Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA.
Curr Cardiol Rep. 2023 May;25(5):295-305. doi: 10.1007/s11886-023-01852-3. Epub 2023 Mar 17.
Congenital heart disease includes a wide variety of structural cardiac defects, the most severe of which are single ventricle defects (SVD). These patients suffer from significant morbidity and mortality; however, our understanding of the developmental etiology of these conditions is limited. Model organisms offer a window into normal and abnormal cardiogenesis yet often fail to recapitulate complex congenital heart defects seen in patients. The use of induced pluripotent stem cells (iPSCs) derived from patients with single-ventricle defects opens the door to studying SVD in patient-derived cardiomyocytes (iPSC-CMs) in a variety of different contexts, including organoids and chamber-specific cardiomyocytes. As the genetic and cellular causes of SVD are not well defined, patient-derived iPSC-CMs hold promise for uncovering mechanisms of disease development and serve as a platform for testing therapies. The purpose of this review is to highlight recent advances in iPSC-based models of SVD.
Recent advances in patient-derived iPSC-CM differentiation, as well as the development of both chamber-specific and non-myocyte cardiac cell types, make it possible to model the complex genetic and molecular architecture involved in SVD development. Moreover, iPSC models have become increasingly complex with the generation of 3D organoids and engineered cardiac tissues which open the door to new mechanistic insight into SVD development. Finally, iPSC-CMs have been used in proof-of-concept studies that the molecular underpinnings of SVD may be targetable for future therapies. While each platform has its advantages and disadvantages, the use of patient-derived iPSC-CMs offers a window into patient-specific cardiogenesis and SVD development. Advancement in stem-cell based modeling of SVD promises to revolutionize our understanding of the developmental etiology of SVD and provides a tool for developing and testing new therapies.
先天性心脏病包括广泛的心脏结构缺陷,其中最严重的是单心室缺陷(SVD)。这些患者患有严重的发病率和死亡率;然而,我们对这些疾病的发育病因学的理解是有限的。模式生物为正常和异常心脏发生提供了一个窗口,但往往无法重现患者中所见的复杂先天性心脏病。来自患有单心室缺陷的患者的诱导多能干细胞(iPSC)的使用为在各种不同的背景下(包括类器官和室特异性心肌细胞)研究 SVD 在患者来源的心肌细胞(iPSC-CM)中打开了大门。由于 SVD 的遗传和细胞原因尚未明确,患者来源的 iPSC-CM 有望揭示疾病发展的机制,并作为测试疗法的平台。本综述的目的是强调基于 iPSC 的 SVD 模型的最新进展。
最近在患者来源的 iPSC-CM 分化方面的进展,以及腔特异性和非心肌细胞类型的心脏细胞的发展,使得能够模拟涉及 SVD 发展的复杂遗传和分子结构。此外,随着 3D 类器官和工程化心脏组织的产生,iPSC 模型变得越来越复杂,为深入了解 SVD 发展的新机制打开了大门。最后,已经在概念验证研究中使用 iPSC-CM,证明 SVD 的分子基础可能是未来治疗的靶点。虽然每个平台都有其优点和缺点,但使用患者来源的 iPSC-CM 提供了一个了解患者特异性心脏发生和 SVD 发展的窗口。SVD 的基于干细胞的建模的进展有望彻底改变我们对 SVD 的发育病因学的理解,并为开发和测试新疗法提供了一种工具。