If I Can Stop One Heart From Breaking
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If I can stop one heart from breaking
— -Emily Dickinson 1
In the Ode to Broken Things, Pablo Neruda tenders a powerful metaphor of existence.2 It is not difficult to recognize the unwinding of human life in the broken clock that was once “the secret thread of our weeks” and now, with its “blue guts” exposed and its “wide heart unsprung,” is the symbol of agony and death. The beginning and ending of life are embraced in a poem about simple and ordinary things that accompany human beings throughout life and then are lost, together with the feelings and significance that were assigned to them. All things break, even the heart. What to do for broken things and broken hearts? The poet suggests collecting our treasures and sinking them in the ocean with the hope that the “long labor of its tides” may give back wholeness to the fragments. While we wait for the sea to reveal its strength and miraculous effects, the discovery that stem cells repair broken organs projects a more hopeful view of medicine and the way it is practiced.
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Soon after the first experimental evidence that bone marrow cells (BMCs) induce cardiac repair in the postinfarcted heart,3 unfractionated mononuclear BMCs and CD34-positive cells were given to patients affected by acute myocardial infarction or chronic ischemic heart failure.4,5 Results accumulated so far have documented the feasibility of this therapeutic approach with indications of potential beneficial effects on cardiac function and critical clinical end points. Although the mechanisms by which BMCs improve ventricular performance in humans are currently unknown, experimental evidence favors cardiac regeneration and the production of paracrine factors by these cells.6 New myocytes and coronary vessels are formed by transdifferentiation of the delivered cells, a process that …