Stem cells for myocardial repair

Chung-Wah Siu; Song-Yan Liao; Yuan Liu; Qizhou Lian; Hung-Fat Tse

doi:10.1160/TH09-05-0336

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 104(01): 6-12
DOI: 10.1160/TH09-05-0336

Theme Issue Article

Schattauer GmbH

Stem cells for myocardial repair

Authors

Chung-Wah Siu

¹Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China

²Research Center of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong, China
Song-Yan Liao

¹Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
Yuan Liu

¹Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
Qizhou Lian

¹Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China

²Research Center of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong, China
Hung-Fat Tse

¹Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China

²Research Center of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong, China

Abstract

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Summary

There is a growing interest in the clinical application for stem cell as a novel therapy for treatment of acute myocardial infarction and chronic myocardial ischaemia. The initial premise is the transplanted exogenous stem cells can engraft and integrate with host myocardium for cardiac regeneration. However, recent experimental studies suggest that multiple mechanisms, including remodelling of extracellular matrix, enhancement of neovascularisation and recruitment of endogenous stem cells are more likely to contribute to the beneficial effects of stem cell therapy that direct trans-differentiation of stem cells into functional myocardium. Among different potential cell sources, bone marrow-derived cells and skeletal myoblasts have been tested in pilot clinical trials. Phase I/II randomised controlled clinical trials suggest that intracoronary or intramyocardial injection of bone marrow-derived cells may be safe and feasible strategies for treatment of acute myocardial infarction as well as chronic myocardial ischaemia. In addition, these studies show a modest, but significant improvement in left ventricular ejection fraction and clinical status of patients after cell transplantation. Nevertheless, most of these studies included a relatively small sample size (<200) and short duration of follow-up (<6 months), and the clinical efficacy of stem cell therapy need to be confirmed by future clinical trials. Furthermore, the optimal timing, cell types and mode of delivery need to be addressed, and strategies to improve cell survival and engraftment should also be developed to overcome the potential hurdles related to cell-based therapy.

Keywords

Stem cells - cardiology - ischaemic heart disease

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References

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