Arrive early. The sooner the symptoms begin to reach the hospital for treatment of ischemia, with consequent initiation of treatments, the less damage the heart attack will be. This is the first rule to preserve the heart muscle, since the myocardial cells, once dead from lack of oxygen, cannot be replaced, leaving a scar in their place. At least for now it is like that. But research is trying in every way to restore breath and above all life to myocardiocytes, since in this way they could alleviate the chronic damage of oxygen deficiency to the heart. The path is still in its infancy but, at least in an experimental key, different ways are being developed to try to remedy the natural process of death without the possibility of replacing heart cells.
How to deal with heart failure: prevention and treatments
by Federico Mereta
In this sense, the international research coordinated by scholars of the University of Bologna goes, which has focused attention on some steroid hormones, glucocorticoids. The study, which appeared on Nature Cardiovascular Research, identifies among the various factors that prevent the cellular regeneration of the myocardium also these hormones that have a role in the process of maturation and development of myocardiocytes. In practice, according to the survey, glucocorticoids after birth would push the muscle cells of the heart to mature, at the same time blocking their proliferation. Glucocorticoids are hormones that come into play when we have to manage stress, but they play other important roles, including that of promoting the development of the organism and in particular lung maturation.
The ability to regenerate after a heart attack
By analyzing the heart tissue the scholars led by Gabriele D’Uva have seen that also in heart tissue the glucocorticoid receptor increases quantitatively, with its possible role in the maturation of myocardial cells and consequent negative action in regeneration in adulthood. On the animal it has been shown that if this receptor, called GR is eliminated, the differentiation of cardiac muscle cells is limited and therefore the clock that guides them is “set back”, keeping them in a state of immaturity and thus enabling them to reproduce. , if necessary, after a heart attack. In short, as D’Uva explains, “the deletion of the glucocorticoid receptor has been shown to increase the ability of heart muscle cells to replicate following myocardial infarction, promoting a process of heart regeneration within a few weeks” .
Heart door
So we reprogrammed the part of the heart that was damaged by the heart attack
by Federico Mereta
Among the ways of the future for the treatment of heart attack damage, then, there could be the use of RNA-messenger, which has come to the fore for vaccines for Covid-19 but has already been under the magnifying glass of experts for some time. for the therapy of various pathologies. To propose this hypothesis is a study by experts from the University of Houston, led by Robert Schwartz, Hugh Roy and Lillie Cranz Cullenwho published a report on Journal of Cardiovascular Aging. In this case, mRNA becomes a sort of guided “informer” for the growth of stem cells, thanks to the action of two specific mutated transcription factors, called Stemin and YAP5SA. These two invisible “regulators” together favor the replication of the animal’s myocardial cells and now we are trying to “turn back” the clock of the heart cells to return them to a state more similar to that of stem cells and therefore be able to give them the ability to transform into heart cells when needed. At the moment, research is limited to the very early stages of the laboratory.
The role of white blood cells
Another area in great ferment is that which studies the possible actions of the immune system on the processes of cardiac regeneration. In this case the attention is focused in particular on cells that can have a double action, particular white blood cells called macrophages. To signal its importance is a research published on Journal of Clinical Investigation, conducted by scholars from the Ann & Robert H. Lurie Children’s Hospital of Chicago and the Feinberg Cardiovascular Research Institute at Northwestern University. According to the study, macrophages have a double action, which occurs immediately after the heart attack.
Bad and good macrophages
On the one hand they play a role of “scavengers” that clean the organ from dead myocardial tissue, on the other hand, however, they favor the release of a growth factor for the vessels called VEGFC which triggers the formation of new lymphatic vessels and promotes healing. The idea of the scholars is to be able to limit the action of the “bad” macrophages to the advantage of the good ones and thus make the macrophages themselves specialize even more in the production of VEGFC, with the possibility of accelerating the processes of heart repair. Ultimately, the goal is to preserve a larger portion of myocardium by reducing the risk of future heart failure.
Heart door
Thus we will protect the hearts of people with diabetes after a heart attack
by Federico Mereta
Finally, we always work for an increasingly targeted use of stem cells. In this sense, a Mayo Clinic study coordinated by Andre Terzic appeared some time ago on NPJ Regenerative Medicine, shows that treatment with cardiopoietic stem cells could completely reverse the lesion in mice and thus restore tone and vigor to the area affected by the infarct lesion. The research was conducted in mice and showed that the treatment was able to bring heart tissue back, at least in part, to how it was before the severe ischemic crisis. These cells are currently also being studied in humans.
The patch that releases stem cells
To prevent heart failure following a particularly extensive infarction in the future, one could also focus on a “patch” intended to release stem cells to be applied to the heart in correspondence with the lesion, already tested with satisfactory results on the rabbit. Research on this technique was coordinated by Sian Harding of Imperial College London. British scientists have shown that the treatment is safe in rabbits and that, above all, over time the stem cells are able to transform into myocardial units capable of contracting, vicarious the function of those who have suffered from lack of oxygen and nourishment until they die. The patch measures three by two centimeters and contains over 50 million human stem cells, which are programmed to become myocardial cells that can contract. And let’s not forget that we also work for the “reconstruction” of the supporting tissue of the heart, always with a view to limiting the damage of the heart attack over time. Just think in this sense of the therapeutic method studied at the Monzino Cardiology Center called “Cardiac Pro-angiogenic Cell Plus – CPCPlus”. It all starts with the discovery of CD90 negative baptized heart cells. It is a subtype of stromal cells of the human heart, that is the scaffold cells of the heart, which have a particular ability to induce neo-vascularization. A way was found to isolate, select and inject them into the heart affected by ischemia to very effectively stimulate the creation of new vessels (therapeutic angiogenesis) within the myocardial tissue. In practice, a new blood microcirculation is created in the heart, as an alternative to the damaged and out of use one of the patient.