Terapêutica com células estaminais no enfarte agudo do miocárdio e insuficiência cardiaca pós – enfarte

Autores

  • C. Marecos Hospital de Santa Maria
  • L. Menezes Falcão Hospital de Santa Maria

Palavras-chave:

Células estaminais, enfarte agudo do miocárdio, insuficiência cardíaca, mioblastos, remodelagem ventricular

Resumo

O transplante de células estaminais no coração tem surgido como
uma terapêutica potencial em doentes com enfarte agudo do
miocárdio e insuficiência cardíaca pós-enfarte. O estadio actual
do conhecimento permite esperar que o uso de mioblastos derivados do tecido muscular esquelético ou de células estaminais da
medula óssea venha a revelar-se uma terapêutica segura, viável e
eficaz. Os dados disponíveis sugerem o seu benefício na função
cardíaca, com o aumento da fracção de ejecção do ventrículo
esquerdo e diminuição dos volumes telessistólico e telediastólico.
Perspectiva-se diminuição da área de enfarte, aumento da contractilidade da área enfartada, diminuição da classe funcional de
insuficiência cardíaca e diminuição do número de procedimentos
de revascularização e de hospitalizações.
Apesar de ainda se desconhecerem os mecanismos envolvidos, sugerem-se como hipóteses a diferenciação em miócitos, a
promoção da angiogénese, a secreção de factores parácrinos que
aumentam a função dos miócitos sobreviventes ou responsáveis
pela mobilização de células estaminais residentes no coração,
oposição à destruição da matriz extracelular com diminuição da
apoptose dos cardiomiócitos e fusão entre as células transplantadas e os miócitos residentes.
É importante sublinhar que não se encontra esclarecido qual
o melhor local para a colheita das células estaminais nem qual
a melhor forma de as administrar.
Também permanecem em aberto questões referentes a
dificuldades técnicas e eventuais complicações. A investigação
em curso permitirá, espera-se, esclarecer dúvidas e chegar a
conclusões mais fiáveis.

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Referências

Hagege AA, Marolleau JP, Vilquin JT et al. Skeletal myoblast transplantation in ischemic heart failure: long-term follow-up of the first phase I cohort of patients. Circulation2006;114(1):I108-1113.

Kepez A., Oto, A. Cardiac stem cell therapy : hope for myocardial repair. E- journal volume 2007; vol5, nº31 .

Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction: experimental observations and clinical implications. Circulation 1990; 81: 1161-1172.

Ohtsuka M, Takano H, Zou Y, et al. Cytokine therapy prevents left ventricular remodeling and dysfunction after myocardial infarction through neovascularization. FASEB J 2004; 18: 851–853.

Wollert KC, Drexler H. Cell based therapy for heart failure. Curr Opin Cardiol 2006; 21: 234-239.

Jorgensen E, Ripa RS, Helqvist S, et al. In-stent neo-intimal hyperplasia after stem cell mobilization by granulocyte-colony stimulating factor. Preliminary intracoronary ultrasound results from a double-blind randomized placebo-controlled study of patients treated with percutaneous coronary intervention for ST-elevation myocardial infarction (STEMMITrial). Int J Cardiol 2006;111:174–177.

Fernandez-Aviles F, San Roman JA, Garcia-Frade J et al. Experimental and clinical regenerative capability of human bone marrow cells after myocardial infarction. Circ Res 2004; 95(7): 742-748.

Schachinger V, Assmus B, Britten MB et al. Transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction: final one-year results of the TOPCARE-AMI Trial. J Am Coll Cardiol 2004; 44(8): 1690-1699.

Strauer BE, Brehm M, Zeus T et al. Regeneration of human infarcted heart muscle by intracoronary autologous bone marrow cell transplantation in chronic coronary artery disease: the IACT Study. J Am Coll Cardiol 2005; 46(9): 1651-1658.

Meyer GP, Wollert KC, Lotz J et al. Intracoronary bone marrow cell transfer after myocardial infarction: eighteen months’ follow-up data from the randomized, controlled BOOST (Bone marrow transfer to enhance ST-elevation infarct regeneration) trial. Circulation 2006; 113(10): 1287-1294.

Lunde K, Solheim S, Aakhus S et al. Intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction. N Engl J Med 2006; 355(12): 1199-1209.

Wollert KC, Meyer GP, Lotz J et al. Intracoronary autologous bone-marrow cell transfer after myocardial infarction:the BOOST randomised controlled clinical trial. Lancet 2004; 364: 141–148.

Ince H, Petzsch M, Kleine HD et al. Prevention of left ventricular remodeling with granulocyte colony-stimulating factor after acute myocardial infarction: final 1-year results of the Front-Integrated Revascularization and Stem Cell Liberation in Evolving Acute Myocardial Infarction by Granulocyte Colony-Stimulating Factor (FIRSTLINE-AMI) Trial. Circulation 2005; 112: I73– 180.

Ohki Y, Heissig B, Sato Y et al. Granulocyte colony-stimulating factor promotes neovascularization by releasing vascular endothelial growth factor from neutrophils. FASEBJ 2005;19:2005–2007.

Engelmann MG, Theiss HD, Hennig-Theiss C et al. Autologous bone marrow stem cell mobilization induced by granulocyte colony-stimulating factor after subacute ST-segment elevation myocardial infarction undergoing late revascularization: final results from the G-CSF-STEMI (Granulocyte Colony-Stimulating Factor ST-Segment Elevation Myocardial Infarction) trial. J Am Coll Cardiol 2006; 48(8): 1712-1721.

Kang HJ, Kim HS, Zhang SY et al. Effects of intracoronary infusion of peripheral blood stem-cells mobilised with granulocyte-colony stimulating factor on left ventricular systolic function and restenosis after coronary stenting in myocardial infarction: the magic cell randomised clinical trial. Lancet 2004; 363: 751–756.

Kang HJ, Kim HS, Koo BK et al. Intracoronary infusion of the mobilized peripheral blood stem cell by G-CSF is better than mobilization alone by G-CSF for improvement of cardiac function and remodeling: 2-year followup results of the Myocardial Regeneration and Angiogenesis in Myocardial Infarction with G-CSF and Intra-Coronary Stem Cell Infusion (MAGIC Cell) 1 trial. Am Heart J 2007; 153(2): 237.e1-8.

Zohlnhofer, Dietlind et al. Stem Cell Mobilization by Granulocyte ColonyStimulating Factor for Myocardial Recovery after Acute Myocardial Infaction : A Meta-Analysis. JACC 2008; 51: 1429-1437.

Memon IA, Sawa Y, Fukushima N et al. Repair of impaired myocardium by means of implantation of engineered autologous myoblast sheets. J Thorac Cardiovasc Surg 2005; 130(5): 1333-1341.

Dowell JD, Rubart M, Pasumarthi KB et al. Myocyte and myogenic stem cell transplantation in the heart. Cardiovasc Res 2003; 58: 336-350.

Hagege AA, Carrion C, Menasche P, et al. Viability and differentiation of autologous skeletal myoblast grafts in ischaemic cardiomyopathy. Lancet 2003; 361(9356): 491-492.

Leobon B, Garcin I, Menasche P et al. Myoblasts transplanted into rat infarcted myocardium are functionally isolated from their host. Proc Natl Acad Sci USA 2003; 100: 7808-7811.

Menasché P, Hagége AA, Vilquin JT et al. Autologous skeletal myoblast transplantation for severe postinfarction left ventricular dysfunction. J Am Coll Cardiol 2003; 41: 1078-1083.

Smits PC, Van Geuns RJ, Poldermans D et al. Catheter-based intramyocardial injection of autologous skeletal myoblasts as a primary treatment of ischemic heart failure. J Am Cardiol 2003; 42: 2063-2069.

Siminiak T, Fiszer D, Jerzykowska O et al. Percutaneous trans-coronaryvenous transplantation of autologous skeletal myoblasts in the treatment of post-infarction myocardial contractility impairment: the POZNAN trial. Eur Heart J 2005; 26(12):1188-1195.

Strauer BE, Brehm M, Zeus T et al. Repair of infarcted myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans. Circulation 2002; 106: 1913-1918.

Assmus B, Schachinger V, Teupe C et al. Transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction (TOPCAREAMI). Circulation 2002; 106: 3009-3017.

Stamm, C. et al. Autologous bone-marrow stem cell transplantation for myocardial regeneration. The Lancet 2003; 361: 45-46

Chen SL, Fang WW, Ye F et al. Effect on left ventricular function of intracoronary transplantation of autologous bone marrow mesenchymal stem cell in patients with acute myocardial infarction. Am J Cardiol 2004; 94(1): 92-95

Schachinger V, Erbs S, Elsasser A et al. Intracoronary bone marrow-derived progenitor cells in acute myocardial infarction. N Engl J Med 2006; 355(12): 1210-1221.

Hirsch A, Nijveldt R, van der Vleuten PA et al. Intracoronary infusion of autologous mononuclear bone marrow cells or peripheral mononuclear blood cells after primary percutaneous coronary intervention: rationale and design of the HEBE trial- a prospective, multicenter, randomized trial. Am Heart J 2006; 152(3): 434-441.

Seeger FH, Tonn T, Krzossok N et al. Cell isolation procedures matter: a comparison of different isolation protocols of bone marrow mononuclear cells used for cell therapy in patients with acute myocardial infarction. Eur Heart J 2007; 28(6): 766-772.

Burt, Richard et al . Clinical Applications of Blood-Derived and Marrow-Derived stem Cells for Nonmalignant Diseases. JAMA 2008; 299: 925-936.

Martin-Rendon, Enca et al. Autologous bone marrow stem cells to treat acute myocardial infaction : a systematic review. EHJ 2008; 29: 1807-1818.

Perin EC, Dohmann HF, Borojevic R et al. Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure. Circulation 2003; 107: 2294-2302.

Perin EC, Dohmann H, Borojevic R et al. Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure. Circulation 2003; 107: 2294-2302.

Fazel, Shafie et al. Current Status of Cellular Therapy for Ischemic Heart Disease. Ann Thorac Surg 2005, 79: 2238 – 2247.

Cohn JN, Bristow MR, Chien KR et al. Report of the National Heart, Lung and Blood Institute special emphasis panel on heart failure research. Circulation 1997; 95: 766-770.

Zhan-quan L, Ming Z, Yuan-zhe J et al. The Clinical Study of autologous peripheral blood stem cell transplantation by intracoronary infusion in patients with acute myocardial infarction. Int J Cardiol 2007; 115: 52-56.

Pagani FD, DerSimonian H, Zawadzka A et al. Autologous skeletal myoblasts transplanted to ischemia-damaged myocardium in humans. J Am Coll Cardiol 2003; 41: 879-888.

Fuchs S, Satler LF, Kornowski R et al. Catheter-based autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease: a feasibility study. J Am Coll Cardiol 2003; 41: 1721–1724.

Tse HF, Kwong YL, Chan J et al. Angiogenesis in ischaemic myocardium by intramyocardial autologous bone marrow mononuclear cell implantation. Lancet 2003; 361: 47-49.

Nyolczas N, Gyongyosi M, Beran G et al. Design and rationale for the Myocardial Stem Cell Administration After Acute Myocardial Infarction

(MYSTAR) Study: a multicenter, prospective, randomized, single-blind trial comparing early and late intracoronary or combined (percutaneous intra-myocardial and intracoronary) administration of nonselected autologous bone marrow cells to patients after acute myocardial infarction. Am Heart J 2007;153(2):212.e1-7.

Sutherland, F et al. From Stem Cells to Viable Autologous Semilunar Heart Valve. Circulation, 2005: 2783 – 2791.

Murray, F. The Stem – Cell Market – Patients and the Pursuit of scientific Progress. The New England Journal of Medicine, 2007: 2341-3.

Schachinger V, Erbs S, Elsasser A et al. Improved clinical outcome after intracoronary administration of bone-marrow-derived progenitor cells in acute myocardial infarction: final 1-year results of the REPAIR-AMI trial. Eur Heart J 2006; 27(23):2775-2783.

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Publicado

30-09-2010

Como Citar

1.
Marecos C, Menezes Falcão L. Terapêutica com células estaminais no enfarte agudo do miocárdio e insuficiência cardiaca pós – enfarte. RPMI [Internet]. 30 de Setembro de 2010 [citado 5 de Novembro de 2024];17(3):187-95. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/1219

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