The NHCS team, that achieved the breakthrough includes (from left) Dr Winston Shim, Dr Reginald Liew and Associate Professor Philip Wong. ST PHOTO: DESMOND FOO 

Heart centre's breakthrough in stem-cell technique can replace need for transplants

Researchers from the National Heart Centre Singapore (NHCS) have successfully created beating heart cells from skin cells, a development that could replace the need for heart transplants. 

Such a breakthrough would benefit the 5,000 patients who are treated annually here for heart failure. The NHCS treats about a fifth of these sufferers, a proportion of whom are advanced cases treatable only with a heart transplant. 

Singapore's heart transplant programme began in 1990 but only 53 operations have been performed to date.

"Cardiovascular diseases are overtaking cancers as the No. 1 killer disease and heart failure is one of the main causes of deaths," said Associate Professor Philip Wong, director of the research and development unit at NHCS.

"Our research team is excited about the...potential for helping heart patients."

A 15-member team is behind this $9 million project funded by the National Research Foundation. The clinicians have begun preparatory work on animal testing to ensure the efficacy, safety and feasibility of the therapy's use on humans.
The beating heart cells are made through a method that creates "pluripotent stem cells" from human cells.

Stem cells can develop and form the type similar to the cells in the part of the body they are transplanted to. There are several types of stem cells, with pluripotent stem cells being one of the most powerful. It can become almost all cell types.

Traditionally, pluripotent stem cells were made by injecting a virus which carries materials that reprogramme the human cell to "think" like a stem cell.

But using a virus makes it unsuitable for use in patients as it carries a risk of infection, soa substitute carrier known as a plasmid is used.

Using a virus to create a pluripotent stem cell is typically faster than the plasmid method, but the NHCS laboratory has a streamlined technique that can achieve results that are equally efficient.

The NHCS research and development unit is one of a handful of basic research labs worldwide that have the know-how to do this.

With this method, skin cells from heart patients can be used to generate the stem cells, which can then be transformed into beating adult heart cells outside the body.

The creation process - from skin cell to beating heart cell - takes about six to eight weeks. 

Prof Wong describes the technique as a "game changer for stem-cell work and cell therapy for the heart".

Because the beating heart cells are made from a patient's own skin cells, it would remove the need for immunosuppressants.

Organ-transplant patients typically take them over the long term and suffer side effects such as bone loss and diabetes. 

The beating heart cells also emit electrical signals, which means a human-heart cell model can be created outside the body to study how a patient's heart disease is progressing.

Doctors can also use the human-heart cell model to do drug tests for patients, to find out what type and dosage best suits them. 

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