Stem Cell Therapy : New Hope for the Failing Heart

Permyos Ruengsakulrach, MD., PhD., FRCST., FCCP
Kitipan Visudharom, MD., PhD., FACS, FACC, FACCP

Stem cells are undifferentiated or partially differentiated cells. Therefore they are capable of dividing and renewing themselves and also can give rise to specialized cell types, a phenomenon known as plasticity or transdifferentiation. Stem cells can be obtained from many sources such as embryo, fetal, umbilical cord blood, bone marrow or peripheral blood. The adult stem cells are the stem cells found in the mature tissue. Some scientists use the term "somatic stem cells" instead of adult sem cell. Most fetal and adult stem cells are considered to be multipotent and therefore capable of producing a small range of differentiated cell lineages appropriate to their location. Some adult stem cells, or progenitor cells, with the least differentiation potential (such as skeletal myoblasts, angiogenic precursor cells (APC's) or epidermal stem cells in the basal layer of the skin) are designated as unipotent.

The Bangkok Heart Hospital is now treating patients with heart failure and damage to the heart muscle due to the blockage of the coronary artery using angiogenic precursor cells produced from the patient's own peripheral blood. This treatment is in collaboration with Theravitae Ltd. and the University of Pittsburgh. The patient's medical history will be taken and a physical examination performed as usual. A number of blood tests will be screened for the blood concentration, infection (e.g. hepatitis, HIV, bacteremia) and general health (e.g. liver and kidney function). The six-minute test will be used to assess the physical status of the patient before and after the surgery. The magnetic resonance imaging of the heart is used to assess the heart muscle viability. If the patient is eligible for the therapy, a 250 cc of autologous blood will be collected from the patient and it will then be sent to the laboratory for cell selection and expansion. This process can take up to one week. Then the final cell product will be sent back to the Bangkok Heart Hospital for administration.

The cardiac surgeon will make a small incision on the left side of the chest wall. The thoracoscopic camera will be placed through a small hole into the thoracic cavity to assist with the procedure. Basically, the cells will be injected directly into the cardiac muscle (where the damaged heart muscle is located) by the magnetic resonance imaging of the heart.

What are the results of the treatment?
To date, the cell therapy from various kinds of cell origins and from various types of administations shows that this cell therapy is feasible and improves the function of the damaged heart muscle. These APC's are capable of generating new vessels and perhaps new heart muscles. This new area of medicine and rapidly evolving field need more understanding and research.

Bangkok Hospital Medical Center

Of the 82 people to have received stem cell treatment for serious heart conditions at Bangkok Heart Hospital, 56 were from the United States.

Dr Kit V. Arom, Director and Chief Surgeon at the hospital, based in the campus of Bangkok Hospital Medical Centre, Thailand, explains the surge in

interest for treatments: “We currently have 20% of our patients from outside of Thailand, and we are well on the way to 40%. When we opened 2 years ago I thought 100 beds might be too many, but we’re full!”

One of the many reasons for this is Dr Kit’s reputation. He was schooled at the University of Minneapolis, earning a PhD in surgery. He later founded the

Minneapolis Heart Foundation with 5 colleagues, which rapidly established itself amongst America’s finest heart institutions. In 2001, he returned to his home town of Bangkok, where he opened another stand-alone heart hospital.

“I was lucky that the owner decided to buy only the very best. State-of-the-art technologies, an excellent infrastructure, machines and OR, and allow us

practice the same treatments I worked on in the US.

“There is absolutely no difference between the treatment you would receive here than that which you would get in the best institutions in America. In fact, it may even be better as the machines are newer!"

Dr Kit points out that Stem Cell treatment is only used when medical and surgical treatments have not worked. The results speak for themselves though, with every patient recording significant improvements in overall quality of life.

The treatments (which have all been 100% safe) include 7 days recovering in hospital followed by a further week in Bangkok before a check-up to make sure its safe to board a plane. Follow-ups are continued after 1, 3 and 5 months, usually involving co-ordination with cardiologists back home.

With this quality of care, an extended stay in one of the most beautiful parts of the world, and at a fraction of the cost of the same treatment in the US, it’s not hard to see the attraction.