Physiologic force-frequency response in engineered heart muscle by electromechanical stimulation

A hallmark of mature mammalian ventricular myocardium is a positive force-frequency relationship (FFR). Despite evidence of organotypic structural and molecular maturation, a positive FFR has not been observed in mammalian tissue engineered heart muscle. We hypothesized that concurrent mechanical and electrical stimulation at frequencies matching physiological heart rate will result in functional maturation. To this end, we investigated the role of such biomimetic mechanical and electrical stimulation in functional maturation in engineered heart muscle (EHM) comprising collagen type I and neonatal rat heart cells. Following tissue consolidation (8 days), EHM were subjected to electrical field stimulation at 0, 2, 4, or 6 Hz for 5 days, while strained on flexible poles to facilitate auxotonic contractions. EHM stimulated at 2 and 4 Hz displayed a similarly enhanced inotropic reserve, but a clearly diverging FFR. The positive FFR in 4 Hz stimulated EHM was associated with reduced calcium sensitivity, frequency-dependent acceleration of relaxation, and enhanced post-rest potentiation. This was paralleled on the cellular level with improved calcium storage and release capacity of the sarcoplasmic reticulum, increased amounts of SERCA2a and RyR2 protein, and enhanced T-tubulation. We demonstrate that electromechanical stimulation at a frequency matching closely the physiological heart rate supports functional maturation in mammalian EHM. The observed positive FFR in EHM has important implications for the applicability of EHM in cardiovascular research and drug testing.