State-of-the-Art in Tissue-Engineered Heart Repair

Abstract

Heart muscle restoration with in vitro engineered tissue constructs is an exciting and rapidly advancing field. Feasibility, safety, and efficacy data have been obtained in animal models. First clinical trials are on the way to explore the therapeutic utility of cell-free and non-contractile cell-containing grafts. Engineering of contractile patches according to current good manufacturing practice (cGMP) for bona fide myocardial re-muscularization and scalability to address clinical demands remains challenging. Proof-of-concept for solutions to address obvious technical hurdles exists, and it can be anticipated that the first generation of clinically applicable engineered heart muscle (EHM) grafts will become available in the near future. Foreseeable, but likely manageable risks include arrhythmia induction and teratoma formation. Remaining biomedical challenges pertain to the requirement of immune suppression and the strategic approach to optimize immune suppression without subjecting the target patient population to an unacceptable risk. This chapter summarizes the current state of tissue-engineered heart repair with a special emphasis on knowledge gained from in vitro and in vivo studies as well as issues pertaining to transplant immunology and cGMP process development.