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Cell therapy provides a promising approach in the treatment of chronic ischaemic heart disease (IHD) and heart failure (HF) secondary to IHD. Preclinical and clinical studies have suggested that cell therapies may potentially reverse left ventricular dysfunction in chronic IHD and congestive heart failure (CHF). The cell therapy procedure involves stem or progenitor cells being collected from the recipient, either harvested from bone marrow (BM) or through mobilisation of BM cells into circulation by a growth factor stimulant, most commonly granulocyte colony-stimulating factor. In both procedures, the cells are infused directly into the recipient’s coronary arteries or heart. Delivery of cells to the coronary arteries is made via a special balloon catheter during angioplasty, whereas administration of cells into the heart muscle is made during an angioplasty-like procedure using electromechanical mapping and direct intramyocardial injection or during cardiac surgery (eg, coronary artery bypass grafting).
This treatment is currently only available in research settings, but if long-term effectiveness is confirmed, it may become available to some or all people with chronic heart disease since BM and peripheral blood harvest is a standard procedure used in BM transplantation. Clinical trials and systematic reviews of BM-derived cells administered to patients with IHD or CHF have yielded divergent results, and therefore the mechanism of action of such therapies remains unclear.
In this Cochrane Corner we report the main findings of our recent Cochrane systematic review of BM-derived cell therapy in patients with chronic IHD and CHF1 which incorporates evidence from a total of 38 eligible randomised controlled trials (RCTs).
Review methods followed the Cochrane Handbook for Systematic Reviews of Interventions.2 We searched CENTRAL in The Cochrane Library, MEDLINE, Embase, CINAHL and …
Contributors All authors contributed to the original Cochrane review and have approved this Cochrane Corner article.
Funding Supported by NHS Blood and Transplant, Research and Development, UK, the William Harvey Research Institute, UK, and the Oxford Biomedical Research Centre Programme.
Competing interests AM was the chief investigator of four included studies and is the lead investigator of the ongoing BAMI trial.
Provenance and peer review Commissioned; internally peer reviewed.