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World J Cardiol. Feb 26, 2017; 9(2): 147-153
Published online Feb 26, 2017. doi: 10.4330/wjc.v9.i2.147
Clinical cardiac regenerative studies in children
Imre J Pavo, Ina Michel-Behnke
Imre J Pavo, Ina Michel-Behnke, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, A-1090 Vienna, Austria
Author contributions: Each author contributed significantly to this review to: concept and design, and interpretation of the data, drafting the article and revising it critically for important intellectual content; and final approval of the version to be published.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
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: Imre J Pavo, MD, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1909 Vienna, Austria. imre.pavo@meduniwien.ac.at
Telephone: +43-140-40032170 Fax: +43-140-40060650
Received: September 11, 2016
Peer-review started: September 13, 2016
First decision: December 13, 2016
Revised: December 15, 2016
Accepted: January 11, 2017
Article in press: January 13, 2017
Published online: February 26, 2017
Processing time: 165 Days and 6.6 Hours
Abstract

Although the incidence of pediatric heart failure is low, the mortality is relatively high, with severe clinical symptoms requiring repeated hospitalization or intensive care treatment in the surviving patients. Cardiac biopsy specimens have revealed a higher number of resident human cardiac progenitor cells, with greater proliferation and differentiation capacity, in the neonatal period as compared with adults, demonstrating the regeneration potential of the young heart, with rising interest in cardiac regeneration therapy in critically ill pediatric patients. We review here the available literature data, searching the MEDLINE, Google Scholar and EMBASE database for completed, and www.clinicaltrials.gov homepage for ongoing studies involving pediatric cardiac regeneration reports. Because of difficulties conducting randomized blinded clinical trials in pediatric patients, mostly case reports or cohort studies with a limited number of individuals have been published in the field of pediatric regenerative cardiology. The majority of pediatric autologous cell transplantations into the cardiac tissue have been performed in critically ill children with severe or terminal heart failure. Congenital heart disease, myocarditis, and idiopathic hypertrophic or dilated cardiomyopathy leading to congestive heart failure are some possible areas of interest for pediatric cardiac regeneration therapy. Autologous bone marrow mononuclear cells, progenitor cells, or cardiospheres have been applied either intracoronary or percutaneously intramyocardially in severely ill children, leading to a reported clinical benefit of cell-based cardiac therapies. In conclusion, compassionate use of autologous stem cell administration has led to at least short-term improvement in heart function and clinical stability in the majority of the critically ill pediatric patients.

Keywords: Congenital heart disease; Heart failure; Cardiac regeneration; Cell-based therapy; Hospitalization; Children

Core tip: This review summarizes the available literature data involving pediatric cardiac regeneration reports. Due to lack of randomized blinded clinical trials in pediatric cardiology patients, mostly case reports with limited number of individuals have been published in the pediatric regenerative cardiology. The majority of pediatric autologous cell transplantations into the cardiac tissue have been performed in children with severe or terminal heart failure, and led to the conclusion, that compassionate use of autologous stem cell administration may lead to at least short-term improvement in heart function and clinical stability in the majority of the critically ill pediatric patients.