Advancements in Stem Cell Therapies and Research for HLHS Heart Warriors

Dr. Timothy Nelson is the director of the Todd and Karen Wanek Family Program for HLHS at Mayo Clinic. Dr. Nelson and his team are specifically interested in the cause of hypoplastic left heart syndrome (HLHS) and finding ways to delay and prevent heart failure for individuals with HLHS. To better understand and treat this congenital heart disease, the program has taken a multifaceted approach that includes research into stem cells, genetics, imaging tools, and the creation of a biorepository. The program has launched clinical trials using autologous stem cells, also known as stem cells collected from an individual’s own body.In today's program, Dr. Nelson talks with Anna about the research that is being conducted at Mayo Clinic for both infants and adults. He talks about who can participate, how to find out more information and how people can contact his program for more information. Dr. Nelso also talks with Anna about where he believes the future of stem cell therapy and research is headed.

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Transcript

spk_0:   0:05
Welcome to heart to heart with Anna featuring your host on a Gorski. Our program is designed to empower the CH, or congenital heart defect community. Our program may also help families who have Children who are chronically ill by bringing information and encouragement to you in order to become an advocate for your community. Now, here is on the door to

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the ninth

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season of heart to heart with Anna Arthuis. Ignace is in his advances and congenital

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heart disease, and we have a great show for you today. Today show is advancements in stem cell therapies and research for H. L. H s Heart Warriors, and our guest is Dr Timothy Nelson. Dr. Timothy Nelson is the director of the time Hearing Juan IQ Family program for a chili Chest at Mayo Clinic. Dr. Nelson earned his PhD an MD from the Medical College of Wisconsin in Milwaukee, Wisconsin. His residency and fellowship work was done at Mayo Clinic in Rochester. Dr. Nelson's research work is focused on cardiovascular regeneration, using bio engineered stem cells to improve the ability to discover, diagnose and ultimately treat mechanisms of degenerative diseases. As director of the program, Dr Nelson and his team are specifically interested in the cause of HHS and finding ways to delay and prevent her failure for individuals with its religious or hypoplastic left heart syndrome. To better understand and treat this congenital heart disease. The program has taken a multifaceted approach that includes research into stem cells, genetics imaging tools and the creation of a bio depository. The program has launched clinical trials using autologous stem cells, also known as stem cells collected from an individual's own body. Welcome to heart to heart with you in a Dr Nelson.

spk_2:   1:50
Thanks so much for having me today.

spk_1:   1:52
Well, I'm very excited about this program because we actually started Season nine featuring Jennifer Government who sent participated in the clinical trial using stem cells collected from umbilical cord blood at your facility. And she was my very first episode of this season. So here we are. You are ending the season for me. And here we are, talking about stem cells again. So can you tell us about the research you're doing regarding stem cell therapy for events born with hypoplastic left heart syndrome or Rachel Aegis?

spk_2:   2:25
Great. Thank you. Our work here at the time Karen wanted family program is really focused on the causes and cures for hypoplastic left heart, and the main thing that we're focusing on is a curative focus is regenerative medicine using cell based therapies. And so our ability to move this forward and congenital heart diseases such as HHS has really been informed, based on a decade's worth of work in the adult dictations with diseases of the heart. So we have repurposed similar technology used in patient's own cells to be able to try to rebuild and re strengthen the heart of the Hypo plastic left hardest, earliest possible. And so one of the main focal point of our program today is using on bill cord blood to be able to collect from the baby when they're born, process them and store them in the freezer until they have their second surgery at the Glen operation. And at that stage that sells air ready to be delivered into the heart muscle during the surgery. And we can then follow the patients to make sure that we are not doing any harm to the heart, but also hoping that we could make heart stronger in the coming months. And so this work is exciting and that it gives us move treatment options potentially down the road. But it's important to realize that we have done this on only four patients today, and it's early stages research. And we're learning every single day of how to make this type of therapy safer and more effective as we go forward with the ultimate goal of being able to rebuild the heart of these babies with hypoplastic left heart such that they don't develop heart failure. And ultimately they don't ever require the need for heart transplantation.

spk_1:   4:01
I just think that's amazing. So you have to wait several months. Is there something happening to this cells while you're waiting? Are you actually having to grow more? Or why is it that you have to wait before you can see the stem cells back into the heart?

spk_2:   4:15
It's a great question, so we collect the cells from the umbilical cord blood at the time of birth, so we obviously have to know the diagnosis and have a plan in place before the child is born. But then the processing of the cells takes place in a centralized facility, and we do multiple testing on those cells over the next couple of weeks to make sure that they're safe. Things such as any contamination during the collection process would prevent us from using those cells in future clinical applications. So we do not grow them actually in the lab. We actually just process them and then do our release testing on them to make sure that we have a safe product that we can use during a scheduled cardiac surgery, which in this case, the next one would be the Glen operation at 3 to 6 months.

spk_1:   4:59
Right? Because usually the Norwood is starting within the first few days of life, and that wouldn't be enough time to process the blood. Is that true?

spk_2:   5:08
That's two of her current processing. We obviously are working on new cells and new processing procedures to be able to do that sooner because it's our philosophy and our belief, based on our research that we believe that earlier we do these types of therapies, the more potential benefit we could have with them. So ideally, we would be able to do these at even the Norwood and may be repeated at subsequent surgeries, so that type of work is currently being informed with the animal and research work that we're testing to build to define the next clinical trial.

spk_1:   5:40
Okay, so maybe you can answer a burning question for me. I was reading about this research, and it surprised me that the seating of the cells happens on the right ventricle for HHS warriors, since the left one is while type of plastic. Since it's too small, why wouldn't you put the cells on the small one toe try and beef it up?

spk_2:   6:02
Yeah, it's a great question. So because of the Norwood operation, these babies become dependent on the right ventricle, and the left ventricle is really not doing much, if anything, in circulation of these Davies. And so our view has been initially to tryto strengthen the right side of the heart, which the baby is now dependent on. And if we can make that right side of our bigger and stronger with that Norwood operation, that would be a nim. Prove mint on what our current standard of care is. However, you can absolutely envision when and if the technology matures to the point where we could rebuild the left side of the heart where now you could probably have a increased left ventricle. And maybe for some people someday down the road, that could be the type of therapy that would a lotto a five ventricular system to be repaired and not be dependent on a single ventricle. So that would be the ultimate goal. But that isn't where our current focuses today.

spk_1:   6:58
Okay, so I was wondering, I would think that the ultimate goal would be to have a four chamber heart instead of the two chamber heart that we do now because we know that the Fontane physiology is good enough for our survivors to make it to adulthood. But we also know that if auntie and physiology has inherent problems, so if you could make the heart of four chamber heart, it would prevent certain problems. I'm glad to see this is something that could change over time.

spk_2:   7:24
Absolutely. And that four chambered heart is the normal structure and has obviously got superior benefits over a single ventricle hump, whether it's the right side or the left side. So the phase approach of this technology will be to try to augment our current standard of care. But as that evolved in is, that proves to be effective, we would absolutely be able to take on the next layer of challenges, which would be ultimately to strengthen both chambers.

spk_1:   7:50
When I was doing a lot of this research and mind you, I started to research about 20 years ago, and I'm not a doctor. I'm just a mom. I have a son who was diagnosed with H. L A chest 22 years ago, and he is my inspiration and why I do what I do. But when I was doing research early on, it said that the left side of the heart, the cells or the muscle looks different than the right side of the heart. It's more muscular, and it's supposed to work harder than what the right side does when your receding stem cells would. They know that they have to be different. Is there some kind of magic that goes on that way?

spk_2:   8:29
There's a couple of points to be thinking about in the question you're raising as the embryo develops. Actually, the right side of the heart and left side of the heart come from two completely different sources of stem cells in the embryo. It's called the primary Hartsfield in the secondary Hartfield until the origins, the starting material of the right and most side actually come from two different cell populations as our embryo develops. So it's thought that because we have a left sided problem that those left sided primary Hartfield cells may be the problem for the development of hyper plastic left heart. It's also true that as the baby develops with post natal circulation and the pulmonary circulation increases, the less site have higher pressures than the right side of the left. Normally pumps blood to the whole body, where the right heart usually only pumps blood to the lungs and that pressure difference that workload of the right side and left side forces the left side of the heart to grow bigger and stronger because of a workload. So it's both the origins of the cell. The starting material are different, but also the pressures are dramatically different in a normal heart. And the combination of those two definitely leads to the left heart being a different shaped structure and function in the right heart. If we can learn from those lessons of embryology and physiology, the goal is really to try to reshape and re cultivate the right ventricle into what would look and feel and behave more like a natural.

spk_1:   9:59
Yeah, wow, that's fascinating. But that also explains why it's been so difficult to grow a heart in the laboratory. It seems like cloning hearts. It just hasn't been successful yet. And I think it's because it's so complicated, like what you were just describing.

spk_2:   10:16
Well, the heart is made up of many, many different from cardio, my sights to smooth muscles to end Ophelia and getting them all to function in their normal pattern. Way of it is absolutely a challenge of bioengineering, and I think the way to focus that initially was to try to focus on the cardio, my sex on the workload of the heart and try to rebuild that. But as the technology evolves in his three D printing and bio engineering technologies involved, I think there's lots of exciting avenues where this type of technology could be this in the future.

spk_1:   10:49
It is exciting. It really isn't. I was just talking with Dr Bove a last week and he was saying that one of the big problems is to provide a consistent blood source to the cells so that they can continue to grow properly. And so the electrical impulses will be configured so that they work in harmony together. That right now they can get it to pump. But it's not necessarily pumping away. It needs to in order to sustain life. Is that right? Am I understanding that right is I guess what I'm asking

spk_2:   11:22
It comes to trying to recreate the stations of re engineer. Um, I think that the blood supply from the capital A is all the way to the pumping chamber and musicians here, the pumping him, All these things come into play, and there's probably never going to be a one solution that six. All of these problems and the way we focus on it, is trying to think what is the most important of the highest priority we can affect today. And that's why we've chosen to focus on trying to make the heart muscle stronger with new cardio Maya sites that increase the workload heart. That, by itself is not sufficient to address all the circulatory issues that ma'lik issues other things like that. So it ultimately is going to take a multidisciplinary team approach with multiple technologies to continue to improve this, but that makes it very exciting. And it's all optimistic, for the future will bring

spk_1:   12:13
absolutely well. We need to take a quick commercial break, but don't leave yet listeners, because when we come back, we're going to talk to Dr Nelson about how you can find out if your baby can take part in one of these clinical trials. And we'll also find out what kind of stem cell research is going on

spk_0:   12:30
for adult heart warriors. We'll be

spk_1:   12:32
back in just a brief moment.

spk_4:   12:34
The most common here is why she always needed a lot of attention. She had strokes, even though it's a national inclination to withdraw from the CHD community. I think being a part of it, help me be part of a solution. Heart to heart With Michael Please join us every Thursday at noon. Eastern. I'm Michael, even on I'll be your host is we talked with people from around the world who have experienced those most difficult moments tonight forever by the Baby Blue Sound collective. I think what I love so much about this CD is that some of the songs were inspired by the patient's many listeners will understand many of the different songs and what they've been inspired by. Our new album will be available on iTunes. Amazon dot com. Spotify I love the fact that the proceeds from this CD are actually going to help those with congenital heart defects. Joining Music Home

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Tonight forever

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You are listening to heart to heart with Anna. If you have a question or comment that you would like to dress down, show police in an email to Anna Dworsky at Anna at heart to heart with anna dot com. That's Anna at heart to heart with anna dot com Now back to heart, to heart with them Welcome back to our show. Heart to Heart With Anna A show for the congenital

spk_1:   14:09
heart defect community Today Show is advancements and stem cell therapies and research for HHS Heart Warriors, and our guest is Dr Timothy Nelson. We got pretty deeply into the stem cell research that's going on right now at Mayo Clinic, but we didn't find out how people can participate in this clinical trial. So you said there have only been four babies who have been in this trial. Can you tell us a little bit more about it.

spk_2:   14:37
Yes, so we have two main protocols that are open. Currently, the 1st 1 is for babies with hypoplastic left heart, and this requires us to collecting umbilical cord blood at the time of birth. So it does require us to be able to make the diagnosis in utero and get a plan in place to get the court blood collected. That effort is now available to everybody with the diagnosis of HHS, no matter where they are in the United States, and we have the ability and the resource is, Do they wanna family foundation to build a collect and process and store up to 1000 cord blood's a year for these families with a junkie? Just And that's the important starting point was typically the far majority of cord blood today, for a cello just is not being collected at the time of birth. And with our infrastructure in place, we think that this is going to allow more babies to participate in this type of research as we go forward. And so that's really important starting point and in addition to that, then those babies at the Glen operation or when the cells are delivered into their heart during that clinical trial at 3 to 6 months of age.

spk_1:   15:45
So can you tell me what the advantage would be for a baby to receive the kind of treatment that you're talking about? Where the umbilical cord blood is putting this bio repositories and then used during the Glen procedure versus having just a traditional Norwood without having to worry about this extra step?

spk_2:   16:05
Yeah, it's a great question, and it's important for everybody to realize that this is very really research in that we've only done it a handful of times, and the reason we're doing that is because we hope that the cell based therapies can augment and increase the natural regenerative response of the heart to make that right ventricle bigger and stronger. What we don't know and the reason we're doing the research is how effective those cells will be. Long time, and so there is a lot of unknown, and that's why it's a girly phase. One research study and so reason to participate in this is because of families wanting to be part of a research study. It was the hope that the research will lead us to new discoveries, but it's very important for people to realize that it's not for everybody. Not everybody would want to do this because it's not proven. It's not known and it is early Phase one research studies and that's the reality of where the technology is right now. But we believe the technology is matured to the point that it's the right time to begin testing and exploring these new opportunities, because the potential benefit long term is worth the exploration of this now is an innovative

spk_1:   17:17
right. It certainly is innovative. But the FDA is usually really strict when it comes to any kind of research, and usually you have to do some research on animals before it's tested on humans. Have there been studies done like this on animals that have really good outcomes?

spk_2:   17:35
And so we do all of our testing as required by the FDA before we get the permission to do this and you're absolutely correct. The FDA is a critical partner in being able to move these types of studies forward, and we have a very strong working relationship with the FDA and we go through all of the appropriate pre clinical testing to be able to get the approval to be able to do this the first time in patients and that absolutely is critical. Equally important is being able to do this in a small number of patients to start with toe, learn from that very reflective on successes and potential challenges before we then go on to a larger studies. This has been done extensively in the adult patients with human heart disease patients that have had heart attacks. And really, our job is to re purpose in explore new technology that can be more effective in congenital heart babies.

spk_1:   18:27
Yeah, I love it. I love how we can take these ideas that are working in a different population and see, Will this work with a younger population? Will this work in infants? I don't know if you listen to Jennifer Show, but she is so excited with how well her son is doing. And she even reported that person's cardiologists said he wished everybody will get this kind of treatment. So right now I know it's still early in the clinical trial, but right now, at least with this one patient, the results seem to be outstanding.

spk_2:   18:59
Well, We're obviously very cautious with over interpreting when we have just a few patients. But we are very excited to continue moving forward as aggressively as possible with these types of study because this is exactly the vision. Long term is to be able to make this widely available to everybody if we can demonstrate that it's not only safe, but it actually can be effective on augment the cardiac function. So it takes a whole team of people from researchers in the laboratory all the way. Families participate to allow us to accelerate and do these types of studies

spk_1:   19:34
absolutely. And I love it that we're able to provide this information to the population at large so they can get the information and then that way, even if they're hospital isn't doing it, Perhaps we can work in conjunction with one another. Just because you're receiving treatment at one facility doesn't mean that you can't travel and receive an augment. It'd treatment at another facility and that's what I love about the hard world. It's a very tight community and people are talking about things sharing information and any and all of us benefit from sharing that knowledge now Of course, the one thing that I'm really excited about is that you don't have to have the cord blood in order to take part in stem cell research, that we can actually get stem cells from another part of the body. And so even adults can benefit from this new research. So can you tell us about the research that you're doing with adults?

spk_2:   20:26
Yes, you're absolutely right that everybody does have umbilical cord blood to be used in these types of clinical trials. Another cell type that's been commonly used in the adult population is bone marrow derived mano nuclear cells, which are quite simply collected from a bone marrow harvest, which requires blood to be collected out of the hip bone. Those cells could be processed very similar to the way we process umbilical cord blood, and we do that in a way that doesn't cause pain. It's a bit of an invasive procedure, but can be done relatively easily. The cells can be processed, and then we can use a catheter based approach to build to deliver the cells into the blood supply of the heart muscle during a catheter procedure, rather than an open heart procedure.

spk_1:   21:13
This wonderful, I mean, because I think one of the things that would be scary about this is, why would I wanna have another open heart invasive procedure when it's unproven? And that's really scary. But if this is something you can do in a cath lab, that makes it much more attainable for everybody.

spk_2:   21:30
What? So this study that we use adult bone marrow drive cells for is for patients that have a Fontane circulation that have a cardiac function that's less than ideal. But they're not on a transplant list and aren't overly sick. So it's a narrow population of patients that have reduced heart function but are not on the transplant list. And we can collect their stem cells, use their own cells and deliver it back into their heart muscle in this capital base procedure. And our hope there is that these cells can be proven as an adult to be safe, but also augment the regenerative capacity of their heart muscle to try to strengthen and make it stronger again to avoid heart failure and ultimately delay or prevent transplant. For these Fontane patients that may be in their teenage years, or even in their early twenties,

spk_1:   22:19
right? I was talking to Dean a barber earlier this season, and she actually is a nurse to one of the patients who has been in your adult studies. So we were talking about it. We're so excited. This is an up and coming field. I mean, this really is on the cusp of innovation and a pioneering efforts. So I commend you for all that you're doing. And it's very exciting to me to see that there are so many different therapies that are available right now, Dr Pavilion, or we're talking about that just last week, saying that what's up incoming is that our Fontane patients won't necessarily need a heart transplant. And I think that's really exciting because we know that there aren't enough hearts available. And when you have a heart transplant, then you have a whole new host of problems that can occur. So if we can just beef up people's hearts themselves so they don't go into heart failure and don't need a transplant, that's just it really is miraculous when she say,

spk_2:   23:15
Well, it's what we hope to be able to participate and try to move forward because we obviously recognize the need and the transformative ability for families and individuals that faced ease concerns every single day. So it absolutely is the right time to be testing your things and move in the science and technology forward. And we're just simply grateful for the families and the care providers across the country that are ableto participate and willing to partner with us to do these things because it doesn't happen without families. And it doesn't happen without the courageous participation in these types of studies. One, It's early stages and not proven. But that's where it starts, and that's what it takes. And we're quite confident that we're in a good time with a good team of people, and we are confident that we'll be able to help move this type of technology forward.

spk_1:   24:07
Okay, well, we need to take a quick commercial break, but I want to learn more about this, and I want to find out how people can be part of this research, so don't leave yet. Friends will be back after this quick break, and we'll talk to Dr Nelson about how you can get involved with this research.

spk_0:   24:25
When I saw so many of the CH three groups growing, I found family just written to join May. Anyone who is a member of the adult congenital heart defect community can be a guest on our show way. Have a great year plan that we look forward to sharing other interesting topics. Heart to heart With Poland David Serving a CHD community Wednesdays at noon Eastern.

spk_3:   24:54
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spk_0:   25:26
to our shell heart to heart within a show for the congenital heart defect

spk_1:   25:30
community today shows advancements of stem cell therapies and research for HHS warriors, and our guest is Dr Timothy Nelson. We just finished talking to Dr Nelson about a clinical trial that's being done at Mayo Clinic for infants and also 14 adults with HHS. And now I want to get from you specifically what people have to do so they can take part in your studies, Dr Nelson.

spk_2:   25:55
But this first study with cord blood in the babies, the first step is toe have the cord blood collected, and we have a team of people and infrastructure to be able to help any mother anywhere. Be able to do this. And it's quite simply, the ability to email us at HHS at Mayo that you and that actually just at Mayo Daddy, you email address allows us to get connected immediately with our study coordinator team and be able to coordinate the collection process. And I think that's a really important first step that if we don't get, we don't have the ability for that first study. Once the poor blood is collected, we are creating a consortium of centers across the country that are participating in the delivery of those cells. And so not only in Rochester, Minnesota, here at Mayo Clinic, but we also have the building currently to do this at University of Oklahoma is part of that clinical trial, and we're in the process of creating a consortium beyond that across the country. Recently, we're super excited. When Chop Children's Hospital Philadelphia became the first member of this nationwide consortium. That consortium is going to allow us to bring the cells that have been frozen doom or local regional areas where families are closer. In the last four or five years, we've learned the hard way that it's very difficult for them to travel far with a family and with the support system to centers that do it in one place in the country. And so we're thinking that very concerted effort to bring this to regional areas across the country so that we can increase the participation and we're super excited. The chop is our initial partner to help us figure this out, and you hope 2017 there'll be three or four other centers that come on board with the same way of being able to deliver these cord blood cells during the clinical operation.

spk_1:   27:46
That would be fabulous. I hope you come to Texas Children's because you know I'm in Texas and they have a wonderful facility there. They should be part of this consortium

spk_2:   27:57
and the other way to participate with the Dell Bone Males themselves again. Do that email address h l. A job that mail that even you were able to connect with screening patients of how they might be eligible for the study. And that can happen by anywhere new place in the country. Sending us records. Do that system and we can screen. And we have had patients that are older with Fontana that are a bit more more violent, easier to travel. That study is currently only available in Rochester, Minnesota, but again, these types of studies. The goal is to be able to make them more broadly available. Toe local regional partners that prevent families from the need to travel far

spk_1:   28:37
right. And you were saying that the adult clinical trial that you're doing is only for people with a very narrow diagnosis? Does it go by the rejection fraction? Does it go by how many years post Fontane they are? I mean, how is it that you determine who can take part in that clinical trial?

spk_2:   28:58
I would encourage anybody that is interested in it to contact us and let us help figure that out for you. I don't expect anybody to know the details of this themselves. Yet One of the main criteria is that the heart function on the right side can't be normal. The heart function has to be decreasing in its cardiac function to essentially an ejection fraction less than 40% which is estimated with an echo. But this is a bit subjective, and it's a bit difficult to actor measure. And so that's where it's important for families and individuals that think they would be interested. I want to learn more to contact us and let us help you figure that out Ourselves,

spk_1:   29:40
I know forms them research that I've done recently, that the foundation actually has some scholarships or some ways to help people financially to do this. Can you tell us about that?

spk_2:   29:52
Yes, we recognize that the travel for research participation is the big limitation, and so we do have the ability to help offset some of the travel expenses when families have to travel to participate in these research studies, and so that is available in most of our research studies. It sometimes doesn't cover all of the expenses, but it is meant to help decrease the burden and try to enable more participation because, as I've said before, the studies are exciting. But they are never completed without families participating in them.

spk_1:   30:24
Right, right. Well, I love how the community is really excited about this research that I don't know if you're out on Facebook and you're seeing that. But when we start posting things about this, there are a lot of questions, and a lot of people are really excited. It's not uncommon for people assume as they find out they're pregnant with a baby with Rachel a chest for them to turn to the Internet. And Facebook is just exploding with the number of groups and pages to help families like that. Sisters by heart is another big group that actually devotes itself to HHS and to have them be part of this and helping to promote understanding of this is just huge. So now I'm gonna ask you to make a prediction and tell us what you think The next big advancement regarding stem cell therapy will be.

spk_2:   31:16
I clearly believe that the next big advancement for cell based therapy in the heart is going to be realized in congenital heart for multiple reasons. I think that the science is teaching us that the pediatric infant heart is designed and does grow more than ever recognized in the past, and by augmenting that with cell based therapies to stimulate it and increase its ability to regenerate is what we've been doing for a decade in the adult world. Yet that same type of technology is going to be even more effective. The younger we use it. And so I do predict. And I do anticipate that the next big thing for cell based therapy is going to be augmentation of cardiac function in congenital heart patients. And each I just is a really wonderful area, too. Start because of all of the surgical intervention, a lot opportunities that we have with each of these Children and the need is so great for them. I believe that we will learn a lot in the coming 2 to 3 years, and I do believe that we will know where the trajectory is heading with a greater degree of certainty in the coming couple of years.

spk_1:   32:25
I just love that prognosis when you're a parent and you're told your baby has a diagnosis that most of us have never heard of before and that the prognosis when I was told y two years ago is very poor, they didn't expect my son to survive. The first surgery, much less the next to that, were coming down the line. In fact, they told us to take my son home toe, love him for what little time he had left. Clearly, that wasn't an option for me, and I begged them to do whatever they could. I can't imagine being in a environment where possibly something like stem cell therapy or stem cell treatment would be available and could possibly prevent the HHS from being as bad as it is. And maybe in the future, not even occurring at all. We're diagnosing thes heart defects in utero with much better accuracy. Do you first see a time when perhaps an in utero diagnosis might also yield an in utero treatment with stem cells?

spk_2:   33:26
I think it's possible. I think it's a bit difficult for me to see a direct line of sight of that today with where we're at with the research studies in the science and obviously learning from our patients and their clinical trials that are currently ongoing is going to determine the trajectory on that. But absolutely, the technology and the vision of where this leads not only allows us to start planning and anticipating how we can do this in you, Toral in some select patients to strengthen the heart. That would be a conceivable vision of where this leads us. But it also allows us to start thinking about how to rebuild tissues and structures that augment our surgical correction procedures. So many of those things are conceivable with where the technology is reading us. Our focus also needs to be on what we can do today to make that vision more of a reality. And I think it's important to realize that the investment of the wanted Family Foundation, the partnership of the consortium and the participation of families is really what allows us to accelerate this so that we're not talking about what will happen 20 years from now. But we're really trying to design therapies that can solve the problems that we face today, and so I think that's what's most motivating for all of us is to really have your ability to focus on the needs of today and try to offer solutions for that is what motivates our team.

spk_1:   34:48
I just absolutely loved that. Now we may have some people who are listening who would like to donate financially to the foundation. How would they go about doing that?

spk_2:   34:57
Well, our programs that Mayo Clinic's a nonprofit institution. We do obviously used philanthropy with all the intentions of stewarding that and we would't any nonprofit institution. And the time Karen wanted Family Foundation is great example of that. So I think there's many ways of engaging in this, and I think that that philanthropic component of this is equally important that all the other pieces that we talked about

spk_1:   35:24
So if somebody were interested in donating Thio, the wanted foundation, what they use that same hohs that mayo dot did you?

spk_2:   35:32
Yeah, I think the actually just at Mayo that Edie you is ah, great portal for any of these types of questions that we can help channel into the right teams of people. That's our primary communication portal for all of the stakeholders, while their families or other people and other institutions, so it's a great place to use.

spk_1:   35:49
It is absolutely fabulous. Thank you so much for coming on the show today, Dr Nelson. I'm so inspired by what you've shared with me.

spk_2:   35:57
Thanks for having me. And I think that the families like yours and families that listen to your program that I really, truly the inspiration for our team. So thanks for having us.

spk_1:   36:06
It has been my pleasure. Definitely. And that does conclude this episode of heart to heart with Anna. Thanks for listening today. This is the final episode of season nine of Heart to Heart. With Anna. We hope you've enjoyed this season of shows putting a spotlight on advancements in congenital heart disease. We're going to take a few weeks off to prepare for Season 10 education for CHD Warriors. But we'll be broadcasting a few shows with guest host until then. So please come back next week and take a minute to find our show and raid us on iTunes so that even more people can

spk_0:   36:39
find us Ellis into the program. Until then, remember, my friends, you are not alone. Thank you again for joining us this week Way Hope you have been inspired on, empowered to become an advocate for the congenital heart defect community. Heart to heart With Anna With your hose down, Dworsky can be heard every Tuesday at 12 noon Eastern time.

spk_5:   37:12
Heart to Heart with Emma is a presentation of hearts, Unite the Globe and is part of the hug Podcast Network Hearts Unite The Globe is a nonprofit organization devoted to providing resource is to the congenital heart defect community to uplift and power and enrich the lives of our community members. If you would like access to free Resource, is pretending to the C H T community. Please visit our website at www congenital heart defects dot com for information about CHD, the hospitals that treat Children with CHD summer camps for CHD survivors and much, much more.