From heart transplants to implantable devices, BHF-funded science has helped to develop innovations that once seems like science fiction. Heres a preview of what the future of medicine might bring next.
Around one in every 200 newborn babies has a heart problem that needs surgery or another procedure. Professor John Simpson and his team at Evelina London Childrens Hospital and Kings College London are using a BHF grant to work on a virtual reality technology to improve these procedures.
He explains: We look at detailed scan images of an individuals heart in order to decide what is the right procedure, at the right time, with the minimum risk.
In the last couple of decades, weve gone from 2D to 3D images. But youre still looking at them on a flat screen. Even 3D printed models of hearts are not perfect you have to break it to see the structures inside. Also, the 3D models show the heart at one moment in time. But the living heart is dynamic; it beats, and the valves open and close.
With his teams new technology, information from heart scans routinely taken in hospitals can be turned into a virtual, beating heart. With the headset on, and joystick in your hand, the virtual heart is right in front of you. You can zoom in and out, see it from every angle and look inside, says Dr Natasha Stephenson, Professor Simpsons fellow researcher.
In a previous study, surgeons used the technology to review operations that had already taken place. They found that, compared to traditional 3D imaging, it gave them a better understanding of the patients heart and would have helped them better plan the surgeries. Now the team are working towards testing this technology to plan real procedures, which they hope to do in the next two years.
This technology allows surgeons to understand what theyll actually face in the operation, says Professor Simpson. You can put a virtual device into the virtual heart and see which will be the best device. Or even share the imaging with companies that can make bespoke devices to fit the individuals heart. We hope this will mean better repairs, fewer complications, shorter hospital stays and better long-term outcomes.
These virtual reality images can also be used to show patients what the issues are with their heart, or used to train doctors.
While Professor Simpsons focus is on congenital heart diseases, he says, In the long term, this technology could also help better visualise the problems of adults with other types of heart disease.
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After a heart attack, some heart muscle cells can die off, which can lead to heart failure. Dr Nicola Smart is trying to answer questions that might one day help us to help hearts regrow themselves.
From studies in mice, we know a couple of days after birth, the heart can fully regenerate. A week after birth, it loses that ability, explains Dr Smart.
To repair itself, the heart needs to grow new blood vessels, as well as new muscle. In adults, there is some growth of blood vessels, but it happens slowly and inefficiently.
She and her team at the University of Oxford are studying how different types of cells in different parts of the heart send signals to each other, helping the heart to grow new blood vessels. Through a technique called single-cell RNA-sequencing, she is seeing which of the genes involved in this process are switched off (not expressed) in adults.
Single-cell RNA-sequencing has completely changed our level of understanding. It used to be that we could only look at overall gene expression changes in a heart. That could tell you nothing about how different cells were responding to a heart attack. Now we see which genes are being expressed in each cell, we know even the same types of cells will respond differently in different parts of the heart.
Dr Smart says were just at the start of understanding how this new knowledge might lead to treatments in future. Regrowing heart muscle and blood vessels is only one part. Other teams are looking at how to limit scarring and how to work with the immune system, which also influences the hearts ability to regenerate. But if we can bring together all these ideas, we could develop a combination therapy to stimulate the heart to regenerate, and that could prevent more people developing heart failure.
Scarring is part of the bodys healing process. But it can cause problems. After a heart attack, too much scarring can stop the heart working well and cause heart failure.
MRI scansare currently used to look at scars that have already formed in peoples hearts. Now BHF-funded research is developing a cutting-edge technique so doctors can track scarring as it happens.
Professor Marc Dweck and his team at the University of Edinburgh are using PET scanning, a type of very detailed scan that can show how your bodys cells are working. Were using a new tracer a special chemical, which attaches to cells that cause scarring. The tracer sends a signal that we can detect on the scan.
Right now, we dont have a clear idea of when scarring occurs following a heart attack. In people who develop heart failure, do they have too much scarring activity or is it that scarring doesnt turn off at the right time?
His team will try to find the answers by studying people whove recently had heart attacks, as well as people who have old scarring from previous heart attacks, and healthy people.
Understanding how scarring develops may help us predict who will make a good recovery after a heart attack and who will need more treatment to prevent heart failure, explains Professor Dweck. Were talking precision medicine: with better scanning, we can tailor the right treatment to the right patient.
Pulmonary arterial hypertension (PAH) is a rare but serious condition, which causes high blood pressure in the arteries of the lungs. It can lead to heart failure and can sometimes be fatal. Currently there is no cure. BHF-funded researcher Alex Ainscough, at Imperial College London, is developing a new way to look for treatments.
He's created a pulmonary artery on a chip, in which the innermost layers of the artery walls are recreated inside a silicone rubber microchip just 1mm wide (the same size as the small arteries that are first affected in PAH).
In traditional research, you look at one type of cell, but in our bodies different cell types interact with each other, explains Dr Ainscough. We are trying to make it as representative of the human body as possible.
By running liquid through the chip, he can mimic the flow of blood in the body, which has a big impact on the cells. He explains: When you grow cells in a petri dish for research, its like theyre in the calm of a lake; but in the body, they are being subjected to forces like a fast-flowing stream.
He created a model of a diseased artery by using stem cells from people with PAH to create a pulmonary artery on a chip, which led to him discovering a previously unknown way in which PAH develops.
As well as being used as an investigative tool to understand how PAH happens, the pulmonary artery on a chip is being used to try out potential treatments. Dr Ainscough is working with a pharmaceutical company to test some of their existing drugs, as well as new drugs that are in development to treat PAH.
He predicts that in future, organ-on-a-chip models will help make treatments cheaper and quicker to develop. These models more closely match conditions in people compared to traditional petri dish research, so it will be faster to identify promising drugs before moving to clinical trials.
Theres also potential to use these for more personalised medicine. You could use stem cells from a particular person to create a microchip model to see how theyll react to a specific drug before giving it to them.
Most babies having surgery for heart defects will need repairs using additional materials such as patches, valves or tubes. These products are either made from animal tissue or synthetic material: they wont grow with the child and will become scar tissue and gradually deteriorate.
Massimo Caputo, BHF Professor of Congenital Heart Surgery at the University of Bristol, explains: This means a child might need surgery weeks after theyre born, again after a year or two, then after another five years, and carry on having repeated surgeries all their lives.
Each surgery can cause more scarring, which can cause problems like heart failureor abnormal heart rhythms. Theres also the mental stress of going through these operations. For years, patients and parents have said to me, Why cant we have a valve that lasts forever?
Thanks to one of our research grants, Professor Caputo is developing a kind of living tissue, made partly from stem cells, that will grow with the child. Hes currently in the process of securing regulatory approval and the first tests in patients should start in two to three years.
This living tissue could reduce the need for multiple surgeries, in adults as well as children. If you have a valve replacement from animal tissue, this will wear down and you will need to replace it after 10 years. Even if youre in your 50s or 60s, that could mean multiple surgeries. The tissue Im working on could be applied to adult surgery too, says Professor Caputo.
Another benefit is that this tissue could be less likely to be rejected by the body: A patients own stem cells could be used to produce the tissue, so that the immune system recognises it and doesnt reject it.
Published 10 June 2022
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From sci-fi to reality: a peek into the future of medicine - British Heart Foundation