Meta-Analysis of Cell Therapy Studies in Heart Failure and Acute Myocardial Infarction

Abstract

Heart failure (HF) is one of the leading causes of death worldwide and has reached epidemic proportions in most industrialized nations. Despite major improvements in the treatment and management of the disease, the prognosis for patients with HF remains poor with approximately only half of patients surviving for 5 years or longer after diagnosis. The poor prognosis of HF patients is in part because of irreparable damage to cardiac tissue and concomitant maladaptive changes associated with the disease. Cell-based therapies may have the potential to transform the treatment and prognosis of HF through regeneration or repair of damaged cardiac tissue. Accordingly, numerous phase I and II randomized clinical trials have tested the clinical benefits of cell transplant, mostly autologous bone marrow-derived mononuclear cells, in patients with HF, ischemic heart disease, and acute myocardial infarction. Although many of these trials were relatively small, meta-analyses of cell-based therapies have attempted to apply rigorous statistical methodology to assess the potential clinical benefits of the intervention. As a prelude to larger phase III trials, meta-analyses, therefore, remain the obvious means of evaluating the available clinical evidence. Here, we review the different meta-analyses of randomized clinical trials that evaluate the safety and potential beneficial effect of cell therapies in HF and acute myocardial infarction spanning nearly 2 decades since the first pioneering trials were conducted.

An Overview of the Journey of Stem Cell Based Interventions from Bench to Bedside and the Growing Challenge of Unproven Interventions

“…Proper meta-analyses of SCI trials are essential for moving forward from multiple completed trials with varying results, to clinical application (Haidich, 2010;Ciccocioppo et al, 2018;Gyöngyösi et al, 2018;Shu et al, 2018;Sun et al, 2018;Yang et al, 2018). Weiss et al suggest that medical societies and associations play a proactive role in keeping clinicians informed and educating patients about approved interventions along with counselling by health care providers (Weiss et al, 2018).…”

Cardiac Stem Cell-Loaded Delivery Systems: A New Challenge for Myocardial Tissue Regeneration

“…On the other hand, despite the incontrovertible beneficial effects observed in patients with chronic heart failure using autologous and allogenic CSCs [ 54 ] and in patients with refractory angina using endothelial progenitor cells [ 55 ], clinical trials for myocardial regeneration remain still debated and controversial because the results are modest [ 56 ]. CSCs transplantation, as tested so far in humans, is not sufficient to promote an effective cardiac regeneration [ 57 ], and the low survival rate of transplanted cells further limits the therapeutic efficacy of cell therapy [ 57 ], coupled with the fact that CSCs could be rapidly removed from the body shortly after systemic injection.…”

Cardioprotective Potential of Human Endothelial-Colony Forming Cells from Diabetic and Nondiabetic Donors

“…Therefore, the concept of cell-based therapies may have the potential to transform the treatment and prognosis of heart failure through regeneration or repair of injured cardiac tissue [3,4]. Most clinical trials have used bone marrow derived mononuclear cells (BMCd), which have demonstrated inconsistent and, overall, modest efficacy [5].…”