Journal of Cardiology & Current Research Autologous Concentrate Bone Marrow Cell Therapy for Ischemic Cardiomyopathy Unsuitable for Revascularization: Feasibility Study Submit Manuscript | http://medcraveonline.com Abbreviations: BMSCs: Bone Marrow Stem Cells; CSCs: Cardiac Stem Cells; VEGF: Vascular Endothelial Growth Factor; BMAC: Bone Marrow Aspirate Concentrate; PBS: Phosphate- Buffered Saline; BMA: Bone Marrow Aspirate; EDD: End Diastolic Diameter; EDV 2C: End Diastolic Volume 2 Chamber; EDV 4C: End Diastolic Volume 4 Chamber; ESD: End Systolic Diameter; ESV 2C: End Systolic Volume 2 Chamber; ESV 4C: End Systolic Volume 4 Chamber Introduction The incidence of refractory angina and ischemic cardiomyopathy is increasing and novel therapeutic options are necessary [1]. Implantation of bone marrow stem cells (BMSCs) in the myocardium is feasible and safe [2,3]. However, is still unclear which is the best therapeutic strategy. Isolated BMSCs, mainly CD34+ CD133+, have been used in almost all published studies. Recent scientific evidence suggest the importance of cooperation between different type of cells, CD133+, CD34+, c-kit, cardiac stem cells (CSCs), platelets and cytokines, to repair the ischemic myocardium [4-9]. The process to repair the ischemic myocardium is complex and involves CSCs, BMSCs, cytokines, and platelets [10]. For example, hibernated myocardium is characterized by an increased expression of cytokines, such as vascular endothelial growth factor (VEGF), that appear to be important for both protection and functional recovery [11,12]. Autologous bone marrow aspirate concentrate (BMAC) obtained by using a point of care device, consists of a heterogeneous cell population including hematopoietic and mesenchymal stem/ progenitor cells as well as granulocytes and platelets. BMAC has the full complement of the nucleated cellular niche suspended in its natural plasma environment. Platelets and cytokines (e.g., VEGF, stromal derived factor-1α, transforming growth factor-β1, platelets derived growth factor) are present [13]. Stem cells are not manipulated. Their homing properties are not impaired as when obtained with culture and density gradient methods [14-17]. BMAC has been infused intracoronary in patients with positive results [18]. To assess the feasibility, safety and efficacy of BMAC implantation, we treated five patients with ischemic congestive heart failure (4 pts.) and Canadian class III angina (1 pt.) with BMAC implantation directly into the myocardium via a left anterior thoracotomy. Volume 5 Issue 3 - 2016 1 Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Italy 2 Ospedale San Raffaele, Italy 3 Laboratory of Molecular and Nutritional Epidemiology, Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Italy 4 Department of Cardiac Surgery, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Italy 5 Harrell BioScience Consulting, USA *Corresponding author: Eugenio Caradonna, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100 Campobasso, Italy, Tel: 390874312320; Email: Received: February 20, 2016 | Published: February 29, 2016 Research Article J Cardiol Curr Res 2016, 5(3): 00163 Abstract Stem Cells, platelets, and cytokines cooperate to repair ischemic myocardium. Autologous bone marrow aspirate concentrate (BMAC), obtained using a point of care device, has all the component in their natural plasma environment. Objectives: To assess the feasibility and safety to harvest and implant BMAC, in the same session, into myocardium via left anterior thoracotomy, in patients with untreatable ischemic cardiomyopathy. Methods: presence of viable myocardium was assessed with dobutamine echocardiography. Segments ischemic/hibernated were: apical anterior, medial anterior, apical lateral, medial, basal lateral. Bone marrow harvested from iliac crest and centrifuged with a point of care device, was implanted through left anterior thoracotomy into hibernated myocardium (20 injections, 1 ml each). Segments treated were: medial anterior (10 ml), medial and basal lateral (10 ml). Results: five patients with untreatable coronary artery disease (CAD) underwent BMAC implantation; four patients had ischemic congestive heart failure, one had Canadian class III angina. All patients completed one-year follow-up; three patients had history of AMI, 2 had coronary revascularization; 5 patients were in New York Heart Association functional class III/IV; all pts had a mean of 3 hospital admission; at follow-up they were in class I/II. EF% improved by 14%, 19% and 30% at 3, 6, 12 months follow-up (p = 0.008). Variation of cardiac echocardiographic parameters, demonstrate similar improvement. Conclusion: In 5 patients with ischemic cardiomyopathy treated with BMAC, EF, NYHA class and quality of life are improved. Further studies are necessary to confirm these results. Keywords: Stem cells; Bone marrow; Ischemic cardiomyopathy; Angina