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Walking to His Own Beat
Edward Sukyas’ morning walk takes him down a bustling section of Third Street in West Hollywood, past vintage stores, upscale coffee houses, and gourmet eateries—and past the spot on the sidewalk where two years ago he suffered a shattering heart attack.
On this chilly Los Angeles morning, Edward promises to point out where he was when he fell to his knees clutching his side in agonizing pain. But the 66-year-old commodities broker feels so healthy, so engaged in lively conversation that he strides right past the scene of his heart attack without taking notice until he is long past it.
“I don’t feel any sensation of handicap when it comes to my heart,” he says. “I feel great and the heart attack was simply a parenthesis—opened and closed.”
A stout gastronome with an infectious optimism and a somewhat difficult-to-place accent, Edward has enjoyed his quick-paced, daily hour long walks in view of Cedars-Sinai for more than 10 years, and resumed them six short weeks after his heart attack.
He attributes his remarkably robust health to two shares of good fortune: one, that he was wheeled into surgery at Cedars-Sinai within an hour of the heart attack and, two, that he had the unprecedented opportunity to take part in the Medical Center’s revolutionary study involving the use of his own stem cells to “rebuild” his heart.
The father of two and soon-to-be grandfather was one of 25 volunteers who participated in the CADUCEUS clinical trial. The brainchild of Eduardo Marbán, MD, PhD, director of Cedars-Sinai’s Heart Institute, the breakthrough study showed that treating heart attack patients with an infusion of their own heart-derived stem cells helps damaged hearts regrow healthy muscle. Published online in The Lancet medical journal in February, the findings convincingly challenge longstanding conventional wisdom that damaged heart tissue cannot regenerate.
Edward, whose father died of a heart attack in 1979, says he is thrilled to have had a role in the pioneering clinical trial.
“These doctors are at the frontier of something big, a major advance in medicine that could lead to a huge improvement in the health of men and women around the world,” Edward says. “In my own infinitesimal way, it’s like I planted a flag.”
For at least a decade, scientists around the world have been trying to harness stem cells to regenerate destroyed heart muscle.
When early studies that used stem cells from bone marrow were unsuccessful, some researchers began exploring the idea of using cardiac stem cells to regenerate damaged heart tissue. The problem with this approach? The adult heart only contains a very small reservoir of stem cells.
Dr. Eduardo Marbán’s elegantly simple solution to that problem involved taking a small biopsy of healthy heart tissue from a heart failure patient and coaxing the heart stem cells to reproduce in the laboratory. Once they reached a satisfying number, the stem cells could be injected back into the damaged zone of the patient’s heart.
The study, conducted at Cedars- Sinai in partnership with The Johns Hopkins University, would eventually enroll 25 patients who had suffered a moderate to major heart attack. As part of the trial, 17 patients received an infusion of their own laboratory-grown stem cells while the other eight received standard care.
On August 17, 2009, one slot remained for a patient to receive stem cell therapy. That was the day that Edward, nearing the end of his walk, stumbled to the ground with nausea and shooting pain in his chest and back. He managed to phone his wife, Kathy, and asked her to pick him up. When she arrived, they both knew something was terribly wrong. She drove him straight to the Emergency Department at Cedars-Sinai, just a few blocks away, where he told the attendant who arrived with the wheelchair, “I think I’m having a heart attack.”
When Edward was rushed into the operating room, he underwent a procedure to install three stents in a clogged coronary artery. “I felt discomfort in the heart, but nothing I could pinpoint,” Edward recalls. “It was over in half an hour.”
He was still recovering in the hospital when he received a visit from Mahul B. Amin, MD, chair of the Department of Pathology and Laboratory Medicine, who asked if he would consider participating in a groundbreaking study, and explained the potential risks.
Edward was not put off by the risks: He had undergone successful emergency surgery at Cedars-Sinai 23 years earlier to remove a tumor on his spine that threatened to leave him paralyzed. He did some research on stem cells, consulted with his wife and his cardiologist, and decided to volunteer.
“I’ve always liked a good challenge, and I thought, ‘This is an opportunity I cannot miss,’” recalls Edward. “I also thought, ‘If there is a place that could do such research, it would have to be Cedars-Sinai.’”
Almost four weeks after his heart attack, Edward returned to Cedars-Sinai to undergo a biopsy to harvest heart tissue containing a few precious stem cells. The stem cells were cultivated in a nourishing medium until they grew to about 25 million in number. Six weeks later, Rajendra Makkar, MD, director of the Interventional Cardiology and Cardiac Catheterization Laboratory, injected the cell mixture into the damaged region of his heart.
A Canadian citizen who has lived in nine countries and speaks seven languages fluently, Edward has opened a wall-to-wall carpet factory in Tangiers, Morocco, and a French-Italian restaurant in Cabo San Lucas, Mexico. Still, the globe-trotter and adventure-seeker felt an uncharacteristic sense of apprehension as Dr. Makkar prepared to inject him with the stem cells. But, he says, his lifelong thirst for new experiences and sensations, along with his utter faith in Dr. Marbán and the members of his medical team, quickly outweighed any concerns or doubts he had about the procedure.
“You have to accept a certain dose of risk in life,” Edward says. “Besides, if I hadn’t done this, I might have felt emotionally or psychologically debilitated for the rest of my life, as if I had a handicap or a physical shortcoming. This was a way to remedy that.”
In accordance with the study’s terms, he returned to Cedars-Sinai at monthly intervals for six months and again after a year for MRIs and pulmonary function tests to measure his recovery.
“I almost didn’t need those results to know how I was doing,” Edward says. “I felt different and felt better.”
In fact, a pulmonary function test performed after six months showed he was processing 2.5 liters of oxygen—significantly better than the expected baseline of 1.9 liters—and, after a year, 3.2 liters.
Edward’s results were similar to what other patients in the trial experienced. MRI scans showed that scar tissue in the stem cell recipients shrank between 30 percent and 47 percent following the stem cell infusion. On average, the stem cell recipients grew the equivalent of 600 million new heart cells, or about 60 percent of the billion cells lost in a typical heart attack.
“Stem cells in the heart do their best to cope with catastrophic injury, but they’re overwhelmed by a situation like a heart attack,” Dr. Marbán says. “By harnessing the innate regenerative process of the heart itself, we feel we are recruiting nature’s own healing process and just amplifying it.”
Although Dr. Marbán makes the philosophy behind the study sound simple, his achievement in actually coaxing heart-derived stem cells to regenerate heart tissue is monumental, according to Tim Henry, MD, director of Research at the Minneapolis Heart Institute Foundation.
“This is a remarkable achievement that marks a major step forward in stem cell therapy,” Dr. Henry says. “It used to be we thought the heart didn’t regenerate itself, but we now know it does and these cells are evidence of that.”
The technique of growing cardiac stem cells in a medium that includes other supporting cells was a distinguishing facet of the CADUCEUS study.
“Stem cells can’t function if they die off quickly after injection,” Marbán says. “The supporting cells keep them alive.”
For Edward, who has extensive knowledge of world gastronomies and has been known to drive across town for a special brand of Italian pasta, the hardest part of his recovery process has been the effort to improve his diet and lower his cholesterol.
“When you come from the Mediterranean, food isn’t just food,” he says. “It’s what ties you to your social environment.”
Whereas he used to eat a goat-cheese-and-tomato omelet nearly every day, “loosely rolled instead of folded, the French way, of course,” he now must content himself with a boiled egg twice a week. He misses his French cheese and charcuterie but tries to make do with a diet of heirloom tomatoes, low-sodium bread, salmon, chicken, and a cut of beef every two weeks.
But Edward says he feels more responsible for his health today than he ever did in the past and is grateful to be alive, a fact he acknowledges to himself every morning when he catches sight of the Cedars-Sinai building on the last turn of his daily walk, which has become surprisingly easier since the heart attack.
“Before my heart attack, I had shortness of breath when I was under effort, such as exercising or climbing stairs,” Edward says. “I don’t experience that anymore.”
Recently, when he stopped into his favorite coffeehouse for an espresso, Edward recognized Dr. Marbán at another table. Edward had seen pictures but had never met the distinguished heart researcher in person. He introduced himself, shook his hand, and thanked him for “opening a door of possibility to so many people,” he says.
“I truly feel privileged to have had access to this extraordinary clinical trial,” Edward says. “I have Dr. Marbán to thank for that.”