The first paper in this week's Lancet Series on stem cells, states that it has never been more crucial to use opportunities for collaborating on a multidisciplinary level, in order to realize the development of effective regenerative treatments for heart disease, than now. The secret is to overcome existing traditional barriers between individual areas of specialization, starting from cardiovascular medicine to device technology, and to create interdisciplinary teams from the academic and private sector.
The paper's lead author, Kenneth Chien from Harvard University in the USA explains:
"The development of regenerative strategies to reverse the progression of advanced heart failure is one of the most urgent clinical needs of this century...and has become a holy grail of modern cardiovascular science. But if we are to move beyond stem cell biology towards the development of true cardiovascular regenerative therapy...a parallel regenerative effort to change the existing academic culture and environment might be necessary...the fate of patients with heart failure will probably hinge on the outcome."
Until now, clinical trials have been based on heart attacks, chronic heart failure as well as dilated cardiomyopathy, but regardless of the fact that regenerative therapies that are based on various non-cardiac cell types seem to be safe, their efficacy has not yet been tested in a clinical trial.
However, possible new targets and treatment strategies are now emerging due to recent progress in cardiac stem cell research and regenerative biology.
Scientists used to think that the heart only has a minimal capacity for self-renewal and saw no prospect in reversing the loss of healthy heart muscle and function. This perception has been altered because of recent findings, such as the discovery of several distinct embryonic progenitor cell types of which some are found in the heart.
A certain number of these cells can be activated in people with cardiac injuries and are now targeted by scientists to develop novel cardiac regenerative therapeutics either by delivery of the cells, or by new methods that activate expansion and conversion of functioning heart cells.
For instance, clinical studies conducted a short while ago demonstrated that scar formation following a heart attack can be reduced by taking cells from the patient's own heart tissue. Even though it remains uncertain whether the delivered cells are indeed stem cells, these studies nevertheless demonstrate that this is a small, educational step towards the goal of utilizing the heart's potential for self-healing.
There is still a lot of work to be done. The complexity of the heart means that in order to restore its function requires more than just regenerating one cell type, it also means that the native structure of the heart needs to be recreated.
The authors comment:
"An ideal cardiac regenerative therapy would possess a key cell and paracrine factor combination, a cardiac tissue niche optimized to enhance cell engraftment and differentiation, and a safe, minimally invasive delivery procedure that introduces the regenerative therapy specifically to the affected areas with the least risk of acute and long-term side effects."
They conclude that a multidisciplinary collaboration of partners in various specialty areas, including stem cell biology, transplantation, grafting, tissue engineering, rejection biology, as well as clinical cardiovascular medicine and device technology is absolutely crucial.
Dusko Ilic from King's College London, UK, and Julia Polak from the Imperial College in London write in a linked comment:
"Governments and the private sector will have to show confidence in stem cell research by continuous investment in a new generation of researchers who will move science forward and translate discoveries into reliable clinical outcomes."
Written by Petra Rattue