Biomedical Engineering Reference
In-Depth Information
Fig. 15.4
Bone marrow aspiration and fi ltering of bone marrow after intervention on patient's
bedside
Potential risks of mobilization
: In dogs, Vulliet et al., have found that injection of
BM derived mesenchymal stromal cells caused acute and subacute myocardial
microinfarction by occluding coronary circulation [
99
]. They showed that the size
of mesenchymal stromal cells was twofold larger then freshly prepared monoucle-
ated cells. In MAGIC study G-CSF alone did not have any effect on cardiac
function.
A mild increase in cardiac enzymes was found after cell infusion by Kang et al.
in the same study [
21
]. The results of Fig.
15.4
published in these two papers sug-
gest that more investigation of potential complications should be done before mes-
enchymal stromal cells or G-CSF-mobilized cells are routinely injected into the
arterial circulation of the patients. In humans, there is the lack of regeneration of
myocardium by autologous BM mononuclear cell (MNC) with large anterior myo-
cardial infarctions [
82
]. Infarct size is a major determinant of morbidity and mortal-
ity, as massive infarcts affecting 40% or more of the left ventricle in patients are
associated with intractable cardiogenic shock or the rapid development of conges-
tive heart failure. Lack of regeneration due to insufficient number of stem cells gave
only 4 × 10
7
MNCs while in TOPCARE-AMI study (2002) performed by the same
author, fourfold higher amount of MNCs with a presumably higher amount of cells
with stem cell characteristics was given [
77
] .
