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The generation of cardiomyocytes from hPSCs, including hESC and hiPSC, can function as an in vitro model of very early human cardiac developmental processes, providing insight into stages not otherwise accessible for mechanistic studies. This model system provides unique opportunities to study the molecular pathways that control cardiac lineage commitment and cell fate specification. In recent years, the ability to efficiently generate cardiomyogenic cells from hPSCs has greatly improved1-15. However, among protocols there is cell line variation with respect to the efficiency in generating cardiomyogenic cells and timing at which the cells express chamber-specific markers (e.g., ventricle and atria). Ideally, for future applications of this model system, more homogeneous populations of functionally defined cells are desired. In contrast to previous methods, the cardiomyocyte differentiation protocol described here does not require cell aggregation or the addition of Activin A or Bone morphogenetic protein 4(BMP4) and robustly generates cultures highly positive for TNNI3, TNNT2, IRX4, MLC2v, and MLC2a by day 10 cells across all hESC and hiPSC lines tested to date. The strategy is technically simple to implement, especially compared to three-dimensional cultures, mass culture, or embryoid body based strategies4-9, and was recently defined in a study that describes a small molecule with selective toxicity to hPSCs (Boheler et al.)65. Features of this protocol include differentiation of hPSCs in monolayer culture using a single layer of a hESC qualified matrix (Matrigel), fully defined media using small molecules to modulate Wnt signaling (similar, yet distinct from1,2,7,13), and optimized flow cytometry staining methods for evaluation of differentiation efficiency and cell identity. In summary, advantages of this protocol compared to previous reports include its cost-effectiveness, reproducibility, and its high efficiency for generating cardiomyocytes among multiple hPSC lines, including hESC and hiPSC lines.
Flow cytometry is a powerful analytical tool for assessing the quality of cells in culture and determining subpopulation homogeneity, and with proper experimental design, can provide quantitative measurements. As with all antibody-based strategies, accurate interpretation of experimental results requires that elements of the assay design including antibody concentration and fixation and permeabilization conditions (when targeting intracellular antigens) are carefully tested for each antibody as sub-optimal conditions significantly affect efficiency of antibody binding, and therefore, interpretation of results. Importantly, if quantitation is required, monoclonal antibodies are essential, as polyclonal antibodies can recognize multiple epitopes and are prone to batch-to-batch variation. Currently, a variety of antibodies (polyclonal and monoclonal) and staining protocols have been described for the assessment of in vitro differentiation, making it difficult to compare efficiency of cardiomyogenesis among protocols1,2,9,11. For that reason, monoclonal antibodies are used when available for all flow cytometry analyses. Going forward, it is expected that standardization of these staining protocols, especially with regards to quantitation, should better permit comparison among differentiation strategies.
The choice of markers, and their corresponding antibodies, used to assess purity of in vitro cardiomyogenesis varies among reports. TNNT2 has been considered an indicator of cells committed to the cardiomyogenic fate and is routinely used to assess efficiency of cardiac differentiation protocols. However, TNNT2 is also expressed in skeletal muscle during early chick and rat development16,17 and it is present in human smooth muscle18. Thus, TNNT2 is not necessarily a specific marker of human cardiomyogenesis in vitro. MLC2v and MLC2a are routinely used as surrogate markers of ventricular and atrial subtypes, respectively. However, challenges with relying on MLC2v and MLC2a to determine cardiomyocyte subtype in the context of in vitro differentiation arise from the fact that these gene products may not be restricted to a specific chamber throughout cardiac development, from heart tube through adult. In the rodent looped heart, MLC2a mRNA is predominant in the atrial/inflow tract area and MLC2v mRNA is predominant in the ventricular/outflow tract regions. In the looped heart, co-expression of MLC2a and MLC2v mRNAs are observed in the inflow tract, atrioventricular canal, and the outflow tract19,20. By 3 days after birth, MLC2v mRNA is restricted to the ventricle and by 10 days after birth, MLC2a is restricted to the atria in the neonatal rat heart19. Therefore, interpretation of data regarding cardiomyogenesis efficiency and subtype identity must not only consider the presence and quantity of reference marker levels, but must consider the developmental stage(s) to which the timepoints of differentiation that are analyzed correspond. This is especially important considering that the maturation stage of cardiomyogenic cells generated by in vitro differentiation of hPSCs resembles most closely those of embryonic/fetal development21-25. Thus, relying on a marker’s spatial expression in the postnatal heart may not be appropriate for the assessment of hPSC-derived cells, at least in some cases.
In an effort to facilitate the development of more specific criteria for defining cardiomyocyte identity in vitro, TNNI3 is considered to be a valuable marker for evaluating cardiomyogenesis in vitro as it is restricted to cardiac muscle throughout embryogenesis in chick and zebrafish15,20 and is absent in human fetal skeletal muscle26. While TNNI1 is present in human fetal heart, TNNI3 is the only TNNI isoform present in normal adult heart27,28. Regarding cardiomyocyte subtype identity, IRX429-31 is an informative marker of cells with a ventricular fate. At the protein level, IRX4 has recently been shown to be restricted to the ventricle from linear heart tube through neonatal stages in the mouse32. Accordingly, optimized staining protocols for the analysis of TNNI3 and IRX4 by flow cytometry are described. To our knowledge, this is the first description of a method for efficient antibody-based staining and analysis of IRX4 levels in human cardiomyocytes by flow cytometry.