Table 1 Optimization efforts for the cardiac regenerative paradigm
From: Integrate and boost: bioscaffolds nurture the cardiac regenerative paradigm
Cell populations | Optimization strategy | Expected impact | Progress to date |
|---|---|---|---|
Purified cells, mesenchymal stem cells (MSCs), and endothelial progenitor cells (EPCs) | Well-defined population | Repair effect of well-defined progenitors with potential allogeneic off-shelf therapy | • Synergistic use of MSCs and cardiac progenitor cells (CPCs) is currently under investigation |
• Strong signals of benefit with EPCs | |||
CPCs | Anatomical matching | Boosting intrinsic regenerative pool | • Two phase II trials completed |
• Further studies with allogenic populations are under way | |||
Functional lineage matching | Growth factor-guided lineage specification | Boosting paracrine effects together with intrinsic regenerative pool | • Early signals of efficacy |
• This paradigm is under phase III investigation | |||
Delivery techniques | Needle design | Increased retention and cell survival | Curved needle design shown to improve the cell retention |
Procedural guidance | |||
Myocardial niche modification | Enhanced homing signaling | Boosting cell retention and endogenous repair | Paracrine influence of progenitors achieves enhanced stem cell content in the perivascular stem cell niche within the heart |
Tissue engineering | Bioscaffolds | Facilitate cell survival and endogenous repair | Significant advances in tissue processing and three-dimensional printing have paved the way for cell-free approaches for cardiac regeneration |