Wollert Kai C, Drexler Helmut
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Curr Opin Cardiol. 2006 May;21(3):234-9. doi: 10.1097/01.hco.0000221586.94490.d2.
Chronic heart failure is a leading cause of hospitalization and is associated with a poor prognosis. Current therapeutic strategies do not address the underlying cause of the disease. Experimental studies have suggested that stem cells can exert beneficial effects on the failing heart by transdifferentiating into cardiac cell types and/or by providing a source of cardioprotective paracrine factors.
Early cell therapy studies in patients with heart failure have explored the suitability of distinct stem and progenitor cell populations for cardiac repair and the feasibility of different cell delivery methods. Autologous, unfractionated bone marrow cells or skeletal myoblasts have been used in the majority of clinical trials so far. One safety concern that has arisen from these studies is that myoblast grafts may represent an arrhythmogenic substrate. Improvements of regional systolic function and/or tissue viability have been reported. Due to the small number of patients in these studies and a lack of randomized control groups, meaningful conclusions regarding efficacy cannot be drawn at this time.
Cell therapy for patients with heart failure is still in its infancy. While early clinical studies suggest that stem and progenitor cell transfer to the failing heart may be feasible, firm conclusions regarding efficacy cannot be drawn at this time. The cell types that have undergone clinical testing so far, i.e. bone marrow cells and skeletal myoblasts, cannot promote true tissue regeneration. Further research into cell types with true cardiac transdifferentiation capacity is necessary in order to realize the prospects of cell therapy in this patient population.
慢性心力衰竭是住院治疗的主要原因，且预后较差。目前的治疗策略并未针对该疾病的根本病因。实验研究表明，干细胞可通过转分化为心肌细胞类型和/或通过提供心脏保护旁分泌因子来源，对衰竭心脏发挥有益作用。
早期针对心力衰竭患者的细胞治疗研究探索了不同干细胞和祖细胞群体用于心脏修复的适用性以及不同细胞递送方法的可行性。迄今为止，大多数临床试验使用的是自体未分离的骨髓细胞或骨骼肌成肌细胞。这些研究引发的一个安全问题是，成肌细胞移植可能是一种致心律失常的基质。有报道称局部收缩功能和/或组织活力有所改善。由于这些研究中的患者数量较少且缺乏随机对照组，目前尚无法就疗效得出有意义的结论。
心力衰竭患者的细胞治疗仍处于起步阶段。虽然早期临床研究表明将干细胞和祖细胞转移至衰竭心脏可能可行，但目前尚无法就疗效得出确凿结论。迄今为止接受临床测试的细胞类型，即骨髓细胞和骨骼肌成肌细胞，无法促进真正的组织再生。为实现该患者群体细胞治疗的前景，有必要对具有真正心脏转分化能力的细胞类型进行进一步研究。
