Finding your Inner Rhythm: Cedars-Sinai Cardiologists Create Biological “Pacemakers” in the Heart

If your heart has trouble keeping a steady rhythm, you normally get a pacemaker: a small device that is inserted into your body and attached to your heart. About 300,000 people receive a pacemaker each year. But what if we could harness the body’s own cells to do what an external device does today?

Cedars-Sinai cardiologists have discovered a new way to keep the heart beating in rhythm.

Cedars-Sinai cardiologists have discovered a new way to keep the heart beating in rhythm.

In research published today in Science Translational Medicine, cardiologists from the Cedars-Sinai Heart Institute have found a way to reprogram one type of heart cell into another type that actually keeps the heart beating at a steady rate. These findings, performed in animal models, open the door to replacing an artificial pacemaker with a natural, biological one.

Dr. Eduardo Marbán, CIRM-grantee and the study’s lead author, explained the importance of their research:

“We have been able, for the first time, to create a biological pacemaker using minimally invasive methods—and to show that the biological pacemaker supports the demands of daily life. We also are the first to reprogram a heart cell in a living animal in order to effectively cure a disease.”

In this study, researchers injected a gene called TBX18 into the hearts of laboratory pigs. They then monitored any changes in heart rhythms of those pigs, comparing them to the hearts of pigs that did not receive the injection.

In just two days, the pigs that had received the injection showed stronger, faster rhythms, compared to the controls. And even more importantly—that strong rhythm persisted for the entire duration of the study (14 days), indicating that the therapy could be sustainable as a longer-term alternative to traditional, artificial pacemakers.

Intriguingly, the research team argues that their new method could be especially useful in cases where a traditional pacemaker is not an option, such as in newborns. Dr. Eugenio Cingolani, another member of the Cedars-Sinai team explained:

“Babies still in the womb cannot have a pacemaker, but we hope to work with fetal medicine specialists to create a life-saving catheter-based treatment for infants diagnosed with congenital heart block. It is possible that one day, we might be able to save lives by replacing hardware with an injection of genes.”

In addition to newborns, this new method could help a variety of other heart disease patients unable to receive traditional pacemakers—such as those who would suffer certain negative effects, or more complex heart arrhythmias—should the research proceed to clinical trials, which they hope to begin in approximately three years.

Added Marbán:

“Originally, we thought that biological pacemaker cells could be a temporary bridge therapy for patients who had an infection in the implanted pacemaker area. These results show us that with more research, we might be able to develop a long-lasting biological treatment for patients.”