Stammzelltherapie bei kardiovaskulären Erkrankungen

Zusammenfassung

Die selektive intrakoronare Transplantation von autologen mononukleären Knochenmarkzellen (chronischer Infarkt: 10⁹ Millionen Zellen) stellt ein neuartiges und effektives Therapieverfahren dar. Zusätzlich zur Koronarintervention (PTCA + Stent), die zur Gefäßrestitution führt, zielt die Zelltherapie darauf ab, geschädigtes Myokard im Sinne einer Kausaltherapie wiederherzustellen.

Bei chronischer koronarer Herzkrankheit (im Mittel 108 Monate nach Infarkt) kommt es zur signifikanten Verbesserung der Pumpfunktion und Kontraktilität sowie parallel zur Infarktgrößenabnahme, zur Zunahme der myokardialen Glukoseaufnahme und der Belastungstoleranz und des subjektiven Wohlbefindens.

Die Effektivität der Knochenmarkzelltransplantation beruht nach dem derzeitigen Kenntnisstand auf vier unterschiedlichen Mechanismen: Zell-Transdifferenzierung, Zellfusion, zytokinvermittelte Myozyten-Vermehrung und Mobilisierung intrinsischer kardialer Stammzellen.

Die kombinierte intraarterielle und intramuskuläre Transplantation von autologen, adulten Knochenmarkstammzellen könnte eine klinisch einfache und sichere Therapieoption für Patienten mit schwerer pAVK darstellen. Sie bewirkt eine signifikante Steigerung der Perfusionsindizes. Bisher sind keine Komplikationen/Nebenwirkungen bekannt. Bezüglich der Transplantation autologer Knochenmarkzellen bestehen keine ethischen Bedenken.

Abstract

The selective transplantation of autologous bone marrow cells (chronic infarction 10⁹ million cells) as well as the intracoronary approach, represents a novel and effective therapeutic procedure.

The improvement of autologous stern cell therapy is achieved in addition to the catheterinterventional procedures and is a procedure for regeneration of destroyed heart muscle in the early phase after myocardial infarction. In patients with chronic coronary artery disease (mean 108 months after myocardial infarction) intracoronary stern cell therapy leads to significant increase of left ventricular pumpfunction and contractility, reduction of infarct size, increase of myocardial glucose storage and an increase of physical ability (functional capacity) and feeling of well-being. Autologous stern cell therapy in patients with dilated cardiomyopathe seems to be a new option for myocardial restitution. A significant improvement of the subjective aas well as the objective functional capacity was documented. Also a significant reduction of ventricular arrhythmias was revealed in patients with chronic coronary artery disease and non-ischemic cardiomyopathy.

Stern cells have the important properties of self-regeneration and organ plasticity. Therefore they are ideal candidates for regeneration of myocardial tissue. The regenerative potential of bone-marrow-derived stern cells may be explained by four mechanisms: 1) direct cell differentiation from monoclear cells to cardiac myocytes, 2) cytokine-induced growing and increase of residual viable myocytes, especially within the border zone of the infracted area, 3) stimulation of resident cardiac stern cells (endogenous stern cells), and 4) induction of cell fusion between transplanted bone marrow cells and resident myocytes.

For this method of therapy, no ethical problems exist, and no side effects were observed. The therapeutic benefit for the patient’s heart seems to prevail.

Peripheral arterial occlusion disease

The combined intraarterial and intramuscular transplantation of autologous, mononuclear bone marrow stern cells is a clinical feasible and safe therapeutical option for patients with severe chronic limb ischemia. It leads to a significant increase of the perfusion indices and of the quality of life. Further studies are required to prove the benefit of these new therapeutic approach.

Schlüsselwörter

Herzschwäche - Stammzelltherapie - dilatative Kardiomyopathie - koronare Herzerkrankung - periphere Verschlusskrankheit

Keywords

heart failure - autologous stem cell therapy - dilated cardiomyopathe - coronary artery disease - peripherial artery disease

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