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Bench to Bedside: Insights from Large Animal Models and Emerging Clinical Trials of Endogenous Cardiac Regeneration
Shu-Xuan Chen1, Liu-Hua Zhou1, Tong-Tong Yang1
1Department of Cardiology, the First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
Insights
Stimulating the heart's natural regenerative capacity offers a promising approach to repair damage after myocardial infarction (MI). This review explores strategies to promote cardiac regeneration and improve outcomes following heart injury.
Area of Science:
- Cardiovascular Research
- Regenerative Medicine
- Cardiac Biology
Background:
- Cardiovascular disease (CVD), especially myocardial infarction (MI), is a major global cause of death.
- Loss of cardiomyocytes and fibrosis post-MI lead to heart failure.
- The adult mammalian heart possesses latent regenerative potential.
Purpose of the Study:
- To review strategies for stimulating endogenous cardiac regeneration after myocardial injury.
- To explore methods for promoting myocardial repair and improving clinical outcomes post-MI.
- To bridge mechanistic discoveries with clinical applications in cardiac regenerative medicine.
Main Methods:
- Review of intervention strategies for cardiac regeneration.
- Examination of approaches including cardiomyocyte cell-cycle re-entry, growth factors, paracrine mediators, cell-free vesicles, and small molecules.
- Analysis of translational progress using data from large animal models and clinical trials.
Main Results:
- Multiple strategies show potential for reactivating the heart's regenerative capacity.
- Stimulating cardiomyocyte proliferation and survival are key targets.
- Therapeutic approaches are progressing towards clinical application.
Conclusions:
- Harnessing endogenous cardiac regeneration is a promising strategy for treating heart failure post-MI.
- Further research and clinical trials are essential to translate regenerative approaches into effective therapies.
- Targeting cardiomyocyte cell-cycle re-entry and utilizing pro-regenerative signals are crucial for myocardial repair.
Abstract:
Cardiovascular disease (CVD), particularly myocardial infarction (MI), remains a leading cause of morbidity and mortality worldwide. The irreversible loss of cardiomyocytes (CMs) and subsequent fibrosis following MI due to delayed or absent reperfusion are central drivers of heart failure progression. Recent evidence indicates that the adult mammalian heart retains a latent regenerative capacity, which can be reactivated under specific conditions. Therefore, stimulating endogenous cardiac regeneration represents a promising strategy to improve clinical outcomes following MI. This review summarizes a range of intervention strategies designed to wake up cardiac regeneration and promote myocardial repair in the setting of residual following myocardial injury. Key approaches examined include stimulating cardiomyocyte cell-cycle re-entry, leveraging growth factors and paracrine mediators as pro-regenerative signals, and applying cell-free vesicles and small molecule compounds. We discuss the translational progress of these strategies, drawing on evidence from large animal models and ongoing clinical trials, aiming to bridge mechanistic discoveries to future clinical applications in cardiac regenerative medicine.
