Cell therapy for age-related disorders: myocardial infarction and stroke--a mini-review.

BACKGROUND The leading causes of death and disability in the elderly are from cardiovascular and cerebrovascular diseases. The biological role of stem cells in the hematopoietic system has been well characterized and has led to the development of hematopoietic stem and progenitor cell (HSPC) transplantation for the treatment of numerous malignant and nonmalignant diseases. More recently, stem cells have been found in many other tissues of the body including the heart and brain. As the field of stem cell biology has progressed, cell therapies for the treatment of myocardial infarction and stroke have been tested in early stage clinical trials using a variety of cellular agents. OBJECTIVE To review the clinical evidence supporting the role of cell therapies for myocardial infarction and stroke. METHODS A systematic review of the literature was conducted to identify clinical trials using cell therapies for myocardial infarction and stroke. RESULTS Clinical trials of granulocyte colony-stimulating factor to mobilize HSPC after percutaneous coronary intervention for acute myocardial infarction have not shown clinical benefit. Direct delivery of HSPC to coronary arteries supplying the infarcted region using percutaneous coronary intervention does improve hemodynamic endpoints such as left ventricular ejection fraction in many studies. One randomized trial demonstrated improvement in clinically meaningful endpoints such as death, recurrence of myocardial infarction and re-hospitalization for heart failure. Several small trials of cell therapy for stroke have been reported, including cytokine-mobilized HSPC, mesenchymal stromal cells and cell lines transplanted stereotactically into the region affected by stroke. CONCLUSIONS In some prospective randomized trials, cell therapy for myocardial infarction leads to improvement in hemodynamic parameters. Cell therapy for stroke is a relatively new area of translational and clinical research with preliminary studies showing safety and some measurable benefit in small numbers of subjects.