Biomaterial applications in cardiovascular tissue repair and regeneration

Department of Surgery, Division of Plastic and Reconstructive Surgery, Hagey Pediatric Regenerative Research Laboratory, Stanford University School of Medicine, CA, USA.
Expert Review of Cardiovascular Therapy 08/2012; 10(8):1039-49. DOI: 10.1586/erc.12.99
Source: PubMed


Cardiovascular disease physically damages the heart, resulting in loss of cardiac function. Medications can help alleviate symptoms, but it is more beneficial to treat the root cause by repairing injured tissues, which gives patients better outcomes. Besides heart transplants, cardiac surgeons use a variety of methods for repairing different areas of the heart such as the ventricular septal wall and valves. A multitude of biomaterials are used in the repair and replacement of impaired heart tissues. These biomaterials fall into two main categories: synthetic and natural. Synthetic materials used in cardiovascular applications include polymers and metals. Natural materials are derived from biological sources such as human donor or harvested animal tissues. A new class of composite materials has emerged to take advantage of the benefits of the strengths and minimize the weaknesses of both synthetic and natural materials. This article reviews the current and prospective applications of biomaterials in cardiovascular therapies.

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Available from: Joseph C Wu, Feb 13, 2015
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    • "In the future, tissue engineering is expected to provide enduring and non-immunogenic heart valves, possibly able to grow and remodel as the age of the patient advances [29] [30]. In a traditional tissue engineering approach, a fundamental requirement for heart valve engineering is a three dimensional scaffold with appropriate mechanical properties which is seeded with appropriate cell types [31]. Examples of decellularized grafts include aortic homografts [32] and porcine valves and pericardium [33]. "
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    ABSTRACT: Cardiovascular disease (CVD) is one of the leading causes of death in the Western world. The replacement of damaged vessels and valves has been practiced since the 1950's. Synthetic grafts, usually made of bio-inert materials, are long-lasting and mechanically relevant, but fail when it comes to "biointegration". Decellularized matrices, instead, can be considered biological grafts capable of stimulating in vivo migration and proliferation of endothelial cells (ECs), recruitment and differentiation of mural cells, finally, culminating in the formation of a biointegrated tissue. Decellularization protocols employ osmotic shock, ionic and non-ionic detergents, proteolitic digestions and DNase/RNase treatments; most of them effectively eliminate the cellular component, but show limitations in preserving the native structure of the extracellular matrix (ECM). In this review, we examine the current state of the art relative to decellularization techniques and biological performance of decellularized heart, valves and big vessels. Furthermore, we focus on the relevance of ECM components, native and resulting from decellularization, in mediating in vivo host response and determining repair and regeneration, as opposed to graft corruption.
    Full-text · Article · Mar 2014 · American Journal of Stem Cells
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    • "A number of strategies have been proposed for enhancing transplanted cell survival and engraftment, including genetic manipulation of stem cells, precondition strategy, as well as the injectable cardiac tissue engineering strategies (the use of an injectable hydrogel to deliver stem cells into myocardium) [2e4]. Among them, injectable biomaterials, such as alginate, fibrin, collagen, matrigel, chitosan, have shown increasing potential as a strategy to support the stem cell therapy and enhance their efficacy for treating cardiac disease, owing to their biocompatibility, ability to provide beneficial chemical environments and for their potential to be delivered noninvasively [5]. "
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    ABSTRACT: The ability to restore heart function by replacement of diseased myocardium is one of the great challenges in biomaterials and regenerative medicine. Brown adipose derived stem cells (BADSCs) present a new source of cardiomyocytes to regenerate the myocardium after infarction. In this study, we explored an injectable tissue engineering strategy to repair damaged myocardium, in which chitosan hydrogels were investigated as a carrier for BADSCs. In vitro, the effect and mechanism of chitosan components on the cardiac differentiation of BADSCs were investigated. In vivo, BADSCs carrying double-fusion reporter gene (firefly luciferase and monomeric red fluorescent protein (fluc-mRFP)) were transplanted into infarcted rat hearts with or without chitosan hydrogel. Multi-techniques were used to assess the effects of treatments. We observed that chitosan components significantly enhanced cardiac differentiation of BADSCs, which was assessed by percentages of cTnT(+) cells and expression of cardiac-specific markers, including GATA-4, Nkx2.5, Myl7, Myh6, cTnI, and Cacna1a. Treatment with collagen synthesis inhibitors, cis-4-hydroxy-d-proline (CIS), significantly inhibited the chitosan-enhanced cardiac differentiation, indicating that the enhanced collagen synthesis by chitosan accounts for its promotive role in cardiac differentiation of BADSCs. Longitudinal in vivo bioluminescence imaging and histological staining revealed that chitosan enhanced the survival of engrafted BADSCs and significantly increased the differentiation rate of BADSCs into cardiomyocytes in vivo. Furthermore, BADSCs delivered by chitosan hydrogel prevented adverse matrix remodeling, increased angiogenesis, and preserved heart function. These results suggested that the injectable cardiac tissue engineering based on chitosan hydrogel and BADSCs is a useful strategy for myocardium regeneration.
    Full-text · Article · Feb 2014 · Biomaterials
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    • "Since the cell niche provides crucial support [19e21], tissue-engineered scaffolds, resembling the characteristics of the native tissue, may be a feasible therapeutic approach. In fact biomaterials have been increasingly used in targeting heart repair [22] [23], as they can provide a proper platform for stem cell survival, proliferation and differentiation, as well as a guide for threedimensional (3-D) tissue reconstruction [24]. Proper myocardium regeneration and function may be largely dependent on the properties of the scaffolds. "
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    ABSTRACT: Despite the enormous progress in the treatment of coronary artery diseases, they remain the most common cause of heart failure in the Western countries. New translational therapeutic approaches explore cardiomyogenic differentiation of various types of stem cells in combination with tissue-engineered scaffolds. In this study we fabricated PHBHV/gelatin constructs mimicking myocardial structural properties. Chemical structure and molecular interaction between material components induced specific properties to the substrate in terms of hydrophilicity degree, porosity and mechanical characteristics. Viability and proliferation assays demonstrated that these constructs allow adhesion and growth of mesenchymal stem cells (MSCs) and cardiac resident non myocytic cells (NMCs). Immunofluorescence analysis demonstrated that stem cells cultured on these constructs adopt a distribution mimicking the three-dimensional cell alignment of myocardium. qPCR and immunofluorescence analyses showed the ability of this construct to direct initial MSC and NMC lineage specification towards cardiomyogenesis: both MSCs and NMCs showed the expression of the cardiac transcription factor GATA-4, fundamental for early cardiac commitment. Moreover NMCs also acquired the expression of the cardiac transcription factors Nkx2.5 and TBX5 and produced sarcomeric proteins. This work may represent a new approach to induce both resident and non-resident stem cells to cardiac commitment in a 3-D structure, without using additional stimuli.
    Full-text · Article · Oct 2013 · Biomaterials
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