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Paracrine Secretion of Cardiac‐Derived Erythropoietin is Required for Cardiogenesis

Erythropoietin (EPO) is widely recognized as the principle regulator of erythropoiesis, however, extra‐erythropoietic functions have been identified including cytoprotection, cardiac inotropy, cellular proliferation, and embryonic development. Whole body deletion of either EPO or the EPO receptor is embryonic lethal with impaired cardiogenesis leading to ventricular hypoplasia. While multiple extra‐renal tissue and cell types produce EPO, whether the heart is a direct source remains unclear. Human recombinant EPO increases myocardial contractility and confers cytoprotection against cardiac injury, which suggests a role for EPO signalling in the heart. Our objectives were to (1) confirm whether the heart produces EPO and (2) determine if there is a role for paracrine EPO signalling during cardiogenesis. We generated constitutive, cardiomyocyte‐specific EPO knockout mice driven by the Mlc2v promoter (EPOfl/fl:Mlc2v‐cre+/−; EPOΔ/Δ‐CM). We confirmed that the heart is a source of EPO expression with a distinct circadian rhythm in adult hearts and increased expression during embryonic development. During cardiogenesis, cardiac EPO expression was reduced, but not eliminated, in EPOΔ/Δ‐CM hearts with decreased cardiac cell proliferation. This suggests EPO signalling is partially compensated by an alternate cardiac cell type during cardiac development. In adult EPOΔ/Δ‐CM mice, global cardiac mass was preserved while cardiomyocyte cross‐sectional area was increased. Taken together, cellular cardiomyocyte hypertrophy in the absence of gross organ hypertrophy, and the observed reduction in cardiac cell proliferation during cardiogenesis, points towards a reduction in the overall number of cardiomyocytes in EPOΔ/Δ‐CM mice. Collectively, these data identify the first physiological roles of extra‐renal EPO by confirming that the heart is a source of EPO and that paracrine expression is required for cardiogenesis. Further, cardiac EPO expression is a complex interplay of multiple cell types where loss of cardiomyocyte production results in compensation from other cardiac cell lineages.