You are here

| Bone Marrow Stem Cells

Treating Heart Disease with Stem Cells: From Left to Right!

Comment

Discuss

Review of “CD34+ Cell Transplantation Improves Right Ventricular Function in Patients with Nonischemic Dilated Cardiomyopathy” from STEM CELLS Translational Medicine by Stuart P. Atkinson

While non-ischemic dilated cardiomyopathy (DCM) affects both ventricles of the heart, cell therapy trials have concentrated on the reversal of left ventricular (LV) dysfunction [1-4] and not right ventricular (RV) dysfunction. This lack of findings prompted a “shift” from left to right by researchers in the group of Bojan Vrtovec (Ljubljana University Medical Centre, Slovenia) who now report the results of CD34+ stem cell therapy on RV function in patients with DCM in STEM CELLS Translational Medicine [5].

The procedures and results of the trial (NCT02248532) included:

  • Patients receiving stem cells received granulocyte-colony stimulating factor (GCSF) to stimulate stem cell release from the bone marrow
    • CD34+ stem cells collected subsequently by apheresis
    • 80 million cells transendocardially injected into target areas within the left ventricle defined by electroanatomical mapping
  • Baseline results for Treated and Untreated patients suggested no differences in left ventricular ejection fraction (LVEF) or various parameters tested for RV function
  • At six months following treatment, only patients receiving CD34+ stem cells displayed significant improvements in RV function
  • Repeat electroanatomical mapping demonstrated an improvement in interventricular septum viability in 19 of 30 patients from stem cell treated group
    • This correlated with improvements in RV function, suggesting that ventricular interdependence may represent a potential underlying mechanism

While CD34+ cell therapy appears to improve RV function in this DCM patient cohort, the authors hope to undertake additional studies to first confirm these preliminary findings and then to understand the mechanisms at play and test the therapeutic relevance of this CD34+ cell therapy in other chronic heart failure patients with RV dysfunction.

For more on this stem cell shift from left to right, stay tuned to the Stem Cells Portal!

References

  1. Vrtovec B, Poglajen G, Lezaic L, et al., Comparison of transendocardial and intracoronary CD34+ cell transplantation in patients with nonischemic dilated cardiomyopathy. Circulation 2013;128:S42-9.
  2. Vrtovec B, Poglajen G, Lezaic L, et al., Effects of intracoronary CD34+ stem cell transplantation in nonischemic dilated cardiomyopathy patients: 5-year follow-up. Circ Res 2013;112:165-73.
  3. Hamshere S, Arnous S, Choudhury T, et al., Randomized trial of combination cytokine and adult autologous bone marrow progenitor cell administration in patients with non-ischaemic dilated cardiomyopathy: the REGENERATE-DCM clinical trial. Eur Heart J 2015;36:3061-9.
  4. Hare JM, DiFede DL, Rieger AC, et al., Randomized Comparison of Allogeneic Versus Autologous Mesenchymal Stem Cells for Nonischemic Dilated Cardiomyopathy: POSEIDON-DCM Trial. J Am Coll Cardiol 2017;69:526-537.
  5. Frljak S, Jaklic M, Zemljic G, et al., CD34+ Cell Transplantation Improves Right Ventricular Function in Patients with Nonischemic Dilated Cardiomyopathy. STEM CELLS Translational Medicine 2018;7:168-172.