Angiogenic CD34 Stem Cell Therapy in Coronary Microvascular Repair-A Systematic Review
Balaj Rai1, Janki Shukla2, Timothy D Henry1
1Lindner Center for Research, The Christ Hospital, Cincinnati, OH 45219, USA.
Insights
CD34+ cell therapy shows promise for treating persistent angina in patients with non-obstructive coronary artery disease and microvascular dysfunction. This innovative treatment improved coronary flow reserve and quality of life in a pilot study.
Area of Science:
- Cardiology
- Regenerative Medicine
- Vascular Biology
Background:
- Ischemia with non-obstructive coronary arteries (INOCA) affects millions, often caused by coronary microvascular dysfunction (CMD).
- Persistent angina in INOCA patients with endothelial-independent CMD is challenging to treat with standard antianginal therapies.
- Coronary microvascular dysfunction (CMD) diagnosis relies on coronary flow reserve <2.5, indicating impaired blood flow in heart vessels.
Purpose of the Study:
- To evaluate the safety and efficacy of CD34+ cell therapy for INOCA patients with persistent angina and endothelial-independent CMD.
- To assess the potential of CD34+ cell therapy in promoting vascular repair and angiogenesis in the coronary microvasculature.
- To determine if CD34+ cell therapy can restore coronary microvascular function and improve patient outcomes.
Main Methods:
- A pilot study (ESCaPE-CMD) administered autologous intracoronary CD34+ stem cells to INOCA patients with persistent angina.
- Coronary flow reserve was measured to assess microvascular function before and after treatment.
- Patient-reported outcomes, including angina frequency and quality of life, were evaluated.
Main Results:
- Treatment with CD34+ stem cells significantly improved coronary flow reserve in INOCA patients.
- Patients experienced a reduction in angina frequency and Canadian Cardiovascular Society class.
- Quality of life scores showed significant improvement following CD34+ cell therapy.
Conclusions:
- Autologous CD34+ cell therapy is a promising therapeutic option for INOCA patients suffering from persistent angina due to endothelial-independent CMD.
- The therapy effectively enhances microvascular function, leading to improved myocardial perfusion and symptom relief.
- Further evaluation in larger trials like FREEDOM is ongoing to confirm these findings.
Abstract:
Ischemia with non-obstructive coronary arteries (INOCA) is an increasingly recognized disease, with a prevalence of 3 to 4 million individuals, and is associated with a higher risk of morbidity, mortality, and a worse quality of life. Persistent angina in many patients with INOCA is due to coronary microvascular dysfunction (CMD), which can be difficult to diagnose and treat. A coronary flow reserve <2.5 is used to diagnose endothelial-independent CMD. Antianginal treatments are often ineffective in endothelial-independent CMD and thus novel treatment modalities are currently being studied for safety and efficacy. CD34+ cell therapy is a promising treatment option for these patients, as it has been shown to promote vascular repair and enhance angiogenesis in the microvasculature. The resulting restoration of the microcirculation improves myocardial tissue perfusion, resulting in the recovery of coronary microvascular function, as evidenced by an improvement in coronary flow reserve. A pilot study in INOCA patients with endothelial-independent CMD and persistent angina, treated with autologous intracoronary CD34+ stem cells, demonstrated a significant improvement in coronary flow reserve, angina frequency, Canadian Cardiovascular Society class, and quality of life (ESCaPE-CMD, NCT03508609). This work is being further evaluated in the ongoing FREEDOM (NCT04614467) placebo-controlled trial.
