Abstract
Heart failure is the number one killer worldwide with ~50% of patients dying within 5 years of prognosis. The discovery of stem cells, which are capable of repairing the damaged portion of the heart, has created a field of cardiac regenerative medicine, which explores various types of stem cells, either autologous or endogenous, in the hope of finding the “holy grail” stem cell candidate to slow down and reverse the disease progression. However, there are many challenges that need to be overcome in the search of such a cell candidate. The ideal cells have to survive the harsh infarcted environment, retain their phenotype upon administration, and engraft and be activated to initiate repair and regeneration in vivo. Early bench and bedside experiments mostly focused on bone marrow-derived cells; however, heart regeneration requires multiple coordinations and interactions between various cell types and the extracellular matrix to form new cardiomyocytes and vasculature. There is an observed trend that when more than one cell is coadministered and cotransplanted into infarcted animal models the degree of regeneration is enhanced, when compared to single-cell administration. This review focuses on stem cell candidates, which have also been tested in human trials, and summarizes findings that explore the interactions between various stem cells in heart regenerative therapy.
Highlights
Cardiovascular disease remains the number one, non-communicable killer disease, which recorded a mortality rate of 17.5 million in 2012, and was accounted for 46.2% of all reported deaths worldwide in 2014 [1]
Myocardial infarction (MI) is a common cause of heart failure (HF) due to a consequence of partial or complete occlusion of the coronary artery, which diminishes the delivery of oxygen and nutrient supply to the myocardium where the vessel serves [2]
N/A, not applicable (Placebo group was not included in trial); HF, heart failure; MI, myocardial infarction; LV, left ventricular; STEMI, ST-elevated myocardial infarction; PET, positron emission tomography; MRI, magnetic resonance imaging; SPECT, single-photon-emission computed tomography; RNA, radionuclide angiography. aFollow-up studies. *Significant improvement in left ventricular ejection fraction (LVEF) (p < 0.05)
Summary
Cardiovascular disease remains the number one, non-communicable killer disease, which recorded a mortality rate of 17.5 million in 2012, and was accounted for 46.2% of all reported deaths worldwide in 2014 [1]. Synergistic Cells and CSCs in Regeneration procedure is only recommended if severe, irreversible coronary occlusion is evident. These approaches had shown to alleviate the symptoms of the disease and improve the patients’ quality of life. The presence of the akinetic tissue restricts the overall cardiac performance, forcing the remaining myocytes to increase contractility to maintain adequate cardiac output. These events trigger abrupt alterations in cardiac architecture and cause cardiomyocyte hypertrophy, further myocyte loss, thinning of the ventricular wall, weakening of contractility, and an eventual cease in function of the cardiomyocytes [4]. We touch on an emerging prospective application in heart tissue engineering
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