Use Of Stem Cells In The Treatment Of Cardiomyopathy | Mycord

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cardiomyopathy treatment

Cardiomyopathy is the serious disease of heart muscles in which heart muscles become abnormally large and weak which make it difficult to pump blood properly. These condition further results into irregular heartbeats (arrhythmias) or heart failure. Additionally, few cases involve the formation of fat or scar tissue within the heart muscles. There are various form of cardiomyopathy include:

(1) Dilated cardiomyopathy is the most common form of cardiomyopathy in children in which heart muscles get attenuated.

(2) Hypertrophic cardiomyopathy in which the heart muscles get too thick.

(3) Restrictive cardiomyopathy is a rare form of cardiomyopathy found in children’s that causes heart muscles to get stiff or rigid.

Arrhythmogenic right ventricular cardiomyopathy occurs when the muscles of heart’s right ventricle is replaced by fatty scar tissue. This is rare type of cardiomyopathy only affects one in five thousand people. Pediatric cardiomyopathies are disorders that mainly affect the muscles of the heart. At any given time point, they affect at least 100,000 children globally. In United States, at least 1 in every 100,000 children below the age of 18 years experiences a diagnosis of primary cardiomyopathy. The highest prevalence is in children under 1 year of age. Morbidity and mortality of these diseases are high and also most common cause of a heart transplant in children older than 1 year. Approximately, 40 percent of children with a symptomatic cardiomyopathy either undergo heart transplantation or die within 2 years.

cardiomyopathy

Treatment & management of cardiomyopathy

Treatment of cardiomyopathy includes 
1. Drug Therapy
2. Device implantation
• Pacemaker (PPM)
• Automatic Implantable Cardioverter Defibrillator (AICD)
3. Surgical options
• Myectomy
• Heart transplantation
4. Additional treatments
• Genetic Testing
• Specialized Metabolic Treatment

Usage of stem cells on cardiomyopathy   

Mesenchymal stem cells have the potential to self-replicate and differentiate into several tissue lineages, and have been implementing in regenerative therapies for cardiac diseases. MSCs may be isolated from various tissues such as adipose tissue, bone marrow and umbilical cord, but it is unclear whether these stem cells share the similar cardiopoietic and immunomodulatory properties. MSCs are unique immunologically as they have reduced expression of MHC class-I molecule, and lack of MHC class-II and co-stimulatory molecules CD80 (B7-1), CD86 (B7-2), and CD40. MSCs are immunomodulatory and immunoprivileged cells along with proregenerative effects which have been proven to be safe and to stimulate reverse remodeling in ischemic cardiomyopathy. In preclinical study, human bone marrow-derived mesenchymal stem cells (BM-MSCs) reduced myocardial infarctions and improved cardiac function and angiogenesis through intramyocardial transplantation in rat models of ischaemic cardiomyopathy. According to a case report issued in 2010 indicated that intracoronary administration of autologous MSCs in an 11 year old boy with dilated cardiomyopathy and class IV heart failure (HF) was safe and also improved the boy’s clinical condition. Afterwards, the patient’s functional class changed from IV HF to III HF and II HF, the paroxysmal nocturnal dyspnea disappeared, appetite improved and the need for hospitalization was also decrease. According to a study conducted by Butler et al, Patients were randomized to intravenously administered ischemia-tolerant MSCs (itMSCs) (1.5×106 cells/kg) or placebo; at 90 days, each group received the alternative treatment. Treatment with itMSCs resulted in statistically significant amelioration in functional capacity and health status end points. When the change from baseline to 90 days was compared after itMSC therapy with the change during the control period, six minute walk distance (6MWD) was remarkably greater by 36.47 m. Specifically, within the itMSC group, 6MWD increased by an average of 27.40 m, but it decreased by an average of 10.83 m among control patients. Additionally, Zeinaloo et al, inject autologous bone marrow mesenchymal stem cells into the left and right coronary arteries of 11-year-old boy with a diagnosis of dilated cardiomyopathy. The 1 year clinical check-up indicated an improvement of the left ventricular ejection fraction from 20 to 42 percent. In conclusion, several studies describes the role of mesenchymal stem cells for cardiomyopathy which demonstrated that stem cell therapy can be a suitable approach to treat pediatric heart failure via facilitating cardiac regeneration and increasing cardiac function.

Also Read :- Ischemic Heart Disease And Stem Cells : Know Everything

References:
1. Boston Children’s Hospital. Cardiomyopathy in children. http://www.childrenshospital.org/conditions-and-treatments/conditions/c/cardiomyopathy
2. KidsHealth. Cardiomyopathy. https://kidshealth.org/en/parents/cardiomyopathy.html
3. Wilkinson JD, Sleeper LA, Alvarez JA, Bublik N, Lipshultz SE for the Pediatric Cardiomyopathy Study Group. The pediatric cardiomyopathy registry: 1995–2007. Prog Pediatr Cardiol. 2008;25(1):31–36.
4. Lipshultz SE, Sleeper LA, Towbin JA, et al. The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 2003; 348(17):1647-1655.
5. Children’s cardiomyopathy foundation, 2018. (Treatment).
http://www.childrenscardiomyopathy.org/site/treatment.php
6. Selem S, Hatzistergos KE, Hare JM. Cardiac Stem Cells: Biology and Therapeutic Applications. Principles of Regenerative Medicine 2011:327–346.
7. Joshua M. Hare. Allogeneic stem cells show promise for treating nonischemic dilated cardiomyopathy. Conference coverage: cardiology news 2016.
8. Liu JF, Wang BW, Hung HF, et al. Human mesenchymal stem cells improve myocardial performance in a splenectomized rat model of chronic myocardial infarction. Journal of the Formosan Medical Association, 2008;107(2):165–174.
9. Mazo M, Gavira JJ, Abizanda G, et al. Transplantation of mesenchymal stem cells exerts a greater long-term effect than bone marrow mononuclear cells in a chronic myocardial infarction model in rat. Cell Transplantation 2010;19(3):313–328.
10. Zeinaloo A, Zanjani KS, Bagheri MM, et al. Intracoronary administration of autologous mesenchymal stem cells in a critically ill patient with dilated cardiomyopathy. Pediatr Transplant. 2011;15(8):E183-186.
11. Butler J, Epstein SE, Greene SJ, et al. Intravenous Allogeneic Mesenchymal Stem Cells for Nonischemic Cardiomyopathy- Safety and Efficacy Results of a Phase II-A Randomized Trial. Circulation Research. 2016;120(2):332–340.
12. Zeinaloo A, Zanjani KS, Bagheri MM, et al. Intracoronary administration of autologous mesenchymal stem cells in a critically ill patient with dilated cardiomyopathy. Pediatr Transplant. 2011;15:E183–E186.

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