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1Department of Internal Medicine, Hannover Medical School, Hanover, Germany

Stem cells in cardiovascular medicine

Stem cells have emerged as a new exciting therapeutic option for a variety of conditions in cardiovascular medicine such as myocardial infarction, heart failure and peripheral vascular disease. The encouraging results from recent experimental and animal studies are currently being tested in several clinical trials, focusing mainly on the treatment of patients with acute myocardial infarction and/or heart failure [1–4]. For this purpose, mostly bone marrow-derived mononuclear cells (BMCs) have been obtained directly from the patient's bone marrow by aspiration and eventually expanded ex vivo before intra-coronary or even intravenous (i.v.) application. The majority of these rather small studies primarily explored the feasibility and safety of this experimental approach. In the first randomized controlled trial from the Department of Internal Medicine of the Hannover Medical School, several parameters of cardiac function were assessed in patients who received intra-coronary BMCs after acute myocardial infarction [5]. The preliminary results are positive and will certainly boost the enthusiasm of the cardiovascular community for large-scale studies. Of even greater importance than stem cell therapy of acute myocardial dysfunction could be the prevention of progression of chronic atherosclerotic vascular disease and its associated syndromes. In this respect, BMCs seem less useful than circulating progenitor cells, because the latter can be—at least theoretically—persistently stimulated in vivo by targeted pharmacological interventions.

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