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A cell’s function is defined by its intrinsic characteristics and its niche: the tissue microenvironment in which it dwells. Here, we combine single-cell and spatial transcriptomic data to discover cellular niches within eight regions of the human heart. We map cells to micro-anatomic locations and integrate knowledge-based and unsupervised structural annotations. For the first time, we profile the cells of the human cardiac conduction system, revealing their distinctive repertoire of ion channels, G-protein coupled receptors, and cell interactions using a customCellPhoneDB.orgmodule. We show that the sinoatrial node is compartmentalised, with a core of pacemaker cells, fibroblasts and glial cells supporting paracrine glutamatergic signalling. We introduce a druggable target prediction tool, drug2cell, which leverages single-cell profiles and drug-target interactions, providing unexpected mechanistic insights into the chronotropic effects of drugs, including GLP-1 analogues. In the epicardium, we show enrichment of both IgG+ and IgA+ plasma cells forming immune niches which may contribute to infection defence. We define a ventricular myocardial-stress niche enriched for activated fibroblasts and stressed cardiomyocytes, cell states that are expanded in cardiomyopathies. Overall, we provide new clarity to cardiac electro-anatomy and immunology, and our suite of computational approaches can be deployed to other tissues and organs.

The asymmetric morphology of the mammalian heart is essential to its function as the organ of pulmonary and systemic double circulation. Left-right asymmetry is established by a leftward flow in the node that results in the asymmetric expression ofNodal. This triggers a cascade of asymmetric expression of downstream genes, such asPitx2c, in the lateral plate mesoderm that gives rise to the first morphologically recognizable primordial heart structure, the cardiac crescent. Relatively little is known about gene expression asymmetries in the cardiac crescent that might underpin asymmetric cardiac morphogenesis. To systematically identify asymmetrically expressed genes, we performed a single-cell transcriptional analysis of manually dissected left and right halves of the cardiac crescent at stages spanning symmetry breaking. This revealed both left and right-sided genes that have not previously been implicated in left-right symmetry breaking. Some of these were expressed in multiple cell types but showed asymmetric expression in only a sub-set of cell types. We validated these findings using multiplexedin situHybridization Chain Reaction (HCR) and high-resolution volume imaging to characterize the expression patterns of select genes. UsingDnahiv/ivmutant embryos that show randomized situs, we established that all the genes tested tracked the asymmetric expression ofPitx2c, indicating their asymmetric expression also arose from the early asymmetries at the node. This study provides a high-fidelity molecular characterization of left-right symmetry breaking during cardiac crescent formation, providing a basis for future mechanistic studies on asymmetric cardiac morphogenesis.