A Novel Biological Strategy for Myocardial Protection by Intracoronary Delivery of Mitochondria: Safety and Efficacy

[Display omitted] •Mitochondrial transplantation uses mitochondria isolated from the patient’s own body to replace or augment native mitochondria damaged by ischemia reperfusion injury.•The transplanted mitochondria can be delivered to the myocardium by intra-coronary injection.•Intracoronary injection of mitochondria is safe and has no effect on coronary patency.•Intracoronary injection of mitochondria provides for the rapid uptake and specific biodistribution of mitochondria throughout the heart.•Intracoronary mitochondrial transplantation is efficacious and provides for enhanced post-ischemic myocardial function, improved coronary blood flow and reduction of infarct size. Mitochondrial dysfunction is the determinant insult of ischemia-reperfusion injury. Autologous mitochondrial transplantation involves supplying one’s healthy mitochondria to the ischemic region harboring damaged mitochondria. The authors used in vivo swine to show that mitochondrial transplantation in the heart by intracoronary delivery is safe, with specific distribution to the heart, and results in significant increase in coronary blood flow, which requires intact mitochondrial viability, adenosine triphosphate production, and, in part, the activation of vascular KIR channels. Intracoronary mitochondrial delivery after temporary regional ischemia significantly improved myocardial function, perfusion, and infarct size. The authors concluded that intracoronary delivery of mitochondria is safe and efficacious therapy for myocardial ischemia-reperfusion injury.