EFTA01929004.pdf

CLINICAL COMMUNICATION TO THE EDITOR THE AMERICAN JOURNAL of MFDICINF First in Man: Adipose-derived Stromal Vascular composition. This uncultured population taken from lip. Fraction Cells May Promote Restorative Cardiac °aspirate, which had an approximately 86% viability, con- Function sisted of CD34' cells. Within 7 days of the procedure, transesophageal echo- the Mawr: cardiography was performed to evaluate recovery of the patient's left ventricular function. His ejection fraction Despite advances in clinical intervention, heart disease improved to 35% with recovery in the contractility of the remains a causation of mortality in the world. Research previously akinetic inferolateral segment. This confirmed demonstrates that the adipose-derived stromal vascular the effectiveness of cell delivery in improving regional and fraction of cells contains multi-potent cells that exhibit global left ventricular systolic function. mesodermal and ectodermal capacity and contain CD44', CD90*, CD73*, CD105*. CD34*, and CD31* cells, which DISCUSSION act in tissue regeneration and vascular stabilization.' We Spontaneous recovery of the damaged myocardium discuss a patient who underwent such cell administration as occurred. The effective delivery of the stromal vascular rescue therapy for failing cardiac function, despite conven- fraction cell population. which contained stem cells, may tional interventions. have improved regional and global left ventricular systolic function, aiding recovery. Adipose-derived stromal CASE SUMMARY vascular fraction cells may have cardiomyogenic potential. The patient is a 73-year-old white man with a history of Cellular composition of cells administered included endo- hyperlipidemia who presented with recurrent angina pecto- thelial progenitor cells, vascular smooth muscle cells. ris, for which he had undergone multiple angioplasties and 9 mesenchymal stem cells. fibroblasts, growth factors, and coronary stents (right posterior descending and distal right pericytes. This complex population has shown efficacy in coronary beyond a saphenous vein graft to right coronary repairing damaged tissue to partial restoration of functional artery). He had further percutaneous coronary intervention normalcy. to the distal right coronary artery and proximal posterior Angiogenesis may contribute to restoration of cardiac descending branch. His prior coronary bypass artery graft of function through preservation of remaining viable and hi- 3 vessels had been redone. Robotic-assisted transmyocardial bernating cardiomyocytes. This salvaging effect might be revascularization for angina was performed in the patient maintenance of border zone cells through stem cell—mediated 2 months before cell delivery. He had significant left ven- anti-apoptotic and neoangiogenic effects, which are causative tricular systolic dysfunction (ejection fraction, 20%) with a of stem cell—produced paracrine factors.' This cell popula- thinned. akinetic inferolateral segment. To evaluate left tion has a high expression in DKK-I and R3 proteins, which ventricular function, transesophageal echocardiography was are associated with regulation of stem cell proliferation and performed in the patient. differentiation; As a last resort intervention for the patient's dysfunc- tional heart. 100 million adipose-derived stromal vascular CONCLUSIONS fraction cells were delivered via localized intramyocardial We postulate that the intramyocardial administration of injection (left apex). and 200 million adipose-derived stro- multi-potent adipose-derived stromal vascular fraction cells mal vascular fraction cells were delivered systemically via and their diverse composition guided engraftment in the intravenous injection. The intracoronary delivery of freshly damaged area, facilitated the cardiomyocyte regenerative isolated autologous cells consisted of a complex cell properties, and helped improve cardiac function. Because subcutaneous adipose tissue is readily available in most Funding: Provided by the University of Arizona Colkge of Medicine. patients, adipose-derived stromal vascular fraction cells Department of Surgery. Division of Cardiothoracie Surgery. present a feasible clinical intervention for cardiac dysfunc- Conflict of Interest: None. tion. The population complexity, which includes stromal Authorship: All authors had access to the data and played a role in vascular fraction and growth factors, likely promotes repair writing this manuscript. Requests for reprints should he addressed to Courtney Hemphill. BS. by recruiting cardiomyocytes. The autologous nature and 1656 East Mabel St.. Tucson. AZ 85724. multi-potency of these cells may contribute to them being E-mail address: C.ibri,e,O'surg,.ry aritona cdu ideal for cardiac function restoration. 00B2-9343/$ -see front matter O 2014 Elsevier Inc. All rights reserved. EFTA_R1_00377783 EFTA01929004 e12 The American Journal of Medicine, Vol 127, No 5, May 2014 Thin Khalpcy. MD, PhD'h" ACKNOWLEDGMENTS Rajesh Janardhanan, MDa-d The authors thank Or Steven Victor and Stephanie John Konhilas, PhDI' Squicciarini of IntelliCell Biosciences Inc (New York, Courtney Hemphill. BS' NY) for supplying stromal vascular fraction, Dr Craig 'Division of Cardiothoracic Surgery Hurst for providing lipoaspirate, and the patient and Department of Surgery family. University of Arizona College of Medicine Tucson frDepartment of Physiology References University of Arizona College of Medicine I. Alt IL Pinkemell K. Scharalau NI, et al. Effect of freshly isolated Tucson autologous ticsue resident stromal cells on cardiac function and 'Deportment ofBiomedical Engineering perfusion following acute myocardial infarction. tnt J Cardin?. 2009;141:26.35. University of Arizona College of Medicine 2. Lin K. Matsuhara, Masuda Y. et al. Ouractcrization of adipose tissue- Tucson derived cells isolated with Celotionm system. Cytotherapy. 2008:10: 'Department of Medicine and Medical Imaging 4l7.426. University of Arizona College of Medicine Tucson lutp://dx.doi.org./10.1016/j.amjined.2013.12.024 EFTA R1_00377784 EFTA01929005