Despite recent advances in the treatment of cardiac arrhythmia, the available options are still limited and associated with some complications. In present investigation, we aimed to induce biological pacemaker through the insertion of Tbx18 gene, the key regulator of sinoatrial node development, into differentiating stem cells and also rat hearts.

And final result
The Tbx18-delivered cardiomyocytes exhibited pacemaker-like activity in vitro and showed the pacemaker cell-related gene expression profile. After complete heart block, the ECG recording data showed spontaneous pacemaker rhythms in both intervention groups with longer VF duration and signal propagation in Tbx18-lentivirus-received ventricles. In Tbx18-lentivirus-received ventricle tissues, the gene expression changes were in favor of pacemaker cell induction.

Conclusion: We confirmed the formation of functional pacemaker after introduction of Tbx18 via cell and gene therapy strategies. Although pacemaker activity was better in gene-received hearts since there was longer VF duration and signal propagation, more data should be gathered from the long-term activity of such pacemakers in different hosts.