WO2020264308A1 - Generation of quiescent cardiac fibroblasts from human induced pluripotent stem cells for in vitro modeling of cardiac fibrosis - Google Patents

Abstract

Human cardiac fibroblasts obtained from induced pluripotent stem cells (iPS cells) are provided for use in analysis, screening programs, and the like.

Description

GENERATION OF QUIESCENT CARDIAC FIBROBLASTS FROM HUMAN INDUCED PLURIPOTENT STEM CELLS FOR IN VITRO MODELING OF CARDIAC FIBROSIS

CROSS REFERENCE

[0001] This application claims benefit of U.S. Provisional Patent Application No. 62/868,760, filed June 28, 2019, which applications are incorporated herein by reference in their entirety.

GOVERNMENT SUPPORT

[0002] This invention was made with Government support under contract HL141371 , awarded by the National Institutes of Health. The Government has certain rights in the invention.

BACKGROUND

[0003] Fibroblasts are highly plastic and can transdifferentiate into myofibroblasts after tissue injury. Myofibroblasts are distinct from quiescent fibroblasts by demonstrating a contractile phenotype with a greater synthetic ability to produce extracellular matrix (ECM) proteins. Excessive deposition of ECM, a hallmark of tissue fibrosis, can take place in various organs, and may ultimately lead to organ failure. Because the mechanisms underlying tissue fibrosis remain poorly understood, effective antifibrosis therapeutic strategies are not yet available. However, accumulating evidence suggests that the regulatory networks governing fibrogenesis are tissue-specific. Therefore, it would be more effective to develop tissue-specific anti-fibrotic therapies rather than“one-size-fits-all” drugs. However, gene markers that identify fibroblasts from various organs are largely undetermined, making it challenging to delineate the mechanisms of fibrosis in a tissue-specific manner.

[0004] As an emerging and powerful tool for comprehensive transcripfome profile analysis, single ceil RNA-sequencing (scRNA-seq) technology has provided profound insights Into the diversity of cell populations, the heterogeneity of gene expression patterns within the same celi type, and the complex developmental trajectories of different cell types. This powerful technology may help uncover tissue-specific transcriptome profiles of fibroblasts.

[0005] Due to the limited availability of primary human ceils and challenges to propagate them long term in vitro, as well as the limited translational value of animal models in recapitulating phenotypic hallmarks of diseases in humans, human induced pluripoient stem ceil (iPSC)technology has been increasingly used for disease modeling and drug screening. However, until now a reliable protocol to generate human iPSC-derived cardiac fibroblasts has not been available.

[0006] Pharmaceutical drug discovery, a multi-billion dollar industry, involves the identification and validation of therapeutic targets, as well as the identification and optimization of iead compounds. The explosion in numbers of potential new targets and chemical entitles resulting from genomics and combinatorial chemistry approaches over the past few years has placed enormous pressure on screening programs. The rewards for identification of a useful drug are enormous, but the percentages of hits from any screening program are generally very low. Desirable compound screening methods solve this problem by both allowing for a high throughput so that many individual compounds can be tested; and by providing bio!ogicaliy relevant Information so that there is a good correlation between the information generated by the screening assay and the pharmaceutical effectiveness of the compound.

[0007] Some of the more important features for pharmaceutical effectiveness are specificity for the targeted ceil or disease, a lack of toxicity at relevant dosages, and specific activity of the compound against its molecular target. The present invention addresses this issue.

SUMMARY

[0008] Compositions and methods are provided for differentiation and screening of cardiac fibroblasts for therapeutic drugs and treatment regimens, where the methods utilize in vitro ceil cultures or animal models derived therefrom. Diseases of particular interest include cardiac fibrosis. The methods differentiate cardiac fibroblasts from human pluripotent stem cells, including without limitation induced pluripotent stem cells (IPS cells), which may be obtained from patient or carrier cell samples, e.g adipocytes, fibroblasts, and the like in some embodiments human IPSCs are induced to become cardiac fibroblasts (CF), particularly quiescent cardiac fibroblasts in some embodiments the CF are co-cuitured with primary or in vitro-generated cardiac myocytes.

[0009] Benefits of the in vitro generated CF include a high level of purity for cells with a high level of similarity to the corresponding primary cells at both genetic and functional levels, and the ability to preserve a quiescent phenotype over multiple passages. The in vitro generated CF are sensitive to pro-fibrotic stimuli, and are demonstrated to be highly responsive to both anti- and pro-fibrotic drugs. The in vitro generation of CF can be scaled up to generate large numbers of CFs for mechanistic studies and high throughput anti-fibrotic drug discovery. The induction protocol optionally provides for testing of sex- and patient-specific cellular responses to candidate anti-fibrotic drugs in vitro.

[0010] The in vitro differentiation protocol for CF utilizes a series of steps in specific media.

Initially human pluripotent stem ceils are differentiated to pluripotent stem cell-derived epicardial cells (iPSC-EPCs); which epicardial ceils are then differentiated to cardiac fibroblasts

[001 1] In some embodiments, epicardial cells are differentiated from IPSC by (i) culture in medium comprising an effective dose of a wnt agonist, (ii) recovery for a period of time, (iii) culture in medium comprising an effective dose of a wnt inhibitor, (iv) replating in medium in the absence of these factors. After about 1 week, the cells are (v) treated with an effective dose of a wnt activator and retinoic acid, before a final recovery period. [0012] In some embodiments, the induced epicardial cells are differentiated to CF by culture is medium comprising an effective dose of FGF2 and an inhibitor of TGFp. Inhibiting the TGF-b pathway during differentiation can preserve the fibroblast quiescent phenotype and suppress transdifferentiation. Notably, most of these ceils remained quiescent after several passages, and provide a reliable ceil model for the fibrosis studies in vitro. After about 4, about 6, about 10, about 12, about 14, about 16, about 18 or more days of extended culture, for example about day 18 of differentiation, the ceils show a typical fibroblast morphology and express markers (GATA4 and DDR2) that are highly expressed In primary CFs. The human iPSC-CFs are highly pure cultures and can preserve cardiac fibroblast identity during serial passaging.

[0013] In some embodiments, in vitro ceil cultures of cardiac fibroblasts are provided, which may be quiescent human cardiac fibroblasts (CF). The CF may be highly pure, e.g. at least about 75% of the cells in culture, at least about 80%, at least about 85%, at least about 90% or more of the cells in a culture have fibroblast morphology and are GATA4⁺ DDR2⁺.

[0014] CFs are capable of interacting with a broad spectrum of cell types, including cardiac myocytes (CMs), endothelial cells, cardiac smooth muscle (CSM) cells, and immune cells through different signaling pathways in some embodiments in vitro cell cultures comprise a defined co-culture of human cardiac fibroblasts a second, interacting cel! type. In some such embodiments, a co-culture comprises a defined ratio of human cardiac fibroblasts and one or both of cardiac smooth muscle (CSM) cells and cardiac myocytes (CM). The ratio of CF:CSM or CFiCM may be from about 50:1 , 20:1 , 10: 1 , 5:1 , 2:1 , 1 :1 , 1 :2, 1 :5, 1 :10, 1 :20, 1 :50 In some embodiments, co-culture of one or more of such cells are used in screening. It is shown that in co-cultures of CM and Cs, there is cross-talk that can play a role in suppressing cardiac fibrosis, for example through the ANP/BNP pathway. Anti-fibrotic effects seen in co-cu!ture can be enhanced by inhibiting the activity of ANP/BNP-degrading enzyme, neprilysin.

[0015] in some embodiments of the invention, methods are provided for determining the activity of a candidate agent on a cardiac fibroblast, the method comprising contacting the candidate agent with one or a panel of in vitro generated cardiac fibroblasts as described herein, or a co- culture comprising one or a panel of in vitro generated cardiac fibroblasts; and determining the effect on a phenotype of the CF. In some embodiments the phenotype is development of fibrosis. In some embodiments screening includes testing of sex- and patient-specific cellular responses to candidate anti-fibrotic drugs in vitro.

BRIEF DESCRIPTION OF THE DRAWINGS

[0016] Figure 1. Mouse single-cell transcriptome reveals tissue-specific gene markers for fibroblasts are conserved in humans. A, A t-SNE (t-distributed stochastic neighbor embedding) plot showing the distribution patterns of 4,685 fibroblasts derived from 10 tissues of healthy adult mice. The numbers of tissue-specific fibroblasts used for transcriptome analysis are listed in the brackets next to the individual tissue types. B, Representative t-SNE plots showing tissue- specific fibroblast subpopulations express genes reported to be detected in fibroblasts with high abundance. C_s Gene ontology (GO) enrichment analysis reveals that ail the cell clusters in (A) possess fibrobiast-specific biological functions. D, A heafmap comparing the most specifically expressed (25% fibroblasts expressed, logFC>1.5, and FDR adjusted P~va!ue <1 %; Wileoxon rank sum test) transcription factors in 10 tissue-specific mouse fibroblast subpopulations. E, Cross-species validation of cardiac (GATA4 and TBX20), lung (HOXA5 and TBX4), and bladder (HOXA1 1 and ISL1) specific genes in human primary cardiac, lung, and bladder fibroblasts. Primary skin fibroblasts are used as a negative control. N.D., not detected. Data are presented as mean ± SEM.

[0017] Figure 2. Generation human induced pluripotent stem cell-derived cardiac fibroblasts.

A, Developmental pathway enrichment analysis (FDR adjusted P-vaiue <1 %; Hypergeometrie test) showing tissue-specific transcription factors (>25% fibroblasts, logFC>log2 and FDR adjusted P value <1 %: Wileoxon rank sum test) in fibroblasts of different tissue origins. B, A schematic diagram showing the protocol for small molecule-directed differentiation from human iPSCs to iPSC-CFs. iPSC, induced pluripotent stem cell; CPC, cardiac progenitor cell; EPC, epicardial cell; CF, cardiac fibroblast; FGF2, fibroblast growth factor-2; TGF-b, transforming growth factor-b. C, Representative bright-field images showing stage-specific cell morphology changes during the 23 differentiation of human iPSC-CFs. Scale bars, 200 pm. D, Representative immunof!uorescent images showing stage-specific cells express p!uripotency genes (NANOG and SSEA4), cardiac mesodermal gene (NKX2-5), epicardial genes (Z01 and WT1), and CF genes (GATA4 and DDR2) during differentiation. Scale bars, 100 pm. E, Representative flow cytometric histograms showing protein levels of COL-I, DDR2, and TCF21 in human iPSC-CFs on day 18 of differentiation (red) versus undifferentiated IPSCs (blue). F, The expression levels of cardiac-specific, early development-related genes (GATA4, TBX20, NKX2-5, and TBX5) at individual differentiation stages. N.D., not detected. G, The expression levels of epicardial markers (WT1 , TBX18, and TCF21) at individual differentiation stages of iPSC-CFs. H, The expression levels of genes that are highly expressed in fibroblasts (COL1A1 , DDR2, POSTN, and VIM) in stage-specific cells during iPSC-CF differentiation i, The expression levels of lung-specific genes (TBX4 and HOXA5) in stage-specific cells during IPSC- CF differentiation. Primary LFs (lung fibroblasts) are used as a positive control. Data in (E-!) were generated based on three independent differentiations. Data are presented as mean ± SEM.

[0018] Figure 3. Human iPSC-derived cardiac fibroblasts are highly pure and preserve their cardiac identity during passaging. A, Representative immunof!uorescent images showing human iPSC-CFs are positive for gene makers (COL-I, DDR2, VIM, and POSTN) that are highly expressed in primary CFs. Scale bars, 100 pm. iPSC, induced pluripotent stem cell; CF, cardiac fibroblast. B. Representative immunofluorescent images showing the expression levels of cardiacspecific genes (GATA4, TBX20, and TCF21) in human IPSC-CFs, primary cardiac and skin fibroblasts. SF, skin fibroblast. Scale bars, 100 pm. C, The expression levels of cardiac- specific genes (GATA4, TBX20, and TCF21) in human IPSC-CFs at different passages. D, The expression 24 levels of epicardial marker genes (WT1 and TBX18) in human iPSC-EPCs and iPSC-CFs at different passages. EPC, epicardial cell. E, Representative flow cytometric histograms showing the percentage of WT1+ population in human iPSC-EPCs and iPSC-CFs at different passages. Primary CFs are used as a control. The quantitative data are shown on the right. F, Representative immunofluorescent images showing negligible expression of SMC (smooth muscle cell)-specific genes (ACTA2, CNN1 , SMTN, and TAGLN) in iPSC-CFs. The same IPSC lines were used to derive SMCs of the epicardial lineage, which are used as a positive control. Scale bars, 100 p . G, The expression levels of SMC-specific genes (ACTA2, CNN1 , MYH1 1 , and TAGLN) in human IPSCCFs versus iPSC-SMCs of the epicardial lineage. H, The expression levels of pericyte-specific genes (PDGFRB, CSPG4, and MCAM) in human iPSC-CFs, primary cardiac fibroblasts, and brain pericytes. Data in (C, D, E, G, and H) are generated from three independent IPSC lines, and are presented as mean ± SEM. *P<0.05 by one-way ANOVA followed by Bonferroni multiple comparisons.

[0019] Figure 4. Human iPSC-derived cardiac fibroblasts demonstrate similar biological characteristics to primary cardiac fibroblasts. A, Expression levels of cardiac-specific genes (GATA4, TBX20, and TCF21) in human primary CFs In the absence or presence of TGF-b ± a TGF-b inhibitor SB431542 (SB). CF, cardiac fibroblast. *P<0.05 vs. vehicle control, #P<0.05 vs. TGF-b group by one-way ANOVA followed by Bonferroni multiple comparisons. B, Expression levels of cardiac-specific genes (GATA4, TBX20, and TCF21) in human iPSC-CFs in the absence or presence of TGF-b ± SB. IPSC, induced pluripotent stem ceil. *P<0.05 vs. vehicle control, #P<Q.Q5 vs. TGF-b group by one-way ANOVA followed by Bonferroni multiple comparisons. C, Secreted collagen contents (measured by Sirius red) are increased in both human iPSC-CFs and 25 primary CFs after TGF-b treatment. Human iPSCs were used as a negative control. *P<0.05 by one-way ANOVA followed by Bonferroni multiple comparisons. D, Representative collagen gel contraction responses in two independent human iPSC-CFs in the absence or presence of TGF-b ± SB. The residua! surface areas of collagen gel in each group were used for quantification (shown below the representative image), and normalized to that of the vehicle control. The size of the collagen gel area is inversely proportional to the contractility. *P<0.05 by one-way ANOVA followed by Bonferroni multiple comparisons. E, Representative images showing human IPSC derived and primary CF migration in the absence or presence of PDGF-BB (25 ng/ml) at different time points over the 24-hour observation frame using a woundhealing assay. Quantitative data showing similar migration rate (wound closure area) between human iPSC-CFs and primary CFs under the same conditions. *P<0.05 indicates PDGF-BB treatment vs. vehicle control in primary CF, #P<0.05 indicates PDGF-BB treatment vs. vehicle control in iPSC-CF, by one-way ANOVA followed by Bonferroni multiple comparisons. All data were generated from three or four independent iPSC lines, and are presented as mean ± SEM.

[0020] Figure 5. Human IPSC-derived cardiac fibroblasts are quiescent fibroblasts and therefore provide an ideal in vitro platform to mode! fibrosis. A-B, Representative immunofluorescent (A) and flow cytometry (B) images showing the degree of spontaneous transdifferentiation of IPSC-CFs to myofibroblasts (a-SMA+, smooth muscle a-actin) during passages 1-5. TGF-b treated CFs were used as a positive control. The percentage of SMA+ myofibroblasts In each passage of IPSC-GFs are calculated based on the flow cytometry (B, right). iPSC, induced pluripotent ste cell; CF, cardiac fibroblast. Scale bars, 100 pm. C, The expression levels of myofibroblast markers (ACTA2 and ROSIN) in human iPSC-CFs cultured in the absence or presence of TGF-b ± a TGF26 b inhibitor SB431542 (SB). *P<G.05 vs. vehicle control, #P<0.05 vs. TGF-b group by one-way ANOVA followed by Bonferroni multiple comparisons. D, A representative i munob!ot showing the a-SMA levels in CFs derived from two independent IPSC lines in the absence or presence of TGF-b ± SB. The corresponding densitometric quantification data are shown next to the immunobiot. *P<Q.Q5 by one-way ANOVA followed by Bonferroni multiple comparisons. E-H, The expression levels of genes coding extracellular matrix proteins (collagen, fibronectin, proteoglycans, integrins, and matrix proteinases and inhibitors) in human iPSC-CFs cultured in the absence or presence of TGF-b. *P<0 05 vs. vehicle control by one-way ANOVA followed by Bonferroni multiple comparisons I, Representative flow cytometry images and quantitative data showing pirfenidone (a commercial anti-fibrosis drug) or SB significantly suppresses TGF-b induced propagation of the a-SMA+ population In iPSC-CFs. PFD, pirfenidone. *P<0.05 vs. TGF- b group by one-way ANOVA followed by Bonferroni multiple comparisons. J, Representative flow cytometric histograms and quantitative data showing a dose-dependent induction of the a- SMA+ population after human iPSC-CFs were treated with doxorubicin. *P<0.05 vs. Ctrl group by one-way ANOVA followed by Bonferroni multiple comparisons. Data in (B-J) were generated from three independent IPSC lines, and are presented as mean ± SEM.

[0021] Figure 6. Human IPSC-derived cardiomyocytes attenuate TGF^-induced fibrotic responses in IPSC-derived cardiac fibroblasts through a paracrine mechanism. A, Computational analysis showing broad intercellular communications between fibroblasts and a diverse array of cel! types through different complementary ligand-receptor signaling pathways. The threshold for defining a ligand/receptor expressed in a cluster is >25% with gene expression > 0. FB, fibroblast. B, The basal expression levels of ligands NPPA (natriuretic peptide type A) and NPPB and their 27 cognate receptor NPR1 (natriuretic peptide receptor 1) in human iPSC- CMs and IPSC-GFs. IPSC, induced pluripotent stem cell; CM, cardiomyocyte; CF, cardiac fibroblast C, Expression levels of CF and myofibroblast markers in human IPSC-CFs in the absence or presence of TGF-b ± BNP. *P<Q.Q5 vs. vehicle confrol, #P<Q.G5 vs. TGF-b group by one-way ANOVA followed by Bonferroni multiple comparisons. D, A representative im unoblot showing a-SMA (smooth muscle a-actin) levels in human iPSC-CFs treated with TGF-b and escalating concentrations of BNP. Densitometric quantifications are shown above the immunoblot. *P<0.05 by one-way ANOVA followed by Bonferroni multiple comparisons. E, Expression levels of CF and myofibroblast markers in human iPSC-CFs after they were indirectly co-cultured with or without iPSC-CMs in the absence or presence of TGF-b ± sacubitril. Sacubitril is an inhibitor for ANP (atrial natriuretic peptide) and BNP-degrading enzyme. *P<G.Q5 vs. vehicle control, #P<0.05 vs. TGF-b group, $P<0.05 vs. iPSC-CM coculture group by one-way ANOVA followed by Bonferroni multiple comparisons. F, Representative immunoblots showing the levels of a-SMA, periostln (POSTN), collagen ill (COL!l!), and fibronectin (FN) in human IPSC-CFs after they were indirectly co-cu!tured with or without iPSC-CMs In the absence or presence of TGF-b ± sacubitril. Densitometric quantifications are shown below the immunoblots. *P<0 05 by one-way ANOVA followed by Bonferroni multiple comparisons. G, Schematic of the proposed mechanisms for the roie of cardiomyocytes in suppressing TGF-p-induced CF transdifferentiation through the ANP/BNP- NPR1 signaling pathway. Sacubitril, a pharmacological drug, can further enhance the anti- fibrotic effect by suppressing the activity of ANP- and BNP-degrading enzyme, neprilysin. Data in (B-F) were generated based on three independent differentiations, and are presented as mean ± SEM

[0022] Figure 7. A logical flow diagram demonstrates the process of developing the human IPSC derived cardiac fibroblast differentiation protocol. The differentiation protocol for human iPSC -CFs developed in this study is based on the recognition of tissue-specific marker genes expressing in fibroblast subpopulations, as revealed by the mouse single-cell transcriptomic data. Further DEG (differentially expressed genes) analysis highlights the criticai roles of tissue- specific transcription factors in regulating the development trajectories of fibroblast subpopulations, and also suggests that CFs may be derived from the epicardial lineage. As such, human iPSC-CFs were successfully generated after Intermediate cell types of cardiac progenitor cells and epicardial cells being sequentially differentiated. iPSC, induced pluripotent stem cell; CF, cardiac fibroblast.

[0023] Figure 8. Generation tissue-specific fibroblast subpopulations from Tabula Muris. A, Originally assigned annotations to fibroblast-containing cel! clusters derived from different tissues and organs of healthy adult mice In the Tabula Muris database. B, A t-SNE (t-distributed stochastic neighbor embedding) plot showing the distribution pattern of the cel! clusters in (A). C, t-SNE plots showing cells positive for Co!1a2 , Ddr2, Den , Timp2 , and Pdgfra (highlighted in purple) in each duster. D, t-SNE plots showing cells positive for endothelial markers (Pecaml and Cdh5 ), smooth muscle cell markers ( Tagln and Cnni), or an immune cell marker (Pfprc). [0024] Figure 9. Commonly expressed genes in tissue-specific fibroblast subpopulations. These genes are detected by comparing all generated tissue-specific fibroblast subpopulations with other cell types with the cutoff:> 25% fibroblasts expressed, logFC> log2, FDR adjusted P~ calue <1 % under the Wilcox rank sum test.

[0025] Figure 10. Donor and sex effects on tissue-specific fibroblast clustering. A, A t- SNE (t-distributed stochastic neighbor embedding) plot showing a donor-independent distribution pattern of tissue-specific fibroblasts from different mice (n = 4 for M and 4 for F). F, female; M, male. B, A series of t-SNE plots showing the distribution patterns of tissue specific fibroblasts in various organs of male versus female mice.

[0026] Figure 1 1. Genes in fibroblasts from the heart and fat tissues showing a sex dependent expression pattern. A, A heatmap comparing top 10 specifically expressed genes in cardiac fibroblasts from male versus female mice. B, A heatmap comparing top 10 specifically expressed genes in fibroblasts of fat tissues from male versus female mice. C, Violin plots showing the expression levels of estrogen receptor (Esr1) and androgen receptor (Ar) among fibroblasts of various tissue origins.

[0027] Figure 12. The most specifically expressed genes In tissue-specific fibroblasts. The numbers of tissue-specific fibroblasts used to generate this heatmap are 314 (bladder), 1444 (heart), 220 (lung), 41 1 (trachea), 19 (pancreas), 194 (limb muscle), 206 (diaphragm), 1523 (fat), 323 (mammary gland), and 31 (aorta).

[0028] Figure 13 Expression levels of epicardial genes in mouse cardiac fibroblasts. t-SNE (i- distributed stochastic neighbor embedding) plots showing the distribution patterns of epicardial markers (Wt Tbx18, and Tcf21) in adult mouse cardiac fibroblasts (highlighted in purple). These data are generated from the Tabula Muris dataset.

[0029] Figure 14. Expression levels of myogenic repressor genes in human iPSC derived cardiac fibroblasts and smooth muscle cells. Gene expression levels of myogenic repressor genes ( ELK1 and KLF4) in human iPSC-derived cardiac fibroblasts versus smooth muscle cells of the epicardial lineage. iPSC, induced p!uripotent stem cell; CF, cardiac fibroblast; SMC, smooth muscle cell. *P<0.05 by one-way ANOVA followed by Bonferroni multiple comparisons. Data were generated based on three independent differentiations, and are presented as mean ± SEM.

[0030] Figure 15. Human iPSC-derived cardiac fibroblasts upreguiate the expression of MYH7 in iPSC-derived cardiomyocytes in the direct contact coculture condition. A representative immunoblot showing the levels of IVSHY7 (myosin heavy chain 7) in human iPSC-derived cardiomyocytes after cocultured with or without iPSC-derived CFs in the absence or presence of TGF-b. Densitometric quantitifactions are shown above the immunobiots. Data were generated based on three independent differentiations, and are presented as mean + SEM. [0031] The invention is best understood from the following detailed description when read in conjunction with the accompanying drawings.

DETAILED DESCRIPTION OF THE INVENTION

[0032] Before the present compositions and methods are described, it is to be understood that this invention is not limited to particular compositions and methods described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.

[0033] Where a range of values is provided, it is understood that each intervening vaiue, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limits of that range is also specifically disclosed. Each smaller range between any stated value or intervening vaiue in a stated range and any other stated or intervening vaiue in that stated range is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included or excluded in the range, and each range where either, neither or both limits are included in the smaller ranges is also encompassed within the invention, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the invention.

[0034] Unless defined otherwise, ail technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill In the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, some potential and preferred methods and materials are now described. Ail publications mentioned herein are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited. It is understood that the present disclosure supersedes any disclosure of an incorporated publication to the extent there is a contradiction.

[0035] It must be noted that as used herein and in the appended claims, the singular forms "a", "an", and "the" include plural referents unless the context dearly dictates otherwise. Thus, for example, reference to “a reprogramming factor polypeptide” includes a plurality of such polypeptides, and reference to "the induced p!uripotent stem cells" includes reference to one or more induced pluripotent stem cells and equivalents thereof known to those skilled in the art, and so forth.

[0036] The publications discussed herein are provided solely for their disclosure prior to the filing date of the present application. Nothing herein is to be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed.

DEFINITIONS

[0037] By“pluripotency” and pluripotent stem cells it is meant that such ceils have the ability to differentiate into all types of cells in an organism. The term“induced pluripotent stem cel!” encompasses pluripotent cells, that, like embryonic stem (ES) cells, can be cultured over a long period of time while maintaining the ability to differentiate into ail types of ceils in an organism, but that, unlike ES cells (which are derived from the inner cell mass of blastocysts), are derived from differentiated somatic cells, that is, ceils that had a narrower, more defined potential and that in the absence of experimental manipulation could not give rise to all types of cells in the organism. iPS cells have an hESC-!ike morphology, growing as fiat colonies with large nucieo- cytopiasmlc ratios, defined borders and prominent nuclei. In addition, IPS cells express one or more key pluripotency markers known by one of ordinary skill in the art, including but not limited to alkaline phosphatase, SSEA3, SSEA4, Sox2, Oct3/4, Nanog, TRA180, TRA181 , TDGF 1 , DnmtSb, FoxD3, GDF3, Cyp26a1 , TERT, and zfp42. in addition, the IPS cells are capable of forming teratomas in addition, they are capable of forming or contributing to ectoderm, mesoderm, or endoderm tissues In a living organism.

[0038] As used herein, “reprogramming factors” refers to one or more, i.e. a cocktail, of biologically active factors that act on a cell to alter transcription, thereby reprogramming a cell to multipotency or to pluripotency. Reprogramming factors may be provided to the cells, e.g. cells from an individual with a family history or genetic make-up of interest for heart disease such as fibroblasts, adipocytes, etc.; individually or as a single composition, that Is, as a premixed composition, of reprogramming factors. The factors may be provided at the same molar ratio or at different molar ratios. The factors may be provided once or multiple times in the course of culturing the cells of the subject invention in some embodiments the reprogramming factor is a transcription factor, including without limitation, Qct3/4; Sox2; Klf4; c~ Myc; Nanog; and Lin-28.

[0039] Somatic cells are contacted with reprogramming factors, as defined above, in a combination and quantity sufficient to reprogram the cell to pluripotency. Reprogramming factors may be provided to the somatic cells individually or as a single composition, that is, as a premixed composition, of reprogramming factors. In some embodiments the reprogramming factors are provided as a plurality of coding sequences on a vector.

[0040] Genes may be introduced into the somatic cells or the IPS cells derived therefrom for a variety of purposes, e.g. to replace genes having a loss of function mutation, provide marker genes, etc. Alternatively, vectors are introduced that express antisense mRNA or ribozymes, thereby blocking expression of an undesired gene. Other methods of gene therapy are the introduction of drug resistance genes to enable normal progenitor cells to have an advantage and be subject to selective pressure, for example the multiple drug resistance gene (MDR), or anti-apoptosis genes, such as bci-2. Various techniques known in the art may be used to introduce nucleic acids into the target cells, e.g. electroporation, calcium precipitated DNA, fusion, transfection, iipofection, infection and the like, as discussed above. The particular manner in which the DNA is introduced is not critical to the practice of the invention.

[0041] The ceils are harvested at an appropriate stage of development, which may be determined based on the expression of markers and phenotypic characteristics of the desired cell type e.g. at from about 1 to 4 weeks. Cultures may be empirically tested by staining for the presence of the markers of interest, by morphological determination, etc. The cells are optionally enriched before or after the positive selection step by drug selection, panning, density gradient centrifugation, etc. In another embodiment, a negative selection is performed, where the selection is based on expression of one or more of markers found on ES cells, fibroblasts, epithelial cells, and the like. Selection may utilize panning methods, magnetic particle selection, particle sorter selection, and the like.

[0042] The term“population", e.g.,“ceil population” or“population of cells", as used herein means a grouping (i.e., a population) of two or more ceils that are separated (i.e., isolated) from other cells and/or ceil groupings. For example, a 6-well culture dish can contain 6 ceil populations, each population residing in an individual well. The cells of a cell population can be, but need not be, cional derivatives of one another. A cell population can be derived from one individual cell. For example, if individual cells are each placed in a single well of a 6-well culture dish and each cell divides one time, then the dish will contain 6 ceil populations. The cells of a cell population can be, but need not be, derived from more than one ceil, i.e. non-ciona!. The cells from which a non-clonal cell population may be derived may be related or unrelated and include but are not limited to, e.g., cells of a particular tissue, cells of a particular sample, cells of a particular lineage, cells having a particular morphological, physical, behavioral, or other characteristic, etc. A cell population can be any desired size and contain any number of cells greater than one cell. For example, a ceil population can be 2 or more, 10 or more, 100 or more, 1 ,000 or more, 5,000 or more, 10⁴ or more, 10^s or more, 10⁶ or more, 1 Q⁷ or more, 10⁸ or more, 10⁹ or more, 1 Q¹⁰ or more, 1 Q^ri or more, 10¹² or more, 1 Q¹³ or more, 10¹⁴ or more, 1 Q¹⁵ or more, 10¹⁶ or more, 10ⁱ⁷ or more, 1 Q¹⁸ or more, 10¹⁹ or more, or 1 Q²⁰ or more cells.

[0043] The terms“homogenous population”, as it relates to cel! populations, refers to a cell population that is essentially pure and does not consist of a significant amount of undesired or contaminating cell types. By significant amount, in this context, is meant an amount of undesired or contaminating cell types that negatively impacts the use of the isolated desired cell population. As such, the actual amount of undesired or contaminating ceils that defines a significant amount will vary and depend on the particular type of undesired or contaminating cells and/or the particular use of the desired cel! type. For example, in a population of differentiated mesodermal cells used in the treatment of a subject, a significant amount of improperly differentiated contaminating cell types will be small as such cells may a high capacity to negatively impact the use of the generated desired cell population. In comparison, e.g , in a population of differentiated mesodermai ceils used in the treatment of a subject, a significant amount of contaminating progenitor ceils may be relatively large as such ceils may have a low capacity to negatively impact the use of the generated desired cell population. In some instances, a homogenous population may refer to a highly enriched population. Levels of homogeneity will vary, as described, and may, in some instances, be greater than 60% pure, including e.g., more than 65%, more than 70%, more than 75%, more than 80%, more than 85%, more than 90%, more than 95%, more than 96%, more than 97%, more than 98%, more than 99%, more than 99.5%, more than 99.6%, more than 99.7%, more than 99.8%, and more than 99.9%.

[0044] The term“heterologous”, as it refers to a“heterologous sequence” or“heterologous nucleic acid”, means derived from a genotypically distinct entity from that of the rest of the entity to which it is being compared. For example, a polynucieotide introduced by genetic engineering techniques into a plasmid or vector derived from a different species is a heterologous polynucleotide. A promoter removed from its native coding sequence and operatively linked to a coding sequence with which it is not naturally found linked is a heterologous promoter.

[0045] The terms "treatment", "treating", "treat" and the like are used herein to generally refer to obtaining a desired pharmacologic and/or physiologic effect. The effect may be prophylactic in terms of completely or partially preventing a disease or symptom thereof and/or may be therapeutic in terms of a partial or complete stabilization or cure for a disease and/or adverse effect attributable to the disease. "T reatment” as used herein covers any treatment of a disease in a mammal, particularly a human, and includes: (a) preventing the disease or symptom from occurring in a subject which may be predisposed to the disease or symptom but has not yet been diagnosed as having it; (b) inhibiting the disease symptom, i.e., arresting its development; or (c) relieving the disease symptom, i.e., causing regression of the disease or symptom.

[0046] Quiescent cardiac fibroblasts, for the purposes of the present disclosure, are those fibroblasts that share the phenotype of quiescent primary cardiac fibroblasts. It has been previously observed that primary fibroblasts can undergo spontaneous transdifferentiation into myofibroblasts during in vitro culturing. Markers of activation, i.e. lack of quiescence, include expression of a-smootb muscle actin (a-SMA). Additional markers include transcriptional upreguiai!on of ACTA2 and POSTN, which are significantly increased with activation. Because ihe transdifferentiation from fibroblasts to myofibroblasts is strongly associated with the dynamic changes of ECM genes, increased expression levels of ECM genes such as COL1 A1 , COL3A1 , COL4A2, and FN1 are also indicative of activation, as are several proteoglycans (VCAN, CTGF, KAL1 , TNG, and SPARC) and cell-matrix focal adhesion molecules (1TGA4, ITGA5, and ITGB5), and TIMP1 , TIMP2, and TIMP3. There is a downregu!ation of MMP1 with activation.

[0047] Quiescent CF are therefore defined as those CF that share a transcriptional profile of primary, non-activafed fibroblasts, e.g. with respect to the extracellular matrix, actin, proteoglycan, and cell-matrix focal adhesion genes.

[0043] in addition to various uses as in vitro cultured ceils, the cardiac fibroblasts generated by the methods described herein may be tested in a suitable animal model. At one level, cells are assessed for their ability to survive and maintain their phenotype in vivo. Cell compositions are administered to immunodeficient animals (such as nude mice, or animals rendered immunodeficient chemically or by irradiation). Tissues are harvested after a period of regrowth, and assessed as to whether the administered cells or progeny thereof are still present, and may be phenotyped for response to a treatment of interest. Suitability can also be determined in an animal model by assessing the degree of cardiac recuperation that ensues from treatment with the differentiating ceils of the Invention. A number of animal models are available for such testing. For example, hearts can be cryoinjured by placing a precooled aluminum rod in contact with the surface of the anterior left ventricle wail (Murry et a!., J. Clin. Invest 98:2209, 1996; Reinecke et ai. , Circulation 100: 193, 1999; U.S. Pat. No. 6,099,832). In larger animals, cryoinjury can be inflicted by placing a 30-50 mm copper disk probe cooled in liquid N₂ on the anterior wall of the left ventricle for approximately 20 min (Chiu et al., Ann. Thorac. Surg. 60: 12, 1995). Infarction can be induced by ligating the left main coronary artery (Li et al., J. Clin. Invest. 100:1991 , 1997). Injured sites are treated with ceil preparations of this invention, and the heart tissue is examined by histology for the presence of the cells in the damaged area. Cardiac function can be monitored by determining such parameters as left ventricular end-diastolic pressure, developed pressure, rate of pressure rise, rate of pressure decay, etc.

[0049] The terms "individual," "subject," "host," and "patient," are used interchangeably herein and refer to any mammalian subject for whom diagnosis, treatment, or therapy is desired, particularly humans.

[0050] “Myocardial fibrosis” is the excessive deposition of extracellular matrix proteins, including collagens, in the heart. In cardiomyopathies, the formation of interstitial fibrosis and/or replacement fibrosis is almost always part of the pathological cardiac remodeling process. Different forms of cardiomyopathies show particular patterns of myocardial fibrosis that can be considered as distinctive hallmarks. Although formation of fibrosis is initially aimed to be a reparative mechanism, in the long term, on-going and excessive myocardial fibrosis may lead to arrhythmias and stiffening of the heart wail and subsequently to diastolic dysfunction. Ultimately, adverse remodeling with progressive myocardial fibrosis can lead to heart failure.

[0051] Fibrosis is a characteristic of many chronic diseases, including cardiac disease and heart failure. In case of myocardial fibrosis, the balance between synthesis and degradation of ECM proteins is disturbed, leading to excess fibrous connective tissue formation. A main event that occurs is CF activation and differentiation into myofibroblasts, which is primarily triggered by transforming growth factor (TGF-b). Myofibroblasts secrete higher amounts of ECM proteins, thereby playing a key role in fibrosis formation interstitial fibrosis is characterized by an increase in ECM and collagen deposits between the ceils without loss of cardiomyocytes. The fibrosis is diffusely present throughout the myocardium. This type of fibrosis is mostly caused by chronic triggers, such as pressure overload (hypertension), inflammation, and aging. Perivascular fibrosis is characterized by accumulation of collagen fibres in the area surrounding the coronary arteries, and is mainly observed in the setting of hypertension. Replacement fibrosis presents following cardio yocyte death, and occurs for instance after acute ischemic injury, such as myocardial infarction (Ml).

[0052] The standard for visualization of myocardial fibrosis consists of histological analysis of tissue, for example using Masson's trichrome or Sirius red staining. Non-invasive techniques have emerged to investigate cardiac fibrosis in vivo, most commonly using cardiac magnetic resonance (CMR) imaging, e.g. late gadolinium enhancement (LGE) Normal myocardium is visualized as a“dark” area without Gd, and damaged myocardium will be seen as“bright” areas of Gd accumulation. CMR techniques using T 1 mapping have also been developed. T 1 mapping consists of the generation of a pixe!ated map based on the longitudinal or spin-lattice relaxation of protons that recover towards thermodynamic equilibrium following excitation with the radiofrequency beam. In case of myocardial fibrosis, an increase in native T1 relaxation time will be observed. T1 mapping can also be combined with administration of Gd, which increases proton relaxation, and thus decreases T 1 relaxation time. Native and post-contrast T 1 mapping can determine an increase in ECM volume that is not detectable by LGE.

[0053] Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy (LVH), which cannot be explained by abnormal loading conditions. In the majority of HCM patients, often extensive amounts of fibrosis are observed. Typical to HCM, this is most commonly seen as patchy replacement fibrosis, either alone or in combination with interstitial fibrosis, and mostly present at the (basal) iVS and the attachment of the RV and LV.

[0054] Dilated cardiomyopathy (DCM) is characterized by ventricular dilatation and often progressive contractile dysfunction, resulting in great risk of developing HF. Many DCM patients present with substantial amounts of myocardial fibrosis in these patients, myocardial fibrosis is mostly observed as replacement fibrosis with a midwall distribution throughout the LV. Similar to HCM, myocardial fibrosis is related to disease severity in DCM.

[0055] Left ventricular non-compaction (LVNC) is a very rare form of cardiomyopathy, which is characterized by structural abnormality of the LV myocardium. The etiology of LVNC is unknown but is believed to be genetic in nature, causing failure of the compaction process of the myocardial wall during development. Myocardial fibrosis may be present in the compacted myocardium, and most commonly in the IVS.

[0056] Laminopathies are caused by pathogenic variants in the lamin A/C (LMNA) gene. The lamin A and C proteins are produced via alternative splicing of this gene, and are components of the nuclear lamina and hence essential in proper nuclear architecture and function. Several autosomal dominant mutations in the LMNA gene have been associated with cardiac disease that finally can culminate in a DCM phenotype. This cardiomyopathy is, however, also characterized by eariy-onset atrioventricular (AV)~block, (supra)ventricular arrhythmias, and SCD even before DCM development. Localized fibrosis in the IVS may be the mechanism behind reduced septal function, AV-biock, and VA in lamin A/C mutation-positive subjects.

[0057] Phosphoiamban (PLN) p.Arg14de! induced cardiomyopathy shows a unique pattern of myocardial fibrosis. This mutation in the PLN gene, deleting the arginine on position 14 of the PLN protein, results in a severe form of cardiomyopathy with characteristics of DCM and ARVC. This cardiomyopathy is also associated with distinct fibrotic patterns with clinical importance.

METHODS OF THE INVENTION

[0058] Methods are provided for the obtention and use of in vitro cell cultures of cardiac fibroblasts, where the cardiac fibroblasts are differentiated from induced human piuripotent stem cells (IPS ceils) in some embodiments a co-culture of such cardiac fibroblasts are provided. Candidate agents include small molecules, i.e. drugs, genetic constructs that increase or decrease expression of an RNA of interest, protein expression, and the like.

[0059] Aspects of the disclosure include methods for deriving CF from piuripotent progenitor cells. What is meant by piuripotent progenitors is described herein. Piuripotent progenitors of the instant disclosure may be acquired from any convenient source, including but not limited to newly derived from a subject of interest or tissue specimen or other cellular sample, obtained from a public repository, obtained from a commercial vendor, and the like. In some instances, piuripotent ceils of interest include human cells including but not limited to, e.g , human embryonic stem cells, human induced piuripotent stem ceils, human fetal stem cells, and the like.

[0060] In some instances, piuripotent progenitor cells of the subject disclosure may be unmodified such that the ceils have not been genetically or otherwise modified from their natural state prior to modification according the methods described herein. In other instances, pluripotent progenitor cells of the subject disclosure may be unmodified such that the cells have been genetically or otherwise modified from their natural state prior to modification according the methods described herein.

[0061] Following induction of piuripotency, hiPSC are cultured according to any convenient method, e.g. on irradiated feeder cells and commercially available medium. The hiPSC can be dissociated from feeders by digesting with protease, e.g. dispase, preferabiy at a concentration and for a period of time sufficient to detach intact coionies of pluripotent stem ceils from the layer of feeders, or from hiPSC grown in feeder-free conditions, by dissociation into a single cell suspension and aggregation using various approaches, including centrifugation in plates, etc.

[0062] Genes may be introduced into the somatic cells or the hiPSC derived therefrom for a variety of purposes, e.g. to replace genes having a loss of function mutation, provide marker genes, etc. Alternatively, vectors are introduced that express antisense mRNA, siRNA, ribozymes, etc. thereby blocking expression of an undesired gene. Other methods of gene therapy are the introduction of drug resistance genes to enable normal progenitor cells to have an advantage and be subject to selective pressure, for example the multiple drug resistance gene (MDR), or anti-apoptosis genes, such as BCL-2. Various techniques known in the art may be used to introduce nucleic acids into the target cells, e.g. electroporation, calcium precipitated DNA, fusion, transfection, lipofection, infection and the like, as discussed above. The particular manner in which the DNA is introduced is not critical to the practice of the invention.

[0063] Disease-associated or disease-causing genotypes can be generated in healthy hiPSC through targeted genetic manipulation (CRISPR/CAS9, etc) or hiPSC can be derived from individual patients that carry a disease-related genotype or are diagnosed with a disease, e.g. Hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), left ventricular noncompaction (LVNC), laminopathies, phospholamban (PLN) p Arg14dei, etc. Moreover, cardiac diseases with less defined or without genetic components can be studied within the model system. Conditions of neurodeveiopmental and neuropsychiairic disorders and neural diseases that have strong genetic components or are directly caused by genetic or genomic alterations can be modeled with the systems of the invention.

[0064] Mutations of interest include mutations in the genes: cardiac troponin T (TNNT2); myosin heavy chain (MYH7); tropomyosin 1 (TPM1); myosin binding protein C (MYBPC3); 5‘-AMP~ activated protein kinase subunit gamma-2 (PRKAG2); troponin I type 3 (TNNI3); titin (TTN); myosin, light chain 2 (MYL2); actin, alpha cardiac muscle 1 (ACTC1); potassium voltage-gated channel, KQT-like subfamily, member 1 (KCNQ1); plakophilin 2 (PKP2); and cardiac LIM protein (CSRP3). Specific mutations of interest include, without limitation, MYH7 R663H mutation; TNNT2 R173W; PKP2 2013delC mutation; PKP2 Q617X mutation; and KCNQ1 G269S missense mutation. Any number of disorders with a defined genetic etiology can be additionally modeled by introducing mutations in or completely removing disease-relevant gene(s) In control hiPSC using genome editing, e.g. CRISPR. A particular advantage of this method is that fact that edited hiPSC lines share the same genetic background as their corresponding, non-edited hiPSC lines. This reduces variability associated with line-line differences in genetic background.

[0065] in some embodiments a panel of such cardiomyocytes are provided, where the panel includes two or more different disease-relevant cardiomyocytes. In some embodiments a pane! of such cardiomyocytes are provided, where the cardiomyocytes are subjected to a plurality of candidate agents, or a plurality of doses of a candidate agent. Candidate agents include small molecules, i.e. drugs, genetic constructs that increase or decrease expression of an RNA of interest, electrical changes, and the like. In some embodiments the disease-relevant cardiomyocytes are introduced or induced to differentiate from IPS cells in an in vivo environment, for example as an explant in an animal model in some embodiments a panel refers to a system or method utilizing patient-specific cardiomyocytes from two or more distinct cardiac conditions, and may be three or more, four or more, five or more, six or more, seven or more distinct conditions, where the conditions are selected from: dilated cardiomyopathy (DCM); hypertrophic cardiomyopathy (HCM); anthracycline-induced cardiotoxicity; arrhythmogenic right ventricular dysplasia (ARVD); left ventricular non-compaction (LVNC); double inlet left ventricle (DILV); and long QT (Type-1) syndrome (LQT-1)

[0066] in some instances, pathway modulating agents, as described above and including pathway activators and pathway inhibitors include, e.g., those that are commercially available, e.g., from such suppliers such as Tocris Bioscience (Bristol, UK), Sigma-Aldrich (St. Louis, MO), Santa Cruz Biotechnology (Santa Cruz, CA), and the like.

[0067] Pluripotent progenitors and derivatives thereof may be contacted with induction agents by any convenient means. Generally an induction agent is added to culture media, as described herein, within which cells of the instant disclosure are grown or maintained, such that the induction agent is present, in contact with the cells, at an effective concentration to produce the desired effect, e.g., induce a desired lineage restriction event in other instances, e.g., where the existing culture media is not compatible with a particular induction agent, the culture media in which the ceiis are being grown is replaced with fresh culture media containing the particular induction agent present in the fresh media at an effective concentration to produce the desired effect. In instances where fresh or specific culture media is provided with a particular induction agent the culture agent may, in some instances, be specifically formulated for the particular induction agent, e.g., containing one or more specific additional reagents to, e.g., aid in the delivery of the induction agent, aid in the solubility of the induction agent, aid in the stability of the induction agent, etc.

[0068] The effective concentration of a particular induction agent will vary and will depend on the agent. In addition, in some instances, the effective concentration may also depend on the cells being induced, the culture condition of the cells, other induction agents co-present in the culture media, etc. As such, the effective concentration of induction agents will vary and may range from 1 ng/mL to 10 pg/mL or more, including but not limited to, e.g., 1 ng/mL, 2 ng/mL, 3 ng/mL, 4 ng/mL, 5 ng/mL, 6 ng/mL, 7 ng/mL, 8 ng/mL, 9 ng/mL, 10 ng/mL, 1 1 ng/mL, 12 ng/mL, 13 ng/mL, 14 ng/mL, 15 ng/mL, 16 ng/mL, 17 ng/mL, 18 ng/mL, 19 ng/mL, 20 ng/mL, 21 ng/mL,

22 ng/mL, 23 ng/mL, 24 ng/mL, 25 ng/mL, 26 ng/mL, 27 ng/mL, 28 ng/mL, 29 ng/mL, 30 ng/mL,

31 ng/mL, 32 ng/mL, 33 ng/mL, 34 ng/mL, 35 ng/mL, 36 ng/mL, 37 ng/mL, 38 ng/mL, 39 ng/mL,

40 ng/mL, 41 ng/mL, 42 ng/mL, 43 ng/mL, 44 ng/mL, 45 ng/mL, 46 ng/mL, 47 ng/mL, 48 ng/mL,

49 ng/mL, 50 ng/mL, 1-5 ng/mL, 1-10 ng/mL, 1-20 ng/mL , 1-30 ng/mL, 1-40 ng/mL, 1-50 ng/mL,

5-10 ng/mL, 5-20 ng/mL, 10-20 ng/mL, 10-30 ng/mL, 10-40 ng/mL, 10-50 ng/mL, 20-30 ng/mL, 20-40 ng/mL, 20-50 ng/mL, 30-40 ng/mL, 30-50 ng/mL, 40-50 ng/mL, 1-100 ng/mL, 50-100 ng/mL, 60-100 ng/mL, 70-100 ng/mL, 80-100 ng/mL, 90-100 ng/mL, 10-100 ng/mL, 50-200 ng/mL, 100-200 ng/mL, 50-300 ng/mL, 100-300 ng/mL, 200-300 ng/mL, 50-400 ng/mL, 100- 400 ng/mL, 200-400 ng/mL, 300-400 ng/mL, 50-500 ng/mL, 100-500 ng/mL, 200-500 ng/mL,

0.5-7 pg/mL, 0.5-8 pg/mL, 0.5-9 pg/mL, 0.5-10 pg/mL, and the like.

[0069] In some instances, the effective concentration of an induction agent in solution, e.g , cell culture media, may range from 1 n to 100 pM or more, including but not limited to, e.g , 1 nM, 2 nM, 3 nM, 4 nM, 5 nM, 6 nM, 7 nM, 8 nM, 9 nM, 10 nM, 1 1 nM, 12 nM, 13 nM, 14 nM, 15 nM, 16 nM, 17 nM, 18 nM, 19 nM, 20 nM, 21 nM, 22 nM, 23 nM, 24 nM, 25 nM, 26 nM, 27 nM, 28 nM, 29 nM, 30 nM, 31 nM, 32 nM, 33 nM, 34 nM, 35 nM, 36 nM, 37 nM, 38 nM, 39 nM, 40 nM,

41 nM, 42 nM, 43 nM, 44 nM, 45 nM, 46 nM, 47 nM, 48 nM, 49 nM, 50 nM, 1-2 nM, 1-3 nM, 1- 4 nM, 1-5 nM, 1-6 nM, 1-7 nM, 1-8 nM, 1-9 nM, 1-10 nM, 1.5 nM, 1.5-2 nM, 1.5-3 nM, 1.5-4 nM, 1.5-5 nM, 1.5-6 nM, 1.5-7 nM, 1.5-8 nM, 1 .5-9 nM, 1.5-10 nM, 2-3 nM, 2-4 nM, 2-5 nM, 2-6 nM, 2-7 nM, 2-8 nM, 2-9 nM, 2-10 nM, 3-4 nM, 3-5 nM, 3-6 nM, 3-7 nM, 3-8 nM, 3-9 nM, 3-10 nM, 4-5 nM, 4-6 nM, 4-7 nM, 4-8 nM, 4-9 nM, 4-10 nM, 5-6 nM, 5-7 nM, 5-8 nM, 5-9 nM, 5-10 nM,

6-7 nM, 6-8 nM, 6-9 nM, 6-10 nM, 7-8 nM, 7-9 nM, 7-10 nM, 8-9 nM, 8-10 nM, 9-10 nM, 5-15 nM, 5-20 nM, 5-25 nM, 5-30 nM, 5-35 nM, 5-40 nM, 5-45 nM, 5-50 nM, 10-15 nM, 10-20 nM, 10-25 nM, 10-30 nM, 10-35 nM, 10-40 nM, 10-50 nM, 15-20 nM, 15-25 nM, 15-30 nM, 15-35 nM, 15-40 nM, 15-45 nM, 15-50 nM, 20-25 nM, 20-30 nM, 20-35 nM, 20-40 nM, 20-45 nM, 20-

50 nM, 25-30 nM, 25-35 nM, 25-40 nM, 25-45 nM, 25-50 nM, 30-35 nM, 30-40 nM, 30-45 nM, 30-50 nM, 35-40 nM, 35-45 nM, 35-50 nM, 40-45 nM, 40-50 nM, 45-50 nM, 10-100 nM, 20-100 nM, 30-100 nM, 40-100 nM, 50-100 nM, 60-100 nM, 70-100 nM, 80-100 nM, 90-100 nM, 50- 150 nM, 50-200 nM, 50-250 nM, 50-300 nM, 50-350 nM, 50-400 nM, 50-450 nM, 50-500 nM, 10-150 nM, 10-200 nM, 10-250 nM, 10-300 nM, 10-350 nM, 10-400 nM, 10-450 nM, 10-500 nM, 100-150 nM, 100-200 nM, 100-250 nM, 100-300 nM, 100-350 nM, 100-400 nM, 100-450 nM, 100-500 nM, 200-500 nM, 300-500 nM, 400-500 nM, 100 nM, 150 nM, 200 nM, 250 nM, 300 nM, 350 nM, 400 nM, 450 nM,500 nM, 550 nM, 600 nM, 650 nM, 700 nM, 750 nM, 800 nM, 850 nM,900 nM, 950 nM, 200-400 nM, 300-500 nM, 400-600 nM, 500-700 nM, 600-800 nM, 700-900 nM, 800 nM to 1 mM, 0.5-1 mM, 0.5-1.5 mM, 0.5-2 mM, 0.5-2.5 mM, 0.5-3 mM, 0.5-3.5 mM, 0.5-4 mM, 0.5-4.5 mM, 0.5-5 mM, 1 mM, 2 mM, 3 mM, 4 mM, 5 mM, 6 mM, 7 mM, 8 mM, 9 mM, 10 mM, 1 1 mM, 12 mM, 13 mM, 14 mM, 15 mM, 16 mM, 17 mM, 18 mM, 19 mM, 20 mM, 21 mM, 22 mM, 23 mM, 24 mM, 25 mM, 26 mM, 27 mM, 28 mM, 29 mM, 30 mM, 31 mM, 32 mM, 33 mM, 34 mM, 35 mM, 36 mM, 37 mM, 38 mM, 39 mM, 40 mM, 41 mM, 42 mM, 43 mM, 44 mM, 45 mM, 46 mM, 47 mM, 48 mM, 49 mM, 50 mM, 1-2 mM, 1-3 mM, 1-4 mM, 1-5 mM, 1-6 mM, 1-7 mM, 1-8 mM, 1-9 mM, 1-10 mM, 1.5 mM, 1.5-2 mM, 1.5-3 mM, 1.5-4 mM, 1.5-5 mM, 1.5-6 mM, 1.5-7 mM, 1.5-8 mM, 1.5-9 mM, 1.5-10 mM, 2-3 mM, 2-4 mM, 2-5 mM, 2-6 mM, 2-7 mM, 2-8 mM, 2-9 mM, 2-10 mM, 3-4 mM, 3- 5 mM, 3-6 mM, 3-7 mM, 3-8 mM, 3-9 mM, 3-10 mM, 4-5 mM, 4-6 mM, 4-7 mM, 4-8 mM, 4-9 mM, 4- 10 mM, 5-6 mM, 5-7 mM, 5-8 mM, 5-9 mM, 5-10 mM, 6-7 mM, 6-8 mM, 6-9 mM, 6-10 mM, 7-8 mM, 7-9 mM, 7-10 mM, 8-9 mM, 8-10 mM, 9-10 mM, 5-15 mM, 5-20 mM, 5-25 mM, 5-30 mM, 5-35 mM, 5-40 mM, 5-45 mM, 5-50 mM, 10-15 mM, 10-20 mM, 10-25 mM, 10-30 mM, 10-35 mM, 10-40 mM, 10-50 mM, 15-20 mM, 15-25 mM, 15-30 mM, 15-35 mM, 15-40 mM, 15-45 mM, 15-50 mM, 20-25 mM, 20-30 mM, 20-35 mM, 20-40 mM, 20-45 mM, 20-50 mM, 25-30 mM, 25-35 mM, 25-40 mM, 25- 45 mM, 25-50 mM, 30-35 mM, 30-40 mM, 30-45 mM, 30-50 mM, 35-40 mM, 35-45 mM, 35-50 mM, 40-45 mM, 40-50 mM, 45-50 mM, 10-100 mM, 20-100 mM, 30-100 mM, 40-100 mM, 50-100 mM, 60-100 mM, 70-100 mM, 80-100 mM, 90-100 mM, and the like.

[0070] In some instances, the effective concentration of an induction agent will be beiow a criticai concentration such that the induction produces the desired effect essentially without undesirable effects. As used herein, the term“critical concentration” refers to a concentration of induction agent above which undesirable effects are produced. Undesirable effects that may be the result of a concentration exceeding the criticai concentration include but are not limited to, e.g., off-farget effects (off-target activation of signaling, off-target inhibition of signaling), reduction or loss of function (e.g., loss of desired activator function, loss of desired inhibitor function) reduction of cell viability, increase in ceil mortality, lineage restriction towards an undesired cell type, differentiation into an undesired cel! type, loss of expression of a particular desired marker, etc. Whether a particular induction agent will have a critical concentration and what the critical concentrations of those agents having a critical concentration are will depend on the agent and the specific conditions in which the agent is used. [0071] In some instances, cells of the instant disclosure may be contacted with multiple induction agents and/or multiple induction compositions in order achieve a desired cell type of derivative thereof. In some instances, a particular induction composition will contain two or more induction agents such that a particular cel! culture is simultaneously contacted with multiple induction agents in some instances, a particular series of induction compositions may be used, one at a time, In generating a desired mesodermal cell type such that a particular cel! culture is successively contacted with multiple induction agents.

[0072] The duration of contact of a particular induction composition with a particular ceil type, in some instances, may be referred to as the“exposure time” and exposure times may range from a day to weeks or more, including but not limited to e.g , 1 day, 1 .5 days, 2 days, 2.5 days, 3 days, 3.5 days, 4 days, 4.5 days, 5 days, 5.5 days, 8 days, 6.5 days, 7 days, 7.5 days, 8 days, 8.5 days, 9 days, 9.5 days, 10 days, 1 1 days, 12, days, 13, days, 14 days, 15, days, etc. As used herein, exposure times are, In some instances, referred as consisting essentially of, e.g., 24 hours, indicating that the exposure time may be longer or shorter than that specified including those exposure times that are longer or shorter but do not materially affect the basic outcome of the particular exposure. As such, in some instances where a particular exposure is more time sensitive such that under or over exposure, e.g., of more or less than 1 hour, materially affects the outcome of the exposure, a time period consisting essentially of, e.g., 24 hours, will be interpreted to refer to a time period ranging from about 23 hours to about 25 hours in some other instances where a particular exposure is less time sensitive such that under or over exposure, e.g., of more than 12 hours, does not materially affect the outcome of the exposure, a time period consisting essentially of, e.g , 24 hours will mean a time period ranging from about 12 hours or less to about 38 hours or more. In some instances, depending on the context, an exposure period consisting essentially of 24 hours may refer to an exposure time of 22-28 hours, 21-27 hours, 20-28 hours, 19-29 hours, 18-30 hours, etc

[0073] in some instances, time periods of exposure may be pre-determined such that cells are contacted with an induction composition according to a schedule set forth prior to the contacting. In some instances, the time period of exposure, whether pre-determined or otheavise, may be modulated according to some feature or characteristic of the cells and/or cell culture, including but not limited to, e.g., cell morphology, cell viability, cell appearance, cellular behaviors, cel! number, culture confluence, marker expression, etc.

Factors

[0074] inhibitors of the TGF-beta pathway include but are not limited to, e.g., A-83-01 (3-(6- Methyl-2-pyridinyl)-/V-phenyl-4-(4-quinolinyl)-1 /-/-pyrazole-1-carbothioamide), D4476 (4-[4-(2,3- Dihydro-1 ,4-benzodioxin-6-yi)-5-(2-pyridinyl)-1 H-imidazol-2-yl]benzamide), GW 788388 (4-[4- [3-(2-Pyridinyi)-1 H-pyrazol~4-y!]~2-pyridinyi]-A/-(tetrahydro-2H-pyran-4-yl)-benzamide), LY 364947 (4-[3-(2-Pyridinyi)-1 H-pyrazol-4-yij-quinoline), RepSox (2-(3-(6-Methylpyridine-2-yl)- 1 H-pyrazol-4-yl)-1 ,5-naphthyridine), SB431542 (4-[4-(1 ,3-benzodioxoi-5-yl)-5-(2-pyridinyl)-1 H- imidazo!-2-yl]benzamide), SB-505124 (2-[4-(1 ,3-Benzodioxol-5-yl)-2-(1 ,1-dimethylethyl)-1 /-/- imidazol-5-yl]-6-methyl-pyridine), SB 525334 (6-[2-(1 ,1 -Dimethylethyl)-5-(6-methyl-2-pyridinyl)- 1 H-imidazol~4-y!]quinoxaline), SD208 (2-(5-Chioro~2-fluoropheny!)-4-[(4- pyridyi)amino]pteridine), ITD1 (4-[1 , 1 '-Biphenyl]-4-yl-1 ,4,5,6,7,8-hexabydro-2,7,7~irimeihyi~5~ oxo-3-quino!inecarboxylic acid ethyl ester), DAN/Fc, antibodies to TGF-beta and TGF-beta receptors, TGF-beta inhibitory nucleic acids, and the iike.

[0075] Activators of the WNT pathway include but are not limited to, e.g., GHIR99021 (6-[[2- [[4-(2,4-Dichlorophenyl)-5-(5-methyl-1 H-imidazol-2-yl)-2-pyrimidinyl]amino]ethyl]amino]-3- pyridinecarbonitriie), WNT family ligands (e.g., including but not limited to Wnt-1 , Wnt-2, Wnt- 2b, Wnt-3a, Wnt-4, Wnt-5a, Wnt-5b, Wnt-6, Wnt-7a, Wnt-7a/b, Wnt-7b, Wnt-8a, Wnt-8b, Wnt- 9a, Wnt-9b, Wnt-10a, Wnt-10b, Wnt-1 1 , Wnt-16b, etc.), RSPO co-agonists (e.g., RSP02), lithium chloride, TDZD8 (4-Benzyl-2-methyl-1 ,2,4-thiadiazoiidine-3,5-dione), BIO-Acetoxi e ((2’Z,3'E)-6-Bromoindirubin-3'-acetoxime), A1070722 (1-(7-Methoxyquinolin-4-yl)-3-[6- (trifiuoromethyl)pyridin-2-yl]urea), HLY78 (4-Ethyl-5,6-Dibydro-5-metbyl-[1 ,3]dioxoio[4,5- j]phenanthridine), CID 1 1210285 hydrochloride (2-Amino-4-(3,4-

(methylenedioxy)benzylamino)-6-(3-methoxyphenyl)pyrimidine hydrochloride), WAY-316606, (hetero)arylpyrimidines, IQ1 , QS1 1 , SB-216763, DCA, and the like. In some instances, activation of the Wnt pathway may be achieved through repression of the a Wnt pathway inhibitor, e.g., including but not limited to the use of an inhibitory nucleic acid targeting an inhibitor of the Wnt pathway or an antibody or small molecule directed to a Wnt pathway inhibitor.

[0076] inhibitors of the WNT pathway include but are not limited to, e.g., C59 (4-(2-Methyl-4- pyndinyl)-N-[4-(3-pyridinyi)phenyl]benzeneaceiamide), DKK1 , !WP-2 (N-(6-Methyl-2- benzothiazolyl)-2-[(3,4,6,7-tetrahydro-4-oxo-3-phenylthieno[3,2-d]pyrimidin-2-yl)thio]- aeetamide), Ant1.4Br, Ant 1.4CI, Niclosamide, apicularen, bafi!omycin, XAV939 (3, 5,7,8- Teirahydro-2-[4-(irifiuoromeihyi)pheny!]-4H-ihiopyrano[4,3-d]pyrimidin-4-one), IWR-1 (4- (1 ,3,3a, 4,7, 7a-Hexa hydro-1 , 3-dioxo-4,7-methano-2H-isoindol-2-yi)-N-8-quinolinyl- Benzamide), NSC668036 (N-[(1 , 1-Dimethylethoxy)carbonyl]-L-alanyl-(2S)-2-hydroxy-3- methylbutanoyl-L-Aianine-(1 S)-1-carboxy-2-methyipropyi ester hydrate), 2,4-diamino- quinazoline, Quercetin, !CG-001 ((6S,9aS)-Hexahydro-6-[(4-hydroxyphenyl)methyl]-8-(1- naphtha!enyimethyl)-4,7-dioxo-N-(phenylmeihyi)-2H-pyrazino[1 ,2-a]pyrimidine-1 (6H)- carboxamide), PKF1 15-584, B L-284 (2-Amino-4-[3,4-(methylenedioxy)benzylamino]-6-(3- methoxypheny!)pyrimidine), FH-535, iCRT-14, JW-55, JW-67, antibodies to Wnts and Wnt receptors, Wnt inhibitory nucleic acids, and the iike. [0077] Activators of the FGF pathway and/or the MAPK/ERK pathway include but are not limited to, e.g., FGF family ligands (e.g., FGF1 , FGF2, FGF-3, FGF-4, FGF-5, FGF-6, KGF/FGF-7, FGF-8, FGF-9, FGF-10, FGF-1 1 , FGF-12, FGF-13, FGF-15, FGF-16, FGF-17, FGF-19, FGF-20, FGF-21 , FGF-22, FGF-23, etc.), SUN 1 1802 (4-[[4-[[2-[(4-Amino-2, 3,5,6- teiramethy!phenyl)amino]acety!]meihy!amino]-1-piperidinyl]methyl]benzamide), t-

Butyihydroquinone, U-46619, C2 Ceramide, Lactosyl Ceramide, Angiotensin II, Baicalin, and the like. In some instances, activation of the FGF pathway and/or the MAPK/ERK pathway may be achieved through repression of the a FGF pathway and/or the MAPK/ERK pathway inhibitor, e.g., inciuding but not limited to the use of an inhibitory nucieic acid targeting an inhibitor of the FGF pathway and/or the MAPK/ERK pathway or an antibody or small molecule directed to a FGF pathway inhibitor and/or MAPK/ERK pathway inhibitor.

Differentiation of Epicardial and Cardiac Fibroblast Cells

[0078] Cardiac progenitor cells are differentiated from human piuripotent ceils by (i) culture in the presence of an effective concentration of a Wni agonist, including without limitation CHIR99021 of from about 0.1 mM to about 100 mM, and may be from about 1 mM to about 10 mM for a period of from about 24 to about 72 hours, and may be not more than about 48 hours. The cells are then (II) recovered in medium, e.g. RPMi+B27-insuiin for a period of from about 12 to about 36 hours, and the period may be around 24 hours. Following recovery, the cells are (Hi) cultured in the presence of an effective concentration of a Wnt inhibitor, including without limitation iWR-1 of from about 0.1 mM to about 100 mM, and may be from about 1 miM to about 10 mM for a period of from about 24 to about 72 hours, and may be about 48 hours. The cells are then (iv) recovered in medium, e.g. RPMI+B27-insulin for a period of from about 12 to about 38 hours, and the period may be around 24 hours.

[0079] The cardiac progenitor cells are plated in medium, e.g. advanced D EM medium, for a period of from about 1 to about 4 days, e.g. 2 days, 3 days, etc. The cells are then (v) cultured in the presence of an effective concentration of a Wnt agonist, including without limitation CHIR99021 of from about 0.1 mM to about 100 mM, and may be from about 1 mM to about 10 mM; and retinoic acid, e.g. from about 0.1 mM to about 100 mM, and may be from about 1 mM to about 10 m for a period of from about 24 to about 72 hours, and may be not more than about 48 hours to generate a population of human epicardial ceils.

[0080] To generate cardiac fibroblasts, the epicardial cells are cultured in the presence of an effective concentration of an FGF agonist, e.g. FGF2; and a TGF-b inhibitor, e.g. SB431542; each at a concentration of from about 0.1 mM to about 100 mM, and may be from about 1 mM to about 50 mM, from about 5 mM to about 25 mM, and may be about 10 mM, for a period of from aboui 4, about 5, about 8, about 7, about 8, about 9, about 10 days or more. The period may be from about 5 to about 8 days, e.g. around 6 days.

Screening Assays

[0081] Methods are provided for determining the activity of a candidate agent on a cardiac fibroblast, the method comprising contacting the candidate agent with one or a panel of cardiac fibroblasts differentiated from induced human pluripotent stem cells (iPS cells); and determining the effect of the agent on morphologic, genetic or functional parameters, e.g. indications of fibrosis, such as altered morphology, overproduction of collagen, and the like.

[0082] in screening assays for the small molecules, the effect of adding a candidate agent to cells in culture is tested with a panel of cells and cellular environments, where the cellular environment includes one or more of: electrical stimulation Including alterations in ionicity, drug stimulation, and the like, and where panels of ceils may vary in genotype, in prior exposure to an environment of interest, in the dose of agent that is provided, etc., where usually at least one control is included, for example a negative control and a positive control. Culture of cells is typically performed in a sterile environment, for example, at 37°C in an incubator containing a humidified 92-95% air/5-8% CO2 atmosphere. Cell culture may be carried out in nutrient mixtures containing undefined biological fluids such as fetal calf serum, or media which is fully defined and serum free. The effect of the altering of the environment is assessed by monitoring multiple output parameters, including morphogical, functional and genetic changes.

[0083] In the screening assays for genetic agents, polynucleotides are added to one or more of the cells in a panel in order to alter the genetic composition of the cell. The output parameters are monitored to determine whether there is a change in phenotype. In this way, genetic sequences are identified that encode or affect expression of proteins in pathways of interest. The results can be entered into a data processor to provide a screening results dataset. Algorithms are used for the comparison and analysis of screening results obtained under different conditions.

[0084] Parameters are quantifiable components of cells, particularly components that can be accurately measured, desirably in a high throughput system. A parameter can also be any ceil component or cell product including cell surface determinant, receptor, protein or conformationai or posttransiationai modification thereof, lipid, carbohydrate, organic or inorganic molecule, nucleic acid, e.g. mRNA, DNA, etc. or a portion derived from such a ceil component or combinations thereof. While most parameters will provide a quantitative readout, in some instances a semi-quantitative or qualitative result will be acceptable. Readouts may include a single determined value, or may include mean, median value or the variance, etc. Variability is expected and a range of values for each of the set of test parameters will be obtained using standard statistical methods with a common statistical method used to provide single values.

[0085] Parameters of interest include detection of cytoplasmic, cell surface or secreted biomolecules, frequently biopolymers, e.g. polypeptides, polysaccharides, polynucleotides, lipids, etc. Cell surface and secreted molecules are a preferred parameter type as these mediate cell communication and ceil effector responses and can be more readily assayed. In one embodiment, parameters include specific epitopes. Epitopes are frequently identified using specific monoclonal antibodies or receptor probes in some cases the molecular entities comprising the epitope are from two or more substances and comprise a defined structure; examples include eombinatoriaily determined epitopes associated with heterodimeric integrins. A parameter may be detection of a specifically modified protein or oligosaccharide. A parameter may be defined by a specific monoclonal antibody or a ligand or receptor binding determinant.

[0086] Candidate agents of interest are biologically active agents that encompass numerous chemical classes, primarily organic molecules, which may include organo etal!ic molecules, inorganic molecules, genetic sequences, etc. An important aspect of the invention is to evaluate candidate drugs, select therapeutic antibodies and protein-based therapeutics, with preferred biological response functions. Candidate agents comprise functional groups necessary for structural interaction with proteins, particularly hydrogen bonding, and typically include at least an amine, carbonyl, hydroxyl or carboxyl group, frequently at least two of the functional chemical groups. The candidate agents often comprise cyclical carbon or heterocyclic structures and/or aromatic or polyaromatic structures substituted with one or more of the above functional groups. Candidate agents are also found among biomolecuies, including peptides, polynucleotides, saccharides, fatty acids, steroids, purines, pyrimidines, derivatives, structural analogs or combinations thereof.

[0087] included are pharmacologically active drugs, genetically active molecules, etc.

Compounds of interest Include chemotherapeutic agents, anti-inflammatory agents, hormones or hormone antagonists, ion channel modifiers, and neuroactive agents. Exemplary of pharmaceutical agents suitable for this invention are those described in,“The Pharmacological Basis of Therapeutics,” Goodman and Gilman, McGraw-Hill, New York, New York, (1996), Ninth edition, under the sections: Drugs Acting at Synaptic and Neuroeffector Junctional Sites; Cardiovascular Drugs; Vitamins, Dermatology; and Toxicology, ail incorporated herein by reference.

[0088] Test compounds include all of the classes of molecules described above, and may further comprise samples of unknown content. Of interest are complex mixtures of naturally occurring compounds derived from natural sources such as plants. While many samples will comprise compounds in solution, solid samples that can be dissolved in a suitable solvent may also be assayed. Samples of interest include environmental samples, e.g. ground water, sea water, mining waste, etc.; biological samples, e.g. lysates prepared from crops, tissue samples, etc.; manufacturing samples, e.g. time course during preparation of pharmaceuticals; as well as libraries of compounds prepared for analysis; and the like. Samples of interest include compounds being assessed for potential therapeutic value, i.e. drug candidates.

[0089] The term samples also includes the fluids described above to which additional components have been added, for example components that affect the ionic strength, pH, total protein concentration, etc. In addition, the samples may be treated to achieve at least partial fractionation or concentration. Biological samples may be stored if care is taken to reduce degradation of the compound, e.g under nitrogen, frozen, or a combination thereof. The volume of sample used is sufficient to allow for measurable detection, usually from about 0.1 :l to 1 ml of a biological sample is sufficient.

[0090] Compounds, including candidate agents, are obtained from a wide variety of sources including libraries of synthetic or natural compounds. For example, numerous means are available for random and directed synthesis of a wide variety of organic compounds, including biomolecules, including expression of randomized oligonucleotides and oligopeptides. Alternatively, libraries of natural compounds in the form of bacterial, fungal, plant and animal extracts are available or readily produced. Additionally, natural or synthetically produced libraries and compounds are readily modified through conventional chemical, physical and biochemical means, and may be used to produce combinatorial libraries. Known pharmacological agents may be sub]ected to directed or random chemical modifications, such as acylation, alkylation, esterification, amidification, etc. to produce structural analogs.

[0091] As used herein, the term“genetic agent” refers to polynucleotides and analogs thereof, which agents are tested in the screening assays of the invention by addition of the genetic agent to a ceil. The introduction of the genetic agent results in an alteration of the total genetic composition of the ceil. Genetic agents such as DNA can result in an experimentally introduced change in the genome of a cell, generally through the integration of the sequence into a chromosome. Genetic changes can also be transient, w here the exogenous sequence is not integrated but is maintained as an episomal agents. Genetic agents, such as antisense oligonucleotides, can also affect the expression of proteins without changing the cell’s genotype, by interfering with the transcription or translation of mRNA. The effect of a genetic agent is to increase or decrease expression of one or more gene products in the cell.

[0092] Introduction of an expression vector encoding a polypeptide can be used to express the encoded product in cells lacking the sequence, or to over-express the product. Various promoters can be used that are constitutive or subject to external regulation, where in the latter situation, one can turn on or off the transcription of a gene. These coding sequences may include full-length cDNA or genomic clones, fragments derived therefrom, or chimeras that combine a naturally occurring sequence with functional or structural domains of other coding sequences. Alternatively, the introduced sequence may encode an anti-sense sequence; be an anti-sense oligonucleotide; RNAi, encode a dominant negative mutation, or dominant or constitutive!y active mutations of native sequences; altered regulatory sequences, etc.

[0093] Antisense and RNAi oligonucleotides can be chemically synthesized by methods known in the art. Preferred oligonucleotides are chemically modified from the native phosphodiester structure, in order to increase their intracellular stability and binding affinity. A number of such modifications have been described in the literature, which alter the chemistry of the backbone, sugars or heterocyclic bases. Among useful changes in the backbone chemistry are phosphorothloates; phosphorodithioates, where both of the non-bridging oxygens are substituted with sulfur; phospboroamidites; alkyl phospbotriesiers and boranopbosphates. Achiral phosphate derivatives include 3’-0’-5’-S-phosphorothioate, 3’-S-5’-0-phosphorothioate, 3’-CH2-5’-0-phosphonate and 3’-NH-5’-0-phosphoroamidaie. Peptide nucleic acids replace the entire ribose phosphodiester backbone with a peptide linkage. Sugar modifications are also used to enhance stability and affinity, e.g. morpholino oligonucleotide analogs. The E]-anomer of deoxyribose may be used, where the base is inverted with respect to the natural G-anomer. The 2’-OH of the ribose sugar may be altered to form 2’-0-methyl or 2’-0-aiiyi sugars, which provides resistance to degradation without comprising affinity.

[0094] Agents are screened for biological activity by adding the agent to at least one and usually a plurality of cells, in one or in a plurality of environmental conditions, e.g. following stimulation with a b-adrenergic agonist, following electric or mechanical stimulation, etc. The change in parameter readout in response to the agent is measured, desirably normalized, and the resulting screening results may then be evaluated by comparison to reference screening results, e.g. with cells having other mutations of interest, normal cardiac fibroblasts, cardiac fibroblasts derived from other family members, and the like. The reference screening results may include readouts in the presence and absence of different environmental changes, screening results obtained with other agents, which may or may not include known drugs, etc.

[0095] The agents are conveniently added in solution, or readily soluble form, to the medium of cells in culture. The agents may be added in a flow-through system, as a stream, intermittent or continuous, or alternatively, adding a bolus of the compound, singly or incrementally, to an otherwise static solution. In a flow-through system, two fluids are used, where one is a physiologically neutral solution, and the other is the same solution with the test compound added. The first fluid is passed over the ceils, followed by the second. In a single solution method, a bolus of the test compound is added to the volume of medium surrounding the cells. The overall concentrations of the components of the culture medium should not change significantly with the addition of the bolus, or between the two solutions in a flow through method. [0096] Preferred agent formulations do not include additional components, such as preservatives, that may have a significant effect on the overall formulation. Thus preferred formulations consist essentially of a biologically active compound and a physiologically acceptable carrier, e g. water, ethanol, DMSO, etc. However, if a compound is liquid without a solvent, the formulation may consist essentially of the compound itself

[0097] A plurality of assays may be run in parallel with different agent concentrations to obtain a differential response to the various concentrations. As known in the art, determining the effective concentration of an agent typically uses a range of concentrations resulting from 1 : 10, or other log scale, dilutions. The concentrations may be further refined with a second series of dilutions, if necessary. Typically, one of these concentrations serves as a negative control, i.e. at zero concentration or below the level of detection of the agent or at or below the concentration of agent that does not give a detectable change in the phenotype.

[0098] Various methods can be utilized for quantifying the presence of selected parameters, in addition to the functional parameters described above. For measuring the amount of a molecule that is present, a convenient method is to label a molecule with a detectable moiety, which may be fluorescent, luminescent, radioactive, enzymatically active, etc., particularly a molecule specific for binding to the parameter with high affinity Fluorescent moieties are readily available for labeling virtually any biomolecule, structure, or cell type. Immunofluorescent moieties can be directed to bind not only to specific proteins but also specific conformations, cleavage products, or site modifications like phosphorylation. Individual peptides and proteins can be engineered to autofiuoresce, e.g. by expressing them as green fluorescent protein chimeras inside cells (for a review see Jones et a!. (1999) Trends Biotechno!. 17(12):477-81) Thus, antibodies can be genetically modified to provide a fluorescent dye as part of their structure [0099] Depending upon the label chosen, parameters may be measured using other than fluorescent labels, using such immunoassay techniques as radioimmunoassay (RIA) or enzyme linked immunosorbance assay (ELISA), homogeneous enzyme immunoassays, and related non-enzymatic techniques. These techniques utilize specific antibodies as reporter molecules, which are particularly useful due to their high degree of specificity for attaching to a single molecular target. U.S. Pat No. 4,568,649 describes ligand detection systems, which employ scintillation counting. These techniques are particularly useful for protein or modified protein parameters or epitopes, or carbohydrate determinants. Cell readouts for proteins and other ceil determinants can be obtained using fluorescent or otherwise tagged reporter molecules. Cell based ELISA or related non-enzymatic or fluorescence-based methods enable measurement of cell surface parameters and secreted parameters. Capture ELISA and related non-enzymatic methods usually employ two specific antibodies or reporter molecules and are useful for measuring parameters in solution. Flow cytometry methods are useful for measuring cell surface and intracellular parameters, as well as shape change and granularity and for analyses of beads used as antibody- or probe-linked reagents. Readouts from such assays may be the mean fluorescence associated with individual fluorescent antibody-detected cell surface molecules or cytokines, or the average fluorescence intensity, the median fluorescence intensity, the variance in fluorescence intensity, or some relationship among these.

[00100] Both single cell multiparameter and multicell multiparameter multiplex assays, where input cell types are identified and parameters are read by quantitative imaging and fluorescence and confocal microscopy are used in the art, see Confocal Microscopy Methods and Protocols (Methods in Molecular Biology Vol. 122.) Paddock, Ed., Humana Press, 1998. These methods are described in U.S. Patent no. 5,989,833 issued Nov. 23, 1999.

[00101] The quantitation of nucleic acids, especially messenger RNAs, is also of interest as a parameter. These can be measured by hybridization techniques that depend on the sequence of nucleic acid nucleotides. Techniques include polymerase chain reaction methods as well as gene array techniques. See Current Protocols in Molecular Biology, Ausubel et a!., eds, John Wiley & Sons, New York, NY, 2000; Freeman et al. (1999) Biotechniques 26(1):1 12-225; Kawamoto et al. (1999) Genome Res 9(12): 1305-12; and Chen et al. (1998) Genomics 51 (3):313-24, for examples.

[00102] The comparison of a screening results obtained from a test compound, and a reference screening resuits(s) is accomplished by the use of suitable deduction protocols, Al systems, statistical comparisons, etc. Preferably, the screening results is compared with a database of reference screening results. A database of reference screening results can be compiled. These databases may include reference results from panels that include known agents or combinations of agents, as well as references from the analysis of cells treated under environmental conditions in which single or multiple environmental conditions or parameters are removed or specifically altered. Reference results may also be generated from panels containing ceils with genetic constructs that selectively target or modulate specific cellular pathways.

[00103] The readout may be a mean, average, median or the variance or other statistically or mathematically derived value associated with the measurement. The parameter readout information may be further refined by direct comparison with the corresponding reference readout. The absolute values obtained for each parameter under identical conditions will display a variability that is inherent in live biological systems and also reflects individual cellular variability as well as the variability inherent between individuals.

[00104] For convenience, the systems of the subject invention may be provided in kits. The kits could include the cells to be used, which may be frozen, refrigerated or treated in some other manner to maintain viability, reagents for measuring the parameters, and software for preparing ihe screening results. The software will receive the results and perform analysis and can include reference data. The software can also normalize the results with the results from a control culture. The composition may optionally be packaged in a suitable container with written instructions for a desired purpose, such as screening methods, and the like.

[00105] For further elaboration of general techniques useful in the practice of this invention, the practitioner can refer to standard textbooks and reviews in cell biology, tissue culture, embryology, and cardiophysio!ogy. With respect to tissue culture and embryonic stem cells, the reader may wish to refer to Teratocarcinomas and embryonic stem cells: A practical approach (E. J. Robertson, ed., IRL Press Lid. 1987); Guide to Techniques in Mouse Development (P. M. Wasserman et a!. eds , Academic Press 1993); Embryonic Stem Cell Differentiation in Vitro (M. V. Wiles, Meth. Enzymol. 225:900, 1993); Properties and uses of Embryonic Stem Ceils: Prospects for Application to Human Biology and Gene Therapy (P. D. Rathjen et ai., Reprod. Ferti!. Dev. 10:31 , 1998). With respect to the culture of heart cells, standard references include The Heart Cell in Culture (A. Pinson ed., CRC Press 1987), Isolated Adult Cardiomyoeytes (Vo!s. I & l!, Piper & Isenberg eds, CRC Press 1989), Heart Development (Harvey & Rosenthal, Academic Press 1998).

[00106] General methods in molecular and cellular biochemistry can be found in such standard textbooks as Molecular Cloning: A Laboratory Manual, 3rd Ed. (Sambrook et a!., Harbor Laboratory Press 2001); Short Protocols in Molecular Biology, 4th Ed. (Ausubel et al. eds., John Wiley & Sons 1999); Protein Methods (Bollag et al., John Wiley & Sons 1996); Nonvirai Vectors for Gene Therapy (Wagner et al. eds., Academic Press 1999); Viral Vectors (Kapiift & Loewy eds., Academic Press 1995); Immunology Methods Manual (I. Lefkovits ed., Academic Press 1997); and Cell and Tissue Culture: Laboratory Procedures in Biotechnology (Doyle & Griffiths, John Wiley & Sons 1998). Reagents, cloning vectors, and kits for genetic manipulation referred to in this disclosure are available from commercial vendors such as BioRad, Stratagene, Invitrogen, Sigma-Aldrich, and ClonTech.

[00107] Each publication cited in this specification is hereby incorporated by reference in its entirety for all purposes.

[00108] it is to be understood that this invention is not limited to the particular methodology, protocols, cell lines, animal species or genera, and reagents described, as such may vary it is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to limit the scope of the present invention, which will be limited only by the appended claims.

[00109] As used herein the singular forms "a", "and", and "the" include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to "a cel!" includes a plurality of such cells and reference to "the culture" includes reference to one or more cultures and equivalents thereof known to those skilled in the art, and so forth. Ail technical and scientific ierms used herein have the same meaning as commoniy understood to one of ordinary skill in the art to which this invention belongs unless clearly indicated otherwise.

[001 10] The following examples are put forth so as to provide those of ordinary skill in the art with a complete disclosure and description of how to make and use the present invention, and are not intended to limit the scope of what the inventors regard as their invention nor are they intended to represent that the experiments below are all or the only experiments performed. Efforts have been made to ensure accuracy with respect to numbers used (e.g. amounts, temperature, etc.) but some experimental errors and deviations should be accounted for. Unless indicated otherwise, parts are parts by weight, molecular weight is weight average molecular weight, temperature is in degrees Centigrade, and pressure is at or near atmospheric.

EXAMPLES

Example 1

Generation of Quiescent Cardiac Fibrobiasts from Human induced Piuripotent Stem Ceils for in vitro Modeling of Cardiac Fibrosis

[001 1 1] Activated fibrobiasts are the major cell type that secrete excessive extracellular matrix in response to injury, contributing to pathological fibrosis and leading to organ failure. Effective anti-fibrotic therapeutic solutions, however, are not available due to the poorly defined characteristics and unavailability of tissue-specific fibroblasts. Recent advances in single-cell RNA-sequeneing (scRNA-seq) fill such gaps of knowledge by enabling delineation of the developmental trajectories and identification of regulatory pathways of tissue-specific fibroblasts among different organs. By analyzing the single-cell transeripiome profiles of fibroblasts from selected mouse tissues, we identified distinct tissue-specific signature genes, including transcription factors that define the identities of fibroblasts in the heart, lungs, trachea, and bladder. We also determined that CFs in large are of the epicardia! lineage. We thus developed a robust chemically-defined protocol that generates CFs from human iPSCs. Functional studies confirmed that iPSC-derived CFs preserved a quiescent phenotype and highly resembled primary CFs at the transcriptional, cellular, and functional levels. We demonstrated that this cell- based platform is sensitive to both pro- and anti-fibrosis drugs. Finally, we showed that crosstalk between cardio myocytes and CFs via the atrial/brain natriuretic peptide-natriuretic peptide receptor pathway is implicated in suppressing fibrogenesis.

[001 12] This study uncovers unique gene signatures that define tissue-specific identities of fibroblasts. The bona fide quiescent CFs derived from human iPSCs can serve as a faithful in vitro platform to better understand the underlying mechanisms of cardiac fibrosis and to screen antifibrotic drugs.

Abbreviations and Acronyms ANP atrial natriuretic peptide

BNP brain natriuretic peptide

CF cardiac fibroblast

CM cardiomyocyte

CPC cardiac progenitor cell

ECM extracellular matrix

EPC epicardia! cell

FGF2 fibroblast growth factor 2

GO gene ontology

iPSC induced pluripotent stem celi

NPPA/NPPB natriuretic peptide type A/B

NPR1 natriuretic peptide receptor 1

a-SMA a-smootb muscle actin

SB SB431542

scRNA-seq single-cell RNA-sequencing

TF transcription factors

TGF-b transforming growth factor-b

t-SNE t-distributed stochastic neighbor embedding

[001 13] By analyzing the recently reported Tabula Muris, a mouse atlas of single-cell iranscripiome from >100,000 cells across 20 tissues, we report here that fibroblasts carry tissue-specific transeriptomie signatures that are conserved in humans. We found that CFs in large are of the epicardial lineage based on specifically expressed epicardia! transcription factors (TFs) in these cells. We used these insights to develop a robust protocol for generating human iPSC-GFs that closely resemble quiescent human primary CFs at the transcriptional, cellular, and functional levels. We further showed that human iPSC-CFs can serve as a powerful In vitro platform to better understand the mechanisms of cardiac fibrosis and to screen anti- and pro-fibrotic drugs.

[001 14] Collectively, our study used comprehensive scRNA-seq data to define tissue-specific genes and pathways in fibroblasts. Importantly, the human IPSC-based induction protocol we developed can be adapted to generate patient-specific CFs, which may pave the way to reveal the complexity of cardiac fibrosis and thereby offer a new direction for precision medicine.

RESULTS

[001 15] Mouse Singie-Ceil Transcriptome Reveals Tissue-Specific Gene Markers for Fibrobiasts are Conserved in Humans. Because specific genes that can distinguish fibroblasts from other cell types are not yet available, we first subtracted the transcriptome profiles of fibroblast- containing ceil clusters in 10 selected tissues from the Tabula Muris database (Online Figure I A).5 We then mapped these fibroblast containing cell clusters on a t-disiribuied stochastic neighbor embedding (t-SNE) plot, and refined the fibroblast population in each tissue by selecting cells that are positive for genes (Co!1 a2, Ddr2, Den, Timp2, and Pdgfra) highly expressed in fibroblasts, and by excluding those expressing any of the gene markers for endothelial ceils (Pecaml and Cdh5), smooth muscle cells (Tagln and Cnn1), or immune ce!is (Ptprc) (Figure 8D)

[001 16] Ultimately, vve identified a total of 4,685 out of 44,949 cells as fibroblasts in the Tabula Muris dataset, and mapped them on a new t-SNE plot (Figure 1A). As expected, these cells express common fibroblast marker genes (Figures 1 B and Figure 9) Moreover, gene ontology (GO) enrichment analysis revealed that these genes are enriched in fibroblast-related signaling pathways, such as proteinaceous extracellular matrix, extracellular structure organization, and platelet derived growth factor binding (Figure 1 C).

[001 17] Next, we examined which factors are responsible for separating fibroblasts into different dusters (Figure 1 A). After pooling fibroblasts from each mouse and mapping them on a new t- SNE plot, we did not observe any donor effects that contributed to the specificity of fibroblast clustering in different tissues (Figure 10A). However, fibroblasts in the heart and fat tissues were separated by sex (Figure 10B). Further analysis revealed that the sex-polarized gene expression patterns (Figure 1 1A and 1 1 B) might be associated with higher expression levels of sex hormonal receptors in the heart and fat tissues compared to other organs (Figure 1 1 C).

[001 18] We then compared the transcriptome profiles between tissue-specific fibroblasts, and observed that fibroblasts derived from the heart, lungs, bladder, and trachea demonstrated distinct gene signatures (Figure 12). Moreover, we observed that fibroblasts in these four organs also exhibit a tissue-specific distribution pattern of TFs (Figure 1 D). TFs have been suggested to play a critical role in defining cel! identities.6, 7 Tbx2Q, Gata4, and Hand2 are specifically enriched in CFs, whereas Tbx2, Tbx4, and Hoxa5 are highly expressed in lung fibroblasts. Fibroblasts from the aorta, diaphragm, fat, mammary gland, and limb uscle did not show an apparent tissue-specific pattern for TFs (Figure 1 D). Intriguingly, human primary fibroblasts isolated from the heart, lungs, and bladder also specifically expressed GATA4/TBX2Q, HOXA5/TBX4, and HOXA1 1/ISL1 , respectively (Figure 1 E). Together, the single-cell transcriptome suggests that the identities of fibroblasts in different mouse tissues are distinguished and probably determined by a handful of conserved tissue-specific signature genes.

[001 19] Generation of Quiescent Human iPSC-CFs. By performing the GO pathway enrichment analysis on TFs, we observed that some of these genes are enriched in a tissue-specific development pathway (Figure 2A). For example, we identified that Gata4, Gata6, Tbx20, Heyl, Hand2, Mef2c, and Tcf21 are enriched in the cardiac development pathway (Figure 2A). Because GATA4 and TBX20 are highly expressed in cardiac mesoderm and TCF21 is a marker for epicardium, we hypothesized that CFs could be generated from human IPSCs based on this developmental program. Accordingly, we modified an established protocol designed to generate human IPSC-derived epicardial ceils (EPCs) by continuing to differentiate the intermediate cells in a commercial fibroblast growth medium in the presence of fibroblast growth factor (FGF2) and transforming growth factor beta (TGF-b) inhibitor SB431542 (SB) (Figure 2B). After six days of extended culture (i.e., day 18 of differentiation), the cells showed a typical fibroblast morphology (Figure 2C), and expressed markers (GATA4 and DDR2) that are highly expressed in primary CFs (Figure 2D). Notably, flow cytometry analysis revealed that >90% of the ceils were positive for COL-i, DDR2, and TCF21 compared with undifferentiated iPSCs (Figure 2E)

[00120] We then examined the dynamic changes of the transcriptional profiles of cardiac and fibroblast-specific genes at various stages of differentiation. We observed that GATA4 and TBX20, two early cardiac-specific developmental marker genes, showed relative higher expression levels in iPSC-derived cardiac progenitor ceils (CPCs) than in IPSC-EPCs and IPSC-CFs (Figure 2F). By contrast, NKX2-5 and TBX5 were only transiently expressed in IPSC- CPCs. Epicardial markers WT1 and TBX18 became highly expressed in IPSC-EPCs but decreased in iPSC-CFs (Figure 2G). It has been reported that TCF21 -expressing EPCs are initially muitipotent, and eventually become committed to the fibroblast lineage with the upregulation of TCF21.12 Consistently, TCF21 was found to be substantially increased in iPSC- EPCs and became more highly expressed in IPSC-CFs (Figure 2G). As expected, the expression levels of typical fibroblast markers (GOL1A1 , DDR2, POSTN, and VIM) were gradually increased during differentiation (Figure 2H), whereas lung specific development- related genes such as TBX4 and HOXA5 were not detectable at any stage of differentiation (Figure 2I). Taken together, we confirm that iPSC-CFs obtained through the differentiation protocol used in this study express both cardiac and fibroblast-specific markers.

[00121] Human iPSC-CFs Preserve Their Cell identity Profile During Passaging. In order to verify whether iPSC-CFs are bona fide cardiac fibroblasts, we next compared their transcriptomes and proteomes with primary cultures. Intriguingly, human iPSC-CFs expressed similar protein levels of typical fibroblast markers (COL-l, DDR2, VIM, and POSTN) and cardiac markers (GATA4, TBX20, and TCF21) as primary fibroblasts (Figure 3A and 3B). We also found that the human iPSC-CFs couid be expanded for at least five passages without losing their cardiac fibroblast identity (Figure 3C) As expected, the expression levels of TBX18 were persistently much lower in iPSC-CFs during serial passaging than in iPSC-EPCs (Figure 2G and 3D). While WT1 is hardly detectable in adult primary CFs, it decreased dramatically to less than 10% in human iPSC-CFs at passage 5 (Figure 3D, 3E, and Figure 13). Taken together, these data indicate that iPSC-CFs show a high similarity to primary CFs in terms of ceil identity profiles. [00122] Because cardiac smooth muscle cells and pericytes are also derived from the epicardial lineage we blocked these potential differentiation trajectories by adding SB431542 (SB), a TGF- b inhibitor, during CF differentiation (Figure 2B). As a result, human iPSC-CFs expressed negligible levels of smooth muscle marker genes (ACTA2, CNN1 , TAGLN, SMTN, and MYH1 1) at both transcriptional and protein levels (Figure 3F and 3G). We also observed that human iPSC CFs expressed higher levels of myogenic repressor genes ELK1 and KLF415, 16 than derived smooth muscle cells of the epicardial lineage (Figure 14) Moreover, human iPSC-CFs expressed significantly lower levels of pericyte markers (PDGFRB, CSPG4, and MCAM) compared to primary pericytes (Figure 3H). Therefore, the human iPSC-CFs generated in this study are highly pure cultures and can preserve cardiac fibroblast identity during serial passaging.

[00123] Human iPSC-CFs Closely Resemble Primary CFs. Next, we conducted a series of functional studies comparing human primary and iPSC-CFs Under pathological conditions, upreguiated TGF-b is one of the potent effectors that can stimulate fibrobiast-to-myofibrobiast transdifferentiation and thereby contribute to tissue fibrosis interestingly, we observed that the expression levels of cardiac-specific genes (GATA4, TBX20, and TCF21) were significantly downregulated in TGF-p-treaied primary CFs as compared with vehicle-treated cells (Figure 4A). A similar phenotype was also observed in human IPSC-CFs after TGF-b treatment (Figure 4B). Because a previous study reported that fibroblast-restricted depletion of Tbx20 is associated with thicker scar tissues in infarcted mouse hearts, the downregu!ation of these cardiac-specific TFs may be involved in promoting CF transdifferentiation and cardiac fibrosis. However, the precise role of cardiac-specific TFs in cardiac fibrosis warrants further investigation.

[00124] Aberrant collagen synthesis contributes to tissue fibrosis. Using a Sirius red-based colorimetric assay kit, we observed that human iPSC-CFs and primary CFs secreted comparable basal levels of collagen into culture media, which were not detectable in human iPSCs (Figure 4C). A similar rise in collagen content was detected in both groups of CFs upon TGF-b treatment (Figure 4C). Increased contractile activity is also a specific measure of fibroblast transdifferentiation. We seeded human iPSC-CFs on collagen membranes, and observed a stronger collagen gel contraction effect in the TGF-b treated group than the vehicle group, whereas this effect was completely abrogated by SB (Figure 4D). Human iPSC-CFs and primary CFs responded similarly to platelet derived growth factor~BB~induced cell migration (Figure 4E). It has been shown that cardiac myofibroblasts could lead to myosin heavy chain 7 re-expression during cardiac fibrosis in vivo.

[00125] Interestingly, this phenotype was successfully recapitulated by co-culturing human iPSC-derived cardiomyocytes (IPSC-CMs) with IPSC-CFs in the presence of TGF-b (Figure VIII). Taken together, these functional studies confirm that the human iPSC-CFs generated in ihis study are bona fide cardiac fibroblasts, which resemble the biological and physiological properties of their primary counterparts.

[00126] Quiescent Human iPSC-CFs Provide an in vitro Piatform to Mode / Fibrosis. Previous studies have shown that primary fibroblasts can undergo spontaneous transdifferentiation into myofibroblasts during in vitro culturing. We hypothesized that inhibiting the TGF-b pathway during IPSC-CF differentiation may preserve their quiescent phenotype and suppress transdifferentiation. Using the a-smootb muscle aetin (a-SMA) level as an indicator for the extent of fibroblast activation, we observed that the generated human iPSC-CFs were quiescent cells when the TGF-b pathway was inhibited (Figure 5A and 5B). Notably, most of these cells remained quiescent after several passages, and only about 5% of iPSC-CFs at passage 5 were positive for a-SMA (Figure 5A and 5B). Therefore, we used iPSC-CFs between passages 1-4 as a reliable ceil model for the subsequent fibrosis studies in vitro.

[00127] We first confirmed that the expression levels of ACTA2 and POSTN were significantly increased in human iPSC-CFs upon TGF-b treatment as compared with the vehicle treatment (Figure 5G) As expected, the addition of SB effectively inhibited the upregulation of these two myofibroblast markers (Figure 5C). The a-SMA protein levels were also significantly increased in CFs derived from different human iPSC lines after TGF-b treatment, which were abolished by SB (Figure 5D). Because the transdifferentiation from fibroblasts to myofibroblasts is strongly associated with the dynamic changes of ECM genes, we next performed a comprehensive ECM iranseripiomic analysis on human iPSC-CFs after treatment with vehicle or TGF-b We observed that the expression levels of ECM genes such as CQL1A1 , COL3A1 , GOL4A2, and FN1 were significantly increased by TGF-b (Figure 5E) Similarly, several proteoglycans (VCAN, CTGF, KAL1 , TNG, and SPARC) and cell-matrix focal adhesion molecules (ITGA4, ITGA5, and ITGB5) also showed upreguiaied expression in the presence of TGF-b (Figure 5F and 5G). Matrix etailoproteinases (MMPs) and their endogenous inhibitors (T!MPs) regulate the dynamic turnover of ECM.21 We observed an upregulation of TIMP1 , TIMP2, and TIMP3 concurrently with downregulation of MMP1 by TGF-b (Figure 5H). Because MMP2 has been shown to be involved in activating TIMP2,22 it is not surprising that we observed an upregulation of MMP2 in iPSC-CFs after TGF-b treatment (Figure 5H).

[00128] Next, we tested if the FDA-approved anti-idiopathic lung fibrosis drug pirfenidone could suppress TGF-p-induced transdifferentiation of human iPSC-CFs. Pirfenidone showed a dose dependent inhibitory effect on TGF^-induced upregulation of a-SMA (Figure 5i). Doxorubicin, a widely used chemotherapy drug, has been shown to cause several cardiac side effects, including cardiac fibrosis. Using human iPSC-CFs, we recapitulated doxorubicin-induced profibrosis phenotype in vitro, which also showed a dose-dependent pattern (Figure 5J). Together, these results show that the human IPSC-GFs generated in this study preserve a quiescent phenotype after differentiation and during early passages, making them sensitive to pro- fibrogenic stimuli. Therefore, these cells can serve as a faithful in vitro platform to screen drugs that can promote or suppress fibrosis.

[00129] Crosstalk Between Human iPSC-CMs and iPSC-CFs Through the ANP/BNP-NPR1 Signaling Pathway Represents a Novel Strategy for Anti-Fihrotic Therapy. Cardiac fibroblasts are a key component of the heart that play a critical role in cardiac remodeling through dynamic cell-cell interactions. By carrying out complementary receptor-ligand interaction analysis (Figure 6A), we observed that CFs are capable of interacting with a broad spectrum of cell types such as CMs, endothelial ceils, smooth muscle cells, and immune ceils through different signaling pathways. For example, we identified a novel interaction between ANP/BNP, the commonly used hypertrophic markers in CMs, and their cognate receptor NPR1 in CFs. We further verified that natriuretic peptide type A/B (NPPA/NPPB) and NPR1 are expressed in human iPSC-CMs and iPSC-CFs, respectively (Figure 8B).

[00130] To understand whether the interaction through the ANP/BNP-NPR1 plays a role in cardiac fibrosis, we treated human iPSC-CFs with BNP in the presence of TGF-b. interestingly, CFs expressed significantly lower mRNA levels of myofibroblast markers and ECM genes (ACTA2, POSTN, COL1A1 , and COL3A1), and higher levels of CF markers (PDGFRA and TCF21) with BNP treatment (Figure 6C). a-SMA protein levels were also significantly suppressed with escalating concentrations of BNP in a dose-dependent manner (Figure 6D). We then co-cuitured human IPSC-CFs with iPSC-CMs in the presence of TGF-b, and observed a similar expression pattern of these genes in co-culture as was seen with BNP treatment (Figure 6E). The protein levels of myofibroblast markers and ECM proteins (a-SMA, collagen III, and fibronectin) in human iPSC-CFs were also significantly lower in the eo-cu!tured than non-co-cultured condition (Figure 6F).

[00131] ANP and BNP are known to be upreguiated in cardiac hypertrophy and fibrosis.

However, evidence shows that ANP and BNP have relatively short half-lives (3 minutes and 20 minutes, respectively) due to the ubiquitous presence of their degrading enzyme, nepriiysin, in the circulatory system. As such, ANP/BNP may not be able to exert a long-lasting anti-fibrotic effect through the interaction with their receptor NPR1 expressed on CFs. Sacubitril, a nepriiysin inhibitor, has been shown to ameliorate heart failure when used together with va!sartan. Therefore, we further examined whether the addition of sacubitril to the co-culture system would further suppress CF transdifferentiation. Indeed, we observed that sacubitril further decreased the mRNA and protein levels of myofibroblast markers and ECM genes in the co-cuitured condition (Figure 6E and 6F). In particular, the myofibroblast marker periostin was significantly decreased only when sacubitril was added to the co-culture system. Together, these data show that targeting the ANP/BNP-NPR1 signaling pathway can be a strategy for anti-cardiac fibrosis therapy (Figure 8G). [00132] It is increasingly recognized that fibroblasts in different tissues are heterogeneous as evident by their distinct gene expression patterns. However, the inability to characterize the full transcriptomic picture of fibroblasts in a tissue-specific manner has impeded the development of mechanism-oriented, organ-specific anti-fibrotic therapies in this study, by performing an in depth analysis of mouse single-cell transcriptomics data in combination with several assays, we identified a group of tissue-specific signature genes that are conserved in mouse and human primary fibroblasts. Alter identifying that CFs in large are of the epicardia! lineage, we successfully developed a robust protocol to generate quiescent bona fide CFs from human iPSCs that could recapitulate most of the fundamental biological features of primary CFs (Figure 7). We further demonstrated that human iPSC-CFs could be used as a faithful in vitro cell model to test drugs with pro- or anti-fibrosis potentials. Moreover, we identified that crosstalk between iPSC CMs and IPSC-CFs through the ANP/BNP-NPR1 pathway can represent a novel route for anticardiac fibrosis therapy. Our study also highlights the value of scRNA-seq in developing new candidate therapeutic strategies for treating tissue-specific fibrosis

[00133] Accumulating evidence from animal studies suggests that cel! lineage specification is governed by a handful of tissue-specific TFs. In this study, we observed that fibroblasts express high levels of tissue-specific, development-related TFs, raising the possibility that these genes may help define fibroblast tissue identity. Animal studies support this idea. Deficiency of Gata4 leads to failure to initiate proepicardium formation during cardiogenesis, and ablation of Tcf21 blocks the differentiation of CFs from proepicardia! ceils by suppressing epithelial-mesenchymal transition. In line with these in vivo findings, we observed a significant rise in GATA4 and TCF21 expression in human iPSC-CPCs and IPSC-EPCs, respectively. Collectively, these data show that a sequential expression of these lineage predominant TFs can play a critical role in defining the fate of CFs.

[00134] Driven by this hypothesis, we successfully differentiated human iPSCs into CFs by modifying a protocol initially developed to generate IPSC-EPCs. importantly, we demonstrated that our human IPSC-CFs can serve as a faithful in vitro cel! model to explore the underlying mechanisms of cardiac fibrosis and to screen anti-fibrotic drugs due to the following advantages. First, human iPSC-CFs highly resemble primary ceils at the genetic and functional levels, and preserve a quiescent phenotype until passage 4. Therefore, the derived cells are sensitive to pro-fibrotic stimuli. Indeed, using this powerful in vitro platform, we demonstrated that human iPSC-CFs are highly responsive to both anti- and pro-fibrotic drugs. Second, human iPSCs can be used as an unlimited cell source to generate a large quantity of CFs for mechanistic studies and high throughput anti-fibrotic drug discovery. Third, the induction protocol for human iPSC- CF developed in this study will allow for testing of sex- and patient-specific cellular responses to candidate anti-fibrotic drugs in vitro. [00135] A substantial body of evidence shows that crosstalk between fibroblasts and inflammatory cells regulates fibrosis in different injured tissues, such as the heart, lungs, and liver. Interestingly, using the complementary receptor-ligand analysis tool, intercellular communication networks generated using mouse scRNA-seq data suggest that fibroblasts reciprocally interact with a wide range of cell types other than inflammatory cells to regulate their cellular and biological functions. By coculturing human iPSC-CMs and iPSC-CFs, we identified that crosstalk between these two cell types through the ANP/BNP-NPR1 pathway may play a fundamental role in suppressing cardiac fibrosis. Importantly, we further showed that the anti-fibrotic effect seen in co-culture couid be significantiy enhanced by treating these ceils with sacubitril, a drug that inhibits the activity of ANP/BNP-degrading enzyme neprilysin. Sacubltril has been used in combination with an angiotensin II type 1 receptor biocker called vaisartan (a drug named LCZ696) to reduce the blood pressure and improve mortality in patients with heart failure. However, evidence shows that LCZ696 improved isoproterenol-induced cardiac fibrosis more significantly than vaisartan alone in rats, suggesting the anti-fibrotic effect of neprilysin inhibitor beyond its diuretic function. In agreement with the animal study, a recent large-scale prospective cohort study showed that compared with baseline, the administration of LCZ898 for eight months drasticaiiy attenuated profibrotic signaling in heart failure patients with reduced ejection fraction.

[00136] Collectively, these results show that modulating fibrosis-related intercellular signaling cascades such as the ANP/BNP-NPR1 signaling pathway provides a promising route for antifibrotic therapies in addition to suppressing fibroblast activation directly.

[00137] In conclusion, the heterogeneity of fibroblasts in different tissues is associated with the expression of tissue-specific signature genes during development. The induction protocol for bona fide quiescent human IPSC-CFs developed in this study allowed us to identify and validate signaling pathways that may be involved in cardiac fibrosis. This study also sheds light on the significance of using human iPSC-CFs as a robust cell platform to test the efficacy of candidate anti-fibrotic drugs in a patient-specific manner.

Methods

[00138] Human primary skin, cardiac, lung, bladder fibroblast, and brain pericyte cultures.

Human primary cardiac fibroblasts were isolated and cultured as follows: a piece of fresh right atrial biopsy was weighed, minced into small pieces (1-2 mm³), and digested in 6-well peri- dishes as described. Human primary cardiac fibroblasts were grown and maintained in a fibroblast growth medium (C-23025, Promoceil) supplemented with 1 % penicillin-streptomycin (15140-122, Gibco) in a humidified atmosphere (95% air, 5% C02) at 37 °C. The medium was renewed every 2-3 days. Ceils were passaged using standard trypsinization techniques at 80 90% confluency. The same protocol was also used to isolate and culture fibroblasts from human skin and lung tissues. Primary bladder fibroblasts were purchased from Lifeline (FC-QQ5Q) and maintained in the same fibroblast growth medium. Human brain pericytes were purchased from Ceil systems (ACBR! 498) and cultured in SmGM-2 medium (Lonza, CC-3182). Ail experiments were carried out using cells at low cell passages (<P4) and cells were serum-starved for 24 hrs before treatment.

[00139] Quantitative real-time PCR. Total RNA was isolated using the Qiagen miRNeasy Mini Kit (Qiagen Sciences, Inc, Germantown, MD) following the manufacturer’s instruction. For reverse transcription, a High Capacity RNA-to-cDNA kit (Life Technologies) was used, and the cDNA template was synthesized based on 1 pg of total mRNA. After mixing 0.2 mI of the cDNA template, 1 m! of TaqMan® primer sets (Life Technologies), 10 mI of TaqMan® Master Mix (Life Technologies), and 8.8 pi of ddH2G in the reacfion system, real-time quantitafive PCR was performed on the StepQne™ Real-Time PCR System (Life Technologies). Each reaction was run in triplicate. Expression values were normalized to the average expression of GAPDH.

[00140] Immunobiotting and quantification. Cultured ceils were homogenized in the RIPA buffer with proteinase and phosphatase inhibitor cocktails (78440, ThermoFisher), and quantified by Pierce™ BCA Protein Assay Kit (Pierce Biotechnology Inc.). A tofal of 20 pg protein was separated on NuPAGE® Novex® 4-12% Bis-Tris Protein Gels (invitrogen, Carlsbad, CA). After being transferred to Amersham™ Hybond™ Blotting Membranes (GE Healthcare), proteins were incubated with primary antibodies against a-SMA (ab7817, Abeam), periostin (ab14041 , Abeam), collagen ill (ab7778, Abeam), fibronectin (ab8328, Abeam), MYH7 (sc-53089, Santa Cruz), and GAPDH (MA5-15738, Invitrogen). Band intensities for target bands were analyzed and quantified by the imaged Fuji program.

[00141] Immunofluorescent staining. Cells were fixed using 4% paraformaldehyde for 15 min, permeabi!ized with 0.2% Triton X-100 in PBS (Sigma-Aldrich) for 10 min, and blocked with 3% bovine serum albumin (BSA). Cells were incubated overnight at 4 °C with primary antibody or isotype controls diluted in 3% BSA. Ceils were incubated with Alexa Fluor™ secondary antibodies (1 :500 dilution) at room temperature for 1 hr, and mounted with mounting medium with 4’,6-diamidino-2-phenyiindole (DAP!) (Vector Laboratories). Primary antibodies against NANGG2 (ab109250, Abeam), SSEA-4 (ab16287, Abeam), NKX2.5 (MAB2444, R&D), WT1 (ab899Q1 , Abeam), Z01 (40-2200, Invitrogen), GATA4 (sc-25310, Santa Cruz), DDR2 (sc~ 81707, Santa Cruz), COLI (ab9Q395, Abeam), VIM (V6630, Sigma-Aldrich), POSTN (ab14041 , Abeam), TBX20 (hpa008192, Sigma-Aldrich), TCF21 (hpa013189, Sigma-Aldrich), a-SMA (ab7817, Abeam), CNN1 (ab46794, Abeam), SMTN (ab204305, Abeam), and TAGLN (ab14106, Abeam) were used. Labeled ceils were imaged by a confocai microscope (Carl Zeiss, LSM 510 Meta, Gottingen, Germany).

[00142] Fiuorescence-acfivated cell sorting (FACS) analysis. Cells were dissociated into singlets by TrypLE™ (12805, Gibco,) for 10 min at 37 °C, and the cell suspension was filtered through a 40-pm cell strainer (BD Falcon, San Diego) to remove cell clumps. Single cells were fixed and permeabilized by BD Cytofix/Cytoperm™ buffer (BD 554722) for 20 min at 4 °C. Next, ceils were incubated with primary antibodies followed by Alexa Fluor™ secondary antibodies (invitrogen). Primary antibodies against COLI (ab90395, Abeam), DDR2 (sc-81707, Santa Cruz), TCF21 (hpa013189, Sigma-Aldrich), a-SMA (ab7817, Abeam), and WT1 (ab89901 , Abeam) were used. The percentage of fibroblasts was calculated as the ratio of TCF21 +, DDR2+, and COL- l+ cells in the whole population, respectively. The percentage of myofibroblasts was calculated as the ratio of a-SMA + cells in the whole population.

[00143] Differentiation of human induced piuhpotent stem ceii-derived cardiomyocytes. Ail of the protocols for this study were approved by the Stanford University Human Subjects Research Institutional Review Board (IRB). Human induced pluripotent stem cell-derived cardiomyocyte (iPSC-CM) differentiation protocol was used as previously described. Briefly, human iPSC lines were maintained on Matrigel-coated plates (CB-40234, BD Biosciences, San Jose, CA) in Essential 8™ Medium (A1517001 , Gibco®, Life Technologies). Human iPSCs were treated with 6 mM of CHIR99Q21 (S2924, Selieck chemicals) for 2 days, recovered in RPM! medium (1 1875- 1 19, Gibco®, Life Technologies) with B27 supplements minus insulin (A1895601 , Gibco®, Life Technologies) (RPMi+B27-insu!in) for 24 hrs, treated with 5 mM of IWR-1 (10161 , Sigma) for 2 days, and then placed in RPM!+B27-insu!in for another 2 days, and finally switched to RPMI medium with B27 supplements (17504044, Gibco®, Life Technoiogies). Beating cells were observed at days 9-1 1 after differentiation. Human IPSC-CMs were re-plated and purified with the glucose-free RPMI medium (1 1879020, Gibco®, Life Technologies) for 2-3 rounds. Typically, the purity of human IPSC-CMs (TNNT2+) is >90% after purification. Cultures were maintained in a humidified atmosphere (95% air, 5% C02) at 37 °C.

[00144] Differentiation of human iPSC-derived cardiac fibroblasts. Human IPSCs were treated with 6 pM of CHIR99021 for 2 days, recovered in RPM!+B27-insuiin for 24 hrs, treated with 5 mM of IWR-1 (10161 , Sigma) for 2 days, and then RPMi+B27-insulin for another 24 hrs. On day 6, human induced pluripotent stern cell-derived cardiac progenitor ceils (iPSC-CPCs) were replated at a density of 20,000 cel!s/cm2 in advanced DMEM medium (12634028, Gibco®, Life Technologies). On day 7 or 8, cells were treated with 5 pM of CHIR99021 and 2 pM of retinoic acid (R2625, Sigma-Aldrich) for 2 days, and recovered in advanced DMEM for 3 days. Typically, the purity of human induced pluripotent stem cell-derived epicardial cells (iPSC-EPCs) is > 90% (WT1 +). Human iPSC-EPCs were re-plated and treated with 10 pM of FGF2 (100-18B, PeproTech) and 10 pM of SB431542 (S1067, Selieck chemicals) in a fibroblast growth medium for another 6 days. >90% purity of IPSC-CFs (COL-I+/DDR2+/TCF21 +) can be achieved as assessed by FACS. Cultures were maintained in a humidified atmosphere (95% air, 5% C02) at 37 °C. [00145] Differentiation of human iPSC-derived cardiac smooth muscle ceils. Human iPSC-EPCs were plated in a chemically defined medium and treated with PDGF-BB (10 ng/ml, 100-14B, PeproTech) and TGPpi (2 ng/ml, 100-2, Peprotech) for 12 days.3 Over 90% purity of human induced pluripotent stem cell-derived smooth muscle cells (iPSC-SMCs) (SMTN+/TAGLN÷) can be achieved as assessed by immunofiuorescent staining. Cultures were maintained in a humidified atmosphere (95% air, 5% C02) at 37 °C.

[00146] Drug treatment. Unless otherwise stated, cells were treated with all drugs for 48 hrs. We used 5 ng/ml of TORb1 (240-B-010, R&D) to activate iPSC-CFs. Due to the short half-life, BNP (CYT-369, Prospec) was added into the medium three times a day. We used 20 mM of sacubitril (SML1380, Sigma) to inhibit ANP/BNP degradation. We used pirfenidone (S2907, Seileck Chemicals) and doxorubicin (25316-40-9, Seileck Chemicals) to test their anti-fibrotic and pro- fibrotic effects on iPSC-CFs, respectively.

[00147] Indirect and direct contact co-culture. Transweils (353102, Corning) containing fibroblasts were suspended over the iPSC-CMs in the plastic bottom dish, so that the base of the Transwell sat within the culture medium on the IPSC-CMs but did not touch the base of the dish. As a control, iPSC-CMs were co-cultured with IPSC-CMs in the transwells. The co-cultures were incubated at 37 °C and 5% C02 before analysis. For direct contact co-culture, we first labeled fibroblasts and iPSC-CMs with CFSE (C34554, Thermo Fischer) and Far cell trace red (C34564, Thermofisher) dyes, respectively. Then, iPSC-CFs were seeded on top of the IPSC- CM monolayer at a ratio of 1 :5, allowing for direct cell-cell contact. After 5 days of co-culture, the two cell types were separated by FACS sorting for downstream molecular analyses. The medium used for co-culture is the mixture of RPMI+B27 and fibroblast growth medium at a ratio of 3: 1.

[00148] Colorimetric assays. The cells were treated in the absence or presence of TGF-b for 48 hrs. Quantification of total secreted collagen in the ceil culture supernatant was performed using a Sirius red collagen detection kit (9062, Chondrex). The colorimetric assay was performed according to the manufacturers protocol.

[00149] Gel contraction assay. Collagen gel contraction assays were performed in three independent lines of iPSC-CFs (2.0 ^c 105 cells per well) using a Cell Contraction Assay kit (CBA5020, Cell Biolabs) as per the manufacturer’s protocol. The cells were treated in the absence or presence of TGF-b ± a TGF-b inhibitor SB431542 (SB). The gels were imaged after 24 hrs and gel area was quantified using imaged software (version 1.49)

[00150] In vitro wound-healing assay. The migration of human iPSC-CFs and primary CFs was determined using a Cytoselect™ 24-Well Wound Healing Assay Kit (CBA-120, Cell Bio!abs). Briefly, after confluent monolayers of CFs were formed, cells were synchronized in a low serum medium (0.5% FBS) for 24 hrs. After the wound-generating scaffold was removed from each well, cells were washed in PBS to remove residual ceils in the wounded area. Cells were treated with vehicle or PDGF-BB (25 ng/ml), and images were captured using a light microscope in identical areas at baseline, 12 hrs, and 24 hrs post -treatment. The cell-free areas at each time point were measured by Image-Pro Plus (version 6 0, Media Cybernetics). For quantification purposes, the wound area generated at 0 hr was set as SO, the uncovered areas captured at 12 hrs, and 24 hrs were recorded as Si (M 2 or 24). The wound closure rate was then calculated by the following equation: wound closure rate

( = ¾ x ;ioo

[00151] Bioinformatics analysis. We downloaded all single-cel! RNA sequencing (scRNA-seq) data from the Tabula Muris database. Specifically, Seurat objects were downloaded from Figshare and cell annotations were downloaded from the Tabula Muris Github website. We filtered out cells with fewer than 500 genes expressed or 50,000 reads covered with“FilterCells” function. Next, raw counts data were normalized using“Normalize Data” function and further regressed against the number of total reads (“nRead”) and mitochondrial proportion (“percent. mito”). The dimensional reduction was performed on genes with dispersion >0.5 using Principal Component Analysis (PCA) algorithm implemented in“RunPCA” function. We ran t- distributed stochastic neighbor embedding (t-SNE) algorithm using top 20 PCs for ail FB and top 10 PCs for heat FB with“RunTSNE” function. We detected differentially expressed genes (DEGs) among organs and between sexes using the Wi!coxon rank sum test under adjusted P- value <0.01 , fold-change > 2, and >25% ceils expressed in either group, and only positive markers were reported. All the above steps were performed with Seurat R package.5 We performed pathway enrichment analysis on DEGs with a hypergeomeiric test using geneAnswers R package under FDR <0.05 and visualized the results using Cytoscape software vS.6.6 The ligand-receptor analysis was performed following the steps previously and visualized with Cytoscape software.

[00152] Statistical analyses. For statistical analyses, the Student's t-test was used to compare two normally distributed data sets. One-way or two-way ANOVA was used, where appropriate, to compare multiple data sets, and Bonferroni multiple comparison after-tests were used for ail pairwise comparisons, depending on the properties of the data sets. A P value <0.05 was considered to be statistically significant. Ail data are shown as mean ± SEM.

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Example 2

Differentiation Protocol

[00190] By comparing the single-cell transcriptome profiles from various organs, we previously identified distinct tissue-specific genes in cardiac fibroblasts, including early cardiac development-related genes (GATA4, TBX20, MEF2C, HAND2, and GATA6) and epicardia! markers such as TCF21 , indicating CFs at large are derived from cardiac and epicardial lineages. Based on that, we are able to show that human IPSC-CFs are successfully generated after the sequential differentiation of intermediate cardiac progenitor cells and epicardial ceils.

[00191] 1. Culture human iPSCs on Matrigel-coated 6-well plates in E8 medium as previously reported. 2. On day 0, prepare RPMI/B27 minus insulin (RPMI/B27- insulin) medium containing 6 mM of CHIR99021 (CHIR, GSK3 inhibitor). Once the ceil confluence reaches 80-90%, aspirate spent medium and add 3 ml of the newly prepared RPM!/B27-insulin + CHIR medium to each well of the 6-well plate. Leave cells undisturbed for 2 days (see Note 1). 3. On day 2, aspirate the spent medium from each well of 6-weil plates and add 3 ml of RPMI/B27-insuiin medium. 4. On day 3, prepare RPMI/B27-insu!in medium containing 5 mM of IWR-1 (Wnt inhibitor). Aspirate the spent medium and then add 3 ml of the freshly prepared RPMI/B27- insu!in + IWR-1 medium to each well of 8-weli plates. 5. On day 5, aspirate the spent medium from each well of 6-well plates and add 3 ml of RPMI/B27-insulin medium (see Note 2).

[00192] Differentiation of Cardiac Progenitors info Proepicardiai Cells. 1. On day 6, prepare Advanced DMEM/G!utaMAX medium containing 5 mM of CHIR99021 , 2 mM of retinoid acid, 5 mM of Y27632 (ROCK inhibitor), and 1% FBS. 2. Aspirate the spent medium, add 1 ml of Accutase per well in a 6-well plate, and incubate the plate in a 37°C, 5% C0₂ incubator for 5 min. Gentiy pipette 5-10 times to singularize the cells, and then transfer the cell mixture to a 15-mi conical tube containing 1 ml of RPMi medium. Count the ceil density with a hemocytometer, centrifuge the cells at 200 x g for 3 min at room temperature, and aspirate the supernatant. 3. Resuspend the ceii pellet in medium prepared in step 6, and then seed singularized ceils onto a Matrigel-coated cell culture dish at a density of 20,000 per cm² (or a 1 :12 split ratio). Incubate the plate at 37 99 _C, 5% C02 overnight to allow cell attachment. 4. On day 7, aspirate the spent medium and add 2 ml of Advanced DMEM/GlutaMAXmedium containing 5 mMoί CHIR99021 and 2 mM of retinoid acid per well. 5. On day 9, aspirate the spent medium and add 2ml of Advanced DMEM/GlutaMAX medium per well. 6. On day 1 1 , prepare Advanced DMEM/GlutaMAX medium containing 2 mM SB431542 (a TGF inhibitor). 7. Aspirate the spent medium, add 1 ml Accutase per well, and incubate the plate in a 37 109 _C, 5% C02 incubator for 5 min. Pipette 5-10 times to singularize the cells, and then transfer the cell mixture to a 15-ml conical tube containing 1 ml of Advanced DMEM/GlutaMAX medium. Centrifuge the cells at 200 x g for 3 min and aspirate the supernatant. 8. Resuspend the ceil pellet in Advanced DMEM/GlutaMAX medium containing 2 mM SB431542 (prepared in step 11), and seed ceils onto a Matrigel-coated ceil culture dish at a split ratio of 1 :3 to 1 :6 Incubate the plate at 37°C, 5% C0₂ overnight to allow cell attachment. 9 On day 12 and every other day thereafter, change the medium with Advanced DMEM/GlutaMAX containing 2 mM of SB431542. 10. Once the ceils are confluent, the proepicardiai cells can be passaged for long-term maintenance, frozen down, or further differentiated into CFs (see Note 3).

[00193] Differentiation of Quiescent Cardiac Fibroblasts from iPSC Derived Epicardial Cells. 1.

On day 14, prepare fibroblast growth medium containing 20 ng/ml of FGF2 and 10 mM of SB431542. 2. Aspirate the spent medium, add 1 ml of Accutase per well in a 6-well plate, and incubate the plate in a 37 129 _C, 5% C02 incubator for 5 min. Pipette 5-10 times to singularize the cells, and then transfer the cel! suspension to a 15-ml conical tube containing 1 ml of Advanced DMEM/GlutaMAX medium. Count the cell density with a hemocytometer, centrifuge the ceils at 200 x g for 3 min at room temperature, and aspirate the supernatant. 3. Resuspend the epicardial cells and seed them onto a Matrigei- coated cell culture dish at a density of 10,000 cells per cm² (or a 1 :3 split ratio) in the medium prepared in step 16. Incubate the plate at 37°C, 5% C02 overnight to allow cell attachment. 4. On day 16, change the spent medium with 2 mi freshly prepared fibroblast growth medium with 20 ng/ml of FGF2 and 10 mM of SB431542. 5. On day 18, resuspend the ceils and seed them onto a Matrigei- coated cell culture dish at a density of 10,000 cells per cm² (or a 1 :3 split ratio) in fibroblast growth medium containing 20 ng/ ml of FGF2 and 10 mM of SB431542. 6. On day 20 and each other day thereafter, aspirate the medium from each well of the 6-well plate, and add 2 ml per well of fibroblast growth medium with 10 mM of SB431542. The quiescent CFs (Fig. 2) can be passaged, frozen down for longterm storage, or collected for characterization (see Note 4).

[00194] Notes. 1 . In general, culturing IPSCs in 6 mM of CHIR99021- containing medium for 48 h is sufficient to initiate cardiac progenitor ceil differentiation. However, if massive cell death or detachment is observed on day 2, the concentration (4-8 mM) and duration of CHIR99021 (24- 48 h) should be titrated for your specific IPSC lines. 2. As both iPSC-derived eardiomyocyies and CFs are generated from the cardiac progenitor cells, differentiation steps during the first 6 days are identical for both cell types if the cardiac progenitor cells are maintained in original plates on day 6, robust beating sheets of cTnT⁺ cardiomyocytes will be observed, which suggests that ceil density toggles epicardial vs. cardiomyocyte differentiation. 3. This protocol is developed based on an earlier protocol for iPSC-epicardial cel! differentiation. A low yield of CFs may be due to poor quality of epicardiai cells. Typical epicardial cells should have a cobb!estone-!ike morphology, and the purity of VVT1+ ceils should be >90% on day 12. 4. Fibroblasts can undergo spontaneous transdifferentiation into myofibroblasts during in vitro culture conditions. The majority of iPSC-derived CFs can preserve a quiescent state (~5% aSMA+ ceils) until passage 5 with the presence of TGFp inhibitor SB431542 in fibroblast growth medium. The TGF inhibitor should be removed from the medium at least 1 day prior to transdifferentiation experiments.

[00195] References: Hinderer S, Schenke-Layland K (2019) Cardiac fibrosis - a short review of causes and therapeutic strategies. Adv Drug Deliv Rev 146:77-82. 2. Zeisberg M, Kalluri R (2013) Cellular mechanisms of tissue fibrosis. 1. Common and organ-specific mechanisms associated with tissue fibrosis. Am J Physiol Cell Physiol 304(3):C216-C225. 3. Furtado MB, Costa MW, Pranoio EA, Salimova E, Pinto AR, Lam NT, Park A, Snider P, Chandran A, Harvey RP, Boyd R, Conway SJ, Pearson J, Kaye DM, Rosenthal NA (2014) Cardiogenic genes expressed in cardiac fibroblasts contribute to heart development and repair. Circ Res 1 14(9): 1422-1434. 4. Shi Y, inoue H, Wu JC, Yamanaka S (2017) induced pluripotent stem cel! technology: a decade of progress. Nat Rev Drug Discov 16 (2): 1 15-130 5. Zhang H, Tian L, Shen M, Tu C, Wu H, Gu M, Paik DT,Wu JC (2019) Generation of quiescent cardiac fibroblasts from human induced pluripotent stem cells for In vitro modeling of cardiac fibrosis. Circ Res 125(51:552-566. 6. (2018) Single-cell transcriptomics of 20 mouse organs creates a

Tabula Muris. Nature 562 (7727):387-372. 7. Burridge PW, Matsa E, Shukla P, Lin ZC, Churko JM, Ebert AD, Lan F, D ecke S, Huber B, Mordwinkin NM, Flews JR, Abiiez OJ, Cui B, Gold JD, Wu JC (2014) Chemically defined generation of human cardiomyocytes. Nat Methods 1 1 (8): 855-860 8. Bao X, Lian X, Hacker TA, Schmuck EG, Gian T, Bhute VJ, Han T, Shi M, Drowley L, Plowright A, Wang QD, Goumans MJ, Pa!ecek SR (2016) Long-term self-renewing human epicardial ceils generated from pluripotent stemce!!s under defined xeno-free conditions Nat Biomed Eng 1 :0003 . 9. Swaney JS, Roth DM, Olson ER, Naugie JE, Meszaros JG, insei PA (2005) Inhibition of cardiac myofibroblast formation and collagen synthesis by activation and overexpression of adenylyl cyclase. Proc Natl Acad Sci U S A 102 (2):437-442

96] The preceding merely illustrates the principles of the invention. It will be appreciated that those skilled in the art will be able to devise various arrangements which, although not explicitly described or shown herein, embody the principles of the invention and are included within its spirit and scope. Furthermore, all examples and conditional language recited herein are principally intended to aid the reader in understanding the principles of the invention and the concepts contributed by the inventors to furthering the art, and are to be construed as being without limitation to such specifically recited examples and conditions. Moreover, all statements herein reciting principles, aspects, and embodiments of the invention as well as specific examples thereof, are intended to encompass both structural and functional equivalents thereof. Additionally, it is intended that such equivalents include both currently known equivalents and equivalents developed in the future, i.e., any elements developed that perform the same function, regardless of structure. The scope of the present invention, therefore, is not intended to be limited to the exemplary embodiments shown and described herein. Rather, the scope and spirit of present invention is embodied by the appended claims.

Claims

T HAT WHICH IS CLAIMED IS:

1. An in vitro culture method of generating a population of human cardiac fibroblast cells from a human pluripotent stem cell, the method comprising:

(a) generating in culture a population of human cardiac progenitor cells from human pluripotent stem cells;

(b) generating in culture a population of human epicardiai ceils from the human cardiac progenitor cells;

(c) generating in culture a population of human cardiac fibroblast cells from the human epicardiai cells by culture in the presence of an effective concentration of an inhibitor of transforming growth factor b (TGF-b).

2. The method of claim 1 , wherein the population of human cardiac fibroblast cells is at least 80% pure.

3. The method of claim 1 , wherein the population of human cardiac fibroblast cells is at least 90% pure.

4. The method of any of claims 1-3, wherein the human cardiac fibroblast cells are quiescent.

5. The method of any of claims 1-4, wherein step (c) comprises culturing the population of human epicardiai cells in the presence of an effective concentration of an FGF agonist, and a TQRb inhibitor, for a period of from 5 to 8 days.

6. The method of claim 5 wherein the effective concentration of an FGF agonist, and a TORb inhibitor, is each from about 1 mM to about 50 mM.

7. The method of any of claims 1 -8, wherein step (a) comprises culturing a population of human induced pluripotent stem cells in the presence of an effective concentration of a Wnt agonist for a period of from about 24 to about 72 hours; culturing in medium for a period of from about 12 to about 38 hours; culturing in the presence of an effective concentration of a Wnt inhibitor for a period of from about 24 to about 72 hour; and culturing in medium for a period of from about 12 to about 36 hours to generate the population of cardiac progenitor cells.

8. The method of any of claims 1-7, wherein step (b) comprises culturing the population of cardiac progenitor cells in the presence of an effective concentration of a Wnt agonist, and retinoic acid, for a period of from about 24 to about 72 hours.

9. A population of human cardiac fibroblast cells generated by the method of any of claims 1-8.

10. A co-cu!ture comprising the population of cardiac fibroblast cells of claim 9; and a one or more additional cardiac cell types.

1 1. The co-culture of claim 10, comprising one or both of cardiac smooth muscle cells; and cardiac myocytes.

12. A method for screening of a candidate agent, the method comprising: contacting the candidate agent with one or a pane! of quiescent human cardiac fibroblasts of claim 9, or co culture of claim 10 or 1 1 ; and determining the effect of the agent on morphologic, genetic or functional parameters.

13. The method of claim 12, wherein the phenotype is fibrosis.

14. The method of Claim 12 or 13, wherein a panel of human cardiac fibroblasts comprises at least 2 differing genotypes.

15. The method of Claim 14, at least one genotype comprises an allele associated with cardiac disease.

18. The method of Claim 12, wherein determining the effect of the agent comprises single ceil analysis.

17. The method of Claim 12, wherein the candidate agent is a drug candidate.

18. The method of Claim 12, wherein the candidate agent is a genetic agent.