Stem Cell Treatment Might Reverse Heart Attack Damage

MONDAY, Feb. 13 (HealthDay News) — Stem cell therapy‘s promise
for healing damaged tissues may have gotten a bit closer to reality. In a
small, early study, heart damage was reversed in heart-attack patients
treated with their own cardiac stem cells, researchers report.

The cells, called cardiosphere-derived stem cells, regrew damaged heart
muscle and reversed scarring one year later, the authors say.

Up until now, heart specialists’ best tool to help minimize damage
following a heart attack has been to surgically clear blocked
arteries.

“In our treatment, we dissolved scar and replaced it with living heart
muscle. Such ‘therapeutic regeneration’ has long been the holy grail of
cell therapy, but had never been accomplished before; we now seem to have
done it,” said study author Dr. Eduardo Marban, director of the
Cedars-Sinai Heart Institute in Los Angeles.

However, outside experts cautioned that the findings are preliminary
and the treatment is far from ready for widespread use among heart-attack
survivors.

The study, published online Feb. 14 in The Lancet, involved 25
middle-aged patients (average age 53) who had suffered a heart attack.
Seventeen underwent stem cell infusions while eight received standard
post-heart attack care, including medication and exercise therapy.

The stem cells were obtained using a minimally invasive procedure,
according to the researchers from Cedars-Sinai and the Johns Hopkins
Hospital in Baltimore.

Patients received a local anesthetic and then a catheter was threaded
through a neck vein down to the heart, where a tiny portion of muscle was
taken. The sample provided all the researchers needed to generate a supply
of new stem cells — 12 million to 25 million — that were then
transplanted back into the heart-attack patient during a second minimally
invasive procedure.

One year after the procedure, the infusion patients’ cardiac scar sizes
had shrunk by about half. Scar size was reduced from 24 percent to 12
percent of the heart, the team said. In contrast, the patients receiving
standard care experienced no scar shrinkage.

Initial muscle damage and healed tissue were measured using MRI
scans.

After six months, four patients in the stem-cell group experienced
serious adverse events compared with only one patient in the control
group. At one year, two more stem-cell patients had a serious
complication. However, only one such event — a heart attack — might have
been related to the treatment, according to the study.

In a news release, Marban said that “the effects are substantial and
surprisingly larger in humans than they were in animal tests.”

Other experts were cautiously optimistic. Cardiac expert Dr. Bernard
Gersh, a professor of medicine at Mayo Clinic, is not affiliated with the
research but is familiar with the findings.

“This study demonstrates that it is safe and feasible to administer
these cardiac-derived stem cells and the results are interesting and
encouraging,” he said.

Another specialist said that while provocative and promising, the
findings remain early, phase-one research. “It’s a proof-of-concept
study,” said interventional cardiologist Dr. Thomas Povsic, an assistant
professor of medicine at the Duke Clinical Research Institute, in Durham,
N.C.

And Dr. Chip Lavie, medical director of Cardiac Rehabilitation and
Prevention at the John Ochsner Heart and Vascular Institute, in New
Orleans, also discussed the results. He said that while the study showed
that the cardiac stem cells reduced scar tissue and increased the area of
live heart tissue in heart attack patients with moderately damaged overall
heart tissue, it did not demonstrate a reduction in heart size or any
improvement in the heart’s pumping ability.

“It did not improve the ejection fraction, which is a very important
measurement used to define the overall heart’s pumping ability,” Lavie
noted. “Certainly, much larger studies of various types of heart attack
patients will be needed before this even comes close to being a viable
potential therapy for the large number of heart attack initial
survivors.”

Povsic concurred that much larger studies are needed. “The next step is
showing it really helps patients in some kind of meaningful way, by either
preventing death, healing them or making them feel better.”

It’s unclear what the cost will be, Povsic added. “What society is
going to be willing to pay for this is going to be based on how much good
it ends up doing. If they truly regenerate a heart and prevent a heart
transplant, that would save a lot money.”

Marban, who invented the stem cell treatment, said the while it would
not replace bypass surgery or angioplasty, “it might be useful in treating
‘irreversible’ injury that may persist after those procedures.”

As a rough estimate, he said that if larger, phase 2 trials were
successful, the treatment might be available to the general public by
about 2016.

More information

The U.S. National Heart, Lung, and Blood Institute describes
current heart attack treatment
.

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