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Mesenchymal STRO-1/STRO-3+ precursor cells for the treatment of chronic heart failure with reduced ejection fraction

    Andrew Sundin‡

    Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA

    ‡Authors contributed equally

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    ,
    Simona I Ionescu‡

    Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA

    ‡Authors contributed equally

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    ,
    Wayne Balkan

    Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA

    Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA

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    &
    Joshua M Hare

    *Author for correspondence: Tel.: +1 305 243 5579;

    E-mail Address: jhare@med.miami.edu

    Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA

    Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA

    Search for more papers by this author

    Published Online:7 Nov 2023https://doi.org/10.2217/fca-2023-0081

    Abstract

    The heart is susceptible to proinflammatory and profibrotic responses after myocardial injury, leading to further worsening of cardiac dysfunction. Important developments in the management of heart failure with reduced ejection fraction have reduced morbidity and mortality; however, these therapies focus on optimizing cardiac function through hemodynamic and neurohormonal pathways and not by repairing the underlying cardiac injury. The potential of cell-based therapy to reverse cardiac injury has received substantial attention. Herein are examined the phase II and III studies of bone marrow-derived mesenchymal STRO-1+ or STRO-1/STRO-3+ precursor cells in patients with ischemic and nonischemic heart failure with reduced ejection fraction, addressing the safety and efficacy of cell-based therapy throughout multiple clinical trials, the optimal dose and the steps toward revolutionizing the treatment of heart failure.

    Plain language summary

    Heart disease can occur due to the blockage of blood flow to the heart muscle (heart attack). This damage reduces heart function, in part because of inflammation and fibrosis (scarring). Over time, these problems lead to heart failure and death. Advances in treating heart disease focus on maintaining heart function rather than healing the heart. A cell-based treatment designed to actually repair the heart has been used with some success. In this approach, stem cells are extracted from the bone marrow of a healthy adult, processed and then injected into a patient's diseased heart. This approach is promising, but heart repair remains incomplete. This article looks at a specific type of bone marrow stem cell that has been used as a treatment for patients with heart disease. This cell treatment was recently tested in the largest such study and the first phase III clinical trial to date in the area – the DREAM-HF study. This article addresses the safety and best dosage of these cells and examines how this new approach of cell-based therapy might change how heart disease is treated.

    Tweetable abstract

    This review examines phase II and III studies of bone marrow-derived mesenchymal precursor cells in patients with ischemic and nonischemic heart failure, addressing the safety and efficacy of cell-based therapy, the optimal dose and ways to revolutionize the treatment of heart failure.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

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