Heart failure, a condition responsible for 13% of deaths worldwide with half of patients dying within five years, may find new hope in cell-based therapies. A comprehensive review in Nature Reviews Cardiology examines two decades of clinical trials, revealing both the challenges and promise of using cell therapies to repair damaged heart tissue.
The Long Road to Acceptance
Jianyi “Jay” Zhang, M.D., Ph.D., professor and chair of the Department of Biomedical Engineering at the University of Alabama at Birmingham (UAB), and colleagues highlight the lengthy development process of current heart failure therapies. It took nearly four decades to optimize implantable cardioverter-defibrillators and guideline-directed medical therapy to reduce mortality in heart failure patients.
Cell Therapy: A Promising Avenue
The review details completed and ongoing clinical trials assessing the safety and efficacy of cell- and cell product-based therapy approaches. While no cell therapies have yet gained medical approval, some have shown beneficial effects, spurring further research and development.
Novel Approaches in Ongoing Trials
Ongoing trials are exploring several novel directions, including:
- New cell types: Pluripotent stem cell-derived cardiomyocytes/spheroids and umbilical cord-derived mesenchymal stem cells.
- Repeated intravenous injections: A noninvasive cell delivery method.
- New cell products: Engineered epicardial cardiomyocyte patches.
- Novel cell-free products: Extracellular vesicle-enriched or exosome-enriched secretomes.
Addressing Criticisms and Ensuring Progress
The review acknowledges criticisms regarding the use of public funding for cell therapy research, citing poorly designed or underpowered clinical trials and modest improvements in cardiac function in preclinical studies. Zhang emphasizes the need for future trials to be adequately powered and rigorously designed to ensure continued progress in the field.
The Future of Cell Therapy for Heart Failure
Despite the challenges, Zhang remains optimistic about the potential of cell therapy. "In the past 20 years, cell therapy has emerged and evolved as a promising avenue for cardiac repair and regeneration," he said. "Cell therapy has encountered substantial barriers in both preclinical studies and clinical trials, but the field continues to progress and evolve through lessons learned from such research."
