Interventions in WNT Signaling to Induce Cardiomyocyte Proliferation: Crosstalk with Other Pathways

Mol Pharmacol. 2020 Feb;97(2):90-101. doi: 10.1124/mol.119.118018. Epub 2019 Nov 22.


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, unable to proliferate. Therefore, the wound-healing response in the infarct area typically yields scar tissue rather than newly formed cardiomyocytes. In the last decade, several lines of evidence have challenged the lack of proliferative capacity of the differentiated cardiomyocyte: studies in zebrafish and neonatal mammals have convincingly demonstrated the regenerative capacity of cardiomyocytes. Moreover, multiple signaling pathways have been identified in these models that-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 wingless/int-1 protein 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. The extensive crosstalk with other pathways implicated in cardiomyocyte proliferation calls for the identification of nodal points in the cell signaling before cardiomyocyte proliferation can be moved forward toward 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 wingless/int-1 protein signaling, crosstalk between the pathways, and controversial results obtained in vitro and in vivo.

Publication types

  • Review

MeSH terms

  • Adaptor Proteins, Signal Transducing / antagonists & inhibitors
  • Adaptor Proteins, Signal Transducing / metabolism
  • Animals
  • Animals, Newborn
  • Cardiovascular Agents / pharmacology*
  • Cardiovascular Agents / therapeutic use
  • Cell Cycle / drug effects
  • Cell Differentiation
  • Cell Proliferation / radiation effects*
  • Cicatrix / pathology
  • Cicatrix / prevention & control*
  • Follistatin-Related Proteins / antagonists & inhibitors
  • Follistatin-Related Proteins / metabolism
  • Hippo Signaling Pathway
  • Humans
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / pathology
  • Myocytes, Cardiac / drug effects*
  • Myocytes, Cardiac / pathology
  • Neuregulins / antagonists & inhibitors
  • Neuregulins / metabolism
  • Protein Serine-Threonine Kinases / metabolism
  • Receptors, Notch / antagonists & inhibitors
  • Receptors, Notch / metabolism
  • Sarcomeres / drug effects
  • Sarcomeres / metabolism
  • Trans-Activators / antagonists & inhibitors
  • Trans-Activators / metabolism
  • Transcription Factors / antagonists & inhibitors
  • Transcription Factors / metabolism
  • Transcriptional Coactivator with PDZ-Binding Motif Proteins
  • Wnt Signaling Pathway / drug effects*
  • Wnt Signaling Pathway / physiology
  • YAP-Signaling Proteins
  • Zebrafish


  • Adaptor Proteins, Signal Transducing
  • Cardiovascular Agents
  • Follistatin-Related Proteins
  • Neuregulins
  • Receptors, Notch
  • Trans-Activators
  • Transcription Factors
  • Transcriptional Coactivator with PDZ-Binding Motif Proteins
  • WWTR1 protein, human
  • YAP-Signaling Proteins
  • YAP1 protein, human
  • Protein Serine-Threonine Kinases