Cardiac Repair Clinical Trials

Cardiovascular disease is a major problem worldwide, and remains the leading cause of death within Europe. Clinical trials of stem cells have been conducted in the setting of acute myocardial infarction and chronic heart disease. At the time of writing there have been a number of different cell types, preparation and doses delivered by a number of different delivery routes to a variety of patients in small, mostly uncontrolled trials, generally with positive outcomes. Larger placebo-controlled trials are ongoing and we eagerly await their results. The challenges currently facing the field are to define the optimal target patient population, cell source, preparation, dose, delivery and retention of cells within the myocardium and the appropriate assays to detect meaningful clinical changes. Clearly not all of these questions can be answered in the clinical trial setting and it is imperative that basic science and translational research are conducted simultaneously to help guide clinical research. At present there appears to be no clear steer in answering these questions but we attempt to discuss the evidence to date and the future of stem cells in the management of cardiovascular disease.