Key result
Biomimetic pig myocardial slices successfully detect 5 arrhythmic drugs and their modes of action.
Why the study?
Cardiotoxicity frequently prevents drugs from entering or remaining on the market, necessitating sensitive, specific screening methods in intact cardiac tissue relevant to humans.
Pig myocardial slices in biomimetic cultivation setups offer a highly specific and sensitive preclinical screening approach for detecting drug-induced cardiotoxicity and proarrhythmic effects.
Offers sensitive preclinical cardiotoxicity screening; leaves open human translation pending clinical validation.
AIMS: Cardiotoxicity is one major reason why drugs do not enter or are withdrawn from the market. Thus, approaches are required to predict cardiotoxicity with high specificity and sensitivity. Ideally, such methods should be performed within intact cardiac tissue with high relevance for humans and detect acute and chronic side effects on electrophysiological behaviour, contractility, and tissue structure in an unbiased manner. Herein, we evaluate healthy pig myocardial slices and biomimetic cultivation setups (BMCS) as a new cardiotoxicity screening approach. METHODS AND RESULTS: Pig left ventricular samples were cut into slices and spanned into BMCS with continuous electrical pacing and online force recording. Automated stimulation protocols were established to determine the force-frequency relationship (FFR), frequency dependence of contraction duration, effective refractory period (ERP), and pacing threshold. Slices generated 1.3 ± 0.14 mN/mm2 force at 0.5 Hz electrical pacing and showed a positive FFR and a shortening of contraction duration with increasing pacing rates. Approximately 62% of slices were able to contract for at least 6 days while showing stable ERP, contraction duration-frequency relationship, and preserved cardiac structure confirmed by confocal imaging and X-ray diffraction analysis. We used specific blockers of the most important cardiac ion channels to determine which analysis parameters are influenced. To validate our approach, we tested five drug candidates selected from the Comprehensive in vitro Proarrhythmia Assay list as well as acetylsalicylic acid and DMSO as controls in a blinded manner in three independent laboratories. We were able to detect all arrhythmic drugs and their respective mode of action on cardiac tissue including inhibition of Na+, Ca2+, and hERG channels as well as Na+/Ca2+ exchanger. CONCLUSION: We systematically evaluate this approach for cardiotoxicity screening, which is of high relevance for humans and can be upscaled to medium-throughput screening. Thus, our approach will improve the predictive value and efficiency of preclinical cardiotoxicity screening.
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Shi et al. (2023) studied Cardiotoxicity. Five drug candidates from the Comprehensive in vitro Proarrhythmia Assay list vs. Acetylsalicylic acid and DMSO was evaluated on Detection of arrhythmic drugs and their respective mode of action. Biomimetic cultivation setups using pig myocardial slices successfully detected all five tested arrhythmic drugs and their modes of action in a blinded, multi-laboratory validation.
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