Abstract
Introduction: Hypoplastic left heart syndrome (HLHS) is one of the most difficult congenital cardiovascular conditions. There are no proven therapeutic strategies for systemic right ventricular (RV) heart failure till now. Hypothesis: We investigated whether mesenchymal stem cells (MSCs) can ameliorate heart failure (HF) in HLHS patients. Methods & Results: We analyzed the cardiac tissues of patients with HLHS (N = 20) and healthy donors (N = 12). Compared to the controls, the cross-sectional area of cardiomyocytes determined by wheat germ agglutinin staining significantly increased in the HLHS hearts. Furthermore, quantitative RT-PCR (qRT-PCR) confirmed the expression of fetal genes, including atrial natriuretic factor (ANF), natriuretic peptide B (BNP), and myosin heavy chain-β (MHC-β), were significantly upregulated in the HLHS. The results indicated severe pathological hypertrophy in HLHS patients. To investigate our hypothesis, we employed HLHS patients’ iPSCs and differentiated them into cardiomyocytes (iCMs). Differentiated HLHS-iCMs were confirmed by expression of the cardiac markers, cardiac troponin T. In vitro , 10nM Endothelin-1 (ET-1) stimulation successfully induced cardiac hypertrophy confirmed by cell size and fetal gene expression. Interestingly, co-cultured HLHS-iCMs with mesenchymal stem cells (MSCs) in the trans-well plates reduced the ET-1 induced hypertrophy. The results indicated that secretome from MSCs played a critical role in referring to the anti-hypertrophic effects. Compared to the control conditioned media from fibroblasts, GDF-15 was highly expressed in the MSC-conditioned medium. GDF-15 alone also reduced ET-1 induced hypertrophy in the HLHS-iCMs. Conclusions: In HLHS patients, RV hypertrophy is a hallmark of heart failure. MSCs potentially inhibited hypertrophic remodeling in HLHS patient-specific cardiomyocytes through beneficial secretomes, such as GDF-15.
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