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Athymic nude rats resemble nude mice in their lack of a normal thymus and functionally mature T cells. They have been useful in the study of mechanisms of tumor growth or graft rejection in immunocompromised hosts since they can accept major histocompatibility complex (MHC) mismatched organ allografts or xenografts for several months and because a number of tumor cell lines of human and rodent origin grow well in these rats. Injection of a few helper T (Th) cells from euthymic littermate rats partly restores the pool of mature T cells as well as full immunocompetence to reject organ allografts and has helped to reveal some of the cell interactions necessary for rejection to occur In contrast, immunologically naive athymic nude rats of certain strains, acutely reject allografts consisting of lymphocytes or bone marrow cells, which is due to the presence of alloreactive natural killer cells. These cells can recognize and kill MHC incompatible hematopoietic cells through the recognition of both mismatches within the classical (RT1.A) and nonclassical (RT1.C/E) MHC class I regions with a repertoire of inhibitory and activating killer lectin-like receptors (KLR) for MHC-I molecules, encoded by the Ly-49 portion of the rat natural killer cell gene complex (NKC). Some of these receptors have been identified and molecularly cloned and show similarities with NK receptors identified in the mouse. Other leukocytes in nude rats, such as dendritic cells, may also contribute to specific innate immune responses in the absence of mature T cells. Nude rats develop T-like cells expressing CD3 and T-cell receptor (TCR) with increasing age. Though their phenotype in peripheral lymphatic tissues resembles that of normal T cells, consisting mainly of CD4+ or CD8+ cells, they lack alloreactivity in vivo and their TCR repertoire is more of an oligoclonal nature. Their contribution to allograft rejection in T-cell-reconstituted rats is therefore questionable, and their role in innate immune response in these rats still enigmatic.
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Compact cardiomyocytes that make up the ventricular wall of the adult heart represent an important therapeutic target population for modeling and treating cardiovascular diseases. Here, we established a differentiation strategy that promotes the specification, proliferation and maturation of compact ventricular cardiomyocytes from human pluripotent stem cells (hPSCs). The cardiomyocytes generated under these conditions display the ability to use fatty acids as an energy source, a high mitochondrial mass, well-defined sarcomere structures and enhanced contraction force. These ventricular cells undergo metabolic changes indicative of those associated with heart failure when challenged in vitro with pathological stimuli and were found to generate grafts consisting of more mature cells than those derived from immature cardiomyocytes following transplantation into infarcted rat hearts. hPSC-derived atrial cardiomyocytes also responded to the maturation cues identified in this study, indicating that the approach is broadly applicable to different subtypes of the heart. Collectively, these findings highlight the power of recapitulating key aspects of embryonic and postnatal development for generating therapeutically relevant cell types from hPSCs.
Human pluripotent stem cell (hPSC)-derived cardiomyocytes represent a promising source of cells for developing in vitro models to study diseases of the human heart and for establishing therapies to treat them. Successful translation of these applications to clinical and/or commercial practice is, however, dependent on our ability to derive the appropriate target cell(s) of the disease of interest from hPSCs in vitro1. While diseases can affect different cell types of the heart, those that impair ventricular function such as myocardial infarction (MI) and ventricular arrhythmias are amongst the most severe and debilitating and can lead to organ dysfunction and failure. Given this, hPSC-derived ventricular cardiomyocytes are attractive therapeutic targets for both modeling life threatening arrhythmias and heart failure in vitro and for developing cell therapies to remuscularize ventricular myocardium damaged by MI. However, to produce appropriate ventricular cells for these applications, it is essential to understand how they are specified and develop in the embryo and neonate and apply this knowledge to the generation of comparable cell types from hPSCs.
In the mouse, the cardiomyocytes that make up the ventricular chambers derive from progenitors that are specified at the earliest stages of heart development, prior to the emergence of progenitors that contribute to the atrial and sinoatrial pacemaker lineages2. In addition to distinct right and left ventricular cells, the ventricular population in each chamber consists of subpopulations known as trabecular and compact cardiomyocytes3. Trabecular cardiomyocytes are the first to develop and are most abundant during fetal life. These cells develop in close contact with the endocardium and form the finger-like structures that protrude into the lumen of the chambers of the fetal heart. Compact cardiomyocytes develop next to the outer epicardium and give rise to the compact myocardium, the thick outer layer of the ventricular wall that provides the contractile force to pump blood throughout life. This myocardium is formed through a process of compaction that involves a transient proliferative stage required to generate sufficient numbers of compact cardiomyocytes to create the muscle3. Studies from model organisms have shown that factors secreted from the epicardium including retinoic acid (RA), Wnt, fibroblast growth factors (FGFs) and insulin-like growth factors (IGFs), play important roles in specification and proliferation of the compact lineage in the early fetal heart4,5,6,7.
Cardiomyocytes that make up the fetal heart are immature and display characteristics that distinguish them from their counterparts in the adult organ. These include automaticity, underdeveloped calcium handling capacity, poor mitochondrial oxidation capacity and a low level of contractile apparatus organization8,9. A major transition in the maturation status of the cardiomyocytes occurs at birth as the cells switch their energy production from glycolysis to fatty acid oxidation (FAO) to meet the increased workload of the newborn heart. Along with this switch, cardiomyocytes rapidly increase their mitochondrial mass resulting in enhanced mitochondrial oxidation capacity and exit the cell cycle giving rise to the quiescent population found in the adult organ10,11. While the regulation of fetal/postnatal cardiomyocyte maturation is not fully understood, evidence from a number of different studies have shown that signaling through peroxisome proliferator-activated nuclear receptors (PPARs) and responses to hormonal changes and lipids play a role in the metabolic switch and mitochondrial biogenesis in the postnatal heart12,13,14,15,16.
Studies aimed at generating ventricular cardiomyocytes from hPSCs have investigated different stages of this developmental progression, but none has recapitulated the entire developmental path from specification to maturation and function. With respect to the earliest lineage specification step, we have previously shown that the human ventricular lineage develops from a mesoderm population that is distinct from the one that gives rise to atrial cells, recapitulating the finding in the early embryo that these cell types derive from different progenitors17. The cardiomyocyte populations generated in our study as well as in most others published to date are immature and display characteristics similar to cardiomyocytes in the early fetal heart. Strategies aimed at maturing hPSC-derived cardiomyocytes have used electromechanical stimulation as well as exposure to pathway agonists and hormones that promote maturation of the metabolic machinery18,19,20. With respect to the latter approach, a number of different studies have shown that the addition of either lipids, hormones or PPARalpha (PPARa) agonists to the differentiation cultures will induce metabolic changes in the hPSC-derived cardiomyocytes indicating that the in vitro-derived cells can respond to stimuli that promote cardiomyocyte maturation in vivo20,21,22. While encouraging, none of these studies included quantitative approaches to determine the efficiency of maturation at the population level and none used well characterized target cardiomyocyte populations. As a consequence, it is difficult to compare the effect of the stimuli used in the different studies and it is not known if the manipulations described can impact the maturation status of different cardiomyocyte subtypes.
In this study, we followed a staged approach to generate functionally mature compact cardiomyocytes from hPSCs focusing on recapitulating the key events that regulate ventricular development and maturation in vivo. We show that Wnt and IGF signaling specify a compact cardiomyocyte population that in response to transient activation of PPARa signaling and hormonal and FA stimuli undergoes a series of maturation steps that include a switch from glycolysis to FAO. The mature cells are able to use exogenous FAs as an energy source, and show improved sarcomere structure, increased contraction force, increased mitochondrial oxidative capacity and changes in global RNA expression patterns. The metabolically mature ventricular cells initiate a reversion to glycolysis and an increase in lipid accumulation and progression to apoptosis following exposure to stimuli that mimic heart failure. Transplantation studies using the nude rat model revealed that the mature cells generated more mature grafts than the immature cells, suggesting that the maturation status of the transplant population can impact the quality of the graft. When exposed to the combination of maturation factors, atrial cardiomyocytes showed similar patterns of maturation, indicating that the strategy is not chamber specific. 041b061a72

