Cell Therapy for the Treatment of Chronic Ischemic Heart Disease

Abstract

Over the last decade, much was learned about the biology of several types of stem and progenitor cells. It has become apparent that various cell sources may have the capacity to promote cardiomyogenesis and new blood vessel formation through different mechanisms, forming the rationale for cell-based therapy in patients with chronic ischemic heart disease. After initial clinical studies have provided evidence for safety of cell administration, larger randomized trials demonstrated variable effects on myocardial perfusion and contractile performance. Although cell-based therapy is a promising strategy for the treatment of myocardial disease, many questions remain to be answered with respect to the optimal cell type, delivery route and mechanism of action in order to improve the outcome of cardiac cell therapy. This paper aims to provide an overview of the methods available to apply cell-based therapy in chronic ischemic myocardial disease. The different cell types that have been tested in (pre)clinical trials and their proposed mechanism of action will be discussed, along with the possible routes of cell delivery. Furthermore, the experience from experimental and clinical studies will be summarized, and innovative strategies to enhance the efficacy of cell therapy, for example by improving cell retention and survival, will be reviewed.

Guidance of Stem Cells to a Target Destination in Vivo by Magnetic Nanoparticles in a Magnetic Field

“…9−11 Cellular therapies are increasingly applied in clinical trials; in recent years the use of stem cells as repairing modules in a compromised cardiovascular system has obtained modest success. 1,4,12 However, one of the current challenges in stem cell therapy is the localization of cells to the site of interest for the repair of damaged tissue. Developing methodologies that would target, monitor, and control cell guidance would therefore help current stem cell therapies make further progress.…”

“…Soon after the identification of stem cells (SCs), including hematopoietic stem cells, endothelial progenitor cells, cardiac stem cells, and bone marrow mononuclear cells, their use for regenerative therapies was explored. SCs have the capability to regenerate cardiomyocytes, − restore the function of ischemic organs by stimulating the re-endothelialization of injured blood vessels, and induce and modulate vasculogenesis and angiogenesis in areas with reduced oxygen supply. − The suitability of stem cells for the repair of myocardial tissue after myocardial infarction and for the repair of vascular injury have received much clinical attention. − Cellular therapies are increasingly applied in clinical trials; in recent years the use of stem cells as repairing modules in a compromised cardiovascular system has obtained modest success. ,, However, one of the current challenges in stem cell therapy is the localization of cells to the site of interest for the repair of damaged tissue. Developing methodologies that would target, monitor, and control cell guidance would therefore help current stem cell therapies make further progress.…”