Single nucleus transcriptomics supports a role for CCNA2-induced human adult cardiomyocyte cytokinesis

Cyclin A2 (CCNA2) is a master regulatory gene of the cell cycle that is normally silenced in postnatal mammalian cardiomyocytes. We have previously demonstrated that it can induce significant cardiac repair in both small and large animals when delivered to the heart via a viral vector. To date, whether CCNA2 gene delivery can induce cytokinesis in isolated cardiomyocytes from adult human hearts has not been investigated. Therefore, we designed a human gene therapy vector featuring a replication-deficient, E1/E3-deleted human adenovirus 5 encoding human CCNA2 driven by the cardiac Troponin T promoter to enable expression of CCNA2 in freshly isolated human cardiomyocytes. Utilizing time-lapse microscopic live imaging of cultured adult human cardiomyocytes isolated from a 21-year-old male, 41-year-old female, and 55-year-old male, we now report that human adult cardiomyocytes can be induced to undergo complete cytokinesis in response to CCNA2 gene delivery with preservation of sarcomere integrity in the resultant daughter cells. To elucidate the mechanistic underpinnings of CCNA2-dependent gene regulation in governing cardiomyocyte cytokinesis, we conducted single nucleus transcriptomics (SnRNA-seq, 10X Genomics) analysis in hearts isolated from adult transgenic mice that constitutively express CCNA2 in cardiomyocytes (CCNA2-Tg) and non-transgenic mice (NTg). Remarkably, we identified a subpopulation of cardiomyocytes enriched with cytokinesis, proliferative, and reprogramming genes in hearts obtained from CCNA2-Tg mice as compared to hearts obtained from NTg mice. We also performed bulk RNA sequencing of human adult and fetal hearts, and we identified key reprogramming genes that are targets for CCNA2-induced cytokinesis. These results provide a compelling pathway forward for the clinical development of cardiac regenerative therapy based on strategic manipulation of the cardiomyocyte cell cycle. ### Competing Interest Statement H.W.C. is a founder and equity holder in VentriNova Inc. and is co-inventor on issued patents (10/557,873; 11/267,431; 11/535,444) and patent applications (EPO 4752668.6; Canada 2526490; Hong Kong 6110012.7; United States 12/642,055; EPO 6815444.2; Canada 2,660,661; Hong Kong 9102068.4) associated with this work and owned by Icahn School of Medicine at Mount Sinai. The other authors declare no competing interests.