Abstract

The goal of cellular cardiomyoplasty (i.e.: intra myocardial cell grafting) is to limit the consequences of the decreased contractile function and compliance of damaged ventricles following myocardial infarction. A cell-based therapeutic approach for post-ischemic scars is particularly attractive dueto the potential for myocardial regeneration of a variety of myogenic and angiogenic cell types: skeletal myoblasts, bone marrow-derived mesenchymal stem cells, circulating blood-derived progenitor cells, smooth muscle cells, vascular endothelial cells, and embryonic stem cells. Cellular cardiomyoplasty using autologous skeletal myoblasts was performed by our centers in 18 patients. Over 100 patients have been treated worldwide. Inclusion criteria for adult patients were: a low ejection fraction, a kinetics and non-viable post-infarction scar. Cell-based myogenic therapy seems to reduce the size and fibrosis of infarct scars, limit post ischemic remodeling, and restore regional myocardial contractility in patients following extensive myocardial infarction. Techniques for skeletal myoblasts culture and ex vivo expansion using autologous patient serum (obtained from plasmapheresis) have been developed. These techniques yield over 300 million cells in 3 weeks, of which more than 70% are myoblasts. Cell viability at the moment of injection is greater than 90%. The main benefits of human autologous serum cell culture is that it can be performed without risk of prion, viral or zoonoses contamination. Traditional cell cultures techniques involve the use of fetal bo-vine serum for cell growth. Contact of human cells with fe-tal bovine serum results after 3-week in fixation of animal proteins on the cell surface, representing an antigenic substrate for immunological adverse events. After cell implantation an inflammatory reaction occurs in these cases with subsequent fibrosis. Malignant ventricular arrhythmias and sudden deaths have been reported following serum bovine-cultivated cell therapy; in many cases this complication required the implantation of cardioverter-defibrillators. In this article we present a total autologous cell culture technique for myocardial regeneration and preliminary clinical results