Conventional pacemakers have a finite battery life and hence need replacements which involves cost and discomfort of the surgical procedure. Genetically engineered pacemakers could be a possible alternative to implantable electronic devices for the treatment of bradyarrhythmias. The strategies for a biological pacemakers include: upregulation of beta receptors, conversion of myocytes into pacemaker cells and stem cell therapy. The unresolved issues are the longevity and safety of pacemaker genes. Potential for induction of arrhythmias have also to be considered .
Stem cell and reprogramming methods have been applied to develop putative pacemaker cells from non pacemaker cells . Recent discoveries in the molecular biology of sinus node has triggered research in this direction. Minimally invasive somatic reprogramming has been done in pigs with complete heart block . Adenoviral TBX18 gene transfer was used and pacemaker activity was detected from the intramyocardial injection site from day two and persisted throughout the duration of the two week study period, with minimal back electronic pacemaker use.
- Rajesh G, Francis J. Biological pacemakers. Indian Pacing Electrophysiol J. 2006 Jan 1;6(1):1-5.
- Vedantham V. New Approaches to Biological Pacemakers: Links to Sinoatrial Node Development. Trends Mol Med. 2015 Dec;21(12):749-761.
- Hu YF, Dawkins JF, Cho HC, Marbán E, Cingolani E. Biological pacemaker created by minimally invasive somatic reprogramming in pigs with complete heart block. Sci Transl Med. 2014 Jul 16;6(245):245ra94.