Abstract
This review article reports on the new field of stem cell therapy and tissue engineering and its potential on the management of congenital heart disease. To date, stem cell therapy has mainly focused on treatment of ischemic heart disease and heart failure, with initial indication of safety and mild-to-moderate efficacy. Preclinical studies and initial clinical trials suggest that the approach could be uniquely suited for the correction of congenital defects of the heart. The basic concept is to create living material made by cellularized grafts that, once implanted into the heart, grows and remodels in parallel with the recipient organ. This would make a substantial improvement in current clinical management, which often requires repeated surgical corrections for failure of implanted grafts. Different types of stem cells have been considered and the identification of specific cardiac stem cells within the heterogeneous population of mesenchymal and stromal cells offers opportunities for de novo cardiomyogenesis. In addition, endothelial cells and vascular progenitors, including cells with pericyte characteristics, may be necessary to generate efficiently perfused grafts. The implementation of current surgical grafts by stem cell engineering could address the unmet clinical needs of patients with congenital heart defects.
Highlights
Congenital heart disease (CHD) is defined as an abnormality in heart structure that occurs before birth, while the fetus is developing (Sun et al, 2015)
Common single CHD are represented by holes inside the internal wall of the heart (Figure 1, left): in septal defects, oxygenated blood returning from the pulmonary veins flows from the left to the right chambers of the heart, where it mixes with deoxygenated blood returning from the body, causing an overloading of the right ventricle (RV) (Geva et al, 2014; Sun et al, 2015)
This review focuses on stem cell therapy and tissue engineering as a new option to implement current surgical methods for definitive correction of CHD
Summary
Congenital heart disease (CHD) is defined as an abnormality in heart structure that occurs before birth, while the fetus is developing (Sun et al, 2015). Common single CHD are represented by holes (intra-cardiac shunts) inside the internal wall of the heart (Figure 1, left): in septal defects, oxygenated blood returning from the pulmonary veins flows from the left to the right chambers of the heart, where it mixes with deoxygenated blood returning from the body, causing an overloading of the right ventricle (RV) (Geva et al, 2014; Sun et al, 2015). Limitations of Current Surgical Approach The use of prosthetic materials in the form of conduits, patches and new valves made by xenografts, homografts, or autografts is routine in congenital cardiac surgery. Even though these grafts may be life-saving, they are characterized by some limitations, represented by a limited durability, and the risks of infection, host immune response, and thrombotic complications. Stem cell therapy has provided first proof-ofconcept, paving the way to tissue engineering to fabricate cellularized valves endowed with anti-coagulative properties and living cardiac tissue that grows physiologically in parallel with the heart’s growth
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