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(Circulation. 2007;115:3165-3172.)
© 2007 American Heart Association, Inc.

Coronary Heart Disease

Intramyocardial Transplantation of Autologous CD34⁺ Stem Cells for Intractable Angina

A Phase I/IIa Double-Blind, Randomized Controlled Trial

Douglas W. Losordo, MD; Richard A. Schatz, MD; Christopher J. White, MD; James E. Udelson, MD; Vimal Veereshwarayya, PhD; Michelle Durgin, MHA; Kian Keong Poh, MD; Robert Weinstein, MD; Marianne Kearney, BS; Muqtada Chaudhry, MD; Aaron Burg, BS; Liz Eaton, BS; Lindsay Heyd, BS; Tina Thorne, BS; Leon Shturman, MD; Peter Hoffmeister, MD; Ken Story, PhD; Victor Zak, PhD; Douglas Dowling, BS; Jay H. Traverse, MD; Rachel E. Olson, MS; Janice Flanagan, RN; Donata Sodano, RN; Toshinori Murayama, MD; Atsuhiko Kawamoto, MD; Kengo Fukushima Kusano, MD; Jill Wollins, MD; Frederick Welt, MD; Pinak Shah, MD; Peter Soukas, MD; Takayuki Asahara, MD; Timothy D. Henry, MD

From Feinberg Cardiovascular Research Institute and Program in Cardiovascular Regenerative Medicine (D.W.L., V.V., M.D., T.T.), Division of Cardiovascular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Ill; Division of Cardiovascular Medicine (D.W.L., V.V., M.D., K.K., R.W., M.K., M.C., A.B., L.E., L.H., T.T., L.S., P.H., V.Z., J.F., D.S., T.M., A.K., K.F.K., J.W., F.W., P. Shah, P. Soukas, T.A.), Department of Medicine, Caritas St. Elizabeth’s Medical Center, Boston, Mass; Division of Cardiovascular Research (R.A.S.), Scripps Green Hospital, La Jolla, Calif; Department of Medicine (C.J.W.), Ochsner Clinic, New Orleans, La; Division of Cardiology (J.E.U.), Tufts-New England Medical Center, Boston, Mass; Baxter Healthcare (K.S.), Deerfield, Ill; Division of Cardiology (J.H.T., R.E.O., T.D.H.), Minneapolis Heart Institute, Minneapolis, Minn; and Cardiovascular Core Laboratories Inc (D.D.), Boston, Mass.

Correspondence to Douglas W. Losordo, MD, Feinberg Cardiovascular Research Institute and Northwestern Memorial Hospital, Tarry 12-703, 303 E Chicago Ave, Chicago, IL 60611. E-mail d-losordo{at}northwestern.edu

Received December 29, 2006; accepted April 11, 2007.

Background— A growing population of patients with coronary artery disease experiences angina that is not amenable to revascularization and is refractory to medical therapy. Preclinical studies have indicated that human CD34⁺ stem cells induce neovascularization in ischemic myocardium, which enhances perfusion and function.

Methods and Results— Twenty-four patients (19 men and 5 women aged 48 to 84 years) with Canadian Cardiovascular Society class 3 or 4 angina who were undergoing optimal medical treatment and who were not candidates for mechanical revascularization were enrolled in a double-blind, randomized (3:1), placebo-controlled dose-escalating study. Patients received granulocyte colony-stimulating factor 5 µg · kg^–1 · d^–1 for 5 days with leukapheresis on the fifth day. Selection of CD34⁺ cells was performed with a Food and Drug Administration–approved device. Electromechanical mapping was performed to identify ischemic but viable regions of myocardium for injection of cells (versus saline). The total dose of cells was distributed in 10 intramyocardial, transendocardial injections. Patients were required to have an implantable cardioverter-defibrillator or to temporarily wear a LifeVest wearable defibrillator. No incidence was observed of myocardial infarction induced by mobilization or intramyocardial injection. The intramyocardial injection of cells or saline did not result in cardiac enzyme elevation, perforation, or pericardial effusion. No incidence of ventricular tachycardia or ventricular fibrillation occurred during the administration of granulocyte colony-stimulating factor or intramyocardial injections. One patient with a history of sudden cardiac death/ventricular tachycardia/ventricular fibrillation had catheter-induced ventricular tachycardia during mapping that required cardioversion. Serious adverse events were evenly distributed. Efficacy parameters including angina frequency, nitroglycerine usage, exercise time, and Canadian Cardiovascular Society class showed trends that favored CD34⁺ cell–treated patients versus control subjects given placebo.

Conclusions— A randomized trial of intramyocardial injection of autologous CD34⁺ cells in patients with intractable angina was completed that provides evidence for feasibility, safety, and bioactivity. A larger phase IIb study is currently under way to further evaluate this therapy.

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