In the area of the "infarction zone" of the The High Blood Pressure Program Review heart, a very significant 31 percent increase in cardiac contractility was observed in the patients who had undergone bone marrow cell transplant, suggesting that the infused bone marrow stem cells had actually incorporated themselves into the infarcted heart muscle, and had successfully transformed themselves into functional cardiac myocytes. When compared to the control group patients, the patients who had undergone autologous intracardiac bone marrow cell transplantation also experienced significantly improved exercise tolerance and a decreased risk of death throughout the 5-year observation period within this study. Furthermore, these highly significant improvements in cardiac function continued to remain stable and durable throughout the 5-year period of post-transplant observation of these patients. As the "treatment group" patients were infused with their own bone marrow cells, there were no episodes of rejection, and no major complications were reported with this novel treatment. This small prospective pilot study strongly suggests that autotransplantation with stem cells contained in the bone marrow can significantly reduce the risk and extent of CHF following acute myocardial infarction. Not only does this therapy appear to be clinically effective, but it appears to be associated with a very low risk of complications, and it also side-steps the ongoing ethical debate that surrounds the use of more versatile, but more controversial, fetal stem cells. Based upon the rather remarkable findings of this small clinical study, much larger multi-institution, prospective, randomized, controlled studies of autologous intracardiac bone marrow cell transplantation, following acute myocardial infarction, need to be performed. Fortunately, several such studies are already underway in the United States and Europe. I look forward to the long-term results of such studies, as I believe that they may have the potential to radically transform the management of coronary artery disease and acute myocardial infarction, and offer the best and most practical hope of reducing both the incidence of CHF and the mortality rate associated with CHF.

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