Kardiochirurgia dorosłych
Myocardial regeneration – the revolution continues

Cellular therapy – from bench to bedside and back
Functional restoration of the damaged heart presents a formidable challenge and developing strategies for treatment and prevention of post-infarct heart failure remains of utmost priority. The past decade has witnessed growing attention to regenerative therapy of the failing heart [1]. Several factors have influenced such rapid propagation of this unconventional treatment of heart disease: Evidence from experimental as well as preclinical studies supporting the role of stem/progenitor cells in myocardial regeneration is a fast growing topic in biomedicine which has benefited greatly from recent improvements in the quality and credibility of published data [2]. Furthermore, initial clinical applications have proven the feasibility and safety of cellular myoplasty in patients [3-10], encouraging further research. The ultimate challenge, to successfully and everlastingly cure a diseased human heart, is yet to be undertaken. For cellular cardiomyoplasty to occur, numerous clinical problems must be solved. First, the most effective cell type, given the underlying pathology, must be determined. Second, a group of patients suitable for cellular transplantation needs to be defined. Third, the optimal timing, or so-called “window of opportunity” for each cell/disease combination has to be found. Fourth, the most effective and safest delivery method must be resolved. Last but not least, the question of long-term side-effects must be addressed, as none of the experimental studies seemed to clearly challenge most of these issues.
Cell type – where multitude brings confusion
As of the third quarter of 2007 bone-marrow derived cells alongside skeletal myoblasts (SMs) dominate the clinical arena of cellular transplantation. Although both cell types have proven effective in restoring the myocardium in preclinical studies [11-13], the mechanism of their action is far from conclusive. The vast majority of clinical studies utilizing bone marrow derived cells administer a pool of unfractionated mononuclear cells (BMMNCs). Such a pool contains hematopoietic (HSCs) and mesenchymal (MSCs) stem cells and endothelial progenitor cells (EPCs) as well as some other cell populations. Hematopoietic stem cells (HSCs) give rise to all hematopoietic lineages, and are characterized by specific cell markers, whose constellation varies among species. In humans HSCs are positive for...


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