High-throughput screening of tyrosine kinase inhibitor cardiotoxicity with human induced pluripotent stem cells

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Science Translational Medicine  15 Feb 2017:
Vol. 9, Issue 377, eaaf2584
DOI: 10.1126/scitranslmed.aaf2584

Failing fast for tyrosine kinase inhibitors

Discovery early in its life cycle that an anticancer drug causes heart damage (a common side effect) can halt development—saving money, time, and perhaps lives. To this end, Sharma and colleagues derived heart cells from human induced pluripotent stem cells and then examined how a battery of anticancer tyrosine kinase inhibitors altered their physiology. By measuring cell death, contraction, excitability, calcium dynamics, and signal transduction and integrating the results, they calculated a drug-specific “cardiac safety index.” This index proved highly informative, with low values corresponding to those drugs known to cause heart problems in patients. The analysis even revealed that VEGFR2-inhibiting drugs caused cells to try to compensate for the toxic effects by up-regulating protective insulin/IGF pathways, prompting the authors to devise a combination treatment that may limit the toxicity of this class of drug. This screening method is expected to reveal early on whether potential anticancer drugs are cardiotoxic.


Tyrosine kinase inhibitors (TKIs), despite their efficacy as anticancer therapeutics, are associated with cardiovascular side effects ranging from induced arrhythmias to heart failure. We used human induced pluripotent stem cell–derived cardiomyocytes (hiPSC-CMs), generated from 11 healthy individuals and 2 patients receiving cancer treatment, to screen U.S. Food and Drug Administration–approved TKIs for cardiotoxicities by measuring alterations in cardiomyocyte viability, contractility, electrophysiology, calcium handling, and signaling. With these data, we generated a “cardiac safety index” to reflect the cardiotoxicities of existing TKIs. TKIs with low cardiac safety indices exhibit cardiotoxicity in patients. We also derived endothelial cells (hiPSC-ECs) and cardiac fibroblasts (hiPSC-CFs) to examine cell type–specific cardiotoxicities. Using high-throughput screening, we determined that vascular endothelial growth factor receptor 2 (VEGFR2)/platelet-derived growth factor receptor (PDGFR)–inhibiting TKIs caused cardiotoxicity in hiPSC-CMs, hiPSC-ECs, and hiPSC-CFs. With phosphoprotein analysis, we determined that VEGFR2/PDGFR-inhibiting TKIs led to a compensatory increase in cardioprotective insulin and insulin-like growth factor (IGF) signaling in hiPSC-CMs. Up-regulating cardioprotective signaling with exogenous insulin or IGF1 improved hiPSC-CM viability during cotreatment with cardiotoxic VEGFR2/PDGFR-inhibiting TKIs. Thus, hiPSC-CMs can be used to screen for cardiovascular toxicities associated with anticancer TKIs, and the results correlate with clinical phenotypes. This approach provides unexpected insights, as illustrated by our finding that toxicity can be alleviated via cardioprotective insulin/IGF signaling.

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