Abstract
Cardiovascular disease (CVD) remains the leading cause of death in Western countries. Post-myocardial infarction heart failure can be considered a degenerative disease where myocyte loss outweighs any regenerative potential. In this scenario, regenerative biology and tissue engineering can provide effective solutions to repair the infarcted failing heart. The main strategies involve the use of stem and progenitor cells to regenerate/repair lost and dysfunctional tissue, administrated as a suspension or encapsulated in specific delivery systems. Several studies demonstrated that effectiveness of direct injection of cardiac stem cells (CSCs) is limited in humans by the hostile cardiac microenvironment and poor cell engraftment; therefore, the use of injectable hydrogel or pre-formed patches have been strongly advocated to obtain a better integration between delivered stem cells and host myocardial tissue. Several approaches were used to refine these types of constructs, trying to obtain an optimized functional scaffold. Despite the promising features of these stem cells’ delivery systems, few have reached the clinical practice. In this review, we summarize the advantages, and the novelty but also the current limitations of engineered patches and injectable hydrogels for tissue regenerative purposes, offering a perspective of how we believe tissue engineering should evolve to obtain the optimal delivery system applicable to the everyday clinical scenario.
Highlights
Nowadays, cardiovascular diseases (CVDs) represent some of the main causes of death in the industrialized world, especially for low- and middle-income countries [1]
Costs for primary life-saving procedures in case of acute clinical syndromes as myocardial infarction (MI) and chronic heart failures (CHFs) are gradually increasing while the medical management of the chronic sequalae of the acute syndromes remains mainly based on standard classic approaches such as β-adrenergic receptor blocking agents, angiotensin-converting enzyme (ACE) inhibitors and mineralocorticoid-receptor antagonists [2,3]
In this review we analysed several proof of concept studies related to stem cell-based therapy as promising agents to treat heart injury. Considering their high tropism for the adult heart tissue, we focused our attention on endogenous cardiac stem cells (CSCs) as a powerful regenerative and reparative tool that has increasingly attracted the attention in the regenerative medicine field with the aim to use them in both gene therapy, stem cell therapy and tissue engineering [11]
Summary
Cardiovascular diseases (CVDs) represent some of the main causes of death in the industrialized world, especially for low- and middle-income countries [1]. Cell transplantation may be limited by their insufficient survival rate in the diseased human heart [14], and by their low engraftment in the injured situ [15] For these reasons, cell therapy applied to cardiac regeneration has significant room for improvement before establishing an economically affordable, widely available and efficacious clinical approach. In this review we analysed several proof of concept studies related to stem cell-based therapy as promising agents to treat heart injury Considering their high tropism for the adult heart tissue, we focused our attention on endogenous CSCs as a powerful regenerative and reparative tool that has increasingly attracted the attention in the regenerative medicine field with the aim to use them in both gene therapy, stem cell therapy and tissue engineering [11]. Looking out to the future, the pre-loading of CSCs in 3D-scaffolds before their implantation in a heart injury or the delivery into in-situ forming scaffold could be a promising new solution as well as the re-solution of many limitations associated with current stem/progenitor cell transplantation approaching, eventually impacting the efficacy of the CVDs’ management
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