Animal models have been a valuable tool used for understanding the underlying mechanisms of human physiology and pathophysiology, as well as a platform for preliminary testing of therapies to treat various diseases1. Great strides have been taken in the field of biomedical research based on these animal studies2. However, significant interspecies differences exist between human and animal physiologies, including mice, rats, guinea pigs, rabbits, sheep, pigs, and dogs3,4. As a result, there have been numerous drug, gene, and cell therapies that showed promise during the animal testing stage but failed to live up to the results in clinical trials5. To bridge this gap, isolated cardiac myocytes and human induced pluripotent stem cells (iPSCs) were developed as models to test the response of human physiology to various drugs and diseases6. Stem cell-derived cardiomyocytes have been widely used in organ-on-a-chip systems as a surrogate of the heart6,7,8. However, the usefulness of iPSC-derived cardiomyocytes (iPSC-CMs) is impeded by their relatively immature phenotype and the lack of representation of the cardiomyocyte subpopulation; the mature myocardium is a complex structure comprised of several coexisting cell types such as fibroblasts, neurons, macrophages, and endothelial cells. On the other hand, isolated human cardiomyocytes are electrically mature, and different cardiomyocyte subpopulations can be obtained by altering culturing parameters9. Still, these myocytes generally exhibit altered action potential morphologies due to the lack of cell-cell coupling, rapid de-differentiation, and occurrence of proarrhythmic behavior in vitro10,11. Some of the limitations were addressed by 3D cell culture models of iPSC-CMs and cardiac myocytes. These models, which include spheroids, hydrogel scaffold encapsulated 3D cultures, engineered heart tissues (EHTs), and heart-on-a-chip systems, use multiple cardiac cell populations such as cardiomyocytes, fibroblasts, and endothelial cells. They either self-assemble or assemble along a scaffold to form 3D structures, and some even reproduce the complex anisotropic nature of the myocardium. These models have been reported to have cells of mature phenotypes, contractile properties, and molecular profiles similar to cardiac tissue. The heart-on-a-chip system also allows the study of systemic effects in drug testing and disease models. However, in vitro cell-based models lack the native extracellular matrix and therefore cannot accurately mimic organ level electrophysiology. Human cardiac slices, by contrast, have an intact extracellular matrix and native cell-to-cell contacts, making them useful for more accurately examining arrhythmogenic properties of the human myocardium.
Researchers have developed human cardiac organotypic slices as a physiological preclinical platform for acute and chronic drug testing and to study cardiac electrophysiology and cardiac disease progression12,13,14,15,16,17,18,19. When compared with iPSC-derived cardiomyocytes, human cardiac slices more faithfully replicate adult human cardiac electrophysiology with a mature cardiomyocyte phenotype. When compared with isolated human cardiomyocytes, cardiac slices exhibit physiological action potential durations because of the well-preserved cell-cell coupling and the intrinsic existence of their native intra- and extracellular environments.
This protocol describes the process of generating human cardiac slices from whole donor hearts, performing acute (i.e., hours-long) and chronic (i.e., days-long) studies to test cardiac electrophysiology parameters via optical mapping. While this protocol describes only the use of the left ventricular (LV) tissue, it has been successfully applied to other regions of the heart as well as other species such as mice, rats, guinea pigs, and pigs14,20,21,22. Our laboratory uses whole human donor hearts that have been rejected for transplantation for the last 5 years, but it is feasible for these same procedures to be carried out on any donor heart sample tissues obtained by alternative means (e.g., left ventricular assist device [LVAD] implantations, biopsies, myectomies) as long as the tissues have the ability to be sectioned into cubes. Optical mapping is employed for analysis in this study due to its capacity to simultaneously map optical action potentials and calcium transients with high spatial (100 x 100 pixels) and temporal (>1,000 frames/s) resolution. Alternative methods can also be used, such as multielectrode arrays (MEAs) or microelectrodes, but these techniques are limited by their relatively low spatial resolutions. Additionally, MEAs were designed for use with cell cultures, and sharp microelectrodes are more easily managed for use with whole hearts or large tissue wedges.
The goal of the article is to enable more researchers to use human cardiac tissues for cardiac electrophysiology studies. It should be noted that the technology described in this article is relatively simple and beneficial for short-term studies (on the order of several hours to days). More physiological biomimetic culture for longer-term studies (on the order of weeks) has been discussed and described by a number of other studies12,18,23. Electrical stimulation, mechanical loading, and tissue stretching are advantageous conditioning mechanisms that can help limit the onset of in vitro tissue remodelling12,18,23.