EMERGING ROLE OF STEM CELLS
In
CARDIOVASCULAR THERAPY
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Stem Cells in Cardiovascular Therapy: A Fresh Approach to Heart Regeneration, Slides of Cardiology
The use of stem cells in cardiovascular therapy as a potential solution for heart failure, discussing historical evidence, different types of stem cells, and their limitations and benefits. It also covers the goals of cell therapy in failing hearts and the challenges that remain.
Typology: Slides
2011/2012
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EMERGING ROLE OF STEM CELLS
In
CARDIOVASCULAR THERAPY
Why Rejenuate the Heart Muscle?
THE PROBLEM :
- ~ 30 million suffer from heart failure world wide
- ~ 3-4 million develop hear failure every year CAUSES OF VENTRICULAR REMODELLING
- Acute Myocardial Infarction
- Cardiomyopathy
- Valvular congenital heart disease OUTCOMES
- <1% of all hear failure patients receive donor hearts or assist devices
- Annual mortality in hear faisure is 7.5 to 38%
The Answer!
No.
Historical Evidence – The basis
Men the who received sex mismatched donor
hearts shows primitive cells bearing Y
chromosomes which expressed the markers of
cardiomyocytes, smooth muscle cells and
endothelial cells (Quainani et al.)
Foetal Cardiomyocytes
Ideal cell replacement Ultrastructural integratian Good functional improvement of LV
Limitations
Limited source / ethics Immunogenicity Ischemia sensitivity
Embryonal stem cells
Note: Day 5 Human blastocyst inner cell mass Differentiation Early stage : Pacemaker cells Intermediate : Myocardial cell Late : Nodal, His purkinjee cells
- High yield of cardiomyocytes -? Useful in bio-engineering
- Human spare parts factory
Autologous stem cells
- Easy to source
- Non immunogenic
Cell Therapy in Failing Heart
• GOAL
- Transfer of functional myocytes to heart – Improve its function
- The DEALS “ Homing of grafted cells”
- Engraft into non functional scar
- Electromechanical coupling and synchronisation
- Neo angiogenesis and myogenesis
- Good craft survival
- Low immunogenecity
- Ethical acceptance
- Low oncogenicity
- Case of application
Stem cells therapy
- Cardiovascular note
- Infarct repair
- Cardiomyopathy treatment
- End stage coronary artery disease
SKELETAL MYOBLASTS
- Satellite cells found in skeletal muscle
- Mature into slow twitch fibers
- No ultra structural integration
- Stretch-ion channel & direct trans-membrane activation
- Scaffolding effect – Cell to cell fusion
Bone marrow stem cells
Hemapoeitic Stem cells T-2% Endothelial Progenitor cells <0.05% (Stromal stem cells) (Lin – c Kit (+ve) ; AC 133+) Transplantation (^) HEART Translocation (Endogenous stem cell mobilization) CARDIOMYOCYTES Endothelium sm cells G – CSF GM - CSF CD 34+
Homing – in of Graft
Ischemia ; Hypoxia Cytokines Increased vascular permeability V CAM I CAM VEGF – 2 GCSF SDF – Increased MMP 9
- Immunogenecity
- How effective / How risky
- Optimal timing of therapy
- Ethical timing of therapy
- Durability of therapy
Some Unresolved Issues
You see things; and you say “Why”
But I dream things that never were;
And I say “Why not”
G.B. Shaw