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      Human-iPSC-Derived Cardiac Stromal Cells Enhance Maturation in 3D Cardiac Microtissues and Reveal Non-cardiomyocyte Contributions to Heart Disease

      1 , 17 , 1 , 17 , 1 , 17 , 1 , 1 , 1 , 1 , 2 , 3 , 1 , 1 , 4 , 4 , 5 , 6 , 4 , 6 , 7 , 8 , 1 , 15 , 9 , 16 , 4 , 10 , 7 , 11 , 3 , 2 , 1 , 1 , 18 , , 1 , 12 , 13 , 18 , ∗∗ , 1 , 14 , 18 , 19 , ∗∗∗
      Cell Stem Cell
      Cell Press
      human-induced-pluripotent-stem-cell-derived cardiomyocytes, human-induced-pluripotent-stem-cell-derived cardiac fibroblasts, cardiac microtissue, cardiomyocyte maturation, cell-cell interaction, gap junction, cyclic AMP, cAMP, arrhythmogenic cardiomyopathy, cardiac disease model

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          Cardiomyocytes (CMs) from human induced pluripotent stem cells (hiPSCs) are functionally immature, but this is improved by incorporation into engineered tissues or forced contraction. Here, we showed that tri-cellular combinations of hiPSC-derived CMs, cardiac fibroblasts (CFs), and cardiac endothelial cells also enhance maturation in easily constructed, scaffold-free, three-dimensional microtissues (MTs). hiPSC-CMs in MTs with CFs showed improved sarcomeric structures with T-tubules, enhanced contractility, and mitochondrial respiration and were electrophysiologically more mature than MTs without CFs. Interactions mediating maturation included coupling between hiPSC-CMs and CFs through connexin 43 (CX43) gap junctions and increased intracellular cyclic AMP (cAMP). Scaled production of thousands of hiPSC-MTs was highly reproducible across lines and differentiated cell batches. MTs containing healthy-control hiPSC-CMs but hiPSC-CFs from patients with arrhythmogenic cardiomyopathy strikingly recapitulated features of the disease. Our MT model is thus a simple and versatile platform for modeling multicellular cardiac diseases that will facilitate industry and academic engagement in high-throughput molecular screening.

          Graphical Abstract


          • Cardiac fibroblasts and endothelial cells induce hiPSC-cardiomyocyte maturation

          • CX43 gap junctions form between cardiac fibroblasts and cardiomyocytes

          • cAMP-pathway activation contributes to hiPSC-cardiomyocyte maturation

          • Patient-derived hiPSC-cardiac fibroblasts cause arrhythmia in microtissues


          Orlova, Bellin, Mummery, and colleagues combined three hiPSC-derived cardiac cell types in 3D microtissues. Cardiomyocytes matured structurally and functionally. Replacing healthy hiPSC-cardiac fibroblasts with patient fibroblasts recapitulated aspects of arrhythmogenic cardiomyopathy. Single-cell transcriptomics, electrophysiology, metabolomics, and ultrastructural analysis revealed roles for CX43 gap junctions and cAMP signaling in the tri-cell-type dialog.

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          Most cited references48

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          Single-cell sequencing reveals dissociation-induced gene expression in tissue subpopulations

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            Calcium and Excitation-Contraction Coupling in the Heart

            Cardiac contractility is regulated by changes in intracellular Ca concentration ([Ca2+]i). Normal function requires that [Ca2+]i be sufficiently high in systole and low in diastole. Much of the Ca needed for contraction comes from the sarcoplasmic reticulum and is released by the process of calcium-induced calcium release. The factors that regulate and fine-tune the initiation and termination of release are reviewed. The precise control of intracellular Ca cycling depends on the relationships between the various channels and pumps that are involved. We consider 2 aspects: (1) structural coupling: the transporters are organized within the dyad, linking the transverse tubule and sarcoplasmic reticulum and ensuring close proximity of Ca entry to sites of release. (2) Functional coupling: where the fluxes across all membranes must be balanced such that, in the steady state, Ca influx equals Ca efflux on every beat. The remainder of the review considers specific aspects of Ca signaling, including the role of Ca buffers, mitochondria, Ca leak, and regulation of diastolic [Ca2+]i.
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              Patient-specific induced pluripotent stem cell derived models of LEOPARD syndrome

              Generation of reprogrammed induced pluripotent stem cells (iPSC) from patients with defined genetic disorders promises important avenues to understand the etiologies of complex diseases, and the development of novel therapeutic interventions. We have generated iPSC from patients with LEOPARD syndrome (LS; acronym of its main features: Lentigines, Electrocardiographic abnormalities, Ocular hypertelorism, Pulmonary valve stenosis, Abnormal genitalia, Retardation of growth and Deafness), an autosomal dominant developmental disorder belonging to a relatively prevalent class of inherited RAS-MAPK signaling diseases, which also includes Noonan syndrome (NS), with pleiomorphic effects on several tissues and organ systems1,2. The patient-derived cells have a mutation in the PTPN11 gene, which encodes the SHP2 phosphatase. The iPSC have been extensively characterized and produce multiple differentiated cell lineages. A major disease phenotype in patients with LEOPARD syndrome is hypertrophic cardiomyopathy. We show that in vitro-derived cardiomyocytes from LS-iPSC are larger, have a higher degree of sarcomeric organization and preferential localization of NFATc4 in the nucleus when compared to cardiomyocytes derived from human embryonic stem cells (HESC) or wild type (wt) iPSC derived from a healthy brother of one of the LS patients. These features correlate with a potential hypertrophic state. We also provide molecular insights into signaling pathways that may promote the disease phenotype.

                Author and article information

                Cell Stem Cell
                Cell Stem Cell
                Cell Stem Cell
                Cell Press
                04 June 2020
                04 June 2020
                : 26
                : 6
                : 862-879.e11
                [1 ]Department of Anatomy and Embryology, Leiden University Medical Center, 2333 Leiden, the Netherlands
                [2 ]Leiden Institute of Physics, Leiden University, 2333 Leiden, the Netherlands
                [3 ]Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 Leiden, the Netherlands
                [4 ]Department of Cell and Chemical Biology, Leiden University Medical Center, 2333 Leiden, the Netherlands
                [5 ]Sequencing Analysis Support Core, Leiden University Medical Center, 2333 Leiden, the Netherlands
                [6 ]Centro de Biologia Molecular Severo Ochoa, Departamento de Física de la Materia Condensada, Instituto Nicolas Cabrera and Condensed Matter Physics Center (IFIMAC), Universidad Autónoma de Madrid, 28049 Madrid, Spain
                [7 ]Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
                [8 ]Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
                [9 ]Central Laboratory Animal Facility, Leiden University Medical Center, 2333 Leiden, the Netherlands
                [10 ]Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, 1007 Amsterdam, the Netherlands
                [11 ]Department of Cardiology, Leiden University Medical Center, 2333 Leiden, the Netherlands
                [12 ]Department of Biology, University of Padua, 35121 Padua, Italy
                [13 ]Veneto Institute of Molecular Medicine, 35129 Padua, Italy
                [14 ]Department of Applied Stem Cell Technologies, University of Twente, 7500 Enschede, the Netherlands
                Author notes
                []Corresponding author v.orlova@ 123456lumc.nl
                [∗∗ ]Corresponding author m.bellin@ 123456lumc.nl
                [∗∗∗ ]Corresponding author c.l.mummery@ 123456lumc.nl

                Present address: Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, 20095 Cusano Milanino, Italy


                Present address: Department of Pathobiology, Anatomy and Physiology Division, Faculty of Veterinary Medicine, Utrecht University, 3584 Utrecht, the Netherlands


                These authors contributed equally


                Senior author


                Lead Contact

                © 2020 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).


                Molecular medicine
                human-induced-pluripotent-stem-cell-derived cardiomyocytes,human-induced-pluripotent-stem-cell-derived cardiac fibroblasts,cardiac microtissue,cardiomyocyte maturation,cell-cell interaction,gap junction,cyclic amp,camp,arrhythmogenic cardiomyopathy,cardiac disease model


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