Friday, November 17, 2006

Hottest cardiac topic - Stem cells for the heart

Cardiology is probably one of the fastest advancing fields in medicine. We have seen many innovations in percutaneous coronary interventional techniques, but this scene seemed to have plateaued with the development of the drug-eluting stents.

Almost every time I meet lay people, and when they find out that I am a cardiologist, they would mention the stem cell therapy for the heart. Sometimes, they don't even know what it is used to treat, but they have heard about stem cells. Well, this is even more so lately, with the publication last week that doctors in UK are undertaking a clinical trial, using stem cells from the patients'own bone marrow, to try and regrow damaged muscle cells, follwoing angioplasty.

This idea certainly sounds very attactive and I have written on this earlier, mentioning the latest trials. I was golfing today and I was asked by my flight-mate about this "stem cell thingie" while we were playing. Well, it is certainly advantageous if we could regrow damaged heart muscle cells following a heart attack. However, we must know that this subject is under tremendous scrutiny through many clinical trials. This UK one, is just another one of the many.

The idea is great, however, much caution must be exercised, as even bone marrow derived stem cells, although they are pluripotential, are slightly differentiated and may give rise to other kinds of cells unless they are well targeted. They cannot be as good as embryonic stem cells. There is then also the question of the dose required and how to deliver. Delivering them intra-coronary, following successful angioplasty and stenting makes sense. But there is the problem of stent restenosis (as we have learnt from the Korean experience), using peripheral stem cells. There are many issues yet to be settled, and some workers are still wondering whether the current used techniques are safe.

I have heard of various cardiologist in Malaysia, injecting some form of "peripheral stem cells", self manufactured, into the patients' coronary following angioplasty.The idea is very attactive, I don't think that stem cells for heart attack recovery is not yet ready for primetime, but we need to observe the scene closely.

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