Cardiomyocytes from human pluripotent stem cells (hPSCs-CMs)
could revolutionise biomedicine. Global burden of heart failure will soon reach USD
$90bn, while unexpected cardiotoxicity underlies 28% of drug withdrawals. Advances in
hPSC isolation, Cas9/CRISPR genome engineering and hPSC-CM differentiation have
improved patient care, progressed drugs to clinic and opened a new era in safety
pharmacology. Nevertheless, predictive cardiotoxicity using hPSC-CMs contrasts from
failure to almost total success. Since this likely relates to cell immaturity,
efforts are underway to use biochemical and biophysical cues to improve many of the
~ 30 structural and functional properties of hPSC-CMs towards
those seen in adult CMs. Other developments needed for widespread hPSC-CM utility
include subtype specification, cost reduction of large scale differentiation and
elimination of the phenotyping bottleneck. This review will consider these factors in
the evolution of hPSC-CM technologies, as well as their integration into high content
industrial platforms that assess structure, mitochondrial function,
electrophysiology, calcium transients and contractility. This article is part of a
Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and
Environmental Cues in the Heart edited by Marcus Schaub and Hughes
Abriel.