Regenerative Medicine for Heart Failure: A Comprehensive Overview of Clinical Studies, Current Challenges, and Future Directions

Abstract

Cell therapies have the potential to bring a paradigm shift to the treatment of heart failure (HF). Since the initial report of cell therapy with skeletal myoblasts in HF, a number of preclinical and clinical studies have been conducted, which support the ability of various stem cell populations to improve cardiac function and reduce the infarct size in HF. However, it is still too early in this new era of regenerative cell therapy as the novel modality. To address the fact that no cell therapy has been conclusively shown to be effective, the important issues involved have been discussed. First, the types of stem cells to be clinically investigated in HF have been reviewed; skeletal myoblasts, bone marrow-derived mononuclear and mesenchymal stem cells, adipose tissue-derived cells, and pluripotent stem cells have been discussed with their cell characteristics. Second, differentiation into cardiac lineage or paracrine effects as potential modes of action of stem cells in HF has been discussed. Finally, the routes of administration, cell dose and cell survival, and long-term engraftment have been discussed as current challenges and future directions. The purpose of this chapter is to review the preclinical and clinical studies carried out with respect to the use of stem cells in HF, and to discuss current unresolved issues and future directions.