Abstract
Stem Cells and Myocardial Regeneration is based on the epidemic status and great impact of cardiovascular diseases, and considers the current inability of the various state-of-the-art treatments to change this worldwide scenario.
The book presents a pool of selected articles in stem cell therapy for cardiac diseases and regeneration, embodying articles of historical note as well as the most important and breakthrough ones. The potential of the different stem cell sources to promote myocardial regeneration, the possible mechanisms involved in this repair, and the ideal routes of cardiac stem cell administration are discussed throughout the chapters. It contains a good and fair retrospective of the last 5 years of stem cell research, including preclinical and clinical trials. The new technologies involved in this field are also mentioned, including catheter-based cell delivery and minimally invasive cardiac approach techniques.
The stem cell researcher's basic questions are addressed. The first two sections of the book review the two major groups of stem cell sources, embryonic stem cells and adult stem cells; and some specific stem cell populations, such as hematopoietic stem cells, mesenchymal stem cells, multipotent adult stem cells, umbilical cord blood stem cells, skeletal myoblasts, and endogenous cardiac stem cells. The potential for inducing myocardial regeneration, including the ability to promote myogenesis and/or angiogenesis, as well as arrhythmogenic and electrical coupling properties (gap junction) of the different stem cell sources and types are analyzed. Mechanisms of stem cell action and critical pathways involved in myocardial repair, mainly focusing on paracrine effects, are also discussed in these sections.
Translating from bench to bedside, sections three and four are based on strategies for cardiac cell delivery and stem cell clinical trials for cardiac dysfunction. Among the possible routes for cardiac stem cell administration, section three examines the main advantages and disadvantages of percutaneous cellular cardiomyoplasty, analyzing different types of delivery catheters, the effectiveness and superiority of the intramyocardial route (endocardial injection) in comparison with the intracoronary one, and open-chest and minimally invasive surgical techniques. Section four presents a critical review of the stem cell-based clinical trials in chronic heart failure and acute myocardial infarction and measures for stem cell therapy efficacy. This section emphasizes the short follow-up, lack of control group, and the small number of patients included in these trials, and differences in studies outcomes and designs.
The final section of the book discusses reasons for cautious optimism regarding the use of stem cells for cardiac diseases in the clinical setting, through the unlocking of the extraordinary potential for cardiac regeneration with stem cell therapy.