When a heart attack occurs, the area of the heart affected by ischemia dies. The larger this area is, the more damage can be created. Arriving early with treatment, reopening the blood flow, means being able to limit the risks, with an impact both on the size of the lesion and on the potential for subsequent recovery. But there is a reality that is currently incontrovertible: the specialized muscle cells of the heart, myocardiocytes, once dead cannot be replaced in the adult, contrary to what happens in the fetus. In fact, inside the uterus, if the fetus suffers heart damage, the problem can be corrected thanks to the self-regeneration capacity of the stem cells. But after birth, myocardiocytes lose their ability to regenerate. Starting from the observation of what happens in intrauterine life, a group of researchers from German and Canadian centers has proposed a technique to make the cells of the heart once again “children” which, as demonstrated by what was published in Science (first author Yanpu Chen) offered encouraging results in mice even if there are question marks on the real applicability of the technique.
Heart door
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The challenge to scars starts from the studies of the Nobel Prize Shinya Yamanaka, who discovered “stem-like” cells, pluripotent units that can also be identified in the adult organism and that could transform themselves in the different tissues of the body, allowing the regeneration of parts altered by the disease. Scientists have managed to “rejuvenate” the muscle cells of the heart, thus making them similar to those of the fetus, through the use of specific factors “Yamanaka c-Myc, Klf4, Sox2 and Oct4”, regulating their function through a long-standing antibiotic , which acts as a switch, doxycycline. In the experimentation, mice with reprogrammed cells were administered doxycycline immediately before and immediately after heart damage, and it was seen that a recovery in cellular terms was obtained which also translated into an improvement in the contractile function of the heart.
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Unfortunately, if doxycycline is instead administered a few days later the impact is not the same. A lot of study still needs to be done, also because the risk of developing tumors related to the treatment could emerge, but this strategy could in the future try to counter the possible outcomes of heart attack, such as heart failure. As emerged during a conference organized by Novartis and sponsored by the Health City Institute, heart failure is now the leading cause of hospitalization in people over 65 and records high mortality rates. In Italy it affects about 1 million Italians over 40, with a cost of around 3 billion a year, equal to over 11,800 euros of average expenditure for the management of a single patient. Pending the development of research to rejuvenate heart cells, therefore, it is necessary above all to focus on prevention and healthy habits, as well as on health organization, to address the decompensation that can follow heart attack or even other risk conditions, such as ‘hypertension.
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“Certainly heart failure is a very complex pathology both because in many cases it is diagnosed late, and because it is characterized by comorbidities and the simultaneous presence of other chronic diseases, with the consequent need for constant assistance to follow its evolution and avoid emergency or acute phase situations, such as hospitalization – he explains Maria Rosaria Di Somma, Director of the Italian Compensated Association (Aisc). A complexity in the management of the pathology even more emphasized by the pandemic situation in the course of which the patient lost his hospital and territorial references. But precisely the pandemic has made it possible to identify the best path to follow through, the implementation of an interdisciplinary and integrated pathology management model in which all those who take care of the patient can communicate in a circular manner, also making use of systems of digitization “. In short, the future has already begun, albeit with current treatment strategies. “It is urgent, in the short term, that full awareness of the need to structure a care response for the management of complex and chronic patients, such as those suffering from heart failure, matures – he specifies Pasquale Perrone Filardi, president-elect of the Italian Society of Cardiology (Sic) – starting from personalized paths of taking charge of the patient through the identification and stratification of risk, the definition of referral references to the specialist or to the territory, a new method of follow- up and the introduction of remote monitoring. It is also necessary to work to ensure that everyone has more equal access to care and innovation ”.
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