A number of hot trials have been coming out of AHA’s meeting in Los Angeles over the past few days, including several with positive results that underscore the future of cardiology and stem cell therapy.
Results from the POSEIDON trial indicate that transendocardial injection of allogeneic and autologous mesenchymal stem cells (MSCs) without a placebo control were both associated with low rates of treatment-emergent serious adverse events, including immunologic reactions in patients with left ventricular (LV) dysfunction due to ischemic cardiomyopathy. In addition, results from the ALCADIA trial suggest that transplantation of autologous cardiac-derived stem cells (CSCs) with controlled release of basic fibroblast growth factor (bFGF) is both safe and effective in treating injured human hearts with reconstruction of the post-ischemic environment. While the SCIPIO trial results suggest that infusion of autologous CSCs harvested from the left atrial appendage at the time of coronary bypass surgery in patients with ischemic heart failure is safe and beneficial in both ventricular function and myocardial viability. These effects are sustained at 2 years and improve over time (read the full CardioSource article here). Whether these exciting new observations are sustained in a larger cohort of patients remains to be determined in future studies.
These innovative advances in stem cell therapy offer opportunities to cure, not just treat, patients with cardiovascular disease, and show how far we’ve come over the past decade since the first application of stem cell transplantation occurred in 2000 involving heart failure therapy. Phase I and Phase II trials have since indicated that it is both feasible and safe for physicians to isolate stem cells and to transplant them. Results however on improvement in ventricular function, viability and outcome have been mixed. Researchers are going back to the bench to gain more insight into the basic and molecular mechanisms of stem cells to improve the potential clinical effectiveness of this approach and also concurrently looking at the best methods of stem cell types and delivery. Among the methods being tested are direct epicardial injection, intravenous infusion and endocardial delivery. However, no single method has emerged as a major winner or standard.
One thing is certain, we will continue to see this hot topic emerge in future meetings (including ACC.13 in San Francisco) and publications as the science rapidly evolves and as we look for novel and more definite cures for heart failure in our patients.