Kardiale Stamm- und Progenitorzelltherapie: Bereit für die Zukunft?

Abstract

Cardiovascular diseases represent the major cause of mortality in the western world. The concept of regenerative medicine has been repeatedly suggested to be an innovative approach to repair and regenerate the diseased myocardium after acute myocardial infarction and chronic ischemic cardiomyopathy. However, while numerous experimental and preclinical studies using various types of stem and progenitor cells have shown promising results, the outcomes of first clinical pilot trials have only shown marginal effects with regards to the improvement of cardiac performance after cell-based therapies. Current meta-analyses demonstrate a mean of only 3 % improvement of cardiac function. The reasons for the ineffective translation into the clinical setting are related to many unanswered key questions comprising the ideal cell type, the mode of delivery, the optimal timing, the application format (2D versus 3D) and the definition of effective study endpoints. Furthermore, advanced, non-invasive imaging techniques as well as the development of appropriate animal models are mandatory for the assessment of cell based-therapies and represent the key requisite for a safe translation into the clinical setting. Future cell-based therapy concepts need to be optimized to achieve long-term efficiency and in particular the clinical potential of novel pluripotent stem cells such as induced pluripotent cells (IPS) needs to be addressed. In addition, recent experimental studies demonstrate the principal feasibility of direct reprogramming of myocardial fibroblasts into functional cardiomyocytes in vitro and in-vivo what may represent a novel myocardial regenerative strategy without the direct necessity of stem cells.

A Cell-Free SDKP-Conjugated Self-Assembling Peptide Hydrogel Sufficient for Improvement of Myocardial Infarction

“…In particular, several clinical trials have been designed or conducted based on the promising results of MSC therapy for MI (clinicaltrials.gov identifier: NCT03798353, NCT02323477, NCT01392105, NCT00114452, NCT01291329). However, cardiac cell therapy has shown partial success, which is likely due to low engraftment of the transplanted cells [12,13]. Both viability and retention of the transplanted cells could be hampered by insufficient nutrition caused by lack of vasculature, inflammatory conditions, and remodeled ECM in the fibrotic area [14].…”