Heart repair, cardiac regeneration and stem cells

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Background

Cardiovascular diseases are the leading cause of mortality worldwide according to the World Health Organization, mainly due to the occurrence of coronary heart disease and stroke but also to congenital diseases. Because of the phenomenon of population aging and unhealthy ways of life which contribute to increased risk factors, the number of death from cardiovascular diseases is expected to rise in the near future. So far the heart has been considered to be an organ composed of terminally differentiated cells and not capable of self-regeneration. However recent decisive advancements in this field of research provided evidence that cardiac tissues have the potential for a limited self-renewal. This novel concept thus expands the possibilities for cell-based therapies in the heart to replace dead cardiac muscle cells, since not only exogenous cells could be transplanted but also endogenous progenitor cells could be re-activated.
The latest improvements in stem cell bioengineering enable scientists to produce cardiomyocytes from the differentiation of embryonic stem cell lines, but also from adult (animal and human) cells via the so-called induced pluripotent stem cells (iPSCs). The iPSC technology offers the unique opportunity to create cellular models of human adult diseases such as inherited arrhythmia, which proves useful for toxicity studies and drug design. Moreover many of these embryonic or adult cell lines could be considered as candidates for transplantation, provided they would be successful in surviving, migrating, differentiating, distributing, and aligning after engraftment, fundamental properties which still remain huge challenges according to recent studies. Indeed while human embryonic stem cell-derived cardiac myocytes are not yet satisfactory for regeneration of the myocardium in terms of safety and efficacy, the production of sufficient quantities of adult iPSC-derived cardiomyocytes would require immense costs. An alternative promising approach is the use of autologous bone marrow stem cells that can be injected in patients via intra-coronary or intra-myocardial delivery. More clinical trials will be necessary to determine whether this method provides real improvements in ischaemic heart disease.
The scope of this Research Topic is to propose a platform of exchange and discussion for scientists interested in the utilisation of stem and progenitor cells for cardiac repair. Our emphasis will range from physiological aspects to bioengineering and clinical applications. Hence we aim at bringing ideas of collaboration and improvements, preliminary results and new perspectives, in order to start answering the following questions:
1) What would be the ideal cell type for therapy?
2) Are we ready yet for cell transplantation?
3) Can we make progress in the maturation of cardiomyocytes derived from stem cells?
4) Cell therapy or engineered heart tissue? For which disease?

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