Stem cells therapy for cardiovascular repair in ischemic heart disease: How to predict and secure optimal outcome?

Abstract

Coronary artery disease is a growing problem worldwide. Early treatment with stabilizing drugs and revascularization by percutaneous coronary intervention or by-pass surgery has reduced the mortality significantly, but it is still the most common cause of death and a major cause of hospital admissions in industrialized countries. Treatment with stem cells with the potential to regenerate the damaged myocardium is a relatively new approach. However, the results from clinical studies on stem cell therapy for cardiac regeneration in patients with acute or chronic ischemic heart disease have been inconsistent. Some of the discrepancy could be due differences in study designs or patient selection. The review will based on conducted clinical stem cell trials try to elucidate how to predict and personalize this new treatment approach.

Fig. 1

Cultivation of mesenchymal stromal cells for clinical treatment. Collagen staining. The cells needs several weeks of proliferation to reach a sufficient number for clinical treatment. The cells are becoming more and more confluent during cultivation and when they are approximately 80–90% confluent (week 5) they are harvested for treatment or for the next expansion passage

Fig. 2

NOGA mapping of left ventricle with intramyocardial injections of mesenchymal stromal cells (brown spots). A mapping catheter is introduced percutaneously from the groin into the left ventricle across the aortic valve. The catheter is then used for creating a tree-dimensional image of the left ventricle and for injection of stem cells into the ventricular myocardium (outlined with the white line)