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Guidance of postinfarct myocardial remodeling processes by an epicardial patch system may alleviate the consequences of ischemic heart disease. As macrophages are highly relevant in balancing immune response and regenerative processes their suitable instruction would ensure therapeutic success. A polymeric mesh capable of attracting and instructing monocytes by purely physical cues and accelerating implant degradation at the cell/implant interface is designed. In a murine model for myocardial infarction the meshes are compared to those either coated with extracellular matrix or loaded with induced cardiomyocyte progenitor cells. All implants promote macrophage infiltration and polarization in the epicardium, which is verified by in vitro experiments. 6 weeks post-MI, especially the implantation of the mesh attenuates left ventricular adverse remodeling processes as shown by reduced infarct size (14.7% vs 28-32%) and increased wall thickness (854 mu m vs 400-600 mu m), enhanced angiogenesis/arteriogenesis (more than 50% increase compared to controls and other groups), and improved heart function (ejection fraction = 36.8% compared to 12.7-31.3%). Upscaling as well as process controls is comprehensively considered in the presented mesh fabrication scheme to warrant further progression from bench to bedside.
Based on suggested interactions of potential tipping elements in the Earth's climate and in ecological systems, tipping cascades as possible dynamics are increasingly discussed and studied. The activation of such tipping cascades would impose a considerable risk for human societies and biosphere integrity. However, there are ambiguities in the description of tipping cascades within the literature so far. Here we illustrate how different patterns of multiple tipping dynamics emerge from a very simple coupling of two previously studied idealized tipping elements. In particular, we distinguish between a two phase cascade, a domino cascade and a joint cascade. A mitigation of an unfolding two phase cascade may be possible and common early warning indicators are sensitive to upcoming critical transitions to a certain degree. In contrast, a domino cascade may hardly be stopped once initiated and critical slowing down-based indicators fail to indicate tipping of the following element. These different potentials for intervention and anticipation across the distinct patterns of multiple tipping dynamics should be seen as a call to be more precise in future analyses of cascading dynamics arising from tipping element interactions in the Earth system.