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Stem-cell transfer could improve cardiac functioning after heart attack (pp 121, 141)
July 07, 2004Results of a randomised trial in this week's issue of THE LANCET suggest that the transfer of adult stem cells derived from bone marrow could improve cardiac functioning after heart attack.
Evidence is emerging that adult stem cells from bone marrow have therapeutic potential for restoring cardiac cells among people who have had heart attack. Helmut Drexler (University of Freiburg, Germany) and colleagues assessed whether the transfer of patients' own bone-marrow cells could improve functioning of the left ventricle of the heart 6 months after treatment.
60 patients who had undergone successful percutaneous coronary intervention (PCI; balloon angioplasty and coronary stenting) to restore coronary artery bloodflow took part in the study. Half were given bone marrow stem-cell transfer 5 days after PCI, the other half were given optimum medical therapy. Patients who had been given stem-cell transfer had around a 7% improvement in left-ventricular function compared with only a 0"¢7% increase for patients given medical therapy.
Dr Drexler comments: "Our results lend support to the concept that autologous bone-marrow cells can be used to enhance left-ventricular functional recovery in patients after acute myocardial infarction. Larger trials are needed to address the effect of bone-marrow cell transfer on clinical endpoints such as the incidence of heart failure and survival."
In an accompanying commentary (p 121), Jürgen Hescheler (University of Cologne, Germany) concludes: "Medicine profits from the fact that clinicians often provide a first impulse and then basic scientists take over the background research into mechanisms. After these mechanisms have been elucidated, we might even be able to replace the injection of cells by an appropriate drug. Equally important remains the continuation of basic research with the most promising sources of cardiac-muscle cells-ie, derived from embryonic stem cells or fetal cardiomyocytes in animal models...[the] study exemplifies the fact that clinicians and basic scientists must work more closely together and strengthen their interactions. The ultimate beneficiary will be the patient, which must be the main goal for all of us".
This week's seminar (p 183) discusses current knowledge and future issues surrounding stem-cell therapy for the heart. John Martin (University College London, UK) concludes: "There is evidence across species that regeneration of tissue can occur. Both animal and human studies suggest that stem cells capable of improving cardiac function exist in adults. This might be part of a natural repair process. The benefit of this novel approach to treating cardiovascular disease should be confirmed and optimised. Safety is the key issue. It is important that clinical trials are designed to answer these questions. Funding such large studies will remain a major hurdle. Open collaboration amongst basic scientists and clinicians around the world is crucial for these problems to be overcome."
Lancet
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