New strategies to improve treatment of congenital cardiovascular defects and the subsequent damage acquired after birth that ultimately results in heart failure are being framed by experts.
And the new approaches were discussed at a recent meeting of paediatric cardiovascular experts from around the world who gathered at the Indiana University School of Medicine and Riley Hospital for Children for the second annual Riley Heart Center Symposium on Cardiac Development.
The symposium focused on molecular mechanisms that implement the instructions embedded within DNA that enable cells to form a functional heart.
The key proteins studied called transcription factors regulate how other genes are turned on and off in a complicated ballet that ultimately instructs a cell to become a cardiomyocyte and where to move and how to function.
When this dance goes awry, congenital heart defects are the unfortunate result.
"Although the process by which transcription factors regulate the expression of other gene products is well understood, how the many factors coordinate their functions to precisely define a cell's purpose is only now becoming possible to understand," said symposium co-organizer Dr. Anthony Firulli, professor of paediatrics and member of the Riley Heart Research Centre.
"Indeed, when one considers the numerous different cell types that make up the heart and great vessels that are required to function in unison to pump blood throughout the body and that in every cell type there are complex combinatorial codes instructing each cell on how to function and how to communicate with their neighbouring cells, it provides a complex challenge for heart researchers to understand," said Dr. Simon J. Conway, professor of paediatrics and member of the Riley Heart Research Centre, who co-organized the symposium.
Heart development is characterized by the differentiation, proliferation and movement of cardiac muscle cells, which interact with extra cardiac tissues connecting the heart with the vasculature.
Firulli presented a comprehensive overview of the role that the Hand1 and Hand2 genes play during cardiogenesis, touching on interesting aspects of their overlapping functions.
Conway presented data that directly tested whether the developing heart really requires both Hand1 and Hand2, and if one could be replaced by the other.
These data from transgenic mouse models suggest that even though the Hand proteins are very similar in structure and may be expected to fulfill similar roles, Hand1 and Hand2 are independently required for the heart to develop normally.
Dr. Tiffanie R. Johnson from Riley Hospital, presented a review of ideal imaging techniques for the most common complex congenital heart defects.
She discussed the best ways to diagnose and follow patients as they grow, both before and after surgical intervention.
Johnson believes advances in imaging techniques will lead to higher quality and safer diagnostic imaging capabilities that will continue to be needed in the field of congenital heart disease.
The details of the symposium have been published in the latest issue of the journal Pediatric Cardiology.