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Can Stem Cell Therapy Effectively Rescue Damaged Heart?
 

Every year, around 17 million people die from heart disease worldwide. In Taiwan along, there are about 2 million patients developed heart disease each year and some 40,000 die because of heart failure.

Coronary occlusion or myocardial infarction is the most common cause for heart disease. These conditions prevent blood from going to the heart, which leads to myocardial necrosis and apoptosis. The mortality rate for these conditions can be as high as 30 percent. Even if patients could fortunately survive, their myocardial cells can hardly regenerate. The myocardial cells cannot withstand intraventricular pressure, and will gradually expand and become thin. The patients are therefore at high risk of having heart failure that could eventually lead to death.

While heart transplant is the best treatment, it is not commonly used because of limited heart donors and risks like immune rejection and infection. As such, heart disease patients are commonly treated by medication, including ACE inhibitors, beta-blockers, digitalis glycosides and diuretics. But drugs can only slow down disease progression and they usually have side effects.

Is there a better way to treat heart disease patients?

After conducting experiments on pigs, researchers from Institute of Nanotechnology and Microsystems Engineering, College of Medicine, National Cheng Kung University (NCKU), Tainan, Taiwan has proved that by combining self-assembling peptide nanofiber hydrogel with autologous bone marrow stem cell, it is possible to improve myocardial protection after acute myocardial infarction, heart functions and vascular regeneration. The findings were published in “Circulation” in September 2010, and the technology is currently under the applications of domestic and foreign patents.

Recent research studies have already indicated that many types of stem cells can be used to improve heart functions and be clinically effective and secure, but still there is room for improvement. For example, when stem cells are cultured outside the body and injected into the heart, most of these cells are either immediately carried away by the blood flow or they die rapidly. For those few that could survive, they could hardly become mature and functional cardiac or vascular cells.

So far, the survival rate of the cells staying in the heart after 24 hours is known to be less than 1 percent. However, if self-assembling peptide nanofiber hydrogel is combined with stem cells, and the mixture is injected into cardiac muscle, the stem cells would not be easily carried away from the heart by the blood. The retention rate can then be raised to 100 percent.

Nevertheless, problems, like source, amount and exclusion of stem cells, as well as how to accurately inject stem cells into damaged parts of cardiac muscle and how to pass trials in large animal experiments to ensure safety, are yet to be solved.

Researchers developed novel pharmaceutical compositions and treatment methods hoping to solve these problems. Experiments were conducted on Lanyu miniature pig, which has a similar cardiac structure as human beings, and self-assembling peptide nanofiber hydrogel were used to inject into the damaged areas of cardiac infarction. The sequelae such as ventricular wall thinning and ventricular dilation were reduced and diastolic dysfunction was improved from 54.2 percent to 85.5 percent after cardiac infarction.

The self-assembling peptide nanofiber hydrogel can integrate stem cells from the bone marrow in the miniature pig to effectively prevent pathological ventricular remodeling and diastolic dysfunction. This would significantly improve the myocardial viability and systolic function from 65.6 percent to 91.4 percent, increase the myocardial angiogenesis from 13.7 percent to 46.5 percent, reduce the range of myocardial infarction from 18.6 percent to 11.3 percent, and even promote potential myocardial regeneration.

The new method is modeled on the implementation of clinical therapy, from extracting stem cells from the bone marrow and mixing it with nanofiber hydrogel to completing the surgery of cardiac injection. The entire process only takes 30 minutes.

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