Terapêutica com células estaminais no enfarte agudo do miocárdio e insuficiência cardiaca pós – enfarte
Palavras-chave:
Células estaminais, enfarte agudo do miocárdio, insuficiência cardíaca, mioblastos, remodelagem ventricularResumo
O transplante de células estaminais no coração tem surgido como
uma terapêutica potencial em doentes com enfarte agudo do
miocárdio e insuficiência cardíaca pós-enfarte. O estadio actual
do conhecimento permite esperar que o uso de mioblastos derivados do tecido muscular esquelético ou de células estaminais da
medula óssea venha a revelar-se uma terapêutica segura, viável e
eficaz. Os dados disponíveis sugerem o seu benefício na função
cardíaca, com o aumento da fracção de ejecção do ventrículo
esquerdo e diminuição dos volumes telessistólico e telediastólico.
Perspectiva-se diminuição da área de enfarte, aumento da contractilidade da área enfartada, diminuição da classe funcional de
insuficiência cardíaca e diminuição do número de procedimentos
de revascularização e de hospitalizações.
Apesar de ainda se desconhecerem os mecanismos envolvidos, sugerem-se como hipóteses a diferenciação em miócitos, a
promoção da angiogénese, a secreção de factores parácrinos que
aumentam a função dos miócitos sobreviventes ou responsáveis
pela mobilização de células estaminais residentes no coração,
oposição à destruição da matriz extracelular com diminuição da
apoptose dos cardiomiócitos e fusão entre as células transplantadas e os miócitos residentes.
É importante sublinhar que não se encontra esclarecido qual
o melhor local para a colheita das células estaminais nem qual
a melhor forma de as administrar.
Também permanecem em aberto questões referentes a
dificuldades técnicas e eventuais complicações. A investigação
em curso permitirá, espera-se, esclarecer dúvidas e chegar a
conclusões mais fiáveis.
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Referências
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