Dusseldorfer Autologous Bone Marrow Cells In Dilated Cardiomyopathy Trial (Dusseldorfer Abcd Study)

Introduction: Heart failure is a dangerous disease with an increasing frequency. Heart failure impairs the quality of life and increases expenses to a great extent. Although conventional drug therapy may delay remodeling, there is no basic therapeutic regime available for preventing or even reversing this process. Several preclinical as well as clinical trials have shown that transplantation of autologous bone marrow cells or precursor cells improves cardiac function after myocardial infarction and chronic heart disease. Due to the fact that transplantation of mononuclear cells is an approved and safe method, we investigated the effects of intracoronary autologous stem cell transplantation in patients with non-ischemic dilated cardiomyopathy.Methods: A total of 10 patients with dilated cardiomyopathy were included in this study (group I). The control group consisted of 10 age-and sexmatched patients with comparable ejection fraction (group II). Coronary artery disease and myocarditis were excluded in both groups by coronary angiography and endomyocardial biopsy. All patients of group I underwent intracoronary autologous stem cell transplantation with mononuclear cells. All cells were infused directly into the dominant coronary vessel via an angioblasty balloon catheter, which was inflated at a low pressure. To achieve a maximal ischemic stimulus all patients received dobutamine intravenously and dipipyridamol by intracoronary application. To ensure a prolonged contact time for cellular adhesion of the mononuclear cells we additionally applicated "macroalbumin aggregates" intracoronary. All 20 patients were re-investigated after 3 months.Results: Three months after intracoronary cell therapy, the global left ventricular ejection fraction increased in patients from 17 +/- 1 up to 26 +/- 3 %. In parallel, the physical ability (functional capacity) rose from 25 watt to 75 watt. In addition, we found an improvement of maximum oxygen uptake under stress from 1236 +/- 217 ml/min to 1473 +/- 198 ml/min. Furthermore, we documented a reduction of arrythmia. An unchanged or even impaired left ventricular function was not observed in any patient of group I. In the control group (group II), no significant changes were documented. No side effects of intracoronary autologous stem cell therapy were found, particularly no arrythmias, no heart insufficiency, no dyspnoea and no palpitations.Conclusion: These results show that transplantation of autologous bone marrow cells, as well as the intracoronary approach, represent a novel and effective therapeutic procedure for the therapy of dilated cardiomyopathy. The obtained therapeutic success encourages further research into this therapeutic concept and suggests its validation by studies with high case numbers. For this method of therapy, no ethical problems exist, and no side effects were observed. The therapeutic benefit for the patient's heart seems to prevail.