November 17th, 2013

Remaking the Heart: Stem Cells, Patches, Scaffolds, and More

Several Cardiology Fellows who are attending AHA.13 in Dallas this week are blogging for CardioExchange. The Fellows include Vimal RamjeeSiqin YeSeth MartinReva Balakrishnan, and  Saurav Chatterjee. You can find the previous post here. For more of our AHA.13 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our AHA.13 Headquarters.

Day 2 of AHA Sessions continues to maintain a high bar, with a number of talks on cutting-edge science. Having had a good dose of young investigator talks yesterday, I decided to focus on basic-translational lectures in the realm of regenerative cardiovascular biology this morning.

Drs. Jonathan Epstein, Eric Olson, Piero Anversa, James Willerson, and Joseph Hill gave really great lectures on regenerative cardiovascular biology. Collectively, they covered a number of exciting advances in the field with potential forthcoming therapies falling into broad categories: reprogramming fibroblasts into functional cardiomyocytes, development of a prosthetic heart built from a decellularized heart scaffold, insertion of a reparative “bio-patch,” augmentation of endogenous stem cell regenerative potential, and peri-infarct administration of stem cells. It is clear that a vast amount of groundwork still needs to be done in all of these areas.

It seems to me that the most elegant system – and perhaps the one closest to clinical application (by concept) – is direct reprogramming of fibroblasts into functional, healthy cardiomyocytes. This system bypasses the limitations intrinsic to foreign material insertion and cell delivery, both of which are problematic in a number of ways. For this reason, harnessing the regenerative potential of endogenous cardiac stem cells (or epicardial-derived progenitors, for that matter) are a close runner-up to reprogramming fibroblasts in my opinion.

Do you think that one modality may be better than the others? It would be great to hear everyone’s thoughts.

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