Duke study uncovers foundations of heart regeneration

While the human heart can't heal itself, the zebrafish heart can easily replace cells lost by damage or disease. Now, researchers have discovered properties of a mysterious outer layer of the heart known as the epicardium that could help explain the fish's remarkable ability to regrow cardiac tissue.

After an injury, the cells in the zebrafish epicardium dive into action - generating new cells to cover the wound, secreting chemicals that prompt muscle cells to grow and divide, and supporting the production of blood vessels to carry oxygen to new tissues.

A study appearing May 4 in the journal Nature found that when this critical layer of the heart is damaged, the whole repair process is delayed as the epicardium undergoes a round of self-healing before tending to the rest of the heart. The new research showed that the process requires signaling through a protein called sonic hedgehog, and demonstrated that adding this molecule to the surface of the heart can drive the epicardial response to injury.

The finding points to a possible target for repairing the damage caused by a heart attack, a major cause of death and disability in the United States. More than five million Americans are currently experiencing heart failure, and over 900,000 suffer from a heart attack each year.

"The best way to understand how an organ regenerates is to deconstruct it. So for the heart, the muscle usually gets all the attention because it seems to do all the work," said Kenneth D. Poss, Ph.D., senior author of the study and professor of cell biology at Duke University School of Medicine. "But we also need to look at the other components and study how they respond to injury. Clearly, there is something special about the epicardium in zebrafish that makes it possible for them to regenerate so easily."

Poss has been studying heart regeneration in zebrafish for the last 13 years. As a postdoctoral fellow he was the first to show that the puny, striped fish could regrow severed pieces of heart tissue, like a lizard growing back a pinched tail. Since then, his group has found that this regeneration involves the input of the epicardium, a thin layer of cells that cover the surface of the heart.

"The epicardium is underappreciated, but we think it is important because similar tissues wrap up most of our organs and line our organ cavities," Poss said. "Some people think of it as a stem cell because it can make more of its own, and can contribute all different cell types and factors when there is an injury. The truth is we know surprisingly little about this single layer of cells or how it works. It is a mystery."

In this study, Poss and his colleagues were determined to identify the properties of the epicardium that make it such a regenerative powerhouse. First, Duke postdoctoral fellow Jinhu Wang performed open-heart surgery on live zebrafish, removing approximately one fifth of the vital organ. Afterwards he used a set of sophisticated genetic tools to kill 90 percent of the epicardial cells and then measured how well the heart healed at various time points. He found that removing this outer layer created a clear lag in regeneration, but that eventually the healing process caught up to that of zebrafish with an intact epicardium.