Author : Hung-Fat Tse
Publisher : Open Dissertation Press
ISBN 13 : 9781374663770
Total Pages : pages
Book Rating : 4.6/5 (637 download)
Book Synopsis Bone Marrow Cell Transplantation for Therapeutic Angiogenesis in Ischemic Myocardium by : Hung-Fat Tse
Download or read book Bone Marrow Cell Transplantation for Therapeutic Angiogenesis in Ischemic Myocardium written by Hung-Fat Tse and published by Open Dissertation Press. This book was released on 2017-01-27 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation, "Bone Marrow Cell Transplantation for Therapeutic Angiogenesis in Ischemic Myocardium: From Bench to Bedside" by Hung-fat, Tse, 謝鴻發, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Abstract Abstract of thesis entitled Bone Marrow Cell Transplantation for Therapeutic Angiogenesis in Ischemic Myocardium- From Bench to Bedside Submitted by Hung-Fat TSE for the Degree of Doctor of Philosophy (Ph.D.) at The University of Hong Kong in May 2007 Abstract Coronary artery disease (CAD) remains the leading cause of morbidity and mortality in the Western world and in Asia, including Hong Kong and China. Despite the advances in medical and surgical therapies, up to 20%-37% of patients with severely CAD are either unsuitable or can only receive incomplete revascularization with conventional revascularization procedures. Recent experimental studies showed that bone marrow (BM) cells can be used to regenerate cardiomyocytes and to induce neovascularization in injured myocardium after myocardial infarction. Nevertheless, several major issues concerning autologous BM cell therapy remained to be addressed. This thesis comprises both experimental and clinical studies on the use of BM cells for therapeutic angiogenesis in chronic ischemic left ventricular (LV) myocardium. In a swine model, I demonstrated the acute safety and feasibility of catheter-based direct endomyocardial injection for delivering BM cells into the targeted sites within the LV. Furthermore, the functional role of BM mononuclear cells (MNC) versus BM endothelial progenitor cells (EPC) in enhancing therapeutic angiogenesis was studied in a porcine chronic ischemic myocardium model. It was found that catheter-based direct endomyocardial injection of BM-MNC was more effective than BM-EPC or saline in enhancing neovascularization and improving LV function in chronic ischemic myocardium. I performed the world's first human study on percutaneous direct endomyocardial injection of autologous BM-MNC in patients with "end-stage" CAD. The initial clinical results suggested that autologous transplantation of BM-MNCs enhanced myocardial perfusion and improved symptoms in these patients. Mid-term of follow-up of patients in this pilot study suggested that direct endomyocardial injection Abstract of autologous BM cells was not associated with any major adverse effects. Furthermore, the beneficial effect of direct endomyocardial injection was over and beyond those noted in those treated with percutaneous laser myocardial revascularization, suggesting a potential direct therapeutic effect of BM cells, rather than the effects resulting from myocardial channeling alone. Nevertheless, the possible potent placebo effect on symptoms observed in these pilot studies highlights the need for a randomized, placebo-controlled group to prove the clinical efficacy of cell based angiogenic therapy for treatment of severe CAD. In the first human randomized controlled study (PROTECT-CAD) including 28 patients enrolled from 2 centers, I studied the safety and clinical efficacy of electromechanical guided catheter-based direct endomyocardial delivery of BM cells into targeted ischemic myocardium. This randomized, placebo controlled trial showed beneficial effects of BM cell therapy over saline injection on symptoms and functional capacity in patients with chronic myocardial ischemia who failed conventional medical and revascularization procedures. In conclusion, the findings of this thesis provide important information
