Ischaemic heart disease remains the leading cause of heart failure in the Western World, and its prevalence continues to rise. Despite marked advances in the treatment of heart failure, heart muscle death remains irreversible. However, over the last decade the concept of the heart as a terminally differentiated organ has been refuted, and this has lead to an avalanche of research into potential mechanisms of stem cell myocardial regeneration.
In the Stem Cell Infusion in Patients with Ischemic cardiomyopathy (SCIPIO) trial, Bolli et al. report on 81 patients with ischaemic heart disease undergoing CABG for revascularisation with a poor left ventricular ejection fraction (LVEF<40%). They were assigned to receive either intracoronary cardiac stem cells (CSCs) or no treatment at 16 weeks post-surgery. The cells used were c-kit positive autologous CSCs derived from right atrial appendage tissue taken at the time of surgery.
Although the study is still in progress, the initial published results have shown a marked difference in LVEF in patients that received CSCs (30.3% to 38.5% at 4 months, n=14), compared to those who had received no treatment (30.1% to 30.2%, n=7). These effects were more marked at one year with 12.3% increase in LVEF noted (n=8). In those patients that could undergo Cardiac MRI, there was a decrease in infarct size by 24% at 4 months and 30% at one year (n=7). No adverse events were reported.
Conclusions:
These initial results are promising for the future of cell-based therapy of ischaemic heart failure, but further data and longer follow-up is required. Many basic science questions also remain, particularly as regards to which cell-type is used, and how to best to deliver these cells. Therefore, although SCIPIO provides some encouraging results, many fundamental questions remain to be answered.
References:
- Bolli R, Chugh AR, D’Amario D, Loughran JH, Stoddard MF, Ikram S, Beache GM, Wagner SG, Leri A, Hosoda T, Sanada F, Elmore JB, Goichberg P, Cappetta D, Solankhi NK, Fahsah I, Rokosh DG, Slaughter MS, Kajstura J, Anversa P. Cardiac stem cells in patients with ischaemic cardiomyopathy (SCIPIO): initial results of a randomised phase 1 trial. Lancet. 2011 Nov 14. [Epub ahead of print] PubMed PMID: 22088800.