Synthetic extracellular matrix approaches for the treatment of myocardial infarction

Injectable biomaterials, that mimic one or more functions of the natural extracellular matrix (ECM), are used in therapies that aim at improvement of cardiac repair and induction of regeneration of the heart. In this chapter we discuss recent trends in synthetic ECM approaches using injectable biomaterials to repair and regenerate the heart, and relate this to the design criteria to truly mimic (parts of) the natural ECM in a synthetic way. To fully understand the design criteria we first discuss the healthy and adverse remodeled cardiac niche in which the ECM and soluble factors play important roles. Additionally, knowledge of the remodeling processes and cardiac performance post-myocardial infarction is needed. Finally, we review various synthetic ECM approaches for the treatment of the infarcted heart; i.e. (i) hydrogels that support the myocardial matrix via mechanical and/or bioactive cues, (ii) hydrogel materials that release bioactive factors, (iii) materials that deliver cells, and (iv) hydrogel materials that induce cell recruitment.