A study of artificial heart wearers has found that a subset of them can regenerate heart muscle tissue – the first time such an observation has been made.
This could open the door to new ways to treat and perhaps one day cure heart failure, the deadliest non-communicable disease on Earth. The results were published in the journal Circulation.
A team of physician-scientists from the University of Arizona Heart Center in Tucson led a collaboration of international experts to determine whether heart muscles can regenerate.
According to the Centers for Disease Control and Prevention, heart failure affects nearly 7 million American adults and is responsible for 14% of deaths annually. There is no cure for heart failure, although medications can slow its progression. The only treatment for advanced heart failure, other than a transplant, is replacing a pump with an artificial heart, called a left ventricular assist device, which can help the heart pump blood.
“Skeletal muscles have an important capacity to regenerate after injury. If you’re playing football and you tear a muscle, you have to rest it and it heals. said Hesham Sadek, director of the University’s Sarver Heart Center.
It was previously thought that when a heart muscle is injured, it could never grow back.
“Compelling evidence for heart muscle regeneration has never been demonstrated before in humans,” he said. “This study provided direct evidence.”
The project began with tissue from artificial heart patients provided by colleagues at the University of Utah Health College and School of Medicine, led by Stavros Drakos, MD, PhD, and pioneer of recovery mediated by a left ventricular assist device.
Swedish and German teams used their innovative method of carbon-14 dating of human heart tissue to determine whether these samples contained newly generated cells. Investigators found that patients with artificial hearts regenerate their muscle cells at a rate six times higher than healthy hearts.
“This is the strongest evidence we have so far that human heart muscle cells can actually regenerate, which is really exciting because it reinforces the idea that there is an intrinsic capacity of the human heart to regenerate,” Sadek said.
“It also strongly supports the hypothesis that the inability of the heart muscle to ‘rest’ is a major factor in the heart’s loss of ability to regenerate shortly after birth. It may be possible to target the molecular pathways involved in cell division to improve the heart’s ability to regenerate.
In 2011, Sadek published a paper in Science showing that although heart muscle cells actively divide in utero, they stop dividing shortly after birth to devote their energy to continually pumping blood around the body, without any pause.
In 2014, he published evidence of cell division in patients with artificial hearts, suggesting that their heart muscle cells might regenerate because they were able to rest.
These findings, combined with observations from other research teams that some artificial heart patients might have their devices removed after seeing a reversal of symptoms, led him to question whether the artificial heart provides the heart muscles with the equivalent of bed rest that a person needs to recover from heart disease. injury.
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“The pump pushes blood into the aorta, bypassing the heart,” he said. “The heart is essentially at rest.”
Sadek’s previous studies indicated that this rest might benefit heart muscle cells, but he needed to design an experiment to determine whether patients with artificial hearts actually regenerated their muscles.
Next, Sadek wants to understand why only about 25 percent of patients are “responders” to artificial hearts, meaning their heart muscle regenerates.
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“It is not clear why some patients respond and others do not, but it is very clear that those who respond have the ability to regenerate heart muscle,” he said. “What’s exciting now is figuring out how we can make sure that everyone can step up, because if you can, you can essentially cure heart failure.”
“The beauty of this is that a mechanical heart is not a therapy that we hope to offer to our patients in the future: these devices have proven themselves and we have been using them for years.
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