Decellularized Hearts, by James Fargnoli

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The transplant list for hearts in the US alone is over 3500 and growing. Even when a patient does receive a working donor heart, the risk of organ rejection is significant and the patient is condemned to immunosuppressant treatment for the rest of their lives. Allographic transplants of hearts recellularized with immune compatible cells offer to alleviate the risk of organ rejection. Ultimately, xenographic transplants of recellularized hearts could solve the organ shortage entirely.


Procedure

A recellularized heart undergoes a process of washing, which removes the cell contents while preserving the Extracellular matrix, often termed the scaffold structure. This consists of cartilage, laminin, and other structural proteins that are integral to the three-dimensional structure. The wash step is currently the most advanced section of the procedure and is typically carried out by one of two methods. Perfusion Decellularization is a method that pumps a detergent through the heart, degrading and washing away lipids, nucleic acids, soluble proteins, and sugars while retaining the structural components of the matrix. Immersion Decellularization is a method of submerging the cellularized heart into a detergent solution and allowing the solution to degrade and wash off lipids, nucleic acids, soluble proteins, and sugars, while retaining the structural components of the matrix.

Following the wash, the organ is verified to be acellular through a comnbination of PCR assays and histochemical stains. There is a trade-off between the thoroughness of the wash to eliminate cells and the integrity of the decellularized matrix. Upon confirmation, the decellularized heart is reseeded with progenitor cells of either the iPS or embryonic variety. In the heart, at least two types of progenitor cells are used, endothelial and muscle progenitors, respectively for the epithelial lining and cardiomyocyte production.

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