Immature cells strengthen damaged heart (NEJM)

20Sept2006

Immature cells strengthen damaged heart

http://news.yahoo.com/s/nm/20060920/hl_nm/heart_study_dc_3

Injecting immature cells into hearts damaged months or years earlier by
a heart attack can help that heart beat more efficiently, a study
showed on Wednesday.

The treatment, using cells culled from a patient's bone marrow, marks
the latest attempt to try to coax cells to grow into replacement heart
cells and repair damage inflicted by a heart attack, a quest that could
forestall heart failure.

The research team, led by Birgit Assmus of Johann Wolfgang Goethe
University in Frankfurt, found that the 28 volunteers who received bone
marrow cells developed hearts that pumped with nearly 5 percent more
force.

For the 24 patients who received immature cells extracted from blood
instead of bone marrow, there was no significant improvement. The 23
people in the control group who did not receive an injection seem to
lose, on average, nearly 3 percent of their pumping power after three
months.

When some of the patients in the control group were given bone marrow
transplants, their hearts also strengthened.

The gains from bone marrow injections were "modest," said Anthony
Rosenzweig of the Harvard Stem Cell Institute, who was not involved in
the study. "It was remarkable that any benefit was seen in these
patients" because the typical volunteer received the injection more
than six years after their heart attack and were receiving the best
available care.

The Assmus team said bone marrow injections may have worked better
because they included 10 times more immature cells than the technique
used to extract those cells from the blood.

'CAUTIOUS OPTIMISM'

The study, published in this week's New England Journal of Medicine,
was accompanied by two other studies that tried a similar technique
under different conditions. Those results, first reported at a heart
conference in November, were mixed.

One study, known as REPAIR-AMI, involving 204 volunteers at 17 European
medical centers, found that bone marrow cell injections nearly doubled
the heart's pumping ability if the treatment was given within a week of
the heart attack.

But a smaller study, known as ASTAMI, found no improvement in patients
who received the bone marrow cells.

Those findings "provide a realistic perspective on this approach while
leaving room for cautious optimism" about a technique that clearly
requires further study before it can be recommended, said Rosenzweig in
a Journal editorial.

It is not known if the benefits seen in the Assmus study will persist
long enough to help patients live longer.

One thing that needs to be done, Rosenzweig said, is to figure out
which bone marrow cells offer the biggest benefit to the heart.

"Even aspirin might not be as effective," he said, "if it were still
being delivered as willow bark."

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