Stem-cell angiogenesis and regeneration of the heart: review of a saga of 2 decades

Abstract

Advances in the novel approach to control ischemic heart disease and heart failure using stem cells or progenitor cells from bone marrow, mesenchyme, or myocardial tissue itself have demonstrated efficacy for increasing left ventricular function, decreasing infarct scar tissue, improving exercise tolerance and heart failure symptoms, and, in some studies, decreasing mortality and reducing rehospitalization for intractable angina or subsequent myocardial infarction. The most common techniques utilize injections of cells into the coronary vasculature or directly into specific areas of vulnerable myocardium. Although few adverse effects have been noted in clinical trials of these procedures, further clinical trials over the next decade should provide further advances in interventional techniques, ancillary supporting technologies to enhance cell regeneration, and applications in ischemic heart disease, cardiomyopathies, and cardiac genetic disorders.

Figure 1

EPC administration into the coronary artery leads to engraftment into coronary endothelium. EPCs promote (1) revascularization of the coronary vessel. Some EPCs can transdifferentiate into cardiomyocytes or through paracrine effects causing (2) recruitment of resident cardiomyocyte stem cells that proliferate and regenerate myocardial tissue. Both effects can increase myocardial function. Abbreviations: EPC, endothelial progenitor cell.

Figure 2

Simultaneous electromechanical mapping system for determining location of cell injection sites. Voltage map (A) showing normal voltage activity (blue). Mechanical activity map (B) showing absent local shortening (red). The superimposed information indicates hibernating but viable myocardium. Illustration courtesy of Dr. Gary L. Schaer, Division of Cardiology, Rush University Medical Center; and Biologics Delivery Systems Group. Abbreviations: LAO, left anterior oblique projection.