【The story of coordinator】Myocardial regeneration treatment using autologous skeletal muscle myoblast sheet　Recovered enough to remove pacemaker and study abroad

The government of the patient’s home country contacted EAJ that they would like the patient to receive the treatment developed in Japan

Born having heart disease complicated with ventricular dilatation

The patient, a 20-year-old from the Middle East, was born with a heart block and had a pacemaker installed shortly after birth. Since then, he had been in normal health, but three years ago, while he was sleeping, he suddenly experienced chest pain and shoulder pain on the left side, and was diagnosed with myocarditis. Echocardiography during hospitalization confirmed left ventricular dilatation and severe left ventricular dysfunction. Although he felt well enough to walk up three flights of stairs, he was later diagnosed with severe left ventricular dilatation at a hospital in the United States. He also hoped for a heart transplant, but that was not feasible. At that time, his home country’s doctor contacted EAJ to have him undergo myocardial regeneration treatment using an autologous skeletal muscle myoblast sheet developed in Japan. This case was proceeded under a scheme in which his home country’s government provides treatment support.

What is myocardial regeneration treatment using autologous skeletal muscle myoblast sheets?

The only treatments for severe heart failure in which new function cannot be restored even with surgery or drugs are heart transplantation or left ventricular assist system (LVAS), which is used as a bridge until transplantation. This treatment method was developed to collect skeletal muscle myoblasts from the patient’s thigh, culture them, make them into a sheet, and attach it to the heart. The sheet releases cytokines and stimulates the regeneration of the heart muscle. In 2007, this treatment was performed for the first time in the world in Japan, and the patient recovered enough to have the LVAS removed.

Hospitalization plan and preparation for coming to Japan

EAJ received medical information from the patient and he decided to come to Japan. The patient underwent examinations and surgery to harvest skeletal muscle during the first hospitalization, and if there were no problems, the plan was drawn up to have the sheet transplanted at the second hospitalization one month later.

EAJ was steadily proceeding with preparations while communicating with his home country’s government and its embassy. EAJ checked the language and meals. The patient said that halal food is preferable. But although it was not possible to provide complete halal food at the hospital, EAJ had obtained the patient’s approval about food by taking all possible precautions, such as removing pork as the patient decided that his treatment is top priority.

At that time, a symposium on Japanese medical care was to be held in the country where the patient was living. As the doctor in charge from Japan and EAJ employees were scheduled to attend the symposium, they decided to meet the patient there. When accepting a patient, a doctor wants to know the degree of heart failure and the patient’s personality, so the doctor checked things like how far he can walk, whether he has chest pain, his rehabilitation status, and his priorities on religious matters. After that, coordination with the home country’s government progressed, and the date of the patient’s arrival in Japan was decided. EAJ arranged multiple visas for all family members of the patient. When considering the risks of surgery for a serious heart disease, there was a possibility of sudden medical emergencies in the middle of the night, so EAJ decided to provide Arabic and English interpreters 24 hours a day. For this reason, EAJ had decided to strengthen our Arabic interpreter network.

Skeletal muscle collection during the first hospitalization

A blood test just before the trip confirmed that the patient had no infectious disease, so he arrived in Japan as scheduled. An interpreter met the patient at the airport and accompanied him to the reserved hotel. EAJ also arranged a hire car from the serviced apartment to the hospital.

Interpretation was usually done in English, while an Arabic interpreter was involved in time of explanations by a doctor and when informed consent becomes necessary. Since interpreting is required 24 hours a day, EAJ arranged rotation of the new interpreter every other day and the necessary information was shared between the interpreters. In addition, since the families and other people who help the patient came to Japan in rotation, EAJ provided interpreters to welcome them and help them so that they can spend their daily lives. Since the surgery requires general anesthesia, the patient was explained of the anesthesia. After taking a muscle sample and confirming that the culture was successful, the date for the surgery to harvest the skeletal muscle was determined. The surgery was successful in harvesting 5 grams of skeletal muscle. After the surgery, the patient needed to use a wheelchair for a while. After being discharged from the hospital, the patient returned to his home country and then came back again to Japan one month later for his second hospitalization. This time, the patient was coming again to Japan to receive cutting-edge Japanese treatment with the support of the Middle East government, so he was interviewed on TV and published in newspapers, and became a hot topic on the information space.

Transplantation of culture sheet at second hospitalization

The patient came to Japan with schedule to stay for about a month and a half in the hospital for the second time. Immediately after being admitted to the hospital, the doctor explained that the myoblasts which had been cultured had grown sufficiently large and were in good condition, and it was decided that the surgery would be performed in 10 days. The location for the new pacemaker will be determined at the time of surgery, and the new pacemaker will be inserted two to three weeks after surgery.

After that, the patient underwent regular heart CT, echocardiogram, and electrocardiogram tests while awaiting surgery. By the time the patient was hospitalized for the second time, he seemed to have gotten used to the environment, and spent time in the day room playing games and receiving sympathy from other patients he had met during previous hospitalizations.

On the day of the surgery, the patient entered the operating room at 8:30 in the morning and was given general anesthesia before the surgery, which was completed in 4 hours. The parents were worried that the patient was not awake for a long time due to anesthesia after the surgery, so the professor who was the leader of the treatment team came to the parents and explained to them with a smile to reassure that the surgery was a success. After the surgery, the patient spent some times in the ICU. Since it was an open chest surgery, the patient was asleep under anesthesia for three days. After waking up from anesthesia, the patient’s progress was uneventful, and he was soon transferred to the general ward. As the return date approached, preparations for returning home began, including obtaining documents from the hospital to receive permission to board the aircraft. The patient passed various tests before his scheduled discharge, and on the day of his discharge, a member of the royal family from the patient’s country, who happened to be visiting Japan, came to see him.

Recovered enough to study in Japan after follow-up

Since this treatment took the form of participating in a clinical study, examination was required 2 to 3 months after surgery. For this reason, the patient decided to come back to Japan to undergo examination one month after returning to his home country. The patient underwent tests and examinations at the outpatient clinic, and was confirmed progressing smoothly. On this visit to Japan, the patient’s father held appreciation party at a hotel to express his gratitude to the doctors who had taken care of the patient.

The next visit to Japan was scheduled 6 months after surgery. The patient was hospitalized and underwent a cardiac catheterization examination. Another test was scheduled for one year after the surgery, so EAJ contacted the patient’s family and was told that the patient was currently in Japan to study Japanese language. Both we and the doctors were surprised to hear that he has recovered completely and is now able to attend school overseas to study.