Systems Biology and Functional Assessments of Human iPSC-Cardiomyocyte Models of Insulin Resistance Capture Key Hallmarks of Diabetic Cardiomyopathy

Human-centric models of diabetic cardiomyopathy (DbCM) are needed to provide mechanistic insights and translationally relevant therapeutic targets for patients with diabetes. A systems biology approach using insulin resistant (IR) two-dimensional (2D) human induced pluripotent stem cell–derived cardiomyocytes (hiPSC-CMs) and three-dimensional (3D) engineered heart tissue (EHT) provides a comprehensive evaluation of dysregulated pathways and determines suitability as a translationally relevant model of DbCM. Culturing hiPSC-CMs in 2D or 3D EHT in IR media induced insulin resistance and activated multiple pathways implicated in DbCM, including metabolic remodeling, mitochondrial dysfunction, extracellular matrix remodeling, endoplasmic reticulum stress, and blunted response to hypoxia, as assessed using transcriptomics and proteomics. Metabolic flux measurements in both IR 2D and 3D platforms demonstrated increased fatty acid oxidation and lipid storage, whereas glucose metabolism was downregulated. Modeling DbCM in 3D EHTs conferred additional metabolic and functional advantages over the 2D hiPSC-CM, demonstrating impaired contractility and muscle architecture. Metformin treatment improved both contractility and metabolic function, demonstrating the utility of IR EHT for drug assessment. In conclusion, IR 2D and 3D hiPSC-CM models effectively capture key DbCM features. However, 3D EHT provides additional insights into physiological and structural modifications. This highlights the potential of IR EHT for both mechanistic studies and drug screening in DbCM. Article Highlights Human-centric cardiac models are needed that recapitulate mechanistic and functional changes in the type 2 diabetic myocardium for understanding disease pathogenesis and developing new therapies. Using human induced pluripotent stem cell–derived cardiomyocytes (hiPSC-CM) in 2D and 3D as engineered heart tissue (EHT), we aimed to model diabetic cardiomyopathy in cellulo. Taking an unbiased systems biology approach, our cellular models recapitulated the dysregulated pathways and functional derangement of diabetic cardiomyopathy. Three-dimensional EHT models showed contractile dysfunction akin to that seen in patients, with mechanistic and functional changes reversed with metformin. It is possible to generate translationally relevant hiPSC-CM models that mimic diabetic cardiomyopathy.