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论文范文
1. Introduction Ischaemic cardiomyopathy, which mainly results from the blockage of multiple coronary arteries, is the most common cause of early death in adults worldwide [1]. A myocardial infarction (MI) can kill approximately 25% of cardiomyocytes in only a few hours [2]. However, the adult human heart has limited potential for regeneration to repair the injury caused by MI. Over the past two decades, cardiac transplantation has been the only available cure for people who develop advanced heart failure [3]. Cardiac homeostasis has traditionally been considered to be static in the adult mammalian heart. This might seem perplexing because the heart is one of the least regenerative organs, and it possesses a relatively constant number of myocytes that are as old as the individual [4]. Even under the most ideal circumstances, when all therapeutic interventions are applied to preserve the remaining myocytes from death, a moderate rate of cellular apoptosis leads to the erosion of the myocardium over time. In this case, the onset of heart failure in the elderly appears to be inevitable. Currently, remarkable progress has been made to demonstrate the presence of cycling cardiomyocytes in humans [5–7]. Radiocarbon birth dating has suggested that turnover rate in the endogenous adult human heart is approximately 1% per year, with approximately 45% of cardiomyocytes predicted to be renewed after birth [8]. Unfortunately, the injury from an acute MI cannot be reversed by resident cardiomyocyte proliferation during normal aging. Pulse-chase labelling has suggested that cardiac stem/precursor cells contribute to cardiomyocytes replenishment and regeneration after injury [9]. Therefore, the existence of cardiac stem-like cells promises a tantalizing approach to the treatment of ischaemic cardiomyopathy. The ultimate goal of cardiac repair is to regenerate functionally viable myocardium after MI to prevent or heal heart failure. Conventional surgical interventions, such as coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), are only able to restore heart function to a minor degree, with an improvement in the left ventricular ejection fraction (LVEF) of only approximately 3-4% [10]. Stem cell therapy has emerged as a promising strategy for the treatment of dead myocardium, directly or indirectly, and seems to offer functional benefits to patients [11]. Recently, a substantial number of clinical trials have proven that stem cell therapy is safe [12]. Infusion of bone marrow-derived stem cells (BMCs) represents the greatest number of clinical studies for MI. The overall efficacy for BMCs from meta-analysis on multiple published data has been inconsistent but relatively modest, with an improvement in LVEF of approximately 3-4% [11]. The majority of BMCs data for therapy, however, is less than ideal due to the limited component of active undifferentiated stem cells existing in bone marrow from early studies [13]. Many different types of stem cell with greater potential for cardiomyocyte regeneration, such as mesenchymal stem cells, cardiac stem cells, cardiosphere-derived cells, embryonic stem cells, and induced pluripotent stem cells, have been investigated in preclinical studies or clinical trials, which may help to improve the efficacy of cell therapies in cardiomyopathy [14]. The discrepancies among the multiple clinical studies may result from the various types of stem cells utilized in the studies as well as their different isolation and delivery procedures [15]. The beneficial outcomes from cell therapy are associated with paracrine effects, rather than direct regeneration of new tissue [5]. Therefore, large phase III clinical trials will be needed to confirm the salubrious effect of stem cell therapies in MI over placebo control. This review provides a comprehensive overview of treatment with stem-like cells in preclinical and clinical studies to assess the feasibility and efficacy of this novel therapeutic strategy in ischaemic cardiomyopathy. 
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