New Treatment Option for Heart Failure PatientsNov 14, 2013
Until recently, six million patients suffering from heart failure only had a couple options for treatment, and both are fairly invasive. Now, there's a new procedure that's under clinical trial at the University of Utah that offers an ultra-minimally invasive way to intervene before a heart transplant or artificial heart is needed. Director of Clinical Regenerative Medicine Dr. Amit Patel talks about a procedure where stem cells are injected into a patient's heart to help it heal itself, how it works and other applications for the treatment.
Amit Patel, MD: Imagine having a heart procedure that potentially can help regenerate or rejuvenate your heart muscle, and it's done as an outpatient.
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Amit Patel, MD: Hi, I'm Amit Patel. I'm the director of clinical regenerative medicine here at the University of Utah.
Interviewer: Tell me about this brand new procedure that injects stem cells into a person's heart to treat heart failure. It effects about six million people.
Amit Patel, MD: That's true. There's millions of people who have heart failure. And as the heart failure progresses the heart weakens, and the only options are a heart transplant or assist devices or artificial hearts. So the goal is how can we intervene before you end up needing a heart transplant or an artificial heart. So we've come up with an ultra minimally invasive technique where we just go through the vein and backwards into the heart and we could deliver gene therapy and/or stem cells. And we do this as an outpatient procedure.
Interviewer: What are these stem cells doing that you're injecting into the heart?
Amit Patel, MD: In this case we're actually injecting gene therapy. This is actually human gene, no viruses, no animals. We always want the body to heal itself. The goal is these genes act like homing beacons. Basically when we put them into patient's heart with heart failure they marinate the entire heart and they basically act like a lighthouse with a signal basically saying, "How do we get the ships that need to get to this port, which is the heart, get there?" When the signal, or this light from the SDF1, which is that gene, shows up, the stem cells not only inside your own heart, but also that circulate from your blood and bone marrow all get attracted to the heart which is injured. They actually bring reinforcements and troops to actually make it stronger and actually pump more efficiently.
Interviewer: They come to the rescue so to speak.
Amit Patel, MD: That's exactly what they do.
Interviewer: That is amazing. When was this discovery made?
Amit Patel, MD: The concept of retrograde therapy has been there for probably fifty years, but, clinically, people have started talking about it in the last ten years. This is the first time ever in the world where we've been able to do what they can retrograde, that means to go backwards, into the heart and actually deliver gene therapy into a human.
Interviewer: In a very, what did you say, super duper minimally invasive manner?
Amit Patel, MD: It's ultra minimally invasive because basically you're going through the vein and so it's a low pressure system. The problem is many of these patients with heart failure, because they've had so many heart attacks, their heart muscle gets thinner and weaker, so you don't actually want to use a lot of techniques when we first developed this over a decade ago where we inject with needles, so you could risk perforating the heart. Some of the thickness of the walls are too thin. Many of them have artificial valves, pacemakers. There's so much risk to these incredibly frail, sick people that you want to do the least invasive thing with the most potential for success to actually make them better so they can go back to having great lives with their loved ones and going back to work.
Interviewer: At the University of Utah you're the first in the world to do that. What does it feel like to be the first in world to offer this new treatment?
Amit Patel, MD: I think it's incredible. Imagine having a heart procedure that potentially can help regenerate or rejuvenate your heart muscle and it's done as an outpatient.
Interviewer: Yeah, you go in and you're out the same day.
Amit Patel, MD: You could be out the same day.
Interviewer: As opposed to the old model how long would you have been in the hospital?
Amit Patel, MD: With many of the old techniques we would actually be about three to five days, so almost a week.
Interviewer: What's next for this type of therapy? Are there applications beyond the heart? If I had a bad liver would you be able to inject these cells there?
Amit Patel, MD: That's great you asked that because outside of the U.S. in Japan they actually are using this sort of technique for liver therapy for alcoholic liver cirrhosis. This technique is also being developed for the brain for patients with strokes. There's many different applications for this, but as we currently do this our goal is to keep patients safe. As we are the first in the world to do this we've already trained other physicians around the country, so in the next upcoming month there will be four other centers. Hopefully by the end of January there will be about 12 to 15 centers in the U.S. that will be able to provide this retrograde gene therapy for their patients.
Interviewer: Do you think this will be the procedure in five years?
Amit Patel, MD: This will be one of the most safest, best procedures out there to provide biological therapy, so gene therapy stem cells, for patients not only with heart failure, but also patients with chronic chest pain and potentially patients who also need therapy right after they have a heart attack.
Interviewer: Any last thoughts?
Amit Patel, MD: This is one of the great moments of biological therapy. We've been doing this for over 12 years. It's taken that long to provide the most safest, reproducible delivery. We also have the best products. We're so close in the U.S. that within the next couple of years we actually will have an approved biological product to treat patients with cardiac disease.
Interviewer: From a physician's standpoint, is that pretty amazing?
Amit Patel, MD: That's incredible because we have millions of patients dying with no options. We are truly providing options for patients who have no possible solutions.
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