Stem Cells in Cardiac Repair – Recent Developments and Future Directions

Robert J Henning
Interventional Cardiology, 2012;7(1):10–3
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Abstract

Myocardial infarction (MI) is the leading cause of death among people in the industrialised world and will, according to the World Health Organization (WHO), become the leading cause of death in the world in 2020. For the treatment of patients with MIs and ischaemic cardiomyopathies, remarkable medical advances have been made during the second half of the 20th Century that have increased patient survival. As a consequence, patients with heart disease are living longer and the incidence of congestive heart failure in patients is significantly increasing. New treatments for patients with acute MI and ischaemic cardiomyopathies are needed. In this regard, the next major advance in the treatment of patients with cardiac disease promises to be stem cells and stem cell products. Currently, basic research scientists and clinicians worldwide are investigating human embryonic stem cells, skeletal stem cells (myoblasts), adult bone marrow stem cells, cardiac stem cells and human umbilical cord stem cells for the treatment of patients with MIs and ischaemic cardiomyopathies. This review highlights the recent developments and the future directions of each of these stem cells in the treatment of patients with heart disease.

Acknowledgements: This work was supported in part by facilities at the James A Haley Hospital and by the Muscular Dystrophy Association and the Bugher Foundation.
Keywords
Human embryonic stem cells, skeletal myoblasts, adult bone marrow cells, cardiac stem/progenitor cells, human umbilical cord blood stem cells, acute myocardial infarction, ischaemic cardiomyopathy, cardiac repair
Disclosure The author has no conflicts of interest to declare.
Received: November 24, 2011 | Accepted January 05, 2012 | Citation Interventional Cardiology, 2012;7(1):10–3
Correspondence: Robert J Henning, Center for Cardiovascular Research and the James A Haley Hospital, 13000 Bruce B Downs Blvd, 111, Tampa, FL, US. E: robert.henning@va.gov

Myocardial infarction (MI) is the leading cause of death among people in the industrialised world and will, according to the World Health Organization (WHO), become the leading cause of death in the world in 2020.1 For the treatment of patients with MIs and ischaemic cardiomyopathies, remarkable medical advances have been made during the second half of the 20th Century that have increased patient survival. These advances include external cardiac defibrillation and closed chest cardiopulmonary resuscitation, coronary care units, echocardiography, coronary angiography, cardiac pacemakers/automatic implantable defibrillators, the heart–lung machine, coronary artery bypass surgery, mechanical and bioprosthetic heart valves, heart transplantation, coronary artery thrombolytic therapy, coronary angioplasty and coronary artery stents. Further refinements and advances in each of these treatments or techniques are contributing to reductions in patient morbidity and increased patient survival from MI. As a consequence patients are living longer and the incidence of congestive heart failure in patients with damaged hearts is significantly increasing. New treatments for patients with acute MI and ischaemic cardiomyopathies are needed; in this regard, the next major advance in the treatment of patients with cardiac disease promises to be stem cells and stem cell products. Currently, basic research scientists and clinicians worldwide are investigating human embryonic stem cells, skeletal stem cells (myoblasts), adult bone marrow stem cells, cardiac stem cells and human umbilical cord stem cells. The use of each of these cell types has distinct advantages in the repair of damaged hearts in patients but also presents specific treatment challenges that must be overcome prior to widespread acceptance by clinicians and clinical use.

Human Embryonic Stem Cells

Interest in human embryonic stem cells (hESCs) was ignited by the work of Thomson and coworkers in 1998.2 Thomson successfully isolated, maintained and propagated primitive pluripotent stem cells from the inner cell mass of the human embryonic blastocyst. These hESCs contain the nuclear transcription factors Oct 4, Nanog and SOX-2, which form the core regulatory network that maintains stem cells in a primitive state and ensures pluripotency and suppression of genes that lead to differentiation. These hESCs can form any one of the 220 different cell types that compose the human body, including cardiac myocytes and blood vessels.3,4

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