Chronic heart failure is a progressively worsening condition caused by a decrease of the strength and pumping power of the heart. The current treatments are primarily aimed at reversing the negative effects of the complex neurohormonal pathways that are activated as a result of poor heart function. The activated pathways eventually contribute to the worsening of the disease and lead to more frequent hospitalizations. Despite advances in therapies targeting these pathways, mortality rates are still high. Now, the largest cell therapy trial to date in patients with chronic heart failure owing to low ejection fraction has shown that the therapy benefited patients by improving the heart’s pumping ability, as measured by ejection fraction, and reducing the risk of heart attack or stroke, especially in patients with high levels of inflammation. In addition, a strong signal was found in the reduction of cardiovascular death in patients treated with cells.

In the landmark clinical trial, physician-scientists at The Texas Heart Institute (Houston, TX, USA) showed that a special immunomodulatory cell type called MPC (mesenchymal precursor cells) developed by Mesoblast Inc. (Melbourne, Australia) has the potential to tackle one of the largest contributors to heart failure, inflammation. Participants in the trial were already making use of all available state-of-the-art heart failure drugs, which suggests that MPC cell therapy could work synergistically and add to the current medication in an effective way. The exceptional mode of action of MPC offers an alternative approach that has the possibility of significantly reducing the high mortality rate associated with heart failure.

The findings of beneficial long-term outcomes for patients with chronic heart failure due to lower ejection fraction and weakened pumping function are a major breakthrough in cell therapy for cardiovascular diseases. The results can help identify which heart failure patients with inflammation have the highest risk and likelihood to benefit from MPC therapy, and these findings will be further investigated in future studies. The groundbreaking trial has established the groundwork for potentially adding cell therapy to the treatment options available for heart failure.

“The results of DREAM-HF are an important step in understanding how cell therapy provides benefits in patients with chronic heart failure due to poor pump function,” said the study’s lead author, Dr. Emerson C. Perin, MD, Ph.D, Medical Director at The Texas Heart Institute. “The cells appear to work by reducing inflammation, increasing microvascular flow, and strengthening heart muscle. Locally, in the heart, the MPCs can protect cardiac muscle cells from dying and can improve blood flow and energetics. In large blood vessels throughout the body, the reduced inflammation resulting from the activation of MPCs may decrease plaque instability, which is what leads to heart attacks and strokes. The cells seem to have a systemic immune-modulatory and anti-inflammatory effect.”

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