Potentiating the naturally occurring process for repair of damaged heart

This article reviews the current progresses in application of both exogenous and endogenous progenitor cells/stem cells for cardiac repair, and the current understanding of the naturally-occurring process for physiological myocyte turnover and possibly cardiac repair. In particular the development of methods for potentiating the naturally-occurring mechanism for substantial repair of pathologically damaged cardiac tissues is discussed. In the last decade, tremendous efforts to identify both exogenous and endogenous progenitor cells/stem cells possessing capacities of differentiating into cardiac lineages have been made for potential cardiac repair. Although many impressive progresses have been made in the application of differently sourced progenitor cells/stem cells, such as embryonic stem cells (ESCs), induced pluripotent stem cell (iPS), bone marrow-derived mesenchymal stem cells (MSCs), skeletal myoblasts (SMs), umbilical cord blood cells (UCBs), residential cardiac stem cells (CSCs), cardiac resident fibroblasts (CRFs), or adipose tissue-derived stem cells (ASCs) for repair of damaged heart, however, inevitable controversies exist concerning: (i) the immune compatibility of the exogenous donor progenitors/stem cells, (ii) the tumorigenicity with ESCs and iPS, and (iii) the efficiency of these exogenous or endogenous progenitors/ stem cells to acquire cardiac lineages to reconstitute the lost cardiac tissues. The recent recognition of some active small molecules that can induce myocardial regeneration to repair damaged heart tissues through enhancing the naturally-occurring cardiac-repair mechanism has offered the hope for clinical translation of the technology. Potentiating the naturally-occurring process for cardiac repair by administration of such small molecules has provided a promising strategy for reconstruction of damaged cardiac tissues after heart infarction. Therefore, this article is in favor of the notion that such small molecules with the activity of manipulating gene expressions in such a way of inducing endogenous stem cells to commit cardiac lineage differentiation and consequently myocardial regeneration may fulfill the dream of substantial repair of damaged heart.