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J Thorac Cardiovasc Surg 2006;131:1213-1214
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Surgical treatment for congestive heart failure with autologous adult stem cell transplantation

Vincenzo Pitini, MD, Giuseppe Altavilla, MD, Carmela Arrigo, MD

Department of Medical Oncology and Bone Marrow Transplantation, University of Messina, Italy

To the Editor:

Patel and colleagues 1 Go have provided further evidence of the benefit of autologous stem cell transplantation in patients with ischemic cardiomyopathy. However, even if, in the past years, observational studies and some randomized controlled trials have established that autologous stem cell transplantation has led to significant improvement in myocardial infarction and congestive heart failure, this study unfortunately has not specifically addressed several clinically relevant questions: What dose of CD34+ cells for stem cell therapy in this area should we use? Furthermore, what is the best cell type and the best cell dose for each cell type?

In recent studies, doses of CD34+ cells ranging from 106 to 108 have been used; however, if the optimum dose of CD34+ cells needed is proven to be much less than 106, procedures involved in collecting sufficient amounts for therapeutic use can be less time-consuming and thus potentially cost-saving. Furthermore, the expression of CD34 surface antigen characterizes a heterogeneous population of cells including hematopoietic progenitor cells, endothelial progenitor cells, mature endothelial cells, and tissue-committed stem cells as recently reported. 2 Go It is still not clear whether the beneficial effect of these cells in regeneration can be explained by the transdifferentiation of hematopoietic stem cells, the paracrine secretion of angiopoietic factors from bone marrow-derived stem cells, 3 Go or the presence of tissue-committed stem cells for myocardium or endothelium. We believe that there is a pressing need to standardize therapeutic protocols to allow tailor-made therapies for these patients.


   References
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  1. Patel AN, Geffner L, Vina RF, Saslavsky J, Urschel HC, Kormos R, et al. Surgical treatment for congestive heart failure with autologous adult stem cell transplantation. a prospective randomised study. J Thorac Cardiovasc Surg 2005;130:1631-1638.[Abstract/Free Full Text]
  2. Kucia M, Ratajczak J, Reca R, Janowska-Wieczorek A, Ratajczak MZ. Tissue-specific muscle, neural and liver stem/progenitor cells reside in the bone marrow, respond to an SDF-1 gradient and are mobilized into peripheral blood during stress and tissue injury. Blood Cells Mol Dis 2004;32:52-57.[Medline]
  3. Majka M, Janowska-Wieczorek A, Ratajczak J, Ehrenman K, Pietrzykowsky Z, Kowalska A, et al. Numerous growth factors, cytokines, and chemokines are secreted by human CD34+ cells, myeloblasts, erythroblasts, and megakaryoblasts and regulate normal hematopoiesis in an autocrine/paracrine manner. Blood 2001;97:3075-3085.[Abstract/Free Full Text]

Related Article

Reply to the Editor
Amit N. Patel
J. Thorac. Cardiovasc. Surg. 2006 131: 1214. [Extract] [Full Text] [PDF]




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