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Autologous bone marrow-derived mononuclear stem cells for STEMI

Commented by the ESC WG on Cardiovascular Regenerative & Reparative Medicine

Comment: The first purely academic, phase III, multinational and randomized clinical trial to analyse the clinical effect of first generation autologous bone marrow-derived mononuclear stem cells in STEMI patients was presented last month during the ESC Congress and simultaneously published in the European Heart Journal. Very much anticipated, this trial was hampered by under recruitment (375 randomized patients out of 3000 planned originally). Therefore, no definitive conclusions can be drawn on the effect of those cells on all-cause mortality in STEMI but and safety has been established once again. Nevertheless, the trial demonstrated that autologous cell-based therapies can be administered in multiple sites across Europe in a harmonized way and with standardized manufacturing protocols. Furthermore, the very low contemporary mortality rates of STEMI at two years (3.5% and not 12% as designed) pointed out the difficulties of future clinical trials of cell-based (or other) therapies aimed at improving the prognosis of patients suffering from STEMI.


References of Commented Article: 1.- Mathur A, Fernández-Avilés F, Dimmeler S, et al. The consensus of the Task Force of the European Society of Cardiology concerning the clinical investigation of the use of autologous adult stem cells for the treatment of acute myocardial infarction and heart failure: update 2016. Eur Heart J 2017;38:2930–2935.
2.- Mathur A, Arnold R, Assmus B, et al. The effect of intracoronary infusion of bone marrow-derived mononuclear cells on all-cause mortality in acute myocardial infarction: rationale and design of the BAMI trial. Eur J Heart Fail 2017;19:1545–1550.
3.- Assmus B, Leistner DM, Schächinger V, et al. REPAIR-AMI Study Group. Long-term clinical outcome after intracoronary application of bone marrow-derived mononuclear cells for acute myocardial infarction: migratory capacity of administered cells determines event-free survival. Eur Heart J 2014;35:1275–1283.
4.- Schächinger V, Erbs S, Elsässer A, et al. REPAIR-AMI Investigators. Intracoronary bone marrow-derived progenitor cells in acute myocardial infarction. N Engl J Med 2006;355:1210–1221.
5.- Martin-Rendon E, Brunskill SJ, Hyde CJ, et al. Autologous bone marrow stem cells to treat acute myocardial infarction: a systematic review. Eur Heart J 2008;29:1807–1818.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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