In a small study involving 25 volunteers, stem cell recipients had their heart attack scars reduced most dramatically - on average, 50 percent - and damaged muscle replaced by new healthy heart tissue.

(Credit: CBS News)

(CBS) A new study offers an effective way to mend a broken heart: Stem cells.

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The study looked at patients with damaged hearts from myocardial infarctions, or heart attacks, and found stem cells reduced the amount of scarring and helped hearts regrow healthy muscle.

"This discovery challenges the conventional wisdom that, once established, scar is permanent and that, once lost, healthy heart muscle cannot be restored," study co-author Dr. Eduardo Marban, director of the Cedars-Sinai Heart Institute and inventor of the techniques used in the procedure, said in a hospital written statement.

For the study, researchers tested 25 patients, an average of 53 years old, who had experienced heart attacks that had left them with damaged heart muscle. Eight patients served as controls and were treated with conventional treatments including medication, and diet and exercise recommendations. The other 17 patients received stem cells, which researchers derived from raisin-sized pieces of patients' own heart tissue.

The researchers found that patients treated with stem cells experienced almost a 50 percent reduction of heart attack scars within 12 months of treatment, while the eight patients who received conventional treatment saw no reductions in damage.

"This has never been accomplished before, despite a decade of cell therapy trials for patients with heart attacks. Now we have done it," Marban said. "The effects are substantial, and surprisingly larger in humans than they were in animal tests."

The study is published online in the Feb 13. Issue of The Lancet.

One of the 17 patients in the study, 59-year-old Fred Lesikar of Menifee, Calif., said his major heart attack reduced his heart function by more than 30 percent.

"The doctors treating me told me that there was no way to repair a heart damaged by a heart attack," he told Cedars-Sinai. But then he saw a news report on the study and called Cedars-Sinai, asking to be a part of the trial. "Today I'm feeling super - better than I did before the heart attack."

Dr. Sonia Skarlatos, deputy director of the division of cardiovascular sciences at the NIH's National Heart, Lung, and Blood Institute, told CNN that the procedure needs to be tested on more patients before it rolls out to the public, but remains hopeful it can improve quality of life for heart attack patients.

She said, "By preventing the consequences of a heart attack you may be able to prevent further down the heart failure that happens in [many of these] patients."

In November, the stem cell procedure was profiled on the CBS Evening News.

Read the rest here:
Stem cells heal heart attack scars, regrow healthy muscle

When a piece of muscle in a person's heart dies from lack of blood flow, it scars over and is lost.

But a team of researchers from the Cedars Sinai Heart Institute in Los Angeles has proven that those muscles may not necessarily be gone forever.

In a study that may change how heart attacks are treated, Eduardo Marban and his team used stem cells to re-grow damaged heart muscle. In the 17 patients who received the therapy, Marban measured an average 50 percent reduction in the size of the scar tissue.

"One of the holy grails in medicine has been the use of medicine to achieve regeneration," Marban said. "Patients that were treated not only experienced shrinkage of their scars, but also new growth of their heart muscle, which is very exciting."

The stem cells were not derived from embryos, but instead were developed from the patients' own hearts. Marban's team inserted a catheter into the diseased hearts and took a small biopsy of muscle. In the laboratory, the tissue was manipulated into producing stem cells to re-inject into the patients' hearts.

Over the course of a year, the cells took root in cardiac tissue, encouraging the heart to create new muscle and blood vessels. In other words, the heart actually began to mend itself.

While similar research has been done using stem cells from bone marrow, this is the first time that stem cells derived from a patient's own cardiac tissue have been used.

Marban believes this therapy could be broadly used in many of the five to seven million Americans who suffer from heart disease every year. And he said the applications could go well beyond diseased hearts.

"If we can do that in the heart, I don't see any reason, conceptually, why we couldn't do it in kidneys for example, or pancreas or other organs that have very limited regenerative capacity," Marban said.

While the procedure may be a revolutionary medical technique, there are still a few more puzzling questions about the research that Marban would like to investigate further.

For example, while the patients grew new heart muscle and saw a dramatic reduction in scar tissue, the actual function of their hearts did not show a significant improvement. And it appeared the stem cells themselves may not have turned into cardiac muscle, but rather they stimulated the heart to produce new muscle cells.

Nonetheless, the potential success of this research could hold a lot of promise for the millions of Americans who suffer from heart disease each and every year, which is the leading cause of death in the United States.

If his future experiments yield the same results as this initial study, Marban believes he could be offering this therapy to patients within four years -- and that could go a long way in mending all of America's broken hearts. Read more: FOXNews

Excerpt from:
Stem Cells Might Fix Broken Hearts

By FOX News

February 14, 2012

LOS ANGELES -- When a piece of muscle in a person's heart dies from lack of blood flow, it scars over and is lost.

But a team of researchers from the Cedars Sinai Heart Institute in Los Angeles has proven that those muscles may not necessarily be gone forever.

In a study that may change how heart attacks are treated, Eduardo Marban and his team used stem cells to re-grow damaged heart muscle. In the 17 patients who received the therapy, Marban measured an average 50 percent reduction in the size of the scar tissue.

"One of the holy grails in medicine has been the use of medicine to achieve regeneration," Marban said. "Patients that were treated not only experienced shrinkage of their scars, but also new growth of their heart muscle, which is very exciting."

The stem cells were not derived from embryos, but instead were developed from the patients' own hearts. Marban's team inserted a catheter into the diseased hearts and took a small biopsy of muscle. In the laboratory, the tissue was manipulated into producing stem cells to re-inject into the patients' hearts.

Over the course of a year, the cells took root in cardiac tissue, encouraging the heart to create new muscle and blood vessels. In other words, the heart actually began to mend itself.

While similar research has been done using stem cells from bone marrow, this is the first time that stem cells derived from a patient's own cardiac tissue have been used.

Marban believes this therapy could be broadly used in many of the five to seven million Americans who suffer from heart disease every year. And he said the applications could go well beyond diseased hearts.

"If we can do that in the heart, I don't see any reason, conceptually, why we couldn't do it in kidneys for example, or pancreas or other organs that have very limited regenerative capacity," Marban said.

While the procedure may be a revolutionary medical technique, there are still a few more puzzling questions about the research that Marban would like to investigate further.

For example, while the patients grew new heart muscle and saw a dramatic reduction in scar tissue, the actual function of their hearts did not show a significant improvement. And it appeared the stem cells themselves may not have turned into cardiac muscle, but rather they stimulated the heart to produce new muscle cells.

Nonetheless, the potential success of this research could hold a lot of promise for the millions of Americans who suffer from heart disease each and every year, which is the leading cause of death in the United States.

If his future experiments yield the same results as this initial study, Marban believes he could be offering this therapy to patients within four years -- and that could go a long way in mending all of America's broken hearts.

Read more: http://www.foxnews.com/health/2012/02/14/stem-cells-could-potentially-fix-broken-hearts/#ixzz1mNGKYMvI

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Stem cells could potentially fix broken hearts

Stem cells are proving themselves beneficial once again after scientists used the controversial building blocks to resurrect dead, scarred heart muscle damaged by recent heart attack.

Results from a Cedars-Sinai Heart Institute clinical trial show that treating heart attack patients with an infusion of their own heart-derived cells helps damaged hearts re-grow healthy heart muscle.

Reporting in The Lancet medical journal, the researchers said this is the clearest evidence yet that broken hearts can heal. All that is needed is a little help from one’s own heart stem cells.

“We have been trying as doctors for centuries to find a treatment that actually reverses heart injury,” Eduardo Marban, MD, PhD, and lead author of the study, told WebMD. “That is what we seem to have been able to achieve in this small number of patients. If so, this could change the nature of medicine. We could go to the root of disease and cure it instead of just work around it.”

Marban invented the “cardiosphere” culture technique used to create the stem cells and founded the company developing the treatment.

“These findings suggest that this therapeutic approach is feasible and has the potential to provide a treatment strategy for cardiac regeneration after [heart attack],” wrote University of Hong Kong researchers Chung-Wah Siu and Hung-Fat Tse in an accompanying editorial of Marban’s paper.

The British Heart Foundation told James Gallagher of BBC News that this could “be great news for heart attack patients” in the future.

A heart attack occurs when the heart is starved of oxygen, such as when a clot is blocking the blood flow to the organ. As the heart heals, the dead muscle is replaced by scar tissue, which does not beat like heart muscle. This in turn reduces the hearts ability to pump blood around the body.

Doctors have long been searching for ways to regenerate damaged heart muscle, and now, it seems heart stem cells are the answer. And the Cedars-Sinai trial was designed to test the safety of using stem cells taken from a heart attack patient’s own heart.

The researchers found that one year after receiving the treatment, scar size was reduced from 24 percent to 12 percent of the heart in patients treated with heart stem cells. Patients in the control group, who did not receive stem cells, did not experience a reduction in their heart attack scar tissues.

“While the primary goal of our study was to verify safety, we also looked for evidence that the treatment might dissolve scar and re-grow lost heart muscle,” Marban said in a statement. “This has never been accomplished before, despite a decade of cell therapy trials for patients with heart attacks. Now we have done it. The effects are substantial, and surprisingly larger in humans than they were in animal tests.”

“These results signal an approaching paradigm shift in the care of heart attack patients,” said Shlomo Melmed, MD, dean of the Cedars-Sinai medical faculty and the Helene A. and Philip E. Hixon Chair in Investigative Medicine. “In the past, all we could do was to try to minimize heart damage by promptly opening up an occluded artery. Now, this study shows there is a regenerative therapy that may actually reverse the damage caused by a heart attack.”

Marban cautioned that stem cells do not do what people generally think they do. The general idea has been that stem cells multiply over and over again, and, in time, they turn themselves and their daughter cells into new, working heart muscle.

But Marban said the stem cells are actually doing something more amazing.

“For reasons we didn’t initially know, they stimulate the heart to fix itself,” he told Daniel J. DeNoon of WebMD. “The repair is from the heart itself and not from the cells we give them.”

Exactly how the stem cells invigorate the heart to do this was a matter of “feverish research” in the lab.

The CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction (CADUCEUS) clinical trial was part of a Phase I study approved by the US Food and Drug Administration (FDA) and supported by the National Heart, Lung, and Blood Institute.

Marban used 25 volunteer patients who were of an average age of 53 and had recently suffered a heart attack that left them with damaged heart muscle. Each patient underwent extensive imaging scans so doctors could pinpoint the exact location and severity of the scars. Patients were treated at Cedars-Sinai in LA and at Johns Hopkins Hospital in Baltimore.

Eight of the 25 patients served as a control group, receiving conventional medical treatment. The other 17 patients who were randomized to receive the stem cell treatments underwent a minimally invasive biopsy, under local anesthesia. Using a catheter inserted through a vein in the neck, doctors removed a small sample of heart tissue, about half the size of a raisin. The heart tissue was then taken to the lab at Cedars-Sinai and cultured and multiplied the cells using specially developed tools.

The doctors then took the multiplied heart-derived cells — roughly 12 million to 25 million of them per patient — and reintroduced them into the patient’s coronary arteries during another minimally invasive catheter procedure.

The process used in the trial was developed earlier by Marban when he was on the faculty at Johns Hopkins. Johns Hopkins has filed for a patent on the intellectual property and has licensed it to a company in which Marban has a financial interest. However, no funds from that company were used to support the clinical study. All funding was derived from the National Institutes of Health and Cedars-Sinai Medical Center.

This study followed another in which doctors reported using cells taken from the heart to heal the heart. That trial reported in November 2011 that cells could be used to heal the hearts of heart failure patients who were having heart bypass surgery.

And another trial is about to get underway in Europe, which will be the largest ever for stem cell therapy in heart attack patients.

The BAMI trial will inject 3,000 heart attack patients with stem cells taken from their bone marrow within five days of the heart attack.

Marban said despite the heart’s ability to re-grow heart muscle with the help of heart stem cells, they found no increase in a significant measure of the heart’s ability to pump — the left ventricle ejection fraction: the percentage of blood pumped out of the left ventricle.

Professor Anthony Mathur, a coordinating researcher for the upcoming BAMI trial, said that even if the Marban trial found an increase in ejection fraction then it would be the source of much debate. As it was a proof-of-concept study, with a small group of patients, “proving it is safe and feasible is all you can ask.”

“The findings would be very interesting, but obviously they need further clarification and evidence,” he told BBC News.

“It’s the first time these scientists’ potentially exciting work has been carried out in humans, and the results are very encouraging,” Professor Jeremy Pearson, associate medical director at the British Heart Foundation, told BBC News.

“These cells have been proven to form heart muscle in a petri dish but now they seem to be doing the same thing when injected back into the heart as part of an apparently safe procedure,” he added. “It’s early days, and this research will certainly need following up, but it could be great news for heart attack patients who face the debilitating symptoms of heart failure.”

—

On the Net:

Original post:
Stem Cells Regrow Healthy Heart Muscle In Heart Attack Patients

WHEN a piece of muscle in a person's heart dies from lack of blood flow, it scars over and is lost.

But a team of researchers from the Cedars Sinai Heart Institute in Los Angeles has proven that those muscles may not necessarily be gone forever.

In a study that may change how heart attacks are treated, Eduardo Marban and his team used stem cells to re-grow damaged heart muscle. In the 17 patients who received the therapy, Mr Marban measured an average 50 per cent reduction in the size of the scar tissue.

"One of the holy grails in medicine has been the use of medicine to achieve regeneration," he said. "Patients that were treated not only experienced shrinkage of their scars, but also new growth of their heart muscle, which is very exciting."

The stem cells were not derived from embryos, but instead were developed from the patients' own hearts. Mr Marban's team inserted a catheter into the diseased hearts and took a small biopsy of muscle. In the laboratory, the tissue was manipulated into producing stem cells to re-inject into the patients' hearts.

Over the course of a year, the cells took root in cardiac tissue, encouraging the heart to create new muscle and blood vessels. In other words, the heart actually began to mend itself.

While similar research has been done using stem cells from bone marrow, this is the first time that stem cells derived from a patient's own cardiac tissue have been used.

Mr Marban believes this therapy could be broadly used in many of the five to seven million Americans who suffer from heart disease every year. And he said the applications could go well beyond diseased hearts.

"If we can do that in the heart, I don't see any reason, conceptually, why we couldn't do it in kidneys for example, or pancreas or other organs that have very limited regenerative capacity," he said.

While the procedure may be a revolutionary medical technique, there are still a few more puzzling questions about the research that Mr Marban would like to investigate further.

For example, while the patients grew new heart muscle and saw a dramatic reduction in scar tissue, the actual function of their hearts did not show a significant improvement. And it appeared the stem cells themselves may not have turned into cardiac muscle, but rather they stimulated the heart to produce new muscle cells.

Nonetheless, the potential success of this research could hold a lot of promise for the millions of Americans who suffer from heart disease each and every year, which is the leading cause of death in the United States.

If his future experiments yield the same results as this initial study, Mr Marban said he could be offering this therapy to patients within four years - and that could go a long way in mending all of America's broken hearts.

Read more here.

Read the original:
Stem cells could fix broken hearts

When a piece of muscle in a person’s heart dies from lack of blood flow, it scars over and is lost.  But a team of researchers from the Cedars-Sinai Heart Institute in Los Angeles has proven that those muscles may not necessarily be gone forever.

In a ground-breaking study that may change how heart attacks are treated, Dr. Eduardo Marban and his team used stem cells to re-grow damaged heart muscle.  In the 17 patients who received the therapy, Marban measured an average 50 percent reduction in the size of the scar tissue

“One of the holy grails in medicine has been the use of medicine to achieve regeneration,” Marban said.  “Patients that were treated not only experienced shrinkage of their scars, but also new growth of their heart muscle, which is very exciting.”

The stem cells were not derived from embryos, but instead were developed from the patients’ own hearts.  Marban’s team inserted a catheter into the diseased hearts and took a small biopsy of muscle.  In the laboratory, the tissue was manipulated into producing stem cells.  After a few weeks of marinating in culture, researchers had enough stem cells to re-inject them into the patients’ hearts.  Over the course of a year, the stem cells took root in cardiac tissue, encouraging the heart to create new muscle and blood vessels.  In other words, the heart actually began to mend itself.

Click here to see an animation of how the process works.

“We’ve achieved what we have achieved using adult stem cells – in this case – actually specifically from a patient’s own heart back into the same patient.   There’s no ethical issues with that – there’s no destruction of embryos.  There’s no reason to worry about immune rejection."

While similar research has been done using stem cells from bone marrow, this is the first time that stem cells derived from a patient’s own cardiac tissue have been used.

Marban believes this therapy could be broadly used in many of the 5 to 7 million Americans who suffer from heart disease every year.  And he said the applications could go well beyond diseased hearts.

“If we can do that in the heart, I don’t see any reason, conceptually, why we couldn’t do it in kidneys for example, or pancreas or other organs that have very limited regenerative capacity,” Marban said.

While the procedure may be a revolutionary medical technique, there are still a few more puzzling questions about the research that Marban would like to investigate further.  For example, while the patients grew new heart muscle and saw a dramatic reduction in scar tissue, the actual function of their hearts did not show a significant improvement.  And it appeared the stem cells themselves may not have turned into cardiac muscle, but rather they stimulated the heart to produce new muscle cells.

Because this was a “Phase 1” study, it was really meant to measure whether the procedure was safe.  Of the 17 patients who were given the stem cell injections, six experienced “serious adverse events,” but only one was regarded to be possibly related to the treatment.  

The potential success of this research could hold a lot of promise for the millions of Americans who suffer from heart disease each and every year, which is the leading cause of death in the United States.  If his future experiments yield the same results as this initial study, Marban believes he could be offering this therapy to patients within four years – and that could go a long way in mending all of America’s broken hearts.

Here is the original post:
Stem cells a fix for 'broken hearts'?

For the first time, researchers have used stem cells from a patient’s own heart to repair the damage to the muscle that occurs during heart attack.

Dr. Eduardo Marban, director of the Cedars Sinai Heart Institute, and his team report in the journal Lancet that 17 patients who received an injection of their own heart cells grown from their stem cells saw the scarring on their hearts shrivel by 50% over a year. Eight patients who received usual care had no change.

During a heart attack, some of the heart’s muscle is cut off from its oxygen supply, so within seconds these cells start to die. The body’s immune system treats the change like a trauma and begins to wall off the dying tissue, creating an ever-thickening layer of scarring; eventually, the scar tissue hampers the heart’s ability to pump blood efficiently throughout the body. Keeping this scarring to a minimum, or even reversing it is the Holy Grail of heart attack research: maintaining as much healthy and active heart muscle as possible increases patients’ chances of recovering quickly and completely.

“Heart disease is still the number one killer of men and women, so there is a dire need for new therapies to be tested,” says Dr. Deepak Srivastava, director of the Gladstone Institute Cardiovascular Disease, who is a leader in heart stem-cell research and was not involved in the current study. “I applaud them carrying through with a clinical trial, which is great.”

MORE: Stem Cell Miracle? New Therapies May Cure Chronic Conditions Like Alzheimer’s

The heart has a natural ability to fix minor defects by regenerating new muscle cells to replace dying ones. About 1% to 2% of heart cells die each year, and are replaced this way. This process can’t come close to regenerating the one-third of heart muscle that is typically affected by a heart attack, however, so Marban and his team decided to give the process a boost. The researchers extracted some of the naturally healing stem cells from the heart and nurtured them in a lab dish. The hope was to inject a large enough population of the cells back into the heart to trigger a broad-scale repair of the muscle after heart attack.

“We were gratified to see that the scars shrank in patients who had gotten the cells,” Marban says. “Not only that, but these patients also had a big increase in living heart muscle. The regeneration of living tissue, or regrowth of lost tissue, which is what we were able to achieve, is encouraging.”

All of the patients were enrolled in the trial within 1.5 months of having a heart attack, and had their hearts scanned with an MRI. Seventeen of the patients had a biopsy of their heart tissue so the researchers could extract the heart’s stem cells and expand them in the lab; the researchers then re-infusing 12 million to 25 million new heart cells into each patient’s heart artery 1.5 months to 3 months later. The control patients received standard care of medications and monitoring to recover from their heart attack.

At six months and again at one year into the study, Marban and his colleagues took additional MRIs of the patients’ hearts, to measure any changes in the size of their scar tissue. The patients who had received the heart cells showed markedly smaller scars and more living tissue over time, compared with those who received standard therapy. In fact, new tissue formation increased by 60% on average, compared with scar shrinkage.

Unfortunately, however, the patients did not show any change in heart function, as measured by the ejection fraction, or the ability of the heart to pump blood. In patients who got the stem cells, their ejection fraction went from 39% at the start of the study to 41% a year later; healthy hearts pump at about 50% or greater efficiency.

MORE: Rethinking the Framingham Score: Is There a Better Way to Predict Heart Disease?

But Marban isn’t discouraged by that, noting that although he wasn’t able to show that the heart functioned better overall in the stem-cell patients, he did find that in the areas where the scars had shrunk, the muscle appeared to be working more efficiently. “When you zoom in and look at regional function, there was big improvement,” he says. “We believe that the changes we see in the amount of scar tissue, even though it’s dramatic and unmistakable and significant, still aren’t enough to tilt the balance toward complete repair of the heart.”

Will it take more cells, or more time, or different types of cells to generate that type of complete repair? That’s impossible to tell from this study, but the results are encouraging enough to trigger more work into such cell-based treatments. “This is part of a series of important steps toward ultimately moving to cell-based therapy that will someday create new muscle in the heart,” says Srivastava.

Future studies could answer some critical questions about exactly how the infused cells are helping to shrink scars and prompt the growth of new heart muscle. Srivastava notes that it’s unlikely that the new cells are turning into heart muscle themselves, but are more likely helping existing heart muscle generate new tissue. If that’s the case, then researchers can refine the technique to help heart attack patients months or even years after their event to repair their scarred hearts. “The real objective is to offer treatment for people who have a long-standing injury to the heart, and more severe heart disease,” says Marban.

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Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

Read more:
Healing a Broken Heart: Stem Cell Breakthrough Repairs Scars