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Cardiovascular cell therapy and endogenous repair

Cardiovascular disease (CVD) exceeds infection and cancer as the leading cause of death. In the USA alone, approximately a million individuals suffer an acute myocardial infarction (AMI) annually. As the prevalence of CVD risk factors (e.g. hypertension, obesity and type 2 diabetes) rises, CVD is increasing in younger individuals. Fortunately, existing therapies have improved post‐AMI mortality, but in turn have increased the prevalence of post‐AMI heart failure (HF). Approximately half‐a‐million new HF cases are diagnosed each year in the USA. In the next 25 years, up to 15% of the population over the age of 65 in the USA is projected to have HF. Therapeutic interventions that prevent/reverse atherosclerosis, prevent post‐AMI HF and halt the progressive functional deterioration once HF occurs are all needed. Cell therapy – either via exogenous delivery or by endogenous mobilization of cells – may be able to do so, in part, by improving the body’s capacity for repair. To date, primarily bone marrow‐ or blood‐derived cells have been utilized after AMI to prevent left ventricular dysfunction, and skeletal myoblasts have been transplanted into failing myocardium. Preclinical studies are directed at prevention/reversal of atherosclerosis with bone marrow precursors, and ultimately at replacing failing heart with a cell‐based bioartificial construct.