The most common cause of heart failure is blockage of the coronary arteries which leads to the death of heart muscle cells or cardiomyocytes. It can also be linked to a history of heart attack. When this muscle tissue is replaced by dense scar tissue with little blood flow, the injured heart loses its force of contraction, leading to enlargement of the heart, progressive loss of pumping ability, increased risk of ventricular arrhythmias and end-stage clinical heart failure.
What a recordwho does not dispute the progress made, emphasizes that these new treatments for heart failure take a long time, far too long compared to the prevalence of the condition, which today exceeds 3% of the global prevalence. This is also the case for the two current therapies aimed at reducing mortality linked to heart failure: implantable automatic defibrillators and medical therapy based on recommendations, which took nearly 40 years to be approved, implemented. work and recommended.
Similarly, new attempts to repair scar tissue in hearts using cellular therapies and cellular products require more time to reach routine clinical use.
20 years of completed and ongoing clinical trials show that although none of these treatments have been approved, some have been confirmed to be safe and some to be beneficial.
This is what prompted lead author Dr. Jianyi “Jay” Zhang and his colleagues to talk about « tribulations » : “The history of the development of life-saving medical therapies for heart failure teaches us a lesson but inspires us to remain hopeful.”
A simple concept, a complex implementation
A simple concept: The idea behind cell therapies is to add or inject replacement cells into the scarred area to restore muscle tissue, whereas shortly after birth, human heart muscle cells lose their ability to divide.
Multiple obstacles: The analysis of 20 years of research, i.e. 13 completed clinical trials published over the last 12 years and 10 recently launched and ongoing clinical trials, reveals the slow pace of development of these therapies, the obstacles encountered, the setbacks suffered.
-Progress:
- if several randomized, double-blind, multicenter phase II or III trials support the effectiveness of a single dose of cellular products in patients suffering from heart failure under optimal medical treatment,
- current trials are taking new directions;
- that of new types of cells: cardiomyocytes/spheroids derived from pluripotent stem cells and mesenchymal stem cells derived from the umbilical cord;
- that of repeated intravenous injections as a method of non-invasive cell delivery;
- that of new cellular products, such as patches of artificial or even cell-free epicardial cardiomyocytes: secretomes enriched in extracellular vesicles or exosomes.
This synthesis suggests that the results of these trials will refine our understanding of cell therapy and cell products as a new innovation in the treatment of patients with heart failure.
She recognizes a slow but constant evolution of cell therapy.
However, its authors say they are convinced that the research will lead to clinical translation.
“Over the past 20 years, cell therapy has been confirmed as a promising avenue for cardiac repair and regeneration. It continues to progress thanks to the lessons learned from this research, however this evolution remains very slow.”
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