# The Long and Winding Road to Cardiac Regeneration
## 4 Biomaterials
### Natural Biomaterials
#### 4.2.8. Decellularized Extracellular Matrix
Through a combination of physical and chemical methods, the researchers managed to decellularize human myocardial tissue while preserving the extracellular matrix. Repopulating the d-ECM with human iPSC-derived cardiac cells yielded impressive results. The resulting constructs showcased organized tissue structure, contractility, and electrical coupling, effectively demonstrating the successful regeneration of functional human cardiac tissue [267]. Furthermore, a groundbreaking study by [PERSON] et al. (2018) explored the feasibility of utilizing decellularized porcine cardiac extracellular matrix for cardiac regeneration. By employing a combination of detergents and enzymes, the researchers successfully decellularized porcine hearts, yielding acellular scaffolds. These scaffolds were then seeded and implanted into the infarcted hearts of pigs. The study highlighted that the decellularized scaffolds not only promoted cell survival and tissue integration but also significantly improved cardiac function, offering compelling evidence of the regenerative potential held by d-ECM [268]. In addition to these studies, an article published by [PERSON] et al. (2020) further contributes to the understanding of decellularization in cardiac tissue engineering. The researchers focused on the decellularization of human skin to create a scaffold for cardiac cell seeding. By implementing a combination of enzymatic and physical methods, they successfully decellularized the human skin, preserving the extracellular matrix. Subsequent repopulation of the d-ECM with human CTCs led to the formation of organized tissue structures and the expression of cardiac-specific markers, indicating the potential for functional cardiac tissue regeneration [50; 269]. Moreover, a groundbreaking publication by [PERSON] et al. (2023) investigated the potential of d-ECM materials as a scaffold for cardiac regeneration [270]. Additionally, a noteworthy study by [PERSON] et al. (2017) showcased the regenerative potential of decellularized human skin in a rat model of myocardial infarction. The researchers effectively decellularized human dermal skin using anionic surfactants, resulting in an acellular matrix. By seeding the decellularized matrix with rat cardiac cells and implanting it into the infarcted hearts of rats, the study revealed significant improvements in cardiac function, tissue regeneration, and angiogenesis. These findings underscored the therapeutic potential of decellularized skin for cardiac tissue engineering [271]. Collectively, these published examples provide compelling evidence for the effectiveness of decellularization in cardiac regeneration. They illustrate the successful repopulation of decellularized scaffolds with cardiac cells, ultimately leading to the formation of fully functional cardiac tissue and substantial improvements in cardiac function. These studies highlight the immense potential held by decellularization techniques in advancing the field of cardiac tissue engineering, emphasizing the necessity for further research and development in this promising area of study Inizio modulo. The application of natural biomaterials for cardiac regeneration has yielded significant achievements across multiple areas. Published studies have demonstrated the creation of new blood vessels using biomaterials-based approaches [272]. Furthermore, innovative heart valves fabricated from biomaterials have shown promise in improving the long-term outcomes of valve replacement surgeries [273; 274]. Implantable devices, such as pacemakers, heart valves, and stents, have also witnessed noteworthy advancements due to the integration of biomaterials. These biomaterial-based devices have demonstrated improved biocompatibility and durability, contributing to the restoration of cardiac function and enhanced quality of life for patients with cardiovascular conditions [275; 276]. The rapid progress in the field of biomaterials for cardiac regeneration is impressive.