Lactate promotes cardiomyocyte dedifferentiation through metabolic reprogramming

Cardiomyocytes undergo different metabolic changes during development and differentiation crucial for their maturation and adult function, such as contraction, growth and survival. Alterations of cardiac metabolism have been associated with multiple disease states and pathological hypertrophy. The shift in substrate preference can impair the stress response, but it may also have a role in cell growth and survival. Here, we evaluated the response of cardiomyocytes to the presence of exogenous lactate, an important metabolite for the fetal heart and cardiogenesis. Lactate-exposed mouse primary cardiomyocytes and human iPSC-derived cardiomyocytes quickly acquired a characteristic dedifferentiated phenotype, with enhanced proliferative capacity as determined by an increased expression of cell cycle (Ki67) and cytokinesis (Aurora-B) effectors. This effect was specific to cardiomyocytes and did not affect other heart cell populations (e.g. cardiac fibroblasts). Nevertheless, cardiac fibroblasts exposed to lactate promoted a pro-regenerative environment through the modulation of the release of cytokines (such as Fas, IL-13 or SDF1a). We characterized lactate-induced cardiomyocyte dedifferentiation through RNA-sequencing and gene expression analysis and identified increased expression of BMP10 (a TGFβ family protein involved in embryonic cardiomyocyte proliferation and stemness) and proteins associated to cell fate regulation (LIN28, TCIM) together with downregulation of cardiac maturation genes (GRIK1, DGKK). Bottom-up analysis suggested the phenotype promoted by lactate could be related to the activation of hypoxia signaling pathways. This finding indicated that, indeed, lactate may be a key player of hypoxic regenerative responses in the heart, as it usually accumulates as a result of glycolysis. In addition, ex vivo neonatal heart culture showed prolonged beating function and cardiac tissue integrity when culture media was supplemented with lactate. Thus, we conclude that lactate enhances cardiac proliferation by reprogramming cardiomyocytes towards a dedifferentiated stem cell-like state, supporting the notion that modulation of the metabolic microenvironment might be a powerful novel approach for promoting cardiac regeneration and tissue engineering applications.