Clinical trials of cardiac regeneration using adult stem cells: Current and future prospects

Abstract

Myocardial infarction (MI) is one of the leading causes of death worldwide. Despite several recent advancements in surgery and medicine, an effective measure to repair damaged myocardium is still unavailable. Regenerative medicine has endowed with new light in treatment of MI. Currently, the two different sources of stem cells are used in various applications in regenerative medicine, these are embryonic stem cells (ESCs) and adult stem cells (ASCs). ASCs are highly preferred over ESCs due to ethical acceptance, less/no risk of teratoma formation, easy isolation from different adult tissues, and expandable in culture. The first-generation clinical trials were based on stem cells derived from bone marrow-derived mononuclear cells (BM-MNCs) followed by mesenchymal stem cells (MSCs) isolated from bone marrow, adipose tissue, or Wharton's jelly. Although many trials showed glimpses of clinical improvement, the inconsistent results so far obtained were primarily due to nonuniform isolation techniques, donor specificity, and culture conditions adopted for expansion of MSCs. The strategies currently under investigation are believed to contribute in the future regenerative medicine, which include the use of induced pluripotent stem cells (iPSCs)-derived cardiac progenitor cells, directly reprogrammed cardiomyocytes from and acellular therapies using cytokines, and growth factors. In this chapter both current and future aspects of stem cells in cardiac regeneration will be discussed.