Biomedical Engineering Reference
In-Depth Information
5.5 Conclusions and Final Remarks
In the last two decades, science has assayed new approaches for treating cardiovascular
diseases. Among others, stem cell, gene, and protein therapies have been shown to
present an enormous potential, although, of course, many aspects still need to be solved
or better understood. In the case of stem cell therapy, hopes were initially directed
toward the differentiation capacity of the cells, which ideally, could replace the injured
heart with new cardiac and vascular tissue. However, the results have not been as
positive as expected and data obtained from many in vivo and even clinical studies have
shown that the main mechanisms of action of the cells are not through differentiation but
through cytokine and factor secretion. There are several reasons for this lack of trans-
lation from in vitro to in vivo differentiation, including, together with the variable degree
of real differentiation potential among the stem cell populations, the lack of an adequate
microenvironment to host the cells and guide their differentiation. Thus, it has been
shown that one of the main limitations that stem cell therapy has presented is the low
level of engraftment and survival of the transplanted cells, which greatly diminish their
efficacy. New strategies, like the combination of stem cells with the bioengineering or
micro/nano-technologies, are intended to solve this problem and furthermore, allow to
more complex tissues to be created, which can be transplanted into the tissue. Impor-
tantly, the employment of materials has proven useful to limit infarct expansion,
maintain ventricle geometry, and compensate loss of functional capacity. Thus,
although many aspects like the electro-mechanical properties of the cardiac cell/tissues
will need to be strictly controlled and obtaining a real source of cardiac progenitor cells
without tumor or immunological risks is still not straightforward, this new approach for
treating cardiovascular disease appears to be a very promising alternative that will boost
the established positive benefits of stem cell transplantation.
Acknowledgments Instituto de Salud Carlos III (ISCIII PI050168, PI10/01621, CP09/00333,
and ISCIII-RETIC RD06/0014), Ministerio de Ciencia e Innovación (PLE2009-0116 and PSE
SINBAD, PSS 0100000-2008-1), Gobierno de Navarra (Departamento de Educación), Comun-
idad de Trabajo de los Pirineos (CTP), European Union Framework Project VII (INELPY),
Agencia Española de Cooperación Internacional para el Desarrollo (AECID), Caja de Ahorros de
Navarra (Programa Tu Eliges: Tu Decides) and the ''UTE project CIMA''.
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