According to WHO data, 17.9 million people died from cardiovascular disease worldwide in 2019, accounting for about 32% of all deaths globally, with ischemic heart disease being an important cause of death in people with cardiovascular disease [1]. Although there are currently thrombolytic, coronary interventional surgery and other ways to reopen occluded and narrowed coronary veins, timely rescue the myocardium on the verge of ischemic necrosis, thereby preventing the further decline of cardiac function and reducing the mortality of patients, but the above treatment methods can not save the cardiomyocytes that have been ischemic necrotic, nor can they solve the problem of permanent myocardial tissue loss.
In recent years, stem cells and stem cell exosomes have been widely used in the treatment of ischemic heart disease, providing new ideas for solving permanent myocardial tissue loss. Recently, international researchers published a review in the European Journal of Pharmacology [2], which systematically summarized the properties and roles of exosomes derived from stem cells in ischemic heart disease. There is growing evidence that stem cell-derived exosomes can play an increasing role as potential therapies for ischemic heart disease.
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Why can stem cells and exosomes treat ischemic heart disease?
Cardiomyocytes cannot divide and proliferate, and there are no stem-like multipotent cells in the myocardium. Therefore, once the heart muscle cells die, it is irreversible! Ischemic heart disease refers to cardiac ischemia, which leads to ischemic necrosis or apoptosis of cardiomyocytes, which reduces the number of cardiomyocytes and eventually leads to heart failure in the long run.
With in-depth research, more and more evidence proves that stem cell therapy can regenerate and repair damaged myocardium and improve heart function. Stem cells have a wide source, strong repair power, multi-directional differentiation and low immunogenicity, which can not only differentiate into cardiomyocytes, but also promote the regeneration of blood vessels and cardiomyocytes, improve myocardial function, and is one of the current hot spots in heart repair research.
In addition, some researchers have expanded their research to exosomes derived from stem cells. Exosomes are membrane sac structures of proteins, lipids and nucleic acids secreted by stem cells, which are characterized by stability, general tolerance and low side effects, easy separation and efficacy.
Some researchers have analyzed that the reason why stem cells can repair myocardial damage is through the secretion of exosomes to achieve repair effect. Exosomes flowing in vivo, for example by regulating certain miRNAs, can regulate the mutual communication between heart cells, often enhancing cardioprotective properties through various signaling mechanisms, leading to increased angiogenesis, prevention of apoptosis and reduction of fibrosis.
All of the above makes it one of the drug candidates for the treatment of ischemic heart disease.
Literature corroborates this
Effect of stem cells and exosomes in the treatment of ischemic heart disease
In recent years, clinical research data on stem cells and their exosomes in the treatment of ischemic heart disease have been published in the literature. In 2012, The Lancet published a prospective trial in patients with ischemic cardiomyopathy [3] that included 25 patients, divided into two groups, one receiving heart-spherocyte-derived cells (cardiac progenitor cells, CDC) and one receiving standard treatment. No complications were reported within 24 hours of CDC infusion. After 6 months of follow-up, no patients died in either group, nor did they develop heart tumors or adverse events related to the heart.
At 6 months, patients in the CDC group analyzed by magnetic resonance imaging (MRI) had reduced scar volume, increased cardiac viability, local contractility, and thickening of the local systolic ventricular wall. The study also confirms that cell-based therapies can improve the patient's heart condition.
Figure from literature[3]
In 2021, domestic researchers developed a minimally invasive exosome spray [4] that can help repair the heart of rats after myocardial infarction. They mixed exosomes, fibrinogen (which promotes blood clotting), and then placed the exosome-fibrinogen solution and the thrombin (which can make fibrinogen coagulation) solution in a double-chamber syringe, and sprayed the solution onto the damaged heart through a small chest incision, at which time the three liquids mixed to form a gel containing exosomes stuck to the heart, which not only improved heart function, reduced fibrosis, but also promoted endogenous angiogenesis of the heart after injury. This method is more convenient and safer than surgery, and exosome spray lasts longer and heals better wounds.
Summary: At present, there has been no effective treatment that can reverse the myocardial damage caused by ischemic heart disease, and many scholars are committed to the study of stem cells, stem cell exosomes and other new therapeutic drugs to reverse myocardial ischemic necrosis. A growing body of data shows that both can radically improve a patient's heart condition, leading to a better prognosis for patients. It is believed that in the future, with the further deepening of research, it is expected to achieve new treatments for ischemic heart disease, so that more people can benefit.
bibliography
[1] https://www.who.int/health-topics/cardiovascular-diseases
[2] Dehkordi NR, Dehkordi NR, Farjoo MH. Therapeutic properties of stem cell-derived exosomes in ischemic heart disease. Eur J Pharmacol. 2022;920:174839.
Links: https://pubmed.ncbi.nlm.nih.gov/35189089/
[3] Makkar RR, Smith RR, Cheng K, et al. Intracoronary cardiosphere-derived cells for heart regeneration after myocardial infarction (CADUCEUS): a prospective, randomised phase 1 trial. Lancet. 2012;379(9819):895-904.
Links: https://pubmed.ncbi.nlm.nih.gov/22336189/
[4] Yao J, Huang K, Zhu D, Chen T, Jiang Y, Zhang J, Mi L, Xuan H, Hu S, Li J, Zhou Y, Cheng K. A Minimally Invasive Exosome Spray Repairs Heart after Myocardial Infarction. ACS Nano. 2021 Jun 21.
Links: https://pubmed.ncbi.nlm.nih.gov/34152126/
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