6 Emerging Cardiology Solutions in Late-Stage Research at Georgia Tech and Emory University

  • Researcher Vahid Serpooshan sets up a medical 3D printer that will print a patch engineered to strengthen heart muscle damaged in a heart attack. Photo credit: Rob Felt, Georgia Tech

    "[The heart is] an amazing electromechanical pump that keeps on going in some people for 60, 70, or 80 years without needing a single repair. I can’t think of any human-made device, be it a valve, a pump, or anything, that can do that without breaking down,” said Ajit Yoganathan, a regents professor at the Georgia Institute of Technology (Georgia Tech) and a cardiology researcher for more than 40 years. “Obviously, though, in some cases, things do go wrong with the heart, but like any living system, it has self-repair mechanisms. It can rebuild itself after a heart attack."

    And of course, there are times when doctors must intervene to keep the heart functioning. Translational researchers at Georgia Tech and Emory University in Atlanta, GA are engineering methods to detect and fix damage from heart disease and structural heart problems.

    The researchers caution that none of the solutions presented here are currently available for patients. They are in preclinical and clinical trials or other human test phases, and if they succeed, it could be years before they are available to patients.

    But even if these developments never make it to market, the underlying research is readily accessible and can inspire the improvement of existing or future therapies to save more patients’ lives, noted Ben Brumfield, senior science writer for Georgia Tech's Research Horizons magazine in a recent feature article, "Mending a Broken Heart."

    The following is a brief snapshot of each of the research projects detailed in the Research Horizons article.

  • Researcher Vahid Serpooshan starts the 3D printer. The screen displays a model of the myocardial infarct patch. Photo credit: Rob Felt, Georgia Tech

    1. The Heart Attack Patch

    When someone has a heart attack, the myocardial infarction destroys blood vessels that feed damaged tissue, and it depletes the heart's epicardium of a regenerative protein called FSTL1. The protein then concentrates in the wrong places. Vahid Serpooshan, an assistant professor in the Coulter Department. 

    Serpooshan and colleagues have created an infarct repair patch when he was at Stanford University. He has furthered its development at Coulter's Emory location. The idea is to cover infarcted tissue with a collagen patch infused with the missing FSTL1. The patch is also designed to structurally shore up the weak myocardium. The patch is designed to be attached to the outside of the heart with a few stitches, and the protein time-releases into the scar tissue to encourage blood vessels to regrow, and new cardio muscle cells to form. The patch is also designed to emulate the soft texture of epicardium in an embryo.

    The researchers said the patch is primarily targeted to terminal patients who have no other viable treatment possibilities. Serpooshan said partners of the project are working in the United States and Europe to move the patch toward the market. He also noted that they are developing a minimally invasive procedure to apply the patch.

  • Researchers Phil Santangelo and Hee Cheol Cho in a preclinical trial angiocath procedure room at the Global Center of Medical Innovation in Atlanta. Photo credit: Allison Carter, Georgia Tech

    2. Replacing Pacemakers with an RNA Injection

    Other researchers at Georgia Tech and Emory are trying to recreate a biological pacemaker nearly identical to the heart's natural pacemaker nodes via a minimally invasive, cardiac catheter injection of messenger RNA. The mRNA derives from a regulatory gene, TBX18 which, during the embryonic phase, makes the pacemaker nodes we’re born with. Upon injection in the heart wall, the mRNA converts ordinary heart muscle cells into pacemaker cells, and then the mRNA biodegrades.

    “Cardiologists do plenty of injections in the heart already, and they place them very precisely, so the new pacemaker cells form in a good place,” said Phil Santangelo, an associate professor in the Coulter Department who led the synthesis of the mRNA.

    According to the researchers, the new, more natural pacemaker adjusts the heart rate to meet the body’s changing demands the way the original nodes do — something electronic pacemakers don’t do well.

  • Researchers Manu Platt and Michael Davis in a patient room at Children’s Healthcare of Atlanta. Photo credit: Allison Carter, Georgia Tech

    3. Stem Cell Injections for Baby Hearts

    Babies born without a left side of the heart have what’s called hypoplastic left heart syndrome.

    “If they don’t have surgery within a week, they’ll die,” said Michael Davis, an associate professor at the Coulter Department's Emory location. “They get three surgeries over the course of three years to re-route all their blood through their right heart because it’s the only ventricle they have.”

    That puts a lot more stress on that ventricle, and it can fail, Davis said.

    “If children survive, the condition can keep them from playing freely, or they can develop neurological deficits.”

    Advancing new treatments for these babies has been difficult because there are only a couple thousand patients a year, he noted.

    Davis' plan is to inject stem cells into pediatric patients' hearts in hopes that the cells will fortify the children's only ventricle and prevent heart failure until the children can get a heart transplant. His team is also developing a heart patch with stem cells that would treat adults who have had heart attacks, vastly increasing the therapy’s market value. That would make it more available for children, too. Georgia Tech’s Manu Platt, an associate professor in the Coulter Department, computationally determined the stem cells’ potential mechanisms, which is necessary for FDA approval.

  • Researchers Andres García and Rebecca Levit in García’s lab at Georgia Tech. Photo credit: Allison Carter, Georgia Tech

    4. Better Drug Delivery for Atrial Fibrillation

    The anti-fibrillation drug Amiodarone, in use since the 1980s, has proven the most effective therapy, but it is toxic to the liver, lungs, and thyroid.

    “Less than 1% of the drug goes to the heart when it’s given as a pill or infusion. The rest builds up in high concentrations in these off-target organs,” said Rebecca Levit, a physician and assistant professor of cardiology at Emory.

    Researchers have proposed a way to localize drug delivery by applying a hydrogel containing Amiodarone onto the outside of the fibrillating atrium.

    “We engineered a gel that sets to a patch on the target location,” said Andrés García, executive director of the Petit Institute for Bioengineering and Bioscience at Georgia Tech. “The material had to be soft so it wouldn’t cause friction when the heart beats.”

    García collaborates with Levit, who developed a minimally invasive delivery method to apply the gel.

    “We implant the hydrogel just inside the sheath that encircles the heart called the pericardium,” Levit said.

    The procedure takes less than an hour, uses a local anesthetic, and only requires a small hole in the chest and pericardium to insert a catheter through. Once inside, the catheter’s tip forms a circle that lies flat on the atrium.

    “The gel injects into the middle of the circle,” Levit said. “The pericardium drapes over the top of it to enclose the gel. You withdraw the catheter and close the chest puncture with a Band-Aid.”

    Almost none of the Amiodarone becomes systemic, according to the researchers.

  • A researcher at Georgia Tech demonstrates the positioning of the wearable seismocardiograhy. Photo credit: Rob Felt, Georgia Tech

    5. A Wearable to Detect 'Tiny Earthquakes' in the Chest

    Georgia Tech researchers are developing a wearable “seismocardiography” device designed to monitor heart vibrations to help doctors advise patients on dosing their heart meds. “Seismo” refers to what the device detects.

    “It’s like measuring a tiny earthquake in your chest,” said Omer Inan, an associate professor in Georgia Tech's School of Electrical and Computer Engineering. “Vibrations sent out by the heart beating and blood pulsating have a waveform that subtly moves the chest wall.”

    Wearing the patch, a patient does a six-minute walking task guided by a smartphone app. The GPS and accelerometer in the phone collect data that gets paired with data from the wearable seismo, which additionally records an EKG (ECG). If the combined data from the walking task indicates that the patient’s condition has declined, then the doctor may adjust medication dosage over the phone, preventing a hospital stay.

  • Research team members Jingting Yao (left), Pamela Bhatti, and Srini Tridandapani (right) place ECG electrodes and an accelerometer on the chest of a person positioned in a CT scanner. Photo credit: Rob Felt, Georgia Tech

    6. A Cheaper Alternative to a Coronary Angiogram

    CT scans provide a cheaper, faster, and less invasive alternative to a coronary angiogram, but there is a drawback. The heart is always in motion and by the time a technologist can snap a good CT image of the coronary arteries, the scanner can expose the patient to three times as much radiation as an angiogram.

    The proposed solution is a device that could detect the split second when the heart is motionless, between beats, while a patient is lying in a CT scanner. The device is intended to measure the vibrations of valves opening and closing, according to Pamela Bhatti, an associate professor in Georgia Tech's School of Electrical and Computer Engineering.

    “We can detect the moment several milliseconds ahead of time,” Bhatti said. “That lead time gives the technologist an edge.”

    The researchers note that angiograms are still the best diagnostic tool, but seismo-CT could bring CAD diagnostics to those for whom the cost is prohibitive.

    For more information about any of the technology research mentioned in this slideshow, see Georgia Tech's Research Horizons article, "Mending a Broken Heart."

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