# Neonatally-derived multipotent Islet-1+ Mesp1+FOXA2+ stem cell clones restore cardiac function in sheep

## TL;DR

Neonatal heart-derived stem cells can restore heart function in sheep after heart attacks without needing immune suppression.

## Contribution

Identification of neonatally-derived ISL1+ MESP1+ FOXA2+ stem cells as a novel cell source for cardiac repair in large animals.

## Key findings

- Neonatal ISL1+ stem cells restored cardiac function to normal levels in sheep.
- Transcriptomic analysis revealed paracrine and cardiogenic effects in treated heart regions.
- Stem cell retention and endothelial cell recruitment were observed without immunosuppression.

## Abstract

Stem cell therapeutics is an area of active investigation for the treatment of cardiovascular disease. Unlike adults, neonatal hearts possess unique regenerative capacity immediately after birth, suggesting that neonatal cardiovascular tissue may be a promising and untapped resource of stem cells. In the current study, we present the unique transcriptome and differentiation capability of neonatal ISL1+ MESP1+ FOXA2+ stem cell clones isolated from humans. Comparable ISL1+ MESP1+ FOXA2+ stem cell clones were then isolated from sheep for functional analysis in a sheep model of myocardial infarction and allogeneic stem cell-based repair without immunosuppression.

The transcriptome of early-stage, human neonatal ISL1+ stem cell clones was identified by RNAseq analysis. Differentiation capability was validated by flow cytometry, RT-qPCR and electrophysiology. Matched ISL1+ neonatal sheep stem cell clones were isolated for the purpose of developing an allogeneic, preclinical large animal model of ISL1+ stem cell-based repair in sheep. A myocardial infarction was induced by ligation of left anterior descending coronary artery followed by ISL1+ stem cell transplantation three-four weeks later by direct intracardiac injection in the absence of immunosuppression. The in vivo transplant outcomes in stem cell-treated vs. controls were assessed at three months after myocardial infarction by echocardiography, immunohistochemistry, western blot, RT-qPCR, and RNAseq analyses.

Neonatally-derived ISL1+ clones restored cardiac function to normal levels as shown by echocardiography. Stem cell retention was identified by histology in the cardiovascular repair zone and transcriptomic analysis identified the contribution of several signaling pathways leading to activation of paracrine and cardiogenic effects in the stem-cell treated regions of the heart. We further define the contribution of immunosuppressive mediators that contribute to stem cell retention and factors that stimulate endothelial cell recruitment in this allogeneic model of stem cell-based therapy.

ISL1+ MESP1+ FOXA2+ stem cell clones isolated from neonatal cardiovascular tissue represent a novel resource of cells with the capacity to restore cardiac function following myocardial infarction in a preclinical large animal model.