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From Bone Marrow to Cardiac Atrial Appendage Stem Cells for Cardiac Repair: A Review

[ Vol. 23 , Issue. 23 ]


Marc Hendrikx, Yanick Fanton, Leen Willems, Annick Daniels, Jeroen Declercq, Severina Windmolders, Karen Hensen, Remco Koninckx, Luc Jamaer, Jasperina Dubois, Dagmara Dilling-Boer, Jos Vandekerkhof, Filip Hendrikx, Eric Bijnens, Nick Heuts, Boris Robic, Virginie Bito, Marcel Ameloot, Paul Steels and Jean-Luc Rummens   Pages 2421 - 2438 ( 18 )


Traditionally the heart is considered a terminally differentiated organ. However, at the beginning of this century increased mitotic activity was reported in ischemic and idiopathic dilated cardiomyopathy hearts, compared to healthy controls, underscoring the potential of regeneration after injury. Due to the presence of adult stem cells in bone marrow and their purported ability to differentiate into other cell lineages, this cell population was soon estimated to be the most suited candidate for cardiac regeneration. Clinical trials with autologous bone marrow-derived mononuclear cells, using either an intracoronary or direct intramyocardial injection approach consistently showed only minor improvement in global left ventricular ejection fraction. This was explained by their limited cardiomyogenic differentiation potential. To obtain more convincing improvement in cardiac function, based on true myocardial regeneration, the focus of research has shifted towards resident cardiac progenitor cells. Several isolation procedures have been described: the c-kit surface marker was the first to be used, however experimental research has clearly shown that c-kit+ cells only marginally contribute to regeneration post myocardial infarction. Sphere formation was used to isolate the so-called cardiosphere derived cells (CDC), and also in this cell population cardiomyogenic differentiation is a rare event. Recently a new type of stem cells derived from atrial tissue (cardiac atrial stem cells – CASCs) was identified, based on the presence of the enzyme aldehyde dehydrogenase (ALDH). Those cells significantly improve both regional and global LV ejection fraction, based on substantial engraftment and consistent differentiation into mature cardiomyocytes (98%).


Cardiac stem cell, Differentiation, Magnetic resonance imaging, Mapping, Migration, Mesenchymal stem cells, Myocardial infarction, Platelet derived growth factor.


Jessa Ziekenhuis vwz Department of Cardiothoracic and Vascular Surgery, Hasselt, Belgium.

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