Bhawnani Nitin, Ethirajulu Aarthi, Alkasabera Almothana, Onyali Chike B, Anim-Koranteng Comfort, Shah Hira E, Mostafa Jihan A
Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2021 Aug 16;13(8):e17236. doi: 10.7759/cureus.17236. eCollection 2021 Aug.
Heart failure (HF), continuing to be a notable cause of morbidity and mortality worldwide, also is a noteworthy economic burden to the patients. Current medical management of HF has poor efficacy to completely arrest or reverse the progression to end-stage disease. As the option of cardiac transplantation remains limited to few patients, the stem cell approach continues to be a promising one in developing a novel therapy in the treatment of HF. This review attempts to discuss and compare the outcomes of numerous clinical trials that involved treatment of HF of variable etiologies with stem cells of numerous lineages such as bone marrow-derived cells (BMCs), mesenchymal stem cells (MSCs), cardiosphere derived progenitor cells (CDCs), etc. We reviewed articles and randomized controlled trials (RCT) that used stem cells to treat heart failure. The articles and RCT studies were obtained through a search on PubMed and Medline databases and performed using regular and medical subject heading (MeSH) keyword search strategy. A total of 17 trial-based studies, along with other articles that met the aim of the review, were selected. A discussion of the findings from major clinical trials such as the C-CURE, CHART-1, POSEIDON, POSEIDON-DCM, TAC-HFT, and other small scale trials highlights the change in functional and mechanical parameters of HF, namely, left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV), 6-minute walking test distance (6MWTD), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and assessment of New York heart association (NYHA) class of heart failure, and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score to reflect improvement in quality of life (QoL) of patients. Out of the studies analyzed, the majority reported significant improvements in at least two of the parameters mentioned above. However, more phase three randomized trials are required to compare the efficacy of multiple lineages of stem cells, factoring in molecular and dosage factors to develop a standardized therapy.
心力衰竭（HF）仍是全球发病和死亡的重要原因，对患者来说也是一项值得关注的经济负担。目前HF的药物治疗在完全阻止或逆转疾病进展至终末期方面疗效不佳。由于心脏移植的选择仍仅限于少数患者，干细胞方法在开发治疗HF的新疗法方面仍然很有前景。本综述试图讨论和比较众多临床试验的结果，这些试验涉及用多种谱系的干细胞治疗不同病因的HF，如骨髓来源细胞（BMCs）、间充质干细胞（MSCs）、心球衍生祖细胞（CDCs）等。我们回顾了使用干细胞治疗心力衰竭的文章和随机对照试验（RCT）。这些文章和RCT研究是通过在PubMed和Medline数据库上进行搜索获得的，并使用常规和医学主题词（MeSH）关键词搜索策略进行。总共选择了17项基于试验的研究以及其他符合综述目的的文章。对C-CURE、CHART-1、POSEIDON、POSEIDON-DCM、TAC-HFT等主要临床试验以及其他小规模试验的结果进行讨论，突出了HF功能和力学参数的变化，即左心室射血分数（LVEF）、舒张末期容积（EDV）、收缩末期容积（ESV）、6分钟步行试验距离（6MWTD）、N末端B型利钠肽原（NT-proBNP）水平以及纽约心脏协会（NYHA）心力衰竭分级评估和明尼苏达心力衰竭生活问卷（MLHFQ）评分，以反映患者生活质量（QoL）的改善情况。在所分析的研究中，大多数报告了上述至少两个参数有显著改善。然而，需要更多的三期随机试验来比较多种谱系干细胞的疗效，同时考虑分子和剂量因素以制定标准化治疗方案。
