Improvements in the treatment of
ischemic heart disease have led to a significant growth in the numbers of patients with
systolic heart failure secondary to myocardial injury. Current
therapies fail to address the loss of contractile tissue due to myocardial injury.
Cell therapy is singular in its promise of primarily treating this underlying issue through salvage of viable myocardium or generation of new contractile tissue. Multiple cell types have been used to target acute
myocardial infarction, chronic
ischemic heart disease and
heart failure due to
infarction. Bone marrow mononuclear cells have been used to increase myocardial salvage after acute
infarction. Randomized trials of over 800 patients have demonstrated no safety issues, and meta-analyses have suggested an improvement in left ventricular function in treated patients with trends toward improvements in hard cardiac end points.
Cell therapy for chronic
ischemic heart disease with bone marrow angiogenic progenitors has shown similar safety and trends toward improvement in function. While these
therapies have targeted patients with viable myocardium, myoblasts have been used to treat patients with
left ventricular dysfunction secondary to transmural
infarction. Cell types with cardiomyogenic potential, including induced pluripotent stem cells and cardiac progenitor cells, offer the promise of true myocardial regeneration. Future studies with these cells may open the door for true myocardial regeneration.