Stem Cell Selection - Ischaemic Heart Disease - Alternative Treatment Options

Stem Cell Selection - Ischaemic Heart Disease - Alternative Treatment Options

Klein Hans-Michael
European Cardiovascular Disease 2007 - Issue 1
Published: June 2007
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An increasing number of patients survive acute myocardial infarction. Surgical and interventional revascularisation of the ischaemic myocardium can treat angina, reduce risk of myocardial infarction and improve the function of the viable myocardium. However, the therapeutic possibilities in end-stage heart failure patients are limited. This article investigates alternative treatment options such as combined therapies using bone marrow-derived stem cells (BMSCs).

Despite the success of current medical and surgical management of ischaemic heart disease, a growing number of patients have diffuse obstructive coronary artery disease that is not suitable for coronary artery bypass grafting or catheter-based interventions. Furthermore, complete revascularisation procedures are not suitable for many patients due to total arterial occlusion, poor distal vessels or unacceptable procedural risks caused by concomitant medical conditions. Regardless of maximal pharmacotherapy and conventional revascularisation, up to 15% of patients with end-stage coronary artery disease suffer from disabling symptoms.1 In addition, there is a lack of donors for heart transplants, which increases the need to offer viable alternatives for patients in the future. Recently, cell therapy has evolved as an option for the treatment of ischaemic heart disease. Several cell types including skeletal myoblasts, bone marrow stem cells, endothelial progenitors, mesenchymal stem cells, resident cardiac stem cells and embryonic stem cells are under pre-clinical and clinical investigation.2


Figure 1: Intra-myocardial Injection of CD133+ Stem Cells in the
Immediate Vicinity of the Laser Holes Accrued byTransmyocardial Laser Revascularisation Treatment
Intra-myocardial Injection of CD133+ Stem Cells in themediate Vicinity of the Laser Holes Accrued byTransmyocardial Laser Revascularisation Treatment

Figure 3: Representative Magnetic Resonance Image of a PatientShowing Improved Wall Thickness after Treatment with CoronaryArtery Bypass Graft, Transmyocardial Laser Revascularisation andCD133+ Cells (12-month Follow-up)
Representative Magnetic Resonance Image of a PatientShowing Improved Wall Thickness after Treatment with CoronaryArtery Bypass Graft, Transmyocardial Laser Revascularisation andCD133+ Cells (12-month Follow-up)
A = pre-operative; B = post-operative; ED = end-diastolic; ES = end-systolic.
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