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Bone marrow mononuclear cell therapy for acute myocardial infarction: we know what we want, but we just don’t know how yet
  1. Kai C Wollert
  1. Correspondence to Professor Kai C Wollert, Hans Borst Centre for Heart and Stem Cell Research, Hannover Medical School, Hannover 30625, Germany; wollert.kai{at}mh-hannover.de

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Manic depression is searching my soul,I know what I want,but I just don’t know, honey,how to go about getting it.Jimi Hendrix

Infusion of autologous bone marrow mononuclear cells (BMMCs) into the infarct-related coronary artery has been shown in clinical trials to improve systolic function in patients with a large ST-segment elevation myocardial infarction (STEMI).1 Based on these results, it was hoped that BMMC infusions may represent a new strategy to protect this vulnerable patient population that continues to be at high risk of developing chronic heart failure.

Trial results have been rather heterogeneous, however, and the latest clinical trials—timing in myocardial infarction evaluation (TIME) and SWiss Multicenter Intracoronary Stem Cells Study in Acute Myocardial Infarction (SWISS-AMI)—did not confirm a significant impact of BMMCs on LVEF after STEMI.S1 S2 To make matters worse, a hotly debated meta-analysis by Francis and colleagues has cast doubt on the scientific integrity of the available trial evidence. This study examined reports (abstracts and final publications) of all available BMMC trials for discrepancies in design, methods or results and reported a positive correlation between the number of discrepancies and the magnitude of LVEF improvement.S3 Given these recent developments, it has been argued that the clinical validation process of BMMC therapy may approach a dead end,S4 and that physicians need to reconsider whether BMMC therapies should be pursued at all.S5 It seems, the field has fallen into a state of depression and it is uncertain whether it will ever recover. Contrast this with the stem cell mania at the turn of the century, when a report that bone marrow-derived stem cells can generate de novo myocardium,S6 a claim that has been refuted since,S7 S8 electrified cardiologists around the globe (including this editorialist) and stimulated the first …

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