12th Biennial Meeting of the International Andreas Gruentzig Society: Rio de Janeiro - February 2-6, 2014
Myocyte Recovery Strategies and Cell Therapies for Myocardial Regeneration Post MI
Ischemia leads to cell death that can transfer through 3 pathways – energy depletion, reperfusion injury and complement activation. All happen in different timing intervals. Additionally, infarct size corresponds to increased mortality. Therefore Ischemic conditioning may be useful for myocardial regeneration.
Are there any effective therapies that increase salvage apart from PCI reperfusion?
Cell Therapy and other modalities such as hypothermia can we improve outcomes and reduce infarct size?
However, results of these treatments have been generally disappointing – ie., cell transplantation, Therox, cooling studies and others.
What are the Gaps in the current knowledge?
- We need to evaluate strategies and assess the optimum management plan for patients.
- Cooling trials were negative, but the poor result was likely due to patient selection. New faster cooling devices may improve results. Whether or not cooling can decrease MI size is still unanswered.
- Stem cells are available and promising, however we likely need better delivery methods since current methods have been only somewhat successful. It is also very challenging to evaluate success. Many different lines of cells and many delivery approaches and devices has been developed but nothing yet is a clear winner. Finally, more controlled studies are warranted to evaluate efficacy of pre-ischemic conditioning work. We need to evaluate strategies carefully and assess the optimum management plan for patients.
Our Summary and Recommendations:
- Research needs to continue to determine which cells and delivery systems are best and how they can best be integrated into the flow of treatment of these severely ill patients.
- We need to continue experimental and clinical research on pre- and post-conditioning.
- We recommend use of MRI and other diagnostic tools to assess MI reduction strategy.
- We continue to advocate for 911 call and field ECG from ambulances.