Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University-Chieti, Italy.
University of Texas Medical School in Houston, USA.
Cardiovasc Res. 2019 Mar 1;115(3):488-500. doi: 10.1093/cvr/cvz010.
Morbidity and mortality from ischaemic heart disease (IHD) and heart failure (HF) remain significant in Europe and are increasing worldwide. Patients with IHD or HF might benefit from novel therapeutic strategies, such as cell-based therapies. We recently discussed the therapeutic potential of cell-based therapies and provided recommendations on how to improve the therapeutic translation of these novel strategies for effective cardiac regeneration and repair. Despite major advances in optimizing these strategies with respect to cell source and delivery method, the clinical outcome of cell-based therapy remains unsatisfactory. Major obstacles are the low engraftment and survival rate of transplanted cells in the harmful microenvironment of the host tissue, and the paucity or even lack of endogenous cells with repair capacity. Therefore, new ways of delivering cells and their derivatives are required in order to empower cell-based cardiac repair and regeneration in patients with IHD or HF. Strategies using tissue engineering (TE) combine cells with matrix materials to enhance cell retention or cell delivery in the transplanted area, and have recently received much attention for this purpose. Here, we summarize knowledge on novel approaches emerging from the TE scenario. In particular, we will discuss how combinations of cell/bio-materials (e.g. hydrogels, cell sheets, prefabricated matrices, microspheres, and injectable matrices) combinations might enhance cell retention or cell delivery in the transplantation areas, thereby increase the success rate of cell therapies for IHD and HF. We will not focus on the use of classical engineering approaches, employing fully synthetic materials, because of their unsatisfactory material properties which render them not clinically applicable. The overall aim of this Position Paper from the ESC Working Group Cellular Biology of the Heart is to provide recommendations on how to proceed in research with these novel TE strategies combined with cell-based therapies to boost cardiac repair in the clinical settings of IHD and HF.
缺血性心脏病(IHD)和心力衰竭(HF)的发病率和死亡率在欧洲仍然很高,在全球范围内呈上升趋势。IHD 或 HF 患者可能受益于新型治疗策略,例如细胞疗法。我们最近讨论了细胞疗法的治疗潜力,并就如何改善这些新型策略的治疗转化提出了建议,以实现有效的心脏再生和修复。尽管在优化细胞来源和递送方法方面取得了重大进展,但细胞疗法的临床疗效仍不尽如人意。主要障碍是移植细胞在宿主组织有害微环境中的低植入率和存活率,以及内源性具有修复能力的细胞数量少甚至缺乏。因此,需要新的方法来输送细胞及其衍生物,以实现 IHD 或 HF 患者的基于细胞的心脏修复和再生。利用组织工程(TE)的策略将细胞与基质材料结合起来,以增强移植区域内细胞的保留或细胞递送,最近为此目的受到了广泛关注。在这里,我们总结了来自 TE 方案的新兴新方法的知识。特别是,我们将讨论细胞/生物材料(例如水凝胶、细胞片、预制基质、微球和可注射基质)组合如何增强移植区域内的细胞保留或细胞递送,从而提高 IHD 和 HF 细胞疗法的成功率。我们不会专注于使用具有完全合成材料的经典工程方法,因为它们的材料性能不理想,不适合临床应用。ESC 工作组心脏细胞生物学的这份立场文件的总体目标是就如何在这些新型 TE 策略与基于细胞的疗法相结合的研究中提供建议,以促进 IHD 和 HF 的临床环境中的心脏修复。
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