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Extracellular Vesicle-Enhanced Stem Cell Therapy in Acute Myocardial Infarction: A Case Report of Cardiac
Halil Hüzmeli1, Ayberk Akat2, Ahmet Özkara1
1Department of Cardiovascular Surgery, Liv Hospital Ulus, Istanbul, Turkey.
Insights
Mesenchymal stem cells and their extracellular vesicles improved heart function after myocardial infarction. This regenerative therapy showed sustained cardiac benefits even with bypass graft failure.
Area of Science:
- Regenerative Medicine
- Cardiovascular Research
- Stem Cell Therapy
Background:
- Myocardial infarction (MI) remains a leading cause of death, characterized by heart muscle damage due to reduced blood flow.
- The heart possesses limited intrinsic healing capabilities, driving the search for effective regenerative treatments.
- Current therapeutic strategies for severe ischemic damage often face limitations, necessitating novel approaches.
Purpose of the Study:
- To investigate the efficacy of mesenchymal stem cells (MSCs) and their derived extracellular vesicles (EVs) in treating acute myocardial infarction.
- To evaluate the impact of direct myocardial injection of MSCs and EVs during coronary artery bypass grafting (CABG) surgery.
- To assess cardiac function recovery and long-term outcomes in a patient with severe ischemic heart damage.
Main Methods:
- A case report detailing the surgical administration of MSCs and EVs directly into the myocardium during CABG.
- Utilized myocardial perfusion scintigraphy and echocardiography to monitor cardiac function post-intervention.
- Assessed changes in ejection fraction, end-diastolic volume, and end-systolic volume over a six-month follow-up period.
Main Results:
- The patient exhibited significant improvements in cardiac function, with ejection fraction increasing from 28% to 35% (scintigraphy) and 43% (echocardiography) at six months.
- Observed reductions in end-diastolic and end-systolic volumes, indicating improved ventricular remodeling.
- These functional benefits were sustained despite the subsequent blockage of the surgically placed bypass graft.
Conclusions:
- Extracellular vesicle-enhanced stem cell therapy holds promise as a regenerative strategy for severe myocardial damage post-MI.
- Direct myocardial delivery of MSCs and EVs during surgical revascularization may restore cardiac function effectively.
- This approach offers a potential therapeutic avenue for patients with ischemic heart disease refractory to conventional treatments.
Abstract:
Myocardial infarction is still a significant cause of morbidity and mortality. Coronary artery obstruction reduces blood flow and oxygen supply to the heart muscle, resulting in ischemia and necrosis. Due to the heart's limited healing mechanisms, regenerative therapies to restore cardiac function are being investigated. This case report, describes the utilization of mesenchymal stem cells and extracellular vesicles derived from these cells during coronary artery bypass grafting surgery for the patient who had a recent acute myocardial infarction. A direct injection into the myocardium was performed during surgery after a failed percutaneous coronary intervention. During the follow-up, the patient demonstrated improvements in cardiac function, with the ejection fraction increasing from 28 to 35% as measured by myocardial perfusion scintigraphy, and up to 43% on echocardiographic assessment at six months post-operation, as well as decreases in end-diastolic and end-systolic volumes. Significantly, these advantages remained despite the blockage of the bypass graft. The present case shows that extracellular vesicle-enhanced stem cell treatment may be used in surgical revascularization to restore myocardium in severe ischemic damage.
