Bone marrow stem cell therapy for myocardial angiogenesis

Despite the recent advances in medical therapy and coronary revascularization procedures, coronary artery disease (CAD) remains the major cause of morbidity and mortality in the developing countries. In patients with severe CAD, persistent myocardial ischemia in hibernated myocardium resulted in progressive loss of cardiomyocytes with development of heart failure. As a result, therapeutic approaches to enhance neovascularization are being underwent intensive investigation. Recent experimental studies have demonstrated adult bone marrow (BM) can induce neovascularization in ischemic myocardium can improve heart function. These findings have prompted the development of different cellular transplantation approaches for heart diseases refractory to conventional therapy after myocardial infarction. Although the initial pilot clinical trials have shown potential clinical benefit of BM therapy for therapeutic angiogenesis, the long-term safety, the optimal timing and treatment strategy remains unclear. Furthermore, in order to acquire more optimized quality and quantity of BM derived stem cell for myocardial regeneration, several issues remain to be addressed, such as the development of a more efficient method of stem cells identification, purification and expansion. Emerging, rationally designed, randomized clinical trials are required to assess the clinical implication of BM derived stem cells therapy in treatment of CAD.