Despite the development of state-of-the-art surgical procedures, medical devices and generations of drugs, heart disease remains the number one cause of death worldwide. What option is there for cardiac patients who do not respond to current drug regimens and technology?
Stem cell therapy promises to be the next evolution in medicine because of its important features:
Stem cells are unspecialized cells that have the unique capability to develop into many different cell types in the body. To illustrate, at conception each person is created by combining two stem cells, the sperm and the egg cells. After 4-5 days, in a series of cell divisions, that combination further develops into an embryo consisting of 150 embryonic stem cells. These primitive cells continue to divide, and later begin to become specialized into different cell types and tissues as they develop into the whole body at birth.
Adult stem cells exist throughout the body after embryonic development and are found in different types of tissue. As the differentiation and specialization of our cellular make-up evolves, these cells remain in a quiescent or non-dividing state for years until activated by cellular life cycle, disease or tissue injury. They are found in:
Although adult stem cells can be found in nearly every part of the body, the most abundant source is in a person’s own adipose tissue.
AutologousFrom one's own body. adult stem cells can be safely harvested from these sources and have been found to be useful in the treatment of certain disease states such as blood cancers, osteoarthritis and cardiac disease. Approximately 1 million people in the U.S. have been treated with their own stem cells since the mid-1980s.
Many clinical trials at prestigious research institutions such as the Hospital Universitario Gregorio Marañón in Madrid, Spain, Thorax Center Erasmus Medical Center Hospital in Rotterdam, and University Medical Center in Utrecht, The Netherlands, and Rigshospitalet in Copenhagen, Denmark are studying the potential applications of stem cells in the treatment of:
The inherent purpose of adult stem cells is primarily repair. Cells, such as those derived from adipose tissueThe medical term for body fat. It is the richest source of adult stem cells as yet discovered., bone marrow, and liver lie quiescently in their native state until signals relating to injury such as inflammation “wake” them up. Their function then, is to begin the healing process. At the time of an injury, adult stem cells go into action and move, or hone in to where they are needed.
Stem cells possess two important properties: one is its ability for self-renewal, where it undergoes numerous cycles of cell division while maintaining its undifferentiated state, and the other is its multipotency or multidifferentiative potential, in which it is able to generate progeny (offspring) of multiple distinct cell types. With these properties, stem cells are able to perform reparative function by exhibiting these actions:
An important and central finding has been that throughout these processes, stem cells are giving, receiving, interpreting and modulating signals from the surrounding environment. The signals produced by stem cells are capable of “cell-to-cell” communication that is intrinsic to them only and cannot be replicated by non-stem cells.
Autologous stem cell therapy for ischemic heart disease Heart disease caused blood flow being restricted to due plaque in the arteries, also known as coronary artery diseaseoffers unique advantages to patients:
Mesenchymal stem cells are adult stem cells that can give rise to a large number of tissue types such as muscle, heart muscle, bone, cartilage (the lining of joints), fat tissue, and connective tissue (tissue that is in between organs and structures in the body).
Autologous mesenchymal stem cells, or MSCs, are primarily sourced from bone marrow or adipose (fat) tissue. Bone marrow-derived adult stem cells (BMCs) and adipose-derived stem and regenerative cells (ADRCs) are currently the subject of the vast majority of clinical research trials and patient treatments.
MSCs may be infused directly into points of inflammation such as arthritis or a wound. Once in these sites of injury or inflammation, MSCs coordinate healing and tissue regeneration by producing growth factors, blocking inflammation and reducing or improving scarring.
ADRCs and bone marrow – mesenchymal stem cells (BM-MSCs), both similar stem cells, tend to produce the similar therapeutic benefits, with the primary mechanism of action being the growth of new blood vessels or angiogenesis and anti-inflammatory properties.
The ADRC stem cells are multipotent “repair cells” that can differentiate into a variety of cell types including muscle, heart muscle, bone, cartilage, fat and the connective tissue that lies between organs and structures in the body.
A significant benefit of ADRCs, as opposed to BM-MSCs, is that it is less intrusive and less painful to extract cells from fat than from bone marrow. There are also far more stem cells in fat tissue than in bone marrow. Thus, they are a particularly attractive source of therapeutic cells for ischemic heart repair.
In particular, the use of adipose-derived stem and regenerative cells has unique advantages as compared to other autologous cell-types such as bone marrow, in that:
Adipose tissue is commonly known as a by-product of liposuction that is generally considered to be medical waste. Recently, however, it has been found to be the richest known source of adult stem and regenerative cells in the body. When one gains weight, adipose tissue gets larger as fat cells are filled with lipid and increase in size. As the tissue expands the blood vessels feeding the tissue must also grow to support it. ADRCS are rich in biological factors that help drive blood vessel growth and expansion.
In addition to their potential capacity for tissue regeneration, research has shown that they also secrete many different potent growth factors and cytokines that are important for repairing ischemic injury sites.
There is evidence that mesenchymal stem cells may create a small amount of new cardiomyocytes (heart muscle cells). According to Beltrami, et al (2003) the mechanism by which human ADRCs might preserve heart function after ischemic injury is through:
Still, results of other studies (Planat-Benard, V., et al. , 2004) suggest that “the efficiency of ADRCs in regenerative medicine could be related more to their capacity to modulate immunity and/or inflammation than to their differentiation potentials”.
Clinical grade ADRCs have been used on over 4,000 patients with ischemic conditions such as radiation wounds, heart attacks, heart failure and Crohn’s fistulas. ADRC cell-therapy treatments for these disease states have consistently demonstrated safety and improved heart function exceeding the existing standard of care and improving patients’ lives.
Approximately 1.3 million patients in the United States and 1.9 million in Europe suffer from acute heart attacks each year. Heart disease is the leading cause of death in the United States, and according to the Centers for Disease Control and Prevention (CDC), in 2010, the total costs of cardiovascular diseases were estimated to be $444 billion. On top of that, a policy statement published in Circulation: Journal of the American Heart Association (Circulation, January 24, 2011) predicts that this may triple by the year 2030.
Multiple rigorous clinical trials have evaluated the use of adipose-derived stem and regenerative cells to treat acute myocardial infarction or heart attack (APOLLO) and chronic myocardial ischemia, a severe form of coronary artery disease (PRECISE). After gathering data for 18 months both clinical trials showed statistically significant results, proving that ADRCs can improve cardiac function in no-option heart patients.