Biomaterials, Drug Delivery and Nanotechnology Unit, Centre for Biomedical and Biomaterials Research, University of Mauritius, Réduit, Mauritius.
Biomater Sci. 2022 Mar 29;10(7):1626-1646. doi: 10.1039/d1bm01641e.
Following myocardial infarction (MI) and the natural healing process, the cardiac mechanostructure changes significantly leading to reduced contractile ability and resulting in additional pressure on the heart muscle thereby increasing the risk of heart failure (HF). The application of cardiac scaffolds in the form of epicardial patches or injectable hydrogels at the infarcted region of the myocardium helps to mechanically reinforce the ventricular walls and allows control over the various stages of the healing process, reducing pathological remodeling and fibrosis and eventually restoring cardiac function. Recent progress in the field of biomaterials engineering allows tuning of cardiac scaffold properties for more effective tissue-biomaterial interaction leading to improved therapeutic outcomes. Nanoscaffold characteristics required for myocardial tissue engineering (TE) including mechanical property, pore size/porosity, immunomodulation, bioactivity, electroconductivity, injectability (for hydrogels) and thickness (for cardiac patches) are herewith reviewed. Strategies for controlling each of these properties blending, scaffold fabrication, degree of crosslinking, and incorporation of bioactive molecules, amongst others are also discussed. The mechanism of myocardial restoration enhanced angiogenesis, stem cell homing and mechanical support is further detailed. Finally, key novel innovative strategies with high promise for clinical translation are presented; in particular, the use of extracellular vesicle-loaded scaffolds, integration of electronics within scaffolds for real time monitoring of the engineered tissue performance as well as the possibility of refilling scaffolds with drugs/cells/proteins a subcutaneous port are highlighted.
心肌梗死后（MI）和自然愈合过程中，心脏力学结构发生显著变化，导致收缩能力降低，从而对心肌造成额外压力，增加心力衰竭（HF）的风险。在心梗区域应用心脏支架（如心外膜贴片或可注射水凝胶）有助于机械增强心室壁，并可控制愈合过程的各个阶段，减少病理性重塑和纤维化，最终恢复心脏功能。生物材料工程领域的最新进展允许调整心脏支架的特性，以实现更有效的组织-生物材料相互作用，从而改善治疗效果。本文回顾了用于心肌组织工程（TE）的纳米支架特性，包括机械性能、孔径/孔隙率、免疫调节、生物活性、导电性、可注射性（水凝胶）和厚度（心外膜贴片）。还讨论了控制这些特性的策略，包括混合、支架制造、交联程度和生物活性分子的掺入等。进一步详细阐述了心肌修复的机制，包括增强血管生成、干细胞归巢和机械支持。最后，提出了具有高临床转化前景的关键新颖创新策略，特别是使用负载细胞外囊泡的支架、在支架中集成电子设备以实时监测工程组织性能以及通过皮下端口用药物/细胞/蛋白质填充支架的可能性。
