The cardiogenic potential of stem-cell derived cardiomyocytes (iPSC-CM) and their prospective use for cardiac cell therapy crucially depends on their excitability and functional integration in myocardial tissue. Indeed, previous studies from our group have shown that cell excitability and intercellular coupling are strongly reduced in iPSC-CMs compared to primary cardiomyocytes. For clinical aspects, impaired excitability and electrical signal propagation may lead to conduction slowing and the development of arrhythmia. In this project, we focus on the idea that cardiomyocyte excitability and conduction properties are interrelated and depend on the expression of the cardiac sodium channel Nav1.5 and the major gap junction forming protein connexin-43 (Cx43). We tested the hypothesis that molecular remodeling of both proteins enhances cell excitability as reflected in Nav1.5 activity and action potential (AP) properties with the aim to approach native cardiomyocyte function. Using a combination of molecular modulation and electrophysiological evaluation in voltage and current clamp modes, our data demonstrate that enhanced Nav1.5 expression in iPSC-CMs significantly increased sodium current (INa in pA/pF: control 40.5±10.5, Nav1.5 118.3±27.2) and upstroke velocity (dv/dtmax, in V/s: 156±18 vs. 276±29, respectively) of the AP, a critical determinant of cell excitability. Typically, a fraction of iPSC-CMs also exhibited spontaneous APs with low dv/dtmax (<50 V/s) driven without Nav1.5, a hallmark of immaturity. However, after Nav1.5 overexpression, all recorded APs showed fast dv/dtmax. Furthermore, INa was also increased in Cx43-overexpressing iPSC-CMs (INa 66.2±19.8 pA/pF) suggesting that Cx43 may influence Nav1.5 expression and thereby cell excitability. This notion was further confirmed in immunostainings of Cx43-overexpressing iPSC-CMs demonstrating increased Nav1.5 expression at the plasma membrane, which suggests a common regulation pathway between both proteins. In conclusion, modulation of Nav1.5 and Cx43 expression greatly enhances the excitability of iPSC-CMs and may represent a powerful new target for improving the functional maturation of iPSC-CMs.
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