Purpose of review
Ischemic heart disease and stroke lead to the greatest number of
deaths worldwide. Despite decreased time to intervention and improvements in
the standard of care, 1 out of 5 patients that survive a myocardial
infarction (MI) still face long-term chronic heart failure and a 5-year
mortality rate of about 50%. Based on their multi-potency for
differentiation and paracrine activity, epicardial cells and their
derivatives have potential to rescue jeopardized tissue and/or promote
cardiac regeneration. Here we review the diagnosis and treatment of MI,
basic epicardial cell biology, and potential treatment strategies designed
to harness the reparative properties of epicardial cells.
Recent Findings
During cardiac development, epicardial cells covering the surface of
the heart generate migratory progenitor cells that contribute to the
coronary vasculature and the interstitial fibroblasts. Epicardial cells also
produce paracrine signals required for myocardial expansion and cardiac
growth. In adults with myocardial infarction, epicardial cells and their
derivatives provide paracrine factors that affect myocardial remodeling and
repair. At present, the intrinsic mechanisms and extrinsic signals that
regulate epicardial cell fate and paracrine activity in adults remain poorly
understood.
Summary
Human diseases that result in heart failure due to negative
remodeling or extensive loss of viable cardiac tissue require new, effective
treatments. Improved understanding of epicardial cell function(s) and
epicardial-mediated secretion of growth factors, cytokines and hormones
during cardiac growth, homeostasis and injury may lead to new ways to treat
patients with myocardial infarction.