doi: 10.1161/01.RES.0000155333.69009.63
© 2005 American Heart Association, Inc.
Review |
Clinical Applications of Stem Cells for the Heart
From the Department of Cardiology and Angiology, Hanover Medical School, Hanover, Germany.
Correspondence to Priv-Doz Dr med Kai C. Wollert, Abt. Kardiologie und Angiologie Medizinische Hochschule Hannover Carl-Neuberg Str. 1 30625, Hannover, Germany. E-mail wollert.kai{at}mh-hannover.de
This Review is part of a thematic series on Stem Cells, which includes the following articles:
Differentiation of Pluripotent Embryonic Stem Cells into Cardiomyocytes
Derivation and Potential Applications of Human Embryonic Stem Cells
Stem Cells for Myocardial Regeneration
Myocyte Death, Growth, and Regeneration in Cardiac Hypertrophy and Failure
Neural Stem Cells: An Overview
Mesenchymal Stem Cells and Their Potential as Cardiac Therapeutics
Clinical Applications of Stem Cells for the Heart
Toren Finkel , Roberto Bolli, Editors
Repair of the heart is an old dream of physicians caring for patients with cardiac disease. Experimental studies suggest that cardiac transfer of stem and progenitor cells can have a favorable impact on tissue perfusion and contractile performance of the injured heart. Some researchers favor stable stem cell engraftment by fusion or transdifferentiation into cardiomyocyte or vascular cell lineages as likely explanations for these beneficial effects. Others have proposed that transient cell retention may be sufficient to promote functional effects, eg, by release of paracrine mediators. Although the mechanistic underpinnings of stem cell therapy are still intensely debated, the concept of cell therapy has already been introduced into the clinical setting, where a flurry of small, mostly uncontrolled trials indicate that stem cell therapy may be feasible in patients. The overall clinical experience also suggests that stem cell therapy can be safely performed, if the right cell type is used in the right clinical setting. Preliminary efficacy data indicate that stem cells have the potential to enhance myocardial perfusion and/or contractile performance in patients with acute myocardial infarction, advanced coronary artery disease, and chronic heart failure. The field now is rapidly moving toward intermediate-size, double-blinded trials to gather more safety and efficacy data. Ultimately, large outcome trials will have to be conducted. We need to proceed cautiously with carefully designed clinical trials and keep in mind that patient safety must remain the key concern. At the same time, continued basic research to elucidate the underlying mechanism of stem cell therapy is clearly needed.
Key Words: stem cells • myocardial infarction • myocardial ischemia • clinical trials
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