Ann Thorac Surg 2008;85:580. doi:10.1016/j.athoracsur.2007.10.089
© 2008 The Society of Thoracic Surgeons
Original Articles: Cardiovascular
Invited Commentary
Yao Liang Tang, MD
Stem Cell Biology, Keck Graduate Institute, 535 Watson Dr, Claremont, CA 91711
(Email: ytang{at}kgi.edu).
Myocardial ischemia is a leading cause of morbidity and mortality of elderly patients in the United States, and it can progress to end-stage heart failure. Cell transplantation with an autologous stem cell source (including myoblasts and bone marrow stem cells) can avoid the problems of host immune and inflammatory reactions, and it has been used successfully to treat acute and chronic ischemic heart diseases. Thus, stem cell therapy with autologous cells holds great promise for treating ischemic heart disease, and the limited availability and poor functional activity of autologous stem cells in elderly patients have prompted examination of alternative cell source directed toward aged patients with advanced heart failure. More than 35 years of successful experience in bone marrow transplantation using allogeneic stem cell sources suggest that bone marrow derived stem cells may circumvent the problem of graft rejection and alleviate the need for immunosuppression after cell transplantation.
Atoui and colleagues [1] further studied the potential of using human bone marrow stromal cells (hMSCs) as "universal donor cells" for myocardial regeneration. In this study, the authors selected an extreme model of xenogeneic mismatch to investigate heart repair and the immune tolerance of hMSCs in rat ischemic hearts. These hMSCs can survive for at least 8 weeks. To confirm this finding, the authors analyzed the cell survival with three different methods: (1) immunohistochemistry, (2) polymerase chain reaction (PCR), and (3) fluorescent in situ hybridization (FISH) for human "Y" chromosome. These data were interpreted as suggesting that hMSCs can efficiently avoid immune attack from the host rat myocardium. Interestingly, the implanted hMSCs can significantly contribute to the improvement in ventricular function and attenuate left ventricular remodeling. Future studies that define the mechanism of immune tolerance of hMSCs and heart repair in xenogeneic cell transplantation will be important for continued characterization of this cell population.
The proven efficacy of immune tolerance using hMSCs underscores the potential of human bone marrow stromal cells and provides further rationale for the application of hMSCs as "universal stem cell treatment" in elderly patients with heart disease. We need to further evaluate hMSCs in a large animal model of myocardial ischemia prior to preclinical assessment of this novel therapeutic strategy. If efficacious, allogeneic bone marrow stromal cells can be applied in hospitals with a stem cell transplantation program for the treatment of elderly patients with ischemic heart disease.
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- Atoui R, Asenjo J-F, Duong M, Chen G, Chiu RC-J, Shum-Tim D. Marrow stromal cells as universal donor cells for myocardial regenerative therapy: their unique immune tolerance Ann Thorac Surg 2008;85:571-580.[Abstract/Free Full Text]
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