Marbán Eduardo, Cho Hee Cheol
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Cardiol. 2008 Jan;23(1):46-54. doi: 10.1097/HCO.0b013e3282f30416.
Cardiac rhythm disorders are caused by malfunctions of impulse generation or conduction. Malfunctions of impulse generation, that is, defects in pacemaking, are often life-threatening. Present therapies span a wide array of approaches, but remain largely palliative. Recent progress in understanding of the underlying biology of pacemaking opens up new prospects for better alternatives to the present routine. Specifically, development and use of biological pacemakers could prove to be advantageous to the conventional approaches.
We review the current state of the art in gene and cell-based approaches to correct cardiac rhythm disturbances. These include genetic suppression of an ionic current, embryonic as well as adult stem cell therapies, novel synthetic pacemaker channels, and adult somatic cell-fusion approach.
Biological pacemaking can be achieved by modulating ionic currents by gene transfer or by delivering engineered pacemaker cells into normally quiescent myocardium. The present state of development is proof-of-concept; we are now working on reducing to practice a stable, reliable biological product as an alternative to electronic pacemakers.
心律失常是由冲动产生或传导功能障碍引起的。冲动产生功能障碍，即起搏缺陷，往往危及生命。目前的治疗方法多种多样，但大多仍为姑息性治疗。对起搏基础生物学的最新认识进展为替代当前常规治疗方法的更好选择开辟了新前景。具体而言，生物起搏器的开发和应用可能证明比传统方法更具优势。
我们综述了基于基因和细胞的纠正心律失常方法的当前技术水平。这些方法包括对离子电流的基因抑制、胚胎及成体干细胞治疗、新型合成起搏通道以及成体体细胞融合方法。
生物起搏可通过基因转移调节离子电流或通过将工程化起搏细胞导入正常静止心肌来实现。目前的发展状况处于概念验证阶段；我们现在正致力于将一种稳定、可靠的生物产品付诸实践，以替代电子起搏器。
