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Jin YK, Li XH, Wang W, Liu J, Zhang W, Fang YS, Zhang ZF, Dai HP, Ning W, Wang C. Follistatin-Like 1 Promotes Bleomycin-Induced Pulmonary Fibrosis through the Transforming Growth Factor Beta 1/Mitogen-Activated Protein Kinase Signaling Pathway. Chin Med J (Engl) 2018; 131:1917-1925. [PMID: 30082522 PMCID: PMC6085847 DOI: 10.4103/0366-6999.238151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Follistatin-like 1 (FSTL1) is a novel profibrogenic factor that induces pulmonary fibrosis (PF) through the transforming growth factor-beta 1 (TGF-β1)/Smad signaling. Little is known about its effects on PF through the non-Smad signaling, like the mitogen-activated protein kinase (MAPK) pathway. Therefore, this study aimed to investigate the role of FSTL1 in PF through the MAPK signaling pathway and its mechanisms in lung fibrogenesis. Methods PF was induced in Fstl1+/-and wild-type (WT) C57BL/6 mice with bleomycin. After 14 days, the mice were sacrificed, and lung tissues were stained with hematoxylin and eosin; the hydroxyproline content was measured to confirm PF. The mRNA and protein level of FSTL1 and the change of MAPK phosphorylation were measured by quantitative polymerase chain reaction and Western blotting. The effect of Fstl1 deficiency on fibroblasts differentiation was measured by Western blotting and cell immunofluorescence. MAPK signaling activation was measured by Western blotting in Fstl1+/- and WT fibroblasts treated with recombinant human FSTL1 protein. We pretreated mouse lung fibroblast cells with inhibitors of the extracellular signal-regulated kinase (ERK), p38, and Jun N-terminal kinase (JNK) signaling and analyzed their differentiation, proliferation, migration, and invasion by Western blotting, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide analysis, and transwell assays. The Student's t-test was used to compare the differences between two groups. Results Fstl1 deficiency attenuated phosphorylation of the ERK, p38, and JNK signaling in bleomycin-induced fibrotic lung tissue 14 days after injury (0.67 ± 0.05 vs. 1.22 ± 0.03, t = 14.92, P = 0.0001; 0.41 ± 0.01 vs. 1.15 ± 0.07; t = 11.19; P = 0.0004; and 0.41 ± 0.01 vs. 1.07 ± 0.07, t = 8.92, P = 0.0009; respectively), compared with WT lungs at the same time and in primary lung fibroblasts (0.82 ± 0.01 vs. 1.01 ± 0.04, t = 4.06, P = 0.0150; 1.04 ± 0.03 vs. 1.24 ± 0.03, t = 4.44, P = 0.0100; and 0.76 ± 0.05 vs. 0.99 ± 0.05, t = 4.48, P = 0.0100; respectively), compared with TGF-β1-stimulated WT group. Recombinant human FSTL1 protein in lung fibroblasts enhanced TGF-β1-mediated phosphorylation of the ERK (1.19 ± 0.08 vs. 0.55 ± 0.04, t = 6.99, P = 0.0020), p38 (1.18 ± 0.04 vs. 0.66 ± 0.03, t = 11.20, P = 0.0020), and JNK (1.11 ± 0.01 vs. 0.84 ± 0.04, t = 6.53, P = 0.0030), compared with the TGF-β1-stimulated WT group. Fstl1-deficient fibroblasts showed reduced alpha-smooth muscle actin (α-SMA) expression (0.70 ± 0.06 vs. 1.28 ± 0.11, t = 4.65, P = 0.0035, compared with the untreated WT group; 1.40 ± 0.05 vs. 1.76 ± 0.02, t = 6.31, P = 0.0007; compared with the TGF-β1-treated WT group). Compared with the corresponding condition in the control group, the TGF-β1/FSTL1-mediated α-SMA expression was significantly suppressed by pretreatment with an inhibitor of p38 (0.73 ± 0.01 vs. 1.13 ± 0.10, t = 3.92, P = 0.0078) and JNK (0.78 ± 0.03 vs. 1.08 ± 0.06, t = 4.40, P = 0.0046) signaling. The proliferation of mouse lung fibroblast cells (MLgs) significantly decreased after treatment of an inhibitor of p38 (0.30 ± 0.01 vs. 0.46 ± 0.03, t = 4.64, P = 0.0009), JNK (0.30 ± 0.01 vs. 0.49 ± 0.01, t = 12.84, P = 0.0001), and Smad2/3 (0.18 ± 0.02 vs. 0.46 ± 0.02, t = 12.69, P = 0.0001) signaling compared with the dimethylsulfoxide group. The migration and invasion cells of MLgs significantly decreased in medium pretreated with an inhibitor of p38 (70.17 ± 3.28 vs. 116.30 ± 7.11, t = 5.89, P = 0.0042 for the migratory cells; 19.87 ± 0.84 vs. 32.70 ± 0.95, t = 10.14, P = 0.0005 for the invasive cells), JNK (72.30 ± 3.85 vs. 116.30 ± 7.11, t = 5.44, P = 0.0056 for the migratory cells; 18.03 ± 0.94 vs. 32.70 ± 0.95, t = 11.00, P = 0.0004 for the invasive cells), and Smad2/3 (64.76 ± 1.41 vs. 116.30 ± 7.11, t = 7.11, P = 0.0021 for the migratory cells; 18.03 ± 0.94 vs. 32.70 ± 0.95, t = 13.29, P = 0.0002 for the invasive cells) signaling compared with the corresponding condition in the dimethylsulfoxide group. Conclusion FSTL1 affects lung fibroblast differentiation, proliferation, migration, and invasion through p38 and JNK signaling, and in this way, it might influence the development of PF.
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Affiliation(s)
- Yan-Kun Jin
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Department of Respiratory Disease, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Capital Medical University; Department of Respiratory Disease, Capital Medical University, Beijing 100020, China
| | - Xiao-He Li
- Department of Life Sciences, State Key Laboratory of Medicinal Chemical Biology, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Wang Wang
- Department of Respiratory Disease, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Capital Medical University; Department of Physiology and Pathophysiology, Capital Medical University, Beijing 100069, China
| | - Jie Liu
- Department of Respiratory Disease, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Capital Medical University; Department of Physiology and Pathophysiology, Capital Medical University, Beijing 100069, China
| | - Wei Zhang
- Department of Respiratory Disease, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Capital Medical University; Department of Physiology and Pathophysiology, Capital Medical University, Beijing 100069, China
| | - Yin-Shan Fang
- Department of Life Sciences, State Key Laboratory of Medicinal Chemical Biology, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Zhi-Fei Zhang
- Department of Respiratory Disease, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Capital Medical University; Department of Physiology and Pathophysiology, Capital Medical University, Beijing 100069, China
| | - Hua-Ping Dai
- Department of Respiratory Disease, Capital Medical University, Beijing 100020, China
| | - Wen Ning
- Department of Life Sciences, State Key Laboratory of Medicinal Chemical Biology, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Chen Wang
- Department of Respiratory Disease, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Capital Medical University; Department of Respiratory Disease, Capital Medical University, Beijing 100020, China
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Verjans R, Peters T, Beaumont FJ, van Leeuwen R, van Herwaarden T, Verhesen W, Munts C, Bijnen M, Henkens M, Diez J, de Windt LJ, van Nieuwenhoven FA, van Bilsen M, Goumans MJ, Heymans S, González A, Schroen B. MicroRNA-221/222 Family Counteracts Myocardial Fibrosis in Pressure Overload-Induced Heart Failure. Hypertension 2017; 71:280-288. [PMID: 29255073 DOI: 10.1161/hypertensionaha.117.10094] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/21/2017] [Accepted: 11/29/2017] [Indexed: 02/06/2023]
Abstract
Pressure overload causes cardiac fibroblast activation and transdifferentiation, leading to increased interstitial fibrosis formation and subsequently myocardial stiffness, diastolic and systolic dysfunction, and eventually heart failure. A better understanding of the molecular mechanisms underlying pressure overload-induced cardiac remodeling and fibrosis will have implications for heart failure treatment strategies. The microRNA (miRNA)-221/222 family, consisting of miR-221-3p and miR-222-3p, is differentially regulated in mouse and human cardiac pathology and inversely associated with kidney and liver fibrosis. We investigated the role of this miRNA family during pressure overload-induced cardiac remodeling. In myocardial biopsies of patients with severe fibrosis and dilated cardiomyopathy or aortic stenosis, we found significantly lower miRNA-221/222 levels as compared to matched patients with nonsevere fibrosis. In addition, miRNA-221/222 levels in aortic stenosis patients correlated negatively with the extent of myocardial fibrosis and with left ventricular stiffness. Inhibition of both miRNAs during AngII (angiotensin II)-mediated pressure overload in mice led to increased fibrosis and aggravated left ventricular dilation and dysfunction. In rat cardiac fibroblasts, inhibition of miRNA-221/222 derepressed TGF-β (transforming growth factor-β)-mediated profibrotic SMAD2 (mothers against decapentaplegic homolog 2) signaling and downstream gene expression, whereas overexpression of both miRNAs blunted TGF-β-induced profibrotic signaling. We found that the miRNA-221/222 family may target several genes involved in TGF-β signaling, including JNK1 (c-Jun N-terminal kinase 1), TGF-β receptor 1 and TGF-β receptor 2, and ETS-1 (ETS proto-oncogene 1). Our findings show that heart failure-associated downregulation of the miRNA-221/222 family enables profibrotic signaling in the pressure-overloaded heart.
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Affiliation(s)
- Robin Verjans
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Tim Peters
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Francisco Javier Beaumont
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Rick van Leeuwen
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Tessa van Herwaarden
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Wouter Verhesen
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Chantal Munts
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Mitchell Bijnen
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Michiel Henkens
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Javier Diez
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Leon J de Windt
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Frans A van Nieuwenhoven
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Marc van Bilsen
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Marie José Goumans
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Stephane Heymans
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Arantxa González
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.)
| | - Blanche Schroen
- From the Department of Cardiology (R.V., T.P., R.v.L., W.V., M.H., L.J.d.W., S.H., B.S.), Department of Physiology (C.M., F.A.v.N., M.v.B.), and Department of Internal Medicine (M.B.), CARIM School for Cardiovascular Diseases, Maastricht University, The Netherlands; Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain (F.J.B., J.D., A.G.); Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain (F.J.B., J.D., A.G.); CIBERCV, Carlos III Institute of Health, Madrid, Spain (F.J.B., J.D., A.G.); Department of Molecular Cell Biology, Leiden University Medical Biology Center, The Netherlands (T.v.H., M.J.G.); Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain (J.D.); Netherlands Heart Institute (ICIN), Utrecht; and Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology (CMVB), KU Leuven, Belgium (S.H.).
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