Rheault-Henry Mathieu, White Ian, Grover Diya, Atoui Rony
Northern Ontario School of Medicine, Sudbury P3E 2C6, Ontario, Canada.
Ross University School of Medicine, St. Michael BB11093, Barbados.
World J Stem Cells. 2021 Apr 26;13(4):236-259. doi: 10.4252/wjsc.v13.i4.236.
Heart failure continues to be one of the leading causes of morbidity and mortality worldwide. Myocardial infarction is the primary causative agent of chronic heart failure resulting in cardiomyocyte necrosis and the subsequent formation of fibrotic scar tissue. Current pharmacological and non-pharmacological therapies focus on managing symptoms of heart failure yet remain unable to reverse the underlying pathology. Heart transplantation usually cannot be relied on, as there is a major discrepancy between the availability of donors and recipients. As a result, heart failure carries a poor prognosis and high mortality rate. As the heart lacks significant endogenous regeneration potential, novel therapeutic approaches have incorporated the use of stem cells as a vehicle to treat heart failure as they possess the ability to self-renew and differentiate into multiple cell lineages and tissues. This review will discuss past, present, and future clinical trials, factors that influence stem cell therapy outcomes as well as ethical and safety considerations. Preclinical and clinical studies have shown a wide spectrum of outcomes when applying stem cells to improve cardiac function. This may reflect the infancy of clinical trials and the limited knowledge on the optimal cell type, dosing, route of administration, patient parameters and other important variables that contribute to successful stem cell therapy. Nonetheless, the field of stem cell therapeutics continues to advance at an unprecedented pace. We remain cautiously optimistic that stem cells will play a role in heart failure management in years to come.
心力衰竭仍然是全球发病和死亡的主要原因之一。心肌梗死是导致慢性心力衰竭的主要病因，会造成心肌细胞坏死以及随后纤维化瘢痕组织的形成。目前的药物和非药物治疗侧重于控制心力衰竭症状，但仍无法逆转潜在的病理状况。心脏移植通常不可靠，因为供体和受体的可获得性存在重大差异。因此，心力衰竭的预后较差且死亡率较高。由于心脏缺乏显著的内源性再生潜力，新型治疗方法采用了干细胞来治疗心力衰竭，因为干细胞具有自我更新以及分化为多种细胞谱系和组织的能力。本综述将讨论过去、现在和未来的临床试验、影响干细胞治疗结果的因素以及伦理和安全性考量。临床前和临床研究表明，应用干细胞改善心脏功能时会产生广泛的结果。这可能反映了临床试验尚处于初期阶段，以及对有助于成功进行干细胞治疗的最佳细胞类型、剂量、给药途径、患者参数和其他重要变量的了解有限。尽管如此，干细胞治疗领域仍以前所未有的速度不断发展。我们仍然谨慎乐观地认为，干细胞在未来几年将在心力衰竭管理中发挥作用。
