The aim of cardiac tissue engineering is twofold: (1) to provide three-dimensional cardiac tissue to restore the function of diseased hearts and (2) to develop improved test beds for target validation and substance screening. Both concepts have been successfully demonstrated by several groups using immature primary heart cells, but these cells are essentially postmitotic, precluding clinical and large-scale in vitro applications. Identification of a renewable cell source is therefore one of the key objectives in the field. Embryonic stem (ES) cells are attractive candidates because they can be propagated in large quantities, have a robust capacity to differentiate into cardiac myocytes, and can be obtained from humans. Classic isolation of ES cells from the inner cell mass is associated with destruction of the respective embryo. Thus, alternative technologies to generate stem cell lines with ES cell properties are inevitably called for. This review discusses the usefulness of ES cells in cardiac tissue engineering and alternative, embryo-sparing technologies to derive ES cells.
