Bartunek Jozef, Vanderheyden Marc
Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium.
Future Cardiol. 2007 Sep;3(5):515-8. doi: 10.2217/14796678.3.5.515.
Stem cell therapy is emerging as a potential therapeutic option for cell death-related heart diseases. Preclinical as well as early-phase human studies have demonstrated the ability for cell therapy to augment perfusion and increase myocardial contractility. In addition, recent intermediate-size randomized trials suggested the potential of bone marrow stem cells to augment left ventricular recovery after a recent myocardial infarction. In general, the effects are modest and often similar despite differences in the study design, cell number or type. Therefore, a number of issues should be addressed before stem cell therapy will become standard clinical practice. They are related to the selection of the optimal cell type, standardization of the cell processing and release criteria. Other issues include timing of the cells injections and cell homing and retention. Further research is needed to understand the mechanisms underlying observed functional and beneficial effects including optimization of myocardial biological effects. Finally, despite overall enthusiasm, safety of the cardiac stem cell therapy should remain under scrutiny. The safety profile needs to be established in the large clinical trials and in a close interaction between translational and clinical research to address conceptual or procedural issues.
干细胞疗法正逐渐成为治疗与细胞死亡相关心脏病的一种潜在治疗选择。临床前研究以及早期人体研究已证明细胞疗法具有增强灌注和提高心肌收缩力的能力。此外，近期的中等规模随机试验表明，骨髓干细胞具有促进近期心肌梗死后左心室恢复的潜力。总体而言，尽管研究设计、细胞数量或类型存在差异，但效果通常较为适度且相似。因此，在干细胞疗法成为标准临床实践之前，有许多问题需要解决。这些问题涉及最佳细胞类型的选择、细胞处理和释放标准的标准化。其他问题包括细胞注射的时机以及细胞归巢和滞留。需要进一步研究以了解观察到的功能和有益效果背后的机制，包括优化心肌生物学效应。最后，尽管总体热情高涨，但心脏干细胞疗法的安全性仍应受到密切审查。需要在大型临床试验以及转化研究与临床研究的紧密互动中建立安全性概况，以解决概念或程序问题。
