The role of regenerative therapy in the treatment of right ventricular failure: a literature review
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REVIEW
Open Access
The role of regenerative therapy in the treatment of right ventricular failure: a literature review Christoph Haller1,2,3, Mark K. Friedberg4,5,6 and Michael A. Laflamme3,7,8*
Abstract Right ventricular (RV) failure is a commonly encountered problem in patients with congenital heart disease but can also be a consequence of left ventricular disease, primary pulmonary hypertension, or RV-specific cardiomyopathies. Improved survival of the aforementioned pathologies has led to increasing numbers of patients suffering from RV dysfunction, making it a key contributor to morbidity and mortality in this population. Currently available therapies for heart failure were developed for the left ventricle (LV), and there is clear evidence that LV-specific strategies are insufficient or inadequate for the RV. New therapeutic strategies are needed to address this growing clinical problem, and stem cells show significant promise. However, to properly evaluate the prospects of a potential stem cell-based therapy for RV failure, one needs to understand the unique pathophysiology of RV dysfunction and carefully consider available data from animal models and human clinical trials. In this review, we provide a comprehensive overview of the molecular mechanisms involved in RV failure such as hypertrophy, fibrosis, inflammation, changes in energy metabolism, calcium handling, decreasing RV contractility, and apoptosis. We also summarize the available preclinical and clinical experience with RV-specific stem cell therapies, covering the broad spectrum of stem cell sources used to date. We describe two different scientific rationales for stem cell transplantation, one of which seeks to add contractile units to the failing myocardium, while the other aims to augment endogenous repair mechanisms and/or attenuate harmful remodeling. We emphasize the limitations and challenges of regenerative strategies, but also highlight the characteristics of the failing RV myocardium that make it a promising target for stem cell therapy. Keywords: Cardiac regeneration, Pluripotent stem cells, Right ventricle, Heart failure, Congenital heart disease, Pulmonary hypertension
Background Right ventricular (RV) failure is an important but often overlooked cause of heart failure. Historically, the importance of the RV has been underestimated because the pulmonary vasculature can be perfused passively [1]. However, it is now clear that RV dysfunction in various * Correspondence: [email protected] 3 McEwen Stem Cell Institute, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada 7 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada Full list of author information is available at the end of the article
conditions is a significant risk factor for poor outcome, it is highly prevalent, and the population at risk for RV failure is increasing [2]. RV failure can result from several etiologies, ranging from failure secondary to left ventricular (LV) disease, pulmonary hypertensio
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