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Contato, Anna (2016) Cardiomyocytes generation by programming human pluripotent stem cell fate in microfluidics: from Wnt pathway modulators to synthetic modified mRNA. [Ph.D. thesis]

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Abstract (italian or english)

Cardiovascular disease (CVD) is still one of the major cause of morbidity and mortality in the world, with ischemic heart disease representing the majority of deaths over the past 10 years. The high burden of the disease, both immediate and chronic, associated with the high costs for the healthcare systems, claim for the development of novel therapeutic strategies. The main issue of current pharmacological and interventional therapeutic approaches is their inability to compensate the great and irreversible loss of functional cardiomycytes (CMs). Because of the limited regenerative capacity of post-natal CMs and the difficulty to obtain and isolate heart bioptic tissue, very limited supplies of these cells are available at present for dedicated studies. Moreover, even if animal models are surely the best tool to study and understand in vivo the mechanisms of specific human pathologies in a complex organism, they are not fully predictive and representative of the human condition; from an economic point of view, animal maintenance and the related experimentations are time consuming and very expensive.
In this scenario, human pluripotent stem cells (hPSCs), including human embryonic (hESCs) and human induced pluripotent stem cells (hiPSCs), play an important role in the cardiovascular research field, because they can be indefinitely expanded in culture without loosing their stemness, and differentiated into cells of the three germ layers, such as CMs. A great breakthrough in science has occurred in 2007 with the discovery of hiPSCs by the Nobel Prize Shinya Yamanaka. This has been the starting point for deriving patient-specific hiPSCs from the reprogramming of somatic cells obtained with less- or non-invasive procedures (skin biopsies, blood, urine…), useful for the generation of tissues for autologous-repair, bypassing the ethical and political debates surrounding the hESCs derivation.
The researchers have made several efforts to develop strategies to efficiently direct hPSCs cardiac differentiation and the existing methods for deriving CMs involve stage-specific perturbations of different signaling pathways using growth factors (GFs) or small molecules that recapitulate key steps of the cardiac development observed in vivo. However, these strategies are accompanied by some limitations including: high intra- and inter-experimental variability, low efficiencies, presence of xeno-contaminants, undefined medium components and differences in the expression of cytokines of endogenous signaling pathways. Other strategies are based on the direct lineage conversion of somatic cells, especially fibroblasts, via the overexpression of cardiac transcription factors (TFs) combinations through integrating and non-integrating vectors. However, also these approaches are characterized by low efficiencies, combined with the risk of genomic integration and insertional mutagenesis when using integrating vectors or the need for stringent steps of purification when using non-integrating techniques. Because of the difficulty to specifically direct hPSCs cardiac fate in a robust way, combined with the scarce ability of conventional culture systems to reproduce in vitro, the environment in which cells reside in vivo, the CMs produced to date are immature and more similar to fetal cardiac cells.
In 2010, Warren L. and co-workers pioneered a novel, non-integrating strategy based on repeated transfection with cathionic vehicles of synthetic modified messenger RNA (mmRNA), specifically designed to avoid innate immune response from the cell, demonstrating the possibility to both reprogram somatic cells to pluripotency and to programm hPSCs fate into terminally differentiated myogenic cells.
Hence, the aim of this PhD thesis is the development of an efficient and robust method for cardiac differentiation of hPSCs by combining the mmRNA with the microfluidic technology. Repeated transfections with mmRNA encoding 6 cardiac TFs are employed to force the endogenous protein expression in the cells and to drive the differentiation toward functional maturation of CMs. The integration of cardiac differentiation within an ad hoc microfluidic platform, facbricated in BioERA laboratory, allows a more precise control of culture conditions, enabling a high mmRNA transfection efficiency, thanks to the high volume/surface ratio, and the in vitro reproduction of physiological niches. In fact, the small scale offered by microfluidics, best mimics the cellular dynamics, which occur in the soluble microenvironment in vivo. Moreover, the microfluidic technology offers the possibility to perform combinatorial, multiparametric, parallelized and highthroughput experiments at one time in a cost-effective manner, not achievable and not economically sustainable in macroscopic conventional culture systems.
Chapter 1 starts with the definition of regenerative medicine and introduces the complexity of cardiac development, with the network of TFs that cooperate in this process. The state of the art regarding the derivation of CMs from hPSCs and from the transdifferentiation of somatic cells is described, together with the current limitations and challenges. Finally, the general aim of this PhD thesis is presented.
Chapter 2 will focus on hPSCs (hES and hiPS) employed during this project, describing their most important characteristics. It will be also presented a monolayer-based cardiac differentiation protocol of hPSCs that, to date is considered the gold standard for the fast generation of a high yield of beating CMs in conventional culture systems. This protocol relies on the temporal modulation of Wnt pathway via the administration of small molecules. In addition, a hES line, dual reporter for 2 cardiac TFs will be described and always adopted as a tool to monitor the progression of cardiac differentiation. The results obtained in standard cultures will be showed.
Chapter 3 will review the state of the art of microfluidic technology for cell culture in regenerative medicine applications. Then, the microfluidic platform fabrication will be described and employed, followed by the optimization of culture, expansion and cardiac differentiation of hPSCs with the gold standard protocol deriving form the translation from macro- to micro-scale.
Chapter 4 will introduce the novel mmRNA strategy for reprogramming and programming cell fate: also in this case the state of the art will be discussed. Then, the experimental strategies developed to program cardiac differentiation of hPSCs toward a more mature CM phenotype will be presented, together with the results obtained and the related structural, functional and molecular characterizations. In this work, for the first time, it has been possible to derive CMs from hPSCs with repeated transfections of mmRNA encoding 6 cardiac TFs in microfluidics, with efficiencies higher to current methods described in literature, performed in standard systems.
Finally, Chapter 5 will present the general discussion and conclusions, with the future perspectives regarding the use of mmRNA combined with microfluidic technology for deriving different CMs phenotypes, just varying the combination of TFs delivered.
To conclude, the experiments developed during this project provide proof-of-principle that it is possible to program hPSCs fate toward cardiac lineage and cardiac maturation in microfluidics; moreover, thanks to the non-integrating characteristic of mmRNA, the CMs obtained are clinical-grade and could potentially be employed in the next future for clinical applications of autologous tissue self-repair and for personalized drug screening.

Abstract (a different language)

Le malattie cardiovascolari rappresentano ad oggi una delle principali cause di morbidità e mortalità nel mondo, tra le quali la patologia ischemica è responsable del maggior numero di decessi negli ultimi 10 anni. L’elevato impatto determinato da tali patologie, sia acute che croniche, e gli elevati costi per i sistemi sanitari, richiedono lo sviluppo di nuove strategie terapeutiche.
La questione principale riguardante gli attuali approcci terapeutici, sia farmacologici sia interventistici, è rappresentata dalla loro incapacità di compensare l’elevata ed irreversibile perdita di cardiomiociti funzionali. A causa della limitata capacità rigenerativa dei cardiomiociti post-natali e della difficoltà di reperire ed isolare tessuto cardiaco bioptico, scarse sono le fonti di tali cellule disponibili per uno studio dedicato. Tra l’altro, anche se i modelli animali ancora oggi rappresentano sicuramente lo stumento migliore per studiare e comprendere in vivo i meccanismi alla base dello sviluppo di specifiche patologie umane, nel constesto di un organismo complesso, essi non sono completamente predittivi e rappresentativi della condizione umana analizzata; da un punto di vista economico, il mantenimento di tali animali e le relative sperimentazioni, richiedono molto tempo e costi elevati.
In questo scenario, le cellule staminali umane pluripotenti (hPSCs), comprese le cellule staminali embrionali (hESCs) e le cellule staminali pluripotenti indotte (hiPSCs), rivestono un ruolo importante nella ricerca cardiovascolare perché possono essere espanse in coltura indefinitamente, senza perdere la loro staminalità, e differenziare nelle cellule che componogono i tre foglietti germinativi, come ad esempio i cardiomiociti. Un’importante svolta nella ricerca scientifica è avvenuta nel 2007, con la scoperta delle hiPSCs da parte del Premio Nobel Shinya Yamanaka. Ciò ha rappresentato il punto di partenza per derivare hiPSCs paziente-specifiche attraverso il reprogramming di cellule somatiche ottenute con procedure mini- o non-invasive (derivate da biopsie cutanee, sangue, urina…), utili per generare tessuti per una riparazione autologa, evitando i problemi etici e politici relativi alla derivazione delle hESCs. Notevoli studi sono stati condotti dai ricercatori nel tentativo di sviluppare strategie che efficientemente ed in maniera robusta guidino il differenziamento cardiaco delle hPSCs, basate sulla perturbazione stadio-specifica di differenti vie di segnalazione, mediante l’uso di fattori di crescita e piccole molecole, che ricapitolano i punti essenziali dello sviluppo cardiaco osservato in vivo. Tuttavia, questi metodi sono accompagnati da alcune limitazioni, quali: elevata variabilità intra ed inter-sperimentale, presenza di xeno-contaminanti, componenti indefinite nei medium di coltura e differenze nei livelli di espressione di citochine endogene. Altre strategie si basano invece sulla conversione diretta di cellule somatiche, specialmente fibroblasti, attraverso l’overespressione di una combinazione di fattori di trascrizione cardiaci mediante vettori integrativi e non-integrativi; tuttavia, anche tali approcci sono caratterizzati da basse efficienze nella generazione di cardiomiociti, associate al rischio di integrazioni genomiche e mutagenesi inserzionale nel caso dei vettori integrativi, o alla necessità di effettuare diversi step di purificazione quando si ultilizzano sistemi non-integrativi. Pertanto, a causa delle difficoltà dei sistemi convenzionali di coltura nel dirigere specificamente ed in maniera robusta il differenziamento cardiaco delle hPSCs, assieme alla scarsa capacità di riprodurre in vitro l’ambiente in cui le cellule risiedono in vivo, i cardiomiociti prodotti attualmente sono immaturi e più simili allo stadio fetale di sviluppo.
Nel 2010 Warren L. ed il suo gruppo di ricerca ha sperimentato per la prima volta una tecnologia innovativa di tipo non-integrativo basata su trasfezioni ripetute con lipidi cationici di RNA messaggeri modificati sinteticamente (mmRNA) per evitare la risposta immunitaria innata da parte delle cellule; egli ha dimostrato la possibilità sia di riprogrammare cellule somatiche allo stato pluripotente, sia di programmare il differenziamento miogenico di hiPSCs.
Pertanto, lo scopo di questa tesi di dottorato è quello di sviluppare un metodo robusto ed efficiente per il differenziamento cardiaco di hPSCs combinando gli mmRNA con la tecnologia microfluidica. Ripetute trasfezioni di mmRNA codificanti per 6 fattori di trascrizione coinvolti nello sviluppo e nel funzionamento cardiaco, vengono impiegate per forzare l’espressione proteica endogena delle cellule e per guidare il differenziamento verso la maturazione funzionale dei cardiomiociti. L’integrazione del differenziamento cardiaco in una piattaforma microfluidica ad hoc, prodotta nel laboratorio BioERA, consente un controllo più preciso delle condizioni di coltura garantendo un’elevata efficienza di trasfezione degli mmRNA grazie all’elevato rapporto superficie/volume e permette la riproduzione in vitro di nicchie fisiologiche. Infatti, la miniaturizzazione consente di mimare al meglio le dinamiche cellulari che avvengono in vivo nel microambiente solubile. Le tecnologia microfluidica offre la possibilità di effettuare esperimenti combinati, multiparametrici e paralleli in una sola volta e con elevato rendimento a costi ridotti, non realizzabili nei macroscopici e costosi sistemi di coltura convenzionali.
Il Capitolo 1 inizia con la definizione di medicina rigenerativa e introduce la complessità dello sviluppo cardiaco ed il network di fattori di trascrizione che cooperano durante questo processo. Viene poi descritto lo stato dell’arte relativo alle strategie per l’ottenimento di cardiomiociti da hPSCs e al transdifferenziamento cardiaco di cellule somatiche, insieme alle relative limitazioni e alle problematiche attuali da risolvere. Infine viene presentato lo scopo generale di questa tesi di dottorato.
Il Capitolo 2 si focalizzerà sulle hPSCs (sia hES sia hiPS) impiegate durante questo progetto, descrivendo le caratterisatiche principali di tali cellule. Verrà inoltre presentato un protocollo di differenziamento cardiaco di hPSCs in monostrato che attualmente è considerato il gold standard per ottenere velocemente un’elevata resa di cardiomiociti contrattili in supporti di coltura convenzionali. Tale protocollo si basa sulla modulazione del pathway canonico di Wnt attraverso l’applicazione di due piccole molecole. Inoltre, una linea di hES, doppio reporter per 2 fattori di trascrizione cardiaci, verrà descritta ed impiegata in tutti gli esperimenti come strumento per monitorare l’andamento del differenziamento cardiaco delle hPSC. I risultati ottenuti in colture standard verranno mostrati.
Il Capitolo 3 esaminerà lo stato dell’arte della tecnologia microfluidica nelle applicazioni di medicina rigenerativa, sottolineando i vantaggi derivanti dalla combinazione della microtecnologia con la biologia cellulare. Verrà successivamente descritta la fabbricazione della piattaforma microfluidica utilizzata, con la successiva ottimizzazione della coltura, espansione e differenziamento cardiaco gold standard delle hPSCs conseguenti alla conversione dalla macro- alla microscala.
Il Capitolo 4 introdurrà la nuova strategia degli mmRNA per la riprogrammazione e la programmazione cellulare: anche in tal caso verrà discusso lo stato dell’arte. In seguito, verranno presentate le strategie sperimentali sviluppate per programmare il differenziamento cardiaco delle hPSCs verso un fenotipo più maturo dei cardiomiociti, insieme ai risultati ottenuti con le relative caratterizzazioni strutturali, funzionali e molecolari. In questo lavoro, per la prima volta, è stato possibile ottenere cardiomiociti da hPSCs attraverso ripetute trasfezioni di mmRNA per 6 fattori di trascrizione cardiaci in microfluidica, con efficienze superiori rispetto ai metodi presenti attualmente in letteratura, svolti in sistemi convenzionali.
Il Capitolo 5 infine presenterà la discussione e le conclusioni generali, assieme alle prospettive future riguardanti l’uso degli mmRNA combinati con la microfluidica per ottenere diversi fenotipi di cardiomiociti, variando la combinazione di fattori di trascrizione veicolati. In conclusione, gli esperimenti sviluppati in questo progetto di dottorato forniscono un proof-of-principle della possibilità di programmare con gli mmRNA il destino delle hPSCs verso il differenziamento e la maturazione di cardiomiociti funzionali in microfluidica; inoltre, essendo gli mmRNA una strategia non-integrativa , i cardiomiociti ottenuti in questo modo possono essere impiegati nel prossimo futuro per applicazioni cliniche di ricostruzione tissutale autologa e per screening farmacologici personalizzati.

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EPrint type:Ph.D. thesis
Tutor:Piccolo, Stefano
Supervisor:Elvassore, Nicola
Ph.D. course:Ciclo 28 > Scuole 28 > BIOMEDICINA > MEDICINA RIGENERATIVA
Data di deposito della tesi:27 July 2016
Anno di Pubblicazione:31 July 2016
Key Words:Human Pluripotent Stem Cells, Cardiomyocytes, Small molecules, signaling pathway, microfluidics, synthetic modified mRNA, mmRNA
Settori scientifico-disciplinari MIUR:Area 05 - Scienze biologiche > BIO/11 Biologia molecolare
Struttura di riferimento:Dipartimenti > Dipartimento di Medicina Molecolare
Codice ID:9694
Depositato il:03 Nov 2017 10:22
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