title: Biological pacemakers as a therapy for cardiac arrhythmias.
abstract: OBJECTIVE
  Cardiac rhythm disorders are caused by malfunctions of impulse generation or conduction. Malfunctions of impulse generation, that is, defects in pacemaking, are often life-threatening. Present therapies span a wide array of approaches, but remain largely palliative. Recent progress in understanding of the underlying biology of pacemaking opens up new prospects for better alternatives to the present routine. Specifically, development and use of biological pacemakers could prove to be advantageous to the conventional approaches.
  
  
  RESULTS
  We review the current state of the art in gene and cell-based approaches to correct cardiac rhythm disturbances. These include genetic suppression of an ionic current, embryonic as well as adult stem cell therapies, novel synthetic pacemaker channels, and adult somatic cell-fusion approach.
  
  
  CONCLUSIONS
  Biological pacemaking can be achieved by modulating ionic currents by gene transfer or by delivering engineered pacemaker cells into normally quiescent myocardium. The present state of development is proof-of-concept; we are now working on reducing to practice a stable, reliable biological product as an alternative to electronic pacemakers.
authors.affiliation: Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. eduardo.marban@csmc.edu
authors.forename: Eduardo
authors.initials: E
authors.lastname: Marbán
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Cho
mesh_terms: D053687:Adult Stem Cells; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D001683:Biological Clocks; D002459:Cell Fusion; D054815:Cyclic Nucleotide-Gated Cation Channels / Q000235:genetics; D053595:Embryonic Stem Cells; D018014:Gene Transfer Techniques; D015316:Genetic Therapy; D006801:Humans; D064428:Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels; D015221:Potassium Channels / Q000235:genetics; D024661:Potassium Channels, Inwardly Rectifying / Q000037:antagonists & inhibitors
chemical_list: D054815:Cyclic Nucleotide-Gated Cation Channels; D064428:Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels; D015221:Potassium Channels; D024661:Potassium Channels, Inwardly Rectifying