Medical Engineer

ADVANCES N THE SCIENCE OF MEDICINE

With an ever ageing population, heart failure is a significant and increasing health problem worldwide. At least 550,000 new diagnoses of heart failure are made each year, and deaths from the disease are on the rise despite new advances in treatment. Cellular cardiomyoplasty is an innovative treatment with the promise of results that exceed the current standard medical and surgical treatments for heart failure. Standard pharmacological treatments such as administration of beta blockers, angiotensin-converting enzyme inhibitors, and aldosterone antagonists result in moderate success but do nothing to prevent left ventricular remodeling and subsequent heart failure. Mechanical support via ventricular assist devices leaves patients struggling with complications such as bleeding due to required anticoagulant therapy and infections. The devices themselves have a high rate of mechanical failure.

Animal research experiments have shown promising results that suggest cell transplantation may be a practical and effective treatment for patients suffering from myocardial cell damage. The stimulation of cell regeneration to engraft and therefore improve function in areas of infarcted myocardial tissues may have widespread applications in a variety of cardiac diseases including cardiomyopathy, chronic myocardial ischemia and post acute myocardial infarction. Cellular cardiomyoplasty is also being explored as a biological pacemaker.

The primary objective of cellular cardiomyoplasty is to replace akinetic scar tissue with
myocardial cells that are viable and that will regenerate to restore myocardial function while preventing ventricular remodeling. In patients that are being treated post acute myocardial infarction, hopes are that myocardial tissues will be saved or cells will be regenerated. Rather than the traditional medical support of restoring function around ischemic tissues, cellular cardiomyoplasty promises the possibility of repair and regeneration of affected tissues, thereby reversing the disease process. An ideal scenario for cellular cardiomyoplasty is transplantation of myocytes that will copy the lost cells and begin to function with contractility and connect electrically with the myocardium.

A wide variety of stem cell varieties are being studied with the hope of finding the best source for cardiomyogenesis. Due to ethical and legal concerns, embryonic stem cells are unlikely to be explored in the application. Also, issues within the structure of embryonic cells make them a poor choice for cellular cardiomyoplasty. Umbilical stem cells show promise, and experiments have shown that they are able to differentiate into cardiac myocytes. Amniotic fluid cells suggest to have a moderate potential for myocardial cell differentiation. Cardiac stem cells have shown promise since their potential for regeneration has been shown in recent years. In fact, cardiac hypertrophy has been shown to be caused by myocyte hyperplasia resulting from a stimulation of cardiac stem cells.

Cellular cardiomyoplasty promises to be a significant treatment in heart failure by restoring heart function at the cellular level. The potential success of the groundbreaking procedure promises to decrease morbidity and mortality in a prominent and serious disease.