A Review article published on November 20 in Trends in Molecular Medicine highlights the promise and limitations of new methods based on stem cell and reprogramming technologies to generate biological pacemakers that might one day replace electronic pacemakers.
To create biological pacemakers, one approach is to coax stem cells to become specialized cardiac pacemaker cells that are normally found within the sinoatrial node of the heart.
Researchers need to better understand the mechanisms controlling the development and maintenance of pacemaker cells in the sinoatrial node, just as they must develop ways to compare experimental biological pacemaker tissue with bona fide sinoatrial node tissue.
“Biological pacemakers must meet a very high standard of performance to supplant electronic pacemakers,” Vedantham says.
Cardiologists at the Cedars-Sinai Heart Institute have developed a minimally invasive gene transplant procedure that changes unspecialized heart cells into “biological pacemaker” cells that keep the heart steadily beating.
The laboratory animal research, published online and in today’s print edition of the peer-reviewed journal Science Translational Medicine, is the result of a dozen years of research with the goal of developing biological treatments for patients with heart rhythm disorders who currently are treated with surgically implanted pacemakers. In the United States, an estimated 300,000 patients receive pacemakers every year.
“We have been able, for the first time, to create a biological pacemaker using minimally invasive methods and to show that the biological pacemaker supports the demands of daily life,” said Eduardo Marbán, MD, PhD, director of the Cedars-Sinai Heart Institute, who led the research team. “We also are the first to reprogram a heart cell in a living animal in order to effectively cure a disease.”