Stabilisation of HIF signalling extends epicardial activation and neonatal heart regeneration

Reviewer #1 (Public review):

Summary:

The manuscript by Gamen et al. analyzed the functional role of HIF signaling in the epicardium, providing evidence that stabilization of the hypoxia signaling pathway might contribute to neonatal heart regeneration. By generating different conditionally mouse mutants and performing pharmacological interventions, the authors demonstrate that stabilizing HIF signaling enhances cardiac regeneration after MI in P7 neonatal hearts.

Strengths:

The study presents convincing genetic and pharmacological approaches to the role of hypoxia signaling in enhancing the regenerative potential of the epicardium.

Weaknesses:

The major weakness is the lack of convincing evidence demonstrating the role of hypoxia signaling in EMT modulation in epicardial cells. Additionally, novel experimental approaches should be performed to allow for the translation of these findings to the clinical arena.

Reviewer #2 (Public review):

Summary:

In this study, Gamen et al. investigated the roles of hypoxia and HIF1a signaling in regulating epicardial function during cardiac development and neonatal heart regeneration. They found that WT1⁺ epicardial cells become hypoxic and begin expressing HIF1a from mid-gestation onward. During development, epicardial HIF1a signaling regulates WT1 expression and promotes coronary vasculature formation. In the postnatal heart, genetic and pharmacological upregulation of HIF1a sustained epicardial activation and improved regenerative outcomes.

Strengths:

HIF1a signaling was manipulated in an epicardium-specific manner using appropriate genetic tools.

Weaknesses:

There appears to be a discrepancy between some of the conclusions and the provided histological data. Additionally, the study does not offer mechanistic insight into the functional recovery observed.

Reviewer #3 (Public review):

Summary:

The authors' research here was to understand the role of hypoxia and hypoxia-induced transcription factor Hif-1a in the epicardium. The authors noted that hypoxia was prevalent in the embryonic heart, and this persisted into neonatal stages until postnatal day 7 (P7). Hypoxic regions in the heart were noted in the outer layer of the heart, and expression of Hif-1a coincided with the epicardial gene WT1. It has been documented that at P7, the mouse heart cannot regenerate after myocardial infarction, and the authors speculated that the change in epicardial hypoxic conditions could play a role in regeneration. The authors then used genetic and pharmacological tools to increase the activity of Hif genes in the heart and noted that there was a significant improvement in cardiac function when Hif-1a was active in the epicardium. The authors speculated that the presence of Hif-1a improved cell survival.

Strengths:

A focus on hypoxia and its effects on the epicardium in development and after myocardial infarction. This study outlines the potential to extend the regenerative time window in neonatal mammalian hearts.

Weaknesses:

While the observations of improved cardiac function are clear, the exact mechanism of how increased Hif-1a activity causes these effects is not completely revealed. The authors mention improved myocardium survival, but do not include studies to demonstrate this.

There is an indication that fibrosis is decreased in hearts where Hif activity is prolonged, but there are no studies to link hypoxia and fibrosis.