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Zwetsloot PP, Végh AMD, Jansen of Lorkeers SJ, van Hout GPJ, Currie GL, Sena ES, Gremmels H, Buikema JW, Goumans MJ, Macleod MR, Doevendans PA, Chamuleau SAJ, Sluijter JPG. Cardiac Stem Cell Treatment in Myocardial Infarction: A Systematic Review and Meta-Analysis of Preclinical Studies. Circ Res 2016; 118:1223-32. [PMID: 26888636 DOI: 10.1161/circresaha.115.307676] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/17/2016] [Indexed: 12/09/2022]
Abstract
RATIONALE Cardiac stem cells (CSC) therapy has been clinically introduced for cardiac repair after myocardial infarction (MI). To date, there has been no systematic overview and meta-analysis of studies using CSC therapy for MI. OBJECTIVE Here, we used meta-analysis to establish the overall effect of CSCs in preclinical studies and assessed translational differences between and within large and small animals in the CSC therapy field. In addition, we explored the effect of CSC type and other clinically relevant parameters on functional outcome to better predict and design future (pre)clinical studies using CSCs for MI. METHODS AND RESULTS A systematic search was performed, yielding 80 studies. We determined the overall effect of CSC therapy on left ventricular ejection fraction and performed meta-regression to investigate clinically relevant parameters. We also assessed the quality of included studies and possible bias. The overall effect observed in CSC-treated animals was 10.7% (95% confidence interval 9.4-12.1; P<0.001) improvement in ejection fraction compared with placebo controls. Interestingly, CSC therapy had a greater effect in small animals compared with large animals (P<0.001). Meta-regression indicated that cell type was a significant predictor for ejection fraction improvement in small animals. Minor publication bias was observed in small animal studies. CONCLUSIONS CSC treatment resulted in significant improvement of ejection fraction in preclinical animal models of MI compared with placebo. There was a reduction in the magnitude of effect in large compared with small animal models. Although different CSC types have overlapping culture characteristics, we observed a significant difference in their effect in post-MI animal studies.
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Affiliation(s)
- Peter Paul Zwetsloot
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Anna Maria Dorothea Végh
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Sanne Johanna Jansen of Lorkeers
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Gerardus P J van Hout
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Gillian L Currie
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Emily S Sena
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Hendrik Gremmels
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Jan Willem Buikema
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Marie-Jose Goumans
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Malcolm R Macleod
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Pieter A Doevendans
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Steven A J Chamuleau
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.)
| | - Joost P G Sluijter
- From the Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands (P.P.Z., A.M.D.V., S.J.J.o.L., G.P.J.v.H., J.W.B., P.A.D., S.A.J.C., J.P.G.S.); Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands (A.M.D.V., M.-J.G.); Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.L.C., E.S.S., M.R.M.); Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands (H.G.); ICIN, Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.); and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands (P.A.D., S.A.J.C., J.P.G.S.).
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