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
