京都大学 / 新制・課程博士 / 博士(医科学) / 甲第23815号 / 医科博第136号 / 新制||医科||9(附属図書館) / 京都大学大学院医学研究科医科学専攻 / (主査)教授 山下 潤, 教授 遊佐 宏介, 教授 伊藤 貴浩 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Frontotemporal Dementia with parkinsonism linked to chromosome 17 (FTDP-17) (OMIM # 600274) is a tauopathy caused by mutations in the MAPT gene. This gene encodes for Tau protein and its alternative splicing normally produces 6 different isoforms with three (3R) or four (4R) repeats of microtubule-binding domains, originated from the alternative splicing of exon 10 in the MAPT transcript. In normal adult brain, neurons and glia cells contain both 3R and 4R splicing isoforms in a 1:1 ratio. Several mutations in the MAPT gene impair exon 10 splicing, causing unbalance between 4R and 3R Tau isoforms (4R > 3R), leading to Tau 4R protein accumulation as insoluble neuronal deposits. Therapeutical correction of MAPT splicing isoforms balance is, in principle, possible using either exon-specific siRNAs, which degrade exon-10-containing mRNA in the cytoplasm, or splice-switching antisense RNAs, that induce skipping of exon 10 during the splicing of MAPT pre-mRNA in the nucleus. Both approaches have been explored in the Laboratory of RNA Biology and Biotechnology at CIBIO (University of Trento) using splicing reporters. Subsequently, several siRNAs and antisense RNAs have been demonstrated to efficiently engage their target (pre-)mRNA and restore 4R:3R balance in neuroblastoma cell lines in culture. Aim of the present work is to obtain pre-clinical evidence of the efficiency of the two approaches, in order to move towards clinical studies. To this purpose, I set up a disease model consisting in hiPSCs-derived neurons carrying a mutation in intron 10, where a C is substituted with a T in position 16 (MAPT IVS10+16; EBiSC, depositor Sigma-Aldrich SIGi001-A-12) and compared them with the appropriate isogenic healthy control (EBiSC; depositor Sigma-Aldrich SIGi001-A-1). 3R and 4R Tau mRNA and protein levels were evaluated at various days of differentiation and neuronal maturation. In my hands, IVS10+16 neurons showed increase 4R Tau mRNA expression at 120 days of differentiation, resembling the patient’s phenotype. The unbalance 4R:3R is reflected in the Tau protein, as assessed by Western blotting . I am presently evaluating other outcome measures of disease in this cellular model, such as synaptic impairment and electrophysiology . The Laboratory of RNA Biology and Biotechnology has reported that microRNAs (miRNAs) can be used as biomarkers of Frontotemporal Dementia (FTD). In particular, we recently reported that miR-92a-3p, miR-320a and miR-320b are misregulated in the plasma of FTD patients in comparison to healthy individuals (manuscript under review). I set out to measure these miRNAs in d120 IVS10+16 and isogenic neurons and in their conditioned medium. I found that all three miRNAs of interest were significantly increased in IVS10+16 samples compared to WT neurons, therefore representing a useful measure of therapeutical efficacy in our protocols. With the use of fluorescently labelled siRNAs, I then tackled the problem of delivering siRNA molecules to mature neurons and set up a protocol for their efficient delivery. Consequently, day120 IVS10+16 and WT neurons were transfected with different concentration of scramble and therapeutic siRNAs and the restoration of the 4R:3R Tau balance was assessed. My results suggest a promising potential for the use of isoform-specific siRNAs in FTDP-17 and possibly in other tauopathies. At the same time, I intended to validate in the same hiPSC-derived neuronal disease model, U1 and U7 chimeric splice-switching antisense RNAs that had been previously tested by plasmid transfection in neuroblastoma cell lines. To overcome the limitation represented by poor plasmid transfection efficiency in mature neurons, I encapsulated them into recombinant adeno-associated viruses (rAAVs). After having optimized the production of rAAVs and set the transduction conditions, IVS10+16 mature neurons were transduced with AAV expressing chimeric splice-switching antisense RNAs. Although neurons successfully got transduced and the cassette transcribed, there was no therapeutic effect when viruses were tested in d130 IVS10+16 neurons. I am presently exploring different experimental paradigms, to test the hypothesis that the 4R:3R unbalance can be prevented in mature neurons.

Der Herzmuskel muss sich einer dynamischen und sich mechanisch verändernden Umgebung anpassen. Die Mechanosignaltransduktion ermöglicht es Zellen mechanischen Kräfte zu erfassen und durch nachgeschaltete biochemische Signalkaskaden darauf zu reagieren. Obwohl verschiedene Gewebestrukturen und Proteine damit in Verbindung gebracht wurden, wie das Herz die mechanischen Kräfte wahrnimmt, ist unser Verständnis der kardialen Mechanosignaltransduktion unvollständig. Durch Dehnung aktivierte Ionenkanäle spielen eine wichtige Rolle bei der mechanosensitiven Autoregulation des Herzens. Um die funktionelle Rolle von PIEZO1 in Kardiomyozyten zu untersuchen, habe ich daher PIEZO1 in induzierten pluripotenten Stammzellen mittels Genomeditierung deletiert. Die PIEZO1-/- Zellen wurden dann in lebensfähige, herzähnlich schlagende Kardiomyozyten differenziert. In phänotypische Analysen der elektrophysiologischer Eigenschaften, Zellmorphologie und der herzähnlichen Schlagaktivität habe ich den Effekt der PIEZO1-deletion in genomeditierten Kardiomyozyten untersucht. Die Deletion von PIEZO1 zeigte zum ersten Mal, dass es PIEZO1-abhängige dehnungsaktivierte und Kalzium-Ströme in vom Menschen stammenden differenzierten Kardiomyozyten gibt. Dies legt nahe, dass PIEZO1 eine Rolle in der Mechanosignaltransduction in Herzzellen spielt. Darüber hinaus zeigte eine RNA-Sequenz Analyse, dass der Verlust von PIEZO1 in vom Menschen stammenden differenzierten Kardiomyozyten mit der Herunterregulation von Proteinen korreliert, die für die extrazellulärer Matrix von Bedeutung sind. Diese Daten unterstreichen die Rolle von PIEZO1 in Kardiomyozyten und legen seine Bedeutung für die Organisation und Struktur der extrazellulären Matrix nahe. / The cardiac muscle has to adapt in a highly dynamic mechanical environment. Mechanotransduction is the process that allows cells to sense the mechanical forces and respond by downstream biochemical signaling cascades. Although different tissue structures and proteins have been implicated in how the heart senses the mechanical forces, yet our understanding in cardiac mechanotransduction is incomplete. Stretch-activated channels (SACs) have been suggested to play an important role in the mechanosensitive autoregulation of the heart. PIEZO1 is a stretch-activated channel and has been involved in vascularization, erythrocyte volume homeostasis and regulation of the baroreceptor reflex, yet its role in cardiac mechanotransduction has not been described. To study the functional role of PIEZO1 in cardiomyocytes I have generated a PIEZO1 knockout (KO) human induced pluripotent cell (hiPSC) line using genome editing technology. The genome edited cells were then differentiated into viable, beating cardiomyocytes. Different phenotypic analyses were conducted, including the evaluation of electrophysiological characteristics, observation of cell morphology and beating activity of the genome edited hiPSC-derived cardiomyocytes. With this approach the aim was to gain more insight into PIEZO1 function in cardiomyocytes using a reliable, efficient and reproducible human cellular model system. For the first time PIEZO1-dependent calcium transients and stretch-activated currents were observed in hiPSC-derived cardiomyocytes (hiPSC-CMs). This proposes a possible role of PIEZO1 as a cardiac mechanotransducer. Furthermore, RNA-seq analysis revealed that loss of PIEZO1 in hiPSC-CMs is associated with downregulation of the expression of extracellular matrix-associated proteins. These data highlight the role of PIEZO1 in cardiomyocytes and suggest its implication in extracellular matrix organization and structure.

La surdité neurosensorielle est définie par une atteinte de l’oreille interne, il résulte principalement d’une perte de cellules ciliées (CC). Chez les mammifères, ce processus est malheureusement irréversible. Le développement de la thérapie cellulaire a fait naître de nouveaux espoirs pour le traitement des surdités neurosensorielles. Les cellules souches d’origine embryonnaire ou adulte seraient capables de se différencier in vitro en progéniteurs otiques et de restaurer partiellement les fonctions auditives in vivo après transplantation. Cependant, les protocoles de différenciation in vitro des CC à partir de cellules souches sont insatisfaisants, et les signaux qui contrôlent ce phénomène restent mal connus. Ainsi, l’objectif de ce travail de thèse était d’étudier in vitro la différenciation des CC à partir de cellules souches pluripotentes induites humaines (hiPSC). Nous nous sommes intéressés à deux voies de signalisation majeures impliquées dans le développement de l’oreille interne in vivo, la voie Notch et la voie Wnt. Dans une première partie, nous avons montré que l’inhibition tardive de la voie Notch favorise la différenciation des hiPSC en CC. Dans une seconde partie, nous avons étudié le rôle de la voie Wnt dans la différenciation des hiPSC en cellules otiques. Nos résultats indiquent que l'inhibition de la voie Wnt durant la première phase d’induction favorise l'expression des marqueurs de la placode otique et initie la spécification des CC.Les travaux présentés dans cette thèse améliorent ainsi les protocoles de différenciation des hiPSC et suggèrent que ce type de cellules serait parfaitement adapté pour traiter les surdités neurosensorielles. / Neurosensory hearing loss is associated to inner ear disorders and degeneration of hair cells (HCs). Unfortunately, this process is irreversible in mammals. Currently, no curative treatment allows these cells to regenerate. For this reason, the development of cell therapy arose new hopes for the treatment of neurosensory hearing loss. Stem cells, either of embryonic or adult origin, seem able to differentiate in vitro into otic progenitors and to partially restore auditory functions in vivo. However, current protocols for in vitro differentiation of stem cells into HCs are unsatisfactory, and the signals that control this phenomenon remain poorly understood. Thus, the objective of this thesis was to study in vitro HC differentiation from human induced pluripotent stem cells (hiPSCs). We were particularly interested in two major signaling pathways involved in vivo in inner ear development, the Notch and Wnt signaling pathways.In a first part, we demonstrated that Notch inhibition during late otic differentiation enhances hiPSC differentiation into hair cell-like cells. In a second part, we studied the role of the Wnt signaling pathway during otic induction and HC specification. Our results indicate that Wnt inhibition during early otic induction promotes the expression of otic placode markers and initiate HC specification. The work presented here thus propose improved protocols to obtain HCs from hiPSCs, and suggest that this cell type is perfectly adapted for the treatment of neurosensory hearing loss.

No description available.

[ES] Las antraciclinas son fármacos antineoplásicos ampliamente utilizados en el trata-miento de varios tipos de cáncer, incluyendo tanto tumores sólidos como hematoló-gicos. A pesar de su eficacia, su uso se ve limitado por su efecto cardiotóxico. El aumento de los supervivientes de cáncer, especialmente pediátrico, ha provocado que cada vez haya más personas con cardiotoxicidad inducida por antraciclinas. Por este motivo, es necesaria la búsqueda de nuevos modelos de enfermedad relevan-tes para comprender la fisiopatología del daño cardíaco inducido por antraciclinas, así como el desarrollo de nuevas terapias cardioprotectoras que permitan el uso de las antraciclinas evitando su efecto cardiotóxico. En este trabajo se ha estudiado, por una parte, la susceptibilidad al daño por do-xorrubicina (una de las principales antraciclinas empleadas en clínica) de cardiomio-citos obtenidos a partir de células madre pluripotentes inducidas derivadas de pa-cientes pediátricos oncológicos que experimentaron cardiotoxicidad causada por an-traciclinas. Los cardiomiocitos de los pacientes fueron tratados con doxorrubicina y se evaluaron diferentes parámetros, incluyendo la viabilidad, apoptosis, estrés oxida-tivo, daño genómico, daño mitocondrial, desorganización sarcomérica, etc. compa-rándolos con cardiomiocitos control. Nuestros resultados mostraron que estos car-diomiocitos recapitulan la susceptibilidad a la doxorrubicina observada en los pacien-tes, constituyendo un buen modelo de enfermedad para estudiar los mecanismos de cardiotoxicidad de la doxorrubicina o el cribado de fármacos. Por otra parte, se ha evaluado el papel cardioprotector de un miARN, el miR-4732-3p, frente al daño inducido por antraciclinas. Este miARN está desregulado en pa-cientes con cáncer de mama que sufrieron cardiotoxicidad inducida por antraciclinas. Para comprobar su efecto cardioprotector, este miARN fue sobreexpresado en célu-las cardíacas de rata, las cuales fueron tratadas con doxorrubicina, observándose que incrementaba la supervivencia de las células y reducía el estrés oxidativo. Tam-bién se estudió la cardioprotección in vivo en un modelo de cardiotoxicidad inducida por doxorrubicina en rata, observando que mejora la función cardíaca, reduce la fi-brosis intersticial y el estrés oxidativo. Además, se hizo un estudio de los posibles genes diana de este miARN. En su conjunto, nuestros resultados muestran que el miR-4732-3p tiene un efecto cardioprotector frente al daño por doxorrubicina, y po-dría ser una herramienta terapéutica para el tratamiento del daño cardíaco causado por las antraciclinas. / [CAT] Les antraciclines són fàrmacs antineoplàstics àmpliament utilitzats en el tractament de diversos tipus de càncer, incloent tant tumors sòlids com hematològics. Tot i la seva eficàcia, el seu ús es veu limitat pel seu efecte cardiotòxic. L'augment dels su-pervivents de càncer, especialment pediàtric, ha provocat que cada cop hi hagi més persones amb cardiotoxicitat induïda per antraciclines. Per aquest motiu, cal cercar nous models de malaltia rellevants per comprendre la fisiopatologia del dany cardíac induït per antraciclines, així com el desenvolupament de noves teràpies cardiopro-tectores que permetin l'ús de les antraciclines evitant-ne l'efecte cardiotòxic. En aquest treball s'ha estudiat, d'una banda, la susceptibilitat al dany per doxorrubi-cina (una de les principals antraciclines emprades en clínica) de cardiomiòcits obtin-guts a partir de cèl¿lules mare pluripotents induïdes derivades de pacients pediàtrics oncològics que van experimentar cardiotoxicitat causada per antraciclines. Els cardi-omiòcits dels pacients van ser tractats amb doxorrubicina i es van avaluar diferents paràmetres, incloent-hi la viabilitat, apoptosi, estrès oxidatiu, dany genòmic, dany mitocondrial, desorganització sarcomèrica, etc. comparant-los amb cardiomiòcits control. Els nostres resultats van mostrar que aquests cardiomiòcits recapitulen la susceptibilitat a la doxorrubicina observada en els pacients, constituint un bon model de malaltia per estudiar els mecanismes de cardiotoxicitat de la doxorrubicina o el cribratge de fàrmacs. D'altra banda, s'ha avaluat el paper cardioprotector d'un miARN, el miR-4732-3p, davant del dany induït per antraciclines. Aquest miARN està desregulat en pacients amb càncer de mama que van patir cardiotoxicitat induïda per antraciclines. Per comprovar el seu efecte cardioprotector, aquest miARN va ser sobreexpressat en cèl·lules cardíaques de rata, les quals van ser tractades amb doxorrubicina, obser-vant-se que incrementava la supervivència de les cèl·lules i reduïa l'estrès oxidatiu. També es va estudiar la cardioprotecció in vivo en un model de cardiotoxicitat induï-da per doxorrubicina en rata, observant que millora la funció cardíaca, redueix la fi-brosi intersticial i l'estrès oxidatiu. A més, es va fer un estudi dels possibles gens di-ana d'aquest miARN. En conjunt, els nostres resultats mostren que el miR-4732-3p té un efecte cardioprotector davant el dany per doxorrubicina, i podria ser una eina terapèutica per al tractament del dany cardíac causat per les antraciclines. / [EN] Anthracyclines are drugs widely used in the treatment of several types of cancer, including both solid tumors and hematologic malignancies. Despite its proven effica-cy, its use is hampered by its cardiotoxic effect. The increase in cancer survivors, especially pediatric, has led to more and more people with anthracycline-induced cardiotoxicity. Therefore, it is necessary to search for new relevant disease models to better understand the physiopathology of cardiac damage-induced by anthracy-clines, as well as the development of new cardioprotective therapies that allow the clinic use of anthracyclines avoiding their cardiotoxic effect. In this work we have studied, on the one hand, the susceptibility against doxorubicin damage (major anthracycline used in clinic) of cardiomyocytes obtained from in-duced pluripotent stem cells derived from oncology pediatric patients that underwent cardiotoxicity-induced by anthracyclines. Cardiomyocytes from these patients were treated with doxorubicin, and we evaluated several parameters, including cell viabil-ity, apoptosis, oxidative stress, genomic damage, mitochondrial damage, sarcomere disorganization, etc. comparing the results with control cardiomyocytes. Our results showed that these cardiomyocytes recapitulate the susceptibility against doxorubicin observed in the patients, making them a good disease model to study cardiotoxicity mechanisms of doxorubicin or drug screening. On the other hand, we evaluated the cardioprotective role of one miRNA, miR-4732-3p, against doxorubicin-induced damage. This miRNA is dysregulated in breast can-cer patients that suffered cardiotoxicity-induced by anthracyclines. To test its cardio-protective effect, this miRNA was overexpressed in rat cardiac cells that were treated with doxorubicin, showing an increment of cell survival and a reduction of oxidative stress levels. We also studied in vivo cardioprotection in a doxorubicin-induced cardi-otoxicity model in rat, showing an improvement in cardiac function, reduced intersti-tial fibrosis and reduced oxidative stress levels. Moreover, we studied possible target genes of this miARN. Overall, our results showed that miR-4732-3p has a cardiopro-tective role against doxorrubicin-induced damage and could be used as a therapeutic tool for treatment of cardiac damage caused by anthracycline. / Reinal Ferré, I. (2023). Modelado de la cardiotoxicidad inducida por antraciclinas en hiPSC-CM de pacientes oncológicos pediátricos y estudio del papel cardioprotector del miR-4732-3p [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/193075

The 15q13.3 microdeletion is a common genetic disorder associated with multiple neurodevelopmental disorders including autism spectrum disorder, epilepsy, and schizophrenia. Patients have diverse clinical presentations, often prompting genetic assays that identify the CNV in the clinic. This late-stage screening leaves a considerable gap in our understanding of the prenatal and prediagnostic developmental impairments in these individuals, providing a barrier to understanding the disease pathobiology. We provide the first investigation into embryonic brain development of individuals with the 15q13.3 microdeletion by generating multiple 3D neural organoid models from the largest clinical cohort in reported literature. We incorporated unguided and guided forebrain organoid models into our multi-transcriptomic phenotyping pipeline to uncover changes in cell type emergence and disruptions to circuit development, all of which had underlying changes to cell adhesion pathways. Specifically, we identified accelerated growth trajectories in 15q13.3del unguided neural organoids and used single cell RNA sequencing to identify changes in radial glia dynamics that affect neurogenesis. We measured changes in the pseudotemporal trajectory of matured unguided neural organoids, and later identified disruptions in synaptic signaling modules amongst the primary constituents to neural circuitry, excitatory and inhibitory neurons. We leveraged dorsal and ventral forebrain organoid models to better assess circuit dynamics, as they faithfully produce the excitatory and inhibitory neurons in the pallium and subpallium, respectively. We then used the entire 15q13.3del cohort and performed bulk RNA sequencing on each tissue type at two timepoints and discovered convergence on transcriptional dysregulation and disruptions to human-specific zinc finger proteins localized to chromosome 19. We also identified cell type-specific vulnerabilities to DNA damage and cell migration amongst the dorsal and ventral organoids, respectively, which was consistent with the excitatory and inhibitory neural subpopulations amongst the unguided neural organoids scRNA Seq, respectively. We then examined neuron migration in a 3D assembloid model by sparsely labeling dorsal-ventral forebrain organoids from multiple genotype-lineage combinations. Light sheet microscopy identified deficits in inhibitory neuron migration and morphology, but not migration distance, suggesting a complex disruption to cortical circuitry. This novel combination of cell type characterization, pathway identification, and circuitry phenotyping provides a novel perspective of how the 15q13.3 deletions impair prenatal development and can be applied to other NDD models to leverage understanding of early disease pathogenesis. / Dissertation / Doctor of Science (PhD) / The development of the human brain is a highly complex and tightly regulated process that requires the participation of multiple cell types throughout development. Disturbances to the emergence, differentiation, or placement of these cell types can cause disruptions and local miswiring of neural circuits, which is often associated with neurodevelopmental disorders (NDDs). The 15q13.3 microdeletion syndrome is a highly complex condition associated with multiple NDDs and has seldom been studied in a human context. To address this, we used stem cells derived from a 15q13.3 microdeletion syndrome cohort and their typically developing familial controls to generate unguided (“whole brain”) and region-specific organoids to investigate early fetal development across time. We used the largest 15q13.3 microdeletion cohort in reported literature to identify shared disruptions in early developmental milestones such as neurogenesis, neural migration, and neural patterning. We identified expansion of specific cell populations, including progenitors that later give rise to mature neurons. Abnormalities persisted in more mature cell populations, including the inhibitory neurons responsible for establishing critical microcircuitry in the human cortex. By generating guided organoids that enrich for excitatory and inhibitory neural populations, we were able to merge the models to form assembloids, where we captured early migratory and morphological deficits in inhibitory neuron populations, which is supported by the multi-transcriptomics experiments performed in both organoid models. This study provides a framework for examining fetal development in a neurodevelopmental disorder context. By using the 15q13.3 microdeletion background, we found novel disruptions in cell type emergence and circuit formation previously unreported in mouse or 2D neuron models, highlighting the utility of the phenotyping platform for disease modeling.

[ES] Cada año, cientos de miles de nuevos casos en todo el mundo son diagnosticados anualmente con fibrilación auricular, estimándose que aproximadamente 33.5 millones de personas viven con esta compleja enfermedad. Sin embargo, se hizo evidente que la fibrilación auricular es una enfermedad multifacética y progresiva. Por lo tanto, se requiere el desarrollo de nuevos modelos experimentales que recapitulen este complejo mecanismo. Por esta razón, esta tesis ha navegado a través del intrincado panorama del remodelado de la fibrilación auricular desde un punto de vista electrofisiológico, estructural e inmunológico, utilizando un modelo in vitro de cardiomiocitos atriales derivados de células madre pluripotentes inducidas humanas (hiPSC-aCM). El modelo demostró ser capaz de recapitular mecanismos de reentrada, así como remodelados genéticos correlacionados con cambios electrofisiológicos, estructurales e inmunológicos similares a los observados en pacientes con fibrilación auricular, demostrando su valor como modelo para estudiar los mecanismos de iniciación de la arritmia. Además, la tesis exploró enfoques optogenéticos innovadores para la perturbación del potencial de acción en hiPSC-aCM, demostrando su posible uso para la terminación de la arritmia. En conclusión, esta tesis de doctorado realiza una contribución significativa al desarrollo y prueba de un nuevo modelo in vitro de fibrilación auricular en atrios humanos, proporcionando una base sólida para futuras mejoras en los objetivos terapéuticos y medicamentos. / [CA] Cada any, centenars de milers de nous casos a tot el món són diagnosticats anualment amb fibrilació auricular, estimantse que aproximadament 33.5 milions de persones viuen amb aquesta complexa malaltia. No obstant això, es va fer evident que la fibril·lació auricular és una malaltia multifacètica i progressiva. Per tant, es requereix el desenvolupament de nous models experimentals que recapitulen aquest complex mecanisme. Per aquesta raó, aquesta tesi ha navegat a través del intrincat panorama del remodelat de la fibrilació auricular des d'un punt de vista electrofisiològic, estructural i immunològic, utilitzant un model in vitro de cardiomiòcits atrials derivats de cèlules mare pluripotents induïdes humanes (hiPSC-aCM). El model va demostrar ser capaç de recapitular mecanismes de reentrada, així com remodelats genètics correlacionats amb canvis electrofisiològics, estructurals i immunològics similars als observats en pacients amb fibril·lació auricular, demostrant el seu valor com a model per estudiar els mecanismes d'iniciació de l'arítmia. A més, la tesi va explorar enfocs optogenètics innovadors per a la pertorbació del potencial d'acció en hiPSC-aCM, demostrant el seu possible ús per a la terminació de l'arítmia. En conclusió, aquesta tesi de doctorat realitza una contribució significativa al desenvolupament i prova d'un nou model in vitro de fibril·lació auricular en atris humans, proporcionant una base sòlida per a futures millores en els objectius terapèutics i medicaments. / [EN] Each year hundreds of thousands of new cases worldwide are annually diagnosed with atrial fibrillation (AF), estimating that approximately 33.5 million of people worldwide live with this complex disease. However, it became clear that AF is not only a prevalent cardiac arrhythmia but also a multifaceted and progressive one. Thus, the development of new experimental models that recapitulate this complex mechanism is required. For this reason, this thesis has navigated through the intricate landscape of AF remodeling under an electrophysiological, structural and immunological point of view using an in vitro model of human induced pluripotent stem cell-derived atrial cardiomyocytes (hiPSC-aCM). The model showed to be able to recapitulate re-entry mechanisms as well as genetic remodeling correlated to electrophysiological, structural and immunological changes similar to those observed in AF patients, demonstrating its value as model for studying initiation arrhythmia mechanisms. Furthermore, the thesis explored innovative optogenetic approaches for action potential perturbation in hiPSC-aCM, demonstrating their possible use for arrhythmia termination. In conclusion, this PhD thesis makes a significant contribution to the development and testing of a new human atrial in vitro model of AF, providing a strong basis for future improvements of therapeutic target and drugs. / Casini, M. (2024). The use of human induced pluripotent stem cell-derived atrial cardiomyocytes for studying arrhythmia mechanisms [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/204142

No description available.

Le noeud sinusal (NS) est le centre de l‟automatisme cardiaque. Grâce à son activité électrique spontanée, il dicte la fréquence cardiaque (FC) en réponse aux demandes physiologiques. A ce jour, le NS demeure un sujet de recherche important puisque les mécanismes moléculaires responsables de sa régulation sont encore méconnus. Par exemple, les processus menant à la bradycardie sinusale et à la maladie du sinus (MS) chez les personnes âgées sont mécompris et présentement l‟implantation d‟un stimulateur cardiaque demeure le seul traitement disponible. Ainsi, l‟objectif de cette thèse était de déterminer les changements moléculaires et cellulaires se produisant au niveau du NS en réponse à divers stimuli physiologiques et pathologiques afin d'établir leurs rôles potentiels dans la régulation de la FC et le développement de la MS. Dans les deux premiers chapitres, la grossesse est présentée comme modèle physiologique. En effet, la réponse adaptative aux demandes croissantes de la mère et du foetus engendre des changements physiologiques considérables au niveau du myocarde, dont une augmentation de la FC essentielle pour la perfusion adéquate des organes. Toutefois, cette augmentation peut aussi favoriser le développement d‟arythmies. Dans le troisième chapitre, l‟inflammation, un facteur présent lors du vieillissement et dans plusieurs pathologies où la MS se manifeste, a fait l‟objet d‟une étude dans le but de déterminer son rôle dans le développement de la MS. Les résultats obtenus dans cette thèse démontrent que la grossesse induit une hausse de la FC chez la souris gestante similaire à celle retrouvée chez la femme enceinte. Cette accélération était due à un remodelage électrique du NS. Plus spécifiquement, la fréquence des potentiels d‟action ainsi que la densité et l‟expression des courants pacemaker (If) et calcique de type L (ICaL) étaient augmentées. De plus, une accélération des transitoires calciques spontanés et de la vitesse de relâche calcique du réticulum sarcoplasmique a été observée. La régulation de l‟automaticité par un stimulus pathologique, l‟interleukine-1β, est abordée par la suite. L‟interleukine-1β, une cytokine ayant un rôle majeur comme médiateur inflammatoire, se retrouve en concentrations élevées dans plusieurs maladies associées avec la ii MS. Nos résultats démontrent que l‟interleukine-1β engendre une diminution de l‟automaticité associée à une réduction de If et ICaL dans les cardiomyocytes humains de type nodal dérivés de cellules souches induites pluripotentes (hiPSC-CM). En parallèle, le phénotype électrophysiologique et moléculaire des hiPSC-CM a été caractérisé démontrant leur homologie avec les cellules du NS humain adulte, les validant comme modèle in vitro de cellules nodales humaines. En conclusion, les études présentées dans cette thèse démontrent que le NS est plus qu‟un simple tissu régulé par l‟innervation autonome. En effet, son automaticité est dynamique et peut être influencée par des facteurs physiologiques ou pathologiques. Nos résultats contribuent ainsi à une meilleure compréhension des mécanismes sous-jacents à l‟automaticité. Ces avancées sont importantes non seulement pour la santé des femmes, mais aussi pour les individus souffrant de la MS. À terme, nous espérons que ces résultats contribueront au développement de stratégies thérapeutiques pour traiter des complications liées aux troubles d‟automaticité cardiaque. / The sinoatrial node (SAN) is the dominant cardiac pacemaker. With its spontaneous automaticity, it dictates rhythm and controls heart rate in response to varying physiological demands. Despite its modest size, the SAN is a very heterogeneous and complex structure that remains the topic of research efforts due, in part, to uncertainties in the mechanisms that regulate pacemaking in various conditions. For instance, the processes that lead to severe sinus bradycardia and SAN dysfunction (SND) in the elderly are unknown and to date, the implantation of electronic pacemaker remains the only SND treatment. Accordingly, the overall objective of this thesis was to explore and highlight the molecular and cellular changes that occur within the SAN in both physiological and pathological states, while determining how they contribute to regulation of heart rate and potentially SND. In the first two chapters, we present pregnancy as a physiological model considering it is a period during which substantial adaptive changes to the myocardium and increases in heart rate occur. Paradoxically, the rapid rate, which is essential for adequate organ perfusion of both mother and foetus, may also increase vulnerability to certain arrhythmias. In the third chapter, inflammation, a central process in pathology and common factor to several diseases and even ageing, was evaluated as potential underlying circumstance contributing to the development of sinus bradycardia and SND. Combinations of in vivo, ex vivo, biochemical, molecular and cellular approaches were used in order to generate an integrated understanding of the models we examined. Our data shows that in pregnant mice, an increase in heart rate similar to that of pregnant women occurs and was due to an electrical remodelling of the SAN. Specifically, an increase in action potential frequency of isolated individual SAN cells was observed. This was attributed to increased expression and density of pacemaker (If) and L-type Ca2+ currents (ICaL) along with a rapid spontaneous Ca2+ transient rate and faster intracellular sarcoplasmic reticulum Ca2+ release. We then demonstrate that the pro-inflammatory cytokine interleukin-1β which is a major inflammatory mediator that is upregulated in several diseases associated with SND, iv dramatically slows automaticity by reducing If and ICaL density in nodal-like cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CM). Importantly, in that study, hiPSC-CMs were also physiologically and molecularly characterized revealing their high resemblance to adult human SAN and a potential use as a novel in vitro model to study pacemaking in humans. In conclusion, the results of this thesis demonstrate that the SAN is not a simple, neurally controlled tissue, but a rather dynamic pacemaker that undergoes extensive intrinsic remodelling during states of health and disease. The results contribute to understanding physiological mechanisms of pacemaking and how they are altered by disease and may be relevant for both women‟s health and the individuals affected by SND. Ultimately, we hope these findings will be helpful in the development of therapeutic strategies to treat pacemaking-related complications.