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A Systematic Review and Meta-analysis

Ahmed Abdel-Latif, MD; Roberto Bolli, MD; Imad M. Tleyjeh, MD, MSc; Victor M. Montori, MD, MSc; Emerson C. Perin, MD; Carlton A. Hornung, PhD, MPH; Ewa K. Zuba-Surma, PhD; Mouaz Al-Mallah, MD; Buddhadeb Dawn, MD

Arch Intern Med. 2007;167(10):989-997.

Background  The results from small clinical studies suggest that therapy with adult bone marrow (BM)–derived cells (BMCs) reduces infarct size and improves left ventricular function and perfusion. However, the effects of BMC transplantation in patients with ischemic heart disease remains unclear.

Methods  We searched MEDLINE, EMBASE, Science Citation Index, CINAHL (Cumulative Index to Nursing and Allied Health), and the Cochrane Central Register of Controlled Trials (CENTRAL) (through July 2006) for randomized controlled trials and cohort studies of BMC transplantation to treat ischemic heart disease. We conducted a random-effects meta-analysis across eligible studies measuring the same outcomes.

Results  Eighteen studies (N = 999 patients) were eligible. The adult BMCs included BM mononuclear cells, BM mesenchymal stem cells, and BM-derived circulating progenitor cells. Compared with controls, BMC transplantation improved left ventricular ejection fraction (pooled difference, 3.66%; 95% confidence interval [CI], 1.93% to 5.40%; P<.001); reduced infarct scar size (–5.49%; 95% CI, –9.10% to –1.88%; P = .003); and reduced left ventricular end-systolic volume (–4.80 mL; 95% CI, –8.20 to –1.41 mL; P = .006).

Conclusions  The available evidence suggests that BMC transplantation is associated with modest improvements in physiologic and anatomic parameters in patients with both acute myocardial infarction and chronic ischemic heart disease, above and beyond conventional therapy. Therapy with BMCs seems safe. These results support conducting large randomized trials to evaluate the impact of BMC therapy vs the standard of care on patient-important outcomes.

Author Affiliations: Division of Cardiology and the Institute of Molecular Cardiology (Drs Abdel-Latif, Bolli, Zuba-Surma, and Dawn) and Department of Epidemiology and Population Health, School of Public Health and Information Sciences (Dr Hornung), University of Louisville, Louisville, Ky; Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minn (Drs Tleyjeh and Montori); King Fahd Medical City, Riyadh, Saudi Arabia (Dr Tleyjeh); Department of Cardiology, University of Texas, Houston (Dr Perin); and Division of Cardiovascular Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Dr Al-Mallah).

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