Locomotion results from the interaction between muscles and the nervous system. Dysfunction of such cells results in deadly diseases such as spinal muscular atrophy (SMA) and amyotrophic lateral sclerosis (ALS). These diseases often show regional selectivity but the underlying reasons remain obscure due to the lack of a suitable model system. In previous work of my laboratory, we established a 3D neuromuscular organoid (NMO) model that allows the simultaneous generation of spinal cord neurons and skeletal muscle cells from human pluripotent stem cells (hPSCs) through a bipotent neuromesodermal progenitor (NMP). NMPs, located in the posterior part of the embryo, are driving axial elongation and coordinated growth of the trunk neuromuscular system. We coaxed hPSC derived NMPs to develop into neuromuscular organoids that form functional neuromuscular junctions supported by the presence of terminal Schwann cells and central pattern generator-like circuits. Thus, we are in the unique position to study in an organoid model the regulatory mechanisms involved in the formation and maintenance of the human neuromuscular system, and the disruption of these mechanisms in diseases. We will (i) identify the molecular requirements for the Generation of Position Specific (GPS) organoids representing distinct spinal cord segments, (ii) use NMOs to model and study ALS and SMA including the establishment of a drug screening platform and (iii) assemble hPSC-derived cerebral organoids and NMOs to include in the model human corticospinal tracts. In the long term, the information gained will have important implications for understanding and eventually treating neuromuscular diseases.

Dilated Cardiomyopathy (DCM) is a heart muscle disorder characterised by thinning and stretching of the heart ventricles, making it harder for the heart to pump blood (systolic dysfunction). This disorder, with an estimated prevalence of up to 1/250, predominantly affects younger adults. It is associated with significant morbidity and mortality, including heart failure and sudden cardiac death, with end-stage DCM being the leading indication for heart transplantation. The current disease burden in DCM is largely attributable to two important gaps in scientific knowledge: Firstly, our understanding of the aetiology and genetic architecture of DCM remains limited, hindering the utility of genetic testing in clinical patient management. Secondly, there are limited therapeutic options for DCM patients. Existing therapies are generic and target symptoms. No curative treatments exist, apart from invasive heart transplantation and there are no approved therapies targeting underlying molecular disease mechanisms. A fuller understanding of the genetic architecture of DCM and knowledge of the genes and genetic variants involved are critically needed to provide solutions for these unmet medical needs. The DCM-NEXT consortium combines world-leading interdisciplinary expertise and resources of 8 investigators in the fields of DCM, deep clinical phenotyping, cardiogenomics, cardiac transcriptomics, artificial intelligence, in silico drug target discovery and functional studies. They will uniquely leverage their unparalleled cohort of 11,750 DCM probands and relatives with extensive clinical and omics data. Through cutting-edge genomic and cardiac transcriptomic studies, the project aims to (1) revolutionise genetic testing and patient stratification for more precise prediction of disease onset, progression and risk of major adverse cardiac events; and (2) accelerate development of novel therapies by identifying and validating targets involved in pathogenesis of DCM.