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). Despite promising results based on 20 years of research, next generation CRM treatments have yet to transform cardiovascular practice.
Given the compelling need for a thorough critical debate on the past, present, and future of CRM, the international consortium Transnational AllianCe for regenerative Therapies In Cardiovascular Syndromes (TACTICS), – the first worldwide cooperative research network in the field of CRM, – summarizes the shared vision of leading expert teams in the field.
The document addresses key priorities and challenges, including basic and translational research, clinical practice, regulatory hurdles, and funding sources. The methodological procedure included the following:
- identification of strengths, weaknesses, opportunities, and threats (SWOT analysis) by means of an open poll;
- distribution of the main topics between at least two worldwide key opinion leaders, who prepared proposals for each topic;
- open discussion and consensus on each proposal between all members of TACTICS;
- review of the document by an independent committee.
The paper summarizes 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. Moreover, the document summarizes the outlook for the next decade, specifically identifying the main challenges and priorities of each area involved in the clinical application of CRM.
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. By pooling the efforts of leading expert groups, we 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. Chairpersons; Basic Research Subcommittee; Translational Research Subcommittee; Challenges of Cardiovascular Regenerative Medicine Subcommittee; Tissue Engineering Subcommittee; Delivery, Navigation, Tracking and Assessment Subcommittee; Clinical Trials Subcommittee; Regulatory and funding strategies subcommittee; Delivery, Navigation, Tracking and Assessment Subcommittee. Pompilio G among collaborators. Global position paper on cardiovascular regenerative medicine. Eur Heart J 2017;38(33):2532-2546. Go to PubMed