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Mol Pharmacol. 2019 Nov 22. pii: mol.119.118018. doi: 10.1124/mol.119.118018. [Epub ahead of print]

Interventions in WNT signaling to induce cardiomyocyte proliferation: crosstalk with other pathways.

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Maastricht University


Myocardial infarction is a frequent cardiovascular event and a major cause for cardiomyocyte loss. In adult mammals, cardiomyocytes are traditionally considered to be terminally differentiated cells. Therefore, the wound healing response in the infarct area typically yields scar tissue, rather than newly formed cardiomyocytes. In the last decade, however, several lines of research have challenged the lack of proliferative capacity of the differentiated cardiomyocyte: studies in zebrafish and neonatal rodents have convincingly demonstrated the regenerative capacity of cardiomyocytes. Moreover, multiple signaling pathways have been identified in these models which - when activated in adult mammalian cardiomyocytes- can reactivate the cell cycle in these cells. However, cardiomyocytes frequently exit the cell cycle before symmetric division into daughter cells, leading to polyploidy and multinucleation. Now that there is more insight into the reactivation of the cell cycle machinery, other prerequisites for successful symmetric division of cardiomyocytes, such as the control of sarcomere disassembly to allow cytokinesis, require more investigation. This review aims to discuss the signaling pathways involved in cardiomyocyte proliferation, with a specific focus on WNT signaling. Comparing the conflicting results from in vitro and in vivo studies on this pathway illustrates that the interaction with other cells and structures around the infarct is likely to be essential to determine the outcome of these interventions. Moreover, the extensive crosstalk with other pathways calls for the identification of nodal points in the cell signaling, for dedifferentiation, cell cycle activation and cytokinesis, before cardiomyocyte proliferation can be moved forward towards clinical application as a cure of cardiac disease. SIGNIFICANCE STATEMENT: Evidence is mounting that proliferation of pre-existing cardiomyocytes can be stimulated to repair injury of the heart. In this review article, an overview is provided of the different signaling pathways implicated in cardiomyocyte proliferation with emphasis on WNT signaling, crosstalk between the pathways and controversial results obtained in vitro and in vivo. .


Cardiac ischemia; Cardiovascular disease; Cell proliferation; Insulin-like growth factor (IGF); MAP kinases; Signal transduction networks

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