Heart stem cells and L-VAD may help avoid transplants

The wait for heart transplant can be deadly.

Statistics from the Department of Health and Human Services reveal that an average of 18 people die waiting for organ transplants each day. Doctors say that stem cell research could make transplants a thing of the past.

However, right now there are about 2,500 hearts available and a waiting list of about 100,000 patients in need.

But the University of Minnesota is trying to bridge that gap.

"We isolate the stem cells and when they go for surgery we inject those cells on the heart wall,” said Dr. Ganesh Raveendran, director of the Cardiac Catheterization Laboratory at the University of Minnesota’s Medical Center.

These new techniques have begun to help individuals like Allan Isaacs.

"I couldn't walk, or breathe, or eat,” said Isaacs.

That was life with congestive heart failure for Isaacs, 71, who started to recover after having a ventricular assist device implanted into his chest.

The L-VAD helps pump oxygen-rich blood throughout the body, but Isaacs’ recovery may also have to do with the fact that his treatment may have included injections of his own bone marrow stem cells. Isaacs’ is taking part in a leading-edge blind study at the University of Minnesota’s Medical Center.

One-third of the patients receive a placebo with the rest receiving ten injections of stem cells into their hearts. Muscle tissue is then analyzed.

“(We analyze to) see whether these cells have made any meaningful change, whether the cells have transformed into cardiac muscle,” said Raveendran.

In many cases an L-VAD is a bridge to transplant, but researchers believe that stem cell therapy like that used in Isaacs’ case could eliminate that need.

"Unbelievable quality of life, I had very little just before it happened,” said Isaacs. “Now, I can do whatever I feel like doing."

The research team at the University of Minnesota’s Medical Center hopes to wrap up the study by the end of this year and collaborate on a multicenter study involving seven medical centers throughout the nation.


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BACKGROUND: Heart transplants are performed when other treatments for heart problems haven't worked, leading to heart failure. Heart failure can be caused by coronary artery disease, a weakening of the heart muscle, failure of a previous heart transplant, valvular heart disease, or congenital heart defect. A heart transplant is not right for everyone. Each case is considered individually by a transplant center. A patient could be prevented from having a heart transplant if they are 65 or older, have another medical condition that could shorten their life, have a personal medical history of cancer, have serious blockages in the arteries in their arms or legs, or are unwilling or unable to make lifestyle changes necessary to keep the donor heart healthy. Another option for people who can't have a transplant is a ventricular assist device (VAD). It is a miniature pump implanted in their chest that helps pump blood through the body. VADs are typically used as a temporary treatment for people waiting for a heart transplant. (Source: www.mayoclinic.com)
RISKS: The most significant risk of having a heart transplant is the risk of the body rejecting the donor heart. The immune system will see the donor heart as a foreign object. It will try to attack the donor heart. Although everyone who receives a heart transplant receives immunosuppressants, close to 25 percent of heart transplant recipients still have some signs of rejection during the first year after their operation. Most of the time rejection doesn't cause any symptoms and requires only an adjustment of medications. When there are symptoms that the body is rejecting the donor heart, they can include fever, shortness of breath, weight gain, not urinating frequently, and fatigue. Other risks can include problems with the arteries, mediation side effects, cancer, and infection. (Source: www.mayoclinic.com)

NEW TECHNOLOGY: The National Institutes of Health funded a groundbreaking multicenter study known as Late TIME (Transplantation in Myocardial Infarction Evaluation) to determine if a implanting a patient's own stem cells into the heart two to three weeks following a heart attack could help to safely and effectively improved cardiac function. University researchers are also participating in a multicenter trial known as TIME, which is evaluating the success of the same stem cell therapy given three to seven days after the patient's heart attack. "There is no doubt that in recent decades, we have continued to significantly improve treatments for patients who have had heart attacks. Despite this, their heart function doesn't recover as well as it should," Ganesh Raveendran, MD, MS, Director, Section of Interventional Cardiology & Cardiovascular Fellowship Program at The University of Minnesota Medical School, was quoted as saying. "Ultimately, we hope that cell therapy will improve cardiac outcomes and quality of life for these patients." Each patient in the study will receive either injections of their own stem cells or a placebo injection during the implantation of a left ventricle assist device (LVADs). The University's study was the first in the U.S. to examine the effects of stem cell therapy during LVAD placement. One-third of the patients receive a placebo and two-thirds will receive their own stem cells. If patients in the study eventually get a heart transplant, then researchers will examine their native hearts to determine whether bone marrow stem cells have grown into cardiac cells. (Source: http://blog.lib.umn.edu/mmf/news/bulletin/2011/timely-intervention.html)

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Ganesh Raveendran, MD, MS
Director, Section of Interventional Cardiology &
Cardiovascular Fellowship Program
University of Minnesota Medical School
(612) 625-7924

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