Coronaropatia Oloker

Introduction

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide despite substantial advances in pharmacological therapy and coronary revascularization. Although contemporary medical and interventional treatments have significantly improved outcomes, a growing population of patients continues to experience chronic myocardial ischemia and persistent anginal symptoms. Cell-based therapy has emerged as a promising regenerative approach for CAD, aiming to repair injured myocardium, promote neovascularization, and improve cardiac function. Various cell types, including stem cells and progenitor cells, have been investigated for therapeutic use. These cells primarily exert their effects through the secretion of growth factors, cytokines, and extracellular vesicles that support tissue repair and regeneration. Preclinical studies have demonstrated encouraging results in enhancing cardiac repair and functional recovery. However, variability in cell types, delivery methods, and study designs has resulted in heterogeneous outcomes. Consequently, identifying the most effective and clinically applicable cell-based therapy remains an important area of ongoing investigation to optimize patient outcomes in CAD. Among these patients with CAD, refractory angina represents a particularly challenging clinical condition characterized by persistent symptom.

Refractory Angina

Refractory Angina is a chronic and debilitating condition characterized by persistent anginal symptoms caused by myocardial ischemia. Patients with refractory angina often experience severe limitations in physical activity, long-term medication, reduced quality of life, and frequent healthcare utilization. As conventional treatment strategies are often insufficient in this population, refractory angina remains an area of significant unmet clinical need, prompting investigation of regenerative therapies including cell-based interventions.

Status of the art

Refractory angina (RA) treatment is focused on enhancing coronary and microvasculature perfusion to reduce occurring reversible ischemia, and on modulating cardiac nociception, thus improving quality of life. Approved therapies for RA include the of Coronary Sinus Reducer (CSR), a treatment that redistributes coronary flow to hypoperfused areas through the placement of a stent in the coronary sinus, and Enhanced External Counterpulsation (EECP), aimed at increasing myocardial perfusion through the sequential compression of three regions of the leg synchronized with the diastole. Recently, gene therapy and cell therapy have been developed to overcome RA perfusion defects through the in situ injection on one hand of viral particles carrying vectors for endothelial growth factors, and on the other hand of progenitor cells like CD34⁺ or mesenchymal stromal cells (MSCs), to boost angiogenesis through the release of angiogenic factors. Even if preclinical test showed positive results, consistent evidence of clinical amelioration has remained elusive to date.

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