Stem Cell Therapy against Ischemic Heart Disease

Abstract

Ischemic heart disease, which is one of the top killers worldwide, encompasses a series of heart problems stemming from a compromised coronary blood supply to the myocardium. The severity of the disease ranges from an unstable manifestation of ischemic symptoms, such as unstable angina, to myocardial death, that is, the immediate life-threatening condition of myocardial infarction. Even though patients may survive myocardial infarction, the resulting ischemia-reperfusion injury triggers a cascade of inflammatory reactions and oxidative stress that poses a significant threat to myocardial function following successful revascularization. Moreover, despite evidence suggesting the presence of cardiac stem cells, the fact that cardiomyocytes are terminally differentiated and cannot significantly regenerate after injury accounts for the subsequent progression to ischemic cardiomyopathy and ischemic heart failure, despite the current advancements in cardiac medicine. In the last two decades, researchers have realized the possibility of utilizing stem cell plasticity for therapeutic purposes. Indeed, stem cells of different origin, such as bone-marrow- and adipose-derived mesenchymal stem cells, circulation-derived progenitor cells, and induced pluripotent stem cells, have all been shown to play therapeutic roles in ischemic heart disease. In addition, the discovery of stem-cell-associated paracrine effects has triggered intense investigations into the actions of exosomes. Notwithstanding the seemingly promising outcomes from both experimental and clinical studies regarding the therapeutic use of stem cells against ischemic heart disease, positive results from fraud or false data interpretation need to be taken into consideration. The current review is aimed at overviewing the therapeutic application of stem cells in different categories of ischemic heart disease, including relevant experimental and clinical outcomes, as well as the proposed mechanisms underpinning such observations.

Keywords: cellular cardiomyoplasty; coronary artery syndrome; ischemia-reperfusion injury; ischemic cardiomyopathy; myocardial infarction.

Figure 1

Therapeutic potential of stem cells against a spectrum of ischemic heart disease. LVEF: left ventricular ejection fraction. Red downwards arrow: reduction.

Figure 2

The reported origins of stem cells in the treatment of ischemic heart disease. Upwards arrow: therapeutic potential against.

Figure 3

Stem-cell-derived exosomes and their therapeutic potentials against ischemic heart disease. miRNA: microRNA; positive sign: reinforcement; negative sign: suppression; small red downwards arrow beside molecular formula of oxygen: hypoxic environment.