ASK THE CARDIO TEAM
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Treating Heart Failure
Can adult stem cell therapy repair or reverse heart failure damage?
>> DR. WARREN SHERMAN: Stem cell therapy is of great benefit to patients who have both advanced heart failure, they’ve already reached a point in their clinical course where they cannot do much, and they’re stuck in that position. So, soon after a heart attack if stem cells are given, there’s very strong evidence that one can prevent heart failure from even occurring if you get to a patient early enough.
How exactly do stem cells work to improve heart function?
>> DR. MARC PENN: So adult stem cell therapy in heart failure patients activates an endogenous stem cell pool, the cardiac stem cell, brings them into play. It also revascularizes, at a microvascular level, the border zone between normal tissue and the scar. This border zone really is what we call hibernating, it’s asleep, but not dead. And by recruiting the work of that border zone and minimizing the inflammation there that ultimately continues further damage, we’re able to recover heart function and the heart being a unique organ in that it moves, once you fix the weakest link in the chain, the rest of the heart starts to remodel and improve itself. So over time, heart function can get better if we can restore the function of that border zone.
What’s the procedure like?
>> DR. PENN: At Okyanos for heart failure patients we treat them with stromal vascular fraction or SVF from adipose tissue or fat. We do a liposuction, collect the lipoaspirate and we use the Tissue Genesis Icellator System to isolate the stem cells from the lipoaspirate or the fat, and what we end up with is a solution of the stem cells free from their matrix so they’re active and dispersed so that it’s safe to infuse them intravenously. We infuse the cells through the coronary sinus, the main vein of the heart, using a catheter system on the right side of the heart, the low pressure side. We engage the coronary sinus and we infuse the stem cells for 10 minutes. After those 10 minutes are up, we take our system out, the catheter’s out and the procedure’s complete.
>> DR. LESLIE MILLER: Many of these patients are taking an endless array of medicines, all with all specific and good intentions, but 15% of people across the board in any drug trial can’t take that drug, drug X, no matter what it is because that percentage of them have an intolerable side effect. A lot of those medicines, particularly for heart failure, cause changes in blood pressure and heart rate and drug interactions. That won’t happen at all with stem cell therapy.
How do you know if a patient’s stem cell treatment is successful?
>> DR. SHERMAN The result of undergoing this procedure is measurable in two ways, and we pay very close attention to that over the following three, six, 12 months. One, how does the patient feel? Are they breathing better? Can they walk, climb stairs, exercise more efficiently, return to work?
>> DR. NICOLAS CHRONOS: Imaging wise, we might actually see better heart function, better pump function. We might also see more blood supply, say on a nuclear scan. So there’s the sort of objective data and then there’s subjective data.
When should a patient consider adult stem cell therapy for heart failure?
>> DR. CHRONOS: I think this is something they need to talk to their cardiologist about. They need to be aware that this option now is starting to exist in a standardized, well, methodically approached system. Patients who have undergone many traditional therapies, stents or bypass surgery, who no longer have the option of further stenting because of technical reasons or are not good candidates for a repeat bypass would be excellent candidates. Patients in Class III heart failure who are not Class IV yet, they’re not requiring a transplant, but they’re getting—they’re on all the medical therapies. We’ve done everything that we can. We’ve improved their function as much as possible. That’s the ideal patient, to try to see could we help regrow, regenerate, the patient’s own heart muscle before considering things like LVADs or Left Ventricular Assist Devices or transplants.
