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Stem Cell Treatment For The Heart!

Can the heart heal itself?

Several clinical trials targeting heart disease have shown that adult stem cell therapy is safe and effective, and is equally efficient in old as well as recent infarcts. Adult stem cell therapy for heart disease was commercially available on at least five continents at the last count (2010).

Possible mechanisms are:

Generation of heart muscle cells

Stimulation of growth of new blood vessels that repopulate the heart tissue

Secretion of growth factors, rather than actually incorporating into the heart

Assistance via some other mechanism

It may be possible to have adult bone marrow cells differentiate into heart muscle cells.

Eduardo Marbán, M.D., Ph.D., director of the Cedars-Sinai Heart Institute, is studying whether the best medicine for a heart attack patient could come from the patient’s own heart.

Dr. Marban is leading a groundbreaking clinical trial in which a patient’s own heart tissue is used to grow specialized heart stem cells. The stem cells are then injected back into the patient’s heart in an effort to repair and re-grow healthy muscle in a heart that has been injured by a heart attack.

The procedure is part of a Phase I investigative study approved by the U.S. Food and Drug Administration and supported by the Specialized Centers for Cell-based Therapies at the National Heart, Lung, and Blood Institute and the Donald W. Reynolds Foundation. It is the first to use adult cells from a patient’s own heart to attempt to heal injured heart muscle.

“This procedure signals a new and exciting era in the understanding and treatment of heart disease,” said Eduardo Marbán, MD PhD, director of the Cedars-Sinai Heart Institute, who developed the technique and is leading the clinical trial. “Five years ago, we didn’t even know the heart had its own distinct type of stem cells. Now we are exploring how to harness such stem cells to help patients heal their own damaged hearts.”

Heart disease is the leading cause of death in the United States. According to the Centers for Disease Control, in 2009, an estimated 785,000 Americans will have a first-time heart attack and about 470,000 will have a recurrent attack.

After undergoing extensive imaging scans so doctors can pinpoint the exact location and severity of the scars wrought by the heart attack, the patient undergoes a minimally-invasive biopsy, with local anesthesia. Using a catheter inserted through a vein in the patient’s neck, doctors remove a small piece of heart tissue, about half the size of a raisin.

The heart tissue is then taken to a specialized lab at Cedars-Sinai, where heart stem cells are cultured using methods invented by Marbán and his team. It takes about four weeks for the cells to multiply to numbers sufficient for therapeutic use, approximately 10 to 25 million.

In the third and final step, the now-multiplied stem cells are re-introduced into the patient’s coronary arteries during a second catheter procedure.

Marbán, who holds the Mark Siegel Family Foundation Chair at the Cedars-Sinai Heart Institute and directs Cedars-Sinai’s Board of Governors Heart Stem Cell Center, is developing future studies that will focus on advanced heart failure patients.

“What we work on in our stem cell lab today could translate into tomorrow’s leading-edge treatment for heart attack patients,” Marbán said.

Can Stem Cells Repair a Damaged Heart?

Heart attacks and congestive heart failure remain among the Nation's most prominent health challenges despite many breakthroughs in cardiovascular medicine. In fact, despite successful approaches to prevent or limit cardiovascular disease, the restoration of function to the damaged heart remains a formidable challenge. Recent research is providing early evidence that adult and embryonic stem cells may be able to replace damaged heart muscle cells and establish new blood vessels to supply them. Discussed here are some of the recent discoveries that feature stem cell replacement and muscle regeneration strategies for repairing the damaged heart.

Stem Cell treatment Introduction

For those suffering from common, but deadly, heart diseases, stem cell biology represents a new medical frontier. Researchers are working toward using stem cells to replace damaged heart cells and literally restore cardiac function.

Today in the United States, congestive heart failure—the ineffective pumping of the heart caused by the loss or dysfunction of heart muscle cells—afflicts 4.8 million people, with 400,000 new cases each year. One of the major contributors to the development of this condition is a heart attack, known medically as a myocardial infarction, which occurs in nearly 1.1 million Americans each year. It is easy to recognize that impairments of the heart and circulatory system represent a major cause of death and disability in the United States.

What leads to these devastating effects on the heart?

The destruction of heart muscle cells, known as cardiomyocytes, can be the result of hypertension, chronic insufficiency in the blood supply to the heart muscle caused by coronary artery disease, or a heart attack, the sudden closing of a blood vessel supplying oxygen to the heart. Despite advances in surgical procedures, mechanical assistance devices, drug therapy, and organ transplantation, more than half of patients with congestive heart failure die within five years of initial diagnosis. Research has shown that therapies such as clot-busting medications can reestablish blood flow to the damaged regions of the heart and limit the death of cardiomyocytes. Researchers are now exploring ways to save additional lives by using replacement cells for dead or impaired cells so that the weakened heart muscle can regain its pumping power.

How might stem cells play a part in repairing the heart?

To answer this question, researchers are building their knowledge base about how stem cells are directed to become specialized cells. One important type of cell that can be developed is the cardiomyocyte, the heart muscle cell that contracts to eject the blood out of the heart's main pumping chamber (the ventricle). Two other cell types are important to a properly functioning heart are the vascular endothelial cell, which forms the inner lining of new blood vessels, and the smooth muscle cell, which forms the wall of blood vessels. The heart has a large demand for blood flow, and these specialized cells are important for developing a new network of arteries to bring nutrients and oxygen to the cardiomyocytes after a heart has been damaged. The potential capability of both embryonic and adult stem cells to develop into these cells types in the damaged heart is now being explored as part of a strategy to restore heart function to people who have had heart attacks or have congestive heart failure. It is important that work with stem cells is not confused with recent reports that human cardiac myocytes may undergo cell division after myocardial infarction. This work suggests that injured heart cells can shift from a quiescent state into active cell division. This is not different from the ability of a host of other cells in the body that begin to divide after injury. There is still no evidence that there are true stem cells in the heart which can proliferate and differentiate.

Researchers now know that under highly specific growth conditions in laboratory culture dishes, stem cells can be coaxed into developing as new cardiomyocytes and vascular endothelial cells. Scientists are interested in exploiting this ability to provide replacement tissue for the damaged heart. This approach has immense advantages over heart transplant, particularly in light of the paucity of donor hearts available to meet current transplantation needs.

What is the evidence that such an approach to restoring cardiac function might work? In the research laboratory, investigators often use a mouse or rat model of a heart attack to study new therapies (see Figure 9.1. Rodent Model of Myocardial Infarction). To create a heart attack in a mouse or rat, a ligature is placed around a major blood vessel serving the heart muscle, thereby depriving the cardiomyocytes of their oxygen and nutrient supplies. During the past year, researchers using such models have made several key discoveries that kindled interest in the application of adult stem cells to heart muscle repair in animal models of heart disease.