Biomedical Engineering Reference
In-Depth Information
Fig. 5.2 Stem cell therapy for cardiovascular disease. Several stem cell populations have been
assayed as a therapy for myocardial infarction, being their mechanisms of action analyzed. In
general, a trophic effect has been described for them, secreting factors and cytokines responsible
of the protection and rescue of the damaged tissue. Also, although with not such a relevant
contribution, it has been shown the potential of some stem cell populations (like some endothelial
progenitors present in the BM, the CSC or pluripotent cells like the ESC and iPS) to differentiate
towards cardiovascular lineages, which could contribute to the regeneration of the heart tissue.
(SkM skeletal myoblasts; BMC bone marrow cells; UCBC umbilical cord blood cells; ADSC
adipose derived stem cells; CPC cardiac progenitor cells; fCM; fetal cardiomyocytes; ESC
embryonic stem cells; iPS induced pluripotent stem cells; CV cardiovascular)
5.3.2.1 Myoblast Clinical Trials
Skeletal myoblast transplantation was initially investigated in patients undergoing
open-heart surgery. The feasibility and safety of this approach was determined in a
phase I, non-randomized, multi-center pilot study published in 2005. In this study, 30
patients with ischemic heart failure received autologous skeletal myoblasts (obtained
from culture of a prior muscle biopsy) injected into the epicardium at the time of
coronary artery bypass surgery (CABG) [
97
]. Myoblasts were successfully trans-
planted in all patients without any acute injection-related complications or significant
long term, unexpected adverse events, apart from the arrhythmic events observed in a
few patients. This study showed that epicardial injection of skeletal myoblasts is
feasible with potential functional benefits. Thus, follow-up positron emission
tomography (PET) scans showed new areas of glucose uptake within the infarct scar,
suggestive of improved myocardial viability. Echocardiography measured an average
improvement in the LVEF even 2 years after the surgery. Another relevant trial was the
MAGIC trial, which was the first randomized placebo-controlled study of myoblast
transplantation in patients with left ventricular systolic dysfunction (LVSD) secondary
