miércoles, 24 de septiembre de 2014

Heart Repair?

Heart Repair?

A service of the U.S. National Library of Medicine
From the National Institutes of HealthNational Institutes of Health

NLM Director’s Comments Transcript
Heart Repair?: 09/15/2014

Picture of Dr. Lindberg

Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
illustration of 2 hearts
I'm Rob Logan, Ph.D. senior staff U.S. National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.listen
Although there is active research about cell therapy approaches that strive to rejuvenate, regenerate, and repair the human heart, none have succeeded, Science recently reported in an insightful, overview article.
The article finds there are at least six approaches to cell therapy intended to revitalize the heart.
They are:
  • mononuclear bone marrow cells. Science reports this mix contains mostly white blood cells and some adult stem cells. This approach is used in clinical trials, including a study of 3000 persons in Europe.
  • embryonic stem cells. Hypothetically, Science reports these cells can transform weak heart cells within different areas of the heart. Albeit promising, Science notes this approach has yet to be tested in humans.
  • mesenchymal stem cells. Science reports these cells are found in bone marrow and can turn into connective tissue, such as heart muscle. These have been tested only in small trials.
  • induced pluripotent stem cells. Science reports these stem cells potentially are versatile and can be turned into heart cells in a laboratory. However,Science notes this approach also has not been tested in humans.
  • c-kit cells. Science reports these cardiac stem cells can form into all of the heart’s components. Yet, recent research suggests they may not be able to turn into heart muscle.
  • cardiosphere-derived cells. Science reports these are produced by carefully culturing cardiac cells. Science notes a recent study suggested reductions in heart scar mass, but did not demonstrate the therapy improved heart function.
Regardless of cell therapy approach, Science reports the history of cell therapy research provides a broader example of the challenges to sustain promising findings from small animal and human clinical trials to large scale, generalizable human clinical trials.
Science notes no cell therapy approach has demonstrated clinical efficacy in clinical trials with thousands of participants. Science notes, to date, the impressive findings in small heart cell therapy trials (and we quote) ‘fades once they are tested in ever-larger cohorts’ (end of quote).
Science adds there have been recent, published criticisms of selective reporting of findings in cell therapy research. Science explains the rush among competing investigators to be the first to regenerate the heart results in considerable pressure.
Jonathan Kimmelman, a McGill University ethicist, tells Science (and we quote), ‘there is so much pressure to demonstrate a major treatment effect that people are not always applying careful, painstaking methodologies’ (end of quote).
More positively, Science explains some heart cell therapy researchers are starting to better identify the specific cells that seem to be the best candidates to revive an ailing heart.  
The article concludes that a new, promising trial will explore for the first time how long cell therapy prolongs the life of a patient with an ailing heart. This research changes the primary outcome from heart rejuvenation to the extent cell therapy adds weeks, months, or years to a heart patient’s life.
Meanwhile, a helpful overview of heart rehabilitation is provided by the American Heart Association in the ‘start here’ section of MedlinePlus.gov’s cardiac rehabilitation health topic page. The National Heart, Lung, and Blood Institute also provides websites on what to expect when starting - and during - cardiac rehabilitation in the ‘specific conditions’ section of MedlinePlus.gov’s cardiac rehabilitation health topic page.
MedlinePlus.gov’s cardiac rehabilitation health topic page additionally provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about cardiac rehabilitation as they become available on MedlinePlus.gov.
To find MedlinePlus.gov’s cardiac rehabilitation health topic page type ‘heart rehabilitation’ in the search box on MedlinePlus.gov’s home page, then, click on ‘cardiac rehabilitation (National Library of Medicine).’ MedlinePlus.gov also has comprehensive health topic pages on heart attacks, and heart diseases-prevention.
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It was nice to be with you. I look forward to meeting you here next week.

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