Biomaterials and heart recovery: cardiac repair, regeneration and healing in the MCS era: a state of the “heart”

Abstract

Regenerative medicine is an emerging interdisciplinary field of scientific research that, supported by tissue engineering is, nowadays, a valuable and reliable solution dealing with the actual organs shortage and the unresolved limits of biological or prosthetic materials used in repair and replacement of diseased or damaged human tissues and organs. Due to the improvements in design and materials, and to the changing of clinical features of patients treated for valvular heart disease the distance between the ideal valve and the available prostheses has been shortened. We will then deal with the developing of new tools aiming at replacing or repair cardiac tissues that still represent an unmet clinical need for the surgeons and indeed for their patients. In the effort of improving treatment for the cardiovascular disease (CVD), scientists struggle with the lack of self-regenerative capacities of finally differentiated cardiovascular tissues. In this context, using several converging technological approaches, regenerative medicine moves beyond traditional transplantation and replacement therapies and can restore tissue impaired function. It may also play an essential role in surgery daily routine, leading to produce devices such as injectable hydrogels, cardiac patches, bioresorbable stents and vascular grafts made by increasingly sophisticated biomaterial scaffolds; tailored devices promptly fabricated according to surgeon necessity and patient anatomy and pathology will hopefully represent a daily activity in the next future. The employment of these devices, still far from the reproduction of functional organs, has the main aim to achieve a self-renewal process in damaged tissues simulating endogenous resident cell populations. In this field, the collaboration and cooperation between cardiothoracic surgeons and bioengineers appear necessary to modify these innovative devices employed in preclinical studies according to the surgeon's needs.

Self-Assembling Peptide EAK16 and RADA16 Nanofiber Scaffold Hydrogel

“…One of the most common applications is for hydrogel-based biomaterials in infarcted myocardia that comprises repeated injections in and around the injured area in order to alter the physiological remodeling of heart tissue to minimize scar tissue and subsequent dysfunction after infarct. 208 Historically, one of the first applications of SAPs in ischemic heart disease (IHD) came from a study by Davis et al 161 They tethered IGF-1 (insulin-like growth factor 1), a growth factor for cardiomyocytes, to RADA-II (AcN-(RARADADA) 2 -C-NH 2 ) via a biotin−streptavidin sandwich and achieved sustained release of IGF-1 in vivo for 28 days. By adding cardiomyocytes to the SAP injections, the myocyte cross-sectional area was increased by 25% and systolic function was improved in rats.…”

Role of Biomaterials in Cardiac Repair and Regeneration: Therapeutic Intervention for Myocardial Infarction

“…It can provide mechanical support to the infarcted fibrous scar tissue and can act as a cellular and/or biomolecule delivery system for the remodeling of scar tissue. 133 In a MI porcine model, autologous adipose tissue-derived MSCs were seeded into a collagen type I scaffold. This cellularized patch showed an increase in the left ventricular ejection fraction (LVEF) compared to the decellularized counterpart.…”

“…This ECM patch was found to increase the left ventricular wall stiffness and thickness, reduced wall stress, and chamber dilatation. 113,133 In the presence of the ECM, neovascularization in the endogenous tissue was achieved and simultaneously lowered inflammatory effects. 133 CorMatrix, a porcine-derived small intestine submucosa extracellular matrix (SIS-ECM) bioscaffold, has been shown to promote fibroblast growth factor-2 (FGF-2) dependent human umbilical vein endothelial cell (HUVEC) mediated angiogenesis and improved cardiac function in a rat MI model.…”

“…113,133 In the presence of the ECM, neovascularization in the endogenous tissue was achieved and simultaneously lowered inflammatory effects. 133 CorMatrix, a porcine-derived small intestine submucosa extracellular matrix (SIS-ECM) bioscaffold, has been shown to promote fibroblast growth factor-2 (FGF-2) dependent human umbilical vein endothelial cell (HUVEC) mediated angiogenesis and improved cardiac function in a rat MI model. 137,138 PhotoFix, a bovine-derived pericardium ECM (BP-ECM) bioscaffold, showed nonimmunogenic actions in vivo.…”

Antimicrobial Properties of Extracellular Matrix Scaffolds for Tissue Engineering

“…When the graft-based treatments are applied, there are many opportunistic bacteria that can grow at the surgery site due to the lack of asepsis, resulting in an unsuccessful treatment, surgical removal of the graft, and economic loss [12]. For this reason, a variety of materials have been developed for their use as biological substitutes, seeking to improve these drawbacks [13][14][15].…”