AutoLogous Human CArdiac-Derived Stem Cell to Treat Ischemic cArdiomyopathy (ALCADIA)

Hybrid Biotherapy Involving Autologous Human Cardiac Stem Cell Transplantation Combined With the Controlled Release of bFGF Using a Gelatin Hydrogel Sheet to Treat Severe Refractory Heart Failure With Chronic Ischemic Cardiomyopathy

The aim of this study is to evaluate the safety and efficacy on the transplantation of autologous human cardiac-derived stem cells (hCSCs) with the controlled release of basic fibroblast growth factor (bFGF) to severe refractory heart failure patients with chronic ischemic cardiomyopathy concordance with reduced left ventricular dysfunction (15%≦LVEF≦35%).

Autologous human stem or progenitor cells of different lineage have been subjected to clinical trials in the past to treat patients with ischemic cardiomyopathy. Although human stem or progenitor cells transplantation had functional benefits in the recovery in experimental myocardial infarction, the major barrier limiting its clinical application is the death of the most of the transplanted cells and poor cardiac differentiation in the host environment. Using the identical technique as clonally cell isolation from experimental animals, we generated human cardiac-derived stem cell (hCSC) enriched Es-marker genes with mesenchymal features. hCSCs included in cell populations accelerating proliferation in the presence of basic fibroblast growth factor (bFGF) on plastic plates are generated from human heart tissues through endomyocardial biopsy. Giving a patient their own hCSCs is an investigational procedure that has been approved by the committee of the Ministry of Health, Labour, and Welfare of Japan for this study. hCSCs have excellent potential to proliferate and regenerate to cardiomyocyte compared with other cells, e.g. myoblasts, bone marrow mononuclear cells and bone marrow stem cells, already evaluated in preliminary experiments on the repair of injured heart muscle. bFGF possesses properties to promote stem cell proliferation, and formation of sufficient microvascular network created by bFGF is critical for long-term survival of transplanted donor cells. This will be the first trial on the use of autologous hCSCs for the treatment of refractory heart failure with chronic ischemic cardiomyopathy. This trial is translational pilot study for looking into the safety and efficacy on the use of autologous hCSCs with the controlled release of bFGF using a gelatin hydrogel sheet.

Inclusion Criteria:

1. Clinical diagnosis of ischemic cardiomyopathy

   • Ischemic cardiomyopathy with old myocardial infarction due to coronary artery atherosclerotic disease.

2. Age: 20 to 80 years old

3. left ventricle (LV) dysfunction : An ejection fraction (EF)≧15%, and ≦35% assessed by echocardiography

4. Refractory heart failure: American Heart Association (AHA)/American College of Cardiology (ACC)heart failure Stage D

5. Heart failure symptom: New York Heart Association (NYHA) Class III or IV

6. An indication for CABG:A myocardial ischemia according to major coronary artery stenosis (>75%)

7. Viability in the infarct area as measured by cardiac delayed hyperenhancement magnetic resonance imaging (MRI)

   • Infarct area affecting >2 contiguous LV segments in a 18-segment model

   • The number of segments which transmural extent of hyperenhancement more than 51% is less than one.

     • Ex1. infarct area with or without bypass graft.
     • Ex2. no correlation with graft number.
     • Ex3. in case of multiple myocardial infarction, an indication for larger in infarct volume.

8. written informed consent

Exclusion Criteria:

1. New onset of myocardial infarction or unstable angina within 28 days prior to study entry

2. Indication for surgical ventricular reconstruction or mitral valve repair *1

3. Contraindication for endomyocardial biopsy *2

4. Evidence for malignant disease within 3 years prior to study entry

5. Chronic hemodialysis

6. Liver Cirrhosis (ICGR 15 >30%)

7. Uncontrollable diabetes mellitus (HbA1c>8.0)

8. Maximum diameter of Aortic aneurysm more than 5.5 cm.(including dissecting aneurysm)

9. Cardiogenic shock

10. Active infection (including cytomegalovirus infection)

11. Drug or alcoholic dependency

12. Positive for HIV antigen

13. Active bleeding state (gastric ulcer, cerebral bleeding, etc.)

14. Gelatin allergy *3

15. Chromosomal abnormality

    • 1 an indication for LV aneurysmectomy; patients with over 2 segments of dyskinesis area

    • 2 contra-indication for endomyocardial biopsy

      • cardiogenic shock
      • end-stage or uncontrollable congestive heart failure without continues infusion of catecholamine
      • complete or mobitz type atria-ventricular block

    • 3 The screening of gelatin allergy is necessary for all patients by gelatin patch test and gelatin-immunoglobulin E.