Intramyocardial Transplantation of Autologous Myoblasts

Background—Autologous skeletal myoblast (SM) transplantation improves function of infarcted myocardium, but pretransplantation cultures remain a complex process. This study assessed whether it could be optimized by muscle preconditioning with the local anesthetic bupivacaine or even bypassed with the use of the so-called mince technique. Methods and Results—Muscle preconditioning consisted of intramuscular injections of the tibialis anterior of rats, 2 days before harvest. After 7 days of culture, the number of available myoblasts was significantly increased compared with nonconditioned controls (1 683 147 versus 85 300, P50.0013). The mince technique was then assessed. A myocardial infarction was created in 66 rats by coronary artery ligation. One week later, rats were reoperated on and intramyocardially injected with culture medium alone (controls, n523), autologous cultured SM (3.5310, n521), or autologous muscle minced into a fine slurry, which was immediately transplanted (n522). All muscles had been preconditioned. Left ventricular function was assessed by 2D echocardiography. Whereas end-diastolic volumes expanded over time in all groups, left ventricular ejection fraction (%, mean6SEM) was increased only in the cultured SM–transplanted group at 1 (P50.0006) and 2 months (P50.0008) versus baseline (37.5261.92 and 40.9262.17 versus 30.3461.74), with a significant additional benefit between 1 and 2 months (P50.0069). Conclusions—Cell culture remains mandatory for SM transplantation to be successful but, in a clinical perspective, this process can be made more expeditious by preharvest muscle conditioning with bupivacaine, which greatly enhances the baseline cell yield. (Circulation. 2000;102[suppl III]:III-210-III-215.)