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Angelini A, Trial J, Saltzman AB, Malovannaya A, Cieslik KA. A defective mechanosensing pathway affects fibroblast-to-myofibroblast transition in the old male mouse heart. iScience 2023; 26:107283. [PMID: 37520701 PMCID: PMC10372839 DOI: 10.1016/j.isci.2023.107283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/12/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
The cardiac fibroblast interacts with an extracellular matrix (ECM), enabling myofibroblast maturation via a process called mechanosensing. Although in the aging male heart, ECM is stiffer than in the young mouse, myofibroblast development is impaired, as demonstrated in 2-D and 3-D experiments. In old male cardiac fibroblasts, we found a decrease in actin polymerization, α-smooth muscle actin (α-SMA), and Kindlin-2 expressions, the latter an effector of the mechanosensing. When Kindlin-2 levels were manipulated via siRNA interference, young fibroblasts developed an old-like fibroblast phenotype, whereas Kindlin-2 overexpression in old fibroblasts reversed the defective phenotype. Finally, inhibition of overactivated extracellular regulated kinases 1 and 2 (ERK1/2) in the old male fibroblasts rescued actin polymerization and α-SMA expression. Pathological ERK1/2 overactivation was also attenuated by Kindlin-2 overexpression. In contrast, old female cardiac fibroblasts retained an operant mechanosensing pathway. In conclusion, we identified defective components of the Kindlin/ERK/actin/α-SMA mechanosensing axis in aged male fibroblasts.
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Affiliation(s)
- Aude Angelini
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - JoAnn Trial
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alexander B. Saltzman
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
- Mass Spectrometry Proteomics Core, Baylor College of Medicine, Houston, TX, USA
| | - Anna Malovannaya
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
- Mass Spectrometry Proteomics Core, Baylor College of Medicine, Houston, TX, USA
| | - Katarzyna A. Cieslik
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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2
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Collins HE. Female cardiovascular biology and resilience in the setting of physiological and pathological stress. Redox Biol 2023; 63:102747. [PMID: 37216702 PMCID: PMC10209889 DOI: 10.1016/j.redox.2023.102747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/29/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
For years, females were thought of as smaller men with complex hormonal cycles; as a result, females have been largely excluded from preclinical and clinical research. However, in the last ten years, with the increased focus on sex as a biological variable, it has become clear that this is not the case, and in fact, male and female cardiovascular biology and cardiac stress responses differ substantially. Premenopausal women are protected from cardiovascular diseases, such as myocardial infarction and resultant heart failure, having preserved cardiac function, reduced adverse remodeling, and increased survival. Many underlying biological processes that contribute to ventricular remodeling differ between the sexes, such as cellular metabolism; immune cell responses; cardiac fibrosis and extracellular matrix remodeling; cardiomyocyte dysfunction; and endothelial biology; however, it is unclear how these changes afford protection to the female heart. Although many of these changes are dependent on protection provided by female sex hormones, several of these changes occur independent of sex hormones, suggesting that the nature of these changes is more complex than initially thought. This may be why studies focused on the cardiovascular benefits of hormone replacement therapy in post-menopausal women have provided mixed results. Some of the complexity likely stems from the fact that the cellular composition of the heart is sexually dimorphic and that in the setting of MI, different subpopulations of these cell types are apparent. Despite the documented sex-differences in cardiovascular (patho)physiology, the underlying mechanisms that contribute are largely unknown due to inconsistent findings amongst investigators and, in some cases, lack of rigor in reporting and consideration of sex-dependent variables. Therefore, this review aims to describe current understanding of the sex-dependent differences in the myocardium in response to physiological and pathological stressors, with a focus on the sex-dependent differences that contribute to post-infarction remodeling and resultant functional decline.
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Affiliation(s)
- Helen E Collins
- Center for Cardiometabolic Science, Christina Lee Brown Envirome Institute, Division of Environmental Medicine, Department of Medicine, Delia B. Baxter Research Building, University of Louisville, 580 S. Preston S, Louisville, KY 40202, USA.
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3
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Doudin A, Riebeling T, Staab J, Menon PR, Lühder F, Wirths O, Vinkemeier U, Ivetic A, Meyer T. Lack of STAT1 co-operative DNA binding protects against adverse cardiac remodelling in acute myocardial infarction. Front Cardiovasc Med 2023; 10:975012. [PMID: 36923955 PMCID: PMC10008942 DOI: 10.3389/fcvm.2023.975012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/02/2023] [Indexed: 03/03/2023] Open
Abstract
In this study, we addressed the functional significance of co-operative DNA binding of the cytokine-driven transcription factor STAT1 (signal transducer and activator of transcription 1) in an experimental murine model of acute myocardial infarction (MI). STAT1 knock-in mice expressing a phenylalanine-to-alanine substitution at position 77 in the STAT1 amino-terminal domain were examined for the early clinical effects produced by ligation of the left anterior descending coronary artery (LAD), an established model for MI. The F77A mutation has been previously reported to disrupt amino-terminal interactions between adjacent STAT1 dimers resulting in impaired tetramerization and defective co-operative binding on DNA, while leaving other protein functions unaffected. Our results demonstrate that a loss of STAT1 tetramer stabilization improves survival of adult male mice and ameliorates left ventricular dysfunction in female mice, as determined echocardiographically by an increased ejection fraction and a reduced left intra-ventricular diameter. We found that the ratio of STAT3 to STAT1 protein level was higher in the infarcted tissue in knock-in mice as compared to wild-type (WT) mice, which was accompanied by an enhanced infiltration of immune cells in the infarcted area, as determined by histology. Additionally, RNA sequencing of the infarcted tissue 24 h after LAD ligation revealed an upregulation of inflammatory genes in the knock-in mice, as compared to their WT littermates. Concomitantly, genes involved in oxidative phosphorylation and other metabolic pathways showed a significantly more pronounced downregulation in the infarcted tissue from STAT1F77A/F77A mice than in WT animals. Based on these results, we propose that dysfunctional STAT1 signalling owing to a lack of oligomerisation results in a compensatory increase in STAT3 expression and promotes early infiltration of immune cells in the infarcted area, which has beneficial effects on left ventricular remodelling in early MI following LAD ligation.
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Affiliation(s)
- Asmma Doudin
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Theresa Riebeling
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Julia Staab
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Priyanka Rajeev Menon
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Fred Lühder
- Institute for Neuroimmunology and Multiple Sclerosis Research, University Medical Centre Göttingen, Göttingen, Germany
| | - Oliver Wirths
- Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
| | - Uwe Vinkemeier
- Division of Infections, Immunity and Microbes, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Aleksandar Ivetic
- British Heart Foundation Centre, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, United Kingdom
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Göttingen, and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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4
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Defining the timeline of periostin upregulation in cardiac fibrosis following acute myocardial infarction in mice. Sci Rep 2022; 12:21863. [PMID: 36529756 PMCID: PMC9760637 DOI: 10.1038/s41598-022-26035-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
After myocardial infarction (MI), the heart's reparative response to the ischemic insult and the related loss of cardiomyocytes involves cardiac fibrosis, in which the damaged tissue is replaced with a fibrous scar. Although the scar is essential to prevent ventricular wall rupture in the infarction zone, it expands over time to remote, non-infarct areas, significantly increasing the extent of fibrosis and markedly altering cardiac structure. Cardiac function in this scenario deteriorates, thereby increasing the probability of heart failure and the risk of death. Recent works have suggested that the matricellular protein periostin, known to be involved in fibrosis, is a candidate therapeutic target for the regulation of MI-induced fibrosis and remodeling. Different strategies for the genetic manipulation of periostin have been proposed previously, yet those works did not properly address the time dependency between periostin activity and cardiac fibrosis. Our study aimed to fill that gap in knowledge and fully elucidate the explicit timing of cellular periostin upregulation in the infarcted heart to enable the safer and more effective post-MI targeting of periostin-producing cells. Surgical MI was performed in C57BL/6J and BALB/c mice by ligation of the left anterior descending coronary artery. Flow cytometry analyses of cells derived from the infarcted hearts and quantitative real-time PCR of the total cellular RNA revealed that periostin expression increased during days 2-7 and peaked on day 7 post-infarct, regardless of mouse strain. The established timeline for cellular periostin expression in the post-MI heart is a significant milestone toward the development of optimal periostin-targeted gene therapy.
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Picone DS, Kodithuwakku V, Mayer CC, Chapman N, Rehman S, Climie RE. Sex differences in pressure and flow waveform physiology across the life course. J Hypertens 2022; 40:2373-2384. [PMID: 36093877 DOI: 10.1097/hjh.0000000000003283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD) has long been deemed a disease of old men. However, in 2019 CVD accounted for 35% of all deaths in women and, therefore, remains the leading cause of death in both men and women. There is increasing evidence to show that risk factors, pathophysiology and health outcomes related to CVD differ in women compared with men, yet CVD in women remains understudied, underdiagnosed and undertreated. Differences exist between the sexes in relation to the structure of the heart and vasculature, which translate into differences in blood pressure and flow waveform physiology. These physiological differences between women and men may represent an important explanatory factor contributing to the sex disparity in CVD presentation and outcomes but remain understudied. In this review we aim to describe sex differences in arterial pressure and flow waveform physiology and explore how they may contribute to differences in CVD in women compared to men. Given that unfavourable alterations in the cardiovascular structure and function can start as early as in utero, we report sex differences in waveform physiology across the entire life course.
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Affiliation(s)
- Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Christopher C Mayer
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | - Niamh Chapman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Sabah Rehman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Rachel E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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6
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Sex Differences in Cardiovascular Diseases: A Matter of Estrogens, Ceramides, and Sphingosine 1-Phosphate. Int J Mol Sci 2022; 23:ijms23074009. [PMID: 35409368 PMCID: PMC8999971 DOI: 10.3390/ijms23074009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
The medical community recognizes sex-related differences in pathophysiology and cardiovascular disease outcomes (CVD), culminating with heart failure. In general, pre-menopausal women tend to have a better prognosis than men. Explaining why this occurs is not a simple matter. For decades, sex hormones like estrogens (Es) have been identified as one of the leading factors driving these sex differences. Indeed, Es seem protective in women as their decline, during and after menopause, coincides with an increased CV risk and HF development. However, clinical trials demonstrated that E replacement in post-menopause women results in adverse cardiac events and increased risk of breast cancer. Thus, a deeper understanding of E-related mechanisms is needed to provide a vital gateway toward better CVD prevention and treatment in women. Of note, sphingolipids (SLs) and their metabolism are strictly related to E activities. Among the SLs, ceramide and sphingosine 1-phosphate play essential roles in mammalian physiology, particularly in the CV system, and appear differently modulated in males and females. In keeping with this view, here we explore the most recent experimental and clinical observations about the role of E and SL metabolism, emphasizing how these factors impact the CV system.
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7
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Masjoan Juncos JX, Shakil S, Ahmad A, Mariappan N, Zafar I, Bradley WE, Dell’Italia LJ, Ahmad A, Ahmad S. Sex differences in cardiopulmonary effects of acute bromine exposure. Toxicol Res (Camb) 2021; 10:1064-1073. [PMID: 34733491 PMCID: PMC8557644 DOI: 10.1093/toxres/tfab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/29/2021] [Accepted: 07/26/2021] [Indexed: 01/07/2023] Open
Abstract
Accidental occupational bromine (Br>2>) exposures are common, leading to significant morbidity and mortality; however, the specific effects of Br>2> inhalation in female victims are unclear. Our studies demonstrated that acute high-concentration Br>2> inhalation is fatal, and cardiac injury and dysfunction play an important role in Br>2> toxicity in males. In this study, we exposed female Sprague Dawley rats, age-matched to those males from previously studied, to 600 ppm Br>2> for 45 min and assessed their survival, cardiopulmonary injury and cardiac function after exposure. Br>2> exposure caused serious mortality in female rats (59%) 48 h after exposure. Rats had severe clinical distress, reduced heart rates and oxygen saturation after Br>2> inhalation as was previously reported with male animals. There was significant lung injury and edema when measured 24 h after exposure. Cardiac injury biomarkers were also significantly elevated 24 h after Br>2> inhalation. Echocardiography and hemodynamic studies were also performed and revealed that the mean arterial pressure was not significantly elevated in females. Other functional cardiac parameters were also altered. Aside from the lack of elevation of blood pressure, all other changes observed in female animals were also present in male animals as reported in our previous study. These studies are important to understand the toxicity mechanisms to generate therapies and better-equip first responders to deal with these specific scenarios after bromine spill disasters.>.
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Affiliation(s)
- Juan Xavier Masjoan Juncos
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Shazia Shakil
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Aamir Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Nithya Mariappan
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Iram Zafar
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Wayne E Bradley
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Department of Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Louis J Dell’Italia
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Department of Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Aftab Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Shama Ahmad
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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8
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Chavva H, Brazeau DA, Denvir J, Primerano DA, Fan J, Seeley SL, Rorabaugh BR. Methamphetamine-induced changes in myocardial gene transcription are sex-dependent. BMC Genomics 2021; 22:259. [PMID: 33845768 PMCID: PMC8042975 DOI: 10.1186/s12864-021-07561-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/26/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Prior work demonstrated that female rats (but not their male littermates) exposed to methamphetamine become hypersensitive to myocardial ischemic injury. Importantly, this sex-dependent effect persists following 30 days of subsequent abstinence from the drug, suggesting that it may be mediated by long term changes in gene expression that are not rapidly reversed following discontinuation of methamphetamine use. The goal of the present study was to determine whether methamphetamine induces sex-dependent changes in myocardial gene expression and whether these changes persist following subsequent abstinence from methamphetamine. RESULTS Methamphetamine induced changes in the myocardial transcriptome were significantly greater in female hearts than male hearts both in terms of the number of genes affected and the magnitude of the changes. The largest changes in female hearts involved genes that regulate the circadian clock (Dbp, Per3, Per2, BMal1, and Npas2) which are known to impact myocardial ischemic injury. These genes were unaffected by methamphetamine in male hearts. All changes in gene expression identified at day 11 returned to baseline by day 30. CONCLUSIONS These data demonstrate that female rats are more sensitive than males to methamphetamine-induced changes in the myocardial transcriptome and that methamphetamine does not induce changes in myocardial transcription that persist long term after exposure to the drug has been discontinued.
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Affiliation(s)
- Hasitha Chavva
- Department of Pharmaceutical Science, Marshall University School of Pharmacy, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Daniel A Brazeau
- Department of Pharmacy Practice, Administration, and Research, Marshall University School of Pharmacy, 1 John Marshall Drive, Huntington, WV, 25755, USA
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - James Denvir
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Donald A Primerano
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Jun Fan
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Sarah L Seeley
- Department of Pharmaceutical and Biomedical Sciences, Ohio Northern University College of Pharmacy, 525 South Main Street, Ada, OH, 45810, USA
| | - Boyd R Rorabaugh
- Department of Pharmaceutical Science, Marshall University School of Pharmacy, 1 John Marshall Drive, Huntington, WV, 25755, USA.
- Department of Biomedical Science, Marshall University School of Medicine, 1 John Marshall Drive, Huntington, WV, 25755, USA.
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9
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Stone G, Choi A, Meritxell O, Gorham J, Heydarpour M, Seidman CE, Seidman JG, Aranki SF, Body SC, Carey VJ, Raby BA, Stranger BE, Muehlschlegel JD. Sex differences in gene expression in response to ischemia in the human left ventricular myocardium. Hum Mol Genet 2020; 28:1682-1693. [PMID: 30649309 DOI: 10.1093/hmg/ddz014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/20/2018] [Accepted: 01/09/2019] [Indexed: 01/28/2023] Open
Abstract
Sex differences exist in the prevalence, presentation and outcomes of ischemic heart disease (IHD). Females have higher risk of heart failure post-myocardial infarction relative to males and are two to three times more likely to die after coronary artery bypass grafting surgery. We examined sex differences in human myocardial gene expression in response to ischemia. Left ventricular biopsies from 68 male/46 female patients undergoing aortic valve replacement surgery were obtained at baseline and after a median 74 min of cold cardioplegic arrest/ischemia. Transcriptomes were quantified by RNA-sequencing. Cell-type enrichment analysis was used to estimate the identity and relative proportions of different cell types in each sample. A sex-specific response to ischemia was observed for 271 genes. Notably, the expression FAM5C, PLA2G4E and CYP1A1 showed an increased expression in females compared to males due to ischemia and DIO3, MT1G and CMA1 showed a decreased expression in females compared to males due to ischemia. Functional annotation analysis revealed sex-specific modulation of the oxytocin signaling pathway and common pathway of fibrin clot formation. Expression quantitative trait locus (eQTL) analysis identified variant-by-sex interaction eQTLs, indicative of sex differences in the genotypic effects on gene expression. Cell-type enrichment analysis showed sex-bias in proportion of specific cell types. Common lymphoid progenitor cells and M2 macrophages were found to increase in female samples from pre- to post-ischemia, but no change was observed in male samples. These differences in response to myocardial ischemia provide insight into the sexual dimorphism of IHD and may aid in the development of sex-specific therapies that reduce myocardial injury.
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Affiliation(s)
- Gregory Stone
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley Choi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Oliva Meritxell
- Institute for Genomics and Systems Biology, Section of Genetic Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Joshua Gorham
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jon G Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Sary F Aranki
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vincent J Carey
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin A Raby
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Stranger
- Institute for Genomics and Systems Biology, Section of Genetic Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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10
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DeLeon-Pennell KY, Lindsey ML. Somewhere over the sex differences rainbow of myocardial infarction remodeling: hormones, chromosomes, inflammasome, oh my. Expert Rev Proteomics 2019; 16:933-940. [PMID: 31483157 DOI: 10.1080/14789450.2019.1664293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Cardiovascular disease is a major cause of death in both men and women. While women are protected until the onset of menopause, after menopause women have increased risk of adverse cardiovascular disease events. Animal models of myocardial infarction recapitulate many of the sex differences observed in humans, and proteomics evaluations offer mechanistic insights to explain sex differences.Areas covered: In this review, we will discuss how proteomics has helped us understand the hormonal, chromosomal, and immune mechanisms behind sex differences in response to ischemic injury and the development of heart failure.Expert opinion: There are a number of ways in which proteomics has and will continue to facilitate our understanding of sex differences in cardiac remodeling after myocardial infarction.
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Affiliation(s)
- Kristine Y DeLeon-Pennell
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, and Research Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Merry L Lindsey
- Department of Cellular and Integrative Physiology, Center for Heart and Vascular Research, University of Nebraska Medical Center, and Research Service, Nebraska-Western Iowa Health Care System, Omaha, NE, USA
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11
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Froese N, Wang H, Zwadlo C, Wang Y, Grund A, Gigina A, Hofmann M, Kilian K, Scharf G, Korf-Klingebiel M, Melchert A, Signorini MER, Halloin C, Zweigerdt R, Martin U, Gruh I, Wollert KC, Geffers R, Bauersachs J, Heineke J. Anti-androgenic therapy with finasteride improves cardiac function, attenuates remodeling and reverts pathologic gene-expression after myocardial infarction in mice. J Mol Cell Cardiol 2018; 122:114-124. [PMID: 30118791 DOI: 10.1016/j.yjmcc.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/21/2018] [Accepted: 08/13/2018] [Indexed: 01/03/2023]
Abstract
Maladaptive cardiac remodeling after myocardial infarction (MI) is increasingly contributing to the prevalence of chronic heart failure. Women show less severe remodeling, a reduced mortality and a better systolic function after MI compared to men. Although sex hormones are being made responsible for these differences, it remains currently unknown how this could be translated into therapeutic strategies. Because we had recently demonstrated that inhibition of the conversion of testosterone to its highly active metabolite dihydrotestosterone (DHT) by finasteride effectively reduces cardiac hypertrophy and improves heart function during pressure overload, we asked here whether this strategy could be applied to post-MI remodeling. We found increased abundance of DHT and increased expression of androgen responsive genes in the mouse myocardium after experimental MI. Treatment of mice with finasteride for 21 days (starting 7 days after surgery), reduced myocardial DHT levels and markedly attenuated cardiac dysfunction as well as hypertrophic remodeling after MI. Histological and molecular analyses showed reduced MI triggered interstitial fibrosis, reduced cardiomyocyte hypertrophy and increased capillary density in the myocardium of finasteride treated mice. Mechanistically, this was associated with decreased activation of myocardial growth-signaling pathways, a comprehensive normalization of pathological myocardial gene-expression as revealed by RNA deep-sequencing and with direct effects of finasteride on cardiac fibroblasts and endothelial cells. In conclusion, we demonstrated a beneficial role of anti-androgenic treatment with finasteride in post-MI remodeling of mice. As finasteride is already approved for the treatment of benign prostate disease, it could potentially be evaluated as therapeutic strategy for heart failure after MI.
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Affiliation(s)
- Natali Froese
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Honghui Wang
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Carolin Zwadlo
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Yong Wang
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Andrea Grund
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Anna Gigina
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Melanie Hofmann
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Katja Kilian
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Gesine Scharf
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Mortimer Korf-Klingebiel
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Anna Melchert
- Leibniz Forschungslaboratorien für Biotechnologie und künstliche Organe, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Maria Elena Ricci Signorini
- Leibniz Forschungslaboratorien für Biotechnologie und künstliche Organe, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Caroline Halloin
- Leibniz Forschungslaboratorien für Biotechnologie und künstliche Organe, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Robert Zweigerdt
- Leibniz Forschungslaboratorien für Biotechnologie und künstliche Organe, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Ulrich Martin
- Leibniz Forschungslaboratorien für Biotechnologie und künstliche Organe, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Ina Gruh
- Leibniz Forschungslaboratorien für Biotechnologie und künstliche Organe, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Kai C Wollert
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Robert Geffers
- Genomanalytik, Helmholtz-Zentrum für Infektionsforschung GmbH, 38124 Braunschweig, Germany
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany
| | - Joerg Heineke
- Klinik für Kardiologie und Angiologie, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, 30625 Hannover, Germany; Abteilung für Herz- und Kreislaufforschung, European Center for Angioscience (ECAS), Medizinische Fakultät Mannheim der Universität Heidelberg, 68167 Mannheim, Germany.
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12
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Huxley VH, Kemp SS. Sex-Specific Characteristics of the Microcirculation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:307-328. [PMID: 30051393 DOI: 10.1007/978-3-319-77932-4_20] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The requirements of metabolizing tissue are both continuous and variable; accordingly, the microvasculature serving that tissue must be similarly dynamic. Just as it is recognized that males and females of the same species have differing metabolic requirements, is it not likely that the microvasculature serving these tissues will differ by sex? This section focusing on the constituents of the microcirculation identifies what is known presently about the role sex plays in matching metabolic demand with microvascular function and areas requiring additional study. Many of the identified sex differences are subtle and easily ignored. In the aggregate, though, they can profoundly alter phenotype, especially under stressful conditions including pregnancy, exercise, and disease states ranging from diabetes to heart failure. Although the features presently identified to "have sex" range from differences in growth, morphology, protein expression, and intracellular signaling, males and females alike achieve homeostasis, likely by different means. Studies of microvascular sexual dimorphism are also identifying age as an independent but interacting factor requiring additional attention. Overall, attempting to ignore either sex and/or age is inappropriate and will prevent the design and implementation of appropriate interventions to present, ameliorate, or correct microvascular dysfunction.
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Affiliation(s)
- Virginia H Huxley
- Center for Gender Physiology, Department of Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO, USA.
| | - Scott S Kemp
- Center for Gender Physiology, Department of Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO, USA
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13
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Tsuji M, Kawasaki T, Matsuda T, Arai T, Gojo S, Takeuchi JK. Sexual dimorphisms of mRNA and miRNA in human/murine heart disease. PLoS One 2017; 12:e0177988. [PMID: 28704447 PMCID: PMC5509429 DOI: 10.1371/journal.pone.0177988] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/05/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sexual dimorphisms are well recognized in various cardiac diseases such as ischemic cardiomyopathy (ICM), hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Thorough understanding of the underlying genetic programs is crucial to optimize treatment strategies specified for each gender. By performing meta-analysis and microarray analysis, we sought to comprehensively characterize the sexual dimorphisms in the healthy and diseased heart at the level of both mRNA and miRNA transcriptome. RESULTS Existing mRNA microarray data of both mouse and human heart were integrated, identifying dozens/ hundreds of sexually dimorphic genes in healthy heart, ICM, HCM, and DCM. These sexually dimorphic genes overrepresented gene ontologies (GOs) important for cardiac homeostasis. Further, microarray of miRNA, isolated from mouse sham left ventricle (LV) (n = 6 & n = 5 for male & female) and chronic MI LV (n = 19 & n = 19) and from human normal LV (n = 6 & n = 6) and ICM LV (n = 4 & n = 5), was conducted. This revealed that 13 mouse miRNAs are sexually dimorphic in MI and 6 in normal heart. In human, 3 miRNAs were sexually dimorphic in ICM and 15 in normal heart. These data revealed miRNA-mRNA networks that operate in a sexually-biased fashion. CONCLUSIONS mRNA and miRNA transcriptome of normal and disease heart show significant sex differences, which might impact the cardiac homeostasis. Together this study provides the first comprehensive picture of the genome-wide program underlying the heart sexual dimorphisms, laying the foundation for gender specific treatment strategies.
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Affiliation(s)
- Masato Tsuji
- Division of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical Dental University, Tokyo, Japan
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
- * E-mail: (MT); (JKT)
| | - Takanori Kawasaki
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeru Matsuda
- Department of Mathematical Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Satoshi Gojo
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun K. Takeuchi
- Division of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical Dental University, Tokyo, Japan
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
- * E-mail: (MT); (JKT)
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14
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Regitz-Zagrosek V, Kararigas G. Mechanistic Pathways of Sex Differences in Cardiovascular Disease. Physiol Rev 2017; 97:1-37. [PMID: 27807199 DOI: 10.1152/physrev.00021.2015] [Citation(s) in RCA: 395] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Major differences between men and women exist in epidemiology, manifestation, pathophysiology, treatment, and outcome of cardiovascular diseases (CVD), such as coronary artery disease, pressure overload, hypertension, cardiomyopathy, and heart failure. Corresponding sex differences have been studied in a number of animal models, and mechanistic investigations have been undertaken to analyze the observed sex differences. We summarize the biological mechanisms of sex differences in CVD focusing on three main areas, i.e., genetic mechanisms, epigenetic mechanisms, as well as sex hormones and their receptors. We discuss relevant subtypes of sex hormone receptors, as well as genomic and nongenomic, activational and organizational effects of sex hormones. We describe the interaction of sex hormones with intracellular signaling relevant for cardiovascular cells and the cardiovascular system. Sex, sex hormones, and their receptors may affect a number of cellular processes by their synergistic action on multiple targets. We discuss in detail sex differences in organelle function and in biological processes. We conclude that there is a need for a more detailed understanding of sex differences and their underlying mechanisms, which holds the potential to design new drugs that target sex-specific cardiovascular mechanisms and affect phenotypes. The comparison of both sexes may lead to the identification of protective or maladaptive mechanisms in one sex that could serve as a novel therapeutic target in one sex or in both.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Georgios Kararigas
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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15
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Blenck CL, Harvey PA, Reckelhoff JF, Leinwand LA. The Importance of Biological Sex and Estrogen in Rodent Models of Cardiovascular Health and Disease. Circ Res 2016; 118:1294-312. [PMID: 27081111 DOI: 10.1161/circresaha.116.307509] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/21/2016] [Indexed: 01/01/2023]
Abstract
Nearly one-third of deaths in the United States are caused by cardiovascular disease (CVD) each year. In the past, CVD was thought to mainly affect men, leading to the exclusion of women and female animals from clinical studies and preclinical research. In light of sexual dimorphisms in CVD, a need exists to examine baseline cardiac differences in humans and the animals used to model CVD. In humans, sex differences are apparent at every level of cardiovascular physiology from action potential duration and mitochondrial energetics to cardiac myocyte and whole-heart contractile function. Biological sex is an important modifier of the development of CVD with younger women generally being protected, but this cardioprotection is lost later in life, suggesting a role for estrogen. Although endogenous estrogen is most likely a mediator of the observed functional differences in both health and disease, the signaling mechanisms involved are complex and are not yet fully understood. To investigate how sex modulates CVD development, animal models are essential tools and should be useful in the development of therapeutics. This review will focus on describing the cardiovascular sexual dimorphisms that exist both physiologically and in common animal models of CVD.
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Affiliation(s)
- Christa L Blenck
- From the Department of Molecular, Cellular, and Developmental Biology & BioFrontiers Institute, University of Colorado, Boulder (C.L.B., P.A.H., L.A.L.); and Women's Health Research Center and Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (J.F.R.)
| | - Pamela A Harvey
- From the Department of Molecular, Cellular, and Developmental Biology & BioFrontiers Institute, University of Colorado, Boulder (C.L.B., P.A.H., L.A.L.); and Women's Health Research Center and Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (J.F.R.)
| | - Jane F Reckelhoff
- From the Department of Molecular, Cellular, and Developmental Biology & BioFrontiers Institute, University of Colorado, Boulder (C.L.B., P.A.H., L.A.L.); and Women's Health Research Center and Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (J.F.R.)
| | - Leslie A Leinwand
- From the Department of Molecular, Cellular, and Developmental Biology & BioFrontiers Institute, University of Colorado, Boulder (C.L.B., P.A.H., L.A.L.); and Women's Health Research Center and Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson (J.F.R.).
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16
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Xu H, van Deel ED, Johnson MR, Opić P, Herbert BR, Moltzer E, Sooranna SR, van Beusekom H, Zang WF, Duncker DJ, Roos-Hesselink JW. Pregnancy mitigates cardiac pathology in a mouse model of left ventricular pressure overload. Am J Physiol Heart Circ Physiol 2016; 311:H807-14. [PMID: 27371681 DOI: 10.1152/ajpheart.00056.2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/27/2016] [Indexed: 02/05/2023]
Abstract
In Western countries heart disease is the leading cause of maternal death during pregnancy. The effect of pregnancy on the heart is difficult to study in patients with preexisting heart disease. Since experimental studies are scarce, we investigated the effect of pressure overload, produced by transverse aortic constriction (TAC) in mice, on the ability to conceive, pregnancy outcome, and maternal cardiac structure and function. Four weeks of TAC produced left ventricular (LV) hypertrophy and dysfunction with marked interstitial fibrosis, decreased capillary density, and induced pathological cardiac gene expression. Pregnancy increased relative LV and right ventricular weight without affecting the deterioration of LV function following TAC. Surprisingly, the TAC-induced increase in relative heart and lung weight was mitigated by pregnancy, which was accompanied by a trend towards normalization of capillary density and natriuretic peptide type A expression. Additionally, the combination of pregnancy and TAC increased the cardiac phosphorylation of c-Jun, and STAT1, but reduced phosphoinositide 3-kinase phosphorylation. Finally, TAC did not significantly affect conception rate, pregnancy duration, uterus size, litter size, and pup weight. In conclusion, we found that, rather than exacerbating the changes associated with cardiac pressure overload, pregnancy actually attenuated pathological LV remodeling and mitigated pulmonary congestion, and pathological gene expression produced by TAC, suggesting a positive effect of pregnancy on the pressure-overloaded heart.
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Affiliation(s)
- Hong Xu
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples Republic of China
| | - Elza D van Deel
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Mark R Johnson
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, United Kingdom; and
| | - Petra Opić
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Bronwen R Herbert
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, United Kingdom; and
| | - Els Moltzer
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Suren R Sooranna
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, United Kingdom; and
| | - Heleen van Beusekom
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Wang-Fu Zang
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, Peoples Republic of China
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, The Netherlands;
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17
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Eclov JA, Qian Q, Redetzke R, Chen Q, Wu SC, Healy CL, Ortmeier SB, Harmon E, Shearer GC, O'Connell TD. EPA, not DHA, prevents fibrosis in pressure overload-induced heart failure: potential role of free fatty acid receptor 4. J Lipid Res 2015; 56:2297-308. [PMID: 26435012 DOI: 10.1194/jlr.m062034] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Indexed: 01/06/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is half of all HF, but standard HF therapies are ineffective. Diastolic dysfunction, often secondary to interstitial fibrosis, is common in HFpEF. Previously, we found that supra-physiologic levels of ω3-PUFAs produced by 12 weeks of ω3-dietary supplementation prevented fibrosis and contractile dysfunction following pressure overload [transverse aortic constriction (TAC)], a model that resembles aspects of remodeling in HFpEF. This raised several questions regarding ω3-concentration-dependent cardioprotection, the specific role of EPA and DHA, and the relationship between prevention of fibrosis and contractile dysfunction. To achieve more clinically relevant ω3-levels and test individual ω3-PUFAs, we shortened the ω3-diet regimen and used EPA- and DHA-specific diets to examine remodeling following TAC. The shorter diet regimen produced ω3-PUFA levels closer to Western clinics. Further, EPA, but not DHA, prevented fibrosis following TAC. However, neither ω3-PUFA prevented contractile dysfunction, perhaps due to reduced uptake of ω3-PUFA. Interestingly, EPA did not accumulate in cardiac fibroblasts. However, FFA receptor 4, a G protein-coupled receptor for ω3-PUFAs, was sufficient and required to block transforming growth factor β1-fibrotic signaling in cultured cardiac fibroblasts, suggesting a novel mechanism for EPA. In summary, EPA-mediated prevention of fibrosis could represent a novel therapy for HFpEF.
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Affiliation(s)
- Julie A Eclov
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
| | - Qingwen Qian
- Cardiovascular Research, Sanford Research, Sioux Falls, SD
| | - Rebecca Redetzke
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Quanhai Chen
- Cardiovascular Research, Sanford Research, Sioux Falls, SD
| | - Steven C Wu
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
| | - Chastity L Healy
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
| | | | - Erin Harmon
- Cardiovascular Research, Sanford Research, Sioux Falls, SD
| | - Gregory C Shearer
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Timothy D O'Connell
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
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18
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Antonio EL, Serra AJ, dos Santos AA, Vieira SS, Silva JMA, Yoshizaki A, Sofia RR, Tucci PJF. Are there gender differences in left ventricular remodeling after myocardial infarction in rats? REVISTA BRASILEIRA DE CIRURGIA CARDIOVASCULAR : ORGAO OFICIAL DA SOCIEDADE BRASILEIRA DE CIRURGIA CARDIOVASCULAR 2015; 30:70-6. [PMID: 25859870 PMCID: PMC4389530 DOI: 10.5935/1678-741.20140093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 06/02/2014] [Indexed: 11/21/2022]
Abstract
Objective An unclear issue is whether gender may influence at cardiac remodeling after
myocardial infarction (MI). We evaluated left ventricle remodeling in female
and male rats post-MI. Methods Rats were submitted to anterior descending coronary occlusion.
Echocardiographic evaluations were performed on the first and sixth week
post-occlusion to determine myocardial infarction size and left ventricle
systolic function (FAC, fractional area change). Pulsed Doppler was applied
to analyze left ventricle diastolic function using the following parameters:
E wave, A wave, E/A ratio. Two-way ANOVA was applied for comparisons,
complemented by the Bonferroni test. A P≤=0.05 was
considered significant. Results There were no significant differences between genders for morphometric
parameters on first (MI [Female (FE): 44.0±5.0 vs. Male (MA): 42.0±3.0%];
diastolic [FE: 0.04±0.003 vs. MA: 0.037±0.005, mm/g] and systolic [FE:
0.03±0.0004 vs. MA: 0.028±0.005, mm/g] diameters of left ventricle) and
sixth (MI [FE: 44.0±5.0 vs. MA: 42.0±3.0, %]; diastolic [FE: 0.043±0.01 vs.
MA: 0.034±0.005, mm/g] and systolic [FE: 0.035±0.01 vs. MA: 0.027±0.005,
mm/g] of LV) week. Similar findings were reported for left ventricle
functional parameters on first (FAC [FE: 34.0±6.0 vs. MA: 32.0±4.0, %]; wave
E [FE: 70.0±18.0 vs. MA: 73.0±14.0, cm/s]; wave A [FE: 20.0±12.0 vs. MA:
28.0±13.0, cm/s]; E/A [FE: 4.9±3.4 vs. MA: 3.3±1.8]) and sixth (FAC [FE:
29.0±7.0 vs. MA: 31.0±7.0, %]; wave E [FE: 85.0±18.0 vs. MA: 87.0±20.0,
cm/s]; wave A [FE: 20.0±11.0 vs. MA: 28.0±17.0, cm/s]; E/A [FE: 6.2±4.0 vs.
MA: 4.6±3.4]) week. Conclusion Gender does not influence left ventricle remodeling post-MI in rats.
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Affiliation(s)
- Ednei Luiz Antonio
- Laboratório de Fisiologia e Fisiopatologia Cardíacas, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Stella Sousa Vieira
- Laboratório de Fisiologia e Fisiopatologia Cardíacas, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Amanda Yoshizaki
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Nove de Julho, São Paulo, SP, Brazil
| | | | - Paulo José Ferreira Tucci
- Laboratório de Fisiologia e Fisiopatologia Cardíacas, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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19
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Van Aelst LN, Voss S, Carai P, Van Leeuwen R, Vanhoutte D, Sanders-van Wijk S, Eurlings L, Swinnen M, Verheyen FK, Verbeken E, Nef H, Troidl C, Cook SA, Brunner-La Rocca HP, Möllmann H, Papageorgiou AP, Heymans S. Osteoglycin Prevents Cardiac Dilatation and Dysfunction After Myocardial Infarction Through Infarct Collagen Strengthening. Circ Res 2015; 116:425-36. [DOI: 10.1161/circresaha.116.304599] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale:
To maintain cardiac mechanical and structural integrity after an ischemic insult, profound alterations occur within the extracellular matrix. Osteoglycin is a small leucine-rich proteoglycan previously described as a marker of cardiac hypertrophy.
Objective:
To establish whether osteoglycin may play a role in cardiac integrity and function after myocardial infarction (MI).
Methods and Results:
Osteoglycin expression is associated with collagen deposition and scar formation in mouse and human MI. Absence of osteoglycin in mice resulted in significantly increased rupture-related mortality with tissue disruption, intramyocardial bleeding, and increased cardiac dysfunction, despite equal infarct sizes. Surviving osteoglycin null mice had greater infarct expansion in comparison with wild-type mice because of impaired collagen fibrillogenesis and maturation in the infarcts as revealed by electron microscopy and collagen polarization. Absence of osteoglycin did not affect cardiomyocyte hypertrophy in the remodeling remote myocardium. In cultured fibroblasts, osteoglycin knockdown or supplementation did not alter transforming growth factor-β signaling. Adenoviral overexpression of osteoglycin in wild-type mice significantly improved collagen quality, thereby blunting cardiac dilatation and dysfunction after MI. In osteoglycin null mice, adenoviral overexpression of osteoglycin was unable to prevent rupture-related mortality because of insufficiently restoring osteoglycin protein levels in the heart. Finally, circulating osteoglycin levels in patients with heart failure were significantly increased in the patients with a previous history of MI compared with those with nonischemic heart failure and correlated with survival, left ventricular volumes, and other markers of fibrosis.
Conclusions:
Increased osteoglycin expression in the infarct scar promotes proper collagen maturation and protects against cardiac disruption and adverse remodeling after MI. In human heart failure, osteoglycin is a promising biomarker for ischemic heart failure.
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Affiliation(s)
- Lucas N.L. Van Aelst
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Sandra Voss
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Paolo Carai
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Rick Van Leeuwen
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Davy Vanhoutte
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Sandra Sanders-van Wijk
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Luc Eurlings
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Melissa Swinnen
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Fons K. Verheyen
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Eric Verbeken
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Holger Nef
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Christian Troidl
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Stuart A. Cook
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Hans-Peter Brunner-La Rocca
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Helge Möllmann
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Anna-Pia Papageorgiou
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
| | - Stephane Heymans
- From the Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, Catholic University of Leuven, Leuven, Belgium (L.N.L.V.A., P.C., A.-P.P., S.H.); Department of Cardiology (L.N.L.V.A., M.S.) and Department of Pathology (E.V.), University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (S.V., H.N., C.T., H.M.); Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), University Hospital
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Murphy E, Steenbergen C. Estrogen regulation of protein expression and signaling pathways in the heart. Biol Sex Differ 2014; 5:6. [PMID: 24612699 PMCID: PMC3975301 DOI: 10.1186/2042-6410-5-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/21/2014] [Indexed: 01/20/2023] Open
Abstract
Sex differences in cardiovascular disease and cardiac physiology have been reported in humans as well as in animal models. Premenopausal women have reduced cardiovascular disease compared to men, but the incidence of cardiovascular disease in women increases following menopause. Sex differences in cardiomyocytes likely contribute to the differences in male-female physiology and response to disease. Sex differences in the heart have been noted in electrophysiology, contractility, signaling, metabolism, and cardioprotection. These differences appear to be due, at least in part, to differences in gene and protein expression as well as in posttranslational protein modifications. This review will focus primarily on estrogen-mediated male-female differences in protein expression and signaling pathways in the heart and cardiac cells. It should be emphasized that these basic differences are not intrinsically beneficial or detrimental per se; the difference can be good or bad depending on the context and circumstances.
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Affiliation(s)
- Elizabeth Murphy
- Laboratory of Cardiac Physiology, Systems Biology Center, NHLBI, NIH, Bethesda, MD 20824-0105, USA
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21
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Abstract
Estrogen is a potent steroid with pleiotropic effects, which have yet to be fully elucidated. Estrogen has both nuclear and non-nuclear effects. The rapid response to estrogen, which involves a membrane associated estrogen receptor(ER) and is protective, involves signaling through PI3K, Akt, and ERK 1/2. The nuclear response is much slower, as the ER-estrogen complex moves to the nucleus, where it functions as a transcription factor, both activating and repressing gene expression. Several different ERs regulate the specificity of response to estrogen, and appear to have specific effects in cardiac remodeling and the response to injury. However, much remains to be understood about the selectivity of these receptors and their specific effects on gene expression. Basic studies have demonstrated that estrogen treatment prevents apoptosis and necrosis of cardiac and endothelial cells. Estrogen also attenuates pathologic cardiac hypertrophy. Estrogen may have great benefit in aging as an anti-inflammatory agent. However, clinical investigations of estrogen have had mixed results, and not shown the clear-cut benefit of more basic investigations. This can be explained in part by differences in study design: in basic studies estrogen treatment was used immediately or shortly after ovariectomy, while in some key clinical trials, estrogen was given years after menopause. Further basic research into the underlying molecular mechanisms of estrogen's actions is essential to provide a better comprehension of the many properties of this powerful hormone.
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Affiliation(s)
- A A Knowlton
- Molecular and Cellular Cardiology, Department of Medicine, University of California, Davis, CA 95616, USA.
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22
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Puzianowska-Kuźnicka M. ESR1 in myocardial infarction. Clin Chim Acta 2012; 413:81-7. [DOI: 10.1016/j.cca.2011.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/19/2011] [Accepted: 10/20/2011] [Indexed: 11/17/2022]
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23
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van Almen GC, Swinnen M, Carai P, Verhesen W, Cleutjens JPM, D'hooge J, Verheyen FK, Pinto YM, Schroen B, Carmeliet P, Heymans S. Absence of thrombospondin-2 increases cardiomyocyte damage and matrix disruption in doxorubicin-induced cardiomyopathy. J Mol Cell Cardiol 2011; 51:318-28. [PMID: 21624372 DOI: 10.1016/j.yjmcc.2011.05.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 05/11/2011] [Accepted: 05/11/2011] [Indexed: 11/28/2022]
Abstract
Clinical use of the antineoplastic agent doxorubicin (DOX) is limited by its cardiomyocyte toxicity. Attempts to decrease cardiomyocyte injury showed promising results in vitro, but failed to reduce the adverse effects of DOX in vivo, suggesting that other mechanisms contribute to its cardiotoxicity as well. Evidence that DOX also induces cardiac injury by compromising extracellular matrix integrity is lacking. The matricellular protein thrombospondin-2 (TSP-2) is known for its matrix-preserving function, and for modulating cellular function. Here, we investigated whether TSP-2 modulates the process of doxorubicin-induced cardiomyopathy (DOX-CMP). TSP-2-knockout (TSP-2-KO) and wild-type (WT) mice were treated with DOX (2 mg/kg/week) for 12 weeks to induce DOX-CMP. Mortality was significantly increased in TSP-2-KO compared to WT mice. Surviving DOX-treated TSP-2-KO mice had depressed cardiac function compared to WT animals, accompanied by increased cardiomyocyte apoptosis and matrix damage. Enhanced myocyte damage in the absence of TSP-2 was associated with impaired activation of the Akt signaling pathway in TSP-2-KO compared to WT. The absence of TSP-2, in vivo and in vitro, reduced Akt activation both under non-treated conditions and after DOX. Importantly, inhibition of Akt phosphorylation in cardiomyocytes significantly reduced TSP-2 expression, unveiling a unique feedback loop between Akt and TSP-2. Finally, enhanced matrix disruption in DOX-treated TSP-2-KO hearts went along with increased matrix metalloproteinase-2 levels. Taken together, this study is the first to provide evidence for the implication of the matrix element TSP-2 in protecting against DOX-induced cardiac injury and dysfunction.
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Affiliation(s)
- Geert C van Almen
- Center for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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