Regenerative heart failure therapy headed for optimization

The heart failure epidemic, accelerated by global ageing, is a rampant contributor to worldwide morbidity and mortality, underscoring the escalating burden of non-communicable diseases. In the context of a growing prevalence in ischaemic heart disease, advances in the acute management of myocardial infarction with rapid percutaneous revascularization have reduced prematuredeath but have resulted in a high incidence of chronic heart failure overloading healthcare systems. The malignant nature of the disease associated with poor outcomes reflects a shortcoming of current therapies, largely ineffective against infarction-triggered tissue destruction. Established therapies target afterload reduction and mineralocorticoid dysregulation to limit myocardial remodelling without, however, treating parenchymal loss that underlies disease. Loss of ventricular mass, compounded by maladaptive remodelling, leads to progressive organ deterioration necessitating recurrent hospitalizations and life-extending measures. Yet, left ventricular assist devices or heart transplantation are complex and costly procedures, available to a limited patient population. In the USA alone, 2500 heart transplants are performed annually. Due to donor paucity, .100 000 additional patients are left without hope for such a life-saving intervention. A pressing need thus exists for institution of innovative therapies that would reach beyond existing standards of care. The emergence of the science-powered regenerative toolkit offers such a prospect, signalling apotential for radical transformation of future practices. Curative options are viewed as being paramount in addressing the evolving patho-demographic landscape. Applied to cardiovascular diseases, regenerative technologies—exemplified by stem cell-based protocols—aim at restoring normative structure and function.Byseekingdefinitive solutions, regenerativeapproaches are predicted to offer a cost-effective outlook. To this end, translation of a growing body of knowledge underlying repair strategies necessitates deployment of robust regenerative platforms for delivery of quality medical and/or surgical algorithms. Indeed, roll-out of the regenerative model of care predicates a rigorous evidencesupported paradigm that will drive validated science into standardized and scalable clinical options.