Introduction: Any form of cardiac dysfunction or structure that causes the heart to fail to perform its normal function is called heart failure. In fact, it can be said that heart failure is a syndrome that results from physiological problems such as impaired left ventricular filling or other physiological problems. Heart failure is divided into several groups, but in this article, we simply divide it into ischemic and non-ischemic groups and briefly review.
Ischemic heart failure means a decrease in blood flow to the myocardium as a result of coronary artery occlusion. The result is a decrease in oxygen intake, infarction, replacement of the damaged myocardium with fibrosis tissue, and abnormal heart function.
Non-ischemic heart failure means the destruction of capillaries, characterized by decreased capillary density, increased resistance of blood vessels to destruction, and inadequate dilation of the capillaries in response to increased oxygen.
One of the treatment options for heart failure is stem cell therapy. The technology is still emerging, but it has unique features such as stem cells that differentiate into heart cells, smooth muscle cells and endothelial cells, so they can facilitate the regeneration process and speed up treatment. However, stem cell therapy in the treatment of heart failure depends on the pathophysiology of the disease and the physiological characteristics of the patients.
Cardiac stem cells) Recent studies have shown that myocardial cells are constantly changing after birth and can be regenerated as a result of which numerous cardiac cells have been identified. These cells express proteins such as C-Kit, Sca-1, Islet-1, SSEA-1 and PDGFRal that C-Kit proteins are suitable for improving left ventricular function. Different populations of heart stem cells have also shown their therapeutic potential. A type of cardiovascular stem cell in the laboratory environment called Cardiosphere, which has a spherical shape, has been shown being successful in early human studies. It has also been shown that injections of cardiac stem cells into ischemic cardiomyopathic patients have improved left ventricular function and reduced infarction.
Mechanism of Stem Cell Therapy with Cardiac cells
The precise mechanism of heart failure cell therapy is unknown. However, research has shown that cells transferred to the heart become new heart muscle. Research has shown that cardiac cells have a shorter lifespan after injection and may benefit from the release of paracrine factors, which leads to neovascularization and remodeling. Different mechanisms include cardiovascular system remodeling, the creation of new blood vessels, etc. produced by stem cells. There are various ways to transfer the cell to the heart, such as the intramyocardial via the endocardial, the epicardial or the cardiac patch, the intra-coronary and intravenous. The intramyocardial approach involves the direct injection of the cell into the heart muscle. The epicardial target is very accurate but invasive. This method is useful for treating patients undergoing surgery. The endocardial target is less invasive and releases stem cells directly to the target site but has high cell death potential and can also lead to myocardial injury and inflammation.
The intracoronary approach is intra-coronary release, which involves the injection of antegrade cells into the coronary artery. This technique can be performed invasively during open-heart surgery or sent by a catheter through the peripheral artery.
The intravenous procedure is a minimally invasive procedure that involves the intravenous injection of stem cells through the peripheral vein but is less reliable.
Methods: In Phase I of the SCIPIO clinical trial, heart stem cells were injected into patients with heart failure who underwent CABG. Also in the CADUCEUS experiment, Tseliou and colleagues used stem cells derived from the heart to treat ventricular dysfunction.
Results: In the SCIPIO trial, an increase in LVEF was shown with a decreasing trend in infarct size. Also, CADUCEUS experiment showed that heart stem cells can be produced allogeneically from the heart.
Conclusion: There have been numerous trials to prove the positive effect of stem cells on heart failure, but in spite of the positive results of some tests, others have yielded negative results. Effective stem cell therapy requires several factors including stem cell type, biochemical agents, and more. Finally, using nanotechnology can design custom stem cells, thereby enhancing cell efficiency.