title: [Cell therapies for cardiopathies: the shift of paradigms].
abstract: Heart failure is a major concern for public health systems, and several approaches of cellular therapy are being investigated with the goal of improving the function of these failing hearts. Many cell types have been used (skeletal myoblasts, hematopoietic, endothelial or mesenchymal progenitors, cardiac cells…), most often in the indication of post-ischemic heart failure rather than in the indication of genetic dilated cardiomyopathy. It is easier, indeed, to target a restricted area than the whole myocardium. Several clinical trials have reported slight but encouraging functional benefits, but their interpretations were frequently limited by the small sizes of cohorts, and by the biological variabilities inherent to the patients status and to the biology of the cells. These trials also shed light on unexpected mechanisms of action of the cells, which are changing the concepts and methodologies of the studies. The functional benefits observed would be due, indeed, to the secretion of trophic factors by the cells, instead of their true structural and mechanical integration within the myocardial tissue. Accordingly, the new generations of clinical trials aim at improving the size and homogeneity of the patient cohorts to increase the statistical power. On the other hand, several studies are associating or conditionning cells with biomaterials or cocktails of cytokines to improve their survival and their biological efficacy. In parallel, bio-engineering investigates several ways to support cells in vitro and in vivo, to sustain the architectural structure of the failing myocardium, to produce ex vivo some true substitutive cardiac tissue, or to purely replace the cells by their active secreted products. Several therapeutic devices should emerge from these researches, and the choice of their respective use will be ultimately guided by the medical indication.
authors.affiliation: Centre de Recherche en Myologie, Sorbonne Universités, UPMC-Inserm UMRS 974, CNRS FRE 3617, Institut de Myologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Jean-Thomas
authors.initials: JT
authors.lastname: Vilquin
authors.affiliation: Centre de Recherche en Myologie, Sorbonne Universités, UPMC-Inserm UMRS 974, CNRS FRE 3617, Institut de Myologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Jessy
authors.initials: J
authors.lastname: Etienne
mesh_terms: D009202:Cardiomyopathies / Q000628:therapy*; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D064987:Cell- and Tissue-Based Therapy; D053595:Embryonic Stem Cells; D006331:Heart Diseases / Q000628:therapy*; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D032446:Myoblasts; D032383:Myocytes, Cardiac; D033581:Stem Cell Transplantation