Myocardial Regeneration After Implantation of Porcine Small Intestinal Submucosa in the Left Ventricle

Abstract

Introduction Most cardiomyocytes do not regenerate after myocardial infarction. Porcine small intestinal submucosa has been shown to be effective in tissue repair. Objective To evaluate myocardial tissue regeneration and functional effects of SIS implantation in pigs after left ventriculotomy. Methods Fifteen pigs were assigned to two groups: porcine small intestinal submucosa (SIS) (N=10) and control (N=5). The SIS group underwent a mini sternotomy, left ventriculotomy and placement of a SIS patch. The control group underwent a sham procedure. Echocardiography was performed before and 60 days after the surgical procedure. Histological analysis was performed with hematoxylin-eosin stain and markers for actin 1A4, anti sarcomeric actin, connexin43 and factor VIII. Results Weight gain was similar in both groups. Echocardiography analysis revealed no difference between groups regarding end diastolic and systolic diameters and left ventricular ejection fraction, both pre (P=0.118, P=0.313, P=0.944) and post procedure (P=0.333, P=0.522, P=0.628). Both groups showed an increase in end diastolic (P<0,001 for both) and systolic diameter 60 days after surgery (P=0.005, SIS group and P=0.004, control group). New cardiomyocytes, blood vessels and inflammatory reactions were histologically identified in the SIS group. Conclusion SIS implantation in pigs after left ventriculotomy was associated with angiomuscular regeneration and no damage in cardiac function.

Regenerative Medicine Strategies for Hypoplastic Left Heart Syndrome

“…Moreover, in the pediatric population, pSIS is associated with vessel stenosis and a suboptimal aortic valve repair. [105][106][107][108] Clinical experience with acellular scaffolds suggests that the scaffolds do not regenerate site-specific tissue. Furthermore, they stimulate very little regenerative response for the myocardium, which limits their use as sole therapy.…”

In Vivo Assessment of Decellularized Porcine Myocardial Slice as an Acellular Cardiac Patch

“…13 The ECM scaffolds derived from the porcine small intestinal submucosa (SIS), when employed as an acellular cardiac patch, have induced angiomuscular regeneration in a porcine MI model. 14 Acellular cardiac patches made of decellularized epicardium have also contributed to post-MI heart function recovery in a rat MI model. 15 Our previous in vitro studies have demonstrated the advantages of using decellularized porcine myocardium slice (dPMS) as a cardiac patch.…”

The clinical application potential of extracellular matrix in cardiac tissue engineering

“…1 In cardiovascular tissue engineering, the SIS-ECM patch has been investigated experimentally and clinically as an on-lay patch or an interposition graft to promote tissue reconstruction. [2][3][4][5][6] Polytetrafluoroethylene and polyester (Dacron) grafts conventionally have been used successfully for vascular and intraventricular repair (eg, surgical ventricular restoration). However, major concerns related to these synthetic grafts include reactive inflammation, calcification, infections, adhesions, and local stiffness over a long period.…”

“…These techniques could provide comprehensive assessment of in situ myocardial reconstruction, such as electrical conductivity. Ramos and colleagues 3 and Yanagawa and colleagues 4 have demonstrated the effects of a SIS-ECM patch for porcine left ventricular and human intraventricular repair, although a long-term investigation is still required. SIS-ECM coated with a gelatin hydrogel incorporating FGF-2, which was constructed by the same procedure as Tanaka and colleagues, also has been investigated in an abdominal wall defect rat model.…”