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Updated: Jan 9, 2026
Intramyocardial Cell Delivery: Observations in Murine Hearts
Published on: January 24, 2014
Intracoronary infusion of autologous bone marrow mononuclear cells in patients with chronic total occlusions and left
Luis Carlos Maestre-Luque1,2,3, Rafael Gonzalez-Manzanares4,5,6,7, Francisco Hidalgo1,2,3,8
1Department of Cardiology, Reina Sofía University Hospital, Córdoba, Spain.
Insights
Bone marrow mononuclear cell (BMMC) infusion appears safe and feasible for improving left ventricular ejection fraction (LVEF) in patients with coronary artery disease. While not statistically significant, BMMC therapy showed a trend towards improved LVEF recovery.
Area of Science:
- Cardiology
- Regenerative Medicine
- Cell Therapy
Background:
- Controversy exists regarding the benefits of bone marrow mononuclear cells (BMMC) for left ventricular dysfunction (LVD) in coronary artery disease (CAD).
- Evaluating the safety, feasibility, and efficacy of intracoronary BMMC infusion is crucial for patients with chronic total coronary occlusions (CTO) and persistent LVD.
Purpose of the Study:
- To assess the safety and feasibility of intracoronary BMMC infusion in patients with CTO-PCI and persistent LVD.
- To evaluate the efficacy of BMMC therapy in improving left ventricular ejection fraction (LVEF) compared to conventional treatment.
Main Methods:
- A prospective, randomized, open-label, controlled study involving patients with CTO-PCI and LVEF < 45%.
- Patients were randomized 1:1 to receive intracoronary BMMC plus standard care or standard care alone (control).
- Primary endpoint: absolute change in LVEF by cardiac magnetic resonance imaging (CMR) at 6 months; secondary endpoints included functional capacity, mortality, and adverse events.
Main Results:
- Twenty-eight patients were included; 13 received BMMC and 15 were in the control group.
- No major procedural complications were observed during BMMC infusion; similar mortality and adverse cardiac event rates between groups.
- At 6 months, the BMMC group showed a greater absolute change in LVEF (2.5%) compared to the control group (0%), though this did not reach statistical significance (p=0.118).
Conclusions:
- Intracoronary BMMC infusion is safe and feasible in patients with prior CTO-PCI and persistent LVD.
- A numerical improvement in LVEF recovery was observed in the BMMC group, but it was not statistically significant.
- The study design provides a basis for future larger trials to definitively assess BMMC therapy's impact in CTO patients.
Background:
There is controversy about the benefits of bone marrow mononuclear cells (BMMC) to improve left ventricular dysfunction (LVD) in patients with coronary artery disease. We sought to evaluate the safety, feasibility and efficacy of the intracoronary infusion of BMMC to improve left ventricular ejection fraction (LVEF) in patients with chronic total coronary artery occlusions (CTO).
Methods:
Prospective, randomized, open-label and controlled study. Patients with a percutaneous revascularization of CTO (CTO-PCI) three months before and persistent LVD (LVEF < 45%) were included and randomized in a 1:1 ratio to receive intracoronary infusion of autologous BMMC plus conventional medical treatment or conventional treatment alone (control group). The primary efficacy endpoint was the absolute change in LVEF by cardiac magnetic resonance imaging (CMR) at 6-month follow-up. The functional capacity status by NYHA class, the overall mortality and the adverse cardiac events rate were also evaluated in the 24-month follow-up period.
Results:
Twenty-eight patients were included, 13 received intracoronary infusion of BMMC and 15 received standard care. No major procedural complications occurred during BMMC infusion, and the rates of overall mortality and adverse cardiac events in follow-up were similar. At 6-month follow-up, the absolute change in LVEF was greater in BMMC group, without reaching statistical significance [∆ LVEF 0% ( - 5 to 0) in the control group vs. 2.5% ( - 2.7 to 4) in the BMMC group, median between-groups difference 2.5% ( - 2 to 4.5), p = 0.118)]. The change in NYHA class did not differ between treatment arms at any stage of follow-up.
Conclusions:
The intracoronary infusion of BMMC in patients with previous CTO-PCI and persistent LVD seemed to be safe and feasible. There was a numerical but not statistically significant difference in terms of LVEF recovery favouring the BMMC group. The study offers a novel design for future larger trials to clarify the impact of BMMC therapy in patients with CTO. Trial registration The trial was registered in the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT number: 2013-000915-26).
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