The Concept of Cell Therapy in Advanced Heart Failure: New Reality, Hope or Hype

Abstract

Chronic heart failure (CHF) is considered as a life-threatening disorder and a leading cause of morbidity and mortality in worldwide. A complex contributing factors including the hypertrophy of ventricles, intracellular organelles dysfunction, structural membrane deteriorations due to oxidative stress, deleterious signaling cascades, that inhibit of endogenous cardioprotective mechanisms and contribute alterations of metabolism, microvascular pathology, apoptosis and necrosis, lead to cardiomyocytes loss, spreading fibrosis, and, in fact, manifestation and advancing CHF. The review summarizes the current challenges and future research directions for concept of regenerative approaches of CHF. While stem cell therapy is currently being considered as a perspective treatment approach for patients with severe and advance CHF, the robust steps for subjects’ enrollment are not still evaluated. There are some wide spectrum stem cells (embryonic stem cell, induced pluripotent stem cells, adult stem cells) that are the most promising potential treatments for CHF. Embryonic stem cell types have limited in their development and have not practical evidences of favorable clinical effects in CHF patients. Pluripotent human embryonic stem cells have emerged as an attractive candidate stem cell source for obtaining cardiomyocytes. Juvenile cells possibly represent a more potent alternative, but the impact of patient-related variables on such cell products is unknown. Although isolated stem cell therapy with different types cells has been demonstrated its clinical efficacy and safety, but additional using novel methods of tissue engineering or stimulation of endogenous cardiac repair by pharmacological agents are conceivable for improving prognosis in CHF patients.