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Cardiac side effects such as the drug-induced long QT syndrome have led to market withdrawals over the past years. Statistics indicate that about 45% of all withdrawals are due to unwanted effects on the cardiovascular system1. This drug failure after the expensive developmental process and approval is the worst-case scenario for pharmaceutical companies. Research and development departments therefore focus on detection of such unwanted cardiovascular effects early on. For economic and ethical concerns, efforts to reduce animal experiments and replace them with new in vitro screening assays are ongoing.
A set of established assays are included in the United States Food and Drug Administration (FDA) and European Medicines Agency (EMA) guidelines for preclinical evaluation of proarrhythmic drug effects2. The technology of reprogramming somatic cells followed by differentiation of human induced pluripotent stem cells (hiPSC) boosted this research field3. It now offers the possibility to screen new drug candidates on human cardiomyocytes in vitro and avoids issues with inter-species differences. Recent cardiac differentiation protocols4,5 provide unlimited supply of cardiomyocytes without ethical concern. However, the measurement of contractile force, the most important and best characterized in vivo parameter of cardiomyocytes, is not well established. This is related to the relative immaturity6 of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) as compared to the adult cardiomyocyte. A possible advancement is to engineer 3-dimensional heart tissue from single cells7 (engineered heart tissue, EHT). The EHT protocol is based on embedding single murine or human cardiomyocytes8,9,10 in fibrin hydrogel between two flexible polydimethylsiloxane (PDMS) posts11 in 24-well format. Within a few days the cardiomyocytes start to contract spontaneously as single cells and start to form cellular networks. After 7-10 days, macroscopic contractions of the entire tissue are visible. During this process the extracellular matrix is remodeled, which leads to a decrease of diameter and length. The shortening of the EHT results in bending of the PDMS post even during rest, subjecting cardiomyocytes in the developing EHT to continuous load. EHTs continue to perform auxotonic muscle contractions over several weeks. Human EHTs show responses to physiological and pharmacological stimulation indicating their suitability for drug screening and disease modeling7.
In this manuscript we present a robust and easy protocol for the generation of human EHT, and the automated contractility analysis of concentration dependent changes of the contraction pattern in the presence of hERG channel inhibitors.