Vazir, A; Fox, K; Westaby, J; Evans, MJ; Westaby, S
(2019)
Can we remove scar and fibrosis from adult human myocardium?
European Heart Journal, 40 (12).
pp. 960-966.
ISSN 0195-668X
https://doi.org/10.1093/eurheartj/ehy503
SGUL Authors: Westaby, Joseph David
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Abstract
The pathological processes leading to heart failure are characterized by the formation of fibrosis and scar, yet the dynamics of scar production and removal are incompletely understood. Spontaneous disappearance of myocardial collagen is reported in infancy but doubted in adulthood where scar volume constitutes a better prognostic indicator than the conventional parameters of ventricular function. Whilst certain drugs are known to attenuate myocardial fibrosis evidence is emerging that stem cell therapy also has the potential to reduce scar size and improve myocardial viability. Both animal studies and clinical trials support the concept that, as in infancy, cellular processes can be triggered to remove collagen and regenerate injured myocardium. The molecular mechanisms likely involve anti-fibrotic cytokines growth factors and matrix-metalloproteinases. Autologous cardiac, bone-marrow and adipose tissue derived stem cells have each shown efficacy. Specific immune privileged mesenchymal stem cells and genetically modified immunomodulatory progenitor cells may in turn provide an allogenic source for the paracrine effects. Thus autologous and allogenic cells both have the potential through paracrine action to reduce scar volume, boost angiogenesis and improve ventricular morphology. The potential benefit of myocardial cell therapy for routine treatment of heart failure is an area that requires further study.
Item Type: | Article | ||||||||
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Additional Information: | This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal following peer review. The version of record Ali Vazir, Kim Fox, Joseph Westaby, Martin J Evans, Stephen Westaby, Can we remove scar and fibrosis from adult human myocardium?, European Heart Journal, Volume 40, Issue 12, 21 March 2019, Pages 960–966 is available online at: https://doi.org/10.1093/eurheartj/ehy503 | ||||||||
Keywords: | 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) | ||||||||
Journal or Publication Title: | European Heart Journal | ||||||||
ISSN: | 0195-668X | ||||||||
Language: | en | ||||||||
Dates: |
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Publisher License: | Publisher's own licence | ||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/113075 | ||||||||
Publisher's version: | https://doi.org/10.1093/eurheartj/ehy503 |
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