The authors thank the following staff members and research personnel for their contributions: Matthew Librach, Leila Maghen, Tanya A. Baretto, Shlomit Kenigsberg, and Andr&#233;e Gauthier-Fisher. This work was supported by the The Ontario Research Fund - Research Excellence (ORF-RE, Round #7) and CReATe Program Inc.

All studies involving animals were conducted and reported according to ARRIVE guidelines48. All studies were performed with institutional research ethics board approval (REB number 454-2011, Sunnybrook Research Institute; REB 29889, University of Toronto, Toronto, Canada). All animal procedures were approved by the Animal Care Committee of the University Health Network (Toronto, Canada), and all animals received humane care in compliance with the Guide for the Care and Use of Laboratory Animals, 8...

Dr. Clifford L. Librach is joint holder of the patent: Methods of isolation and use of cells derived from first trimester umbilical cord tissue, granted in Canada and Australia.

The cardiac differentiation of stem cells has been under development for over 2 decades, with several different strategies being used to generate cardiomyocyte-like cells from MSC sources. Many of these strategies, however, are inefficient, and the conditions used are often not representative of the environment transplanted cells encounter in vivo.
In contrast to existing methods, the protocol presented here utilizes a combination of primary cardiac feeder layers and MSC aggregate for...

Congestive heart failure (CHF) persists as a leading cause of morbidity and mortality worldwide. CHF often occurs following the massive loss of cardiomyocytes and the development of cell-free scar tissue as the pathological result of a myocardial infarction (MI)1. While the heart is a partially self-renewing organ, the resident stem and progenitor cell pool responsible for executing tissue regeneration significantly diminishes in abundance and function in aged patients, often becoming insufficient for optimal recovery after injury. Thus, there is great interest in developing experimental treatments that involve the transplantation of healthy donor cells into the damaged myocardium. It is imperative that the donor cells not only restore the structure of the tissue, but also achieve the functional recovery of the affected myocardium.
The native heart employs heart tissue-resident and endogenous bone marrow-originated stem cells for post-injury repair2,3,4. Regenerative cells- host- and donor-derived alike- must have the capacity to obtain the appropriate phenotype and function in the microenvironment of the remodeling myocardium, along with the ability to efficiently and safely replace the lost cells. In vitro differentiation methods have been used extensively to achieve high-efficiency, stem cell-based cardiomyocyte production5,6. The expression profile of cardiac lineage markers is used to define the process of stem cell differentiation towards the cardiac lineage7. Early differentiation markers, such as NKX2.5, myocyte enhancer factor 2C (Mef2c), and GATA48,9, can be an indication of the initiation of the cardiomyogenic process. Mature cardiomyocyte markers commonly used to assess differentiation efficacy are signal regulatory protein &#945; (SIRPA)10, cardiac troponin T (cTnT)11, heavy chain cardiac myosin (MYH6)8,12,13, and connexin 43 (Cx43)14,15,16. The methods using embryonic stem cells (ESCs) and pluripotent stem cells (PSCs) have been thoroughly optimized and discussed regarding the details of inductive factors, oxygen and nutrient gradients, and the exact timing of action5,6,7,17,18. Nonetheless, ESC- and PSC-based technologies still present multiple ethical and safety concerns, along with suboptimal electrophysiological and immunological features19,20. Hosts transplanted with these cells often experience immunorejection and require permanent immunosuppression. This is mainly due to mismatching major histocompatibility complex (MHC) molecules in the host and donor and to the resulting T-cell response21. While individual MHC class I matching is a possible solution, a more accessible clinical practice would require a cell source that is universally immunoprivileged to overcome the concern of rejection.
As an alternative cell source for use in clinical applications, MSCs and in particular, BMSCs, have been investigated for use in tissue regeneration since their initial description in 199522. MSCs are believed to be resident regenerative cells that can be found in nearly any vascularized tissue23. Upon isolation from the desired source, MSCs can easily be expanded in culture, have extensive paracrine capacity, and often possess immunoprivileged or immunomodulatory properties24,25. Their safety and efficacy have already been shown in several pre-clinical studies, in particular for cardiac regeneration3,26.
Many MSC differentiation strategies utilize pharmacological agents, such as 5-azacytidine22 and DMSO27, and growth or morphogenic factors, like BMPs5,7,28,29 or angiotensin-II30, with variable efficiency. These strategies, however, are not based on the obstacles that a na&#239;ve regenerative cell is likely to encounter after homing or being delivered to the site of injury in vivo. More physiologically relevant strategies, while more difficult to define and manipulate, are based on the premise that MSC differentiation can be induced through signals from the tissue microenvironment itself. Previous studies have shown that exposure to the cardiac cell lysates31 or ventricular myocardium32,33, or direct contact with primary cardiomyocytes in vitro15,34, can increase the expression of cardiac markers in MSCs. Others have demonstrated spontaneous cardiomyogenesis after treating cardiac injuries with MSCs35,36,37,38, although in part, the fusion of BMSCs and cardiomyocytes39,40 generated the nascent myocardium. To our knowledge, functional, spontaneously contracting cardiomyocytes from human MSCs (hMSCs) of any tissue source have not yet been reported.
The current consensus is that all MSCs arise from perivascular cells23. Young MSCs with pericyte properties can be isolated from the perivascular region of human umbilical cord tissue41,42,43. In comparison to BMSCs, HUCPVCs possess increased differentiation potential and several other regenerative advantages, both in vitro41,44 and in vivo45,46,47. Notably, the source being the maternal-fetal interface, HUCPVCs have significantly lower immunogenicity compared to adult sources of MSCs. Our research focuses on the characterization and pre-clinical applications of FTM HUCPVCs, the youngest source of MSCs investigated, which we have previously shown to have increased proliferative and higher multilineage differentiation capacities, including in the cardiomyogenic lineage41.
Here, we present a protocol that combines aggregate formation and primary cardiac cell feeder layers as inductive forces to attain the complete cardiomyogenic differentiation of MSCs. Aggregates provide a 3D environment, which better models conditions in vivo compared to 2D adherent cultures. Utilizing cardiac feeder layers provides an environment that is representative of the ultimate transplantation site for the MSCs. We demonstrate that younger sources of MSCs isolated from pre- or post-natal umbilical cords have a higher capacity to form aggregates and to reach the cardiac phenotype compared to adult BMSCs, while still maintaining their immune-privilege. Besides the steep elevation of cardiac lineage marker genes and the induced expression of intracellular (i.e., cTnT and MYH6) and cell-surface proteins (i.e., SIRPA and Cx43) specific for cardiomyocytes, we show that the differentiation potential of FTM HUCPVCs can be harnessed with this method and that they can give rise to spontaneously contracting cardiomyocyte-like cells.

<table border="0" cellpadding="0" cellspacing="0" width="917">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">0.25% Trypsin/EDTA</td>
			<td style="width:203px;">Gibco</td>
			<td style="width:119px;">25200056</td>
			<td style="width:299px;">For cell dissociation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Alpha-MEM</td>
			<td style="width:203px;">Gibco</td>
			<td>12571071</td>
			<td style="width:299px;">For HUCPVC and BMSC culture media.</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">PE-conjugated anti-human/mouse CD49f antibody</td>
			<td style="width:203px;">Biolegend</td>
			<td style="width:119px;">313612</td>
			<td style="width:299px;">Integrin marker for FC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">APC-conjugated human Cx43/GJA1 antibody</td>
			<td style="width:203px;">R&#38;D Systems</td>
			<td style="width:119px;">FAB7737A</td>
			<td style="width:299px;">Connexin 43 marker for FC</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">FITC-conjugated HLA-A2 antibody</td>
			<td style="width:203px;">Genway Biotech Inc.</td>
			<td style="width:119px;">GWB-66FBD2</td>
			<td style="width:299px;">Immunogenicity marker for FC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">FITC-conjugated anti-HLA-G [MEM-G/9] antibody</td>
			<td style="width:203px;">Abcam</td>
			<td style="width:119px;">ab7904</td>
			<td style="width:299px;">Immunogenicity marker for FC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">FITC-conjugated mouse anti-human SIRPA/CD172a antibody</td>
			<td style="width:203px;">AbD Serotec/Bio-Rad</td>
			<td style="width:119px;">MCA2518F</td>
			<td style="width:299px;">Cardiac marker for FC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">APC-conjugated human TRA-1-85/CD147 antibody</td>
			<td style="width:203px;">R&#38;D Systems</td>
			<td style="width:119px;">FAB3195A</td>
			<td style="width:299px;">Human cell marker for FC and FACS</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">FITC-conjugated human TRA-1-85/CD147 antibody</td>
			<td style="width:203px;">R&#38;D Systems</td>
			<td style="width:119px;">FAB3195F</td>
			<td style="width:299px;">Human cell marker for FC and FACS</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Anti-connexin 43/GJA1 antibody</td>
			<td style="width:203px;">Abcam</td>
			<td style="width:119px;">ab11370</td>
			<td style="width:299px;">Cx43. For ICC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Goat anti-rabbit IgG (H+L) cross-absorbed secondary antibody, Alexa Fluor 555</td>
			<td style="width:203px;">Life Technologies</td>
			<td style="width:119px;">A-21428</td>
			<td style="width:299px;">For ICC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Anti-sarcomeric alpha actinin [EA-53] antibody</td>
			<td style="width:203px;">Abcam</td>
			<td style="width:119px;">ab9465</td>
			<td style="width:299px;">aSARC. For ICC</td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:297px;">Goat anti-mouse IgM heavy chain cross-absorbed secondary antibody, Alexa Fluor 555</td>
			<td style="width:203px;">Life Technologies</td>
			<td>A-21426</td>
			<td style="width:299px;">For ICC</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Mef2C (D80C1) XP rabbit antibody</td>
			<td style="width:203px;">New England BioLabs Ltd.</td>
			<td style="width:119px;">5030S</td>
			<td style="width:299px;">For ICC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Donkey anti-rabbit IgG (H+L) secondary antibody, Alexa Fluor 488</td>
			<td style="width:203px;">Life Technologies</td>
			<td style="width:119px;">A-21206</td>
			<td style="width:299px;">For ICC</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Anti-nuclei (HuNu) (clone 235-1) antibody</td>
			<td style="width:203px;">EMD Millipore</td>
			<td style="width:119px;">MAB1281</td>
			<td style="width:299px;">For ICC</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">MZ9.5 Stereomicroscope</td>
			<td style="width:203px;">Leica</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">For imaging aggregates.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">1.5 ml centrifuge microtubes</td>
			<td style="width:203px;">Axygen</td>
			<td style="width:119px;">MCT-150-C</td>
			<td style="width:299px;">For staining MSCs with fluorescent dye.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">ImageJ</td>
			<td style="width:203px;"></td>
			<td style="width:119px;"></td>
			<td style="width:299px;">Open source image processing software.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Aria II&#160;</td>
			<td style="width:203px;">BD</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">UHN SickKids FC Facility. For cell sorting.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Bone marrow mesechymal stromal cells</td>
			<td style="width:203px;">Lonza</td>
			<td style="width:119px;">PT-2501</td>
			<td style="width:299px;">BMSCs</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Bovine serum albumin</td>
			<td style="width:203px;">Sigma-Aldrich</td>
			<td style="width:119px;">A7030-100G</td>
			<td style="width:299px;">BSA. To prepare solutions for ICC</td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:297px;">BrdU</td>
			<td style="width:203px;">EMD Millipore</td>
			<td style="width:119px;">MAB3424</td>
			<td style="width:299px;">Caution: BrdU is a strong teratogen and suspected mutagen. Please ensure proper training and refer to the SDS before use.</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Canto II</td>
			<td style="width:203px;">BD</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">UHN SickKids FC Facility. For flow cytometry.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">cDNA EcoDry Premix</td>
			<td style="width:203px;">Clontech/Takara</td>
			<td style="width:119px;">639570</td>
			<td style="width:299px;">For preparation of cDNA for qPCR</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">CellTracker Green CMFDA Dye</td>
			<td style="width:203px;">Life Technologies</td>
			<td style="width:119px;">C7025</td>
			<td style="width:299px;">Fluorescent imaging of cell cytoplasm</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Countess automated cell counter</td>
			<td style="width:203px;">Invitrogen Inc.</td>
			<td style="width:119px;">C10227</td>
			<td style="width:299px;">For cell counting</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">DMEM-F12</td>
			<td style="width:203px;">Sigma-Aldrich</td>
			<td style="width:119px;">D6421</td>
			<td style="width:299px;">For rat primary cardiomyocyte culture medium.</td>
		</tr>
		<tr height="24">
			<td height="24" style="height:24px;width:297px;">Dulbecco&#39;s Phosphate Buffered Saline</td>
			<td style="width:203px;">Gibco</td>
			<td>10010023</td>
			<td style="width:299px;">D-PBS, without Ca2+, Mg2+</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">EVOS</td>
			<td style="width:203px;">Life Technologies</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">In-house fluorescent microscope</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">FACSCalibur</td>
			<td style="width:203px;">BD</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">In-house. For flow cytometry.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Fetal bovine serum (Hyclone)</td>
			<td style="width:203px;">GE Healthcare</td>
			<td style="width:119px;">SH3039603</td>
			<td style="width:299px;">FBS. Component of cell culture medium.</td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:297px;">IDT Prime Time qPCR probes</td>
			<td style="width:203px;">Integrated Data Technologies</td>
			<td style="width:119px;">FAM fluorophore</td>
			<td style="width:299px;">http://www.idtdna.com/pages/products/gene-expression/primetime-qpcr-assays-and-primers</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Lab Vision PermaFluor Aqueous Mounting Medium</td>
			<td style="width:203px;">ThermoScientific</td>
			<td style="width:119px;">TA-030-FM</td>
			<td style="width:299px;">For storage of cells to undergo ICC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">LSR II&#160;</td>
			<td style="width:203px;">BD</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">UHN SickKids FC Facility. For flow cytometry.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">MoFlo Astrios</td>
			<td style="width:203px;">Beckman Coulter</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">UHN SickKids FC Facility. For cell sorting.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Normal goat serum</td>
			<td style="width:203px;">Cell Signaling Technology</td>
			<td style="width:119px;">5425S</td>
			<td style="width:299px;">NGS. Used in blocking solution for ICC</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Nunc Lab-Tek II Chamber Coverglass, 8-wells</td>
			<td style="width:203px;">Thermo Scientific Nunc</td>
			<td style="width:119px;">155409</td>
			<td style="width:299px;">To prepare samples for ICC</td>
		</tr>
		<tr height="47">
			<td height="47" style="height:47px;width:297px;">OmniPur Triton X-100 Surfactant</td>
			<td style="width:203px;">EMD Millipore</td>
			<td style="width:119px;">9410-OP</td>
			<td style="width:299px;">As a component of permeabilizing solution when preparing cells for ICC</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Paraformaldehyde, 16% Solution, EM Grade</td>
			<td style="width:203px;">Electron Microscopy Sciences</td>
			<td style="width:119px;">15710</td>
			<td style="width:299px;">For fixing cells for ICC.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Penicillin/streptomycin</td>
			<td style="width:203px;">Gibco</td>
			<td style="width:119px;">15140122</td>
			<td style="width:299px;">Component of cell culture medium.</td>
		</tr>
		<tr height="110">
			<td height="110" style="height:110px;width:297px;">Primers</td>
			<td style="width:203px;">Sigma</td>
			<td style="width:119px;">Custom Standard DNA Oligos, Desalted, 0.2 &#956;mol</td>
			<td style="width:299px;">CTnT_F: GGC AGC GGA AGA GGA TGC TGA A; CTnT_R: GAG GCA CCA AGT TGG GCA TGA ACG A; MYH6 F: GCA AAG TAC TGG ATG ACA CGC T; MYH6 R: GTC ATT GCT GAA ACC GAG AAT G</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Quorum Spinning Disk Confocal</td>
			<td style="width:203px;">Zeiss</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">SickKids Imaging Facility</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">ReproCardio hiPS cell derived cardiomyocytes</td>
			<td style="width:203px;">ReproCell</td>
			<td style="width:119px;">RCD001N</td>
			<td style="width:299px;">Positive control for qPCR</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">RNeasy mini kit</td>
			<td style="width:203px;">Qiagen</td>
			<td style="width:119px;">74106</td>
			<td style="width:299px;">To isolate RNA for qPCR</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Rotor-Gene SYBR Green PCR Kit</td>
			<td style="width:203px;">Qiagen</td>
			<td style="width:119px;">204074</td>
			<td style="width:299px;">For qPCR with master mix</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">RPMI 1640</td>
			<td style="width:203px;">Gibco</td>
			<td>A1049101</td>
			<td style="width:299px;">For MSC, monocyte coculture medium.</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">TaqMan qPCR primer assays</td>
			<td style="width:203px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">4444556</td>
			<td style="width:299px;">For qPCR</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Trypan Blue</td>
			<td style="width:203px;">Life Technologies</td>
			<td style="width:119px;">T10282</td>
			<td style="width:299px;">Staining of cells for viability and counting</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Trypsin</td>
			<td style="width:203px;">Gibco</td>
			<td>272500108</td>
			<td style="width:299px;">For cell dissociation</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Volocity</td>
			<td style="width:203px;">Perkin-Elmer</td>
			<td style="width:119px;">Volocity 6.3</td>
			<td style="width:299px;">Imaging software</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">0.2 &#956;m pore filter</td>
			<td style="width:203px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">566-0020</td>
			<td style="width:299px;">For sterilizing tissue culture media</td>
		</tr>
		<tr height="25">
			<td height="25" style="height:25px;width:297px;">HERAcell 150i CO2 Incubator</td>
			<td style="width:203px;">Thermo Fisher Scientific</td>
			<td align="right" style="width:119px;">51026410</td>
			<td style="width:299px;">For incubating cells</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Dulbecco&#39;s phosphate buffered saline</td>
			<td style="width:203px;">Sigma-Aldrich</td>
			<td style="width:119px;">D8537</td>
			<td style="width:299px;">PBS. 1X, Without calcium chloride and magnesium chloride</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Forceps</td>
			<td style="width:203px;">Almedic</td>
			<td style="width:119px;">7727-A10-704</td>
			<td style="width:299px;">For handing rat heart. Can use any similar forceps.</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Scissors</td>
			<td style="width:203px;">Fine Science Tools</td>
			<td style="width:119px;">14059-11</td>
			<td style="width:299px;">For mincing rat heart. Curved scissors recommended.</td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:297px;">50 mL tube</td>
			<td style="width:203px;">BD Falcon</td>
			<td align="right" style="width:119px;">352070</td>
			<td style="width:299px;">For collection during cardiomyocyte collection and general tissue culture procedures</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">15 mL tube</td>
			<td style="width:203px;">BD Falcon</td>
			<td align="right" style="width:119px;">352096</td>
			<td style="width:299px;">For general tissue culture procedures</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">6-well plates</td>
			<td style="width:203px;">Thermo Scientific Nunc</td>
			<td style="width:119px;">CA73520-906</td>
			<td style="width:299px;">For tissue culture</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">10 cm tissue culture dishes</td>
			<td style="width:203px;">Corning</td>
			<td style="width:119px;">25382-428</td>
			<td style="width:299px;">For aggregate formation</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Axiovert 40C Microscope</td>
			<td style="width:203px;">Zeiss</td>
			<td style="width:119px;"></td>
			<td style="width:299px;">For bright-field imaging through out tissue culture and the rest of the protocol</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">70 &#956;m cell strainer</td>
			<td style="width:203px;">Fisherbrand</td>
			<td align="right" style="width:119px;">22363548</td>
			<td style="width:299px;">To ensure a single cell suspension before flow cytometry or sorting</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:297px;">Triton X-100</td>
			<td style="width:203px;">EMD Millipore</td>
			<td style="width:119px;">9410-1L</td>
			<td style="width:299px;">Used in permeabilization solution for ICC</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:297px;">Hoechst 33342</td>
			<td style="width:203px;">Thermo Fisher Scientific</td>
			<td style="width:119px;">H1399</td>
			<td style="width:299px;">Stain used during visualization of Cx43 localization</td>
		</tr>
	</tbody>
</table>

in vitro differentiation of human mesenchymal stem cells into functional cardiomyocyte-like cells

Myocardial infarction and the subsequent ischemic cascade result in the extensive loss of cardiomyocytes, leading to congestive heart failure, the leading cause of mortality worldwide. Mesenchymal stem cells (MSCs) are a promising option for cell-based therapies to replace current, invasive techniques. MSCs can differentiate into mesenchymal lineages, including cardiac cell types, but complete differentiation into functional cells has not yet been achieved. Previous methods of differentiation were based on pharmacological agents or growth factors. However, more physiologically relevant strategies can also enable MSCs to undergo cardiomyogenic transformation. Here, we present a differentiation method using MSC aggregates on cardiomyocyte feeder layers to produce cardiomyocyte-like contracting cells.
Human umbilical cord perivascular cells (HUCPVCs) have been shown to have a greater differentiation potential than commonly investigated MSC types, such as bone marrow MSCs (BMSCs). As an ontogenetically younger source, we investigated the cardiomyogenic potential of first-trimester (FTM) HUCPVCs compared to older sources. FTM HUCPVCs are a novel, rich source of MSCs that retain their in utero immunoprivileged properties when cultured in vitro. Using this differentiation protocol, FTM and term HUCPVCs achieved significantly increased cardiomyogenic differentiation compared to BMSCs, as indicated by the increased expression of cardiomyocyte markers (i.e., myocyte enhancer factor 2C, cardiac troponin T, heavy chain cardiac myosin, signal regulatory protein &#945;, and connexin 43). They also maintained significantly lower immunogenicity, as demonstrated by their lower HLA-A expression and higher HLA-G expression. Applying aggregate-based differentiation, FTM HUCPVCs showed increased aggregate formation potential and generated contracting cells clusters within 1 week of co-culture on cardiac feeder layers, becoming the first MSC type to do so. 
Our results demonstrate that this differentiation strategy can effectively harness the cardiomyogenic potential of young MSCs, such as FTM HUCPVCs, and suggests that in vitro pre-differentiation could be a potential strategy to increase their regenerative efficacy in vivo.

HUCPVCs Display Higher Aggregate-formation Potential and CD49f Expression Levels Compared to BMSCs:
To induce the differentiation of hMSCs (i.e., FTM HUCPVCs, term HUCPVCs, and BMSCs), single-cell suspensions of undifferentiated MSCs or MSC-containing hanging drops (Table 1) were transferred onto rat primary cardiomyocyte monolayers to establish direct co-cultures or aggregate co-cultur...

Watch this Scientific Journal Video about In Vitro Differentiation of Human Mesenchymal Stem Cells into Functional Cardiomyocyte-like Cells at JoVE.com

In Vitro Differentiation of Human Mesenchymal Stem Cells into Functional Cardiomyocyte-like Cells

Here, we present a method to efficiently harness the cardiac differentiation potential of young sources of human mesenchymal stem cells in order to generate functional, contracting, cardiomyocyte-like cells in vitro.

In Vitro Differentiation of Human Mesenchymal Stem Cells into Functional Cardiomyocyte-like Cells

Myocardial infarction and the subsequent ischemic cascade result in the extensive loss of cardiomyocytes, leading to congestive heart failure, the leading ...

The overall goal of this experimental procedure is to induce and observe the cardiomyogenic induction of mesenchymal stem cells. This method can help answer key questions in the mesenchymal stem cell field such as, what remedies can be induce by environmental signals to generate functional cardiomyocytes. The main advantage of this technique, is that it applies aggregate formation and cardiac fetal layers, instead of pharmacological agents or genetic material.The implications of this technique extend towards therapy of cardiovascular disease because it elaborates on the cardiomyogenic potential of mesenchymal stem cells. Demonstrating this procedure with me will be, Miss Farwah Iqbal, a PhD student of our laboratory, Max Librach and Nadav Gasner, both trainees of our laboratory. After isolating rat pup parts according to the text protocol, cut the ventriculi in half and transfer them to a 10 centimeter dish with 10 milliliters of PBS and pinstripe on ice, to let the blood wash out.Then using curved scissors, cut the ventricular walls into small pieces with a diameter of two to three millimeters. Using a serological pipette, transfer the heart pieces from 10 to 12 animals to a 50 milliliter tube and let them settle. Remove as much PBS P/S as possible, without removing any heart pieces.Then add 10 millimeters of fresh PBS P/S. To isolate the cardiomyocytes, after the heart pieces settle, use 0.15%trypsin in PBS, to replace the PBS P/S and incubate the tissue at 37 degree celsius with shaking, for 10 minutes. Discard the supernatant.Then, repeat the trypsin digestion three more times, except, decanter supernatants into 50 milliliter collection tubes containing 10 milliliters of 100%FBS. Next, centrifuge the tubes of cells and aspirate the supernatant. Then use DMEM-F12 with 10%FBS and 1%P/S to resuspend the cells and seed them onto a six well plate.Once the cells have attached, replace the medium with two milliliters of fresh medium. To prepare pre-stained MSCs, remove the medium from MSC cultures that have reached 70%to 80%confluency in 10 centimeter dishes and add three milliliters of cell dissociation solution. Incubate the dishes at 37 degree celsius and 5%carbon dioxide for five minutes.Transfer the dissociated cells to 15 milliliter tube and centrifuge at 400 x G for five minutes. Aspirate the supernatant without disrupting the cell pellet and re-suspend the cells. Then use an automated cell counter to count the cells.Dilute the cells to a concentration of 1 x 10 to the sixth MSCs per milliliter, in DMEM-F12 containing 10%FBS and 1%P/S. Then, to the cells in 1.5 milliliter centrifuge tubes, add viable, non-transferrable fluorescent dye and incubate the MSCs for half an hour. After centrifuging the tubes at 400 x G for five minutes, aspirate the supernatant and re-suspend the pellet at a concentration of 1 x 10 to the sixth MSCs per milliliter.Then transfer the MSCs onto cardiomyocytes at a concentration of 10 x 10 to the fourth cells per well of the six well plate. To make aggregate co-cultures, prepare a single cell suspension of MSCs in alpha MEM, supplemented with a 10%FBS and 1%P/S. Initiate aggregate formation, by placing 25 microliter drops of cell suspension on the inner surface of the lids of 10 centimeter tissue culture dishes.Place the lids on their bottom counterparts containing PBS P/S. Incubate the dishes at 37 degree celsius and 5%carbon dioxide. Under a stereo microscope, observe aggregate formation in the drops after three days.If over 80%of the drops contained formed aggregates, use a one milliliter micropipette to collect the drops from the lids and transfer the aggregates directly onto primary rat cardiomyocyte monolayers. Incubate the aggregate co-cultures for up to two weeks. Changing the full volume of medium every 72 hours.On a daily basis, use bright field microscopy to observe aggregates attaching to fetal cell layers. Record contracting aggregates when observed. The active aggregates contract in a synchronized manner, we suggest a conductance between them throughout the fetal layer, which has no physical activity.Aspirate the medium and add two milliliters of PBS per well of the six well dish. Then remove the PBS and add two milliliters of dissociation solution per well. Incubate the dishes at 37 degree celsius and 5%carbon dioxide for three minutes.As shown here, HMSCs of three different types displayed similar abundance and appearance in direct co-cultures. Two to three days after transferring hanging drops onto cardiac cells in aggregate co-cultures, FTMs and term huck PBCs appeared in larger aggregates compared to those seen from BMSCs. In this experiment, flow cytometric analysis of CD49F expression in undifferentiated MSCs showed that 96%of FTM huck PBCs, termed 89%of huck PBCs and 53%of BMSCs, were positive for cell surface CD49F.Flow cytometry on TRA won 85 cells, showed the upregulation of the cardiomyocyte associated marker, SIRPA in FTM huck PBCs and term huck PBCs, but not in BMSCs from direct cardiomyocyte co-cultures. As seen here, cx43 upregulation was significantly higher in FTM huck PBCs compared to term huck PBCs or BMSCs in direct co-cultures. Fluorescent microscopy analysis revealed that differentiating FTM and term huck PBCs, both upregulated cx43.With term huck PBCs at a higher portion than FTMs. However, fluorescence microscopy revealed that cx43 positive puncta were observed in the cell membrane of FTM huck PBCs and they were predominantly cytoplasmic in term cells. Finally, as seen here, high magnification fluorescence microscopy was performed on sorted human cells, after co-culturing and the high abundance of cx43 in the plasma membrane was confirmed.Once mastered, the key steps of this procedure can be done in one hour each, if they are performed properly. When attempting this procedure, it is important to maintain aseptic precautions. Primary animal tissues involved which may introduce contamination, if not handled properly.Following this procedure, other methods like further culturing of contracting aggregates can be performed to answer additional questions such as, longevity of these structures. After its development, this technique enables researchers in the field of MSCs to explore the differentiation potential of younger sources of mesenchymal stem cells such as, extra embryonic tissues. After watching this video, you should have a good understanding on how to prepare MSC aggregates and combine them with direct primary tissue fetal layers, in a manner that provides a proper induction for cardiomyogenic differentiation.Don't forget, that working with BRDU can be extremely hazardous and precautions such as, proper handling of cytotoxic waste, should always be taken while performing this procedure.

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Developmental Biology

10.7K Views.  Create Fertility Centre. The overall goal of this experimental procedure is to induce and observe the cardiomyogenic induction of mesenchymal stem cells. This method can help answer key questions in the mesenchymal stem cell field such as, what remedies can be induce by environmental signals to generate functional cardiomyocytes. The main advantage of this technique, is that it applies aggregate formation and cardiac fetal layers, instead of pharmacological agents or genetic material.The implications of this t...