Cardiac stem cell therapy for myocardial regeneration. A clinical perspective.

Myocardial infarction and other pathologic conditions of the heart result in loss of cardiomyocytes, scar formation, ventricular remodeling, and eventually heart failure. Since pharmacologic and interventional strategies fail to regenerate dead myocardium, heart failure continues to be a major health problem worldwide. Recent studies in animal models of myocardial infarction and heart failure have demonstrated that various subsets of adult primitive cells can regenerate functional cardiomyocytes and cardiac vasculature with improvement in cardiac structure and function. Small clinical trials of cell therapy in patients with myocardial infarction and ischemic cardiomyopathy have recapitulated these beneficial effects in humans with infarct size reduction and improvement in ejection fraction, myocardial perfusion, and wall motion. Several phenotypically distinct cell populations have been utilized for cardiac regeneration, and the relative merits of one cell over another remain to be determined. The recent discovery of adult cardiac stem cells has sparked intense hope for myocardial regeneration with cells that are from the heart itself and are thereby inherently programmed to reconstitute cardiac tissue. The purpose of this review is to summarize the evidence regarding the feasibility of cardiac repair in humans via adult stem/progenitor cells, and to discuss the potential utility of cardiac stem cells for therapeutic myocardial regeneration.