Table 1. Advantages and disadvantages of each type of cell used for cellular cardiomyoplasty.
| Cell type | Mechanism of action | Advantages | Disadvantages |
|---|---|---|---|
| Cardiomyocytes (adult, fetal and neonatal) | Myogenesis | Integration with the host tissue, as seen in rodents(
26
,
27
)
Adult cardiomyocytes' phenotype( 26 ) |
Ethics dilemma Inability to reproduce( 25 ) Limited availability Immunogenicity( 18 ) Short cell survival ( 25 ) Poor integration with host tissue in porcine( 27 ) |
| Skeletal myoblasts | Myogenesis | Autologous High cell survival and engraftment( 42 ) Adult skeletal muscle phenotype( 28 ) Easy to isolate |
High risk of arrhythmias(
32
)
Low structural and physiological integration with host tissue( 32 ) |
| Bone marrow-derived stem cells (mesenchymal stem cells, endothelial progenitor cells, hematopoietic stem cells) | Multipotent Autologous Easy to isolate High expansion potential Presence of paracrine effects( 43 ) |
Possible angiogenesis at unwanted sites(
41
)
Limited availability |
|
| Mesenchymal stem cells | Myogenesis | Differentiate into cardiomyocytes-like phenotype(
44
)
Differentiation into endothelial cells as seen in canines( 45 ) Immunosuppressive properties( 46 ) High structural and physiological integration with host tissue( 43 , 45 ) |
Immunogenicity of allogenous mesenchymal stem cells( 47 ) |
| Endothelial progenitor cells | Angiogenesis | Neovasculogenesis( 48 ) | Limitations in number and migration of cells in patients with coronary artery disease( 49 ) |
| Hematopoietic stem cells | Angiogenesis | Beneficial impact on left ventricular remodeling and angiogenesis( 50 ) | Incapable of differentiating into cardiomyocytes( 50 ) |
| Embryonic stem cells | Myogenesis | High proliferation( 51 ) | Ethical dilemma |
| Pluripotent( 51 ) | Risk of teratoma formation( 51 ) | ||
| Differentiate into cardiomyocytes( 32 ) | High immunogenicity( 52 ) | ||
| Integrate with host cardiomyocytes via gap junctions(
30
)
Can be pre-treated with pro-survival factors( 33 ) |
Limited availability | ||
| Smooth muscle cells | Myogenesis | Elastic properties improve heart function( 35 ) | Immunogenicity(
34
)
Do not improve contractile function( 34 ) |
| Adipose tissue-derived stem cells | Angiogenesis Myogenesis |
Multipotent(
53
)
High availability( 36 ) Easy to isolate( 53 ) High proliferation( 36 ) Secrete growth factors( 37 ) Induce myogenesis and angiogenesis( 37 ) |
Poor long-term cell engraftment(
54
)
No significant differentiation( 55 ) |
| Cardiac stem cells | Myogenesis | Autologous Multipotent( 38 ) Expand in vitro ( 38 ) |
Limited availability |
| Induced pluripotent stem cells | Myogenesis | Pluripotent Autologous Differentiate into cardiomyocytes( 39 ) Good availability High expansion potential |
Risk of teratoma formation( 40 ) |