Taylor Doris A, Elgalad Abdelmotagaly, Sampaio Luiz C
Department of Regenerative Medicine Research.
Cullen Cardiovascular Surgery Research Department, Texas Heart Institute, Houston, Texas, USA.
Curr Opin Organ Transplant. 2018 Dec;23(6):664-672. doi: 10.1097/MOT.0000000000000583.
Heart transplantation is the only curative treatment option for end-stage heart failure. However, a shortage of donor organs is a major limitation of this approach. Regenerative medicine targets the goal of increasing the number of available hearts for transplantation. In this review, we highlight the state of the art of building a bioartificial heart. We summarize the components needed, the hurdles, and likely translational steps to make the dream of transplanting a totally functional bioartificial heart a possibility.
The therapies being developed in regenerative medicine aim not only to repair, but also to regenerate or replace failing tissues and organs. The engineering of bioartificial hearts utilizing patient-derived cells could theoretically solve the two main complications of heart transplantations: graft rejection and lifelong immunosuppression. Although many hurdles remain, scientists have reached a point in which some of these hurdles have been overcome. Decellularized heart scaffolds have emerged over the past decade as one of the most promising biofabrications. Two possible options for organ scaffolds exist: nontransplantable human hearts and porcine hearts. The use of these scaffolds could lead to the availability of an unlimited number of transplantable organs. The current challenge remains improving processes required for recellularization - including those for cells, bioreactors, and physiologic conditioning. Researchers should focus to solve these hurdles and pave the way toward the dream of in-vivo bioengineered heart maturation.
Regenerative medicine has emerged as one of the most promising fields of translational research and has the potential to both minimize the need for donor organs and increase their availability. Meeting the challenge of implanting a totally functional bioengineered heart lies in solving multiple issues simultaneously. Dwarfing the technical hurdles, cost is the largest barrier to success. The scientific hurdles mainly involve scaling up and scaling out of laboratory cell processes, building bioreactors, and delivering cells into every needed region of an organ scaffold. Maintaining sterility and quantifying readiness of the nascent organs are also critical for success.
心脏移植是终末期心力衰竭唯一的治愈性治疗选择。然而，供体器官短缺是这种方法的主要限制。再生医学的目标是增加可用于移植的心脏数量。在本综述中，我们重点介绍构建生物人工心脏的最新技术水平。我们总结了所需的组件、障碍以及可能的转化步骤，以使移植完全功能性生物人工心脏的梦想成为可能。
再生医学中正在开发的疗法不仅旨在修复，还旨在再生或替换衰竭的组织和器官。利用患者来源的细胞构建生物人工心脏理论上可以解决心脏移植的两个主要并发症：移植物排斥和终身免疫抑制。尽管仍有许多障碍，但科学家们已经达到了一些障碍已被克服的阶段。在过去十年中，去细胞心脏支架已成为最有前途的生物制造技术之一。器官支架有两种可能的选择：不可移植的人类心脏和猪心脏。使用这些支架可能会导致有无限数量的可移植器官。当前的挑战仍然是改进再细胞化所需的过程，包括细胞、生物反应器和生理调节方面的过程。研究人员应专注于解决这些障碍，为体内生物工程心脏成熟的梦想铺平道路。
再生医学已成为转化研究最有前途的领域之一，有可能既能减少对供体器官的需求，又能增加其可用性。实现植入完全功能性生物工程心脏的挑战在于同时解决多个问题。与技术障碍相比，成本是成功的最大障碍。科学障碍主要涉及扩大实验室细胞过程的规模、构建生物反应器以及将细胞输送到器官支架的每个所需区域。保持无菌状态和量化新生器官的准备情况对于成功也至关重要。
