Cardiac Cell Therapy Evolving From Complex to Straightforward
Enabling Adoption and Affordability
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Progress of Available Mesenchymal Stem Cell Populations: “Waste” Tissues to the Forefront
Numerous trials have evaluated mesenchymal stem/stromal cells (MSCs) derived from bone marrow (BM-MSCs) for a wide range of indications, including diseases of the cardiovascular system, as recently reviewed.1,2 Earlier this year, a seminal study evaluated the safety and feasibility of intravenous BM-MSC administration in nonischemic cardiomyopathy,3 and gathered initial evidence supporting the ability of such an approach to ameliorate inflammation and improve functional status. As described in that study and accompanying editorial,4 the notion of a heart failure therapy based on an allogeneic cell product delivered by intravenous infusion is extremely attractive, given the practicality and affordability of such delivery on a standard hospital unit, or even in an outpatient setting.
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In parallel with the advance of clinical studies involving BM-MSCs, basic and translational efforts have advanced our understanding of mesenchymal stem/stromal cells from the early identification of these cells as bone marrow–resident cells functioning particularly in support of marrow hematopoiesis.5 It is now well-recognized that MSCs are distributed on the vascular network in all vascularized tissues, thus playing a broad tissue-supportive role throughout the body.6–10 This recognition has in turn prompted a quest for tissue sources of both autologous and allogeneic MSCs that might have advantages with respect to either practical or biological properties that support their use as therapeutic agents. Several such sources have been identified that involve tissues that can readily be obtained with limited or no morbidity, as medical waste. These include adipose tissue obtained from minimally invasive lipoaspiration, placental tissue, and umbilical cord tissue.2
The umbilical cord and its components are recognized as a ready source of MSCs that are present immediately surrounding the cord vessels, as well as distributed throughout the Wharton’s jelly in which those vessels are suspended.11 …