让生物起搏梦想照进现实——再建心脏房室传导的策略思考

完全性房室传导阻滞是各种心脏病的重要并发症，生物心脏起搏是近年来其治疗研究的热点。本文通过分析目前生物起搏的临床应用所面临的瓶颈和问题，结合笔者的研究实践，就再建心脏房室传导通路这一课题提出如下思考：（1）组织工程化心传导束（ECT）是生物起搏治疗房室传导阻滞策略中一种较为理想的方式；（2）非基因改造成体干细胞诱导为起搏细胞或传导细胞，能够使生物起搏和ECT治疗房室传导阻滞的临床推广应用变得容易；（3）采用ECT实现生理性房室传导及临床应用，必须对其进行传导速度调控；（4）须围绕"ECT组织细胞类型及缝隙连接蛋白表达"这一关键点，设计传导速度调控的可行性方案。相信随着ECT研究工作的深入开展，ECT必将对生物起搏治疗的临床转化产生重要影响。
Complete atrioventricular conduction block, a significant complication of many heart diseases, is a serious threat to human health, and the biological pacemaker is a research focus in this area. In this paper, we discussed the current obstacles of biological pacemaker from laboratory to clinical application and summarized our practice. We put forward the following considerations for establishing a new atrioventricular conduction pathway:(1) engineered conduction tract or tissue (ECT) is a relatively ideal way to treat atrioventricular conduction block with biological pacing; (2) a transgene-independent method for the generating pacemaker or conduction cells from adult stem cells makes it easy for the biological pacemaker or ECT application; (3) the conduction velocity regulation is important to achieve the physiological atrioventricular conduction in clinical application with ECT; and (4) the feasible solutions of regulating the conduction velocity depend on the cell types and connexins expressions in ECT. It is believed that ECT will soon have a significant impact on the clinical transformation of biological pacing application