Wednesday, November 16, 2011

Now, take heart from stem cells

NEW DELHI: Results from the first small scale human trials to use the heart's own stem cells to battle heart failure have been found to be promising.

Published in the Lancet on Monday, the study showed that Left Ventricular Ejection Fraction (LVEF) - the measurement of how much blood is being pumped out of the left ventricle of the heart (the main pumping chamber) with each contraction after the patient received an infusion of one million cardiac stem cells (CSCs) via a balloon catheter increased from 30·3% before the procedure to 38·5% four months later.

The positive effects of CSCs were even more pronounced at the end of a year in eight of the CSC patients, whose LVEF increased by 12.3% (from 30.2% before the procedure to 42.5%).

In the seven treated patients, whose cardiac MRI could be done, the size of the dead tissue decreased from 32.6g by 7·8g (24%) after four months and 9·8g (30%) at the end of the first year.

The study was conducted by Professor Roberto Bolli from University of Louisville and Professor Piero Anversa from Harvard Medical School. The authors concluded the results are significant because they introduce a new potential treatment for heart failure.

Dr Sujay Shad, head of the cardiac transplant programme at Sir Gangaram Hospital, said, "If the study can be replicated, it's a great advance. Around eight in every million people suffer significant heart failure, who require hospital admission. The two-year mortality among these patients in India is 75%, and in five years' time, none of them are expected to be alive."

Heart failure is a common, disabling and an expensive disorder. Despite advances over the past 30 years, the prognosis for patients remains poor, with a five-year mortality that is nearly 50% worse than those suffering from breast or colon cancer.

Ischaemic heart disease - the blocking of heart blood vessels causing death of heart muscle tissue - is the most common cause of heart failure. This leads to the heart pumping less blood, leading to in a decrease in LVEF. Available treatments do not address the fundamental problem of the loss of cardiac tissue.

Consequently, interest in attempts to repair the failing heart with the use of stem cells has been increasing, since this approach has the potential to regenerate dead tissues and could alleviate the underlying cause of heart failure.

The paper says, "The adult heart contains CSCs that are self-renewing, clonogenic and multipotent. This means they differentiate into all three major cardiac lineages - myocytes, vascular smooth muscle cells and endothelial cells). We, therefore, undertook a phase 1 clinical trial of CSCs in patients with heart failure after a heart attack to assess the safety and feasibility of intracoronary CSC infusion. Our results suggest that CSCs can be isolated and expanded."

The authors reported the results in 23 patients with severe heart failure (LVEF less than 40%), each of whom has had coronary artery bypass grafting (CABG). Around 16 of these received CSCs, while the other seven (control group) received standard care.

"The initial results suggest that intracoronary infusion of autologous CSCs in patients with chronic ischaemic cardiomyopathy and severe heart failure is feasible, safe and apparently highly efficacious in restoring LV systolic function up to one year after treatment," it added.

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