Stem cells in cardiology. The state of the problem in the Islamic Republic of Iran

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Relevance. The rising burden of cardiovascular diseases (CVDs) in Iran warrants innovative therapeutic alternatives that go beyond the pharmacological and surgical treatments available. The regenerative approach of stem cell therapy seems promising in recovering cardiac performance through mechanisms like the induction of angiogenesis, the regeneration of cardiomyocytes, and the reduction of the fibrotic process [1].

Stem Cell therapy has gained tremendous advancement in the world with numerous clinical trials showing benefits of various types of stem cells. In the case of Iran, the government and the scientific community have recognized the potential of regenerative medicine, which has had a positive effect on the establishment of research centers and funding programs for stem cell research. Notable works have been contributed by institutions such as the Royan Institute and academic hospitals in Tehran Despite efforts to support the implementation of evidence-based models in clinical practice, there exists a considerable gap in analyzing laboratory findings to clinical practice [2].

This research is of interest not only to scientists but also to health systems. Stem cell therapies, if they are successful, can potentially lessen the demand for heart transplants and long-term medications, resulting in improved patient outcomes and lower healthcare expenditures. Considering the encouraging preclinical data in Iran, moving towards clinical trials with rigorous designs is imperative to reach conclusive evidence regarding whether these therapies are effective and safe.

The aim is to study reviews the literature on stem cell therapy in cardiology, addresses the challenges of this approach, and provides an overview of its current state and clinical application in Iran, including commonly used stem cell types, therapeutic methods, and their effectiveness in treating cardiovascular diseases within the Iranian healthcare system.

Materials and research methods. This study is focused on modern and reliable sources information and based on an analysis and verified electronic databases. All data required for the aims of this study were extracted from existing regulatory documents, peer-reviewed Iranian and international medical journals and pertinent clinical trial reports.

Research results. In this regard, Iran's pretension in stem cell research and related therapies, particularly in cardiology, has reached a great achievement. Several preclinical and clinical studies have proven that mesenchymal stem cells (MSCs), cardiac progenitor cells, and induced pluripotent stem cells (iPSCs) can repair damaged myocardium. Bone marrow and adipose-derived MSCs have reduced infarct size and increased left ventricular function in preclinical and early clinical studies [1]. Similarly, the iPSC-derived cardiomyocyte models have provided personalized cardiac treatments, minimizing the immune rejection risk and accelerating the histocompatibility process, thus serving as a potential alternative for patient-specific therapies [4].

Iran has established specialized research centers, conducted clinical studies, and used both autologous and allogeneic sources of stem cells to promote stem cell research [1]. Significant emphasis has been placed on developing bioengineered scaffolds and cell-based therapies to augment myocardial repair and improve stem cell delivery efficiency [3]. The National Committee for Ethics in Biomedical Research’s strict adherence to ethical guidelines regarding transparency, risk assessment, and compliance with relevant national policies further solidifies Iran’s commitment to responsible scientific advancement [4].

Iran’s scientific activities include a wide spectrum of basic, translational, and clinical research in all aspects of stem cell biology and regenerative medicine. From basic research, the molecular mechanisms controlling stem cell differentiation and cardiac regeneration have been investigated, while translational research has focused on the implementation of bioengineered cardiac patches utilizing decellularized scaffolds seeded with MSCs. Such a flexible stance allows the nation to progress with stem cell-based therapies [3], but ethical regulations maintain control over human embryonic stem cells, in vitro differentiation of stem cells, and iPSCs research and genetic manipulation [4, 5]. National policies covering tissue engineering and bio-banking are aligned with the initiatives of key institutions and organizations that promote systematic storage and utilization of biological samples for potential regenerative medicine applications.

Key developments over the past decades have reinforced Iran’s position in the global stem cell research space. The successful isolation and culture of these MSCs obtained from many sources like bone marrow, adipose tissue, and umbilical cord blood has been fundamental in developing the clinical applications [1]. Moreover, stem cell-derived extracellular vesicles offer a novel therapeutic approach, highlighting their role as potential alternatives to direct cell transplantation for cardiac reparative purposes [2]. To enhance myocardial repair and repair of injured heart tissue [3], Iran has also adopted techniques in mind, such as recellularizing scaffolds and integrated tissue engineering. Biocompatible materials have also enhanced the retention and sustained survival of transplanted stem cells, thereby fully realizing their regenerative potential [3].

Iran's stem cell research and applications in cardiology are still at the early to middle stage of clinical translation, despite significant progress. Despite promising preclinical and early clinical trial findings, the country is not without its challenges, including limited funding, regulatory obstacles, and the necessity for larger-scale clinical studies to confirm the long-term effectiveness of stem cell treatments [2].

However, Iran has established a robust infrastructure for stem cell research that meets the global criteria while adhering to the ethical limits and national guidelines of the country [4, 5]. Iran’s investment in scientific infrastructure, progressive policies, and immersion in international best-practice for advancing stem cell research position it as one of the leading countries in stem cell science in the Muslim world. Iran can therefore grow its ranks in the stem-cell science league while enhancing its place in the world biomedical stage through even more interdisciplinary and transcultural cooperation.

Conclusion. Iran has made substantial progress in the field of stem cell research and its applications in cardiology, showing promising preclinical and early clinical achievements. Combined with significant government support for stem cell research, the establishment of specialized research centers, and the overall investment in regenerative medicine, the country has become one of the pioneers in stem cell-based therapies. Despite these challenges, including limited funding and the need for large-scale clinical trials, Iran's dedication to ethical and scientific developments is moving it forward. With greater international cooperation and experience in evolving clinical techniques, Iran could lead the nexus between laboratory investigation and patient management, producing better treatment outcomes for cardiovascular disease and decreasing the burden on health care systems around the world.

About the authors

Ali Shishehbor

Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation

Email: a.shishehbor@yandex.ru
ORCID iD: 0009-0003-1862-6298

4th year student, 6.04.02a group, Institute of World Medicine, Department of Propaedeutics of Internal Diseases No.1 of the Institute of Clinical Medicine

Iran, Islamic Republic of, 117513, Russia, Moscow, st. Ostrovityanova, 1

Parham Asghar Abouki

Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation

Email: parhamabouki@yandex.com
ORCID iD: 0009-0003-3387-242X

4th year student, 6.04.02a group, Institute of World Medicine, Department of Propaedeutics of Internal Diseases No.1 of the Institute of Clinical Medicine

Iran, Islamic Republic of, 117513, Russia, Moscow, st. Ostrovityanova, 1

Dmitri Viktorovich Polyakov

Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: dima-polaykov@mail.ru
ORCID iD: 0000-0002-8738-6924

Deputy Director of the Institute of World Medicine, Associate Professor of the Department of Propaedeutics of Internal Diseases No. 1 of the Institute of Clinical Medicine, Associate Professor, PhD D.V. Polyakov

Russian Federation, 117513, Russia, Moscow, st. Ostrovityanova, 1

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