This study was supported by the American Heart Association (AHA) Career Development Award 18CDA34110293 (M-T.Z.), Additional Ventures AVIF and SVRF awards (M-T.Z.), National Institutes of Health (NIH/NHLBI) grants 1R01HL124245, 1R01HL132520 and R01HL096962 (I.D.). Dr. Ming-Tao Zhao was also supported by startup funds from the Abigail Wexner Research Institute at Nationwide Children&#39;s Hospital.

The experimental protocols and informed consent for human subjects were approved by the Institutional Review Board (IRB) at Nationwide Children&#39;s Hospital.
1. Preparation of cell culture media, solutions, and reagents
<ol>
	<li>Prepare PBMC media
	<ol>
		<li>Mix 20 mL of basal PBMC culture media (1x) and 0.52 mL of supplement. Add 20 &#956;L of SCF and FLT3 each (stock concentration: 100 &#956;g/mL), 4 &#956;L of IL3, IL6 and EPO each (stock concentration: 100 &#956;g/mL) and 200 &#956;L...

<ol>
	<li>Takahashi, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Induction+of+pluripotent+stem+cells+from+adult+human+fibroblasts+by+defined+factors.">Induction of pluripotent stem cells from adult human fibroblasts by defined factors.</a> Cell. 131 (5), 861-872 (2007).</li><li>Yu, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Induced+pluripotent+stem+cell+lines+derived+from+human+somatic+cells.">Induced pluripotent stem cell lines derived from human somatic cells.</a> Science. 318 (5858), 1917-1920 (2007).</li><li>Sayed, N., Liu, C., Wu, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Translation+of+Human-Induced+Pluripotent+Stem+Cells:+From+Clinical+Trial+in+a+Dish+to+Precision+Medicine.">Translation of Human-Induced Pluripotent Stem Cells: From Clinical Trial in a Dish to Precision Medicine.</a> Journal of American College of Cardiology. 67 (18), 2161-2176 (2016).</li><li>Itzhaki, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modelling+the+long+QT+syndrome+with+induced+pluripotent+stem+cells.">Modelling the long QT syndrome with induced pluripotent stem cells.</a> Nature. 471 (7337), 225-229 (2011).</li><li>Hinson, J. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Titin+mutations+in+iPS+cells+define+sarcomere+insufficiency+as+a+cause+of+dilated+cardiomyopathy.">Titin mutations in iPS cells define sarcomere insufficiency as a cause of dilated cardiomyopathy.</a> Science. 349 (6251), 982-986 (2015).</li><li>Deacon, D. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combinatorial+interactions+of+genetic+variants+in+human+cardiomyopathy.">Combinatorial interactions of genetic variants in human cardiomyopathy.</a> Nature Biomedical Engineering. 3 (2), 147-157 (2019).</li><li>Gifford, C. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oligogenic+inheritance+of+a+human+heart+disease+involving+a+genetic+modifier.">Oligogenic inheritance of a human heart disease involving a genetic modifier.</a> Science. 364 (6443), 865-870 (2019).</li><li>Lo Sardo, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unveiling+the+role+of+the+most+impactful+cardiovascular+risk+locus+through+haplotype+editing.">Unveiling the role of the most impactful cardiovascular risk locus through haplotype editing.</a> Cell. 175 (7), 1796-1810 (2018).</li><li>Liu, Y. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+embryonic+stem+cell-derived+cardiomyocytes+restore+function+in+infarcted+hearts+of+non-human+primates.">Human embryonic stem cell-derived cardiomyocytes restore function in infarcted hearts of non-human primates.</a> Nature Biotechnology. 36 (7), 597-605 (2018).</li><li>Zhao, M. T., Shao, N. Y., Garg, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Subtype-specific+cardiomyocytes+for+precision+medicine:+where+are+we+now.">Subtype-specific cardiomyocytes for precision medicine: where are we now.</a> Stem Cells. 38, 822-833 (2020).</li><li>Burridge, P. W., Keller, G., Gold, J. D., Wu, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Production+of+de+novo+cardiomyocytes:+human+pluripotent+stem+cell+differentiation+and+direct+reprogramming.">Production of de novo cardiomyocytes: human pluripotent stem cell differentiation and direct reprogramming.</a> Cell Stem Cell. 10 (1), 16-28 (2012).</li><li>Protze, S. I., Lee, J. H., Keller, G. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+pluripotent+stem+cell-derived+cardiovascular+cells:+from+developmental+biology+to+therapeutic+applications.">Human pluripotent stem cell-derived cardiovascular cells: from developmental biology to therapeutic applications.</a> Cell Stem Cell. 25 (3), 311-327 (2019).</li><li>Lian, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robust+cardiomyocyte+differentiation+from+human+pluripotent+stem+cells+via+temporal+modulation+of+canonical+Wnt+signaling.">Robust cardiomyocyte differentiation from human pluripotent stem cells via temporal modulation of canonical Wnt signaling.</a> Proceedings of the National Academy of Sciences of the United States of America. 109 (27), 1848-1857 (2012).</li><li>Zhao, M. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Molecular+and+functional+resemblance+of+differentiated+cells+derived+from+isogenic+human+iPSCs+and+SCNT-derived+ESCs.">Molecular and functional resemblance of differentiated cells derived from isogenic human iPSCs and SCNT-derived ESCs.</a> Proceedings of the National Academy of Sciences of the United States of America. 114 (52), 11111-11120 (2017).</li><li>Burridge, P. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemically+defined+generation+of+human+cardiomyocytes.">Chemically defined generation of human cardiomyocytes.</a> Nature Methods. 11 (8), 855-860 (2014).</li><li>Lian, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemically+defined,+albumin-free+human+cardiomyocyte+generation.">Chemically defined, albumin-free human cardiomyocyte generation.</a> Nature Methods. 12 (7), 595-596 (2015).</li><li>Buikema, J. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Wnt+activation+and+reduced+cell-cell+contact+synergistically+induce+massive+expansion+of+functional+human+ipsc-derived+cardiomyocytes.">Wnt activation and reduced cell-cell contact synergistically induce massive expansion of functional human ipsc-derived cardiomyocytes.</a> Cell Stem Cell. 27 (1), 50-63 (2020).</li><li>Lee, J. H., Protze, S. I., Laksman, Z., Backx, P. H., Keller, G. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+pluripotent+stem+cell-derived+atrial+and+ventricular+cardiomyocytes+develop+from+distinct+mesoderm+populations.">Human pluripotent stem cell-derived atrial and ventricular cardiomyocytes develop from distinct mesoderm populations.</a> Cell Stem Cell. 21 (2), 179-194 (2017).</li><li>Liang, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Canonical+Wnt+signaling+promotes+pacemaker+cell+specification+of+cardiac+mesodermal+cells+derived+from+mouse+and+human+embryonic+stem+cells.">Canonical Wnt signaling promotes pacemaker cell specification of cardiac mesodermal cells derived from mouse and human embryonic stem cells.</a> Stem Cells. 38 (3), 352-368 (2020).</li><li>Protze, S. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sinoatrial+node+cardiomyocytes+derived+from+human+pluripotent+cells+function+as+a+biological+pacemaker.">Sinoatrial node cardiomyocytes derived from human pluripotent cells function as a biological pacemaker.</a> Nature Biotechnology. 35 (1), 56-68 (2017).</li><li>Ren, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Canonical+Wnt5b+signaling+directs+outlying+Nkx2.5++mesoderm+into+pacemaker+cardiomyocytes.">Canonical Wnt5b signaling directs outlying Nkx2.5+ mesoderm into pacemaker cardiomyocytes.</a> Developmental Cell. 50 (6), 729-743 (2019).</li><li>Zhang, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Direct+differentiation+of+atrial+and+ventricular+myocytes+from+human+embryonic+stem+cells+by+alternating+retinoid+signals.">Direct differentiation of atrial and ventricular myocytes from human embryonic stem cells by alternating retinoid signals.</a> Cell Research. 21 (4), 579-587 (2011).</li><li>Fusaki, N., Ban, H., Nishiyama, A., Saeki, K., Hasegawa, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficient+induction+of+transgene-free+human+pluripotent+stem+cells+using+a+vector+based+on+Sendai+virus,+an+RNA+virus+that+does+not+integrate+into+the+host+genome.">Efficient induction of transgene-free human pluripotent stem cells using a vector based on Sendai virus, an RNA virus that does not integrate into the host genome.</a> Proceedings of the Japan Academy, Seriers B, Physical and Biological Sciences. 85 (8), 348-362 (2009).</li><li>Stacey, G. N., Crook, J. M., Hei, D., Ludwig, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Banking+human+induced+pluripotent+stem+cells:+lessons+learned+from+embryonic+stem+cells.">Banking human induced pluripotent stem cells: lessons learned from embryonic stem cells.</a> Cell Stem Cell. 13 (4), 385-388 (2013).</li><li>Karbassi, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiomyocyte+maturation:+advances+in+knowledge+and+implications+for+regenerative+medicine.">Cardiomyocyte maturation: advances in knowledge and implications for regenerative medicine.</a> Nature Reviews Cardiology. 17 (6), 341-359 (2020).</li><li>Zhao, L., Ben-Yair, R., Burns, C. E., Burns, C. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endocardial+notch+signaling+promotes+cardiomyocyte+proliferation+in+the+regenerating+zebrafish+heart+through+Wnt+pathway+antagonism.">Endocardial notch signaling promotes cardiomyocyte proliferation in the regenerating zebrafish heart through Wnt pathway antagonism.</a> Cell Reports. 26 (3), 546-554 (2019).</li><li>Heallen, T. R., Kadow, Z. A., Wang, J., Martin, J. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determinants+of+cardiac+growth+and+size.">Determinants of cardiac growth and size.</a> Cold Spring Harbor Perspectives in Biology. 12 (3), 037150 (2020).</li><li>Campa, V. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Notch+activates+cell+cycle+reentry+and+progression+in+quiescent+cardiomyocytes.">Notch activates cell cycle reentry and progression in quiescent cardiomyocytes.</a> Journal of Cell Biology. 183 (1), 129-141 (2008).</li><li>Collesi, C., Zentilin, L., Sinagra, G., Giacca, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Notch1+signaling+stimulates+proliferation+of+immature+cardiomyocytes.">Notch1 signaling stimulates proliferation of immature cardiomyocytes.</a> Journal of Cell Biology. 183 (1), 117-128 (2008).</li><li>Heallen, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hippo+pathway+inhibits+Wnt+signaling+to+restrain+cardiomyocyte+proliferation+and+heart+size.">Hippo pathway inhibits Wnt signaling to restrain cardiomyocyte proliferation and heart size.</a> Science. 332 (6028), 458-461 (2011).</li></ol>

The authors declare no competing financial interests.

During iPSC reprogramming, it is critical to culture PBMCs for 1 week until they are enlarged with clear nuclei and cytoplasm. Because PBMCs do not proliferate, an appropriate cell number for viral transduction is important for successful iPSC reprogramming. Cell number of PBMCs, multiplicity of infection (MOI) and titer of virus should be considered and adjusted to reach the optimal transduction outcomes. For cardiac differentiation, initial seeding density is critical for iPSCs to reach over 90% confluent on the day wh...

The discovery of human induced pluripotent stem cells has revolutionized modern cardiovascular medicine1,2. Human iPSCs are capable of self-renewing and generating all cell types in the heart, including cardiomyocytes, endothelial cells, smooth muscle cells and cardiac fibroblasts. Patient iPSC-derived cardiomyocytes (iPSC-CMs) can serve as indefinite resources for modeling genetically inheritable cardiovascular diseases (CVDs) and testing cardiac safety for new drugs3. In particular, patient iPSC-CMs are well poised to investigate genetic and molecular etiologies of CVDs that are derived from defects in cardiomyocytes, such as long QT syndrome4 and dilated cardiomyopathy (DCM)5. Combined with CRISPR/Cas9-mediated genome editing, patient iPSC-CMs have opened an unprecedented avenue to understand the complex genetic basis of CVDs including congenital heart defects (CHDs)6,7,8. Human iPSC-CMs have also exhibited potentials to serve as autologous cell sources for replenishing the damaged myocardium during a heart attack9. In recent years, it has become paramount to generate high-quality human iPSC-CMs with defined subtypes (atrial, ventricular and nodal) for cardiac regeneration and drug testing10.
Cardiac differentiation from human iPSCs has been greatly advanced in the past decade. Differentiation methods have gone from embryoid body (EB)-based spontaneous differentiation to chemically defined and directed cardiac differentiation11. Key signaling molecules essential for embryonic heart development, such as Wnt, BMP, Nodal, and FGF are manipulated to enhance cardiomyocyte differentiation from human iPSCs10,12. Significant advances include sequential modulation of Wnt signaling (activation followed by inhibition) for robust generation of cardiomyocytes from human iPSCs13,14. Chemically defined cardiac differentiation recipes have been explored to facilitate large-scale production of beating cardiomyocytes15,16, which have the potential to be upgraded to industrial and clinical level production. Moreover, robust expansion of early human iPSC-CMs is achieved by exposure to constitutive Wnt activation using a small chemical (CHIR99021)17. Most recently, subtype-specific cardiomyocytes are generated through manipulation of retinoic acid (RA) and Wnt signaling pathways at specific differentiation windows during cardiomyocyte lineage commitment from human iPSCs18,19,20,21,22.
In this protocol, we detail a working procedure for robust generation and proliferation of human CMs originating from patient peripheral blood mononuclear cells. We present protocols for 1) reprogramming human PBMCs to iPSCs, 2) robust generation of beating cardiomyocytes from human iPSCs, 3) rapid expansion of early iPSC-CMs, 4) molecular characterization of human iPSC-CMs, and 5) electrophysiological measurement of human iPSC-CMs at the single-cell level by patch clamp. This protocol covers the detailed experimental procedures on converting patient blood cells into beating cardiomyocytes.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>ABI 7300 Fast Real-Time PCR System</td>
			<td>Thermo Fisher Scientific</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Axon Axopatch 200B Microelectrode Amplifier</td>
			<td>Molecular Devices</td>
			<td></td>
			<td>Microelectrode Amplifier</td>
		</tr>
		<tr>
			<td>B27 supplement</td>
			<td>Thermo Fisher Scientific</td>
			<td>17504044</td>
			<td></td>
		</tr>
		<tr>
			<td>B27 supplement minus insulin</td>
			<td>Thermo Fisher Scientific</td>
			<td>A1895601</td>
			<td></td>
		</tr>
		<tr>
			<td>BD Cytofix/Cytoperm Fixation/Permeabilization Kit</td>
			<td>BD Biosciences</td>
			<td>554714</td>
			<td>Fixation/Permeabilization solution, Perm/Wash buffer</td>
		</tr>
		<tr>
			<td>BD Vacutainer CPT tube</td>
			<td>BD Biosciences</td>
			<td>362753</td>
			<td>Blood cell separation tube</td>
		</tr>
		<tr>
			<td>CHIR99021</td>
			<td>Selleck Chemicals</td>
			<td>S2924</td>
			<td></td>
		</tr>
		<tr>
			<td>CytoTune-iPS 2.0 Sendai Reprogramming Kit</td>
			<td>Thermo Fisher Scientific</td>
			<td>A16517</td>
			<td>Sendai virus reprogramming kit</td>
		</tr>
		<tr>
			<td>Digidata 1200B</td>
			<td>Axon Instruments</td>
			<td></td>
			<td>Acquisition board</td>
		</tr>
		<tr>
			<td>Direct-zol RNA Miniprep kit</td>
			<td>Zymo Research</td>
			<td>R2050</td>
			<td>RNA extraction kit</td>
		</tr>
		<tr>
			<td>DMEM/F12</td>
			<td>Thermo Fisher Scientific</td>
			<td>11330057</td>
			<td></td>
		</tr>
		<tr>
			<td>Essential 8 medium</td>
			<td>Thermo Fisher Scientific</td>
			<td>A1517001</td>
			<td>E8 media for iPSC culture</td>
		</tr>
		<tr>
			<td>GlutaMAX supplement</td>
			<td>Thermo Fisher Scientific</td>
			<td>35050061</td>
			<td>L-glutamine alternative</td>
		</tr>
		<tr>
			<td>Growth factor reduced Matrigel</td>
			<td>Corning</td>
			<td>356231</td>
			<td>Basement membrane matrix</td>
		</tr>
		<tr>
			<td>iScript cDNA Snythesis Kit</td>
			<td>Bio-Rad</td>
			<td>1708891</td>
			<td>cDNA synthesis</td>
		</tr>
		<tr>
			<td>IWR-1-endo</td>
			<td>Selleck Chemicals</td>
			<td>S7086</td>
			<td></td>
		</tr>
		<tr>
			<td>KnockOut Serum Replacement (KSR)</td>
			<td>Thermo Fisher Scientific</td>
			<td>10828028</td>
			<td></td>
		</tr>
		<tr>
			<td>pCLAMP 7.0</td>
			<td>Molecular Devices</td>
			<td></td>
			<td>Electrophysiology data acquisition &#38; analysis software</td>
		</tr>
		<tr>
			<td>Recombinant human EPO</td>
			<td>Thermo Fisher Scientific</td>
			<td>PHC9631</td>
			<td></td>
		</tr>
		<tr>
			<td>Recombinant human FLT3</td>
			<td>Thermo Fisher Scientific</td>
			<td>PHC9414</td>
			<td></td>
		</tr>
		<tr>
			<td>Recombinant human IL3</td>
			<td>Peprotech</td>
			<td>200-03</td>
			<td></td>
		</tr>
		<tr>
			<td>Recombinant human IL6</td>
			<td>Thermo Fisher Scientific</td>
			<td>PHC0065</td>
			<td></td>
		</tr>
		<tr>
			<td>Recombinant human SCF</td>
			<td>Peprotech</td>
			<td>300-07</td>
			<td></td>
		</tr>
		<tr>
			<td>RPMI 1640 medium</td>
			<td>Thermo Fisher Scientific</td>
			<td>11875093</td>
			<td></td>
		</tr>
		<tr>
			<td>RPMI 1640 medium, no glucose</td>
			<td>Thermo Fisher Scientific</td>
			<td>11879020</td>
			<td></td>
		</tr>
		<tr>
			<td>SlowFade Gold Antifade Mountant</td>
			<td>Thermo Fisher Scientific</td>
			<td>S36936</td>
			<td>Mounting media</td>
		</tr>
		<tr>
			<td>StemPro-34 SFM</td>
			<td>Thermo Fisher Scientific</td>
			<td>10639011</td>
			<td>PBMC culture media</td>
		</tr>
		<tr>
			<td>TaqMan Fast Advanced Master Mix</td>
			<td>Thermo Fisher Scientific</td>
			<td>4444964</td>
			<td>qPCR master mix</td>
		</tr>
		<tr>
			<td>TrypLE Select Enzyme 10x, no phenol red</td>
			<td>Thermo Fisher Scientific</td>
			<td>A1217703</td>
			<td>CM dissociation solution</td>
		</tr>
		<tr>
			<td>UltraPure 0.5 M EDTA</td>
			<td>Thermo Fisher Scientific</td>
			<td>15575020</td>
			<td>iPSC dissociation solution</td>
		</tr>
		<tr>
			<td>Y-27632 2HCl</td>
			<td>Selleck Chemicals</td>
			<td>S1049</td>
			<td></td>
		</tr>
	</tbody>
</table>

generation and expansion of human cardiomyocytes from patient peripheral blood mononuclear cells

Generating patient-specific cardiomyocytes from a single blood draw has attracted tremendous interest in precision medicine on cardiovascular disease. Cardiac differentiation from human induced pluripotent stem cells (iPSCs) is modulated by defined signaling pathways that are essential for embryonic heart development. Numerous cardiac differentiation methods on 2-D and 3-D platforms have been developed with various efficiencies and cardiomyocyte yield. This has puzzled investigators outside the field as the variety of these methods can be difficult to follow. Here we present a comprehensive protocol that elaborates robust generation and expansion of patient-specific cardiomyocytes from peripheral blood mononuclear cells (PBMCs). We first describe a high-efficiency iPSC reprogramming protocol from a patient&#39;s blood sample using non-integration Sendai virus vectors. We then detail a small molecule-mediated monolayer differentiation method that can robustly produce beating cardiomyocytes from most human iPSC lines. In addition, a scalable cardiomyocyte expansion protocol is introduced using a small molecule (CHIR99021) that could rapidly expand patient-derived cardiomyocytes for industrial- and clinical-grade applications. At the end, detailed protocols for molecular identification and electrophysiological characterization of these iPSC-CMs are depicted. We expect this protocol to be pragmatic for beginners with limited knowledge on cardiovascular development and stem cell biology.

Human iPSC reprogramming from PBMCs 
After pre-culture with Complete Blood Media for 7 days, PBMCs become large with visible nuclei and cytoplasm (Figure 1B), indicating that they are ready for virus transfection. After transfection with the Sendai virus reprogramming factors, PBMCs will undergo an epigenetic reprogramming process for another week. Typically, we get 30-50 iPSC colonies from the transfection of 1 x 105 PBMCs an...

Watch this Scientific Journal Video about Generation and Expansion of Human Cardiomyocytes from Patient Peripheral Blood Mononuclear Cells at JoVE.com

Generation and Expansion of Human Cardiomyocytes from Patient Peripheral Blood Mononuclear Cells

Here, we present a protocol to robustly generate and expand human cardiomyocytes from patient peripheral blood mononuclear cells.

Generating patient-specific cardiomyocytes from a single blood draw has attracted tremendous interest in precision medicine on cardiovascular disease. ...

This is comprehensive protocol facilities, raw boosts generation, and use pouncing of patient specific, cultures from peripheral blood mononuclear cells. This tactics are reproducible and easy to follow, specially for beginners. And don't require, special expertize in stem cell ballads, or cardiovascular medicine.Our protocol can be used to generate patient specific cardiomyocytes from a single blood draw that can be used for modeling cardiovascular diseases and testing the cardiac toxicity of novel drugs. This protocol requires a long time commitment to stem cell reprogramming maintenance and directed differentiation. However, you really appreciate your endeavors.When you see beating cardiomyocytes in the dish. When the human iPSC colonies reach over 90%confluency, rinse each well with three milliliters of DPBS before treating the cells with one milliliter of 0.5 millimolar EDTA in DPBS per well at 37 degrees Celsius. After five to eight minutes, add one milliliter of iPSC passaging medium to each well and manually dislodge the cells.Transfer 600 to 900 microliters of the cells to individual Wells have a basement membrane coated six well plate for an overnight incubation at 37 degrees Celsius and 5%carbon dioxide. Then refresh the cultures with two milliliters of complete E8 medium every day for three to four days. When the culture's reached confluency, replace the medium with two milliliters of cardiomyocyte differentiation medium, two per well.On day two, replace the supernatants with two milliliters of cardiomyocyte differentiation medium one. On day three, replace the supernatants with two milliliters of cardiomyocyte differentiation medium three. On day five.Replace the supernatant with two milliliters of cardiomyocyte differentiation medium one. On day seven through 10, replace the supernatant with two milliliters of cardiomyocyte differentiation medium four. On days 11 and 13.When contracting cells are observed, replace the supernatant with two milliliters of cardiomyocyte differentiation medium five. On days 15, 17, 19 and 21. Replace the supernatant with two milliliters of cardiomyocyte differentiation medium four.After pre-culture with complete blood medium per seven days, PBMC's become large with visible nuclei and cytoplasm indicating that they are ready for transfection with Sendai Virus reprogramming factors. Upon introduction to complete E8 medium. The completely reprogrammed cells will attach and start forming colonies.After four to five passages, highly pure iPSC colonies will form from the reprogrammed cells with very few differentiated cells observed. At this stage, Most of the cells are OCT4 and NANOG positive indicative of their pluripoteny. Beating cardiomyocytes are usually observed after 12 days of differentiation.After glucose starvation, and replating iPSC cardiomyocytes exhibits, spontaneous beating, and an aligned sarcomere structure with intercalated cardiac troponin T and alpha actinin expression. The colonies retain their purity as evidenced by their Troponin T expression. Although iPSC cardiomyocytes are relatively immature compared to adult cardiomyocytes.They demonstrate ventricular and atrial like action potentials as measured by wholesale patch, clamp. Ventricular cardiomyocytes express myosin light chain two, whereas atrial iPSC cardiomyocytes are marked by NR2F2 expression. Wnt activation stimulate cell division and promotes the expression of cell cycle regulators.Interestingly, Wnt activation also induces the robust proliferation of early iPSC cardiomyocytes for two passages compared to controls, although this proliferative ability diminishes over time. Make sure that the PBMS are enlarged with the clear nuclear and cytoplasm before the iPSC reprogramming vectors are introduced as the condition of the PBMs is critical for iPSC reprogramming. Patient specific cardiomyocytes are valuable for modeling cardiovascular disease in vitro and for providing a ton of donor cells for cardiac stem cell therapy.

generation-expansion-human-cardiomyocytes-from-patient-peripheral

Research

JoVE Journal

Developmental Biology

3.8K Görüntüleme.  Nationwide Children’s Hospital. Bu kapsamlı protokol tesisleridir, ham üretimi artırır ve periferik kan mononükleer hücrelerinden gelen hastaya özgü kültürlerin atlanmasını kullanır. Bu taktikler, özellikle yeni başlayanlar için tekrarlanabilir ve takip etmesi kolaydır. Ve kök hücre baladları veya kardiyovasküler tıp konusunda özel uzmanlaşmayı gerektirmez.Protokolümüz, kardiyovasküler hastalıkları modellemek ve yeni ilaçların kardiyak toksisitesini test etmek için kullanılabilecek t...