Chapter 19 – Cardiac Stem Cells: Biology and Therapeutic Applications

Publisher Summary This chapter reviews the biology of cardiac stem cells and the growing body of knowledge regarding cell-based therapeutics. Mammalian cardiogenesis involves proper synchrony of function among a diverse population of cells that comprise the heart such as atrial/ventricular cardiomyocytes, smooth muscle cells, endothelial cells, epicardial cells, conduction system cells, valvular components, and connective tissue. The role of cardiac neural crest precursors is ultimately to give rise to the vascular smooth muscle of the aortic arch, ductus arteriosus, and great vessel, as well as to contribute to the cardiac autonomic nervous system. The proepicardial cells give rise to the smooth muscle cells of the coronary vessels and other epicardial cells. Finally, cardiogenic mesodermal precursor(s) are responsible for the formation of the cardiomyocytes and are most likely to be the source of reservoirs of precursor cells post-natally. Currently there are several contemplated mechanisms of actions underlying successful cell-based therapeutics, each with varying degrees of experimental support. These include differentiation, paracrine signaling, fusion, and cell autonomous niche reconstitution. Ex vivo culture of adult and embryonic stem cells under specific conditions such as the hanging drop technique, stimulation by biochemical compounds, or coculture with cardiac myocytes have demonstrated the capacity of stem cells to differentiate into beating cardiomyocytes and vascular lineages.