| Regenerative Strategy |
Pro |
Contra |
Reference [20] |
| Unselected bone marrow-derived cells |
•largest amount of available data,
•minimal cell manipulation with no requirement for in vitro cell expansion,
•presence of a mixed population containing hematopoietic stem cells, endothelial progenitors and mesenchymal stem cells,
•safety,
•some efficacy.
|
•poorly characterized cell population,
•variable results in clinical trials.
|
Completed Trials: Astami [133], Boost [132], Cao et al. [131], Fincell [130], Hebe [129], Janssens et al.[128], MYSTAR [127], Ramshorst et al. [126], BELAMI [125], REPAIR-AMI [124], TOPCARE-CHD [118] and others. |
| CD133+ bone marrow cells |
•minimal cell manipulation with no requirement for in vitro cell expansion,
•use of a better characterized cell population.
|
•may increase the rate of restenosis,
•early phase clinical trials showed benefits, while larger ones did not.
|
Completed Trials: Bartunek et al. [123], Adler et al.[122], CARDIO133 [121]. |
| CD34+CXCR4+ bone marrow cells |
•minimal cell manipulation with no requirement for in vitro cell expansion,
•use of a better characterized cell population,
•patients with Ejection Fraction at baseline below median benefit the most.
|
•selected cells showed a worse efficacy with respect to unselected bone marrow cells.
|
Completed Trial: REGENT [120]. |
| Circulating Progenitor Cells |
•improvement in symptoms and exercise tolerance when given intramyocardially.
|
•necessity for growth factor-induced progenitor cell mobilization or progenitor cell in vitro culture,
•mobilization procedures are associated with aggravation of restenosis and cardiac enzyme elevation,
•little or no effects when given via intracoronary route.
|
Completed Trials: ACT34-CMI [119], TOPCARE-CHD [118], Magic cell [117]. |
| Mesenchymal stem cells |
•feasibility and safety,
•possible efficacy.
|
•requirement for more than minimal in vitro cell manipulation,
•less data available,
•small number of trials have been completed.
|
Completed Trials: Prochymal [116], POSEIDON pilot study (Clinicaltrials.gov identifier NCT01087996), C-CURE [115]. |
| Cardiac Stem Cells |
•employment of a population of cells isolated from myocardial tissue,
•feasibility and safety,
•possible efficacy.
|
•requirement for more than minimal in vitro cell manipulation,
•less data available,
•only 2 trials have been completed.
|
Completed Trials: SCIPIO [10], CADUCEUS [11]. |
| Skeletal myoblasts |
•feasibility,
•not significant trends towards improvement.
|
•requirement for more than minimal in vitro cell manipulation,
•ventricular tachicardia.
|
Completed trials: MAGIC [93], MARVEL [114]. |
