|Cellular therapy for heart failure|
|Written by Dr. Santoso Karo Karo, SpJP|
|Thursday, 08 January 2009|
During the last decade randomized clinical trials have demonstrated that angiotensin-converting enzyme inhibitors (ACE-I) and beta-blockers can improve survival in patients with heart failure. However the overall results are still suboptimal, as evidenced by the still high mortality.
Recently resynchronization therapy with biventricular pacing has been shown to be of benefits in selected patients with heart failure.
An alternative approach is assisting the failing myocardium based on tissue engineering and cell transplantation. This novel approach, by regenerating cardiac myocytes (myogenesis) and stimulating neorevascularization (angiogenesis) in the infracted area, hopefully can improve left ventricular function and prevent the progression of heart failure. Preliminary experiments in animal models have produced encouraging results. Formation of stable cell graft, increased capillary and augmentation of myocardial contractility have been shown.
Different cell types have been used in cell transplantation. Three main categories have been proposed as potential cell types: allogenic, transgenic, and autogenetic. Autologus skeletal myoblasts have generated most data while results from fetal cardiomyoctes, embryonic and bone marrow stems as well as endhotelial progenitor cells are also promising. The optimal choice of donor cells remains controversial and each cell type has its own advantage and disadvantages.
Various routes are used for cell delivery, e.g. pericardial route, endomyocardial route, tranvenous route, and intracoronay route.
Studies in this field so far involved only a small number of patients. Larger, randomized, placebo-controlled, double-blind studies are clearly required.
Dr. Santoso Karo Karo, SpJP
Department of Cardiology, Faculty of Medicine
University of Indonesia
National Cardiovascular Center Harapan Kita
15th Weekend Course on Cardiology:
“Hypertension, Vascular Disease : Management and Prevention from Dream to Reality”
September 11 – 13, 2003, Shangri-La Hotel - Jakarta