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J Med Virol . SARS-CoV-2 Spike Protein-Mediated Cardiac Dysfunction: Structural Abnormalities, Impaired Calcium Dynamics, and Gene Expression Change

tetano

Editor, Senior Moderator
J Med Virol


. 2026 Jan;98(1):e70789.
doi: 10.1002/jmv.70789. SARS-CoV-2 Spike Protein-Mediated Cardiac Dysfunction: Structural Abnormalities, Impaired Calcium Dynamics, and Gene Expression Changes in Human Stem Cell-Derived Cardiomyocytes

Chen-Yu Huang[SUP] 1 2 3 4 5 [/SUP], Chia-Chi Cheng[SUP] 1 [/SUP], Si-Han Chen[SUP] 1 [/SUP], Dayna Cheng[SUP] 3 [/SUP], Sheng-Hsuan Wang[SUP] 1 [/SUP], Chiao-Hsuan Chao[SUP] 1 6 [/SUP], Chi-Yen Lee[SUP] 1 [/SUP], Jen-Ren Wang[SUP] 1 2 3 7 8 [/SUP]



Affiliations
Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has resulted in more than 7.1 million deaths worldwide since 2019 and is increasingly recognized for its cardiovascular complications beyond respiratory disease. Growing evidence suggests that the SARS-CoV-2 spike protein itself, present during infection or after vaccination, may directly contribute to cardiac dysfunction, including myocarditis, through interaction with angiotensin-converting enzyme 2 (ACE2) receptors expressed in cardiomyocytes. To investigate these effects, we established a lentiviral-based SARS-CoV-2 pseudovirus system expressing spike proteins from the Wuhan and Delta variants and examined their impact on human embryonic stem cell-derived cardiomyocytes (ESC-CMs). Exposure to pseudovirus resulted in significant increases in sarcomere length and promoted syncytium formation in ESC-CMs. Moreover, infection with either Wuhan or Delta spike pseudoviruses caused marked early disturbances in intracellular calcium transient dynamics as early as 1.5 hours post-infection, with partial recovery observed by 24 hours. Transcriptomic analyses further revealed significant dysregulation of key cardiac-related genes involved in cell junction organization, structural integrity, ion channel function, and calcium handling. Together, these findings demonstrate the utility of a lentiviral pseudovirus platform for modeling SARS-CoV-2-induced cardiac injury and highlight a direct pathogenic role of the spike protein in cardiac structural, functional, and molecular abnormalities.

Keywords: COVID‐19; SARS‐CoV‐2; calcium transient; cardiac dysfunction; pseudovirus; spike protein.

 
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