Contents• Cardiovascular disease• Risk factors & diagnosis• Heart development• Stem cell therapy• Types of stem cells used for therapy• Delivery systems• Reference

Cardiovascular disease ?... Cardiovascular disease ?...

Cardiovascular disease is a class of diseases that involve the heart or blood vessels (arteries, capillaries and veins).

Cardiovascular disease refers to any disease that affects the cardiovascular system.Cardiovascular diseases remain the biggest cause of deaths worldwide, and their prevalence is projected to remain the leading cause of death .Two major types of CVDs, hypertension and coronary artery disease, can lead to myocardial infarction (MI) characterized by death of cardiomyocytes and eventual heart failure.

Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die.

This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (cholesterol and fatty acids) and white blood cells (especially macrophages) in the wall of an artery.

Risk factors Age High blood pressureDyslipidemia /hypercholesterolemiaTobacco smokingObesityAlcohol

Diagnosis Clinical history of ischaemic type chest pain lasting for more than

20 minutes.Changes in serial ECG tracings. Rise and fall of serum cardiac biomarkers such as creatine kinase-

MB fraction and troponin

Heart development

• From the cardiac crescent to the embryonic heart• Second heart field cardiac progenitor cell• Cardiac septaion and chamber morphogenesis• Conduction system and epicardial development

In recent years, stem cell-based therapy has attracted much attention as a viable approach to treating heart failure.

Increasing studies have indicated that stem cell-based cardiovascular regeneration has the potential to revolutionize current treatments for patients with ischemic heart disease.

Stem cell therapy

Properties:Self renewal Potency (totipotency , pluripotency ,unipotency)

Potency of stem cell

Types of stem cells used in therapy

Delivery methods

Direct intramyocardial (IM) injection:This epicardial procedure has been the most direct, precise, and accurate approach for injecting stem cells to an infarcted region of the heart. The location can be identified pre-operatively using echocardiography and nuclear imaging and, during surgery, by empirical observation.

Catheter based cell delivery:

• Percutaneous intramyocardial injection is more commonly performed in patients with chronic heart failure secondary to ischemic heart disease.

• MyoCath™ and Myostar™ catheters utilized.

• Catheter-based intramyocardial injections of cells is to optimize an imaging modality, either through two-dimensional (2D) or three-dimensional (3D) imaging. This type of procedure requires extensive imaging guidance within the ventricle to properly position the catheter at the site of injection.

• Example: X-ray fluoroscopic (2D), magnetic resonance imaging (MRI) (3D)

Types of methods for catheter based injection

1.Trans coronary sinus retrograde injection2. Trans coronary artery antegrade injection3. Trans catheter direct myocardial injection

Intravenous systemic delivery:

Intravenous infusion is a selective technique only for treating post-AMI (Acute myocardial infarction)patients, as it is reliant on physiological homing signals to injured myocardium, a condition not present in chronic heart failure.

The greatest advantage to this approach is its simplicity and least invasive route delivery system.

Reference : Current Stem Cell Delivery Methods for Myocardial Repair Calvin C. Sheng1, Li Zhou1 and Jijun Hao2§ 1Vanderbilt University School of Medicine, Nashville, TN 37232 2College of Veterinary Medicine, Western University of Health Sciences Pomona, CA 91766, ESC CBCS summer school on cardiovascular science (15 june 2011) “Heart

development”by robert G .Kelly developmental biology institute of marseilles- luminy.

http://sciencepark.mdanderson.org/labs/tang/intra-cardiac4web.html http://outreach.mcb.harvard.edu/animations/thera7c.swf