Induced Pluripotent Stem Cells for Cardiovascular Disease Modeling and Precision Medicine: A Scientific Statement From the American Heart Association

Abstract

Induced pluripotent stem cells (iPSCs) offer an unprece-dented opportunity to study human physiology and disease at the cellular level. They also have the potential to be leveraged in the practice of precision medicine, for example, personalized drug testing. This statement comprehensively describes the provenance of iPSC lines, their use for cardiovascular disease modeling, their use for precision medicine, and strategies through which to promote their wider use for biomedical applications. Human iPSCs exhibit properties that render them uniquely qualified as model systems for studying human diseases: they are of human origin, which means they carry human genomes; they are pluripotent, which means that in principle, they can be differentiated into any of the human body's somatic cell types; and they are stem cells, which means they can be expanded from a single cell into millions or even billions of cell progeny. iPSCs offer the opportunity to study cells that are genetically matched to individual patients, and genome-editing tools allow introduction or correction of genetic variants. Initial progress has been made in using iPSCs to better understand cardiomyopathies, rhythm disorders, valvular and vascular disorders, and metabolic risk factors for ischemic heart disease. This promising work is still in its infancy. Similarly, iPSCs are only just starting to be used to identify the optimal medications to be used in patients from whom the cells were derived. This statement is intended to (1) summarize the state of the science with respect to the use of iPSCs for modeling of cardiovascular traits and disorders and for therapeutic screening; (2) identify opportunities and challenges in the use of iPSCs for disease modeling and precision medicine; and (3) outline strategies that will facilitate the use of iPSCs for biomedical applications. This statement is not intended to address the use of stem cells as regenerative therapy, such as transplantation into the body to treat ischemic heart disease or heart failure.

Keywords: AHA Scientific Statements; models, cardiovascular; precision medicine; stem cells, induced pluripotent.

Figure 1.

Induced pluripotent stem cells for cardiovascular disease modeling and precision medicine studies.

Figure 2.. Genome-editing tools for use in induced pluripotent stem cells.

Cas indicates CRISPR-associated; CRISPR, clustered regularly interspaced short palindromic repeats; PAM, protospacer adjacent motif; TAL, transcription activator-like; TALENs, transcription activator-like effector nucleases; and ZFN, zinc-finger nuclease.

Figure 3.. Study designs to assess for sufficiency and necessity of disease variants.

iPSC indicates induced pluripotent stem cell.

Figure 4.. Study design using a cohort of iPSC lines.

eQTL indicates expression quantitative trait loci; and iPSC, induced pluripotent stem cell.

Figure 5.

Cardiomyocyte differentiation.