Abstract

Available medical therapy is unable to completely prevent or revert the pathological cardiac remodeling secondary to ischemia or other injuries, which is responsible for the development of heart failure. Regenerative medicine through stem cells had an explosive development in the cardiovascular area during the past decade. Stem cells possess the capacity to regenerate, repair or substitute damaged tissue, allowing the reestablishment of its function. Stem cells can also modulate apoptosis, angiogenesis, fibrosis and inflammation, favoring the endogenous regenerative process initiated by the damaged tissue. These capacities have been corroborated in several animal models of cardiovascular diseases with positive results. In humans, therapies with bone marrow mononuclear stem cells, mesenchymal stem cells and cardiac stem cells are safe. Most randomized clinical trials in patients with myocardial infarction or cardiomyopathies of different etiologies have reported benefits on ventricular function, quality of life and even over mortality of treated patients. This article reviews the state of art of stem cell therapy in cardiovascular diseases, focusing on the most common cellular types used in patients with acute myocardial infarction and chronic cardiomyopathies of different etiologies.

Highlights

  • Correspondencia: Dr Jorge Bartolucci Johnston Unidad de estudios cardiológico, Clínica Santa María

  • Available medical therapy is unable to completely prevent or revert the pathological cardiac remodeling secondary to ischemia or other injuries, which is responsible for the development of heart failure

  • This article reviews the state of art of stem cell therapy in cardiovascular diseases, focusing on the most common cellular types used in patients with acute myocardial infarction and chronic cardiomyopathies of different etiologies. (Rev Med Chile 2014; 142: 1034-1046) Key words: Cardiomyopathies; Myocardial Infaction; Stem Cell Transplantation; Ventricular Remodeling

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Summary

Tipos y fuentes de células madre en cardiología

Las células madre son células caracterizadas por su capacidad de auto-renovación (dividirse en más células madre de forma indefinida) y el potencial de diferenciarse en células maduras de un determinado linaje celular. Si bien se presume que las células multipotenciales tendrían función y diferenciación tejido específica, evidencias recientes sugieren que bajo ciertas condiciones pueden reprogramarse y diferenciarse a células de otros tejidos, capacidad conocida como plasticidad o transdiferenciación celular[13,14]. Resulta particularmente útil considerando que la efectividad de la terapia celular depende de la capacidad proliferativa de las células administradas, capacidad afectada negativamente por la edad, los factores de riesgo cardiovascular y patologías crónicas (insuficiencia cardiaca y diabetes mellitus entre otras)[17]. Aún es motivo de investigación si subpoblaciones de estas células (diferenciadas por marcadores moleculares) poseen distintos efectos terapéuticos[20]

Mecanismos de acción de células madre en el corazón patológico
Vías de implante
Terapia celular en infarto agudo al miocardio
Terapia celular en cardiopatías crónicas
FEVI sin cambios significativos
Contractilidad regional sin cambios
Conclusión

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