Myocardial repair with autologous skeletal myoblasts: a review of the clinical studies and problems

Abstract

Stem cell therapy for myocardial repair after myocardial infarction is a new and promising treatment modality. Currently, bone marrow derived stem cells are used in clinical studies to evaluate its beneficial effect on repair of infarcted/hibernating myocardium in the subacute phase after myocardial infarction. Whereas skeletal myoblasts are nowadays under investigation in the setting of scar repair in chronic congestive heart failure patients. The mechanism of bone marrow derived stem cells is probably mainly related to induction and stimulation of angiogenesis, whereas skeletal myoblasts are more likely to contribute to recovery of left ventricular function by the direct engraftment of contractile cells and hypothetically indirect by stimulation of native and circulation stem cells to home into the scarred tissue. This review will focus on the use of skeletal myoblasts in all clinical studies presented sofar and will discuss several issues like: different transplantation methods, potential mechanism of effect, potential risks like arrhythmia and future concepts. As the target population of skeletal myoblast transplantation is chronic post myocardial infarction heart failure patients, ventricular arrhythmias are very likely to occur. This review will specially address the presence of ventricular arrhythmias observed in some clinical studies and the pre-clinical data on the electrophysiology of skeletal myotubes and its relationship to the surrounding myocardium.