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Updated: Apr 22, 2026
Intramyocardial Cell Delivery: Observations in Murine Hearts
Published on: January 24, 2014
Long term outcome after mononuclear bone marrow or peripheral blood cells infusion after myocardial infarction
Ronak Delewi1, Anja M van der Laan2, Lourens F H J Robbers3
1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
Insights
Intracoronary bone marrow mononuclear cell (BMMC) therapy after myocardial infarction reduced adverse cardiac remodeling long-term. Peripheral blood mononuclear cell (PBMC) therapy, however, was associated with increased adverse cardiovascular events.
Area of Science:
- Cardiology
- Regenerative Medicine
- Clinical Trials
Background:
- The HEBE trial investigated the efficacy of intracoronary infusions of bone marrow mononuclear cells (BMMCs) or peripheral blood mononuclear cells (PBMCs) versus standard therapy in patients with large acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention.
- This study presents the long-term (5-year) follow-up data of the HEBE trial, assessing cardiac structure, function, and clinical adverse events.
Purpose of the Study:
- To evaluate the long-term safety and efficacy of intracoronary BMMC and PBMC therapy in patients following acute myocardial infarction (AMI).
- To assess the impact of these cell therapies on cardiac remodeling and major adverse cardiovascular events (MACE) over a 5-year period.
Main Methods:
- A multicenter, randomized controlled trial involving 200 patients with large first AMI.
- Patients received either BMMC infusion (n=69), PBMC infusion (n=66), or standard therapy (n=65) after primary percutaneous coronary intervention.
- Cardiac MRI was performed at baseline, 4 months, and 2 years post-AMI. Clinical adverse events were tracked for 5 years.
Main Results:
- The BMMC group demonstrated a significantly lower increase in left ventricular end-diastolic volume (LVEDV) compared to the control group (p=0.03) at 2 years, suggesting reduced adverse cardiac remodeling.
- A trend towards decreased LV end-systolic volume was observed in the BMMC group (p=0.07).
- The PBMC group showed a significantly higher incidence of the composite endpoint of death or recurrent myocardial infarction compared to controls (p=0.008).
Conclusions:
- Long-term follow-up of the HEBE trial supports the safety of intracoronary BMMC therapy, showing reduced adverse cardiac remodeling.
- Intracoronary PBMC therapy was associated with a significant increase in major adverse cardiovascular events, indicating potential safety concerns.
- Further research is warranted to optimize cell therapy strategies for post-myocardial infarction recovery.
Objectives:
This study reports the long-term follow-up of the randomised controlled HEBE trial. The HEBE study is a multicentre trial that randomised 200 patients with large first acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention to either intracoronary infusion of bone marrow mononuclear cells (BMMCs) (n=69), peripheral blood mononuclear cells (PBMCs) (n=66) or standard therapy (n=65).
Methods:
In addition to 3-5 days, and 4 months after AMI, all patients underwent cardiac MRI after 2 years. A follow-up for 5 years after AMI was performed to assess clinical adverse events, including death, myocardial reinfarction and hospitalisation for heart failure.
Results:
Of the 200 patients enrolled, 9 patients died and 12 patients were lost to follow-up at 5 years after AMI. BMMC group showed less increase in LV end-diastolic volume (LVEDV) (3.5±16.9 mL/m(2)) compared with (11.2±19.8 mL/m(2), p=0.03) in the control group, with no difference between the PBMC group (9.2±20.9 mL/m(2)) and controls (p=0.69). Moreover, the BMMC group showed a trend for decrease in LV end systolic volume (-1.8±15.0 mL/m(2)) as compared with controls (3.0±16.3 mL/m(2), p=0.07), with again no difference between PBMC (3.3±18.8 mL/m(2)) and controls (p=0.66). The combined endpoint of death and hospitalisation for heart failure was non-significantly less frequent in the BMMC group compared with the control group (n=4 vs n=1, p=0.20), with no difference between PBMC and controls (n=6 vs n=4, p=0.74). The composite endpoint of death or recurrent myocardial infarction was significantly higher in the PBMC group compared with controls (14 patients vs 3 patients, p=0.008), with no difference between the BMMC group and controls (2 vs 3 patients, p=0.67).
Conclusions:
Long-term follow-up of the HEBE trial showed that increase in LVEDV was lower in the BMMC group. This study supports the long-term safety of intracoronary BMMC therapy. However, major clinical cardiovascular adverse events were significantly more frequent in the PBMC group.
Trial Registration Number:
The Netherlands Trial Register #NTR166 (http://www.trialregister.nl) and the International Standard Randomised Controlled Trial, #ISRCTN95796863 (http://isrctn.org).
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