This document discusses cardiovascular disease and stem cell therapy for heart disease. It covers the causes and risk factors for cardiovascular disease, types of stem cells used for therapy, and different delivery systems for stem cell therapy including direct injection into the heart muscle, catheter-based delivery, and intravenous delivery. The goal of stem cell therapy is to repair damage caused by cardiovascular disease such as heart attacks.

2. Contents
• Cardiovascular disease
• Risk factors & diagnosis
• Heart development
• Stem cell therapy
• Types of stem cells used for therapy
• Delivery systems
• Reference

3. Cardiovascular disease ?...
Cardiovascular disease is a class of diseases that involve the
heart or blood vessels (arteries, capillaries and veins).
Cardiovascular disease refers to any disease that affects the
cardiovascular system.
Cardiovascular diseases remain the biggest cause of deaths
worldwide, and their prevalence is projected to remain the leading
cause of death .
Two major types of CVDs, hypertension and coronary artery
disease, can lead to myocardial infarction (MI) characterized by
death of cardiomyocytes and eventual heart failure.

4. Myocardial infarction (MI) or acute
myocardial infarction (AMI), commonly
known as a heart attack, results from the
interruption of blood supply to a part of the
heart, causing heart cells to die.
This is most commonly due to occlusion
(blockage) of a coronary artery following the
rupture of a vulnerable atherosclerotic plaque,
which is an unstable collection of lipids
(cholesterol and fatty acids) and white blood
cells (especially macrophages) in the wall of an
artery.

5. Age
High blood pressure
Dyslipidemia /hypercholesterolemia
Tobacco smoking
Obesity
Alcohol
 Clinical history of ischaemic type chest pain lasting for more than
20 minutes.
Changes in serial ECG tracings.
 Rise and fall of serum cardiac biomarkers such as creatine kinase-
MB fraction and troponin

6. Heart development
•From the cardiac crescent to the embryonic heart
•Second heart field cardiac progenitor cell
•Cardiac septaion and chamber morphogenesis
•Conduction system and epicardial development

9. In recent years, stem cell-based therapy has attracted much
attention as a viable approach to treating heart failure.
Increasing studies have indicated that stem cell-based
cardiovascular regeneration has the potential to revolutionize
current treatments for patients with ischemic heart disease.
Properties:
Self renewal
Potency (totipotency , pluripotency ,unipotency)

10. Potency of stem cell

13. Direct intramyocardial (IM) injection:
This epicardial procedure has been the most direct, precise, and
accurate approach for injecting stem cells to an infarcted region of
the heart. The location can be identified pre-operatively using
echocardiography and nuclear imaging and, during surgery, by
empirical observation.

14. Catheter based cell delivery:
•Percutaneous intramyocardial injection is more commonly performed in patients
with chronic heart failure secondary to ischemic heart disease.
•MyoCath™ and Myostar™ catheters utilized.
•Catheter-based intramyocardial injections of cells is to optimize an imaging
modality, either through two-dimensional (2D) or three-dimensional (3D)
imaging. This type of procedure requires extensive imaging guidance within the
ventricle to properly position the catheter at the site of injection.
•Example: X-ray fluoroscopic (2D), magnetic resonance imaging (MRI) (3D)

15. Types of methods for catheter based injection
1.Trans coronary sinus retrograde injection
2. Trans coronary artery antegrade injection
3. Trans catheter direct myocardial injection

16. Intravenous systemic delivery:
Intravenous infusion is a selective technique only for treating post-AMI
(Acute myocardial infarction)patients, as it is reliant on physiological
homing signals to injured myocardium, a condition not present in chronic
heart failure.
The greatest advantage to this approach is its simplicity and least invasive
route delivery system.

17.  Current Stem Cell Delivery Methods for Myocardial Repair
Calvin C. Sheng1, Li Zhou1 and Jijun Hao2§
1Vanderbilt University School of Medicine, Nashville, TN 37232
2College of Veterinary Medicine, Western University of Health Sciences
Pomona, CA 91766,
 ESC CBCS summer school on cardiovascular science (15 june 2011) “Heart
development”by robert G .Kelly developmental biology institute of marseilles-
luminy.
http://sciencepark.mdanderson.org/labs/tang/intra-cardiac4web.html
http://outreach.mcb.harvard.edu/animations/thera7c.swf