The existence of stem cells in the heart has become a hot topic in the field of cardiac research in recent years. Cardiac biology and heart regeneration have been intensively investigated and debated in the last 15 years. Nowadays, the well-established and old dogma that the adult heart lacks of any myocyte-regenerative capacity has been firmly overturned by the evidence of cardiomyocyte renewal throughout the mammalian life as part of normal organ cell homeostasis, which is increased in response to injury. Concurrently, there is research evidence that the adult heart possesses a pool of multipotent cardiac stem/progenitor cells capable of sustaining cardiomyocyte and vascular tissue refreshment after injury [38]. At present, the commonly used stem cell labeling method is that a marker represents a class of cells. This method is used to detect myocardial stem cells in situ have created the paradox of the adult heart harboring at least seven different cardiac progenitor or stem populations. We found that the density of positive cells expressing stem cell markers within myocardial tissue was not significant. On the basis of these contradictory findings, we re-identified the myocardial stem cell marker-positive cells by cross co-localization of two proteins. The results showed that Sca-1 and Islet-1, Sca-1 and Nanog, and Nanog and Islet-1 were co-expressed in the separate cell subsets. It is suggested that the cellular taxa detected with a single marker do not reflect the true picture of cell classification.
It is generally accepted that stem cells are undifferentiated, immature, self-replicating cells that express two or more marker proteins in the embryonic stage and have the potential to regenerate tissues and organs. This definition is the basic yardstick for judging the presence or absence of stem cells in myocardial tissue. The cells isolated and purified in this study have a good ability to divide and proliferate. Sca-1, Nanog and Islet-1 expressed by these cells are commonly used stem cell marker proteins. At the same time, they can be induced to express the cardiac-specific protein cTnT and differentiate into cardiomyocyte-like cells. The above three aspects are in line with the basic characteristics of stem cells, so we believe that the cells isolated in this study should belong to stem cells. Lin et al. argue that there are stem cells in the myocardium, and these cells can differentiate into one or more of three cell lineages—endothelial cells, smooth muscle cells, and cardiomyocytes in vitro and in vivo, however, the amount of stem cells will gradually decrease as the myocardial tissue matures [2]. A recent study has proven that 80% of Sca-1 positive cells can differentiate into osteoblasts, adipocytes and chondrocytes [26]. Other research evidence shows that a considerable number of stem cells are still present in adult heart tissue, although their stemness and ability to repair myocardial damage are greatly reduced [4, 5]. The discrepancy in conclusions obtained from in vitro experiments to determine the presence or absence of stem cells in adult hearts may be associated with the different methods of isolation and culture in vitro. Previously, most studies have adopted the tissue block applanation culture method [38], which is simple and operational, but has the disadvantage of poor purity of the harvested cells and long culture period. More importantly, the number of stem cells in the primary cell population obtained by this method was low, and its abundance could not meet the requirements of subsequent experiments. In this study, the density gradient centrifugation method [39]-using 0.2% type II collagenase and the cell separation solution poly sucrose-sodium pantothenate solution (1.077 g/mL Ficoll solution)-was used to separate cardiac cells of different densities, with the stem cell population being of medium density and present in the intermediate layer after centrifugation, the "buffy coat". In this way, the number and purity of stem cells we get are greatly improved.
The diversity and heterogeneity of stem cells in myocardial tissue remains controversial. Past works usually assumed that the positive expression of a certain marker means that the positive cells are a cell subset. In this regard, at least subsets of cells such as Sca-1+ cells, lateral population (SP) cells, cardiomyocyte-derived cells (CDCs), Islet-1+cells, and epicardium-derived stem cells (EPDCs) have been identified. If these cells are independent, the true functional relationship between these cell populations is still unclear. We hypothesized that if two or more markers were co-expressed on a single cell, the actual quantity of cell subpopulations would be much smaller than the previously delineated. For this reason, two-two cross co-expression was performed on the isolated cells in this study.
In our study, normal BALB/c mice were grouped into four periods, namely the newborn group, the 1-week-old group, the 3-week-old group, and the 5-week-old group to demonstrate the age-related changes in the quantity and differentiation potential of stem cells in myocardial tissue. Previous studies have rarely performed such a long continuous follow-up. The results of this study exhibited a concurrent change in the co-expression levels of each two markers as time increased. The co-localization level of Sca-1 + Islet-1 gradually decreased from newborn to 5 weeks postnatal heart; the co-localization level of Sca-1 + Nanog first increased and then decreased; the co-localization level of Islet-1 + Nanog gradually increased. Comparing the above findings with the results of single marker labeling showed a high degree of consistency. The expression of Sca-1 reached the maximum at around one week after birth, while that of Nanog and Islet-1 culminated at the 3rd week. Combining the results of single protein expression and co-localization in this study, we found the following regularities: Sca-1+ cell population was more functionally active before 3 weeks of life, and co-expression with Islet-1 mainly occurred within 1 week after birth (probably contributes to cardiac development) and with Nanog predominantly at the period from 1 to 3 weeks of life; Nanog+ cells were dominant between 3 and 5 weeks after birth, and then the co-expression of Islet-1 and Nanog was enhanced, with a gradual synergistic effect on the heart.
To further clarify the relationship between the proportion of Sca-1, Nanog and Islet-1 positive cells in myocardial tissue, we selected several cardiac-specific stem cell genes (including Sca-1, Nanog, Isl-1, Sox-2, NKX2.5, GATA4, Oct4) from the numerous results obtained by scRNA-seq for enrichment analysis. The results showed a strong positive expression of Sca-1, while Nanog and Islet-1 genes were less expressed. This result is consistent with the single-labeling and co-localization results, indicating that both gene and protein expression of Sca-1 is stronger than that of Nanog and Islet-1, which may be attributed to the fact that Nanog and Islet-1 are mainly present in naive cardiomyocyte populations and their expression intensity gradually decreases after birth as cells mature, and furthermore, Nanog has been lately reported to be a marker of muscle senescence [40].
As shown by single-cell gene sequencing and stem cell gene enrichment (Fig. 6,7), Sca-1, GATA4 and Sox2 genes were mainly enriched in the fibroblast cluster, indicating that stem cells may have some kind of functional relationship with fibroblasts. A number of findings have shown that fibroblasts have the features of stem cells and can differentiate in multiple directions [41–43]. Does this suggest that the so-called cardiac stem cells are part of the fibroblast population? It is well worth further exploration.
In conclusion, our study demonstrated that one cell co-expresses two or more proteins through the pairwise co-localization of three stem cell marker proteins, Sca-1, Nanog, and Islet-1. Therefore, one stem cell marker alone cannot be used to classify subpopulations of cardiac stem cells. There are dynamic changes in Sca-1, Nanog, and Islet-1 positive cells at different cardiac developmental stages, which may lead to differences in their naïveté and differentiation potential. Furthermore, what functional relationship exists between cells expressing stem cell markers and fibroblasts needs to be further investigated.