Abstract
BACKGROUND: Cardiovascular metabolic diseases (CMDs) are a major contributor to global mortality and disability, yet their pathogenesis remains incompletely understood, partly because existing in vitro models fail to capture disease complexity. Conventional engineered heart tissues (EHT), which typically contain only a limited set of cell types and lack neural components, cannot replicate the intricate neuro-cardiac interactions involved in CMDs. OBJECTIVE: This study aimed to develop a neuron-like-Integrated Engineered Heart Tissue for investigating neuro-cardiac interactions under both physiological and pathological conditions, offering a new tool for CMD research. METHODS: We constructed a Sympathetic-like-Integrated Engineered Heart Tissue (SIEHT) by incorporating sympathetic-like neuronal cells into EHT. The structural and functional properties of SIEHT were systematically compared with conventional EHT using morphological analysis, immunofluorescence staining, contractility measurements, qPCR, and RNA sequencing. The model was then exposed to advanced glycation end products (AGEs) to assess pathological remodeling through multiple parameters, including cell viability, oxidative stress, structural and functional integrity, and transcriptomic profiles. RESULTS: SIEHT exhibited greater structural and functional maturation than EHT, as indicated by improved cardiomyocyte alignment, increased contraction amplitude, and upregulated expression of connexin 43. Transcriptomic analysis revealed enriched pathways associated with multi-system development. Under AGEs-induced pathological conditions, SIEHT demonstrated a more pronounced reduction in cell viability, elevated reactive oxygen species levels, more severe contractile dysfunction, a higher frequency of abnormal spontaneous beating, and greater neural injury relative to controls. Transcriptome profiling further identified significant enrichment of the AGE-RAGE signaling pathway in diabetic complications. CONCLUSIONS: We successfully established a novel SIEHT model that recapitulates physiological neuro-cardiac interactions and AGEs-induced adverse remodeling across multiple dimensions, providing a powerful and innovative tool for elucidating the pathophysiological mechanisms of neuro-cardiac dysregulation in CMDs.