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Cardiac reparation: fixing the heart with cells, new vessels and genes

P Menasché*,1 and M Desnos2

a Department of Cardiovascular Surgery, Hôpital Bichat Claude Bernard, Paris, France
b Départment of Cardiology, Hôpital, Européen Georges Pompidou and Taculté de Médecine Necker-Enfants Malades, Paris, France

* Correspondence: Dr Philippe Menasché, Department of Cardiovascular Surgery, Hopital Bichat Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France.

Abstract

Cell-based interventions, angiogenesis and gene therapy are among the newest treatment modalities that have been proposed to improve outcomes in patients with ischaemic heart disease. Experimental data have established that implantation of contractile cells into fibrous post-infarction scars can allow those tissues to regain some functionality. Although clinical data are still preliminary, they support the concept of cell transplantation and raise realistic hopes that it will find a place among strategies to ameliorate heart failure in the future. Therapeutic angiogenesis is another promising means of ameliorating ischaemic symptoms as there is already experimental evidence that angiogenic growth factors can stimulate the development of functionally significant new blood supply. In addition, successful correction of major abnormalities of calcium cycling by adenoviral gene transfer represents an encouraging finding in gene therapy. However, the complexity of gene dysregulation that is involved in heart failure complicates identification of the culprit genes, and important safety issues remain to be addressed before such therapies may proceed to clinical trials.

Key Words: Angiogenesis • cellular transplantation • gene therapy • heart failure


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