Cellular transplantation: future therapeutic options.
OBJECTIVE
Cardiac transplantation is a complex undertaking and an imperfect solution to end-stage heart failure. Cellular transplantation has been proposed as an alternative solution; however, clinical trials at present are small and show variable results. The mechanisms behind stem cell therapy have not yet been elucidated.


RESULTS
Several large trials have been presented that address the question of bone marrow stem cells as therapy for acute myocardial infarction, and also the possible benefits of therapy with granulocyte colony-stimulating factor. Although some trials show a modest improvement in ejection fraction or reduction of infarct size, other trials show no change with treatment. Fewer clinical data are available on the treatment of chronic left ventricular systolic function. Many questions remain such as what cell type to use, dosing, the ideal timing for therapy, and the technique of cell delivery. Finally, further research continues on the cellular milieu, enhancement of cell engraftment, proliferation, and survival.


CONCLUSIONS
This review briefly examines the background for stem cell therapy, as well as the larger clinical trials of stem cell therapy for acute myocardial infarction and chronic left ventricular systolic dysfunction, and possible pharmacologic enhancement options.
Allan
Rebecca
R
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Kass
Malek
M
Glover
Christopher
C
Haddad
Haissam
H
D000818:Animals; D016026:Bone Marrow Transplantation / Q000639:trends*; D004730:Endothelium, Vascular / Q000503:physiopathology; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation / Q000639:trends*; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery; D032383:Myocytes, Cardiac / Q000637:transplantation; D032389:Myocytes, Smooth Muscle / Q000637:transplantation; D033581:Stem Cell Transplantation / Q000639:trends*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000601:surgery