Stem cells represent a new possibility for the treatment of refractory angina.


The refractory angina is coronary obstructive disease in it’s terminal presentation, after exhausting all possibilities of conventional treatment currently known. Patients present with recurrent intractable chest angina (chest pain), despite the drug optimization and performance of several hemodynamic procedures (angioplasty and/or stents) and surgical procedures (myocardial revascularization surgery). The greatest impact of this disease is just the quality of life of patients, which is extremely limited for the performance of all daily activities and have several episodes of rest pain.


The prevalence of refractory angina comprises 5% to 15% of patients with coronary artery disease. Despite the severity and the degree of limitation of symptoms, most patients (75%) with refractory angina have normal cardiac function.


For the daily recurrence of symptoms, these patients represent a high cost to any health system, because of hospital (including ICU) and frequent tests. The treatment of refractory angina is very complex, involving optimization of drug and heroic attempts of myocardial revascularization surgery (hemodynamic and/or surgical via); without success, in most cases, the level of resolution of angina. Until the advent of cell therapy, the only option for patients was to learn how to live with pain. With the experimental confirmation of the angiogenic effect (formation of new blood vessels) through stem cells injected into the heart, a new therapeutic option for the treatment of refractory angina emerges.


The intramyocardial injection (directly into the heart muscle) of stem cells from bone marrow promotes heart neoangiogenesis, with an improvement in cardiac perfusion (blood flow) and, consequently, of angina symptoms. Given this new therapeutic possibility, we initiated a protocol of intramyocardial injection of stem cells from bone marrow in patients with refractory angina. This protocol provides a specific formulation of stem cells, MonoCell™, and is called ReACT® (Refractory Angina Cell Therapy Protocol). Until the present date, there are now over 20 patients treated by this specific protocol, with extremely encouraging results. Most patients did not present angina after one year of clinical follow up, and many have standardization of tests that assess cardiac perfusion (muscle pain).






MD. Nelson Américo Hossne Jr, a cardiovascular surgeon, member of Prof. Dr. Enio Buffolo staff, responsible for CellPraxis® Protocol of Cell Therapy for Class IV Angina, is the doctor responsible for carrying out the procedure of cell therapy and follow up patient and answers some questions from our readers.


1. What has encouraged you to start a cell therapy protocol?


Considering the well established angiogenic effect (formation of new blood vessels) of cell therapy in the heart, the possibility of an offer of a promising treatment for patients with refractory angina has been observed.


2. What are your expectations for Heart Cell Therapy?


In my opinion, the expectations of heart cell therapy are endless. With the results of clinical protocols for heart cell therapy, we are getting a better understanding of the behavior of heart cells. From this, theoretically, we would be enabled to rebuild a heart entirely.


3. What is the prospect of use of Umbilical Cord Blood and Placental Blood in Heart Cell Therapy?


SCUP has stem cells younger than those obtained from the bone marrow, while maintain the same theoretical advantages of cardiac neoangiogenesis. Moreover, obtaining stem cells from SCUP is painless for the patient. Thus, the prospects of using stem cells from SCUP in cardiovascular disease are enormous.


4. How do you see the interaction between university and company?


The interaction between universities and companies is a novelty in Brazil. This partnership is critical to the development of clinical research protocols in accordance with international standards of quality assurance and best practices for handling cells and tissues. The possibility of generation of new pharmaceutical products must necessarily be obtained from this interaction.


5. The protocol should generate patents and scientific articles. What is the impact of this for the university and for you as a researcher?


The generation of scientific articles and patents is one way of acquiring knowledge and intellectual property assurance to the university, the researcher and, ultimately, to Brazil. The creation of university patents in the university/company partnership guarantees royalties for both.


6. What are the advantages of having a company like Cryopraxis as a partner?


A company initially designed for the storage of umbilical cord blood has previous scientific and technical knowledge, facilitating the implementation of a protocol for clinical research in cell therapy. In addition, the expertise of the company in areas of quality assurance and data storage media are guarantors of the seriousness and integrity of a clinical protocol.