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An early trial succeeded for the first time in taking skin cells from heart failure patients and reprogramming them to transform into healthy, new heart muscle cells that are capable of integrating with existing heart tissue.
Prof Chris Mason, Chair of Regenerative Medicine Bioprocessing, Advanced Centre for Biochemical Engineering, University College London (UCL), said:
“From a scientific perspective, this novel approach using the patient’s own cells appears to be a potential route forward. Other current options are based on cells from anonymous donors which can be scalably manufactured to treat thousands of patients and available immediately off-the-shelf. Whilst patient-specific cell therapies are very valid, unfortunately they increase manufacturing complexity and need time to prepare before they can be transplanted.
“It is therefore essential when aiming to treat a common medical condition, such as heart failure, that the practical considerations are carefully considered from the outset. There is no value in producing a breakthrough treatment, if it is either too complex or too costly to treat all the patients who could benefit.”
Prof John Martin, Professor of Cardiovascular Medicine, University College London (UCL), said:
“This is an interesting paper but very early and it’s really important for patients that the promise of such a technique is not over-sold. The chances of translation are slim and if it does work it would take around 15 years to come to clinic. There are so many problems with this approach whereas using a patient’s own cells may be in use within the next few years. These cells probably repair the heart through teaching damaged cells how to repair themselves. Importantly, the transplantation of patients’ own cells into the heart has been shown to be safe.”
Dr Nicholas Mills, British Heart Foundation Intermediate Clinical Research Fellow and Consultant Cardiologist, University of Edinburgh, said:
“More people are surviving following a heart attack than ever before and therefore the number of people living with a damaged heart and heart failure is increasing. Unfortunately, the body has only very limited capacity to repair the heart following a heart attack. There is therefore an urgent need to develop effective and safe treatments to regenerate the heart.
“Professor Gepstein and colleagues demonstrate using an established method that skin cells obtained from patients with heart failure can be transformed into stem cells and used to generate new heart muscle cells. These cells are fully functional and capable of working together with adult heart muscle cells.
“This technology needs to be refined before it can be used for the treatment of patients with heart failure, but these findings are encouraging and take us a step closer to our goal of identifying an effective means of repairing the heart and limiting the consequences of heart failure.”
Dr Gabor Foldes, Research associate at the National Heart and Lung Institute, Imperial College London, said:
“This paper is a logical follow up of earlier work from Gepstein’s group who were among the first to publish on human embryonic stem cells almost a decade ago. The paper describes well the various hurdles researchers and clinicians have to overcome before these cells can enter the clinical arena.
“However, in addition there are other important aspects one should think of that are not fully addressed in the paper: these are the diversity of heart muscle cells (ventricular, atrial, or pacemaker/conductive ones); lack of mature forms of heart muscle cells when grown in a culture dish; lack of clinical grade culture conditions where one can eliminate non-human components and retroviruses from the culture; the time-consuming process of generating new cells from stem cells; controversy around hIPSC immunogenicity; and finally our limited knowledge of how 3D structures can be built from single heart muscle cells and other supporting human heart cells.
“In line with this, one may wonder when chronic heart failure, one of the most complex diseases, could be treated with adding new cardiac cells to the diseased organ. So although this is still early days in cardiac cell therapy, results from this study can be a useful addition to further develop heart regeneration strategies.”
‘Derivation and cardiomyocyte differentiation of induced pluripotent stem cells from heart failure patients’ by Zwi-Dantsis et al. (doi:10.1093/eurheartj/ehs096), published in the European Heart Journal on Wednesday 23rd May.