They're called "no-option patients."
They've endured angioplasty, stent procedures, bypasses and a long line of medications. None of the treatments has fixed the plaque-plugged coronary arteries that trigger angina, starve the heart of blood and force people to hunch in pain after walking two blocks.
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Adult stem cell research at an Oxnard, Calif., hospital is aimed at giving them choices.
"A patient who has no hope will have some hope," said Dr. Nabil Dib, a world-renowned researcher partnering with St. John's Regional Medical Center. "It's a hope for potential therapy that will revise the way we treat cardiovascular disease."
Stem cells are blank cells that function as the body's building blocks. They are able to grow into many different kinds of cells, including blood, muscle and tissue. Dib's work involves adult stem cells harvested from his patients, as opposed to stem cells that come from embryos and trigger ethical debates.
In a clinical trial starting at St. John's and 49 other hospitals across the country, the adult stem cells will be isolated and used to create new blood vessels. It's a way of manipulating the body into building new pathways for blood flow impeded by barricaded arteries.
The trial is part of a genre of research aimed at using the body's own resources to repair the heart. It could reduce consequences ranging from heart transplants and hospitalizations to heart failure and death.
The people who could be helped the most are heart attack survivors who don't respond to other treatments, said cardiologist Dr. Vishva Dev.
"If we could try to rebuild the heart muscle with the body's own stem cells, that's a huge opportunity," Dev said, adding that questions remain about the practicality of harvesting stem cells and routinely injecting them back into a patient.
Dib is a stem cell pioneer who in 2000 led the first clinical trial in which stem cells from a skeletal muscle were implanted in patients with heart failure.
He'll lead a heart research program to be funded by about $1 million that will be raised this year by St. John's Healthcare Foundation. The goal of the program is to find better care for people and save them money by reducing the need for care in the hospital.
The work is in its third and final stage before being eligible for FDA approval, although the treatment is still several years away from public use.
As part of the clinical trial, patients are being recruited to participate. They need to have chronic chest pain caused by coronary artery disease that hasn't responded to other treatment or surgical procedures.
They have to be willing to go through a process that includes five days of injections, harvesting of the stem cells and an implantation procedure involving a heart catheter.
Some patients will receive stem cells. Some will get placebos, and others will get traditional care, meaning they won't go through implantation.
They should understand that successful treatment will mean a better quality of life, but not the disappearance of all their symptoms.