Heart heal thyself: a new direction for cardiac researchBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d703 (Published 02 February 2011) Cite this as: BMJ 2011;342:d703
All rapid responses
As much as the news of British Heart Foundation's 50 million pounds
"Mending broken heart" campaign launch was heart warming, it was heart
wrecking to see how media can lead public to expect the impossible.
Thanks to BMJ's editorial oversight and perhaps to Watts experience with
medical journalism, his reporting (1) wasn't as naive as his peers across
the board who reported a miracle pill in offing that will magically fix
diseased heart. The headline - "Heart-healing pill 'could exist in five
years'" - came from the very credible UK Press Association. Others
rallied UKPA with headlines like -"Pill to repair heart disease is just 5
years away, say scientist," (2) - and - "Pill allows damaged hearts repair
available in seven years," (3) - so on so forth. One of them even
declared that British scientists have created such a miracle pill to mend
the broken hearts (4). A pill to regenerate heart tissue is not only a
figment of media's imagination, but it is a scientific impossibility that
BHF will never endorse.
We now know that cardiac tissue regeneration is a local
temporospatial activity within the heart that is driven by a complex
cascade of paracrine regulatory pathways that cross talk with each other
over a period of weeks or months to regenerate, morph and finally assemble
the new functional myocardial and coronary vasculature tissue. Any
intervention that facilitates this process, whether stem cells or small
molecules, have to be delivered via intra-cardiac route and have to last
long enough, otherwise they are either lost in circulation or extremely
toxic to the body. And, more importantly whether small molecules or stem
cells they have to survive the hostile myocardial environment during the
entire period of local stem cell homing, stabilization, proliferation,
differentiation, gene expression, tissue morphing and functional assembly.
Achieving this in-situ indeed is a tall order, may be possible in near
future with the BHF initiative, but certainly never in the form of a pill
that does the magic.
That said, Watts reporting of the event surely wasn't as speculative
as some of his peers. But suggesting that BHF initiative isn't about
"introduction of an outside source of stem cells", but "looking at ways of
encouraging heart to repair itself" is not completely accurate if not
misleading. Whether stem cells or small molecules or any type of
physiological stimulus, human heart can only repair itself when
continuously steered by one or more of these outside sources, through the
different stages, right from stem cell homing through the functional
tissue formation. In fact a careful review of all the BHF affiliate
research groups reveals that the focus of "mending the broken heart"
initiative although delves into enhancing our understanding of the
regenerative physiology of heart, yet still anchors around intra-cardiac
transplants of actives (presently mostly stem cells), whether sourced from
the same patient or not.
As strong believers and stake holders in the business of discovering
strategies for mending broken hearts, it is incumbent upon us to dispel
any misgivings created by an overtly enthusiastic media. One wonders if a
peer review process should be instituted for journalistic expositions of
such highly technical disclosures of global importance. At least a peer-
reviewed clarification should suffice for now.
1. Watts, G. Heart heal thyself: a new direction for cardiac
research. BMJ 2011; 342:d703.
2. Moss, L. Pill to repair heart disease is just 5 years away, say
scientists. www.scotsman.com, published 01 February 1, 2011, accessed
February 5, 2011 at http://news.scotsman.com/news/Pill-to-repair-heart-
3. Macrae, F. Pill that can trick your heart into fixing itself.
www.dailymail.co.uk, published February 1, 2011, accessed February 5,
2011 at www.dailymail.co.uk/health/article-1352257/Pill-allows-damaged-
4. D'Souza, R. British scientists create miracle pill to amend broken
hearts. www.manufacturingdigital.com, published February 1, 2011,
accessed February 5, 2011 at www.manufacturingdigital.com/sectors/health-
Competing interests: No competing interests