Chapter 5 - Stem cells and heart tissue regeneration

Abstract

Heart failure occurring after myocardial infarction is highly associated with fibrotic tissue growth and proliferation in the affected area of cardiac muscle, with a very limited chance for regeneration in the absence of medical intervention. Consequent stiffness of the cardiac muscle after myocardial infarction leads to decreased cardiac output, arrhythmia, and sudden cardiac death. Current medical interventions that is, coronary artery bypass grafting, percutaneous coronary intervention, and finally heart transplantation are helpful but invasive in nature. Looking for novel therapies to reverse the damage inflicted to the heart has led to a cell therapy approach using stem cells in combination with tissue engineering. A variety of stem cells, including mesenchymal stem cells, cardiac and cardiosphere-derived cells, induced pluripotent stem cells, embryonic stem cells, umbilical cord stem cells, and adipose-derived stem cells, have been tried and reported for repairing the myocardium throughout the literature. In addition to ethical issues, many of the challenges remain unsolved, including the alignment and adhesion of cells, the conduction of electrical impulses between the cells, the contractility of the regenerated tissue, the development of tissue junctions, the nutrient/oxygen supply to the tissue, and finally their differentiation to cardiomyocytes in the damaged heart area. This chapter reviews how stem cells contribute in ischemic cardiomyopathy with a focus on the advancements and challenges in this field necessitating a tissue engineering approach.