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The Current Trends and Future Prospects of Regenerative Medicine in Cardiovascular Diseases

Japan

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INTRODUCTION

One of the recent advances, as well as attractive trends, in medical science is regenerative medicine because of its characteristic as translational research based on the most advanced basic sciences. The topics of regenerative medicine include gene therapy, cell transplantation, and tissue engineering, where therapeutic application is concerned. Regarding cell transplantation, stem cell research, both embryonic and mesenchymal, has been rapidly growing as the key to this new medical frontier. I shall give a brief review of currently practiced angiogenesis and cell-based cardiomyoplasty in advanced cardiovascular disease, and consider their roles in relation to surgical approaches.

ANGIOGENESIS

The targets of regenerative medicine have been mostly ischemic lesions such as peripheral arterial disease, ischemic heart disease, and heart failure. Currently, two modalities are practiced for angiogenesis: administration of angiogenic growth factors, and cell transplantation. Vascular endothelial growth factor, fibroblast growth factor, and hepatocyte growth factor (HGF) have been used. The source for cell transplantation is the mesenchymal or hematopoietic stem cell, mainly using bone marrow mononuclear cells (BMMNC) that contain endothelia progenitor (CD34+) cells.

Growth Factors.
In angiogenesis, gene therapy using adenovirus vectors with vascular endothelial growth factor and fibroblast growth factor have been conducted mainly in the United States for arterial obstruction of the lower extremities and also in the ischemic heart. Original work headed by Dr. Isner using vascular endothelial growth factor has shown very effective results and boosted this new strategy of angiogenesis.¹ However, because of the problems of viral vectors and regulatory issues, interest in gene delivery of growth factors has cooled as far as clinical trials are concerned. HGF has been intensively studied experimentally for its potential role in cell protection and . . . [Full Text of this Article]