Biologically based myocardial regeneration: is there a role for the surgeon?
OBJECTIVE
Despite advances in medical, percutaneous, and surgical treatment, there is an increasing burden of ischemic cardiovascular disease and heart failure. Over the past decade, a large number of preclinical and clinical studies have evaluated various biologic agents to treat these diseases.


RESULTS
Although the safety and feasibility of growth factor therapy, using vascular endothelial growth factors and fibroblast growth factors, for myocardial angiogenesis has been well established in a number of clinical trials, their ability to induce clinically significant improvements in symptoms remains uncertain. Numerous candidates have been proposed for cell-based therapies to improve myocardial perfusion and function and have demonstrated efficacy in preclinical studies. These cell types include skeletal myoblasts, bone-marrow derived cells, endothelial progenitors, and mesenchymal stem cells. Early clinical trials have demonstrated feasibility of cell harvest and implantation.


CONCLUSIONS
Biologic myocardial regeneration is a new and rapidly evolving area for the treatment of cardiovascular disease. Translation of these biologic entities into clinically useful therapeutic agents will require a better mechanistic understanding of their effects on the myocardium and the coronary circulation, optimization of delivery techniques, and systematic evaluation in large, randomized, placebo-controlled studies.
Boodhwani
Munir
M
Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Sodha
Neel R
NR
Sellke
Frank W
FW
D001691:Biological Therapy; D002309:Cardiology / Q000639:trends*; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D004727:Endothelium / Q000166:cytology; D005346:Fibroblast Growth Factors; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*; D010819:Physician's Role; D013234:Stem Cells; D042442:Vascular Endothelial Growth Factors
D042442:Vascular Endothelial Growth Factors; D005346:Fibroblast Growth Factors