Stem Cell Treatment for Acute Myocardial Infarction

7/29/2019 Stem Cell Treatment for Acute Myocardial Infarction

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Chester Nicole V. Nilo

CON IV A02

NCM 106

Stem cell treatment for acute myocardial infarctionMyocardial infarction (MI), commonly known as heart attack, is a leading cause of death and disability in Western societies.

MI typically occurs when the blood supply to parts of the heart is cut off by a blocked artery, causing damage to the heart

tissue, and the cells in the affected area to start to die. In the days and weeks following a cardiac incident, this area may

grow, eventually leaving a large part of the heart unable to function properly and increasing the risk of further heart

problems.

Standard treatment following MI has traditionally involved thrombolytic therapy - the use of drugs to break up blood clots.

More recently, coronary angioplasty (also known as percutaneous coronary intervention) has become an intervention of

choice. This treatment involves the inflation of a balloon in the coronary artery to compress obstructions and restore

functionality, and has been credited with significant reductions in death and disability rates. Both of these treatments,

however, are limited in that they can only interrupt an ongoing process: neither can improve or restore cardiac function that

has been lost as a result of damage caused by MI.

Stem cell therapy, a relatively recent development in medicine, introduces new cells into damaged tissue in order to treat

disease or injury. Stem cells, which have the ability to regenerate, can potentially replace diseased or damaged cells and, if

effective, could represent a significant advance over many traditional approaches to disease treatment. Current applications

of stem cell therapy following MI use cells from patients own bone marro w to try to repair and reduce damage to heart

tissue. The treatment is currently available only in research associated facilities, but could theoretically be offered to all MI

patients, if long-term effectiveness, prevention of heart failure and reduced morbidity could be demonstrated.

In 2008, a Cochrane Review of 13 stem cell therapy clinical trials attempted to answer the question of whether adult bone

marrow-derived stem cells (BMSCs) can effectively prevent and repair the damage caused by a heart attack. In a newly

published and extensive update, the recent authors have incorporated findings from 20 more recent trials, analysing data

from all 33 studies now included in the review. By incorporating longer follow-up, the later trials also provide a better

indication of the effects of the therapy several years after treatment.

The Cochrane Reviews findings suggest that stem cell therapy using BMSCs can produce moderate long -term improvement

in heart function, as well as reduction of scars, which are sustained for up to five years. However, there were not enough

data available to reach firm conclusions about improvements in survival rates.

This new treatment may lead to moderate improvement in heart function over standard treatments, said lead author of the

study, Enca Martin-Rendon, of the Stem Cell Research laboratory, NHS Blood and Transplant at the John Radcliffe Hospital

in Oxford, UK. Stem cell therapy may also reduce the number of patients who later die or suffer from heart failure, but

currently the evidence is not definitive based on the small number of pati ents treated so far.

The task force of the European Society of Cardiology for Stem Cells and Cardiac Repair has recently received funding from

the European Union Seventh Framework Programme for Research and Innovation (EU FP7-BAMI) to undertake a large-

scale trial which, using standardised treatment procedures, will attempt to determine whether stem cell therapy is truly

effective in the treatment of MI. Principal Investigator for the BAMI trial, and co-author of this Cochrane Review, Anthony

Mathur, said, The BAMI trial will be the largest stem cell therapy trial in patients who have suffered heart attacks and will

test whether this treatment prolongs the life of these patients.

Reference: http://www.cochrane.org/features/stem-cell-treatment-acute-myocardial-infarction
http://www.cochrane.org/glossary/5#term189http://www.cochrane.org/glossary/5#term274http://www.cochrane.org/glossary/5#term222http://www.cochrane.org/glossary/5#term301http://www.cochrane.org/glossary/5#term242http://www.cochrane.org/features/stem-cell-treatment-acute-myocardial-infarctionhttp://www.cochrane.org/features/stem-cell-treatment-acute-myocardial-infarctionhttp://www.cochrane.org/glossary/5#term242http://www.cochrane.org/glossary/5#term301http://www.cochrane.org/glossary/5#term222http://www.cochrane.org/glossary/5#term274http://www.cochrane.org/glossary/5#term189


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CON IV A02

NCM 106

REACTION:For those suffering from common, but deadly, heart diseases, stem cell biology represents a new medical frontier. Researchers are

working toward using stem cells to replace damaged heart cells and literally restore cardiac function.

What leads to these devastating effects? The destruction of heart muscle cells, known as cardiomyocytes, can be the result of

hypertension, chronic insufficiency in the blood supply to the heart muscle caused by coronary artery disease, or a heart attack, the

sudden closing of a blood vessel supplying oxygen to the heart. Despite advances in surgical procedures, mechanical assistance

devices, drug therapy, and organ transplantation, more than half of patients with congestive heart failure die within five years of

initial diagnosis. Research has shown that therapies such as clot-busting medications can reestablish blood flow to the damaged

regions of the heart and limit the death of cardiomyocytes. Researchers are now exploring ways to save additional lives by using

replacement cells for dead or impaired cells so that the weakened heart muscle can regain its pumping power.

How might stem cells play a part in repairing the heart? To answer this question, researchers are building their knowledge base

about how stem cells are directed to become specialized cells. One important type of cell that can be developed is the

cardiomyocyte, the heart muscle cell that contracts to eject the blood out of the heart's main pumping chamber (the ventricle). Two

other cell types are important to a properly functioning heart are the vascular endothelial cell, which forms the inner lining of new

blood vessels, and the smooth muscle cell, which forms the wall of blood vessels. The heart has a large demand for blood flow, and

these specialized cells are important for developing a new network of arteries to bring nutrients and oxygen to the cardiomyocytes

after a heart has been damaged. The potential capability of both embryonic and adult stem cells to develop into these cells types in

the damaged heart is now being explored as part of a strategy to restore heart function to people who have had heart attacks or

have congestive heart failure. It is important that work with stem cells is not confused with recent reports that human cardiac

myocytes may undergo cell division after myocardial infarction. This work suggests that injured heart cells can shift from a

quiescent state into active cell division. This is not different from the ability of a host of other cells in the body that begin to divide

after injury. There is still no evidence that there are true stem cells in the heart which can proliferate and differentiate.

Although there is much excitement because researchers now know that adult and embryonic stem cells can repair damaged heart

tissue, many questions remain to be answered before clinical applications can be made. For example, how long will the

replacement cells continue to function? Do the rodent research models accurately reflect human heart conditions and

transplantation responses? Do these new replacement cardiomyocytes derived from stem cells have the electrical-signal-

conducting capabilities of native cardiac muscle cells?

Stem cells may well serve as the foundation upon which a future form of "cellular therapy" is constructed. In the current animal

models, the time between the injury to the heart and the application of stem cells affects the degree to which regeneration takes

place, and this has real implications for the patient who is rushed unprepared to the emergency room in the wake of a heart attack.

In the future, could the patient's cells be harvested and expanded for use in an efficient manner? Alternatively, can at-risk patients

donate their cells in advance, thus minimizing the preparation necessary for the cells' administration? Moreover, can these stem

cells be genetically "programmed" to migrate directly to the site of injury and to synthesize immediately the heart proteins

necessary for the regeneration process? Investigators are currently using stem cells from all sources to address these questions,

thus providing a promising future for therapies for repairing or replacing the damaged heart and addressing the Nation's leading

causes of death.
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CON IV A02

NCM 106

NURSING CONSIDERATIONCaring for patients after transplant includes a careful balance of antirejection medications, protection from infection,and frequent monitoring for long-term effects. Protect patients from sources of infection with careful hand washing,selective cohorting, and attention to wounds or I.V. sites. Be vigilant about the possibility of rejection by observing theskin for rashes, monitoring diarrhea, and ensuring the administration of antirejection medication according to thepatient's home administration schedule or the healthcare provider's order.

Patients who've undergone stem cell transplant may never have a fully normal immune system but with carefulattention, these patients can have a long and healthy life after transplant.

ETHICAL, LEGAL AND SOCIAL ISSUES There are several types of issues to consider as we think about stem cell research.

Ethical issues are those that ask us to consider the potential moral outcomes of stem cell technologies.

Legal issues require researchers and the public to help policymakers decide whether and how stem celltechnologies should be regulated by the government.

Social issues involve the impact of stem cell technologies on society as a whole.

PROs and CONsPros

Stem cell research can potentially help treat a range of medical problems. It could lead humanity closer to bettertreatment and possibly cure a number of diseases:

Parkinsons Disease

Alzheimers Disease

Heart Diseases, Stroke and Diabetes (Type 1)

Birth Defects

Spinal Cord Injuries

Replace or Repair Damaged Organs

Reduced Risk of Transplantation (You could possibly get a copy of your own heart in a heart-transplantation in thefuture

Stem cells may play a major role in cancer

Better treatment of these diseases could also give significant social benefits for individuals and economic gains forsociety

Cons

"We should not mess with human life."

"Humans should not be trying to play God"

Some argue that stem cell research in the far future can lead to knowledge on how to clone humans. It is hard to saywhether this is true, but we have seen devastating consequences of other research-programs, even with goodintentions, such as nuclear research.

Read more:Stem Cell Research - Pros and Cons
http://explorable.com/stem-cell-pros-and-cons#ixzz2JadXYlj6http://explorable.com/stem-cell-pros-and-cons#ixzz2JadXYlj6http://explorable.com/stem-cell-pros-and-cons#ixzz2JadXYlj6http://explorable.com/stem-cell-pros-and-cons#ixzz2JadXYlj6

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Stem Cell Treatment for Acute Myocardial Infarction