Stem cell and gene-based approaches for cardiac repair

Besides current medical and surgical revascularization therapy, novel therapeutic interventions such as administration of recombinant or purified proteins, and cell and gene therapies have been used to compensate for the loss of cardiomyocytes and to limit the process of left ventricular remodeling. These approaches have been evaluated for use both alone and as adjuncts to bypass grafting in patients who are not candidates for coronary artery surgery. Additional studies need to focus on the development of strategies for optimization of cell delivery, which include adequate cell volume, preconditioned or gene modified to optimal functional results. Induced pluripotent cells from adult somatic cells, ex vivo cell-based gene therapy, and endogenous progenitor stem cell mobilization by mobilizing drugs (alone or/and as an adjuvant with stem cell therapy) into ischemic tissues may represent new directions for cardiac repair. Recently, stem cell exosome-based therapy in clinical settings may represent a novel and viable cardio-regenerative strategy.