Nanobiology in cardiology and cardiac surgery

Cardiovascular morbidity and mortality account for a major portion of the socioeconomic deficit in industrialized countries with increasing trends in developing countries.1 The diversity and complexity of heart disease and the cost and duration aspects of treatment trigger extensive research activity to develop novel therapeutic concepts for the future. Therefore, atherosclerosis, ischemic heart disease, and heart failure constitute vast fields for the integration of new technologies. Although nanobiology and nanotechnology2 have not been integrated in the clinical practice in cardiology or cardiac surgery to date, they hold great promise for advanced future applications that will reshape cardiovascular medicine. The main domain for nanobiology in cardiology is expected to be interventional drug delivery and the promotion of angiogenesis for the salvage of ischemic tissue. Cardiac surgery will primarily benefit from this advancing technology through applications in tissue engineering and tissue-or cell transfer. However, there is a plethora of pathological entities in contemporary clinical practice that might constitute an immediate field of action for novel nanotechnological applications. These should be subdivided into diagnostic applications and therapeutic applications. Novel diagnostic modalities, based upon nanotechnological accomplishments, will help identify emerging disease processes at a very early stage, accurately capture the pathological process in the threedimensional space within the affected structure, and help guide specific therapeutic applications. The spectrum of cardiovascular pathologies, which may derive enormous therapeutical benefit from the new discoveries in the sector of nanobiology and nanotechnology, includes ischemia, reperfusion-associated conditions, organ undersupply with nutrients and oxygen, acute cardiovascular trauma and wound healing, and atherosclerosis and its hemodynamic consequences. Furthermore, prevention of the progression of a pathological condition will be lifted to a new level of efficacy, by guided antiproliferative drug delivery and miniaturized “detectives” such as nanorobots and nanomachines.