Institution of localized high-frequency electrical stimulation targeting early myocardial infarction: Effects on left ventricle function and geometry

Engineering functional electroconductive hydrogels for targeted therapy in myocardial infarction repair

Myocardial infarction (MI) is characterized by a paucity of cardiomyocyte regeneration, leading to significant morbidity and mortality. Contemporary therapeutic modalities, while mitigating ischemic effects, fail to reconstitute the impaired electromechanical coupling within the infracted myocardium. Emerging evidence supports the utility of electroconductive hydrogels (ECHs) in facilitating post-MI cardiac function recovery by restoring the conductive microenvironment of the infarcted tissue. This comprehensive review delineates the taxonomy of ECHs predicated on their constituent conductive materials. It also encapsulates prevailing research trends in ECH-mediated MI repair, encompassing innovative design paradigms and microenvironment-sensitive strategies. The review also provides a critical appraisal of various implantation techniques, underscored by a thorough examination of the attendant considerations. It elucidates the mechanistic underpinnings by which hydrogels exert salutary effects on myocardial repair, namely by augmenting mechanical and electrical integrity, exerting anti-inflammatory actions, fostering angiogenesis, and curtailing adverse remodeling processes. Furthermore, the review engages with the pressing challenge of optimizing ECH functionality to achieve superior reparative outcomes post-MI. The discourse concludes with an anticipatory perspective on the evolution of ECH scaffolds, advocating for a tailored approach that integrates multifaceted physicochemical properties to cater to the nuances of personalized medicine.

Electrically Active Biomaterials for Stimulation and Regeneration in Tissue Engineering

In the human body, bioelectric cues are crucial for tissue stimulation and regeneration. Electrical stimulation (ES) significantly enhances the regeneration of nerves, bones, cardiovascular tissues, and wounds. However, the use of conventional devices with stimulating metal electrodes is invasive and requires external batteries. Consequently, electrically active materials with excellent biocompatibility have attracted attention for their applications in stimulation and regeneration in tissue engineering. To fully exploit the potential of these materials, biocompatibility, operating mechanisms, electrical properties, and even biodegradability should be carefully considered. In this review, we categorize various electrically active biomaterials based on their mechanisms for generating electrical cues, such as piezoelectric effect, triboelectric effect, and others. We also summarize the key material properties, including electrical characteristics and biodegradability, and describe their applications in tissue stimulation and regeneration for nerves, musculoskeletal tissues, and cardiovascular tissues. The electrically active biomaterials hold great potential for advancing the field of tissue engineering and their demonstrated success underscores the importance of continued research in this field.

Large Animal Models of Cell-Free Cardiac Regeneration

The adult mammalian heart lacks the ability to sufficiently regenerate itself, leading to the progressive deterioration of function and heart failure after ischemic injuries such as myocardial infarction. Thus far, cell-based therapies have delivered unsatisfactory results, prompting the search for cell-free alternatives that can induce the heart to repair itself through cardiomyocyte proliferation, angiogenesis, and advantageous remodeling. Large animal models are an invaluable step toward translating basic research into clinical applications. In this review, we give an overview of the state-of-the-art in cell-free cardiac regeneration therapies that have been tested in large animal models, mainly pigs. Cell-free cardiac regeneration therapies involve stem cell secretome- and extracellular vesicles (including exosomes)-induced cardiac repair, RNA-based therapies, mainly regarding microRNAs, but also modified mRNA (modRNA) as well as other molecules including growth factors and extracellular matrix components. Various methods for the delivery of regenerative substances are used, including adenoviral vectors (AAVs), microencapsulation, and microparticles. Physical stimulation methods and direct cardiac reprogramming approaches are also discussed.

Interstitial changes after reperfused myocardial infarction in swine: morphometric and genetic analysis

Background

Following myocardial infarction (MI), we aimed to characterize morphometric and genetic changes in extracellular matrix (ECM) components from ischemia onset until late phases after coronary reperfusion in necrotic and salvaged myocardium.

Results

Swine were divided into one control (n = 5) and three MI groups: 90-min of ischemia without reperfusion, or followed by 1-week or 1-month reperfusion (n = 5 per group). In samples from the necrotic and salvaged areas, ECM components were morphometrically quantified and mRNA levels of factors involved in ECM remodeling were evaluated. After 90-min of ischemia, fibronectin, laminin, and elastic fibers content as well as upregulated mRNA expression of tissue inhibitors of metalloproteinases (TIMP)1, TIMP2, TIMP3 and connective tissue growth factor increased in the necrotic and salvaged myocardium. In both reperfused MI groups, collagen-I, collagen-III, elastic fibers, glycosaminoglycans, laminin, and fibronectin levels heightened in the necrotic but not the salvaged myocardium. Moreover, mRNA expression of TIMP1, TIMP2 and TIMP3, as well as metalloproteinase-2 and metalloproteinase-9 heightened in the necrotic but not in the salvaged myocardium.

Conclusions

Matrix remodeling starts after ischemia onset in both necrotic and salvaged myocardium. Even if ECM composition from the salvaged myocardium was altered after severe ischemia, ECM makes a full recovery to normal composition after reperfusion. Therefore, rapid coronary reperfusion is essential not only to save cardiomyocytes but also to preserve matrix, thus avoiding impaired left ventricular remodeling.