Flow cytometry of the myocardium: An end-to-end analysis of adult cardiomyocytes isolated from pig and mouse hearts

Selective therapeutic targeting of cardiomyocytes (CMs) and non-myocytes (NMs) within the heart is an active field of research. The success of those novel therapeutic strategies is linked to the ability to accurately assess uptake and gene delivery efficiencies in clinically relevant animal models. Nevertheless, quantification at the single cell level remains a significant challenge. While flow cytometry offers the possibility of an accurate and direct single-cell quantification, the unique structural and physical properties of CMs complicate the analysis. There are no standardized methods reported for the flow cytometry analysis of adult CMs, which is a significant pitfall in the field. Here, we address this gap and introduce a robust and optimized method for the successful flow cytometry analysis of isolated CMs. Starting from tissue digestion, we present a simple workflow for the isolation and characterization of CMs and NMs, tested and validated for pig and mouse. We demonstrate the versatility of this method through three biologically relevant applications. First, we introduce a model to quantify CMs nucleation based on DNA content distribution. Second, we assess cell-specific in vivo gene delivery with AAV-Luc in pig hearts. And last, we demonstrate how structural remodeling of CMs affects their light scattering properties, in a pressure overload-induced hypertrophy mouse model. Together, these findings establish a flexible and quantitative platform for single-cell analysis of cardiac cell populations in both basic and translational cardiovascular research.