Women who develop heart failure during pregnancy have a problem with the heart’s fatty acid metabolism. This has been proved by PhD student Martijn Hoes, who used a revolutionary research technique to cultivate heart cells from patients’ skin cells. ‘Very little is known about heart failure in women. More information could help us to diagnose heart failure at an earlier stage.’ Hoes will be awarded a PhD by the University of Groningen on 20 March.
Heart failure occurs when the muscles of the heart are no longer able to pump sufficient blood around the body. For many years, very little research was conducted into heart failure among women and this remained a grey area. A specific type of heart failure sometimes occurs in women around the time that they give birth (peripartum cardiomyopathy or PPCM). ‘This illness is not always recognized and other explanations are often found for the symptoms. We still know very little about the real cause.’ In his thesis, Hoes describes research into heart failure in general, and more specifically into PPCM. The research was co-funded by the Dutch Heart Foundation.
Until recently, research into cardiovascular disease at the cell level was almost impossible. ‘You can’t just take a few cells from a heart muscle to study,’ explains Hoes. ‘It works with certain other tissue types but it’s not good for the heart.’ But thanks to this new technique, Hoes has been able to study heart cells. ‘We are now able to convert skin cells into stem cells, from which we can cultivate other types of cells, including heart cells.’ An important aspect of this method is the fact that the cultivated cells have the genetic make-up of the person who donated the skin cell. ‘We’ve used this method to grow heart cells from two women with PPCM and a healthy female relative of each of them.’
‘First, we tried to identify the genes that are activated in these heart cells. We saw differences between the cells of the women with PPCM and those of the healthy women.’ These differences could mean that the root of the problem with PPCM lies in the cells’ energy production. ‘A healthy heart generates energy by burning fat. If a heart is compromised (due to disease), it starts to burn sugar instead. This is less efficient in the long term and soon leads to heart failure. Pregnancy stimulates the heart to burn more fat. This occurs in women with PPCM too, but for some reason, they are unable to burn fat and so sugar is burned instead.’
The main aim of Hoes’ research is to learn more about why some women develop heart failure during pregnancy, and ultimately to improve the diagnosis and treatment of the condition. We know that these women may develop PPCM again during every subsequent pregnancy, and that this can lead to serious health problems. Early diagnosis and good treatment could prevent problems that occur around the time of the birth.
Martijn Hoes (1988) studied Biomedical Sciences in Maastricht. He conducted his research at the UMCG Cardiology department and Guide research institute . The research was co-funded by the Dutch Heart Foundation. His thesis is entitled: Studying cardiac diseases using human stem cell-derived cardiomyocytes. He is currently working as a post-doc researcher in the UMCG.