Majid Qasim A, Fricker Annabelle T R, Gregory David A, Davidenko Natalia, Hernandez Cruz Olivia, Jabbour Richard J, Owen Thomas J, Basnett Pooja, Lukasiewicz Barbara, Stevens Molly, Best Serena, Cameron Ruth, Sinha Sanjay, Harding Sian E, Roy Ipsita
Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Department of Material Science and Engineering, Faculty of Engineering, University of Sheffield, Sheffield, United Kingdom.
Front Cardiovasc Med. 2020 Oct 23;7:554597. doi: 10.3389/fcvm.2020.554597. eCollection 2020.
Cardiovascular diseases (CVD) constitute a major fraction of the current major global diseases and lead to about 30% of the deaths, i.e., 17.9 million deaths per year. CVD include coronary artery disease (CAD), myocardial infarction (MI), arrhythmias, heart failure, heart valve diseases, congenital heart disease, and cardiomyopathy. Cardiac Tissue Engineering (CTE) aims to address these conditions, the overall goal being the efficient regeneration of diseased cardiac tissue using an ideal combination of biomaterials and cells. Various cells have thus far been utilized in pre-clinical studies for CTE. These include adult stem cell populations (mesenchymal stem cells) and pluripotent stem cells (including autologous human induced pluripotent stem cells or allogenic human embryonic stem cells) with the latter undergoing differentiation to form functional cardiac cells. The ideal biomaterial for cardiac tissue engineering needs to have suitable material properties with the ability to support efficient attachment, growth, and differentiation of the cardiac cells, leading to the formation of functional cardiac tissue. In this review, we have focused on the use of biomaterials of natural origin for CTE. Natural biomaterials are generally known to be highly biocompatible and in addition are sustainable in nature. We have focused on those that have been widely explored in CTE and describe the original work and the current state of art. These include fibrinogen (in the context of Engineered Heart Tissue, EHT), collagen, alginate, silk, and Polyhydroxyalkanoates (PHAs). Amongst these, fibrinogen, collagen, alginate, and silk are isolated from natural sources whereas PHAs are produced via bacterial fermentation. Overall, these biomaterials have proven to be highly promising, displaying robust biocompatibility and, when combined with cells, an ability to enhance post-MI cardiac function in pre-clinical models. As such, CTE has great potential for future clinical solutions and hence can lead to a considerable reduction in mortality rates due to CVD.
心血管疾病（CVD）是当前全球主要疾病的重要组成部分，导致约30%的死亡，即每年1790万人死亡。心血管疾病包括冠状动脉疾病（CAD）、心肌梗死（MI）、心律失常、心力衰竭、心脏瓣膜疾病、先天性心脏病和心肌病。心脏组织工程（CTE）旨在解决这些病症，总体目标是使用生物材料和细胞的理想组合有效再生患病的心脏组织。迄今为止，各种细胞已被用于CTE的临床前研究。这些细胞包括成体干细胞群体（间充质干细胞）和多能干细胞（包括自体人诱导多能干细胞或异体人胚胎干细胞），后者会经历分化以形成功能性心脏细胞。用于心脏组织工程的理想生物材料需要具有合适的材料特性，能够支持心脏细胞的有效附着、生长和分化，从而形成功能性心脏组织。在本综述中，我们重点关注天然来源生物材料在CTE中的应用。天然生物材料通常具有高度的生物相容性，而且在自然界中是可持续的。我们重点关注了那些在CTE中得到广泛探索的材料，并描述了其原始研究工作和当前的技术水平。这些材料包括纤维蛋白原（在工程心脏组织，即EHT的背景下）、胶原蛋白、藻酸盐、丝绸和聚羟基脂肪酸酯（PHA）。其中，纤维蛋白原、胶原蛋白、藻酸盐和丝绸是从天然来源分离得到的，而PHA是通过细菌发酵生产的。总体而言，这些生物材料已被证明具有很大的前景，表现出强大的生物相容性，并且在与细胞结合时，能够在临床前模型中增强心肌梗死后的心脏功能。因此，CTE在未来临床解决方案方面具有巨大潜力，从而可以显著降低心血管疾病导致的死亡率。
