Influence of the cardiomyocyte niche on cell-based heart repair

Cardiovascular disease remains the leading cause of death worldwide. A lack of curative treatments and a shortage of transplant hearts necessitate new approaches to cardiac repair. Recent advances, including the advent of pluripotent stem cell-derived cardiomyocytes and the development of tissue engineering techniques, represent promising new directions to remuscularize the heart or induce endogenous regeneration. However, these approaches are currently limited by the immaturity of differentiated cardiomyocytes and the inability of cardiomyocytes to functionally integrate with the damaged myocardium. Mimicking the cardiomyocyte niche, the myriad signals surrounding the cardiomyocyte, may enhance the utility of these cells. In this dissertation, each of the three aspects of the cardiomyocyte niche: physical signals, the extracellular matrix, and soluble factors, are examined for their ability to guide cardiomyocyte growth and function. We first explore the effect of electrical stimulation, a physical signal pervasive in the heart, on pluripotent stem cell-derived cardiomyocyte development and function. Stimulated cardiomyocytes are more mature, show greater cell-cell connectivity, and are more resistant to tachycardic stress. Cardiomyocytes adapt their beating rate to the stimulation frequency, an effect mediated by the emergence of a rapidly depolarizing cell type and ion channel expression. We next engineer cardiovascular tissue architecture, critical components of the extracellular matrix, using a micromolding approach and determine geometric parameters necessary for the induction of cardiomyocyte alignment and tissue synchrony. We finally test pluripotent stem cell-derived cardiomyocyte exosomes, soluble nanovesicles specifically packaged and secreted by the cell, in vitro and in vivo, demonstrating functional improvement and reduction of arrhythmia in the heart. Therefore, the use of the cardiomyocyte niche supports the interrogation of cellular function to enable new cell-based approaches for the reduction of arrhythmia or induction of repair in the heart