Journal
EUROPEAN HEART JOURNAL
Volume 37, Issue 23, Pages 1835-1846Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehv579
Keywords
Arrhythmogenic cardiomyopathy; Mesenchymal stromal cells; Adipogenesis; Fibrofatty substitution; Plakophilin2; Plakoglobin
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Funding
- Centro Cardiologico Monzino IRCCS
- Fondazione Umberto Veronesi fellowship
- Young Investigator Program
- Boston Scientific fellowship
- Department of Innovation, Research, Development and Cooperatives of the Autonomous Province of Bolzano-South Tyrol
- Ricerca Corrente from Italian Ministry of Health
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Aim Arrhythmogenic cardiomyopathy (ACM) is a genetic disorder mainly due to mutations in desmosomal genes, characterized by progressive fibro-adipose replacement of the myocardium, arrhythmias, and sudden death. It is still unclear which cell type is responsible for fibro-adipose substitution and which molecular mechanisms lead to this structural change. Cardiac mesenchymal stromal cells (C-MSC) are the most abundant cells in the heart, with propensity to differentiate into several cell types, including adipocytes, and their role in ACM is unknown. The aim of the present study was to investigate whether C-MSC contributed to excess adipocytes in patients with ACM. Methods and results We found that, in ACM patients' explanted heart sections, cells actively differentiating into adipocytes are of mesenchymal origin. Therefore, we isolated C-MSC from endomyocardial biopsies of ACM and from not affected by arrhythmogenic cardiomyopathy (NON-ACM) (control) patients. We found that both ACM and control C-MSC express desmosomal genes, with ACM C-MSC showing lower expression of plakophilin (PKP2) protein vs. controls. Arrhythmogenic cardiomyopathy C-MSC cultured in adipogenic medium accumulated more lipid droplets than controls. Accordingly, the expression of adipogenic genes was higher in ACM vs. NON-ACM C-MSC, while expression of cell cycle and anti-adipogenic genes was lower. Both lipid accumulation and transcription reprogramming were dependent on PKP2 deficiency. Conclusions Cardiac mesenchymal stromal cells contribute to the adipogenic substitution observed in ACM patients' hearts. Moreover, C-MSC from ACM patients recapitulate the features of ACM adipogenesis, representing a novel, scalable, patient-specific in vitro tool for future mechanistic studies.
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