Stem cell therapy for heart disease: truly beneficial?

[摘要] For over 10 years cardiac stem cell therapy has received a considerable amount of attraction, potential, and research money. Autologous bone marrow stem cell therapy has been reported to be safe and to substantially increase cardiac function [1–4]. However, this beneficial effect is not invariably the case as shown in 2011 by the Dutch HEBE trial directed by the Interuniversity Cardiology Institute of the Netherlands together with the Netherlands Heart Foundation (ICIN/NHS) [5–7]. More importantly, the present cardiac bone marrow stem cell research trials have differed in the effect sizes they reported, for reasons that are not fully understood. A recent meta-analysis published in the British Medical Journal (BMJ) on 28 April 2014, the so-called DAMASCENE study [8], did show that many of the most promising results in the field are illusive and that the potential benefits of stem cells to treat heart disease are probably far more modest than has been presumed until now. By pooling all available results from trials of bone marrow stem cells in patients with ischaemic heart disease or congestive heart failure, a Cochrane review found slight evidence to suggest a benefit for stem-cell therapy in those populations. In pooled results from smaller randomised trials it was shown that bone marrow stem cell treatment was associated with reduced mortality (RR 0.28, 95 % CI 0.14–0.53) and less hospitalisations for heart failure (RR 0.26, 95 % CI 0.07–0.94) at follow-up exceeding 1 year. However, the quality of the evidence was considered low, and no significant differences were seen in those outcomes with shorter follow-up. Additionally, it was commented that ‘this research raises disturbing questions about ethics and research conduct and misconduct in a high-flying field’ [9].

[学科分类] 心脏病和心血管学