Ventricular wall biomaterial injection therapy after myocardial infarction: Advances in material design, mechanistic insight and early clinical experiences

Abstract

Intramyocardial biomaterial injection therapy for myocardial infarction has made significant progress since concept initiation more than 10 years ago. The interim successes and progress in the first 5 years have been extensively reviewed. During the last 5 years, two phase II clinical trials have reported their long term follow up results and many additional biomaterial candidates have reached preclinical and clinical testing. Also in recent years deeper investigations into the mechanisms behind the beneficial effects associated with biomaterial injection therapy have been pursued, and a variety of process and material parameters have been evaluated for their impact on therapeutic outcomes. This review explores the advances made in this biomaterial-centered approach to ischemic cardiomyopathy and discusses potential future research directions as this therapy seeks to positively impact patients suffering from one of the world’s most common sources of mortality.

Uncertainty in cardiac myofiber orientation and stiffnesses dominate the variability of left ventricle deformation response

“…One of the key goals of this paper is to quantify and evaluate the impact of uncertainty originating from the variability of the myofiber orientation field f; cf (4). As a statistical model for an input that addresses variability as function of space, it must be described by a random field variable.…”

“…There is currently a drive towards adapting these computational models to individual patient data, to aid in the creation of individualized diagnosis, clinical decision support, and treatment planning. [1][2][3][4][5][6][7] However, this model adaptation presents a number of challenges related to the lack of available data and the fact that measurable data, needed for patient-specific model input parameters, are inherently subject to measurement uncertainties or intrinsic biological variability. For clinical use of models, it is therefore of crucial importance to quantify how these uncertainties propagate through the computational model to impact the output quantities of interest.…”

Degradation properties of a biodegradable shape memory elastomer, poly(glycerol dodecanoate), for soft tissue repair

“…Composites of conventional thermoplastic polymers and hydrogels along with manufacturing innovation can tailor initial material stiffness to match surrounding tissues but often demonstrate unsatisfactory clinical outcomes [1][2][3][4]. When injected in vivo, hydrogels have been prone to migration and biodegradable polymers like PLGA, PLA and PCL predominantly undergo bulk degradation causing rapid changes in mechanical integrity during the degradation timeframe [5]. Biodegradable elastomers like polyglycerol sebacate(PGS) and poly-diol citrates have been increasingly studied for soft tissue repair applications [6][7][8][9].…”

Opinion on the recent development of injectable biomaterials for treating myocardial infarction

“…Also, several synthetic materials, such as polyethylene glycol (PEG) and thermoresponsive poly(N-isopropylacrylamide) (PNIPAAm), have been employed to construct the injectable biomaterials to treat MI. IK-5001 (1% sodium alginate plus 0.3% calcium gluconate) and Algisyl-LVR (a mixture of a Na + -alginate and a Ca 2+ -alginate) have been used in clinical *Corresponding author (email: wgliu@tju.edu.cn) trials, which exhibited conservative clinical results [2]. Recently, a hydrogel (VentriGel) derived from decellularized porcine myocardial tissue was shown to exhibit a promising result in treating porcine MI [3].…”

“…A longer remaining period may hinder repair process. It should be noted that there is still much debate as to the mechanical and degradation properties of injectable materials applied for MI, due to the large disparity between different research reports [2,5].…”