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Figure 1

The main types of stem cells
The main types of stem cells

The biological parameter changes in trials proving the beneficial effect of stem-cell therapy in myocardial infarction

TRIAL CELL TYPE BIOLOGICAL PARAMETER
Fernandez-Aviles et al., 2018 19 Allogenic CSC CRP Similar baseline values between groups.Higher levels decrease by day 7 in the study group (p=0.04).Similar values at 1-month follow-up in both groups.
NT-proBNP Similar baseline values.No statistically significant value at 12 months (p=0.9).
CK and TnT Similar decreasing trend.
Makkar et al., 2020 20 Allogenic CDC NT-proBNP Greater decreasing level at 6 months in study group (p=0.02).
Peregud-Pogorzelska et al., 2020 16 Autologous BM-MNC CRP, CK-MB, TnT, BNP Similar baseline levels between the entire study group and control group but lower CK-MB, TnT, and BNP initial values in responders, with faster decrease in BNP levels in the entire study group and TnT levels in the responders.

Types of stem cells and their advantages and disadvantages

CELL TYPE ORIGIN ADVANTAGES DISADVANTAGES
EMBRYONIC Zygote. Higher differentiation potency.Less risk of cell injury during cultivation due to decreased cell-to-cell adhesion. Subject to ethical issues due to methods of obtaining them.Malignant transformation (teratoma).
FETAL Blastocyst.Fetal structures.Bone marrow.Fetal blood. High differentiation potency.Less risk due to decreased cell-to-cell adhesion in early fetuses.Lower immunogenic effect.Can be obtained from fetal blood. Subject to ethical issues due to methods of obtaining them.
PERINATAL Umbilical cord.Placenta.Amniotic fluid. Multipotent.Can be easily obtained without ethical issues.Lower immunogenic effect. Differentiation potency is lower than that of fetal cells.
ADULT Bone marrow.Other structures (liver, kidney). Oligopotent.No ethical issues.More studies have been based on them; they are already in use for certain disorders. Differentiation potency is the lowest.Higher immunogenic effect (except for mesenchymal stem cells which express lower amounts of antigens).Obtaining these cells can be painful.
INDUCED PLURIPOTENT Adult somatic cells genetically modified to resemble embryonic stem cells. Obtained from adult and perinatal cells (not an ethical issue).High differentiation potency due to the similarity to embryonic cells. Immunogenic effect.

Types of stem cells and their effect in reviewed studies

CELL TYPE [ref] END POINTS NO. OF PATIENTS ENROLLED TIME OF INTERVENTION NO. OF CELLS ASSESSMENT METHOD FOR EFFICACY FINDINGS
Autologous BM-MNC [16] Safety Efficacy 15 in study group,19 in control group. 24 hours after STEMI. 8.37 × 106 LVEDV, LVESV, LVEF by echocardiography (biplane Simpson method – apical two- and four-chamber). Achieved safety.Nine patients in study group (60%) achieved an improvement in LVEF > 10% at 12-month follow-up.
Autologous BM-MSC [14] Safety Efficacy 14 in study group,12 in control group. 1 month after STEMI. 7.2 ± 0.9 × 107 LVEF by SPECT and echocardiography. Achieved safety.Improvement in LVEF in study group at 4-month follow-up (8.8% vs. 4.8%, p=0.031 by SPECT and 9% vs. 5.3%, p=0.023 by echocardiography).
Autologous BM-MNC [18] Efficacy 51 in early study group44 in late study group,54 in control group. Early: 5–7 days after STEMILate: 3–4 weeks after STEMI. 5 × 107 – 5 × 108 GLS and GCS by cardiac magnetic resonance. None of time related treatment proved an improvement in cardiac parameters.
Autologous BM-MNC [17] Efficacy 66 in study group,55 in control group. 6–9 days after STEMI. 100 × 106 LVEF, LVEDV, LVESV, infarct size by cardiac magnetic resonance. Study and control group had similar results at baseline, at 6-month follow-up and between times.
Autologous BM-MSC [10] Safety Efficacy 21 in study group,22 in control group. 14.07 +/−9.53 days after STEMI. 3.31 ± 1.7 × 106 LVEF, LVEDV, LVESV by echocardiography (Simpson method) at 12 months and myocardial perfusion and metabolic activity by SPECT at 6-month follow-up. Achieved safety.No statistically significant difference (p>0,05) between study and control group regarding LVEF, LVEDV and LVESV at 12 months or myocardial perfusion and metabolic defect index at 6-month follow-up.
Allogenic CSC [19] Safety Efficacy 33 in study group16 in control group. Days 5–7 after STEMI. 35 × 106 Infarct size, LVEF, LVEDV, LVESV and wall motion score by cardiac magnetic resonance. Safety was the primary endpoint, and it didn’t reveal any major cardiac adverse events or deaths at 6- and 12-month follow-up. No significant differences in assessed parameters between the groups at baseline and follow-up times.
Allogenic CDC [20] Safety Efficacy 90 in study group44 in placebo group. 4 weeks to 12 months after STEMI. 2.5 × 106 Infarct size, LVEDV, LVESV, LVEF by cardiac magnetic resonance. Safety endpoint was achieved.There was no significant difference in infarct size between groups at 6-month follow-up (p=0.51). Yet there was a reduction in LVEDV (p=0.02) and LVESV (p=0.02) at 6 month follow-up in favor of study group.
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