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Cardiac Stem Cell Transplantation: Exogenous or Endogenous Repair?

Dries Feyen, MSc1, Joost Sluijter, PhD1, Yolande Appelman, MD, PhD2, and Pieter A Doevendans, MD, PhD1

Despite medical treatment and revascula-rization options, heart failure is associated with significant morbidity and mortality rates. As the demand for cardiac transplantation by far exceeds the availability of donor hearts, heart assist devices are used as a bridge to transplant. However, transplantation and assist devices are only available for a minority of individuals. Consequently, new therapeutic strategies are being explored, of which cell transplantation therapy has emerged as a promising option to restore cardiac performance. Several in vivo experiments have demonstrated improved cardiac function and reduced remodeling upon cell injection into injured hearts. This article summarizes the types of stem or progenitor cells that are currently used in cardiac cell therapy, and reviews evidence of their beneficial effects on cardiac function and remodeling after myocardial infarction (MI) from preclinical and clinical studies. In addition, the potential modes of action of cell differentiation of the engrafted cells and/or activation of resident stem cells (SCs) by paracrine factors are discussed.

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