Mesenchymal Stem Cells May Reduce Complications in Heart Failure Patients with LVAD

MedicalResearch.com Interview with:

Annetine C. Gelijns, PhDChair, Department of Population Health Science & PolicyEdmond A. Guggenheim Professor of Health PolicyCo-Director, InCHOIR

Dr. Gelijns

Annetine C. Gelijns, PhD
Professor and System Chair
Population Health Science and Policy
Icahn School of Medicine at Mount Sinai

Alan J Moskowitz, MDProfessor, Population Health Science and PolicyDepartment of Population Health Science & PolicyIcahn School of Medicine at Mount SinaiNew York, NY 10029-6574

Dr. Moskowitz


Alan J Moskowitz, MD

Professor of Population Health Science and Policy
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? Where do these mesenchymal cells come from? 

Response: Implantable LVADs significantly improve the survival and quality of life of advanced heart failure patients. However, these devices are associated with substantial adverse events, including infection and thromboembolic events. Moreover, whereas these devices improve myocardial function, few patients recover sufficient function to be explanted from their LVAD. These observations have focused attention on stem cells as a possible adjunctive therapy to further augment cardiac recovery.

Mesenchymal precursor cells (MPCs), which are obtained from healthy donors and culture-expanded, have been shown in animal and early human studies to improve cardiac function. Using temporary weaning as a signal of cardiac recovery, we conducted an exploratory trial in the Cardiothoracic Surgical Trials Network (CTSN), which found that MPCs increased the probability of temporary weaning from full LVAD support compared to sham-control patients. Therefore, this signal of efficacy led the CTSN to design our current follow-up trial evaluating the efficacy and safety of a higher dose of MPCs in LVAD patients.

MedicalResearch.com: What are the main findings? 

Response: Although, in the overall trial population, the mean proportion of successful temporary weans from LVAD support was not significantly different between MPC and control patients, there was a signal of efficacy in a post-hoc sub-group analysis of patients whose heart failure was due to coronary ischemia. Moreover, interestingly MPCs significantly reduced the frequency of.GI bleeding, a common and potentially fatal complication (occurring in 30 to 70% in LVAD patients depending on risk factors). 

MedicalResearch.com: What should readers take away from your report?

Response: Mesenchymal precursor cells therapy is a potential therapeutic approach for reducing GI bleeding in LVAD patients, and for improving myocardial function in ischemic patients.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to conduct a confirmatory trial that determines, with precision, the efficacy of Mesenchymal precursor cells therapy in reducing GI bleeding in LVAD patients, as well as mechanistic studies to identify the biological mechanisms associated with this effect. In addition, we need to explore whether intramyocardial MPC injections improve cardiac functional status in the high proportion of patients with ischemic cardiomyopathy. 

No disclosures

Citation:

Yau TM, Pagani FD, Mancini DM, et al. Intramyocardial Injection of Mesenchymal Precursor Cells and Successful Temporary Weaning From Left Ventricular Assist Device Support in Patients With Advanced Heart FailureA Randomized Clinical TrialJAMA. 2019;321(12):1176–1186. doi:10.1001/jama.2019.2341

Mar 26, 2019 @ 3:42 pm 

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