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The effect of intracoronary reinfusion of bone marrow-derived mononuclear cells (BM-MNC) on all-cause mortality in acute myocardial infarction

Obiettivo

Although the long term prognosis of patients suffering acute myocardial infarction (AMI) has improved since the introduction of reperfusion therapies and primary angioplasty, the 1 year mortality of patients with AMI and resultant left ventricular systolic dysfunction (LVSD) is still as high as 13%. A major reason for the high morbidity and mortality is that the heart has an inadequate regenerative response to the myocardial necrosis sustained following AMI; cell death from the ischaemic damage can lead to progressive ventricular dilation and dysfunction through the processes of vascular remodelling. Despite the use of full conventional treatment, including ACE inhibitors, beta-blockers, aldosterone inhibitors and diuretics, yearly mortality rates of patients with post-infarction heart failure are still in the range of 13 % and rehospitalisation for worsening of heart failure occurs at a yearly rate of 6–8%.

Clinical data now exists supporting the concept that autologous bone marrow derived cells can restore cardiac function following AMI. We plan to advance this research in the BAMI project and will:
• Develop a standardised method of bone marrow cell collection
• Develop a standardised method of optimising reparative potential of bone marrow derived cells
• Standardise bone marrow preparation procedure so that it can be universally applied
• Standardise method of bone marrow cell delivery post AMI
• Conduct the first large scale all-cause mortality clinical trial to test if the product and delivery method mentioned above can lead to a 25% reduction in mortality end-point at 2 years

Our project will establish the therapeutic value of this approach to stem cell therapy. Success will demonstrate that transcoronary infusion of bone marrow-derived progenitor cells is safe and will reduce the mortality rate by 25% and reduce the rehospitalisation rate by 15%.

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