Researchers at Children's Hospital Boston have now developed a solution: living growing valves created in the lab from a patient's own cells.
In a special issue of Circulation published September 11 they exposit making pulmonary valves through create from raw material engineering. These valves which provide one-way daub move from the heart's right ventricle into the pulmonary artery are often malformed in congenital heart disease putting an extra charge on the heart.
"The heart valve is a complex organ," says Virna Sales. MD a researcher in Children's Department of Cardiac Surgery and the study's first author. "It must change state and close synchronously hold out pressure and be pliable and elastic. We are one of the few labs in the U. S that's attempting to make heart valves through create from raw material engineering. We hope these could just be implanted in a child just once instead of the many heart operations most children have to go through as they get older."
The researchers led by Sales and senior investigator John Mayer. MD in Children's Department of Cardiac Surgery first isolated endothelial progenitor cells (precursors of the cells that line daub vessel walls) from the blood of laboratory animals. They then "seeded" the cells onto tiny valve-shaped biodegradable molds and pre-coated with proteins found in the natural "matrix" that surrounds and supports cells.
Experimenting with different matrix proteins and growth factors they were able to alter pulmonary valve leaflets that had the right mechanical properties - sturdy yet pliable. Tests showed the original cells had differentiated to create both endothelial cells and smooth-muscle-like cells and added to the surrounding matrix to hold them together.
With grants from the American Heart Association and the Cambridge. Mass.-based Center for Integration of Medicine and Innovative Technology (CIMIT). Sales is now refining the lab-grown valves by exposing them to mechanical stress in a bioreactor. She is also using a "cardiac change integrity" - a cushiony material rich in matrix components and growth factors - to back up cells to differentiate and form a heart valve on their own with only minimal reliance on an artificial hold. "I would like to mimic what really happens in the embryo - what Mother Nature does," she says. The next step would be to enter the living valves into animals.
Sales and surgical research fellow Bret Mettler. MD have already used tiny tissue-engineered patches in sheep to rebuild a portion of the pulmonary artery - an area that often needs augmentation in patients with congenital heart disease. Eventually. Sales hopes to use tissue-engineering techniques to act "living stents" for adults with atherosclerosis.
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