Proteome modulation by opposite inotropic drugs in human engineered cardiac tissue revealed by topology-driven cross-modal integration

Engineered heart tissues (EHTs) represent an innovative platform enabling physiologically relevant in vitro evaluation of drug-induced cardiac responses. While functional characterization remains central to EHTs, molecular profiling is increasingly used to elucidate mechanisms underlying drug-induced phenotypes. Proteomics provides broad molecular characterization of drug responses at the protein level, yet the complexity, heterogeneity, and high dimensionality of proteomics datasets challenge conventional statistical approaches, which are not designed for cross-modal integration and streamlined multi-omics analysis. In this study, we developed an innovative framework based on topological data analysis (TDA) for the integration of large proteomics profiles and functional readouts to investigate system-level responses to drugs with opposing inotropic effects, epinephrine and doxorubicin. Samples were organized into a topological connectivity network according to multimodal similarity enabling simultaneous exploration of treatments, cardiac function and proteome alterations. Highly correlated features were then used for pathway enrichment analysis, which revealed strong similarities between the enrichment profiles associated with contractile force and epinephrine. These findings are consistent with the positive inotropic effect of epinephrine, whereas doxorubicin exhibited an opposing enrichment profile. Energy homeostasis, mitochondrial translation and proteostasis emerged as the major cellular processes displaying opposite associations with the two inotropic drugs, highlighting a link between cardiac contractility and perturbations in these processes. In conclusion, our TDA-based framework successfully integrated functional and proteomic data to uncover treatment-specific remodeling in EHTs, offering a modular and scalable approach that could be adapted to other in vitro organ models for systems-level mechanistic studies and next-generation drug development.