Heart failure is a global health challenge that demands innovative therapeutic approaches. Evotec’s pioneering iPSC-derived cardiomyocytes offer a promising solution, addressing the critical challenges of immune rejection, graft-induced arrhythmia, and scalable production.
The growing global burden of heart failure
Heart failure (HF) remains a leading cause of mortality, affecting millions worldwide1. Current estimations predict that there will be over 8 million people in the United States alone living with HF by 20302. The condition is exacerbated by the heart’s limited regenerative capacity, as cardiomyocytes — the cells responsible for heart muscle contraction — have minimal ability to regenerate after injury. Consequently, a single myocardial infarction can result in the irreversible loss of billions of cardiomyocytes, leading to heart failure with reduced ejection fraction (HFrEF)3.
Traditional treatments focus on managing symptoms and slowing the progression of HF but fail to address the root cause — the loss of functional cardiac tissue. Over time, patients will reach the end stage of HF, experiencing a vastly diminished quality of life, with ventricular assist devices or rare heart transplantation being final treatment options. As the global population ages and cardiovascular risk factors rise, there is an urgent need for novel therapies that go beyond symptom management, to regenerate lost heart tissue and prevent HF from progressing.
One promising avenue is regenerative cell therapy using induced pluripotent stem cells (iPSCs). In this article, we explore the current challenges in developing cell therapies for heart failure and Evotec’s innovative approach to overcoming them, with recent findings from their iPSC-derived cardiomyocyte (iCM) Heart Repair program.
The promise of regenerative cell therapy for HF
Regenerative medicine, especially iPSC-based therapies, holds tremendous potential in addressing the unmet needs of HF patients. iPSCs can be reprogrammed from adult cells, and with unlimited proliferative capacity, they have the unique ability to differentiate into any cell type.
Thus, iPSCs offer a renewable source of cardiomyocytes. This makes iPSC cell-derived cardiomyocytes (iCM) an ideal candidate for providing novel and curative HF therapies, with the potential to replenish lost heart cells in HF patients and restore cardiac function. However, the path to clinical application is fraught with challenges.
Challenges in cardiac cell therapy
One of the primary challenges with allogeneic iPSC-based therapies is the prevention of immune rejection. Allogeneic iCM are recognized as foreign by the patient’s immune system. This leads to rejection unless immunosuppressive drugs are used4. However, long-term immunosuppression carries significant risks and is not a viable solution for all patients.
Moreover, there’s the challenge of preventing graft-induced arrhythmias. These can occur when transplanted cardiomyocytes do not integrate properly with the host tissue, leading to irregular heartbeats.
Another key challenge is successfully scaling up production to meet clinical needs. HF patients require over a billion iCM for effective treatment. However, producing large doses of iCM demands cost-effective, scalable processes. Additionally, ensuring consistent quality and purity of these cells at increased scale is critical for their therapeutic success.
Evotec’s iCM Heart Repair program, in collaboration with the Medical Center Hamburg-Eppendorf “UKE”, has been developed to address these challenges. This collaborative program focuses on the development of first-class non-immunogenic iCM that can be produced at scale, offering a promising off-the-shelf treatment that can meet the global demand for HF therapies.
Immune-shielded iCM are protected from T cells and NK cells
As part of Evotec’s iCM Heart Repair program, researchers at Evotec evaluated iCM immune-shielding strategies for tissue replacement in HF patients. In this study, the researchers first developed a robust production process of wildtype (wt) iCM cells, using the fully characterized GMP iPSC line in small-scale GMP-compliant bioreactors. Yield evaluation with flow cytometry demonstrated an exceptionally high purity of >97% cardiomyocyte marker, cardiac troponin T (cTNT).
To investigate strategies to prevent allogeneic immune rejection, two genetically engineered iCM lines were chosen, human leukocyte antigen (HLA)- encoded class I and II knockout iCM, and iACT iCM5,6 (panCELLa Induced Allogenic Cell Tolerance Stealth Cells™). These lines contain genetic modifications to inactivate human leukocyte antigen factors I and II (HLA-I/II KO), or overexpress immune-shielding factors (iACT), which were engineered to the iPSC prior to their differentiation. Thus, both iCM are designed to prevent immune cell activation and cytokine release.
Using in vitro assays, the two iCM lines were co-cultured with primed T cells or expanded natural killer (NK) cells. The subsequent release of the cytokine IFNγ and killing of the iCM was measured to investigate the immune-suppressing potential of HLA-I/II KO and iACT immune-shielded iCM.
Figure 1: Wild type iCM (wt), HLA-I/II KO, and iACT immune-shielded iCM were co-cultured with primed T cells or expanded NK cells of human donors. iCM survival and IFNγ release from immune cells was measured after 6-24 hours.
Results of the in vitro co-culture assays (Figure 1) showed iACT iCM provide efficient protection against NK cells, but only moderate protection against T cells. Contrastingly, HLA-I/II KO iCM were shown to be vulnerable to NK cells due to the “missing-self-response”, but highly efficient against T cells.
Engineering an improved iCM cell line
To improve the therapeutic potential of immune-shielded iCM, Evotec has developed its proprietary EvoCloaking iPSC line. The novel cell line is based on HLA-I/II KO, with an additional innovative anti-NK cell strategy to increase its immune-shielding properties.
In vitro data supports that EvoCloaking iPSC-derived iCM can reduce cytokine release and are protected against both T cells and NK cells. This means the proprietary cell line offers an innovative strategy to ensure the acceptance and persistence of engrafted iCM, improving the safety and long-term function of the therapy, while avoiding the need for immunosuppressants.
In addition to its immune-shielding properties, EvoCloaking iPSC-derived iCM are genetically engineered to safeguard against tumorgenicity, with a drug inducible kill-switch allowing for the elimination of undesired proliferating cells. Importantly, the proprietary cell line will also contain a genetic modification to avoid graft-induced arrhythmia in derived iCM. This is supported by in vitro data, and is currently tested on arrhythmia-prone pigs.
EvoCloaking iCM are highly pure cells optimized for off-the-shelf product use as a single cell suspension. In heart injury guinea pig models, efficient iCM engraftment has been demonstrated when injected as single cell suspensions. Consequently, catheter-based interventional administration should be compatible with this product format.
Evotec's scalable therapeutics platform
The iCM Heart Repair Program aims to overcome challenges associated with large-scale iCM production. Using Evotec’s GMP-compatible manufacturing infrastructure, scalable and cost-effective bioreactor processes have been established for iPSC expansion and differentiation in 3D. Furthermore, predictive in-process controls and advanced in silico modeling have been implemented into the differentiation process, to optimize cell yield and purity.
Evotec’s cell therapy pipeline expansion to include immune-shielded iCM is testament to its commitment to allogeneic cell therapeutics. Our unique end-to-end platform and expertise support the development and manufacturing of off-the-shelf iPSC therapies for a range of diseases and conditions, from cancer and autoimmune disease to diabetes and cardiovascular disease. The integrated platform covers development stages from early exploration to GMP compliant scale-up for further research, pre-clinical, and clinical studies.
Figure 2: An overview of Evotec’s end-to-end platform for iPSC-based therapeutics
The future of heart repair
The development of immune-shielded iPSC-derived cardiomyocytes represents a significant advancement in the field of regenerative medicine. This therapy could revolutionize the treatment of heart failure, offering a solution that addresses the underlying cause of the disease, rather than just managing symptoms. Integrated iCM development and manufacturing processes are also ensuring the scalable, cost-effective production of this therapy, holding great potential for meeting the increasing global demand for curative HF treatment.
Evotec’s commitment to innovation and excellence in the field of regenerative medicine positions it as a leader in the development of next-generation therapies. By addressing the key challenges in iCM therapy, including scalable production, immune rejection, and graft-induced arrhythmias, Evotec is paving the way for a new era in heart failure treatment.
Moreover, the broader impact of this research by Evotec extends beyond heart failure, as the principles of immune-shielding and scalable bioprocessing can be applied to other cell therapies, opening new avenues for treating a range of diseases.
Discover more about Evotec’s innovative iPSC-based therapies
Download the iCM research poster
References
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(2) Golla, M. S. G.; Hajouli, S.; Ludhwani, D. Heart Failure and Ejection Fraction. StatPearls 2024.
(3) Laflamme, M. A.; Murry, C. E. Regenerating the Heart. Nature Biotechnology 2005 23:7 2005, 23 (7), 845–856. https://doi.org/10.1038/nbt1117.
(4) Lanza, R.; Russell, D. W.; Nagy, A. Engineering Universal Cells That Evade Immune Detection. Nature Reviews Immunology 2019 19:12 2019, 19 (12), 723–733. https://doi.org/10.1038/s41577-019-0200-1.
(5) Harding, J.; Vintersten-Nagy, K.; Yang, H.; Tang, J. K.; Shutova, M.; Jong, E. D.; Lee, J. H.; Massumi, M.; Oussenko, T.; Izadifar, Z.; Zhang, P.; Rogers, I. M.; Wheeler, M. B.; Lye, S. J.; Sung, H. K.; Li, C. J.; Izadifar, M.; Nagy, A. Immune-Privileged Tissues Formed from Immunologically Cloaked Mouse Embryonic Stem Cells Survive Long Term in Allogeneic Hosts. Nature Biomedical Engineering 2023 8:4 2023, 8 (4), 427–442. https://doi.org/10.1038/s41551-023-01133-y.
(6) Harding, J.; Vintersten-Nagy, K.; Shutova, M.; Yang, H.; Tang, J. K.; Massumi, M.; Izaidfar, M.; Izadifar, Z.; Zhang, P.; Li, C.; Nagy, A. Induction of Long-Term Allogeneic Cell Acceptance and Formation of Immune Privileged Tissue in Immunocompetent Hosts. bioRxiv 2019, 716571. https://doi.org/10.1101/716571.