Biological therapies targeting arrhythmias: are cells and genes the answer?

ABSTRACT

Introduction: Arrhythmias can cause symptoms ranging from simple dizziness to life-threatening circulatory collapse. Current management includes medical therapy and procedures such as catheter ablation or device implantation. However, these strategies still pose a risk of serious side effects, and some patients remain symptomatic. Advancement in our understanding of how arrhythmias develop on the cellular level has made more targeted approaches possible. In addition, contemporary studies have found that several genes are involved in the pathogenesis of arrhythmias.

Areas covered: In the present review, the authors explore the cellular and genetic mechanisms leading to arrhythmias as well as the progress that has been made in using both gene and cell therapy to treat tachy- and bradyarrhythmias. They also consider why gene and cell therapy has resulted into a few clinical trials with promising results, however still not applicable in routine clinical practice.

Expert opinion: The question currently is whether such biological therapies could replace current established approaches. The contemporary evidence suggests that despite recent advances in this field, it will need more work in experimental models before this is applied into clinical practice. Gene and cell studies targeting conduction and repolarization are promising, but still not ready for use in the clinical setting.

KEYWORDS:

• Genes
• cells
• arrhythmias
• conduction

Article highlights

1. Cardiac arrhythmias are characterized by high mortality rates especially in patients with pre-existing cardiac disorders and the elderly.

2. Studies have shown that genes and cells are involved in the pathogenesis of arrhythmias and appear to control rate limiting steps of the underlying processes.

3. Gene- and cell-based strategies are promising, but still not well evaluated in the clinical setting.

4. Several limiting factors should be taken into consideration before using cell and gene therapeutic approaches in clinical practice.

5. Traditional therapeutic approaches such as drugs, devices and catheter ablation remain superior to cell- and gene-based strategies.

This box summarizes key points contained in the article.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This manuscript has not been funded.