The Current Status of Engineering Myocardial Tissue

Abstract

Myocardial infarction (MI) remains a common fatal disease all over the world. The adult cardiac myocytes regenerative capability is very limited after infarct injury. Heart transplantation would be the best therapeutic option currently but is restricted due to the lack of donor organs and the serious side effects of immune suppression. The emerging of tissue engineering has evolved to provide solutions to tissue repair and replacement. Engineering myocardial tissue is considered to be a new therapeutic approach to repair infarcted myocardium and ameliorate cardiac function after MI. Engineering myocardial tissue is the combination of biodegradable scaffolds with viable cells and has made much progress in the experimental phase. However, the largest challenge of this field is the revascularization of the engineering constructs to provide oxygen and nutrients for cells. This review will give an overview on the current evolution of engineering myocardial tissue and address a new method to improve the vascularization of myocardium tissue in vivo.

Treatment of Myocardial Infarction by Stem Cell Based Therapy

“…In this method the cells are delivered directly to infracted region by advancing a single or double balloon catheter 35 through coronary sinus . This method is already used during cardiac surgery as a prophylactic treatment against iatrogenic 36,37 myocardial ischemia . It shows a safe profile in human subject.…”

Hydrogels for cardiac tissue engineering

“…So far, a wide range of different cell sources have been utilized in engineering cardiac tissues. 6,9 For instance, primary cardiomyocytes, 3 8,67 and mesenchymal stem cells (MSCs) 3,8,9 have been used in efforts to regenerate the damaged myocardium. Because of the limited access to primary cardiomyocytes and their minimal capability for expansion in vitro, alternative cell sources were used as mentioned above.…”

“…6,7 Direct injection of cells into the cardiac muscle has been used as a method of delivering cells into the infarcted tissue. 4,5,8,9 In vivo, this approach has been shown to achieve some success in regaining muscle function after MI. 10,11 However, B90% of the injected cells die after implantation, demonstrating the importance of vasculature and appropriate tissue microarchitecture for cardiac tissue regeneration.…”

“…10,11 However, B90% of the injected cells die after implantation, demonstrating the importance of vasculature and appropriate tissue microarchitecture for cardiac tissue regeneration. 2,8 In particular, environmental stress associated with the lack of a three dimensional (3D) flexible biomimetic microenvironment and direct exposure of single cells to oxygen tension, free radicals and inflammatory cytokines induce cell death. 10 Therefore, there is a significant need for engineered biomaterials that can be used as 3D matrices to efficiently deliver cells to the damaged cardiac muscle and facilitate myocardial regeneration.…”

Myocardial Self-Repair and Congenital Heart Disease

“…For example, integration of the graft into the existing myocardium so that it provides clinically significant augmented force development has been problematic. Additionally, achieving sufficient revascularization of the grafts to sustain viability has been difficult; see review by Sui (Sui et al, 2011). Although the potential utility of such grafts in congenital heart disease is not expectedly large, marked progress in this approach could conceivably provide alternative therapies for patients with failing Fontan circulations or possibly for those with cardiomyopathies.…”