Stem cells: where we stand |
Stem cells are capable of indefinite self-renewal and
can give rise to all tissues derived from the three primary
germ layers. Embryonic stem cells and, to a
lesser extent, bone marrow–derived cells, share these
properties, while skeletal myoblasts should be considered
as precursor cells for myotubes, because of their
restricted commitment to this specific skeletal muscle
lineage. Evidence for the differentiation of bone marrow–
derived stem cells into cardiomyocytes is inconclusive,
and available data indicate that the major
effect of the transplantation of these cells is to increase
angiogenesis, probably through secretion of angiogenic
growth factors rather than conversion into an endothelial-
like phenotype. To date, clinical trials have
documented the feasibility and safety of transplantation
of bone marrow cells and skeletal myoblasts, with
the caveat of a proarrhythmic risk associated with
the latter. However, efficacy data can only be generated
by randomized trials, some of which are already
under way. Initial findings suggest that bone marrow
cells may be particularly suitable for increasing
angiogenesis in patients with acute myocardial infarction
or intractable ischemia, whereas myoblasts
may be more effective in improving function in the
setting of advanced ischemic heart failure...
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