The quest for a successful cell-based therapeutic approach for heart failure.

Abstract

This editorial refers to ‘Cardiopoietic cell therapy for advanced ischaemic heart failure: results at 39 weeks of the prospective, ramdomized, double-blind, sham-controlled CHART-1 clinical trial’, by J. Bartunek et al. , doi:10.1093/eurheartj/ehw543. Two-thirds of all heart failure is due to ischaemic heart disease.1 These patients receive lifelong medication, experience significant morbidity and mortality, and often progress to heart transplantation or insertion of a left ventricular assist device,1,2 In terms of population impact, a successful regenerative medicine strategy will have enormous impact upon patients with heart failure, who number in the millions worldwide. The staggering impact upon patients and healthcare systems provides extraordinary impetus for the development of a regenerative approach to treat these patients.2,3 Indeed, the notion of affecting an improvement in left ventricular structure as a substrate for enhancing patients’ quality of life and functional capacity (ultimately leading to reducing morbidity and mortality) is extraordinarily attractive.2 This quest has spawned several clinical investigative efforts to devise an effective and efficient way to deliver cell-based therapy to this large patient population with major unmet needs.4,5 This resulted in the testing of a vast array of cells ( Table 1 ).2 Currently, there are few decisive successes in the field. However, all of the current efforts are small, with no published studies exceeding 200 patients, and very importantly lack standardization. For reference, an early important study in the development of biventricular pacing enrolled 453 patients.6 View this table: Table 1 Cell types under investigation in cell-based therapy trials for heart failure In 2010, Behfar and colleagues demonstrated that mesenchymal stem cells (MSCs) could be guided to become cardiac progenitor cells in mice.7 Furthermore, this study demonstrated that there are individuals that harbour stem cells with unique reparative capabilities, which are characterized …