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Dr. Rakesh C. Arora
Principal Investigator, Heart Failure Therapy
Institute of Cardiovascular Sciences
In Detail
The Impact of Heart Failure on Canadians
Congestive heart failure (CHF) affects over 350,000 Canadians. It is one of the most common diagnoses that brings a patient to hospital. Once the diagnosis of severe heart failure is made, the 1-year and 5-year survival rates are 57% and 25% in men and 64% and 38% in women, respectively. If the number of CHF incident hospital cases per year meets projections to more than double by the year 2025, health care costs related to CHF will increase substantially.
New Horizons in Heart Failure Therapy
The loss of heart muscle after a myocardial infarction (heart attack) contributes to the progression of heart failure. The replacement of dead tissue by a non-functional fibrous scar combined with the absence of an adequate repair mechanism leads to a change in the ventricular shape from elliptical to a less efficient spherical one. This alteration in shape increases the strain on the already injured heart and thereby initiates a vicious cycle of progressive dilation of the ventricle (the main pumping chamber of the heart) and progression of the heart failure syndrome. Currently heart transplantation and more recently ventricular assist devices (VADs) are the only effective therapies. An ever widening gap, however, between donor availability and patients suitable for transplantation as well as questionable cost-effectiveness of VAD therapy have prompted investigation into new forms of heart failure therapy.
Traditionally, the adult heart was considered an organ incapable of regeneration. Recently this dogma has been challenged by findings of human myocardial cells that are capable of new cell development in normal and pathologic conditions. The heart’s ability to create new cells, unfortunately, is too limited to compensate for the amount of muscle loss following a large myocardial infarction. Nonetheless, this intriguing data has led several investigators (including Dr. Arora’s lab) to examine the role of cell implantation (cellular cardiomyoplasty) from other tissue sources, into the infarcted area in hopes of replacing lost myocardial cells and altering ventricular remodeling in the hopes of regaining ventricular function.
Over the past few years, several promising results have been reported but many questions remain before implantation of new cells can actually be used to treat patients with ventricular dysfunction leading to heart failure. Specifically, it is yet to be determined which cell type to use (if any), what local chemicals (paracrine and/or autocrine) factors are involved, if cells need to be altered into immature heart muscle cells (cardioblasts or cardiomyocytes) before implantation, and how this can be achieved. Eventually, questions need to be answered concerning the best methods to deliver these cells to the patients, at what time-point after injury should we intervene.
About Rakesh Arora
Dr. Arora was born in London, Ontario and obtained a Baccalaureate of Arts degree from the University of Western Ontario. From there, he next achieved his Medical Doctorate from the University of Toronto in 1996 before moving to Dalhousie University in Halifax, Nova Scotia to undergo his Cardiac Surgery Residency. During his time in his residency in Dalhousie, he completed a Doctorate of Philosophy in the Department of Anatomy/Neurobiology under the supervision of Drs. Andrew Armour and David Hopkins in the field of neurocardiology. In addition, collaboration with Dr. Madga Horackova provided the catalyst from his current line of investigation in the area of cellular cardiomyoplasty. Most recently, after completing two further years of training at the University of Calgary, in Calgary, Alberta, Dr. Arora has become the first Cardiac Surgeon in Canada to also complete a fellowship in Critical Care Medicine.
Dr. Arora has recently joined the Cardiac Sciences Program and the Section of Critical Care Medicine as an Academic Clinician Scientist, where he will be devoting a large proportion of time towards to translational research.
For more information contact:
Dr. Rakesh C. Arora
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