Cardiac Tissue Engineering

Cardiac tissue engineering is emerging as a promising approach to replace or support the failing heart [89]. The implantation of cells, native tissues, or in-vitro-reconstituted tissue constructs has been employed for more than a decade, and might provide an effective therapy for patients with end-stage heart disease.

Cardiac tissue engineering has been motivated by the need to create functional tissue equivalents for scientific studies and cardiac tissue repair. The ideal cardiac tissue constructs should faithfully replicate the functional and morphological properties of native heart muscle, and also remain viable after implantation. Mechanical, electrical, and functional integration into the organ architecture should result in improved systolic and diastolic function of the diseased myocardium. Thus, constructs should be: (1) contractile; (2) electrophysiological^ stable; (3) mechanically robust and flexible; (4) vascularized after implantation; and (5) autologous [90]. As with the other cell-based models discussed in this chapter, high-fidelity in-vitro cardiac constructs would also be invaluable as model systems in the early stages of cardiac drug discovery and development.

For clinical applications, cardiac tissue engineering/regenerative medicine can be divided into two categories: (1) the direct implantation of isolated cells [91]; and (2) the implantation of in-vitro-engineered tissue constructs [92, 93]. In the case of the former category, most studies indicate that cell implantation in animal models of myocardial infarction can improve contractile function [94]. Indeed, several clinical studies are currently under way to investigate the safety and feasibility of cell implantation in patients [95]. For the latter category, cardiac tissue engineering involves the construction of cardiac tissue equivalents from donor cells, such as myocytes or stem cells, which are first seeded onto/into 3D engineered scaffolds. The constructs are then cultured and mechanically/electrically preconditioned in vitro prior to implantation into the diseased heart for reparative purposes.

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