Ryan Darwish BME 35200 HW#1

The Heart: Exploration and Regeneration

Electrical systems are based on a series of connections, energy delivered from a central power source is diverted and sent to the appropriate locations within the system. Our heart and arterial/vein network function in a very similar way; our heart being the power source, and filter, then our arties and veins would be no more than connections to distribute the energy required by our bodies, oxygen. With no power supply there is no working system, even though the task seems straight forward, the cardiac system is one of the most complicated, possibly second to the neural network, in our bodies and there are many complications, some major and others minor that have chain effects that could affect our system. Heart disease is currently the number one killer for both men and women in the USA, over 35 heart defects related to heart disease have been identified and research is currently ongoing1. Due to tragic rise in cardiac related issues. Research on the cardiac muscles and tissues has greatly increased over the last decade. This however has proved to be a difficult task, a working heart requires a live test subject and biopsies only give us a part of the whole story. Technology has helped us overcome some of these barriers. Statistics related to the heart, gathered over the last few decades, inspired the creation of the Virtual Physiological Human 2(McFarlane et al., 2011), this 3D modelling software is used to create a virtual heart of any size or defect and allows the users to simulate the effects of stresses on the heart, such as increased arterial blockage or stitching and patching after an operation and examine the long term effects on the muscles or the post operation effects to the cardiac system when deciding what surgical methods to use. The exploration of 3D modelling quickly grew into an exciting, but also very challenging, new field, cardiac tissue engineering3 (Hecker & Birla, 2007). Bioengineering 3D organs in vitro, such as blood vessels, tri-leaflet valves and tissue engineered ventricles, which is then used for implantation may be the solution to many of the organ shortage issues and untreatable conditions in the USA. Functional tests which determine pressure, tensile, twitch force etc. along with biological characterization tests are usually done in vitro whereas in vivo testing is still done on small animals. Recent testing, done late last year, yielded ground breaking results in the field on cardiac tissue engineering, a fibrin hydrogel. This gel when implanted was able to fully support the cardiac cells of a rat test subject, the fibrin the breaks down as the cells continue to multiple and self-organize into tissue a couple of days later4(Hirt, Hansen, & Eschenhagen, 2014). This breakthrough proved that the creation of a bioengineered cardiac muscle could exactly mimic regular cardiac muscle physiology without the use of synthetic scaffolding products. The final hurdle and un-answered question in the growing cardiac tissue engineering field is: What cells to use? Since the human cardiac muscles and tissues are created using several different types of cells, as mentioned before human hearts are not readily available and non-

Ryan Darwish BME 35200 HW#1

embryonic stem cells have not yet yielded any results, attempting to graft muscle cells from other parts of the body have undergone clinical trials however the results were mixed.

References:
1.Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. (2013) Heart disease and stroke statistics2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6-e245. 2.McFarlane, N. J., Lin, X., Zhao, Y., Clapworthy, G. J., Dong, F., Redaelli, A., . . . Testi, D. (2011). Visualization and simulated surgery of the left ventricle in the virtual pathological heart of the Virtual Physiological Human. Interface Focus, 1(3), 374-383. doi: 10.1098/rsfs.2010.0040

3.Hecker, L., & Birla, R. K. (2007). Engineering the heart piece by piece: state of the art in cardiac tissue
engineering. Regen Med, 2(2), 125-144. doi: 10.2217/17460751.2.2.125 4.Hirt, M. N., Hansen, A., & Eschenhagen, T. (2014). Cardiac tissue engineering: state of the art. Circ Res, 114(2), 354-367. doi: 10.1161/CIRCRESAHA.114.300522