Stem Cell Injection to Treat Heart Damage During Open Heart Surgery

Background: \- Bone marrow stromal stem cells (also known as mesenchymal stem cells) have been isolated and are found to make large amounts of growth factors. Because they make growth factors, these cells can help re-grow tissue and encourage repair of damaged tissue. Tests on damaged heart muscle suggest that injecting these cells directly into damaged heart muscle can improve heart function. Researchers want to give stem cells to people who are having open heart surgery to see if they can help to repair heart muscle damage. Objectives: \- To test the safety and effectiveness of bone marrow stromal stem cell injections given during heart surgery to treat heart muscle damage. Eligibility: \- Individuals at least 18 years of age who are scheduled to have open heart surgery for heart artery or vein blockages. Design: * Participants will be screened with a physical exam and medical history. Blood and urine samples will also be collected. * Participants will have bone marrow taken from both hip bones about 3 weeks before the heart surgery. * During the surgery, the stromal stem cells collected from the bone marrow will be given into the damaged portion of the heart muscle. The rest of the heart surgery will be performed according to standard procedures. * After the surgery, participants will be monitored for complications from the stromal stem cells. * Participants will have heart function tests to see if the stromal stem cell treatments were effective....

Background: Many investigators now believe that bone marrow-derived stem cells or endothelial progenitor cells can be recruited to and incorporated into tissues undergoing neovascularization, including cardiac tissue. Stem cells which include hematopoietic stem cells (HSCs), endothelial progenitor cells (EPCs), mesenchymal stem cells / stromal stem cells (MSCs), myoblasts, and undifferentiated side population cells have been used as an alternative therapeutic strategy for ischemic cardiovascular diseases that cannot be treated by routine interventional approaches. In a porcine pre-clinical study we found that cells survived after intramyocardial injection and differentiated into vascular cells, smooth muscle or endothelial cells. Functional analysis of regional wall motion and ejection fraction demonstrated statistically significant improvement in function in cell treated animals after six weeks compared with baseline and sham controls. A variety of studies have been conducted in subjects with coronary artery disease using different cell types and routes of administration. This study will be the first of its kind to administer autologous BMSC via direct intramyocardial injection in a rigorous clinical trial in the U.S. Objectives: To evaluate the safety and feasibility of direct intra-myocardial injection of autologous bone marrow stromal cells (BMSCs) in adult subjects undergoing coronary artery bypass graft (CABG) or transmyocardial revascularization (TMR). A secondary objective is to assess whether direct intra-myocardial injection of autologous bone marrow stromal cells (BMSCs) improves the patient s cardiac function, quality of life, and reduces cardiac events compared with historical controls at three and six months after intervention. Eligibility: Adult subjects with three-vessel coronary artery disease who plan to undergo CABG or TMR at the NIH Heart Center at Suburban Hospital and are willing to participate, who have stable angina, LV EF less than or equal to 50%, and who have evidence of hypokinetic segments. Subjects will be excluded if they have had a recent myocardial infarction (MI), bleeding disorder, infection, HIV or who are unable to wait 3 weeks for surgery while cells are being expanded prior to injection. Design: Bone marrow aspiration will be performed on subjects who suffer from ischemic heart disease with depressed left ventricular function three weeks before their admission to have CABG or TMR in the NIH Clinical Center Outpatient Clinic. Data will be presented based on the subject s treatment regimen: Group 1 CABG+Cells (total of 10 evaluable subjects) Group 2 TMR + Cells (total of 10 evaluable subjects) The autologous MSCs will be isolated from the marrow aspirate, cultured and expanded in vitro for 3 passages (approximately 21 days (+/- 4 days)) in the Clinical Center Cell Processing Laboratory (CPS), located in the Department of Transfusion Medicine (DTM), Clinical Center, NIH. During the surgery at Suburban Hospital, the MSCs will be injected directly into the ischemic area after CABG or TMR. Patients will be assessed for functional improvements pre, 3, 6, 12 and 60 months after the surgery by transthoracic echocardiography and/or by MRI at pre, 3 and 6 months after surgery. Toxicity data will be reported from time of surgery to 6 months after surgery, unless later toxicities occur that are related to cell injection.