Heart Beats- Fixing Hearts with Stem Cells

The most dangerous heart attack is known as a STEMI. It’s when the artery in the heart completely blocks blood flow. Every minute counts when it comes to surviving a STEMI. Now, a patient’s own stem cells could hold the key to recovery.
Branko Koscak is making healthier choices after suffering a massive heart attack. Working 18 hour days had finally caught up with him.
“Just running all day, pretty much day and night,” Branko told Ivanhoe.
Cardiologist Gary Schaer says the damage done by Branko’s nearly 100 percent blocked artery was life-threatening.
“Whole areas of the heart muscle had been severely injured by the heart attack,” Gary L. Schaer, MD, Director of Cardiology Research, Rush University Medical Center, told Ivanhoe.
Dr. Schaer is testing a new technique using a patient’s own stem cells.
“This is the most exciting area of medicine that I’ve been involved in, in my 30 years or so of practice,” Dr. Schaer explained.
A week after Branko’s heart attack, a catheter was placed into his previously blocked artery, and stem cells from his bone marrow were infused.
“It goes all the way through a catheter and comes out to a tip and it’s infused down to the artery, Dr. Schaer said. “It begins the repair process and perhaps could reverse some of the damage that’s already occurred.”
Preliminary evidence shows it takes somewhere between three to six months for maximum benefit.
Branko is taking it day by day.
“I consider myself fortunate that I got a wakeup call,” he said.
It was a call that has already changed his eating habits, his work life, and his heart for the better.
The phase two PreSERVE trial completed enrollment in December. If the trial demonstrates that cell therapy results in benefits compared to placebo, it will more than likely move on to a larger phase three trial.


REPORT:  MB # 3732

BACKGROUND: There are a variety of types of heart attacks, but the most serious kind is known as a STEMI. The acronym stands for ST-segment elevation myocardial infarction; ST-segment elevation refers to the pattern that would show up on a patient’s electrocardiogram. A STEMI occurs when a coronary artery is totally blocked. When a patient has a STEMI heart attack, it requires immediate action in the form of revascularization, which means unclogging the artery and getting the heart pumping normally. There are two ways of achieving revascularization; one is by using clot-busting drugs, and the other is with angioplasty. It’s estimated nearly 250,000 people have STEMI heart attacks a year. (Source: http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=d7afebbf-d04c-4345-a9cd-50e562e58e9b)
CAUSES: Like other kinds of heart attacks, STEMI heart attacks don’t have one singular cause, but rather a variety of involved factors. Some of them include:
* High blood pressure
* High cholesterol
* Genetic factors
* Unhealthy, sedentary lifestyle
* Age, especially those between age 40 and 55 (Source: www.mclaren.org/northernmichigan/STEMIHeartAttacksnm.aspx#contributing_factors)

NEW TECHNOLOGY: Doctors at Rush University Medical Center are now researching how stem cells can help the heart regain its strength. Using a small catheter, doctors inject bone marrow stem cells into the heart. It was believed only embryonic stem cells had the ability to turn into any cells, but adult bone marrow stem cells have shown the ability to do just that. The stem cells essentially strengthen the parts of the heart damaged by the heart attack. Results from the Phase 1 trial showed patients who received the stem cells had better heart function and fewer arrhythmias at six months than untreated patients. The Phase 2 trial recently completed enrollment and is underway. (Source: http://www.newswise.com/articles/study-shows-adult-stem-cells-repair-heart-attack-damage)

Deborah Song
Associate Director, Media Relations
Rush University Medical Center
(312) 942-0588

Gary L. Schaer, MD, Director of Cardiology Research, Rush University Medical Center, talks about new research that could help with the most dangerous type of heart attack.
What is the trial called?
Dr. Schaer: It’s called a Preserve Trial. 
And what is it for?
Dr. Schaer: It is for a STEMI. A STEMI is an ST-elevation myocardial infarction, so it is a large heart attack. 
Why is it considered the most dangerous type?  
Dr. Schaer: It is the most dangerous because it is caused by a totally blocked artery. So depending on how large the blocked artery is, there is a lot of heart muscle that’s in jeopardy for being damaged by the lack of blood flow.  Every single minute counts when you have a heart attack. The term we use is “time is muscle.” So, the quicker we can get that blocked artery open, the quicker we can establish blood flow to the heart muscle supplied by that artery, the more heart muscle we save from damage and death.
What happens when the heart muscle is damaged? How does that affect us?
Dr. Schaer: The more heart damage there is to the heart muscle, the weaker the heart muscle will be. And weak heart muscles, over time, can cause what is called congestive heart failure, which is very debilitating.  People are fatigued, they are short of breath, their survival rate is much less, so it is a bad condition that we would like to try to prevent if we possibly could.
With this new trial we are actually using a patient’s own stem cells to help rebuild the heart muscle?  
Dr. Schaer: Correct. We are using stem cells that are coming from the patient’s own bone marrow. The stem cells are then purified, and specific types of stem cells from the bone marrow are isolated. Then we take those stem cells and about a week, a week-and-a-half, after the heart attack actually occurs and the blocked artery has been opened up, we take the patient back to the cardiac lab and we place a catheter, which is a long thin tube, into the artery that was previously blocked. Then, very slowly, we infuse the stem cells that came from the patient’s own bone marrow. And the hope is that these stem cells will travel to the areas of the heart muscle that have been damaged and will begin the repair process to limit the amount of future damage and perhaps improve the heart function of areas that have been partially damaged by the heart attack.
Is there any possibility of reversing some of the damage?
Dr. Schaer: That’s the hope. The hope is that we can prevent further damage and perhaps reverse some of the damage that has already occurred. 
How big would that be?  
Dr. Schaer: It would be great. Because there are some patients that have a very large heart attack, anything we can do to improve his heart function hopefully will prevent him from developing any adverse effects of this heart attack, like congestive heart failure or severe rhythm disturbances that can occur.
The trial has been going on for about six months now? 
Dr. Schaer: Yeah, about six to 12 months. And there are a number of sites around the country that are enrolling patients in the trial. I think the trial is getting close to being completed, maybe in the next few months, we will have all of the patients that we need.
Where do you think medicine is headed? Are stem cells the future of medicine?
Dr. Schaer: Yeah, this is the most exciting area of medicine that I have been involved in the 30 years or so I have been in practice. The potential for stem cells to repair damaged tissue in the heart I think is huge. What we haven’t figured out yet is which stem cells need to be administered, how they should be administered, and in what setting they need to be administered. All of these questions are still in the investigational stage. So I think many of us kind of hope for a magic bullet; like get stem cells from the bone marrow, shoot it into the heart, and the heart will suddenly become dramatically better. It’s not that simple. It’s not the magic bullet. It requires very careful, well designed trials to answer questions that will clarify how these stem cells are working, which cells should be used, and in what setting.
So will the success of these trials have a huge impact upon people?   
Dr. Schaer: Well, we hope so.  Again, we don’t know for sure if these cells work and we don’t know if we are administering them correctly. We are still in the learning phase.  I think it is probably three to five years, at best, before we are going to have any kind of stem cell therapy for patients with heart attack or other heart diseases.

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