doi: 10.1161/CIRCRESAHA.108.187971
© 2008 American Heart Association, Inc.
Editorials |
From Genes to Regenerative Medicine
Approaches in Development
From the Divisions of Cardiac Surgery (M.R., E.J.S.) and Cardiology (A.F.R.S.), University of Ottawa Heart Institute; and the Departments of Cellular and Molecular Medicine (M.R., E.J.S.) and Biochemistry, Microbiology and Immunology (A.F.R.S.), University of Ottawa, Canada.
Correspondence to Erik J. Suuronen, PhD, Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, K1Y 4W7, Canada. E-mail esuuronen@ottawaheart.ca
See related article, pages 1147–1154
Key Words: genetics • stem cells • angiogenesis • differentiation • therapy
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Coronary artery disease (CAD) persists as a leading cause of morbidity and mortality in the industrialized world. Patients with myocardial damage who have not adequately responded to medical therapy and revascularization may, if eligible, be treated by surgical ventricular restoration, ventricular assist devices, and, ultimately, by transplantation. Although these treatments can extend the lives of some patients, they can only be offered to a minority of affected patients and remain "mechanical" in that they do not biologically address the functional deficit of the heart. This has led to great interest in cell replacement strategies, with the goal of safely and effectively restoring perfusion and/or contractility to ischemic, stunned, hibernating, or scarred myocardium. A number of clinical trials in cell therapy have been performed, most of them using simpler approaches such as the transplantation of unselected bone marrow mononuclear cells. Recent systematic reviews reveal a significant, although modest, benefit of these clinical trials to myocardial function.1,2 Moreover, growing evidence suggests that neovascularization of the dysfunctional myocardium from paracrine/humoral factors and secondary recruitment of host stem/progenitor cells are the likely mechanisms leading to functional improvement rather than cardiomyocyte replacement.3–5 Nevertheless, the development of therapies to actually regenerate contractile myocardium will likely be required for the treatment of larger areas of damage or dysfunction in the heart, which will also necessitate adequate blood supply for the transport of oxygen and nutrients to ensure survival of the regenerated tissue. Considering this, a cell-based therapeutic "angiogenesis" (or "vasculogenesis," a distinction in nomenclature not continued in
Related Article:
Circ. Res. 2008 103: 1147-1154.