Abstract
World Health Organization estimated that heart failure initiated by coronary artery disease and myocardial infarction (MI) leads to 29 per cent of deaths worldwide. Heart failure is one of the leading causes of death in industrialized countries and is expected to become a global epidemic within the twenty-first century. MI, the main cause of heart failure, leads to a loss of cardiac tissue impairment of left ventricular function. The damaged left ventricle undergoes progressive ‘remodelling’ and chamber dilation, with myocyte slippage and fibroblast proliferation. Repair of diseased myocardium with in vitro-engineered cardiac muscle patch/injectable biopolymers with cells may become a viable option for heart failure patients. These events reflect an apparent lack of effective intrinsic mechanism for myocardial repair and regeneration. Motivated by the desire to develop minimally invasive procedures, the last 10 years observed growing efforts to develop injectable biomaterials with and without cells to treat cardiac failure. Biomaterials evaluated include alginate, fibrin, collagen, chitosan, self-assembling peptides, biopolymers and a range of synthetic hydrogels. The ultimate goal in therapeutic cardiac tissue engineering is to generate biocompatible, non-immunogenic heart muscle with morphological and functional properties similar to natural myocardium to repair MI. This review summarizes the properties of biomaterial substrates having sufficient mechanical stability, which stimulates the native collagen fibril structure for differentiating pluripotent stem cells and mesenchymal stem cells into cardiomyocytes for cardiac tissue engineering.
Highlights
Cardiac tissue engineering promises to revolutionize the treatment of patients with end-stage heart failure and provides new solutions to the serious problems of heart donor shortage
Cardiovascular tissue being a hierarchically organized tissue, the delivery of cytokines and bioactive proteins in a controlled and timely manner through nanostructured materials with suitable mechanical properties could be the ideal approach for improving the cardiac function
Even embryonic stem cells could be differentiated into CMs by cardiac paracrine pathways mediated through TGF-b and BMP-2, and patients benefit after its transplantation to the diseased heart
Summary
Cardiac tissue engineering promises to revolutionize the treatment of patients with end-stage heart failure and provides new solutions to the serious problems of heart donor shortage. Current therapeutic strategies to treat CHF are limited to surgical transplantation, coronary artery bypass grafting (CABG), ventricular remodelling (resection), dynamic latissimus dorsi (LD) cardiomyoplasty, cardiac bioassist mechanical support and pharmacological intervention. Two of the promising pathways are direct implantation of primordial type of cells into the injured heart and the replacement of portions of heart muscle with tissue-engineered bioartificial grafts Both the techniques display advantages and limitations. In the last few years, other strategies have been evolved, aiming at restoring diseased areas of the heart These approaches include cellular transplantation, as well as in vitro engineering of bioartificial myocardial tissues for alleviation of MI
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