Читать книгу The SAGE Encyclopedia of Stem Cell Research - Группа авторов - Страница 399

Adult bone marrow (BM) includes several cell types, including hematopoietic and non-hematopoietic SCs. Hematopoietic stem cells can generate red blood cells, lymphocytes, neutrophils, monocytes, and other mononuclear SCs. Together, hematopoietic SCs are called BM-mononuclear cells (BM-MNCs). A majority of BM-MNCs clinical trials use autologous transplantation; however, the FOCUS-CCTRN trial at the Texas Heart Institute demonstrated limitations of autologous treatments in patients with chronic diseases and elderly age.

To improve these limitations, other trials demonstrated that extracorporeal shock wave increases chemokines and other factors that improve BM-MNC retention among cardiomyocytes. Some studies suggest that when administered to patients, BM-MNCs fuse with recipient cardiomyocytes, or release biologically active factors that stimulate recipient cardiac SCs to proliferate. In contrast to other types of SCs, the 2004 C. E. Murry et al. clinical trial published in Nature demonstrated that BM-MNCs themselves do not transdifferentiate into functional cardiomyocytes.

Some BM-MNC trials indicate improvement in ischemic heart disease (IHD). The TIME and LateTIME trials at the Minneapolis Heart Institute found no significant improvement in global or regional LV function, or in wall motion changes of the post-AMI zone, at six months after autologous intracoronary BM-MNC treatment administered three to seven days post-AMI. However, other studies suggest that long-term follow-up and designation of new endpoints may reveal previously hidden benefits of BN-MNC treatment. The U.S.-collaborated REPAIR-AMI trial showed a sustained average improvement in LVEF of 8 percent at 5 years and a reduction of post-AMI size by 5.5 percent at four months, and retrospective analysis demonstrated that the optimal time of intracoronary treatment was five to seven days post-AMI.