UNAIR NEWS – Coronary heart disease (CHD) is one of the most common types of heart disease with a high mortality rate. To date, CHD therapy remains a big challenge for the medical world. Various studies have been carried out to overcome this problem, including the development of drugs and interventions that are more invasive in patients.
In his speech at Universitas Airlangga (UNAIR) inauguration of professors on Wednesday, October 27, 2021, Prof. Dr. dr. Yudi Her Oktaviono, Sp.JP (K), in the field of Cardiology and Vascular Medicine, described his research on breakthroughs with regenerative therapy approaches using stem cells. According to the professor from Malang, percutaneous coronary intervention (cardiac stent placement/PCI), which has developed significantly in the last two decades, is the preferred modality for CHD therapy. PCI has been proven to suppress symptoms and improve the quality of life of CHD patients.
“However, there are also limitations that cannot be ruled out. There may be sudden blockage after the procedure (stent thrombosis), re-occlusion (in-stent restenosis), and incomplete revascularization. Coronary bypass surgery, in fact, also has several limitations in the form of diffuse injury, the possibility of graft failure, and the condition of no-option treatment (being unable to undergo the procedure),” continued the 116th professor of the Faculty of Medicine.
On that occasion, Prof. Yudi explained that the study results showed that the incidence of coronary artery narrowing is related to endothelial cell dysfunction (blood vessel walls). Stem cell counts were found to be 40 percent lower in patients with CHD. This number also correlates with an increase in the severity of CHD patients. Therefore, stem cells have become a new therapeutic modality in handling CHD.
The application of stem cell therapy, he continued, aims to increase the levels of Endothelial Progenitor Cell (EPC) in CHD patients to increase vascularity in the coronary artery system and improve endothelial function and survival rate of CHD patients. At an advanced stage, providing stem cells is expected to help prevent complications of in-stent restenosis and stent thrombosis.
“We see great potential regarding the use of EPC in handling CHD. Through a series of studies that we have conducted, we found that EPC can be isolated and cultured from Mononuclear Cells originating from the peripheral blood circulation of CHD patients. EPC from peripheral blood of CHD patients can be significantly proliferated,” explained the cardiovascular specialist.
In addition, the proliferative process of EPCs was also found to be associated with a signaling cascade called Mitogen-Activated Protein Kinase (MAPK). It is a classical signaling cascade involved in several biological roles, such as normal growth and development of cells, and it can respond to stress to various stimuli from outside the cells.
Of course, with the discovery of pathways that play a role in the proliferation and differentiation of EPCs, there will be more and more roles of EPCs that can be explored in the development of regenerative therapy for CHD.
Prof. Yudi also conducted an exploration to find out the factors that influence the increase in EPC. Several drugs for heart disease, such as statins and ACE inhibitors, have been proven to increase the number and function of EPCs. In addition, there is also an increase in EPC levels and function after the administration of several types of antioxidants, such as garlic and purple sweet potato extracts.
Regenerative medicine using stem cells, he said, has been studied extensively. However, this treatment turns out to be facing challenges, so the research team begins to shift the paradigm of regenerative medicine from cell-based treatment to cell-free treatment using secretomes.
“Secretomes can increase neovascularization, angiogenesis, and systolic cardiac function by protecting myocardial cells from apoptosis. With these various beneficial properties, of course, secretomes have the potential to be used in the management of coronary heart disease,” concluded the UNAIR Alumnus.
Author: Asthesia Dhea Cantika
Editor : Khefti Al Mawalia
