Autologous bone marrow-derived mononuclear cell therapy in three patients with severe asthma.

BACKGROUND: Despite recent advances in understanding its pathophysiology and development of novel therapies, asthma remains a serious public health issue worldwide. Combination therapy with inhaled corticosteroids and long-acting ß2-adrenoceptor agonists results in disease control for many patients, but those who exhibit severe asthma are often unresponsive to conventional treatment, experiencing worse quality of life, frequent exacerbations, and increasing healthcare costs. Bone marrow-derived mononuclear cell (BMMC) transplantation has been shown to reduce airway inflammation and remodeling and improve lung function in experimental models of allergic asthma. METHODS: This is a case series of three patients who presented severe asthma, unresponsive to conventional therapy and omalizumab. They received a single intravenous dose of autologous BMMCs (2 × 107) and were periodically evaluated for 1 year after the procedure. Endpoint assessments included physical examination, quality of life questionnaires, imaging (computed tomography, single-photon emission computed tomography, and ventilation/perfusion scan), lung function tests, and a 6-min walk test. RESULTS: All patients completed the follow-up protocol. No serious adverse events attributable to BMMC transplantation were observed during or after the procedure. Lung function remained stable throughout. A slight increase in ventilation of the right lung was observed on day 120 after BMMC transplantation in one patient. All three patients reported improvement in quality of life in the early post-procedure course. CONCLUSIONS: This paper described for the first time the effects of BMMC therapy in patients with severe asthma, providing a basis for subsequent trials to assess the efficacy of this therapy.

Comparison between short-acquisition myocardial perfusion SPECT reconstructed with a new algorithm and conventional acquisition with filtered backprojection processing.

OBJECTIVE: To compare a novel reconstruction package (Evolution for Cardiac), used to improve image quality in myocardial perfusion single photon emission computed tomography (MPS) and enable shorter scan acquisitions, to filtered backprojection used for conventional time acquisitions. METHODS: Forty-four patients who underwent 2-day Tc-99m sestamibi MPS had both standard [SD: 14-min scan and filtered backprojection processing] and short (SH: 6-min scan and iterative reconstruction with Evolution for Cardiac) studies. In a 17-segment model of the left ventricle, each segment was automatically scored 0-4 (normal to absent radiotracer activity); summed stress, rest and difference scores (SSS, SRS, SDS) were obtained. Spearman's test assessed the correlation between scores from SD and SH studies, and Bland-Altman plots evaluated absolute and mean differences of scores between these studies. RESULTS: The SSS, SRS, and SDS were not statistically different between SD and SH studies (SSS: 5.9 + or - 6.6 vs. 5.8 + or - 6.5; SRS: 2.6 + or - 3.5 vs. 2.6 + or - 2.9; SDS: 3.3 + or - 5.8 vs. 3.2 + or - 5.7). Significant correlations were observed between SD and SH studies regarding SSS (R(2)=0.93), SRS (R(2)=0.85), and SDS (R(2)=0.9) (all P<0.001). Bland-Altman plots showed that differences in SSS, SRS, and SDS fell within 2 standard deviations of the average differences between SD and SH studies. Overall agreement between clinical readings of SD and SH scans was good (up to 100% in abnormal scans). CONCLUSION: A new reconstruction package (Evolution for Cardiac) enabled short MPS acquisition without changes in quantitative perfusion results when compared with conventional acquisition and processing.