Regenerative medicine is working to restore structure and function of damaged tissues and organs and to create solutions for organs that become permanently damaged, trying to find a way to cure previously untreatable diseases and conditions. In particular, based on the increasingly understood regenerative capacity of the human heart and vascular system, cardiovascular regenerative medicine (CRM) encompasses all potential diagnostic and therapeutic strategies aimed at restoring organ health.
Envisioned to enhance the innate regenerative response of cardiovascular tissues, diverse and often complementary products and strategies have been investigated (e.g. stem and progenitor cells, stromal cells, extracellular vesicles such as microvesicles and exosomes, growth factors, non-coding RNAs, episomes and other gene therapies, biomaterials, tissue engineering products, and neo-organogenesis).
Unfortunately, despite promising results based on 20 years of research, tissue-engineered vascular grafts for heart bypass surgery and cardiovascular disease treatment are still at the pre-clinical trial stage, and next generation CRM treatments have yet to transform cardiovascular practice.
A recent position paper by the international consortium Transnational AllianCe for regenerative Therapies In Cardiovascular Syndromes (TACTICS www.tacticsalliance.org), – the first worldwide cooperative research network in the field of CRM, – explains why, to date, this branch of medical research has not yet fulfilled its promises.
The paper, – which was also involved in drafting Professor Giulio Pompilio, deputy scientific Director of Centro Cardiologico Monzino and Head of Laboratory of Vascular Biology and Regenerative Medicine, – summarizes the shared vision of leading expert teams in this field, presenting a critical summary of the state of the art in CRM, covering basic and translational research, clinical practice, regulatory pathways, and funding strategies.
Figure 1. Schematic representation of cardiovascular regenerative advanced therapy medicinal products according to the pre/clinical phase of development.
ADSC, adipose tissue-derived stem cells; BMMNC, bone marrow mononuclear cells; BM-MSC, bone marrow-derived mesenchymal stem cells; CDC, cardiosphere-derived cells; CPC, cardiac progenitor cells; CSC, cardiac stem cells; EPC, endothelial progenitor cells; ESC, embryonic stem cells; iPSC, induced pluripotent stem cells;MSC, mesenchymal stem cells; SM, skeletal myoblasts.1
Among other things, the document illustrates existing knowledge pertinent to the mechanisms of cardiovascular regeneration, the attempts to apply that knowledge in the preclinical arena, and the main achievements and obstacles in translation to clinical practice. Furthermore, the paper summarizes the outlook for the next decade, also identifying the main challenges and priorities of each area involved in the clinical application of CRM.
According to the paper’s conclusions, the opportunity to optimize the regenerative medicine armamentarium and to make real progress in the regeneration of human cardiovascular tissue is through worldwide multidisciplinary cooperation. Only by pooling the efforts of leading expert groups, the scientific community will collectively be able to develop effective treatments that will improve the prognosis of patients with a wide range of heart and vascular diseases.
- Fernández-Avilés F, Sanz-Ruiz R, Climent AM, Badimon L, Bolli R, Charron D, Fuster V, Janssens S, Kastrup J, Kim HS, Lüscher TF, Martin JF, Menasché P, Simari RD, Stone GW, Terzic A, Willerson JT, Wu JC; TACTICS (Transnational Alliance for Regenerative Therapies in Cardiovascular Syndromes) Writing Group; Authors/Task Force Members. Pompilio G among chairpersons. Global position paper on cardiovascular regenerative medicine. European Heart Journal (2017) 38, 2532–2546. [download the Paper in PDF]