Ischemic heart disease is the single most common cause of death worldwide with an annual death rate of over 9 million people. Genome-wide association studies have uncovered over 200 genetic loci underlying the disease, providing a deeper understanding of the causal mechanisms leading to it. However, in order to understand ischemic heart disease at the cellular and molecular level, it is necessary to identify the cell-type-specific circuits enabling dissection of driver variants, genes, and signaling pathways in normal and diseased tissues. Here, we provide the first detailed single-cell dissection of the cell types and disease-associated gene expression changes in the living human heart, using cardiac biopsies collected during open-heart surgery from control, ischemic heart disease, and ischemic and non-ischemic heart failure patients. We identify 84 cell types/states, grouped in 12 major cell types. We define markers for each cell type, providing the first extensive reference set for the live human heart. These major cell types include cardiovascular cells (cardiomyocytes, endothelial cells, fibroblasts), rarer cell types (B lymphocytes, neurons, Schwann cells), and rich populations of previously understudied layer-specific epicardial and endocardial cells. In addition, we reveal substantial differences in disease-associated gene expression at the cell subtype level, revealing arterial pericytes as having a central role in the pathogenesis of ischemic heart disease and heart failure. Our results demonstrate the importance of high-resolution cellular subtype mapping in gaining mechanistic insight into human cardiovascular disease.

Intelligence is usually associated with the ability to perceive, retain and use information to adapt to changes in one's environment. In this context, systems of living cells can be thought of as intelligent entities. Here, we show that the concepts of non-equilibrium tuning and compartmentalization are sufficient to model manifestations of cellular intelligence such as specialization, division, fusion and communication using the language of operads. We implement our framework as an unsupervised learning algorithm, IntCyt, which we show is able to memorize, organize and abstract reference machine-learning datasets through generative and self-supervised tasks. Overall, our learning framework captures emergent properties programmed in living systems, and provides a powerful new approach for data mining. to memorize, organize and abstract reference machine-learning datasets through generative and self-supervised tasks. Overall, our learning framework captures emergent properties programmed in living systems, and provides a powerful new approach for data mining.