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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

Uploaded on 10/19/2012

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EMERGING ROLE OF STEM CELLS
In
CARDIOVASCULAR THERAPY
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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 yearCAUSES OF VENTRICULAR REMODELLING
  • Acute Myocardial Infarction
  • Cardiomyopathy
  • Valvular congenital heart diseaseOUTCOMES
  • <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 blastocystinner 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