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Published on: June 3, 2018
Randomized controlled trial on the cardioprotective effect of bone marrow cells in patients undergoing coronary
Vien Khach Lai1, Keng-Leong Ang, Wendy Rathbone
1Cardiac Surgery Unit, Department of Cardiovascular Sciences, University of Leicester, Clinical Science Wing, Glenfield Hospital, Leicester LE3 9QP, UK.
Insights
Bone marrow cells (BMCs) did not reduce ischaemic injury during cardiac surgery with cardiopulmonary bypass. However, BMCs showed cardioprotection comparable to ischaemic preconditioning when the heart was not under CPB stress.
Area of Science:
- Cardiology
- Regenerative Medicine
- Cardiac Surgery
Background:
- Ischaemic injury is a significant concern during cardiac surgery.
- Bone marrow cells (BMCs) are being investigated for their potential cardioprotective effects.
- Cardiopulmonary bypass (CPB) is a standard procedure in cardiac surgery that can induce myocardial stress.
Purpose of the Study:
- To investigate the efficacy of bone marrow cells (BMCs) in reducing ischaemic injury during cardiac surgery.
- To evaluate the role of cardiopulmonary bypass (CPB) in modulating the cardioprotective effects of BMCs.
Main Methods:
- A randomized study involving 44 patients undergoing elective coronary artery bypass grafting.
- Autologous BMCs were administered antegradely into the coronaries with cardioplegia.
- In vitro analysis of myocardial injury in atrial appendages before and after CPB initiation.
Main Results:
- No significant difference in Troponin I or CK-MB levels between control and BMCs groups during the first 48 hours post-surgery.
- BMCs significantly reduced myocardial injury in vitro prior to CPB, comparable to ischaemic preconditioning (IP).
- The protective effect of BMCs and IP was diminished when myocardial samples were harvested after CPB initiation.
Conclusions:
- Bone marrow cells (BMCs) do not provide additional cardioprotection when administered with cardioplegia during cardiopulmonary bypass (CPB).
- BMCs demonstrate potent cardioprotection, similar to ischaemic preconditioning (IP), in non-stressed myocardium.
- CPB itself may precondition the myocardium, potentially masking the benefits of BMCs or IP.
Aims:
This randomized study investigates whether bone marrow cells (BMCs) can reduce ischaemic injury during cardiac surgery.
Methods And Results:
Forty-four elective coronary artery bypass grafting patients were randomized to control group or BMCs group (whereby autologous BMCs were administered with each dose of cardioplegia antegradely into the coronaries). Troponin I and CK-MB were measured during the first 48 h after surgery and were not significantly different between the control and BMCs groups. The role of cardiopulmonary bypass (CPB) on the cardioprotective effects of BMCs was also studied using an in vitro model of stimulated ischaemia and reoxygenation on right atrial appendages obtained from controls either before or 10 min after the initiation of CPB. Bone marrow cells significantly reduced myocardial injury in muscles obtained prior to CPB. This effect was comparable with ischaemic preconditioning (IP), although their combination did not afford additional benefit. However, when muscles were harvested after CPB, myocardial injury in the ischaemic group alone was less, and BMCs or IP did not exert further protection.
Conclusion:
Bone marrow cells did not afford additional benefit when used as an additive to cardioplegia during CPB. However, BMCs offer cardioprotection as potent as IP, when the heart is not subjected to stress, such as CPB, that per se can precondition the myocardium.
