The mesencephalic astrocyte-derived neurotrophic factor (MANF) as a novel regulator of post-infarction cardiac sympathetic hyperinnervation

Abstract Background Excessive outgrowth of sympathetic nerve fibers (sympathetic hyperinnervation) around the infarcted myocardium is associated with ventricular arrhythmia and an increased risk of sudden cardiac death. Post-infarction, epicardial cells exit quiescence through epithelial-to-mesenchymal transition (EMT), resulting in the formation of epicardium-derived cells (EPDCs). EPDCs support cardiac repair through differentiation into various cardiac cell lineages, as well as secretion of paracrine factors that stimulate processes such as angiogenesis. Recently, we demonstrated that human EPDCs reinforce neurite outgrowth in vitro. Whether EPDCs regulate cardiac innervation through paracrine signaling and contribute to post-infarction sympathetic hyperinnervation is unknown. Purpose To identify epicardial paracrine factors post-infarction that are involved in nerve growth. Methods Single-cell RNA-sequencing (scRNA-seq) datasets capturing epicardial cells of the healthy and infarcted adult mouse heart were collected from published research articles and were integrated into one object using Seurat. A list of gene products of known involvement in biological processes related to nerve growth (675 unique entries in total) was compiled. Based on this list, differential gene expression analysis on data from the integrated scRNA-seq object was performed to uncover highly-expressed candidates in the epicardial cell population. Epicardial expression of a candidate paracrine factor was validated by immunohistochemistry in the infarcted mouse heart as well as in an adult human in vitro model of EPDC EMT by immunocytochemistry and transcriptomic analysis. Results In our integrated scRNA-seq object, we identified high expression of Manf in epicardial cells post-infarction. Consistent with this finding, immunohistochemistry showed that Manf was up-regulated in the infarcted area, borderzone area, and epicardial region situated close to the infarct, an area where also hyperinnervation is observed. In vitro, MANF transcript expression was significantly down-regulated (p<0.01) in human EPDCs that were stimulated with TGFβ3 to induce EMT compared to EPDCs in which EMT was inhibited. In line with this, immunocytochemistry staining of MANF indicated that MANF expression was down-regulated in human EPDCs stimulated with TGFβ3. Conclusion(s) This study is the first to show that Manf is highly expressed in the epicardial region close to the infarct. In vitro, MANF is down-regulated in human adult EPDCs post-EMT. Future experiments will be directed toward determining the effect of MANF knockdown in human EPDC on neurite outgrowth in co-cultured human sympathetic neurons.MANF expression in human EPDCs after EMTManf expression after infarction