Heart disease is the leading cause of death in the Western world. Tissue engineering may offer alternative treatment options or suitable models for studies of normal and pathological cardiac tissue function in vitro. Current tissue engineering approaches have been limited by diffusional oxygen supply, lack of physical stimuli and absence of multiple cell types characteristic of the native myocardium.

We hypothesized that functional, clinically sized (1-5 mm thick), compact cardiac constructs with physiologic cell densities can be engineered in vitro by mimicking cell microenvironment present in the native myocardium in vivo.

Since cardiac myocytes have limited ability to proliferate we developed methods of seeding cells at high densities while maintaining cell viability. Cultivation of cardiac constructs in the presence of convective-diffusive oxygen transport in perfusion bioreactors, maintained aerobic cell metabolism, viability and uniform distribution of cells expressing cardiac markers. To improve cell morphology and tissue assembly cardiac constructs were cultivated with electrical stimulation of contraction in a physiologically relevant regime. Electrical stimulation enabled formation of tissue with elongated cells aligned in parallel and with organized ultrastructure remarkably similar to the one present in the native heart. To investigate the effect of multiple cell types on the properties of engineered cardiac tissue cardiac fibroblasts and cardiac myocytes were cultivated synchronously, separately or serially (pretreatment of scaffolds with fibroblasts followed by the addition of myocytes). Presence of fibroblasts remarkably improved contractile response of the engineered cardiac constructs with the superior biochemical and morphological properties in the pretreated group. Finally, in order to mimic capillary structure cardiac fibroblasts and myocytes were co-cultured on a scaffold with a parallel channel array that was perfused with culture medium supplemented with synthetic oxygen carrier (PFC emulsion). Presence of the PFC emulsion resulted in significantly higher cell density and improved contractile properties compared to the constructs cultivated in the culture medium alone, by increasing total oxygen content and effective diffusivity.