Author + information
- Received March 4, 2011
- Revision received April 6, 2011
- Accepted April 7, 2011
- Published online September 6, 2011.
- ↵⁎Reprint requests and correspondence:
Dr. Gustav Steinhoff, Reference and Translation Center for Cardiac Stem Cell Therapy, Biomedical Research Center Rostock, Department for Cardiac Surgery, University Rostock, Schillingallee 68, Rostock D-18057, Germany
Intracoronary and intramyocardial stem cell therapy aim at the repair of compromised myocardium thereby—as a causal treatment—preventing ventricular remodeling and improving overall performance. Since the first-in-human use of bone marrow stem cells (BMCs) after acute myocardial infarction in 2001, a large number of clinical studies have demonstrated their clinical benefit: BMC therapy can be performed with usual cardiac catheterization techniques in the conscious patient as well as also easily during cardiosurgical interventions. New York Heart Association severity degree of patients as well as physical activity improve in addition to (“on top” of) all other therapeutic regimens. Stem cell therapy also represents an ultimate approach in advanced cardiac failure. For acute myocardial infarction and chronic ischemia, long-term mortality after 1 and 5 years, respectively, is significantly reduced. A few studies also indicate beneficial effects for chronic dilated cardiomyopathy. The clinical use of autologous BMC therapy implies no ethical problems, when unmodified primary cells are used. With the use of primary BMCs, there are no major stem cell-related side effects, especially no cardiac arrhythmias and inflammation. Various mechanisms of the stem cell action in the human heart are discussed, for example, cell transdifferentiation, cell fusion, activation of intrinsic cardiac stem cells, and cytokine-mediated effects. New techniques allow point-of-care cell preparations, for example, within the cardiac intervention or operation theater, thereby providing short preparation time, facilitated logistics of cell transport, and reasonable cost effectiveness of the whole procedure. The 3 main indications are acute infarction, chronic ischemic heart failure, and dilated cardiomyopathy. Future studies are desirable to further elucidate the mechanisms of stem cell action and to extend the current use of intracoronary and/or intramyocardial stem cell therapy by larger and presumably multicenter and randomized trials.
The RTC, University Rostock, receives grant support from the German Ministry of Education and Research (BMBF FKZ 0312138A), the State of Mecklenburg-Pomerania (FKZ V230-630-08-TFMV-F/S-035), and the German Research Foundation (SFB Transregio 37, TP A4, B2, B5). Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 4, 2011.
- Revision received April 6, 2011.
- Accepted April 7, 2011.
- American College of Cardiology Foundation