The successful use of tissue-engineered transplants is hampered by the need for vascularization. Recent advances have made possible the using of stem cells as cell sources for therapeutic angiogenesis, including the vascularization of engineered tissue grafts. The goal of this study was to examine the endothelial potential of human umbilical cord-derived stem (UCDS) cells. UCDS cells were initially characterized and differentiated in an endothelial differentiation medium containing VEGF and bFGF. Differentiation into endothelial cells was determined by acetylated low-density lipoprotein incorporation and expression of endothelial-specific proteins, such as PECAM and CD34. In vivo, the transplanted UCDS cells were sprouting from local injection and differentiated into endothelial cells in a hindlimb ischemia mouse model. These findings indicate the presence of a cell population within the human umbilical cord that exhibits characteristics of endothelial progenitor cells. Therefore, human umbilical cord might represent a source of stem cells useful for therapeutic angiogenesis and re-endothelialization of engineered tissue grafts.

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Acquired cardiovascular diseases and complex congenital heart diseases are leading causes of morbidity and mortality. Cellular therapy and tissue engineering are emerging as promising alternative approaches to treat cardiovascular diseases. Cellular therapy involves isolating cells and delivering the cells to the site of cardiac injury to restore blood flow and contractility to previously infarcted, scarred or dysfunctional heart. Myocardial tissue engineering, engineered heart tissue by seeding cells in three-dimensional matrices of biodegradable polymers or cell sheet engineering without artificial scaffolds to form new myocardial constructs. Questions are common to both these approaches, such as the best cell source and optimal conditions for therapeutic application. The capabilities of stem cells for pluripotency and long-term self-renewal make it an ideal source for myocardial tissue engineering and cell therapy. We review the current understanding of postnatal adult stem and progenitor cells in cellular therapy and myocardial tissue engineering from a surgical view point, and highlight the latest advances in these exciting fields.

We investigated the role of stem cells from human umbilical cord tissue in cardiomyocyte regeneration. The umbilical cord stem cells were initially characterized and differentiated in a myocardial differentiation medium containing 5-azacytidine for 24 h. Differentiation into cardiomyocytes was determined by expression of cardiac specific markers, like cardiac alpha-actin, connexin43, myosin, Troponin T, and ultrastructural analysis. In vivo, the transplanted umbilical cord stem cells were sprouting from local injection and differentiated into cardiomyocyte-like cells in a rat myocardial infarction model. Echocardiography revealed increasing left ventricular function after umbilical cord stem cell transplantation. These results demonstrate that umbilical cord stem cells can differentiate into cardiomyocyte-like cells both in vitro and in vivo. Therefore, human umbilical cord might represent a source of stem cells useful for cellular therapy and myocardial tissue engineering. Future studies are required to determine the molecular signaling mechanisms responsible for this phenomenon.