Extracellular Matrix Promotes Highly Efficient Cardiac Differentiation of Human Pluripotent Stem Cells: The Matrix Sandwich Method.

Rationale: Cardiomyocytes differentiated from human pluripotent stem cells (PSCs) are increasingly being used for cardiovascular research including disease modeling and hold promise for clinical applications. Current cardiac differentiation protocols exhibit variable success across different PSC lines and are primarily based on the application of growth factors. However, extracellular matrix (ECM) is also fundamentally involved in cardiac development from the earliest morphogenetic events such as gastrulation. Objective: We sought to develop a more effective protocol for cardiac differentiation of human PSCs by using ECM in combination with growth factors known to promote cardiogenesis. Methods and Results: PSCs were cultured as monolayers on Matrigel, an ECM preparation, and subsequently overlayed with Matrigel. The matrix sandwich promoted an epithelial-to-mesenchymal transition as in gastrulation with the generation of N-cadherin+ mesenchymal cells. Combining the matrix sandwich with sequential application of growth factors (Activin A, BMP4, and bFGF) generated cardiomyocytes with high purity (up to 98%) and yield (up to 11 cardiomyocytes/input PSC) from multiple PSC lines. The resulting cardiomyocytes progressively mature over 30 days in culture based on myofilament expression pattern and mitotic activity. Action potentials typical of embryonic nodal, atrial and ventricular cardiomyocytes were observed, and monolayers of electrically coupled cardiomyocytes modeled cardiac tissue and basic arrhythmia mechanisms. Conclusions: Dynamic ECM application promoted EMT of human PSCs and complemented growth factor signaling to enable robust cardiac differentiation.