Multi-Electrode Pacemaker

O principal objetivo desta dissertação é apresentar uma pesquisa de mercado sobre as tecnologias existentes bem como descrever um método abrangente para alcançar o protótipo de um pacemaker implantável com recursos sem fio.The main objective of this dissertation is to present a market survey on existing technologies as well as to depict a comprehensive method to achieve the prototype of an implantable pacemaker with wireless capabilities

Electrophysiology

The outstanding evolution of recording techniques paved the way for better understanding of electrophysiological phenomena within the human organs, including the cardiovascular, ophthalmologic and neural systems. In the field of cardiac electrophysiology, the development of more and more sophisticated recording and mapping techniques made it possible to elucidate the mechanism of various cardiac arrhythmias. This has even led to the evolution of techniques to ablate and cure most complex cardiac arrhythmias. Nevertheless, there is still a long way ahead and this book can be considered a valuable addition to the current knowledge in subjects related to bioelectricity from plants to the human heart

Optogenetics in striated muscle: defibrillation of the heart and direct stimulation of skeletal muscles with light

Optogenetic depolarization of cells using the non-selective cation channel Channelrhodopsin-2 (ChR2) enables precise control over the membrane potential of cells within a specific area of intact organs. Furthermore, the selective overexpression of light-gated proteins allows cell type-specific and pain-free stimulation which could be of great benefit for future scientific and therapeutic approaches. In my thesis, I explored two potential applications of optogenetic methods in striated muscle: optogenetic defibrillation to terminate ventricular arrhythmia in intact mouse hearts and direct optogenetic stimulation of skeletal muscles. These new approaches could lead in the future to the development of optogenetic defibrillators and laryngeal pacemakers. Most experiments were performed with explanted hearts, isolated skeletal fibers and muscles or larynges from transgenic ChR2 expressing mice. To add translational perspectives, we also explored optogenetic defibrillation and intralaryngeal muscles stimulation after ChR2 gene transfer to wild type mice using adeno-associated virus (AAV). Optogenetic defibrillation by epicardial illumination was highly efficient in terminating ventricular arrhythmia in transgenic hearts and the success rate of optogenetic defibrillation was depending on the pulse duration, the size of illumination and the light intensity. Importantly, we were also able to terminate ventricular arrhythmia in non-transgenic hearts even one year after AAV mediated gene transfer. The potential applicability of optogenetic defibrillation in the human heart was assessed in experimentally-calibrated computer simulations of a patient’s heart with infarct-related ventricular tachycardia. Because optogenetic stimulation would be in principle pain-free in patients, the proof for its feasibility could lay the foundation for the development of a new treatment option for patients at high risk for ventricular arrhythmia. Direct optogenetic stimulation of skeletal muscle was first proven in isolated Flexor digitorum brevis fibers and in intact soleus muscles, which could both be stimulated using brief light pulses. The force of light-induced single twitches could be precisely controlled by varying the pulse duration and light intensity. Optogenetic stimulation was most efficient with 10 ms long pulses at a repetition rate of 40 Hz reaching ~84% of the maximum force generated by electrical stimulation with 100 Hz. Recurrent nerve paralysis is a severe complication of neck surgery, malignant processes or central neurological diseases and results in a fixed paramedian position of the vocal cords as well as life-threatening dyspnea in the case of bilateral paralysis. Current treatment options consist only of destructive surgery. Unfortunately the use of local electrical stimulation to restore laryngeal function faces severe technical limitations. Therefore I sought to explore direct optogenetic stimulation of intralaryngeal muscles in explanted larynges from ChR2 transgenic mice. Specific illumination of the individual intralaryngeal muscle groups led to an opening or closing of the vocal cords depending on the site of illumination. This proves the sufficient spatial resolution of light for selective stimulation of the intralaryngeal muscles groups. In addition, we were able to induce opening of the vocal cords in wild type mice after AAV-based gene transfer of ChR2 with light. Thus optogenetic stimulation could become a new treatment option for patients suffering from bilateral laryngeal paralysis. In conclusion, optogenetic stimulation can overcome the severe limitations of electrical stimulation of the heart and skeletal muscles. The new technologies, I have developed and characterized in this thesis, allow for the design of completely new stimulation patterns to address open questions in muscle physiology. Furthermore, optogenetic stimulation of striated muscles could become a new treatment option for patients enabling selective and pain-free stimulation with few side effects

Human dermal fibroblast activation under pulsed electrical stimulation via conductive fabrics : signalling pathways and potential benefit for wound healing

Lors de la cicatrisation, plusieurs types cellulaires dont les kératinocytes et les fibroblastes ainsi que plusieurs facteurs de croissance jouent d’importants rôles. La cicatrisation cutanée peut aussi être activée par des facteurs exogènes, dont la stimulation électrique (SE). La SE peut moduler les fonctions fibroblastiques durant la cicatrisation. Le fibroblaste contribue de façon active à la cicatrisation en sécrétant différentes protéines (collagène, fibronectine, élastine) pour favoriser le comblement tissulaire. Les fibroblastes adoptent aussi un phénotype contractile en exprimant l’α-actine contribuant à la fermeture de la plaie. Notre hypothèse est que certaines de ces fonctions fibroblastiques pourraient être modulées par une stimulation électrique. Pour vérifier cette hypothèse nous avons utilisé une membrane biocompatible et conductrice à base de polyethylene terephthalate (PET) recouvert de polypyrrole (PPy). Les fibroblastes dermiques humains ont été cultivés sur ces membranes conducteurs, puis exposés ou non à un courant pulsé (PES) selon deux régimes : soit 10s PES suivi de 1200s de repos, ou 300s PES suivi de 600s de repos, durant 24 h. Deux intensités électriques ont été étudiées, 50 et 100 mV/mm. Nos travaux démontrent que la SE favorise l’adhésion, la prolifération et la migration des fibroblastes dermiques. Ces activités cellulaires sont consolidées par une sécrétion importante de FGF2 et d’α-SMA. Il est important de noter que l’effet de la SE favorise le changement phénotypique des fibroblastes en myo-fibroblastes grâce à la voie des Smad et de TGFβ/ERK. Nous avons aussi démontré que l’effet de la SE est maintenue à long terme et est transférable de la cellule mère vers les cellules filles. En effet après sous-culture les cellules expriment toujours de façon importante l’α-SMA. En conclusion, nous avons démontré que la stimulation électrique pulsée module positivement les fonctions cicatricielles des fibroblastes humains. Ces travaux démontrent pour la première fois les voies de signalisation (Smad et TGFβ/ERK) sollicitées par la SE pour activer les fibroblastes lors de la cicatrisation. Ces travaux suggèrent l’utilisation de la SE pour favoriser la guérison/cicatrisation des plaies.During skin wound healing, cutaneous cells particularly fibroblasts and keratinocytes as well as several growth factors play important roles. Wound healing can be activated by exogenous factors, including electrical stimulation (ES). ES can also modulate fibroblast functions. Fibroblasts contribute to healing by secreting structural proteins (collagen, fibronectin, elastin) to repair the wound area. Fibroblasts also adopt a contractile phenotype expressing α-actin contributing to wound closure. The hypothesis of the thesis is that fibroblasts proliferate and transdifferentiate into myofibroblasts by sensing pulsed electrical signals and adjusting relevant signalling pathways. To test this hypothesis we used biocompatible polyethylene terephthalate (PET) fabrics coated with electrically conductive polypyrrole (PPy). Human dermal fibroblasts were cultured on these conductive fabrics and exposed to the optimized pulsed ES: either 10s PES in a period of 1200s, or 300s PES in 600s period, for a total of 24 hours. Two electric intensities were studied, 50 and 100 mV/ mm. Our work showed that the PES promoted the adhesion, proliferation and migration of dermal fibroblasts. These cellular activities were consolidated by an elevated level of fibroblast growth factor 2 (FGF2) and the high expression of α-smooth muscle actin (α-SMA). Important findings were that PES promoted the phenotypic change of fibroblasts to myofibroblasts, and such change was coordinated through the Smad and TGFβ/ERK pathways. It also demonstrated that the effect of PES was able to maintain for a long period of time after the end of stimulation, and was transferable from the mother cells to the daughter cells. Following subculture, the electrically stimulated fibroblasts still expressed significant amount of α-SMA. In conclusion, this thesis demonstrates that PES through conductive fabrics can activate the wound healing functions in human dermal fibroblasts. This work revealed for the first time that Smad and TGFβ/ERK pathways are required by the PES-induced fibroblasts-to-myofibroblasts differentiation. This work also demonstrated that the PES activated cells can survive in vivo. These studies suggest the application of the PES in promoting tissue regeneration and wound healing

Aspects of Pacemakers

Outstanding steps forward were made in the last decades in terms of identification of endogenous pacemakers and the exploration of their controllability. New "artifical" devices were developed and are now able to do much more than solely pacemaking of the heart. In this book different aspects of pacemaker - functions and interactions, in various organ systems were examined. In addition, various areas of application and the potential side effects and complications of the devices were discussed

ADHERENS JUNCTION ENGAGEMENT REGULATES FUNCTIONAL PATTERNING OF THE CARDIAC PACEMAKER CELL LINEAGE

The heart is the first organ system to form in the embryo. Over the course of development, cardiomyocytes with differing morphogenetic, molecular, and physiological characteristics are specified and differentiate and integrate with one another to assemble a coordinated electromechanical pumping system that can function independently of any external stimulus. As congenital malformation of the heart presents the leading class of birth defects seen in humans, the molecular genetics of heart development have garnered much attention over the last half century. However, understanding how genetic perturbations manifest at the level of the individual cell function remains challenging to investigate. In this dissertation, we briefly introduce the history of imaging approaches for assessing cardiac development, describe some of the reagents and tools required to perform live imaging in the developing heart, and discuss how the combination of modern imaging modalities and physiological probes can be used to scale from subcellular to whole-organ analysis. Through these types of imaging approaches, critical insights into the processes of cardiac physiological development can be directly examined in real-time. Moving forward, the synthesis of modern molecular biology and imaging approaches will open novel avenues to investigate the mechanisms of cardiomyocyte maturation. Specifically, cardiac pacemaker cells (CPCs) will be discussed in detail. CPCs rhythmically initiate the electrical impulses that drive heart contraction. CPCs display the highest rate of spontaneous depolarization in the heart despite being subjected to inhibitory electrochemical conditions that should theoretically suppress their activity. While several models have been proposed to explain this apparent paradox, the actual molecular mechanisms that allow CPCs to overcome electrogenic barriers to their function remain poorly understood. Here, we have traced CPC development at single-cell resolution and uncovered a series of cytoarchitectural patterning events that are critical for proper pacemaking. Specifically, our data reveal that CPCs dynamically modulate adherens junction (AJ) engagement to control characteristics including surface area, volume, and gap junctional coupling. This allows CPCs to adopt a structural configuration that supports their overall excitability. Thus, our data have identified a direct role for local cellular mechanics in patterning critical morphological features that are necessary for CPC electrical activity.Doctor of Philosoph