第 4 章 面白い臨床試験 A. 心拍数と寿命
C. 心筋は再生する
心筋には再生能力がないと考えられてきた。
ところが、心筋に再生能力のあることが、女性の心臓を移植された男性患者を研究する ことにより判明した。つまり、移植された女性の心臓に Y 染色体が存在すれば、この心筋 は男性由来の心筋と判定できる。
Laflamme らは9カ月以上生存した 5例の男性心移植患者の剖検心を検討し、全例にY
染色体陽性の心筋を検出した [1]。その頻度は非常に少なく、平均0.04％、中央値で0.016％
であった。Müller らは13 例の男性心移植患者の右室生検標本 21 個を検討し、13 例中8 例にY染色体のマーカーを検出した [2]。その頻度は0.16±0.04%であった。
Deb らは男性から骨髄移植を受けた 4 例の女性患者の剖検心を検討した [3]。全例に Y 染色体陽性の心筋を検出し、その頻度は0.23±0.06%であった。女性から骨髄移植を受け た4例の女性患者の剖検心にはY染色体陽性の心筋を検出しなかった。したがって、骨髄
由来のprogenitor cellにより心筋の新生が起こることが証明された。
文献
1. Laflamme MA, Myerson D, Saffitz, Murry CE. Evidence for cardiomyocyte repopulation by extracardiac progenitors in transplanted human hearts. Circ Res 2002; 90: 634-40.
2. Müller P, Pfeiffer P, Kogin J, et al. Cardiomyocaytes of noncardiac origin in myocardial biopsies of human transplanted hearts. Circulation 2002; 106: 31-5.
3. Deb A, Wang S, Skelding KA, et al. Bone marrow-derived cardiomyocytes are present in adult human heart. A study of gender-mismatched bone marrow transplantation patients. Circulation 2003; 107: 1247-9.
各臨床試験の略号
ACCOMPLISH
Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
Action to Control Cardiovascular Risk in Diabetes ACT
Acetylcysteine for Contrast-Induced Nephropathy Trial ACTIVE
Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation
AFCAPS/TexCAPS
Air Force/ Texas Coronary Atherosclerosis Prevention Study AFCHF
Atrial Fibrillation and Congestive Heart Failure AFFIRM
Atrial Fibrillation Follow-Up Investigation of Rhythm Management AIM-HIGH
Additional Investigators in the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes AIRE
Acute Infarction Ramipril Efficacy ALLHAT
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ALLHAT-LLT
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial-Lipid Lowering Trial
ANBP 2
Second Australian National Blood Pressure ARBITER
Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol
ARISTOTLE
Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation
ARTS
Arterial Revascularization Therapies Study ARTSⅡ
Arterial Revascularization Therapies StudyⅡ ASCOT-BPLA
Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm ASCOT-LLA
Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm ASTEROID
A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden
ASTRONOMER
Aortic Stenosis Progression Observation: Measuring Effects of Rosuvastatin AURORA
A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodyalysis:
An Assessment of Survival and Cardiovascular Events AVERT
Atorvastatin versus Revascularization Treatment AVID
Antiarrythmic versus Implantable Defibrillators AVOID
Aliskiren in the Evaluation of Proteinuria in Diabetes BARI
Bypass Angioplasty Revascularization Investigation BARI 2D
Bypass Angioplasty Revascularization Investigation 2 Diabetes BEAUTIFUL
Morbidity Mortality Evaluation of theⅠf Inhibitor Ivabradine in Patients with Coronary Disease and Left Ventricular Dysfunction
BIP
Bezafibrate Infarction Prevention BPLTTC
Blood Pressure Lowering Treatment Trialis’ Collaboration
BRAVE-2
Beyond 12 Hours Reperfusion Alternative Evaluation CACTUS
Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents
CAPRICORN
Carvedilol Post-Infarct Survival Control in LV Dysfunction CARDS
Collaborative Atorvastatin Diabetes Study CARE
Cholesterol and Recurrent Events CARE-HF
Cardiac Resynchronization-Heart Failure CARP
Coronary Artery Revascularization Prophylaxis CASH
Cardiac Arrest Study Hamburg CAST
Cardiac Arrhythmia Suppression Trial CHARISMA
Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance
CHARM
Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity CHF-STAT
Survival Trial of Antiarrhythmic Therapy in Congesticve Heart Failure CHOIR
Correction of Hemoglobin and Outcomes in Renal insufficiency CIBIS
Cardiac Insufficiency Bisoprolol Study CIDS
Canadian Implantable Defibrillator Study CLOSURE
Evaluation of the STARFlex Septal Closure Ststem in Patients with a Stroke and/or Transient Ischemic Attack due to Presumed Paradoxical Embolism thorough a Patent Foramen Ovale
COMET
Carvedilol or Metoprolol European Trial COMPANION
Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure CONSENSUS
Cooperative New Scandinavian Enalapril Survival Study COOPERATE
Combination Treatment of Angiotensin- Ⅱ Receptor Blocker and Angiotensin-converting-enzyme Inhibitor in Non-diabetic Renal Disease
COPERNICUS
Carvedilol Prospective Randomized Cumulative Survival CORONA
Controlled Rosuvastatin Multinational Trial in Heart Failure COSMOS
Coronary Atherosclerosis Study Measuring Effects of Rosuvastatin Using Intravascular Ultrasound in Japanese Subjects
COURAGE
Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation CREATE
Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta CREDO
Clopidogrel for the Reduction of Events During Observation CURE
Clopidogrel in Unstable Angina to Prevent Recurrent Events DECREASE
Dutch Echocardiographic Cardiac Risk Evaluation Applying Stess Echocardiography DEDICATION
Drug Elution and Distal Protection in Acute Myocardial Infarction DEFER
Deferral versus Performance of PTCA in patients without Documented Ischemia DEFINITE
Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation DETAIL
Diabetics Exposed to Telmisartan and Enalapril DIABETES
Diabetes and Sirolimus-Eluting Stent
DiDi
Diltiazem in Dilated Cardiomyopathy DIG
Digitalis Investigation Group DINAMIT
Defibrillator in Acute Myocardial Infarction Trial DIPOM
Diabetic Postoperative Mortality and Morbidity DIRECT
Diabetic Retinopathy Candesartan Trials DKDRUSH-Ⅱ
Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions
DREAM
Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication DUAAL
Double-blind Atorvastatin Amlodipine ELITE
Evaluation of Losartan in the Elderly EMIAT
European Myocardial Infarct Amiodarone Trial EMPHASIS-HF
Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure EPHESUS
Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study
ERACIⅡ
Argentine Randomized Trial of Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multi Vessel Disease
E-SIRIUS
European-Sirolimus-Eluting Stent in De-Novo Native Coronary Lesions ESTABLISH
Early Statin Treatment in Patients with Acute Coronary Syndrome EUROPA
European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery disease
FAIR-HF
Ferinject Assessment in Patients with Iron Deficiency and Chronic Heart Failure FAME
Fractional Flow Reserve versus Angiography for Multivessel Evaluation FERRIC-HF
Effect of IntravenousFerrous Sucrose on Exercise Capacity in Chronic Heart Failure FIELD
Fenofibrate Intervention and Event Lowering in Diabetes FIRST
Flolan International Randomized Survival Trial FRISCⅡ
Fragmin and Fast Revascularization during Instability in Coronary Artery Disease GAIN
German Atorvastatin Intravascular Ultrasound study investigators GESICA
Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina GISS-AF
Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-Atrial Fibrillation
GISSI-HF
Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-Heart Failure
GISSI-Prevenzione
Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-Prevenzione
HERS
Heart and Estrogen/Progestin Replacement Study HOPE
Heart Outcomes Prevention Evaluation HOPE 2
Heart Outcomes Prevention Evaluation 2 HORIZONS-AMI
Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction
HYVET
Hypertension in the Very Elderly Trial
ICTUS
Invasive versus Conservative Treatment inUnstable Coronary Syndromes IDNT
Irbesartan Diabetic Nephropathy Trial ILLUMINATE
Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events
INSPIRE
Adenosine Sestamibi Post-Infarction Evaluation I-PRESERVE
Irbesartan in Heart Failure and Preserved Ejection Fraction IRMA2
Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria ISAR-DIABETES
Intracoronary Stenting and Angiographic Results: Do Diabetic Patients Derive Similar Benefit from Paclitaxel-Eluting or Sirolimus-Eluting Stents?
ISIS-4
International Study of Infarct Survival-4 JAPAN-ACS
Japan Assessment of Pitavastatin versus Atorvastatin in Acute Coronary Syndrome JELIS
Japan EPA Lipid Intervention Study J-RHYTHM
Japanese Rhythm Management Trial for Atrial Fibrillation JUPITER
Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin
KAMIR
Korea Acute Myocardial Infarction Registry LIFE
Losartan Intervention for Endpoint Reduction in Hypertension LIMIT-2
Leicester Intravenous Magnesium Intervention Trial-2 LIPID
Long-term Intervention with Pravastatin in Ischemic Disease Long-DES-Ⅱ
Long Drug-Eluting Stent MADIT
Multicenter Automatic Defibrillator Implantation Trial MADIT-CRT
Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy
MAGIC
Magnesium in Coronaries MARVAL
Microalbuminuria Reduction with Valsaratan MASSⅡ
Medicine, Angioplasty, or Surgery StudyⅡ MaVS
Metoprolol after Vascular Surgery MERIT-HF
Metoprolol CR/XL Randomized Intervention Trial in Congesitve Heart Failure MDC
Metoprolol in Dilated Cardiomyopahthy MIRACL
Myocardial Ischemia Reducing with Aggressive Cholesterol Lowering MIRACLE
Multicenter Insync Randomized Clinical Evaluation MIRACLE-ICD
Multicenter Insync ICD Randomized Clinical Evaluation MUSTIC
Multisite Stimulation in Cardiomyopathies MUSTT
Multicenter Unsustained Tachycardia Trial NAVIGATOR
Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research NORVIT
Norwegian Vitamin OAT
Occluded Artery Trial ONTARGET
Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trail
PASSION
Paclitaxel-Eluting Stent versus Conventional Stent in Myocardial Infarction with ST-Segment Elevation
PATH-CHF
Pacing Therapies in Congestive Heart Failure PCI-CLARITY
Percutaneous Coronary Intervention – Clopidogrel as Adjunctive Reperfusion Therapy
PEACE
Prevention of Events with Angiotensin Converting Enzyme Inhibition PIAF
Pharamcological Intervention in Atrial Fibrillation PICO
Pimobendan in Congestive Heart Failure POISE
Perioperative Ischemic Evaluation PRAISE
Prospecive Randomized Amlodipine Survival Evaluation PRECOMBAT
Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease
PREPIC
Prévention du Risque d'Embolie Pulmonaire par Interruption Cave PRIMEⅡ
Second Prospective Randomized Study of Ibopamine on Moratality and EfficacyⅡ PRISONⅡ
Primary stenting of totally occluded native coronary arteriesⅡ PROGRESS
Perindopril Protection against Recurrent Stroke Study PROMISE
Prospective Randomized Milrinone Survival Evaluation PROSPER
Prospective Study of Pravastatin in the Elderly at Risk PROVE IT-TIMI 22
Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22
RACEⅡ
Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison between Lenient versus Strict Rate CintrolⅡ
RADIANCE
Randomized Assessment of the effect of Digoxin on Inhibitors of the Angiotensin-Converting Enzyme
RALES
Randomized Aldactone Evaluation Study PAMELA
Pressioni Arteriose e Loro Associazioni RE-LY
Randomized Evaluation of Long-term Anticoagulation Therapy RENAAL
Reduction of Endpoints in NIDDM with the AngiotensinⅡAntagonist Losartan Rethin Q
Cardiac Resynchronization Therapy in Patients with Heart Failure with Narrow QRS REVERSAL
Reversal of Atherosclerosis with Aggressive Lipid Lowering REVERSE
Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction RIKS-HIA
Register of Information and Knowledge about Swedish Heart Intensive Care Admissions
RITA 3
Randomized Intervention Trial of Unstable Angina-3 ROADMAP
Randomized Olmesartan and Diabetes Microalbuminuria Prevention ROCKET AF
Rivarixaban Once Daily Oral Direct FactorⅩa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation RRISC
Reduction of Restenosis in Saphenous Vein Grafts with Cypher Sirolimus-Eluting Stent
PROVED
Prospecitive Randomized Study of Ventricular Failure and the Efficacy of Digoxin
4S
Scandinavian Simvastatin Survival Study SAGE
Study Assessing Goals in the Elderly SALTIRE
Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression SAVE
Survival and Ventricular Enlargement SCAAR
Swedish Coronary Angiography and Angioplasty Registery SCANDSTENT
Stenting Coronary Arteries in Non-Stress/Benestent Disease Trial SCD-HeFT
Sudden Cardiac Death in Heart Failure Trial SCORPIUS
German Multicenter Randomized Single Blind Study of the CYPHER Sirolimus-Eluting Stent in the Treatment of Diabetic Patients with De Novo Native Coronary Artery Lesions
SEARCH
Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine SESAMI
Sirolimus-Eluting Stent versus Bare-Metal Stent in Acute Myocardial Infarction SES-SMART
Sirolimus-Elutins Stent in the Prevention of Restenosis in Small Coronary Arteries SHARP
Study of Heart and Renal Protection SHIFT
Systolic Heart Failure Treatment with the I fInhibitor Ivabradine Trial SOFA
Study on Omega-3 Fatty Acids and Ventricular Arhythmia SOLVD
Studies of Left Ventricular Dysfunction SoS
Stent or Surgery SOS
Stenting of Saphenous Vein Grafts
SPARCL
Stroke Prevention by Aggressive Reduction in Cholesterol Levels STAF
Strategies of Treatment of Atrial Fibrillation STAMINA-HeFT
Study of Anemia in Heart Failure Trial STICH
Surgical Treatment for Ischemic Heart Failure SWISSⅡ
Swiss Interventional Study on Silent Ischemia TypeⅡ SWORD
Survival with Oral d-Sotalol SYNTAX
Synergy between PCI with Taxus and Cardiac Surgery TACTICS-TIMI18
Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy- Thrombolysis in Myocardial Infarrction 18
TIMACS
Timing of Interventionin Acute Coronary Syndrome TNT
Treating to New Targets TOSCA
Total Occlusion Study of Canada TRACE
Trandolapril Cardiac Evaluation TRANSCEND
Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease
TREAT
Trial to Reduce Cardiovascular Events with Aranesp Therapy TROPHY
Trial of Preventing Hypertension TYPHOON
Trial to Assess the Use of the Cypher Stent in Acute Myocardial Infarction Treated with Balloon Angioplasty
UKPDS