801
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Affiliation(s)
- Harald Arnesen
- Department of Cardiology, Ullevål University Hospital, 0407 Oslo, Norway.
| | - Ketil Lunde
- Department of Cardiology, Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway
| | - Svend Aakhus
- Department of Cardiology, Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway
| | - Kolbjørn Forfang
- Department of Cardiology, Rikshospitalet-Radiumhospitalet University Hospital, Oslo, Norway
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802
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Menasché P. [Cellular therapy in cardiology]. C R Biol 2007; 330:550-6. [PMID: 17631452 DOI: 10.1016/j.crvi.2007.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 05/03/2007] [Accepted: 05/04/2007] [Indexed: 01/16/2023]
Abstract
Cardiac cell therapy has been initially designed to regenerate the infarcted myocardium through its repopulation by new cells able to restore function of scar areas. Six years after the first human application of this novel approach, it is timely appropriate to review the results of the first randomised trials in the three major indications, i.e., acute myocardial infarction, heart failure, and refractory angina. It should be recognized that the results are mixed, with benefits ranging from absent to transient and, at most, marginal. However, lessons drawn from this first wave of clinical series and the experimental data that have been concomitantly collected are multiple and highly informative. They indicate that adult stem cells, whether muscular or bone marrow-derived, fail to generate new cardiomyocytes. They suggest that the potential benefits of cardiac cell therapy are thus mediated by alternate mechanisms such as limitation of left ventricular remodelling or paracrine activation of signalling pathways involved in angiogenesis. They highlight the fact that the therapeutic benefits of grafted cells will not be fully exploited until issues of cell transfer and postengraftment survival have not been adequately addressed. These observations thus allow us to better fine-tune upcoming research, which should specifically concentrate on the development of cells featuring a true regeneration potential. In this setting, the greatest promises are currently held by embryonic stem cells.
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Affiliation(s)
- Philippe Menasché
- Département de chirurgie cardiovasculaire, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, université Paris-5, Inserm U633, 20, rue Leblanc, 75908 Paris cedex 15, France.
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803
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Napoli C, Maione C, Schiano C, Fiorito C, Ignarro LJ. Bone marrow cell-mediated cardiovascular repair: potential of combined therapies. Trends Mol Med 2007; 13:278-86. [PMID: 17574919 DOI: 10.1016/j.molmed.2007.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 04/26/2007] [Accepted: 05/25/2007] [Indexed: 01/07/2023]
Abstract
Recent evidence indicates that bone-marrow cells (BMCs) can contribute to the healing process of the injured cardiovascular system via the chemokine receptor CXCR4/SDF-1, thymosin beta(4) and integrin alpha(4)beta(1) molecular pathways. During tissue ischemia overwhelming numbers of detrimental oxygen radicals are generated, and therefore treatment with antioxidants and L-arginine, the precursor of nitric oxide (NO), could induce beneficial effects beyond those achieved by BMC transplantation alone. Recent studies have reported that BMCs have enhanced neovascularization capacity in cotreatment with alpha-tocopherol (vitamin E), ascorbic acid (vitamin C) and L-arginine. Moreover, BMC therapy can be combined with gene therapy. Clinical trials employing BMCs in the treatment of cardiovascular diseases have been completed with mixed or positive results, and several trials are ongoing. Here, we discuss the clinical potential of BMC transplantation alone and in combined therapy that aims to restore organ vascularization and function. We also consider the mechanisms of mobilization, differentiation and incorporation of BMCs.
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Affiliation(s)
- Claudio Napoli
- Department of General Pathology, Division of Clinical Pathology and Excellence Research Center on Cardiovascular Diseases, 1st School of Medicine, II University of Naples, Italy.
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804
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Baklanov DV, Moodie KM, McCarthy FE, Mandrusov E, Chiu J, Aswonge G, Cheng J, Chow M, Simons M, de Muinck ED. Comparison of transendocardial and retrograde coronary venous intramyocardial catheter delivery systems in healthy and infarcted pigs. Catheter Cardiovasc Interv 2007; 68:416-23. [PMID: 16892441 DOI: 10.1002/ccd.20841] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED We compared two routes for myocardial delivery of therapeutics, transendocardial (TE) delivery with an intramyocardial injection catheter, and retrograde coronary venous (RCV) delivery with a balloon occlusion catheter in the interventricular vein. METHODS TE and RCV injection of 15 microM, neutron-activatable microspheres was compared in healthy pigs (Group I, n = 3), pigs with a 1-week-old myocardial infarction (MI; group II, n = 5), and pigs with a 2-weeks-old MI (group III, n = 4). The MI was induced by a 1-hr balloon occlusion in the LAD. Both methods were compared in the same animal using different microspheres. The RCV catheter allowed for continuous measurement of distal pressure and 2.5 x 10(6) microspheres were injected in 10 ml at 300 mmHg above balloon occlusion pressure. The TE injections were targeted to the infarct zone and 2.5 x 10(6) microspheres were distributed over 10 injections of 200 microl. RESULTS The retention of microspheres decreased with increase in MI age, but was comparable between devices within the groups. RCV delivery resulted in (14.3 +/- 0.9)% microsphere retention in Group I, (10.3 +/- 0.2)% in Group II, and (6.4 +/- 0.1)% in group III (P < 0.05 versus group I). Microsphere retention after TE was (15.1 +/- 0.7)% in group I, (18.9 +/- 0.6)% in group II, (4.1 +/- 0.1)% in Group III (P < 0.05 versus groups I and II). The RCV catheter delivered primarily to midventricular, antero-septal segments, whereas TE targeted apical areas predominantly. CONCLUSIONS Delivery efficacy was comparable between devices in each group however RCV targeted midventricular areas whereas TE targeted apical areas.
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Affiliation(s)
- D V Baklanov
- Angiogenesis Research Center, Dartmouth Medical School, Hanover, NH, USA
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805
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Wolfram O, Jentsch-Ullrich K, Wagner A, Hammwöhner M, Steinke R, Franke A, Zupan I, Klein HU, Goette A. G-CSF-induced mobilization of CD34(+) progenitor cells and proarrhythmic effects in patients with severe coronary artery disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30 Suppl 1:S166-9. [PMID: 17302697 DOI: 10.1111/j.1540-8159.2007.00630.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Granulocyte colony stimulating factor (G-CSF) therapy has been reported to be proarrhythmic. The in vivo mobilization of endothelial progenitor cells (EPCs) and the possible proarrhythmic effects in patients with severe coronary artery disease (CAD) and inducible ischemia have not been described. METHODS We treated 8 patients (mean age = 69 +/- 10) suffering from severe CAD and angina pectoris (CCS 3 +/- 0.5) despite optimal medical therapy with subcutaneous G-CSF over 7 days to mobilize EPCs (CD34(+), CD117(+)). ECG monitoring was performed throughout the treatment period. A 24-hour ECG was recorded before and after G-CSF application. Mobilization of EPCs was monitored by fluorescent activated cell sorter (FACS-Calibur, Becton-Dickinson, Franklin Lakes, NJ, USA) analysis. Other medications remained unchanged. RESULTS G-CSF therapy significantly increased peripheral leukocyte count from 7.45 +/- 2.4 to a peak of 42.2 +/- 10.9 x 10(3)/muL with a parallel rise in CD34(+) EPCs from 4.35 +/- 1.94 to 33.0 +/- 22.8/muL. The percentage of CD34(+)/CD117(+) cells changed from 0.32 +/- 0.25 to 0.24 +/- 0.28% (day of discharge, P = ns). During continuous ECG monitoring, no significant bradycardia, tachycardia, or changes in conduction were observed. Holter data collected after 7 days of G-CSF therapy showed no significant differences from baseline. A linear correlation (r = 0.76) was observed for the absolute values of deltaP wave duration and deltaCD34(+) concentration on day 2 compared to follow-up at 142 +/- 33 days, though it did not reach statistical significance (P = 0.29). CONCLUSION This is the first study showing that mobilization of CD34(+) EPCs is safe in patients with severe CAD. The accompanying leukocytosis did not appear proarrhythmic. Changes in P wave duration might be attributable to G-CSF therapy.
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Affiliation(s)
- Oliver Wolfram
- Division of Cardiology, University Hospital Magdeburg, Magdeburg, Germany
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806
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Li ZZ, Bai SG, Huang J, Qian HY. Trans-coronary transplantation may be an optimal route in cellular cardiomyoplasty with stem cells. Med Hypotheses 2007; 69:1212-8. [PMID: 17555882 DOI: 10.1016/j.mehy.2007.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 04/17/2007] [Indexed: 10/23/2022]
Abstract
Myocardial infarction is the leading cause of congestive heart failure and death in the industrialized world. However, the intrinsic repair mechanism of the injured heart and current therapeutic means are inadequate to regenerate lost myocardium. Recent interests focused on cellular cardiomyoplasty which is an outside intervention to support the reparative process in the heart through transplantation of stem/progenitor cells. Cellular myocardioplasty with stem cells is a possible option to reverse the adverse hemodynamic and neurohormonal imbalance after myocardial infarction. Experimental studies and clinical trials suggest that cellular cardiomyoplasty with stem/progenitor cells may improve cardiac function and prevent ventricular remodeling of the injured heart. Although the mechanisms are still in intensive debate, cellular cardiomyoplasty with stem cells has already been introduced into the clinical settings. However, it is an important challenge how donor cells are delivered to the targeted area. In early studies in animals, intramyocardial injection of stem cells after thoracotomy is the main transplantation route which is not suitable to most patients in clinical settings. Then the catheter-based infusion of stem cells is clinically introduced and rapidly developed because of its safety, convenience and micro-invasion. We hypothesize that catheter-based transplantation with stem cells may be a promising means to treat ischemic heart diseases in the future in clinical settings.
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Affiliation(s)
- Zhi-Zhong Li
- Emergency Center of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital University of Medical Sciences, An Zhen Li, An Ding Men Wai, Chao Yang District, Beijing 100029, PR China.
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807
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Penicka M, Horak J, Kobylka P, Pytlik R, Kozak T, Belohlavek O, Lang O, Skalicka H, Simek S, Palecek T, Linhart A, Aschermann M, Widimsky P. Intracoronary Injection of Autologous Bone Marrow-Derived Mononuclear Cells in Patients With Large Anterior Acute Myocardial Infarction. J Am Coll Cardiol 2007; 49:2373-4. [PMID: 17572255 DOI: 10.1016/j.jacc.2007.04.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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808
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Cubbon RM, Rajwani A, Wheatcroft SB. The impact of insulin resistance on endothelial function, progenitor cells and repair. Diab Vasc Dis Res 2007; 4:103-11. [PMID: 17654443 DOI: 10.3132/dvdr.2007.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The structural and functional integrity of the vascular endothelium plays a critical role in vascular homeostasis. Insulin resistance, an important risk factor for cardiovascular disease, is thought to promote atherosclerosis through a reciprocal relationship with endothelial dysfunction. In health, cumulative damage to endothelial cells incurred by exposure to risk factors is mitigated by endogenous reparative processes. Disruption of the balance between endothelial damage and repair may mediate atherosclerotic progression. Bone marrow-derived 'endothelial progenitor cells' (EPC) have been identified as significant contributors to endogenous vascular repair. Insulin resistance is associated with a spectrum of biochemical abnormalities which have the potential to reduce the availability of EPCs and diminish their capacity for vascular repair. Many lifestyle and pharmacological interventions which improve insulin resistance also increase the numbers and functionality of EPCs. Cell-based therapies may also hold promise for the prevention and treatment of cardiovascular disease.
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Affiliation(s)
- Richard M Cubbon
- The Academic Unit of Cardiovascular Medicine, The LIGHT Laboratories, University of Leeds, Clarendon Way, Leeds, UK
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809
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810
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Tomescot A, Leschik J, Bellamy V, Dubois G, Messas E, Bruneval P, Desnos M, Hagège AA, Amit M, Itskovitz J, Menasché P, Pucéat M. Differentiation in vivo of cardiac committed human embryonic stem cells in postmyocardial infarcted rats. Stem Cells 2007; 25:2200-5. [PMID: 17540853 DOI: 10.1634/stemcells.2007-0133] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Human embryonic stem (HES) cells can give rise to cardiomyocytes in vitro. However, whether undifferentiated HES cells also feature a myocardial regenerative capacity after in vivo engraftment has not been established yet. We compared two HES cell lines (HUES-1 and I6) that were specified toward a cardiac lineage by exposure to bone morphogenetic protein-2 (BMP2) and SU5402, a fibroblast growth factor receptor inhibitor. Real-time polymerase chain reaction (PCR) revealed that the cardiogenic inductive factor turned on expression of mesodermal and cardiac genes (Tbx6, Isl1, FoxH1, Nkx2.5, Mef2c, and alpha-actin). Thirty immunosuppressed rats underwent coronary artery ligation and, 2 weeks later, were randomized and received in-scar injections of either culture medium (controls) or BMP2 (+/-SU5402)-treated HES cells. After 2 months, human cells were detected by anti-human lamin immunostaining, and their cardiomyocytic differentiation was evidenced by their expression of cardiac markers by reverse transcription-PCR and immunofluorescence using an anti-beta myosin antibody. No teratoma was observed in hearts or any other organ of the body. The ability of cardiac-specified HES cells to differentiate along the cardiomyogenic pathway following transplantation into infarcted myocardium raises the hope that these cells might become effective candidates for myocardial regeneration.
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Affiliation(s)
- André Tomescot
- Institut National de la Santé et de la Recherche Médicale/Evry University Unité Mixte de Recherche 861, I-Stem, Association Française contre les Myopathies, 5, rue Desbrières, Evry 91030, France
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811
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García-Moll X, Bardají A, Alonso J, Bueno H. [Ischemic heart disease: 2006 update]. Rev Esp Cardiol 2007; 60 Suppl 1:3-18. [PMID: 17352852 DOI: 10.1157/13099709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article contains a review of the main developments reported in publications and conference presentations in 2006 on the pathophysiology, secondary prevention, prognosis, and treatment of ST-segment elevation and non-ST-segment elevation acute coronary syndrome. The latest clinical practice guidelines are also discussed.
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Affiliation(s)
- Xavier García-Moll
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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812
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Seguin T, Braun T, Mira JP. [Endothelial progenitor cells: new biomarkers and potential therapy in intensive care]. Med Mal Infect 2007; 37:305-11. [PMID: 17512151 DOI: 10.1016/j.medmal.2007.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 03/12/2007] [Indexed: 11/25/2022]
Abstract
One of the most important breakthroughs in the field of vascular biology in the last decade was the discovery of endothelial progenitor cells (EPCs). These angiogenic cells dwell in bone marrow, and may be found in the general circulation spontaneously or in response to various stimuli such as ischemia, growth factor, pro-inflammatory cytokines, and drugs such as statins. There is growing evidence that EPCs can differentiate into mature endothelial cells and facilitate endothelial repair and angiogenesis in vivo. In recent years, consistent publications have shown that EPCs provide both diagnostic and prognostic information with respect to cardiovascular diseases, acute lung injury, and sepsis. Activation of EPCs from the bone marrow or injection of these cells may be used as a therapeutic option for the treatment of ischemic cardiovascular diseases.
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Affiliation(s)
- T Seguin
- Service de réanimation médicale, CHU de Cochin-Saint-Vincent-de-Paul, Assistance publique - Hôpitaux de Paris, université Paris-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
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813
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Jolicoeur EM, Granger CB, Fakunding JL, Mockrin SC, Grant SM, Ellis SG, Weisel RD, Goodell MA. Bringing cardiovascular cell-based therapy to clinical application: perspectives based on a National Heart, Lung, and Blood Institute Cell Therapy Working Group meeting. Am Heart J 2007; 153:732-42. [PMID: 17452146 DOI: 10.1016/j.ahj.2007.02.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 02/26/2007] [Indexed: 10/23/2022]
Abstract
This article reviews the progress in cell therapy for cardiovascular disease and examines the opportunities to accelerate the process to clinical application. It draws from a meeting of the National Heart, Lung, and Blood Institute Working Group on Translation of Cell-based Therapies for Cardiovascular Disease in August 2004 to assess the status of clinical studies of cell-based therapies for cardiovascular disease, to determine the gaps in knowledge and barriers that prevent the implementation of well-designed and safe clinical studies, and to identify the areas of opportunity to apply cell-based therapies for cardiovascular disease to facilitate the clinical implementation of cell-based therapies for cardiovascular disease. We present the perspectives of experts in stem cell biology, cardiovascular physiology, cardiology, clinical research, and regulatory issues confronting the field of cell therapy for cardiovascular disease.
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814
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Abstract
The objective of cardiac cell therapy is to restore cardiac function in infarct zones. This therapy has been tested for two primary diagnoses: chronic heart failure and acute myocardial infarction. Clinical trials have showed that cardiac cell therapy is safe and that its results in terms of efficacy appear encouraging. Three challenges remain to obtain optimal therapeutic benefits: prevent the migration of these cells, increase their survival, and improve their integration into the recipient myocardium.
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Affiliation(s)
- Philippe Menasché
- AP-HP, Département de chirurgie cardiovasculaire, Hôpital européen Georges Pompidou, Paris, France.
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815
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Affiliation(s)
- A Sánchez
- Instituto de Biología y Genética Molecular, Universidad de Valladolid y Consejo Superior de Investigaciones Científicas, Valladolid, Spain.
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816
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Metharom P, Doyle B, Caplice NM. Clinical trials in stem cell therapy: pitfalls and lessons for the future. ACTA ACUST UNITED AC 2007; 4 Suppl 1:S96-9. [PMID: 17230223 DOI: 10.1038/ncpcardio0730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 10/19/2006] [Indexed: 11/09/2022]
Abstract
The first human trial of stem cell therapy for cardiovascular disease was performed 4 years ago. Since that time, almost a dozen studies have reported the early and late clinical effects of cell therapy in acute myocardial infarction and chronic ischemic cardiomyopathy. Initial nonrandomized trials universally showed slight improvement in the left ventricular ejection fraction. Later randomized, controlled trials, however, suggested a less significant effect. They showed either no difference between cell therapy and control treatment or a slight treatment benefit with cell therapy that is lost by 12 months' follow-up. These results have dampened the enthusiasm of some members of the scientific community for the continuation of clinical trials. Because early phase I trials should not be judged on issues other than safety, however, research is unlikely to be hindered. Indeed, the clinical studies reported so far have already taught us a lot about the biology of myocardial repair. Achieving clinical success will, however, probably require much more investment in basic and experimental research. Here, we address some of the current pitfalls in clinical cell therapy trials and lessons that should be learned as we face the challenges of the future.
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Affiliation(s)
- Pat Metharom
- Center for Research in Vascular Biology, Cork, Ireland
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817
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Fuster V, Sanz J. Gene therapy and stem cell therapy for cardiovascular diseases today: a model for translational research. ACTA ACUST UNITED AC 2007; 4 Suppl 1:S1-8. [PMID: 17230204 DOI: 10.1038/ncpcardio0737] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 11/01/2006] [Indexed: 11/09/2022]
Abstract
Clinical trials looking at ways to promote myocardial regeneration have reported that the administered therapies have either neutral effects or modest benefits of questionable impact. These somewhat disappointing results should emphasize the need for translational research, with bidirectional feedback between the basic research laboratory and the clinical arena. Such a translational pathway is illustrated by the quest to find an effective therapy for restenosis, which culminated in the development of sirolimus. At this point a move away from the bedside and a return to the bench seems necessary to better understand the mechanisms of action of progenitor cells and stimulating factors. Without such basic knowledge research might be prematurely discouraged and the opportunity to fully understand the true potential of cardiovascular regenerative therapy might be missed.
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Affiliation(s)
- Valentin Fuster
- The Zena and Michael A Wiener Cardiovascular Institute and The Marie-Josee and Henry R Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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818
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Sherman W, Cho C, Martens TP. Burning Questions in Heart Failure Management: Why Do Surgeons and Interventional Cardiologists Talk of Regenerative Cell Therapy? Heart Fail Clin 2007; 3:245-52. [PMID: 17643925 DOI: 10.1016/j.hfc.2007.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
That cardiac regeneration is remotely feasible elicits thoughts of curing one of the most debilitating of human diseases. The term stem cell brings to the surface many hopes, and concerns, among physicians and the public alike, both of which have come to expect frequent advances in medical therapeutics. The evolution of public opinion toward embryonic stem cell research is clear and positive, and, unfortunately, overshadows, even confuses, that of adult stem cells, despite their use in essentially all clinical studies of cardiovascular disease to date. Strange, perhaps, that the voices of cardiovascular specialists are not to be heard.
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Affiliation(s)
- Warren Sherman
- College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA.
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819
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Suárez de Lezo J, Herrera C, Pan M, Romero M, Pavlovic D, Segura J, Sánchez J, Ojeda S, Torres A. Tratamiento regenerativo en pacientes con infarto agudo anterior revascularizado y función ventricular deprimida. Rev Esp Cardiol 2007. [DOI: 10.1157/13101639] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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820
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Robey TE, Murry CE. Absence of regeneration in the MRL/MpJ mouse heart following infarction or cryoinjury. Cardiovasc Pathol 2007; 17:6-13. [PMID: 18160055 DOI: 10.1016/j.carpath.2007.01.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 11/27/2006] [Accepted: 01/10/2007] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Myocardial infarcts in mammals heal by scar formation rather than formation of new muscle tissue. The MRL/MpJ [Murphy Roths large (MRL) derived by the Murphy group of the Jackson Laboratory (MpJ)] mouse, however, has been reported to exhibit minimal scarring and subsequent cardiac regeneration after cryoinjury of the right ventricle. Other groups have reported that permanent and temporary ligation of the coronary artery resulted in scarring without regeneration. METHODS To clarify these contradictory results, we studied the temporal evolution of infarcts in MRL/MpJ and C57BL/6 control mice from 1 to 90 days post injury and the effects of intrathoracic cryoinjury to 28 days. RESULTS After infarction, the conversion from necrotic myocardium to granulation tissue and then to scar proceeded identically in the two groups. Infarct DNA synthesis, measured by incorporation of a 5-bromo-2-deoxyuridine pulse, peaked at 4 days in both strains and did not differ between strains at any time point. Endothelial cell and total vascular density in the both the infarcted and noninfarcted cardiac tissue did not differ between groups at any time. Histological analysis of directly cryoinjured right and left ventricular myocardium showed indistinguishable wound healing in both strains, and final scar size was identical in each group. CONCLUSIONS These studies demonstrate that both myocardial infarcts and cryoinjuries in MRL/MpJ mice heal by typical scar formation rather than muscle regeneration, in a manner very similar to C57BL/6 controls. We conclude that the MRL mouse is not a model for myocardial regeneration.
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Affiliation(s)
- Thomas E Robey
- Department of Bioengineering and Pathology, Center for Cardiovascular Biology, Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA
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821
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Smadja DM, Cornet A, Emmerich J, Aiach M, Gaussem P. Endothelial progenitor cells: characterization, in vitro expansion, and prospects for autologous cell therapy. Cell Biol Toxicol 2007; 23:223-39. [PMID: 17370127 DOI: 10.1007/s10565-007-0177-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 12/15/2006] [Indexed: 01/14/2023]
Abstract
Injection of hematopoietic stem cells or endothelial progenitor cells (EPCs) expanded ex vivo has been shown to augment neovascularization in adult patients, but the precise origin and identity of the cell population responsible for these clinical benefits are controversial. The limited quantity of EPCs in the circulation has been the main obstacle to clinical trials. Several authors have therefore attempted to expand these cells ex vivo in order to obtain a homogeneous cell therapy product. One possible means of expanding EPCs ex vivo is to activate the thrombin receptor PAR-1 with the specific peptide SFLLRN. Indeed, PAR-1 activation promotes cell proliferation and C-X-C chemokine receptor type 4 (CXCR4) dependent migration and differentiation, with an overall angiogenic effect. This review summarizes the results and rationale of clinical trials of angiogenic therapy, the nature of EPCs, the different methods of ex vivo expansion, and current methods of quantification.
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MESH Headings
- Angiogenesis Inducing Agents/pharmacology
- Animal Testing Alternatives
- Animals
- Bone Marrow Transplantation/methods
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Cells, Cultured
- Clinical Trials as Topic
- Endothelium, Vascular/cytology
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/transplantation
- Hematopoietic Stem Cells/cytology
- Hematopoietic Stem Cells/physiology
- Humans
- Ischemia/therapy
- Neovascularization, Physiologic/drug effects
- Neovascularization, Physiologic/physiology
- Peptide Fragments/pharmacology
- Receptor, PAR-1/drug effects
- Receptor, PAR-1/metabolism
- Receptors, CXCR4/drug effects
- Receptors, CXCR4/metabolism
- Transplantation, Autologous
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822
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Crespo Leiro MG, Jiménez-Navarro M, Cabrera Bueno F, Sánchez PL. [Heart failure in 2006]. Rev Esp Cardiol 2007; 60 Suppl 1:58-67. [PMID: 17352856 DOI: 10.1157/13099713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This article are summarizes the most relevant articles in the field of heart failure including epidemiology, diagnostic and therapeutic issues. Therapy includes drugs, cardiac resinchronization therapy, automatic implantable defibrillator, heart transplantation and cell therapy. Stem cell therapy is feasible and short term data indicates it is safe. However there are unresolved concerns on arrhythmias, restenosis and efficacy. At this point experts recommend that medium-sized randomized controlled trials, using surrogate endpoints, should be carried out to establish the efficacy and safety of this form of treatment.
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Affiliation(s)
- María G Crespo Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, España.
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823
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Hernández Antolín RA, Fernández-Vázquez F, Moreu Burgo J, López Palop R. [Interventional cardiology 2006]. Rev Esp Cardiol 2007; 60 Suppl 1:19-32. [PMID: 17352853 DOI: 10.1157/13099710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The range of applications of percutaneous coronary intervention (PCI) continues to expand and a growing number of patients are being treated, including those with extensive cardiovascular disease, more serious comorbid conditions, and more complex lesions. Even so, the success rate is high, serious complications are rare in stable patients, and the restenosis rate has been dramatically reduced by drug-eluting stents. Nevertheless, percutaneous techniques still have major limitations restricting their use in some type of lesions, such as bifurcations and total occlusions, and their role in relation to surgical revascularization has not yet been well defined in the treatment of the left main coronary artery or multivessel disease. The development of novel types of coated stent with better mechanical characteristics and a lower risk of occlusion will further expand the ambit of PCI. The role of PCI in the management of acute coronary syndromes is already well defined, and has increased the preference for an invasive rather than a conservative approach in high-risk patients without ST elevation and the preference for primary angioplasty rather than thrombolysis in those with ST elevation. The development and implementation of integrated coronary syndrome treatment networks will enable human and material resources to be used efficiently, and will guarantee rapid access to high-quality PCI for those who need it. The potential usefulness of combining cellular therapy with interventional procedures in the treatment of acute myocardial infarction has still to be determined. At present, there is extensive research into noncoronary interventions, which, in the not too distant future, could provide percutaneous treatment for the many elderly patients with severe aortic stenosis who are not currently eligible for surgery.
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824
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Shantsila E, Watson T, Lip GYH. Endothelial progenitor cells in cardiovascular disorders. J Am Coll Cardiol 2007; 49:741-52. [PMID: 17306702 DOI: 10.1016/j.jacc.2006.09.050] [Citation(s) in RCA: 326] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 09/27/2006] [Accepted: 11/28/2006] [Indexed: 12/22/2022]
Abstract
The important role of the vascular endothelium in cardiovascular health is increasingly recognized. However, mature endothelial cells possess limited regenerative capacity. There is therefore much interest in circulating endothelial progenitor cells (EPCs) among the scientific community, especially into their purported role in maintenance of endothelial integrity and function, as well as postnatal neovascularization. It has been suggested that these cells might not only be responsible for the continuous recovery of the endothelium after injury/damage, but also might take part in angiogenesis, giving the hope of new treatment opportunities. Indeed, there is accumulating evidence showing reduced availability and impaired EPC function in the presence of both cardiovascular disease and associated comorbid risk factors. Thus, many studies into the potential for use of EPCs in the clinical setting are being undertaken. The goal of this review article is to provide an overview of data relevant to the clinical role of EPCs and perspectives for treatment of cardiovascular disorders.
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Affiliation(s)
- Eduard Shantsila
- Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, England
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825
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Beeres SLMA, Bengel FM, Bartunek J, Atsma DE, Hill JM, Vanderheyden M, Penicka M, Schalij MJ, Wijns W, Bax JJ. Role of imaging in cardiac stem cell therapy. J Am Coll Cardiol 2007; 49:1137-48. [PMID: 17367656 DOI: 10.1016/j.jacc.2006.10.072] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 10/11/2006] [Accepted: 10/23/2006] [Indexed: 12/17/2022]
Abstract
Stem cell therapy has emerged as a potential therapeutic option for cell death-related heart diseases. Preclinical and a number of early phase human studies suggested that cell therapy may augment perfusion and increase myocardial contractility. The rapid translation into clinical trials has left many issues unresolved, and emphasizes the need for specific techniques to visualize the mechanisms involved. Furthermore, the clinical efficacy of cell therapy remains to be proven. Imaging allows for in vivo tracking of cells and can provide a better understanding in the evaluation of the functional effects of cell-based therapies. In this review, a summary of the most promising imaging techniques for cell tracking is provided. Among these are direct labeling of cells with super-paramagnetic agents, radionuclides, and the use of reporter genes for imaging of transplanted cells. In addition, a comprehensive summary is provided of the currently available studies investigating a cell therapy-related effect on left ventricular function, myocardial perfusion, scar tissue, and myocardial viability.
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Affiliation(s)
- Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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826
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Abstract
PURPOSE OF REVIEW Cardiac transplantation is a complex undertaking and an imperfect solution to end-stage heart failure. Cellular transplantation has been proposed as an alternative solution; however, clinical trials at present are small and show variable results. The mechanisms behind stem cell therapy have not yet been elucidated. RECENT FINDINGS Several large trials have been presented that address the question of bone marrow stem cells as therapy for acute myocardial infarction, and also the possible benefits of therapy with granulocyte colony-stimulating factor. Although some trials show a modest improvement in ejection fraction or reduction of infarct size, other trials show no change with treatment. Fewer clinical data are available on the treatment of chronic left ventricular systolic function. Many questions remain such as what cell type to use, dosing, the ideal timing for therapy, and the technique of cell delivery. Finally, further research continues on the cellular milieu, enhancement of cell engraftment, proliferation, and survival. SUMMARY This review briefly examines the background for stem cell therapy, as well as the larger clinical trials of stem cell therapy for acute myocardial infarction and chronic left ventricular systolic dysfunction, and possible pharmacologic enhancement options.
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Affiliation(s)
- Rebecca Allan
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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827
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Vandervelde S, van Luyn MJA, Rozenbaum MH, Petersen AH, Tio RA, Harmsen MC. Stem cell-related cardiac gene expression early after murine myocardial infarction. Cardiovasc Res 2007; 73:783-93. [PMID: 17208206 DOI: 10.1016/j.cardiores.2006.11.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 11/23/2006] [Accepted: 11/24/2006] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Clinical experimental stem cell therapy after myocardial infarction appears feasible, but its use has preceded the understanding of the working mechanism. The ischemic recipient cardiac environment is determinative for the attraction and subsequent fate of stem cells. Here, we studied expression levels of genes that are anticipated to be essential for adequate stem cell-based cardiac repair at various time-points during the 1 month period following myocardial infarction (MI). METHODS Gene expression in the hearts of mice that underwent MI by permanent or transient (30 min) ligation of the coronary artery was monitored using quantitative RT-PCR analysis of mRNA isolated from whole heart sections as well as from specific, laser micro-dissected, regions of sections. Protein expression was performed by immunohistochemical stainings and Western blot analysis. RESULTS Many inflammatory genes were highly expressed for at least 1 week after MI. The expression of pro-angiogenic genes such as bFGF, VEGF-A and VEGF-R2 changed only marginally post-MI. Markers used to test stem cell gene expression remained unchanged post-MI with the exception of G-CSF and GM-CSF, which are genes that are also known to enhance the inflammatory response. Analysis of micro-dissected regions revealed that SDF-1, SCF (both stem cell attractants) and VEGF-R2 (involved in angiogenesis) gene expression was slightly decreased especially in the infarcted region. CONCLUSION Genes that are generally considered to participate in stem cell-related processes and angiogenesis were not upregulated after MI, whereas the inflammatory gene expression dominated. Modulation of this imbalance might be of value for stem cell-mediated therapy.
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Affiliation(s)
- Susanne Vandervelde
- University of Groningen, University Medical Center Groningen, Department of Pathology and Laboratory Medicine, Section Medical Biology (MB Z1.17), Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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828
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Ylä-Herttuala S, Rissanen TT, Vajanto I, Hartikainen J. Vascular endothelial growth factors: biology and current status of clinical applications in cardiovascular medicine. J Am Coll Cardiol 2007; 49:1015-26. [PMID: 17349880 DOI: 10.1016/j.jacc.2006.09.053] [Citation(s) in RCA: 322] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 09/22/2006] [Accepted: 09/27/2006] [Indexed: 12/12/2022]
Abstract
Members of the vascular endothelial growth factor (VEGF) family are among the most powerful modulators of vascular biology. They regulate vasculogenesis, angiogenesis, and vascular maintenance during embryogenesis and in adults. Because of their profound effects on blood vessels, VEGFs have received much attention regarding their potential therapeutic use in cardiovascular medicine, especially for therapeutic vascular growth in myocardial and peripheral ischemia. However, completed randomized controlled VEGF trials have not provided convincing evidence of clinical efficacy. On the other hand, recent preclinical proangiogenic VEGF studies have given insight, and anti-VEGF studies have shown that the disturbance of vascular homeostasis by blocking VEGF-A may lead to endothelial dysfunction and adverse vascular effects. Excess VEGF-A may contribute to neovascularization of atherosclerotic lesions but, currently, there is no evidence that transient overexpression by gene transfer could lead to plaque destabilization. Here, we review the biology and effects of VEGFs as well as the current status of clinical applications and future perspectives of the therapeutic use of VEGFs in cardiovascular medicine.
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Affiliation(s)
- Seppo Ylä-Herttuala
- Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute, Kuopio University, Kuopio, Finland.
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829
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Farooq M, Qureshi AS, Squire IB. Early management of ST elevation myocardial infarction: a review of practice. Expert Opin Pharmacother 2007; 8:401-13. [PMID: 17309335 DOI: 10.1517/14656566.8.4.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The last two decades of the 20th century witnessed continuous evolution in the understanding of the pathophysiology of ST elevation myocardial infarction. In parallel, the management of these patients developed steadily throughout this time and into the early years of the 21st century. From humble beginnings involving oxygen therapy, bed rest and analgesia, the relative merits of different strategies to open 'infarct-related arteries' (IRAs) are now being debated: pharmacological reperfusion, mechanical reperfusion or a combination of both these modalities. The current understanding of the process of thrombotic occlusion of the coronary artery has led to the appreciation of the importance of not simply opening the IRA, but also maintaining its patency once opened. Considerable attention is now being afforded to the significant minority of patients who do not achieve early, complete myocardial reperfusion, despite restoration of adequate flow down the epicardial IRA. Those patients who fail to achieve myocardial reperfusion, either due to late presentation or failure of reperfusion therapy, and are left with permanent myocardial scarring can now be considered. This article critically appraises the recent and emerging evidence and clinical implications of the contemporary management of ST elevation myocardial infarction.
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Affiliation(s)
- Mohsin Farooq
- Department of Cardiology, University Hospitals of Leicester, Leicester, UK
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830
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Penn MS. Cell-based gene therapy for the prevention and treatment of cardiac dysfunction. ACTA ACUST UNITED AC 2007; 4 Suppl 1:S83-8. [PMID: 17230220 DOI: 10.1038/ncpcardio0733] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 10/18/2006] [Indexed: 11/08/2022]
Abstract
A substantial need exists for new treatments to prevent and treat cardiac dysfunction. In the 1990s, there was great hope for gene therapy in this regard. Since that time, the focus has switched to cell therapy-in particular, therapy-with the aim of inducing myocardial regeneration. Individually, gene and cell therapies still have substantial promise. Ultimately, however, the convergence of both techniques might be necessary to achieve improvements in cardiac function and more successful clinical outcomes in patients with cardiac dysfunction. This approach has already been adopted for treatment of malignancies. Several gene products are currently being studied, including growth factors and chemokines that can modulate the survival and function of cardiac myocytes following an ischemic event and influence remodeling of the left ventricle. However, several issues remain, including the optimization and characterization of cell types, selection of vectors for gene transfer, and identification of appropriate strategies for delivery. Here, we review the potential and need for cell-based gene therapy for the prevention and treatment of cardiac dysfunction and attempt to discuss the unresolved issues.
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Affiliation(s)
- Marc S Penn
- NE3, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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831
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Ince H, Nienaber CA. Granulocyte-colony-stimulating factor in acute myocardial infarction: future perspectives after FIRSTLINE-AMI and REVIVAL-2. ACTA ACUST UNITED AC 2007; 4 Suppl 1:S114-8. [PMID: 17230208 DOI: 10.1038/ncpcardio0731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 10/12/2006] [Indexed: 02/03/2023]
Abstract
Granulocyte-colony-stimulating factor (G-CSF) seems to have direct cardioprotective effects related to mobilization of autologous bone-marrow mononuclear CD34(+) cells. These properties have attracted the attention of researchers investigating new therapeutic strategies for acute myocardial infarction. The role of G-CSF in bone-marrow cell mobilization removes the need for bone-marrow aspiration and repeated invasive procedures. This factor, coupled with the fact that G-CSF can be administered by noninvasive subcutaneous injection, give this approach a potential advantage over other cell-therapy options. This article is intended to present a concise overview of the current experimental and clinical findings for G-CSF therapy after acute myocardial infarction. In particular, we discuss the conflicting findings from the front-integrated revascularization and stem cell liberation in evolving acute myocardial infarction (FIRSTLINE-AMI) and the Regenerate Vital Myocardium by Vigorous Activation of Bone Marrow Stem Cells (REVIVAL-2) studies.
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Affiliation(s)
- Hüseyin Ince
- Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Strasse 6, 18057 Rostock, Germany.
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832
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Autologous transplantation of mononuclear bone marrow cells in patients with chronic myocardial infarction. COR ET VASA 2007. [DOI: 10.33678/cor.2007.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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833
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Balogh L, Czuriga I, Hunyadi J, Galuska L, Kristóf E, Edes I. Effects of autologous bone marrow derived CD34+ stem cells on the left ventricular function following myocardial infarction. Orv Hetil 2007; 148:243-9. [PMID: 17344174 DOI: 10.1556/oh.2007.27994] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A kísérletes és az utóbbi 5 évben végzett humán klinikai vizsgálatok szerint a csontvelői eredetű sejtek részt vesznek a miokardiális infarktus gyógyulási folyamatában. Számos kisebb klinikai vizsgálatban mutattak ki enyhe vagy mérsékelt fokú kedvező hatást a miokardiális infarktus után intracoronariásan beadott csontvelői eredetű őssejtekkel. Mivel a legtöbb eddigi vizsgálatban mononukleáris frakciót használtak, a sejtpopuláció sokfélesége miatt nem volt ismert, hogy melyik a hatásos szubpopuláció. 8 miokardiális infarktust szenvedett, csökkent bal kamra funkciójú betegben vizsgáltuk az akut coronaria esemény után 12 ± 1 nappal intracoronariásan végzett CD34+ saját csontvelői őssejt beültetés biztonságosságát és hatékonyságát. 2D-echocardiographia, FDG-PET és MIBI-SPECT vizsgálatot végeztünk a beültetés előtt és 6 hónappal azt követően. A 6 hónapos követés során szignifikánsan javult a globális bal kamra funkció (alap EF 37,3 ± 2,9%, sejt kezelés után 44,8 ± 4,1%; p = 0,0041) és a regionális viabilitás / metabolizmus (17,6 ± 13,5%-kal; p < 0,05). A szívizom elhalt részének perfúziójában nem szignifikáns tendenciózus növekedést észleltünk. Eredményeinkkel elsőként mutattuk ki, hogy a CD34+ csontvelői sejt szubpopuláció javítja a bal kamra funkciót és a metabolizmust miokardiális infarktust követően.
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Affiliation(s)
- László Balogh
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Altalános Orvostudományi Kar Kardiológiai Intézet, Debrecen Pf. 1. 4004
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834
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Stamm C, Kleine HD, Choi YH, Dunkelmann S, Lauffs JA, Lorenzen B, David A, Liebold A, Nienaber C, Zurakowski D, Freund M, Steinhoff G. Intramyocardial delivery of CD133+ bone marrow cells and coronary artery bypass grafting for chronic ischemic heart disease: safety and efficacy studies. J Thorac Cardiovasc Surg 2007; 133:717-25. [PMID: 17320570 DOI: 10.1016/j.jtcvs.2006.08.077] [Citation(s) in RCA: 248] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 07/30/2006] [Accepted: 08/03/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Cell therapy may offer novel therapeutic options for chronic ischemic heart disease. In a clinical trial, we first assessed the feasibility and safety of intramyocardial CD133+ bone marrow cell injection together with coronary artery bypass grafting (CABG). We then tested the hypothesis that CABG plus CD133+ cell injection would result in better contractile function than CABG alone. METHODS Fifteen patients took part in the safety study, followed by 40 patients who underwent either CABG with cell therapy or CABG alone. Bone marrow was harvested from the iliac crest one day before surgery, and purified CD133+ progenitor cells were injected in the infarct border zone during the CABG operation. LV function was measured by echocardiography and myocardial perfusion by SPECT. RESULTS In the safety study, no procedure-related complications were observed for up to 3 years. LV injection fraction (LVEF) increased from 39.0% +/- 8.7% preoperatively to 50.2% +/- 8.5% at 6 months and 47.9% +/- 6.0% at 18 months (F = 6.03, P = .012). In the efficacy study, LCEF rose form 37.4% +/- 8.4% to 47.1% +/- 8.3% at 6 months in the group with CABG and cell therapy (F = 24.16, P < .0001) but only from 37.9% +/- 10.3% to 41.3% +/- 9.1% in the CABG-only group (F = 7.72, P = .012). LVEF was significantly higher at 6 months in the group with CABG and cell therapy than in the CABG-only group (P = .03). Similarly, perfusion of the infarcted myocardium improved more in patients treated with CABG and cell therapy than in those treated with CABG alone. CONCLUSION Intramyocardial delivery of purified bone marrow stem cells together with CABG surgery is safe and provides beneficial effects, though it remains to be seen whether thewe effects produce a lasting clinical advantage.
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Affiliation(s)
- Christof Stamm
- Department of Cardiac Surgery, University of Rostock, Rostock, Germany
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835
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Bartunek J, Vanderheyden M, Wijns W, Timmermans F, Vandekerkhove B, Villa A, Sánchez PL, Arnold R, San Román JA, Heyndrickx G, Fernandez-Aviles F. Bone-marrow-derived cells for cardiac stem cell therapy: safe or still under scrutiny? ACTA ACUST UNITED AC 2007; 4 Suppl 1:S100-5. [PMID: 17230205 DOI: 10.1038/ncpcardio0744] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 11/01/2006] [Indexed: 01/14/2023]
Abstract
Cardiac stem cell therapy with bone-marrow-derived stem cells is a promising approach to facilitate myocardial regeneration after acute myocardial infarction or in congestive heart failure. The clinical data currently available seem to indicate that this approach is safe and is not associated with an increase in the number of adverse clinical events; nevertheless, the level of safety confidence is limited because of the small number of patients who have been treated and the absence of long-term clinical follow-up data. In order to establish the clinical safety of cardiac stem cell therapy, it will be necessary to collect additional data from both previous and ongoing clinical trials in subsets of patients relative to their background risk. Several conceptual safety concerns should also be addressed. These concerns relate to a number of operational mechanisms and include biological effects on differentiation, remote homing of transplanted stem cells, progression of atherosclerosis, and arrhythmias. The proactive scrutiny of these phenomena could eventually facilitate the translation of the promise of cardiac regeneration into a safe and effective therapy.
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Affiliation(s)
- Jozef Bartunek
- Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, 9 300 Aalst, Belgium.
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836
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Lucignani G. Molecular imaging is indispensable for the development of stem cell-based myocardial regenerative therapy. Eur J Nucl Med Mol Imaging 2007; 34:422-5. [PMID: 17245530 DOI: 10.1007/s00259-007-0369-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Giovanni Lucignani
- Institute of Radiological Sciences, University of Milan, Unit of Nuclear Medicine, Hospital San Paolo, Milan, Italy.
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837
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Hristov M, Heussen N, Schober A, Weber C. Intracoronary infusion of autologous bone marrow cells and left ventricular function after acute myocardial infarction: a meta-analysis. J Cell Mol Med 2007; 10:727-33. [PMID: 16989732 PMCID: PMC3933154 DOI: 10.1111/j.1582-4934.2006.tb00432.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recent clinical studies have demonstrated that intracoronary infusion of autologous bone marrow cells (BMC) in conjunction with standard treatment may improve left ventricular function after an acute myocardial infarction (AMI). However, the results of these studies remain controversial, as the studies were relatively small in size and partially differed in design. We reviewed primary controlled randomized clinical studies comparing intracoronary transfer of autologous non-mobilized BMC combined with standard therapy versus standard therapy alone in patients with AMI. We identified five randomized controlled clinical trials, three of which were also placebo- and bone marrow aspiration-controlled. Non-mobilized BMC were infused into the revascularized coronary target artery 6.6 +/- 6.1 days after AMI. The mean follow- up period of 5.2 +/- 1.1 months was completed by 482 patients, 241 of which received infusion of BMC. The effect of BMC on left ventricular ejection fraction (LVEF) as a major functional parameter was evaluated. Analyzing the overall effect on the change in LVEF between baseline and follow-up value revealed a significant improvement in the BMCtreated group as compared to the control group (P = 0.04). Thus, considering the increase in LVEF during follow-up, transplantation of BMC may be a safe and beneficial procedure to support treatment of AMI. However, the functional improvement observed with this form of therapy was altogether relatively moderate and the studies were heterogeneous in design. Hence, further efforts aiming at large-scale, double-blind, randomized and placebo-controlled multi-center trials in conjunction with better definition of patients, which benefit from BMC infusion, appear to be warranted.
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Affiliation(s)
- M Hristov
- Institute for Molecular Cardiovascular Research (IMCAR) and Interdisciplinary Center for Clinical Research “BIOMAT”, RWTH University Hospital AachenAachen, Germany
| | - Nicole Heussen
- Institute for Medical Statistics, RWTH University Hospital AachenAachen, Germany
| | - A Schober
- Department of Cardiology, Ludwig-Maximilians-University MünchenGermany
| | - C Weber
- Institute for Molecular Cardiovascular Research (IMCAR) and Interdisciplinary Center for Clinical Research “BIOMAT”, RWTH University Hospital AachenAachen, Germany
- * Correspondence to: Prof. Christian WEBER Institute for Molecular Cardiovascular Research, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany Tel.: +49 241 80 88692 Fax: +49 241 80 82716 E-mail:
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838
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Zenovich AG, Davis BH, Taylor DA. Comparison of intracardiac cell transplantation: autologous skeletal myoblasts versus bone marrow cells. Handb Exp Pharmacol 2007:117-65. [PMID: 17554507 DOI: 10.1007/978-3-540-68976-8_6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
An increasing number of patients living with cardiovascular disease (CVD) and still unacceptably high mortality created an urgent need to effectively treat and prevent disease-related events. Within the past 5 years, skeletal myoblasts (SKMBs) and bone marrow (or blood)-derived mononuclear cells (BMNCs) have demonstrated preclinical efficacy in reducing ischemia and salvaging already injured myocardium, and in preventing left ventricular (LV) remodeling, respectively. These findings have been translated into clinical trials, so far totaling over 200 patients for SKMBs and over 800 patients for BMNCs. These safety/feasibility and early phase II studies showed promising but somewhat conflicting symptomatic and functional improvements, and some safety concerns have arisen. However, the patient population, cell type, dose, time and mode of delivery, and outcome measures differed, making comparisons problematic. In addition, the mechanisms through which cells engraft and deliver their beneficial effects remain to be fully elucidated. It is now time to critically evaluate progress made and challenges encountered in order to select not only the most suitable cells for cardiac repair but also to define appropriate patient populations and outcome measures. Reiterations between bench and bedside will increase the likelihood of cell therapy success, reduce the time to development of combined of drug- and cell-based disease management algorithms, and offer these therapies to patients to achieve a greater reduction of symptoms and allow for a sustained improvement of quality of life.
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Affiliation(s)
- A G Zenovich
- Center for Cardiovascular Repair, 312 Church Street SE, NHH 7-105A, Minneapolis, MN 55455, USA
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839
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McMullen NM, Pasumarthi KBS. Donor cell transplantation for myocardial disease: does it complement current pharmacological therapies?This paper is one of a selection of papers published in this Special Issue, entitled Young Investigators' Forum. Can J Physiol Pharmacol 2007; 85:1-15. [PMID: 17487241 DOI: 10.1139/y06-105] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Heart failure secondary to ischemic heart disease, hypertension, and myocardial infarction is a common cause of death in developed countries. Although pharmacological therapies are very effective, poor prognosis and shorter life expectancy of heart disease patients clearly indicate the need for alternative interventions to complement the present therapies. Since the progression of heart disease is associated with the loss of myocardial cells, the concept of donor cell transplantation into host myocardium is emerging as an attractive strategy to repopulate the damaged tissue. To this end, a number of donor cell types have been tested for their ability to increase the systolic function of diseased hearts in both experimental and clinical settings. Although initial clinical trials with bone marrow stem cells are encouraging, long-term consequences of such interventions are yet to be rigorously examined. While additional laboratory studies are required to address several issues in this field, there is also a clear need for further characterization of drug interactions with donor cells in these interventions. Here, we provide a brief summary of current pharmacological and cell-based therapies for heart disease. Further, we discuss the potential of various donor cell types in myocardial repair, mechanisms underlying functional improvement in cell-based therapies, as well as potential interactions between pharmacological and cell-based therapies.
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Affiliation(s)
- Nichole M McMullen
- Department of Pharmacology, Sir Charles Tupper Medical Building, Dalhousie University, Halifax, Canada
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840
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Gene Therapies and Stem Cell Therapies. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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841
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Jacquier A, Higgins CB, Saeed M. MR imaging in assessing cardiovascular interventions and myocardial injury. CONTRAST MEDIA & MOLECULAR IMAGING 2007; 2:1-15. [PMID: 17326039 DOI: 10.1002/cmmi.122] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Performing an MR-guided endovascular intervention requires (1) real-time tracking and guidance of catheters/guide wires to the target, (2) high-resolution images of the target and its surroundings in order to define the extent of the target, (3) performing a therapeutic procedure (delivery of stent or injection of gene or cells) and (4) evaluating the outcome of the therapeutic procedure. The combination of X-ray and MR imaging (XMR) in a single suite was designed for new interventional procedures. MR contrast media can be used to delineate myocardial infarcts and microvascular obstruction, thereby defining the target for local delivery of therapeutic agents under MR-guidance. Iron particles, or gadolinium- or dysprosium-chelates are mixed with the soluble injectates or stem cells in order to track intramyocardial delivery and distribution. Preliminary results show that genes encoded for vascular endothelial and fibroblast growth factor and cells are effective in promoting angiogenesis, arteriogenesis, perfusion and LV function. Angiogenic growth factors, genes and cells administered under MR-guided minimally invasive catheter-based procedures will open up new avenues in treating end-stage ischemic heart disease. The optimum dose of the therapeutic agents, delivery devices and real-time imaging techniques to guide the delivery are currently the subject of ongoing research. The aim of this review is to (1) provide an updated review of experiences using MR imaging to guide transcatheter therapy, (2) address the potential of cardiovascular magnetic resonance (MR) imaging and MR contrast media in assessing myocardial injury at a molecular level and labeling cells and (3) illustrate the applicability of the non-invasive MR imaging in the field of angiogenic therapies through recent clinical and experimental publications.
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Affiliation(s)
- Alexis Jacquier
- Department of Radiology, University of California San Francisco, CA 94134-0628, USA
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842
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Regenerative Therapy in Patients With a Revascularized Acute Anterior Myocardial Infarction and Depressed Ventricular Function. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1885-5857(07)60168-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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843
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Sánchez PL, Villa A, Sanz R, Domínguez M, Ludwig I, Fernández ME, Fernández-Avilés F. Present and future of stem cells for cardiovascular therapy. Ann Med 2007; 39:412-27. [PMID: 17852037 DOI: 10.1080/07853890701513746] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In this review we summarize the available evidence regarding the application of stem cell therapy for human cardiovascular repair, going over the principal concepts that will help us understand the present and future of this therapy: first the different types of cells available in clinical practice, second the delivery approaches, and third highlighting the most important clinical studies and their efficacy and safety results. In addition, we also speculate on the value of current clinical data to gain an insight into the mechanism of stem cell-based cardiac repair and to design clinical trials in the future.
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Affiliation(s)
- Pedro L Sánchez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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844
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Choi JH, Choi J, Lee WS, Rhee I, Lee SC, Gwon HC, Lee SH, Choe YH, Kim DW, Suh W, Kim DK, Jeon ES. Lack of Additional Benefit of Intracoronary Transplantation of Autologous Peripheral Blood Stem Cell in Patients With Acute Myocardial Infarction. Circ J 2007; 71:486-94. [PMID: 17384447 DOI: 10.1253/circj.71.486] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recently the potential of myocardial repair by transplantation of autologous bone marrow stem cells has been suggested. Whether the additional intracoronary transplantation of autologous peripheral blood stem cells (PBSC), which were mobilized by granulocyte-colony-stimulating factor (G-CSF), could safely improve myocardial function in patients with acute myocardial infarction (AMI) was investigated. METHODS AND RESULTS Seventy-three patients with AMI who had successfully undergone percutaneous coronary intervention (PCI) were enrolled in the present prospective nonrandomized open-labeled study. Ten patients with elective PCI received G-CSF for 4 days followed by intracoronary PBSC transplantation. Thirty-two patients with primary PCI and 31 patients with recent AMI and elective PCI served as controls. The left ventricular (LV) function was evaluated using echocardiography and magnetic resonance imaging. G-CSF and intracoronary transplantation of PBSC did not incur any periprocedural myocardial damage. After 6 months, the LV ejection fraction was significantly improved in the cell therapy group. For 2 years of the follow-up period, there was no adverse clinical events, except one asymptomatic in-stent restenosis. However, comparable improvement of the LV ejection fraction was also identified in the primary PCI and elective PCI control groups. CONCLUSIONS In the present study, additional intracoronary infusion of PBSC was safe and feasible for the patients with AMI who had undergone PCI, but did not lead to a significant improvement in LV function compared to standard reperfusion treatment.
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Affiliation(s)
- Jin-Ho Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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845
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Paré-Bardera JC, Aguilar-Torres R, Gallego García de Vinuesa P, Velasco del Castillo S. Actualización en técnicas de imagen cardiaca. Ecocardiografía, resonancia magnética en cardiología y tomografía computarizada con multidetectores. Rev Esp Cardiol 2007; 60 Suppl 1:41-57. [PMID: 17352855 DOI: 10.1157/13099712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article contains a review of the most significant publications on non-invasive recent cardiac imaging techniques in 2005. The increasing importance of technological innovation in echocardiography is reflected in the sections on three dimensional echocardiography, contrast echocardiography, and myocardial deformation measurement techniques (i.e., strain echocardiography). The most important developments affecting cardiology in the techniques of magnetic resonance imaging and multidetector computed tomography are also summarized. This review ends with a detailed description of the contributions made by imaging techniques to the diagnosis of aortic disease.
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846
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Grøgaard HK, Sigurjonsson OE, Brekke M, Kløw NE, Landsverk KS, Lyberg T, Eriksen M, Egeland T, Ilebekk A. Cardiac accumulation of bone marrow mononuclear progenitor cells after intracoronary or intravenous injection in pigs subjected to acute myocardial infarction with subsequent reperfusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2007; 8:21-7. [PMID: 17293265 DOI: 10.1016/j.carrev.2006.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 09/08/2006] [Accepted: 09/08/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of the present study was to compare the efficacy of intracoronary and intravenous injection of autologous progenitor cells for homing to the acutely infarcted but reperfused myocardium in pigs. METHODS Myocardial infarction was induced in 11 anesthetized pigs by 60-min balloon inflation in the mid LAD. After balloon deflation, reperfusion was verified and autologous CD31(+) progenitor cells, or bone marrow mononuclear cells, labeled with PKH67, were injected either intracoronarily (n=6) or intravenously (n=3). By autopsy, 4-5 days after induction of infarction, tissue from the heart and other organs was obtained for fluorescence microscopy. RESULTS In the heart, PKH(+) cells were detected throughout the reperfused infarcted myocardium, and the number of PKH(+) cells was significantly higher after intracoronary than after intravenous injection (3.2+/-0.55 vs. 0.33+/-0.17 cells/high-power field/10(6) cells injected, P=.01). Few PKH(+) cells were detected in the spleen, lung, mesenteric lymph node, and bone marrow. In an additional animal with a coil placed in the mid LAD, progenitor cells were not detected in the infarcted myocardium or in the normal myocardium. CONCLUSION Autologous mononuclear and CD31(+) cells from bone marrow accumulated in the infarcted myocardium when injected intracoronarily or intravenously after established reperfusion, and the accumulation of cells was significantly greater after intracoronary injection than after intravenous injection. Accumulation of PKH(+) cells did not appear in the normal myocardium or in the nonreperfused infarcted myocardium. PKH(+) cells were detected in spleen, lung, and bone marrow but to a lesser degree than in the infarcted myocardium.
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Affiliation(s)
- Haakon K Grøgaard
- Institute for Experimental Medical Research (IEMR), Ulleval University Hospital, N-0407 Oslo, Norway.
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847
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Tögel F, Westenfelder C. Adult bone marrow–derived stem cells for organ regeneration and repair. Dev Dyn 2007; 236:3321-31. [PMID: 17685479 DOI: 10.1002/dvdy.21258] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Stem cells have been recognized as a potential tool for the development of innovative therapeutic strategies. There are in general two types of stem cells, embryonic and adult stem cells. While embryonic stem cell therapy has been riddled with problems of allogeneic rejection and ethical concerns, adult stem cells have long been used in the treatment of hematological malignancies. With the recognition of additional, potentially therapeutic characteristics, bone marrow-derived stem cells have become a tool in regenerative medicine. The bone marrow is an ideal source of stem cells because it is easily accessible and harbors two types of stem cells. Hematopoietic stem cells give rise to all blood cell types and have been shown to exhibit plasticity, while multipotent marrow stromal cells are the source of osteocytes, chondrocytes, and fat cells and have been shown to support and generate a large number of different cell types. This review describes the general characteristics of these stem cell populations and their current and potential future applications in regenerative medicine.
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Affiliation(s)
- Florian Tögel
- Department of Medicine/Nephrology, University of Utah, Salt Lake City, Utah 84148, USA.
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848
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Abstract
The long promised benefits of using stem cells for myocardial repair are still awaited.
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849
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Prockop DJ, Olson SD. Clinical trials with adult stem/progenitor cells for tissue repair: let's not overlook some essential precautions. Blood 2006; 109:3147-51. [PMID: 17170129 PMCID: PMC1852233 DOI: 10.1182/blood-2006-03-013433] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Darwin J Prockop
- Center for Gene Therapy, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
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850
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Abstract
Patients with ischemic cardiomyopathy have a poor prognosis despite all pharmacological, interventional and surgical treatment modalities currently applied. Heart transplantation remains the ideal treatment for this group of patients but the scarcity of donors hinders its widespread application. The autologous transplantation of stem cells (SCs) for cardiac repair is emerging as a new therapy for patients with myocardial dysfunction early after an acute infarction or ischemic cardiomyopathy. The rationale of this novel method is the enhancement of the repair mechanisms achieved by tissue-specific and circulating stem/progenitor cells. SCs assist naturally occurring myocardial repair by contributing to increased myocardial perfusion and contractile performance especially in the setting of acute myocardial infarction (AMI), but also in patients with chronic ischemic heart failure and advanced, diffuse coronary artery disease. The exact mechanism of their action has not been fully elucidated. Few studies continue to suggest a formation of few new contractile tissue. The majority if investigators believe that these cells do not persist long in the myocardium but that they secrete vascular growth and other cardioprotective factors.
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