Clinical cell-based cardiac regeneration therapy in patients with ischemic heart failure
Mariann Gyöngyösi1, Noemi Nyolczas2, Claudia Müller1, Katrin Zlabinger1, Ljubica Mandic1, Martin Riesenhuber1, Paul Haller1, Sandor Batkai3, Denise Traxler1
1Dept. Cardiology, Medical University of Vienna, Austria
2Dept. of Cardiology, Medical Centre Hungarian Defence Forces, Hungary
3Cardior Pharmaceuticals GmbH, Hannover, Germany
Since the number of the autologous remnant cardiac progenitor cells and the mobilized cells form the bone marrow upon injury signal are too low, as well as the own myocyte proliferation rate is insufficient for complete recovery of the heart after ischemic injury, external regenerative cells are implanted into the injured heart to promote the regeneration process. Accordingly, the clinical cardiac regeneration treatment with the intention to improve clinical symptoms, quality of life, and LV performance, as well as prevention of hospitalization, reduction of mortality and morbidity came into the forefront of pre-clinical and clinical investigations in the last 15 years. The majority of the heart failure clinical cell-based cardiac regeneration studies included patients with low ejection fraction (<40%), and applied the cells (mostly bone-marrow, or mesenchymal stem cells) percutaneously intramyocardially. Most studies and meta-analyses resulted in moderate improvement of the left ventricular function and quality of life, however, the last three randomized trials failed to reach the primary efficacy endpoints. To enhance the effectiveness of the regeneration therapy in heart failure, cell-free therapy with paracrine factors, including exosomes and cell function modulators, such as noncoding RNAs came into foreground.