Intra-myocardial biomaterial injection therapy in the treatment of heart failure: Materials, outcomes and challenges

Abstract

Heart failure initiated by coronary artery disease and myocardial infarction (MI) is a widespread, debilitating condition for which there are a limited number of options to prevent disease progression. Intramyocardial biomaterial injection following MI theoretically provides a means to reduce the stresses experienced by the infarcted ventricular wall, which may alter the pathological remodeling process in a positive manner. Furthermore, biomaterial injection provides an opportunity to concurrently introduce cellular components and depots of bioactive agents. Biologically-derived, synthetic and hybrid materials have been applied, as well as designed expressly for this purpose, although optimal design parameters, including degradation rate and profile, injectability, elastic modulus, and various possible bioactivities largely remain to be elucidated. This review seeks to summarize the current body of growing literature where biomaterial injection, with and without concurrent pharmaceutical or cellular delivery, has been pursued to improve functional outcomes following MI. The literature to date generally demonstrates acute functional benefits associated with biomaterial injection therapy across a broad variety of animal models and material compositions. Further functional improvements have been reported when cellular or pharmaceutical agents have been incorporated into the delivery system. Despite these encouraging early results, the specific mechanisms behind the observed functional improvements remain to be fully explored and future studies employing hypothesis-driven material design and selection may increase the potential for this approach to alleviate the morbidity and mortality of heart failure.

Injectable Acellular Hydrogels for Cardiac Repair

“…These techniques are advantageous as they could potentially translate to catheter delivery for minimally invasive, percutaneous therapies. Hydrogels are finding application in cardiac therapy alone as a means for thickening and stabilizing the myocardium via tissue bulking, as well as for the delivery of a wide variety of therapies, such as cells and growth factors [39,40]. This review will specifically focus on the application of hydrogels for (1) tissue bulking and (2) molecule delivery approaches that may translate quickly to the clinic since difficulties related to finding an adequate cell source for transplantation are eliminated.…”

Preparation and characterization of acellular porcinepericardium for cardiovascular surgery

“…There are two main categories of materials that have been clinically used in cardiovascular patching applications, involving engineered tissues and synthetic materials. Composite grafts provide numerous benefits, including strength and durability (Venkatraman et al, 2008;Nelson et al, 2011) but carry risks of infection, thrombogenicity, calcification, and foreign body reaction as the well-known limitations (Kannan et al, 2005;Lam and Wu, 2012). The other potential choice for cardiovascular operations is xenogeneic tissues.…”

pH-Sensitive Chitosan Hydrogel with Instant Gelation for Myocardial Regeneration

“…and the peaks at 3179 cm -1 pertaining to O-H stretching and N-H stretching of chitosan [32]. FTIR spectra of WH hydrogel showed bands at 517, 643, 851 and 1093 cm -1 that are attributed to bending and symmetric stretching of PO 4 3-and P-O [40] in the used buffer. It should be noted that peaks at 643 and 1093 cm -1 were respectively connected to C-H and C-O stretching of chitosan as well, but it is difficult to differentiate them because of overlapping with the bands of phosphate groups.…”

“…The ideal remedial method is heart transplantation that faces the crisis of donor shortage and recipients' rejections [4,5]. Hence, new cell-based therapy methods have emerged such as cell injection along with buffered saline or culture media into myocardium to regenerate the heart tissue [6].…”