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Regenerative therapies for heart and vessels - prof. Piotr Musiałek

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Regenerative therapies for heart and vessels - prof. Piotr Musiałek

  1. 1. Regenerative Therapies for Heart &Vessels Przeszczepiać -czy- Regenerować ? Klinika Chorób Serca i Naczyń CMUJ Szpital im. Jana Pawła II Krakow
  2. 2. WHY ?
  3. 3. 10-year survival in failure
  4. 4. www.poltransplant.org.pl
  5. 5. www.poltransplant.org.pl
  6. 6. www.poltransplant.org.pl
  7. 7. 10-year survival in PAD
  8. 8. Amputations in PAD (Poland) 10 000 / year 1 leg / hour
  9. 9. THE NEED
  10. 10. THE NEED existing state-of-the-art therapies are greatly insuficient
  11. 11. FEASIBLE ?
  12. 12. FEASIBILITY ? 1. ‘post-mitotic’ organ(s) 2. in all mammals... HEALING is naturally biased towards FIBROTIC SCAR formation
  13. 13. Cardiac & Vascular regeneration therapy in 2014...
  14. 14. but...
  15. 15. Cardiac & Vascular regeneration therapy in 2014...
  16. 16. Cardiac & Vascular regeneration therapy in 2014...
  17. 17. Cardiac & Vascular regeneration therapy in 2014...
  18. 18. ‘post-mitotic organ ’
  19. 19. The heart is NOT a post-mitotic organ
  20. 20. The heart is NOT a post-mitotic organ + A P O P T O S I S !
  21. 21. 2001
  22. 22. Bone marrow – mediated endogenous ‘pro-regenerative’ resposne after AMI
  23. 23. Bone marrow – mediated endogenous ‘pro-regenerative’ resposne after AMI SDF expression in infarct zone
  24. 24. Myocardial regeneration therapy in 2014+ Optimal cell type and dose ? Jagiellonian University Dept. of Cardiac & Vascular Diseases John Paul II Hospital Krakow
  25. 25. Intrinsic cardiac stem cells
  26. 26. 10 years Jagiellonian University Dept. of Cardiac & Vascular Diseases John Paul II Hospital Krakow +
  27. 27. Myocardial regeneration therapy in 2014+ How to (best) deliver the cells? Jagiellonian University Dept. of Cardiac & Vascular Diseases John Paul II Hospital Krakow
  28. 28. DEVIC E Development Optimized retention Homing signals Cell functionality Cell adhesion Matrices Survival TISSU E BIOLOGIC S Injection method & technique Needle design Injection speed Tissue-device compatibility Biocompatibility Cell concentration Viscosity Stability Adapted from J. Bartunek et al. Clinical Pharm & Ther 85, 548-552
  29. 29. Labeled cells (SPECT) and cMRI: I M A G E F U S I O N P Banyś 2010-2012 Obrazowanie hybrydowe: zawał (MRI) / komórki (SPECT) Labeled CD34+ cells (3D SPECT) myocardial CD34+ uptake (part of) CD34+ liver uptake
  30. 30. P. Musiałek and Team Circulation: Cardiovasc Img 2013
  31. 31. Infarct Size (not LVEF) Determines Cell Uptake P. Musiałek and Team Circulation: Cardiovasc Img 2013
  32. 32. TERAPIA KOMÓRKOWA * zawału: stan wiedzy (2013) PTK 2012 INCREASE IN LVEF @ 6mo Zimmet * przezwieńcowe podanie komórek Eur J Heart Fail 2012
  33. 33. Biocompatible scaffolds
  34. 34. Biopatches for IPCs
  35. 35. • CE Mark since April 2012 • Available on the market
  36. 36. Development Needle design based on mathematical modeling Variable caliber and distribution of infusion holes: Drug Product is more evenly distributed along the needle extremity  Enhanced fluid distribution inside myocardium
  37. 37. transendocardial
  38. 38. Critical Limb Ischaemia
  39. 39. Critical Limb Ischaemia variable (naturally) disease progression rate ... concomittant revasculatization of the feeding vessel(other confounders (such as exercise – proangiogenic)
  40. 40. INVESTIGATOR – INITIATED STUDY Novel Off-shelf Regenerative Cell Application in Treatment of No-option Critical Limb Ischemia Mariusz TRYSTUŁA, Marcin MAJKA (PIs) email: mrt@onet.pl Jagiellonian University Dept. of Cardiac & Vascular Surgery and Transplantation at John Paul II Hospital and Jagiellonian University Dept. of Transplantation Krakow
  41. 41. Stem cell – cased therapeutic strategies
  42. 42. Cardiac & Vascular regeneration therapy in 2014...
  43. 43. Cardiac & Vascular regeneration therapy in 2014...
  44. 44. Cardiac & Vascular regeneration therapy in 2014...

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