Biohybrid cardiac ECM-based hydrogels improve long term cardiac function post myocardial infarction

Yael Efraim, Hadar Sarig, Noa Cohen Anavy, Udi Sarig, Elio de Berardinis, Su Yin Chaw, Muthukumar Krishnamoorthi, Jérôme Kalifa, Hanumakumar Bogireddi, Thang Vu Duc, Theodoros Kofidis, Limor Baruch, Freddy Y.C. Boey, Subbu S. Venkatraman, Marcelle Machluf*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

68 Scopus citations


Injectable scaffolds for cardiac tissue regeneration are a promising therapeutic approach for progressive heart failure following myocardial infarction (MI). Their major advantage lies in their delivery modality that is considered minimally invasive due to their direct injection into the myocardium. Biomaterials comprising such scaffolds should mimic the cardiac tissue in terms of composition, structure, mechanical support, and most importantly, bioactivity. Nonetheless, natural biomaterial-based gels may suffer from limited mechanical strength, which often fail to provide the long-term support required by the heart for contraction and relaxation. Here we present newly-developed injectable scaffolds, which are based on solubilized decellularized porcine cardiac extracellular matrix (pcECM) cross-linked with genipin alone or engineered with different amounts of chitosan to better control the gel's mechanical properties while still leveraging the ECM biological activity. We demonstrate that these new biohybrid materials are naturally remodeled by mesenchymal stem cells, while supporting high viabilities and affecting cell morphology and organization. They exhibit neither in vitro nor in vivo immunogenicity. Most importantly, their application in treating acute and long term chronic MI in rat models clearly demonstrates the significant therapeutic potential of these gels in the long-term (12 weeks post MI). The pcECM-based gels enable not only preservation, but also improvement in cardiac function eight weeks post treatment, as measured using echocardiography as well as hemodynamics. Infiltration of progenitor cells into the gels highlights the possible biological remodeling properties of the ECM-based platform. Statement of Significance This work describes the development of new injectable scaffolds for cardiac tissue regeneration that are based on solubilized porcine cardiac extracellular matrix (ECM), combined with natural biomaterials: genipin, and chitosan. The design of such scaffolds aims at leveraging the natural bioactivity and unique structure of cardiac ECM, while overcoming its limited mechanical strength, which may fail to provide the long-term support required for heart contraction and relaxation. Here, we present a biocompatible gel-platform with custom-tailored mechanical properties that significantly improve cardiac function when injected into rat hearts following acute and chronic myocardial infarction. We clearly demonstrate the substantial therapeutic potential of these scaffolds, which not only preserved heart functions but also alleviated MI damage, even after the formation of a mature scar tissue.

Original languageEnglish
Pages (from-to)220-233
Number of pages14
JournalActa Biomaterialia
StatePublished - 1 Mar 2017
Externally publishedYes


  • Biohybrid material
  • Cardiac tissue engineering
  • Extracellular matrix
  • Injectable scaffold


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