Developments in Extracellular Matrix-Based Angiogenesis Therapy for Ischemic Heart Disease: A Review of Current Strategies, Methodologies and Future Directions

Figure 1. This figure highlights the roles of the different components of the ECM in regulating cardiac angiogenesis. The image depicts pro-angiogenic factors, such as VEGF, PIGF, FGF, Periostin, NRG1 and OPN, as well as anti-angiogenic factors like TSP, Endostatin, TNC, and SPARC. TGF-β has context-dependent effects on cardiac angiogenesis, acting as a promoter or inhibitor depending on the environment. Created in BioRender.com 9 February 2025.

Figure 2. This diagram illustrates the decellularization process and its relevance to tissue engineering. The application of decellularization agents such as SDS effectively removes cellular components. The next step is the isolation of ECM components, where emphasis is placed on the importance of preserving the ECM structure. Following this, the removal of immunogenic elements is carried out to reduce the risk of immune rejection. Finally, great care is taken to preserve the native biomolecules that are crucial for maintaining homeostasis and supporting angiogenesis. Created in BioRender.com.

Figure 3. This diagram highlights advanced tissue engineering techniques aimed at regenerating damaged cardiac tissue to restore its functionality. (A) 3D hydrogels with their porous structure that support cellular incorporation and how the scaffold can be precisely injected into targeted areas are shown. (B) Bioprinting, particularly the fabrication of cardiac patches using bioink and 3D printing technology, along with the key components involved. (C) Finally, spatial patterning is shown, emphasizing how electrospinning is used to deposit ECM proteins onto a nanofibrous scaffold designed to replicate the natural ECM architecture. Created in BioRender.com.