Stem Cell Therapy in Heart Diseases – Cell Types, Mechanisms and Improvement Strategies

Abstract

A large number of clinical trials have shown stem cell therapy to be a promising therapeutic approach for the treatment of cardiovascular diseases. Since the first transplantation into human patients, several stem cell types have been applied in this field, including bone marrow derived stem cells, cardiac progenitors as well as embryonic stem cells and their derivatives. However, results obtained from clinical studies are inconsistent and stem cell-based improvement of heart performance and cardiac remodeling was found to be quite limited. In order to optimize stem cell efficiency, it is crucial to elucidate the underlying mechanisms mediating the beneficial effects of stem cell transplantation. Based on these mechanisms, researchers have developed different improvement strategies to boost the potency of stem cell repair and to generate the “next generation” of stem cell therapeutics. Moreover, since cardiovascular diseases are complex disorders including several disease patterns and pathologic mechanisms it may be difficult to provide a uniform therapeutic intervention for all subgroups of patients. Therefore, future strategies should aim at more personalized SC therapies in which individual disease parameters influence the selection of optimal cell type, dosage and delivery approach.

Advanced Functional Biomaterials for Stem Cell Delivery in Regenerative Engineering and Medicine

“…Although pharmacological and interventional treatments are well established to relieve symptoms and complications (e.g., arrhythmia) to prevent sudden cardiac death, these strategies mostly delay death and can cause poor long‐term prognosis rather than provide functional recovery of the cardiovascular system. [1b,67] Due to the limited regenerative capacity of mature cardiomyocytes, stem cell–based therapies are considered as one of the most promising treatments to restore cardiovascular function. Clinical trials using various types of stem cells such as MSCs, hematopoietic stem cells (HSCs), and bone marrow–derived mononuclear cells (BMMNCs) showed modest improvement in functional recovery of myocardium and blood vessels due to low survival and retention rate of the transplanted cells.…”

Cardiac Progenitor Cells from Stem Cells: Learning from Genetics and Biomaterials

“…Therefore, the only long-term solution relies on heart transplantation, but this does not come without its own issues such as insufficient number of donors coupled with the requirement for a life-long immunosuppressive therapy. This catapulted research towards cell-based therapies for cardiac regeneration [13]. Cardiomyocytes are the main cardiac cell type that is lost in cardiovascular disorders, like heart failure, myocardial infarction, and ischemia, and therefore, replacing these cells could potentially restore heart function.…”

Apelin and stem cells: the role played in the cardiovascular system and energy metabolism

“…Although plenty of preclinical and clinical studies have demonstrated the potential of stem cells in the treatment of heart and vascular diseases (Chen et al, ; Hu et al, ; Nesselmann et al, ; Watt et al, ), the current cell therapy is not efficient due to the low survival and differentiation potential of stem cells after transplantation. Further investigations are needed to optimize cell therapy efficacy (Murry et al, ; Huang et al, ; van der Bogt et al, ; Der Sarkissian et al, ; Muller et al, ). Different strategies can be used to improve stem cell‐based therapies, including pre‐treatment of stem cells with cytokines and growth factors, tissue engineering, and genetic manipulation of the cells (Muller et al, ).…”

“…Further investigations are needed to optimize cell therapy efficacy (Murry et al, ; Huang et al, ; van der Bogt et al, ; Der Sarkissian et al, ; Muller et al, ). Different strategies can be used to improve stem cell‐based therapies, including pre‐treatment of stem cells with cytokines and growth factors, tissue engineering, and genetic manipulation of the cells (Muller et al, ).…”