The morphological changes during hiPSC differentiation.
The hiPSC cultured in feeder-free plates grew as flat, two-dimensional colonies. Upon reaching around 85% confluency, hiPSCs were treated with 6 µM CHIR for differentiation (Figure 1A). Substantial amounts of cell death, a normal and common phenomenon, were observed after 24 hr of CHIR treatment. After two days of CHIR treatment, the hiPSCs continued to differentiate towards a mesodermal fate. In comparison to cells in hiPSC colonies, cell size for these day 2 cells increased. Cell number also increased through cell division (Figure 1B). At day 5, the mesodermal cells were directed towards the cardiac lineage (cardiac mesoderm). At this time, cells begin coalescing and forming characteristic, branch-like structures (Figure 1C). At day 10, branch-like structures were highly pronounced, and cardiomyocytes started spontaneously beating (Figure 1D). Terminally-differentiated cardiomyocytes will not proliferate beyond this point. A timeline of the differentiation protocol is shown in Figure 2.
Immunostaining and flow cytometry results showed cardiomyocytes were purified with glucose starvation.
After 10 days of differentiation, more than 50% of cell areas are beating. However, beating cell sheets sometimes are also intermingled with non-cardiomyocytes. To examine cardiomyocyte purity, cells with immunostaining against cardiomyocyte marker cardiac Troponin-T (cTnT) were characterized to find that most cells were cTnT positive. However, in an unpurified population of differentiated cells, a number of cells also lacked expression of cTnT, suggesting the presence of non-cardiomyocytes in this differentiated population at day 13 (Figure 3A). However, with glucose starvation, almost all remaining cells were cTnT positive at day 13 (Figure 3B), indicating successful purification of the cardiomyocytes following glucose starvation. These data were further corroborated using flow cytometry analysis. A population of differentiated cells at day 13 post-differentiation contained approximately 50% TNNT2+ cells when not glucose starved (Figure 4A). A parallel differentiation was also conducted but with a 3 day glucose deprivation beginning at day 10 after differentiation. In contrast to the unstarved differentiation, glucose deprivation led to a purified population containing 90% TNNT2+ cells at day 13 (Figure 4B).

Figure 1. The sequential morphological changes during hiPSC differentiation towards the cardiac lineage. (A) Undifferentiated hiPSCs at day 0 exhibit typical colony morphology and reached around 85% confluency. (B) At day 2, cells after treatment with CHIR for two days reached 100% confluency and entered the mesodermal lineage. (C) At day 5, the cells after treatment with IWR1 for 2 days entered the cardiac mesoderm stage. Some cells began to fuse and form characteristic branch-like morphologies (indicated by arrows). (D) At day 7-10, branch-like structures are highly evident, and cardiomyocytes start spontaneously beating. Bar = 200 μm. Please click here to view a larger version of this figure.

Figure 2. Timeline of hiPSC-CM differentiation protocol and subsequent glucose starvation process. Beating cardiomyocytes are typically first observed at approximately days 7-10. Two rounds of glucose starvation will result in a purified population of cardiomyocytes by day 17. Please click here to view a larger version of this figure.

Figure 3. Immunofluorescence reveals purification of cardiomyocytes following glucose starvation. (A) Unpurified cells after 13 days of differentiation were stained with Cardiac Troponin T (cTnT). Most cells have differentiated into cardiomyocytes and were cTnT positive, but a number of non-cardiac, cTnT-negative cells are also present. (B) In contrast, after a 3 day glucose starvation beginning at day 10, almost all of the surviving cells were cTnT positive by day 13. Scale bar = 200 μm. Please click here to view a larger version of this figure.

Figure 4. Flow cytometry reveals purification of cardiomyocytes following glucose starvation. (A) After 13 days of cardiac differentiation without glucose starvation, a population of cells exhibited roughly 50% TNNT2+ cardiomyocytes. Red indicates the differentiated cell population and blue indicates undifferentiated hiPSCs as a negative control. (B) After 10 days of cardiac differentiation and followed by 3 days of glucose starvation, a population of cells from the same batch of differentiations was purified to contain 90% TNNT2+ cardiomyocytes. Please click here to view a larger version of this figure.
| The compositions for E8 medium |
| E8 | Volume: 1 L | Company | Catalog number |
| DMEM/F12 with Glutamine and HEPES | 1,000 ml | Invitrogen | 11330-032 |
| NaHCO3 (7.5%, 75 mg/ml) | 7.24 ml | Invitrogen | 25080-094 |
| L-Ascorbic acid 2-phosphate (64 mg/ml) | 1 ml | Sigma | A8960 |
| sodium selenite (70 µg/ml) | 200 µl | Sigma | S5261 |
| transferrin (50 mg/ml) | 214 µl | Sigma | T3705 |
| insulin (4 mg/ml) | 5 ml | Invitrogen | 12585-014 |
| FGF2 (200 ng/µl) | 500 µl | Peprotech | 100-18B |
| TGFB1 (100 ng/µl) | 20 µl | Peprotech | 100-21 |
| The stock solutions for E8 compositions |
| L-Ascorbic acid-2-phosphate (64 mg/ml) | 3.2 g in 50 ml Ultrapure water, store 500 µl aliquots at -20 °C |
| Transferrin (50 mg/ml) | 500 mg in 10 ml of Ultrapure water, store 107 µl aliquots at -20 °C |
| Sodium selenite (70 µg/ml) | 35 mg sodium selenite into 500 ml ultrapure water, store 100 µl aliquots at -20 °C |
| FGF2 (200 ng/µl) | 1 mg in 5 ml cold D-PBS, store 250 µl aliquots at -20 °C |
| TGFB1 (100 ng/µl) | 100 µg in 1 ml cold 10 mM citric acid, pH 3, store 10 µl aliquots at -20 °C |
Table 1. Composition of E8 Medium.