Every so often I come across a research paper that leaves me feeling as if I am glimpsing the future. I had that experience when I came across the work of Cingolani and colleagues in the Dec. 23 issue of the Journal of the American College of Cardiology (volume 64, no. 24). The paper, entitled “Engineered electrical conduction tract restores conduction in complete heart block: from in vitro to in vivo proof of concept,” details a new approach to an old problem.
Here's the problem. Many people develop serious disturbances of the heart rhythm based on deterioration or destruction of specialized “conduction tissue” within the heart. This tissue is responsible for transmitting the electrical impulses that govern the beating of the heart. In the case of the dysfunction of conduction tissue between the atria and ventricles, the chambers become electrically and mechanically dissociated, a condition termed complete heart block, and generally treated with an implanted pacemaker.
Here's the new approach. The investigators created new, living conduction tissue, the rough equivalent of biological wires, which they termed “engineered electrical conduction tracts” or EECTs. They were able to show that these EECTs could create new functional connections between two separated groups of cultured heart cells. That was pretty slick. They were also able to “affix” these EECTs onto the hearts of rats, demonstrate that the EECTs had established a genuine electrical connection between the atria and ventricles, and then demonstrate that atrio-ventricular conduction was maintained when the native conduction system was poisoned. That was very slick.
The authors were careful to label their work a “proof of concept” and not an imminent cure for complete heart block or other conduction diseases. However, they ended their paper with this:
“The present approach is highly generalizable, offering a novel platform to engineer biocompatible materials for relaying electrical signals. A similar approach could be used, in principle, to bridge interrupted neural circuits in stroke, nerve, or spinal cord injuries.”
That last bit really captured my imagination. It also reminded me of the famously understated ending to Watson and Crick's paper describing, for the first time, the double-helix structure of DNA: “It has not escaped our notice that the specific pairing [of nucleotide bases] we have postulated immediately suggests a possible copying mechanism for the genetic material.”
I think this could have legs. What do you think?
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.