U. researcher looks to regenerate dead heart muscle

from KSL / Utah / Local Stories http://ift.tt/1OnrWbQ

SALT LAKE CITY — In Amit Patel’s lab, science resembles science fiction.

For decades, Patel and other researchers have tried to figure out how to regenerate dead heart muscle in patients who have had massive heart attacks.

"The doctors say, ‘We’ll give you the beta blocker and the aspirin and the Lipitor and we can just hope to maintain you,’" Patel said. "But short of them getting worse or getting a heart transplant, there’s not too many options."

Now he’s leading trials on an experimental technology that might be able to repair scarred heart tissue and freeze — or even reverse — heart failure.

The procedure, in Phase 1 FDA clinical trial, goes as follows:

  1. Mix the "extracellular matrix" powder — a mixture of proteins and molecules isolated from heart muscle — with saline or water.
  2. Inject the mixture into the patient’s dead heart muscle via catheter.
  3. Wait three to six months to see if the patient’s heart muscle regenerates.

If it sounds like a long shot, there’s a reason why Patel’s clinic is nicknamed the Optimus Clinic.

"Heart disease is the most common cause of death in the world, and the most prominent problem is heart failure," said Tim Henry, the director of cardiology at the Cedars-Sinai Heart Institute. "Effectively, it’s basically one of the biggest problems in the U.S."

But though it may sound like something out of "Frankenstein," Henry said the technology — inspired by stem cell research — is "within our reach."

"(Patel) is clearly one of the most experienced stem cell people in the country," Henry said.

Laura Seitz/Deseret News

Researchers have been bearing down on other avenues of research, like stem cell therapy and gene therapy, in a quest to stop the degeneration of heart function that happens after a massive heart attack.

Those are promising in many ways, but haven’t been much good at reviving completely dead scar tissue, said Patel.

He said endocardial matrix therapy would likely also be cheaper than either stem cells or gene therapy because it’s an off-the-shelf product that can be widely produced and delivered in an easy clinical procedure.

But what exactly is "extracellular matrix" if it’s not stem cells?

Every organ has its own unique matrix, Patel explained. It’s everything but the cells — the elixir of nutritious proteins, minerals and other molecules that physically provide a scaffold for the cells, nerves and vessels to attach.

"A heart without scaffolding is just a bag of cells," said Patel.

The matrix also contains important molecules that signal cells to grow and develop.

Just like in the movies, the matrix is the entire environment within which the cells live and grow.

But, Patel said, "This matrix came first."

The powder form of this matrix was developed by researchers at the University of California, San Diego. They found a way to remove heart muscle from pigs, wash away all of the cells and turn the resulting proteins into a powder. Patel and his team have also developed a version made from human heart muscle.


This first patient was able to be done awake and safe and she’s already back to work. She went home the next day.

–Amit Patel


Hydrogels like VentriGel are flexible like natural tissue and are used in tissue engineering to mimic the molecular environment that cells are used to.

VentriGel has already been shown to successfully reduce scar tissue in rats and pigs. The next step is for the technology to pass human trials — and that’s where Patel’s lab comes in.

For the procedure, Patel recruited a Utah woman who had a heart attack six months ago that reduced her overall heart blood pumping ability from 60 percent — which is considered normal — to less than 45 percent.

Patel’s team made a virtual model of the inside of the patient’s heart to figure out where her dead heart muscle was located, marked 18 injection sites, then used a catheter to inject the matrix into her heart.

The procedure took less than two hours.

"This first patient was able to be done awake and safe and she’s already back to work," Patel said. "She went home the next day."

Eighteen patients will eventually undergo the experimental procedure.

Doctors at Minneapolis Heart Institute in Minnesota, the only other site approved to test the new technology, performed the procedure on a second patient on Tuesday.

The risks are known: By injecting directly into the muscle, the surgeon could interrupt the electricity of the heart and cause irregular heartbeats. The matrix could travel to other parts of the body. It could clot and lead to stroke. The patient’s blood vessels could collapse.

"If you go through all the bad things that could happen, you’d be so depressed, you’d be like, ‘Really? You found somebody to go through this?’" Patel said. "The key is that the team that we have here, and also many of my collaborators, we’re all at that same level of healthy enthusiasm mixed with extreme paranoia."

The patients will be examined three and six months out for evidence of muscle regrowth and revived heart function.

"We want to treat this before it ends up leading to permanent damage," Patel said.

The trial, if it returns positive results, will be another step forward in a long journey to eradicate heart disease.

If everything goes well, Patel estimates the technology could become approved for clinical use within five to seven years.


Daphne Chen is a reporter for the Deseret News and KSL.com. Contact her at dchen@deseretnews.com.

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