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World J Stem Cells. Apr 26, 2017; 9(4): 68-76
Published online Apr 26, 2017. doi: 10.4252/wjsc.v9.i4.68
Fifteen years of bone marrow mononuclear cell therapy in acute myocardial infarction
Miruna Mihaela Micheu, Maria Dorobantu
Miruna Mihaela Micheu, Maria Dorobantu, Department of Cardiology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
Author contributions: Both authors equally contributed to the conception of the paper, the literature review and analysis, drafting and to critically revising and editing the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Miruna Mihaela Micheu, MD, PhD, Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania. mirunamicheu@yahoo.com
Telephone: +40-72-2451755
Received: January 6, 2017
Peer-review started: January 10, 2017
First decision: February 17, 2017
Revised: March 16, 2017
Accepted: April 18, 2017
Article in press: April 19, 2017
Published online: April 26, 2017
Abstract

In spite of modern treatment, acute myocardial infarction (AMI) still carries significant morbidity and mortality worldwide. Even though standard of care therapy improves symptoms and also long-term prognosis of patients with AMI, it does not solve the critical issue, specifically the permanent damage of cardiomyocytes. As a result, a complex process occurs, namely cardiac remodeling, which leads to alterations in cardiac size, shape and function. This is what has driven the quest for unconventional therapeutic strategies aiming to regenerate the injured cardiac and vascular tissue. One of the latest breakthroughs in this regard is stem cell (SC) therapy. Based on favorable data obtained in experimental studies, therapeutic effectiveness of this innovative therapy has been investigated in clinical settings. Of various cell types used in the clinic, autologous bone marrow derived SCs were the first used to treat an AMI patient, 15 years ago. Since then, we have witnessed an increasing body of data as regards this cutting-edge therapy. Although feasibility and safety of SC transplant have been clearly proved, it’s efficacy is still under dispute. Conducted studies and meta-analysis reported conflicting results, but there is hope for conclusive answer to be provided by the largest ongoing trial designed to demonstrate whether this treatment saves lives. In the meantime, strategies to enhance the SCs regenerative potential have been applied and/or suggested, position papers and recommendations have been published. But what have we learned so far and how can we properly use the knowledge gained? This review will analytically discuss each of the above topics, summarizing the current state of knowledge in the field.

Keywords: Bone marrow stem cells, Acute myocardial infarction, Cell therapy, Cardiac regeneration, Remodeling

Core tip: Since the first successful bone marrow stem cells transplantation performed 15 years ago in a patient with acute myocardial infarction, we have witnessed a mounting body of data as regards this cutting-edge therapy. During the reporting period, conflicting results have been stated, scientific papers have been under investigation, strategies to enhance the stem cells regenerative potential have been applied and/or suggested, position papers and recommendations have been published. This review will analytically discuss each of the above topics, summarizing the current state of knowledge in the field.