The National Heart Centre Singapore (NHCS) has successfully created beating heart cells from skin, using a virus-free method to create human induced pluripotent stem (hiPS) cells. The NHCS research team is able to take skin cells from heart patients to generate hiPS cells, which can then be transformed into beating adult heart muscle cells outside the body. These beating cells outside the body are similar both genetically and physically to the properties of the heart cells from which

they came from. The NHCS Research & Development Unit is one of only a handful of basic research labs worldwide capable of this technique.

In Singapore, heart failure is a top reason for cardiac admissions with approximately 5,000 cases per year. NHCS treats about 1,000 such cases yearly. A proportion of these cases are advanced in nature and not amenable to standard therapy. Heart transplant is the only viable option. With the heart muscle cells made with hiPS cells, they can be used to replace the damaged heart muscle of heart failure patients, to relieve the symptoms such as breathlessness and possibly delay the need for a heart transplant.

 

A key advantage of NHCS’s own virus-free hiPS cell method is that immunosuppressants to prevent rejection will not be needed as the source cells originate from the patient. The non-viral technique removes the risk of infection after a heart surgery, which may limit the clinical application of such stem cell therapy. Furthermore, hiPS cells, which are known to be as powerful as embryonic stem  cells, can avoid ethical issues associated with the production of the latter. They also provide a renewable source of replacement cells and tissues. 

During simulation, the hiPS cells displayed predictable ECG changes. This allows for the creation of a human heart cell model to examine the progression of heart diseases. In addition, these hiPS cells could apply to pharmacogenetics to examine the impact of genetic variation on the response to medications. This will allow clinicians to tailor drug therapy at a dosage that is most appropriate for an individual patient, without the patient physically consuming any of the drugs. Such a method can be used to assess a patient's risk factor for a number of conditions and tailor individual preventative treatments. 

Associate Professor Philip Wong, Director, Research and Development Unit, National Heart Centre Singapore says, “This technique is really a game changer for stem cell work and cell therapy for the heart. NHCS Research and Development Unit is currently one of only a few labs in the world with such capability and other labs worldwide are now asking us to help them produce these cells. Our research team is really excited about the clinical application and the potential for helping heart patients.” 

Currently, animal models are used to study the pathology of heart disease due to scarcity of human cardiac tissue. However such studies are constrained by the differences in the progression of heart disease between animals and humans and the lack of good correlation with clinical traits. 

The research breakthrough is the combined efforts of research scientists and clinician scientists. The 15-member team, including three clinician scientists and five research scientists, has been working closely on the project since 2009. The success of the stem cell programme lies in the integration of basic science and clinical medicine. The project’s core theme is on regenerative medicine for the ageing population and is funded with a research grant of close to $9 million for five years by the National Research Foundation. 

Moving forward, the team will look at the therapeutic potential of such cells, including their use for cell transplant. With the possibility of using these cells as a genetic-equivalent model outside the body, the team can also study in great detail cardiac genetic disease and their response of specific drugs or also test response of new drugs on specific diseases of the heart. 

The National Heart Centre Singapore (新加坡国家心脏中心) is a 185-bed national and regional referral centre for cardiovascular diseases. A one-stop facility with the largest heart specialists group in Singapore, NHCS treats complex cases and sees the highest volume of heart patients locally. 

Each year, the centre handles over 100,000 outpatient consultations, 7,000 interventional and surgical procedures and 10,000 inpatients. Its outcomes for heart attack treatment, balloon angioplasty with stenting and coronary bypass surgery have been shown to be equivalent to international standards. 

NHCS is the first heart centre outside USA and in Asia to receive the prestigious Joint Commission International (JCI) since 2005, which is an assurance for safe and quality patient care for the patients.