Intervention for apoptosis in cardiomyopathy.

Apoptosis plays an important role in pathogenesis of primary and secondary cardiomyopathies. It is proposed that antiapoptotic interventions may constitute an effective strategy for these diseases. Some of the antiapoptotic interventions are "old wine in a new bottle" measures already included in the conventional pharmacotherapy. As specific antiapoptotic treatment, caspase inhibitors and anti-TNF-alpha antibody are in early phases of clinical trials in non-cardiac diseases or being contemplated for clinical studies. Non-pharmacotherapies such as cardiac resynchronization and left ventricular assist device also exert cardioprotection partly by antiapoptotic mechanisms. In the field of regenerative medicine, myocardial transplantation of bone marrow-derived stem cells has been performed. Although it is controversial whether it is a true regenerative medicine or the cytokine therapy, antiapoptotic effect of transplanted cells may also have a role in cardioprotection. Moreover, apoptosis may develop despite efforts for cardioprotection in some severe situations of heart failure. Cardiac repair and regeneration by cardiac stem cells may compensate a loss of cardiomyocytes avoiding a deleterious situation. Therefore, protection and/or potentiation of such effects by cardiac stem cells appear to be promising therapeutic strategy in the future. In this review, we discuss about the antiapoptotic interventions for cardiomyopathies in the "real world" and the future of clinical cardiology.