Human iPSC-cardiomyocyte models of insulin resistance demonstrate metabolic and contractile dysfunction that recapitulates diabetic cardiomyopathy

In type II diabetes (T2DM), the heart is exposed to hyperglycaemia, hyperlipidaemia, and hyperinsulinaemia, leading to insulin resistance and metabolic dysfunction, culminating in diabetic cardiomyopathy (DbCM). Human-centric models of DbCM are needed to provide mechanistic insights and therapeutic targets in a translationally relevant setting. We hypothesised that culturing human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) in an “insulin resistance” (IR) media, and assessing this using a systems biology approach, would offer a comprehensive evaluation of dysregulated pathways, establishing their suitability as a model of DbCM. Culturing 2D hiPSC-CMs in IR media induced insulin resistance and activated pathways implicated in DbCM, including metabolic remodelling, mitochondrial dysfunction, and endoplasmic reticulum stress. Adaptation to hypoxia, a key component of post-ischaemic remodelling, was blunted in the 2D IR hiPSC-CMs, highlighting impaired cellular responses to low oxygen conditions. Proteomic and transcriptomic analyses revealed significant enrichment of DbCM-related pathways, particularly those involved in metabolic dysregulation. In conclusion, 2D hiPSC-CMs cultured in IR media recapitulate key features of DbCM, including impaired adaptation to hypoxia, providing a valuable model for studying diabetic cardiomyopathy.