Urinary bladder matrix patches yielded significantly more alpha-smooth muscle actin-positive cells than ePTFE patches at 1 month (22.2% vs 8.4%, P=0.04) and trended toward myocardial replacement.
Does a urinary bladder-derived extracellular matrix scaffold improve myocardial repair compared to ePTFE in a porcine model of left ventricular infarction?
In a porcine model of LV infarction, a urinary bladder-derived extracellular matrix scaffold promoted the formation of vascularized fibrocellular tissue with contractile cells, appearing superior to synthetic ePTFE.
Absolute Event Rate: 22.2% vs 8.4%
p-value: p=0.04
BACKGROUND: Heart failure remains a significant problem. Tissue-engineered cardiac patches offer potential to treat severe heart failure. We studied an extracellular matrix scaffold for repairing the infarcted left ventricle. METHODS AND RESULTS: Pigs (n=42) underwent left ventricular (LV) infarction. At 6 to 8 weeks, either 4-layer multilaminate urinary bladder-derived extracellular matrix or expanded polytetrafluoroethlyene (ePTFE) was implanted as full-thickness LV wall patch replacement. At 1-week, 1-month, or 3-month intervals, pigs were terminated. After macroscopic examination, samples of tissue were prepared for histology, immunocytochemistry, and analysis of cell proportions by flow cytometry. One-week and 1-month patches were intact with thrombus and inflammation; at 1 month, there was also tissue with spindle-shaped cells in proteoglycan-rich and collagenous matrix. More alpha-smooth muscle actin-positive cells were present in urinary bladder matrix (UBM) than in ePTFE (22.2+/-3.3% versus 8.4+/-2.7%; P=0.04). At 3 months, UBM was bioresorbed, and a collagen-rich vascularized tissue with numerous myofibroblasts was present. Isolated regions of alpha-sarcomeric actin-positive, intensely alpha-smooth muscle actin-immunopositive, and striated cells were observed. ePTFE at 3 months had foreign-body response with necrosis and calcification. Flow cytometry showed similarities of cells from UBM to normal myocardium, whereas ePTFE had limited cardiomyocyte markers. CONCLUSIONS: Appearance of a fibrocellular tissue that included contractile cells accompanied biodegradation of UBM when implanted as an LV-free wall infarction patch. UBM appears superior to synthetic material for cardiac patching and trends toward myocardial replacement at 3 months.
Robinson et al. (Tue,) conducted a other in Left ventricular infarction (n=42). Urinary bladder-derived extracellular matrix (UBM) vs. Expanded polytetrafluoroethlyene (ePTFE) was evaluated on Proportion of alpha-smooth muscle actin-positive cells at 1 month (p=0.04). Urinary bladder matrix patches yielded significantly more alpha-smooth muscle actin-positive cells than ePTFE patches at 1 month (22.2% vs 8.4%, P=0.04) and trended toward myocardial replacement.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: