The Next Generation of Review for Cardiac Cell Therapies

Abstract

Heart failure is the leading cause of morbidity and mortality in the Western World, affecting approximately 5 million people in the United States [1] and at least 10 million people in Western Europe [2]. Heart transplantation remains the best available treatment option for end-stage heart disease; however, donor availability is limited. Therapeutic options currently available to clinicians have a limited role in improving outcomes in patients with heart failure. Cell-based therapies for heart disease have shown some promise to restore cardiac function in both preclinical and early clinical trials though many scientists and clinicians are still unable to determine which the most appropriate cell to utilize is and the clear mechanism of action within the cardiac tissue. With the excitement of cell therapy for heart disease came numerous papers touting the effectiveness of many different cell types in various small and large animal models. Along with the plethora of experimental data regarding cellular therapy for heart disease, many reviews were published to help both researchers and clinicians understand the types of cells under investigation for heart disease. Most of these reviews were organized by types of cells (i.e., endothelial progenitor cell, mesenchymal stem cells, embryonic stem cells, etc.) and detailed the various positive data, the limitations of the cells, and the future clinical relevance of the cells for different myocardial applications. The review by Stamm et al. [3] not only gives researchers and clinicians the most current up-to-date information regarding cell therapies for cardiac disease, but is organized by the type of regenerative therapy and not the type of cell. Stamm et al. group the different cell therapies into three areas of cardiac regeneration: direct, indirect, and intrinsic. Stamm et al. go on to comment on the potential clinical applicability of each of the three approaches for cardiac regeneration with direct regeneration holding the most promise. The reader is not bombarded with lineage markers but is given just enough technical description of each cell type so as to allow for clear understanding of which cell type is being reviewed. Stamm et al. also sprinkle into the text some illustrative data and insightful comments regarding their own experience in the cardiac cell therapy arena. In addition, Stamm et al. include recent updates on the legal status of the therapeutic use of cells in both North America and Europe along with keen perspective on the progress and pitfalls industrial and academic forays into cell therapy. Overall, Stamm et al. have taken years of experimental and clinical data in the field of regenerative cell therapy for cardiac disease and condensed it into a smartly organized review of the current and next generation cell therapies for heart disease.