Autologous Cell Therapy: Current Treatments and Future Prospects
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Relatively safe, a segment of healthy vessel is harvested from either the leg (saphenous vein), from the inside of the breast (internal mammary artery), or from the forearm (radial artery), which is used to connect the aorta and the coronary artery beyond the blockages. High success rates can mostly be attributed to the autologous nature of the transplant. Such results have inspired work for further autologous treatments.
Due to a population of mainly terminally differentiated myocytes and an insufficient regenerative response, the adult heart is rendered inept to fully repopulate any reduced cardiomyocyte levels after, for example, a myocardial infarction.23,24 Autologous treatments available involve taking skeletal muscle from the patient’s back or abdomen to be enveloped over the weak heart, and subsequently using a device similar to a pacemaker, to electrically stimulate the transplant.
Autologous cells can also be transplanted to aid an ailing heart and involve the use of bone marrow derived stem cells or skeletal myoblasts. Although such work is still undergoing clinical examination, the aim is to replace the damaged myocardium or to assist in the healing process.25–28 Many practical considerations regarding cell therapy remain, such as the timing of transplant into the post infarct heart, whether the patient is fit to undergo surgery, and the method of cell delivery (injection into the coronary sinus, artery or directly into the damaged myocardium).29 The advantage of using skeletal myoblasts over other cell types is that they can be obtained from muscle with relatively little stress put upon the patient after heart trauma. The harvest of hematopoietic stem cells, on the other hand, requires numerous painful bone marrow biopsies that may be questionable in the days or even weeks following a major heart attack. The long-term outcomes of these transplants have yet to be assessed, as this form of treatment is in its developmental phase. However, as with any heart surgery, there are associated risks of arrhythmia, cardiac arrest, pain, or death.
Advances in the potential of stem cells to induce tissue regeneration and neovascularization has increased interest for use in treatment of cardiovascular diseases.30,31 The injection of autologous mononuclear bone marrow cells into areas of ischemic myocardium has been shown to improve the condition of a patient during phase I clinical trials.10,11,30 Moreover, tissue engineering uses a defined and specific cell population cultivated for a purpose, and therefore, unlike surgical reconstruction using other body tissues, these cultivated tissues can reinstate lost function to a better degree. Effectively, these cells can also be cultivated and combined with gene therapy, removing or rectifying deficient genes to correct the operative defect.
Commercially Available Autologous Treatments
Examples of commercially available autologous treatments are discussed throughout this review (Tables 1, 2). This section briefly discusses two such successful treatments. Commercially available since 1987, epidermal autografts consisting of autologous keratinocytes co-cultured with irradiated murine cells has been on the market (Epicel®, Genzyme Biosurgery, Cambridge, MA).32,33 Successful treatment and coverage of large burn wounds has been reported (Table 1). In 1997, the US Food and Drug Administration (FDA) approved a product consisting of autologous cultured chondrocytes (Carticel®, Genzyme Biosurgery).
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