Graft of cardiac progenitors in a pig model of right ventricular failure triggers myocardial epimorphosis, regeneration and protection of function

Abstract

Heart left or right ventricular failure results from either ischemic or congenital diseases, respectively, and remains a major health burden in our societies. There is thus a high demand for a regenerative therapy. Yet, the ability of the adult post-mitotic mammalian heart to self-regenerate remains largely a challenge Here, we combined cell therapy in a pig with right heart failure, cardiac physiology, single cell RNA-seq and spatial transcriptomics. We demonstrate that resident cardiac macrophages mediate a process of cardiomyocytes de-differentiation to form a blastema which produces new proliferative cardiomyocytes. Thus, a mammalian heart close to a human heart features the ability to undergo epimorphosis and to regenerate. A direct and specific target of resident macrophages holds promise to regenerate hearts, specifically in a growing population of now adult congenital heart diseases patients with right ventricular failure and left without any efficient pharmacological relieving treatment.