SARS-CoV-2 Infects Human Pluripotent Stem Cell-Derived Cardiomyocytes, Impairing Electrical and Mechanical Function

Stem Cell Reports. 2021 Mar 9;16(3):478-492. doi: 10.1016/j.stemcr.2021.02.008. Epub 2021 Feb 13.

Abstract

COVID-19 patients often develop severe cardiovascular complications, but it remains unclear if these are caused directly by viral infection or are secondary to a systemic response. Here, we examine the cardiac tropism of SARS-CoV-2 in human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) and smooth muscle cells (hPSC-SMCs). We find that that SARS-CoV-2 selectively infects hPSC-CMs through the viral receptor ACE2, whereas in hPSC-SMCs there is minimal viral entry or replication. After entry into cardiomyocytes, SARS-CoV-2 is assembled in lysosome-like vesicles and egresses via bulk exocytosis. The viral transcripts become a large fraction of cellular mRNA while host gene expression shifts from oxidative to glycolytic metabolism and upregulates chromatin modification and RNA splicing pathways. Most importantly, viral infection of hPSC-CMs progressively impairs both their electrophysiological and contractile function, and causes widespread cell death. These data support the hypothesis that COVID-19-related cardiac symptoms can result from a direct cardiotoxic effect of SARS-CoV-2.

Keywords: COVID-19; SARS-CoV-2; arrhythmias and heart failure; cardiac infection; cardiovascular disease; hESC-CMs; hPSC-CMs; human pluripotent stem cell-derived cardiomyocytes; viral myocarditis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • COVID-19 / virology*
  • Cells, Cultured
  • Humans
  • Induced Pluripotent Stem Cells / virology*
  • Myocytes, Cardiac / virology*
  • RNA Splicing / genetics
  • RNA, Messenger / genetics
  • SARS-CoV-2 / genetics
  • SARS-CoV-2 / pathogenicity*
  • Virus Internalization

Substances

  • RNA, Messenger