Myoblast transplantation for heart failure – From bench to bedside

Heart failure causes morbidity and mortality. Cell transplantation using skeletal muscle myoblast is promising for myocardial repair as it can regenerate and repair the injury. Skeletal myoblasts are unipotent progenitor cells that can be expanded and genetically modified to deliver angiogenic cytokines and growth factors to encourage angiomyogenesis. Myoblast transplantation inhibits ventricular remodelling, decreases left ventricular diastolic dimension, increases myocardial wall thickness and minimizes global ventricular dilatation in animals. Ongoing trials with skeletal myoblast transplantation show improvement in perfusion and metabolic activity. Time constraints and the problem of generating autologous skeletal myoblasts for every patient can be overcome if allogeneic skeletal myoblasts from healthy young donors can be made available. Myoblast transplantation is confronted with the problem of donor cell survival post-transplantation. Its safety and feasibility have been documented during animal and phase I studies. The only serious postoperative adverse event related to the procedure was ventricular arrhythmias. The results of phase I studies are still preliminary. Endpoint measurements highlight improvement in quality of life, reduced nitroglycerine consumption, enhanced exercise tolerance, improvement in NYHA Class and wall motion by echocardiography, and significantly reduced perfusion defects. Future directions include concerted collaborative efforts, strict inclusion and exclusion criteria, better establishment of target population. Further work needs to be done on the ideal cell type, optimal number of cells and route of administration. The most suitable time for cell transplantation after ischemic injury and optimal mode of cell delivery are evaluated. The use of cell-based techniques to assist with cardiac regeneration holds promise for the treatment of heart failure. La insuficiencia cardíaca es causa de morbimortalidad. El trasplante celular con mioblastos de músculo esquelético es prometedor en la reparación miocárdica ya que puede regenerar la zona agredida. Los mioblastos esqueléticos son células progenitoras unipotenciales que pueden ser modificadas genéticamente para liberar citocinas angiogénicas y factores de crecimiento para favorecer la angiomiogénesis. El trasplante de mioblastos inhibe la remodelación ventricular, disminuye el diámetro telediastólico, aumenta el grosor de la pared ventricular y minimiza la dilatación ventricular