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Cardiac Tissue Engineering Kareen L.K. Coulombe
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Kareen L. K. Coulombe
Lauren D. Black III Editors
Cardiac Tissue
Engineering
Methods and Protocols
Second Edition
METHODS    IN     MOLECULAR BIOLOGY
                      Series Editor
                    John M. Walker
          School of Life and Medical Sciences
              University of Hertfordshire
              Hatfield, Hertfordshire, UK
Second Edition
Edited by
                 Kareen L. K. Coulombe
       School of Engineering, Brown University, Providence, RI, USA
This Humana imprint is published by the registered company Springer Science+Business Media, LLC, part of Springer
Nature.
The registered company address is: 1 New York Plaza, New York, NY 10004, U.S.A.
Preface
Due to the limited regenerative potential of the adult human heart, development of
alternative treatment options is needed for the variety of conditions that result in the loss,
or loss of function, of contractile tissue. Perhaps the prime example of this is myocardial
infarction (MI), which results in death of tens of millions of cardiomyocytes. While this loss
is significant, many patients receive minimal intervention following MI, and their cardiac
health is managed with drugs and changes to diet and exercise with satisfactory results.
However, within 5 years, more than half of MI patients will develop heart failure, for which
the only successful late-stage treatment is heart transplantation.
     In the first edition of this book, we published a wide array of protocols important for
cardiac tissue engineering research. Many of these were geared towards in vitro advancement
ahead of future clinical work. In the time since the first edition, the field has continued to
advance in two key directions. The first is a deeper understanding of human pluripotent stem
cell-derived cardiomyocytes in three-dimensional engineered microenvironments and their
use in downstream applications. The second is continued movement towards clinical thera-
pies using tissue engineering approaches in the heart in large animal models and human
clinical trials.
     In this book, the second edition of Cardiac Tissue Engineering: Methods and Protocols,
an updated collection of state-of-the-art protocols in cardiac tissue engineering is presented.
These protocols demonstrate advancements in cell sourcing, assembly, and use of engi-
neered cardiac tissues, imaging and diagnostics, and applications. Platforms developed for
broad use to study development and disease in vitro enable genotype to phenotype evalua-
tion, and many are customized for contractility, arrhythmia, or heart repair in vivo using
small and large animal models. New animal models, biomaterials, and quantitative analyses
are described for broad adoption.
     The diversity of research in cardiovascular development and disease has inspired the
development of a number of techniques and platforms that can be used to address an array of
questions, often leveraging the use of human pluripotent stem cell-derived cardiomyocytes
(hiPSC-CMs). Gene editing for high-throughput genetic screening using a custom CRISPR
library in cultured cardiomyocytes is described by DeLuca and Bursac. Challenges of protein
and mRNA quantification from small samples of hiPSC-CMs are described and overcome by
customized methods presented by Entcheva and colleagues to enable high-throughput
analyses.
     Tissue engineering methods are diverse, enabling selection of an approach based on the
study question and design, including considerations for size, throughput, geometry, and
endpoint metrics. Methods for forming self-assembled 3D spheroids of hiPSC-CMs and
heterotypic myocardial cells are described by Matthys and McDevitt. Fabrication of myo-
cardial scaffolds and slices, integrated with electrical and mechanical stimulation, is pre-
sented by Liao and colleagues. For more complex geometries, bioprinting of a 3D ventricle
and tips for custom shapes using the freeform reversible embedding of suspended hydrogels
(FRESH) method is shared by Feinberg and colleagues. For hydrogel-based elongated
                                              v
vi      Preface
engineered heart tissues designed for contractile, structural, and transcriptional studies, the
Sniadecki group provides templates and insights for lab-made racks of silicone posts in a
standard 24-well dish format.
     Fit-for-purpose platforms require alignment of the system’s biology with quantitative
readouts and has become ever-present as the field of cardiac tissue engineering plunges into
drug testing and disease modeling in vitro. Use of microelectrode arrays for high-
throughput field potential measurements in 2D plated hiPSC-CMs to assess drug responses
is detailed by Wu and colleagues. Micro-heart muscle array technology from the Huebsch
Lab enables moderate throughput in pharmacology and pharmacogenomic studies by visual
assessment of action potential (AP), calcium transient, and contractility with compatibility
for protein and gene analyses. Studies concerned with propagation velocity, or conduction
velocity, as related to arrhythmia will benefit from high-speed visual fluorescence imaging of
calcium waves and analysis algorithms presented by McCain and colleagues in an aligned 2D
cardiac platform. A heterotypic hiPSC-CM and human cardiac fibroblast self-assembled 3D
microtissue platform for arrhythmia assessment by quantitative evaluation of all phases of the
action potential is presented by Kofron, Choi, and Coulombe. While the focus of much of
the cardiac tissue engineering space is on ventricular tissue, an atrial cardiac 3D-engineered
tissue model is described by Eschenhagen, Stenzig, et al. using elastomeric posts for
auxotonic contractions with applications in atrial-specific studies of drug responses and
disease modeling. A cardiac fibrosis model based on the Biowire II platform for contractility
assessment from the Radisic group enables local high-fibroblast content to create scar-like
tissue adjacent to normal cardiac tissue for studying fibrosis and therapeutics.
     As the field of cardiac tissue engineering advances towards clinical heart regeneration,
multiple approaches to remuscularize injured hearts with hiPSC/hESC-CMs are moving
towards phase I trials. Transepicardial hiPSC-CM delivery in a swine model of acute
myocardial infarction is described by Laflamme and colleagues, while defined cellular and
culture conditions in collagen-based engineered heart tissue (EHT) is provided by Zim-
mermann and colleagues for disease modeling, drug screening, and heart repair. Methods
for constructing tubular cardiac tissue from multilayered cell sheets are provided by Okano,
Sekine et al. for applications in heart failure. Finally, in a critically important analysis of
engraftment, Brandt and Mahmoud detail their methods for quantifying cardiomyocyte
proliferation and nucleation in repaired hearts via robust histological methods.
     Novel therapeutics that enable in situ repair and alternative approaches for regeneration
highlight the innovation in the field of cardiac tissue engineering. Using a biomaterials
intervention, Christman and colleagues describe injectable extracellular matrix (ECM)
scaffolds that have been in use in small and large animal models for cardiac repair and initial
safety assessment in a Phase I clinical trial. Use of ECM for encapsulation of cells for
echocardiography-directed injection in rodent models is described by Shakya, Brown, and
Davis. The impact of a biomaterials-based repair strategy on the monocyte population is
described by Suuronen and colleagues using flow cytometry analyses to quantify the levels of
major leukocyte subtypes isolated from mouse hearts. Finally, a novel model of patch-based
repair is provided by Black and colleagues, where cardiovascular patches are implanted to
widen the right ventricular outflow tract in young, rapidly growing porcine hearts to
emulate congenital heart defect reconstructive surgery.
     Bringing new technologies and therapies to the clinic is a challenging task, but one that
is attainable, particularly if we as a field work in collaboration. This second edition of
                                                                        Preface      vii
Cardiac Tissue Engineering: Methods and Protocols aims to be your primary resource for
implementing these cutting-edge approaches in your research. With this book, we hope to
inspire advancement of cardiotoxicity assessment, drug discovery, and heart repair and
regeneration to accelerate heart health around the globe.
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     v
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        xi
                                                                            ix
x            Contents
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   311
Contributors
                                           xi
xii    Contributors
ROCCO ROMAGNUOLO • McEwen Stem Cell Institute, University Health Network, Toronto,
    ON, Canada
PIERRE-LUC SATIN • Institute of Pharmacology and Toxicology, University Medical Center
    Göttingen, Göttingen, Germany; DZHK (German Center for Cardiovascular Research),
    Partner Site Göttingen, Göttingen, Germany
HIDEKAZU SEKINE • Institute of Advanced Biomedical Engineering and Science, Tokyo
    Women’s Medical University, Tokyo, Japan; Center for Advanced Medical and Life Science,
    Tokyo Women’s Medical University, Tokyo, Japan; Cell Sheet Tissue Engineering Center
    (CSTEC), School of Medicine and College of Pharmacy, Department of Pharmaceutics and
    Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA
MICKEY SHAH • Department of Biomedical Engineering, The University of Akron, Akron,
    OH, USA
PREETY SHAKYA • Wallace H. Coulter Department of Biomedical Engineering, Georgia
    Institute of Technology and Emory University School of Medicine, Atlanta, GA, USA
DANIEL W. SIMMONS • Department of Biomedical Engineering, Washington University in St.
    Louis, St. Louis, MO, USA; NSF Science and Technology Center for Engineering
    Mechanobiology, Washington University in St. Louis, St. Louis, MO, USA
JACOB SMITH • Department of Chemical Engineering and Applied Chemistry, University of
    Toronto, Toronto, ON, Canada
DAVID SMYTH • Cardiac Function Laboratory, University of Ottawa Heart Institute,
    Ottawa, ON, Canada
NATHAN J. SNIADECKI • Institute for Stem Cell and Regenerative Medicine, University of
    Washington, Seattle, WA, USA; Department of Bioengineering, University of Washington,
    Seattle, WA, USA; Department of Mechanical Engineering, University of Washington,
    Seattle, WA, USA; Department of Laboratory Medicine & Pathology, University of
    Washington, Seattle, WA, USA
JUSTUS STENZIG • Department of Experimental Pharmacology and Toxicology, University
    Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; DZHK (German
    Centre for Cardiovascular Research), Hamburg/Kiel/Lübeck, Germany
WHITNEY L. STOPPEL • Department of Biomedical Engineering, Tufts University, Medford,
    MA, USA; Department of Chemical Engineering, University of Florida, Gainesville, FL,
    USA
ERIK J. SUURONEN • BioEngineering and Therapeutic Solutions (BEaTS), Division of
    Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada;
    Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON,
    Canada
MALTE TIBURCY • Institute of Pharmacology and Toxicology, University Medical Center
    Göttingen, Göttingen, Germany; DZHK (German Center for Cardiovascular Research),
    Partner Site Göttingen, Göttingen, Germany
BA€ RBEL ULMER • Department of Experimental Pharmacology and Toxicology, University
    Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; DZHK (German
    Centre for Cardiovascular Research), Hamburg/Kiel/Lübeck, Germany
BO WANG • Joint Department of Biomedical Engineering, Marquette University and the
    Medical College of Wisconsin, Milwaukee, WI, USA
ERIKA YAN WANG • Institute of Biomedical Engineering, University of Toronto, Toronto, ON,
    Canada
LAKIESHA N. WILLIAMS • Department of Biomedical Engineering, University of Florida,
    Gainesville, FL, USA
                                                                      Contributors    xv
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