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Abstract
Advances in the treatment of heart failure with reduced ejection fraction due to systolic dysfunction are engaging an ever-expanding compendium of molecular signaling targets. Well established approaches modifying hemodynamics and cell biology by neurohumoral receptor blockade are evolving, exploring the role and impact of modulating intracellular signaling pathways with more direct myocardial effects. Even well-tread avenues are being reconsidered with new insights into the signaling engaged and thus opportunity to treat underlying myocardial disease. This review explores therapies that have proven successful, those that have not, those that are moving into the clinic but whose utility remains to be confirmed, and those that remain in the experimental realm. The emphasis is on signaling pathways that are tractable for therapeutic manipulation. Of the approaches yet to be tested in humans, we chose those with a well-established experimental history, where clinical translation may be around the corner. The breadth of opportunities bodes well for the next generation of heart failure therapeutics.
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Affiliation(s)
| | | | - David A. Kass
- Division of Cardiology, Department of Medicine
- Department of Pharmacology and Molecular Sciences, The Johns Hopkins University, Baltimore Maryland, 21205
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2
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Newman MS, Nguyen T, Watson MJ, Hull RW, Yu HG. Transcriptome profiling reveals novel BMI- and sex-specific gene expression signatures for human cardiac hypertrophy. Physiol Genomics 2017; 49:355-367. [PMID: 28500252 DOI: 10.1152/physiolgenomics.00122.2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/17/2017] [Accepted: 05/11/2017] [Indexed: 01/06/2023] Open
Abstract
How obesity or sex may affect the gene expression profiles of human cardiac hypertrophy is unknown. We hypothesized that body-mass index (BMI) and sex can affect gene expression profiles of cardiac hypertrophy. Human heart tissues were grouped according to sex (male, female), BMI (lean<25 kg/m2, obese>30 kg/m2), or left ventricular hypertrophy (LVH) and non-LVH nonfailed controls (NF). We identified 24 differentially expressed (DE) genes comparing female with male samples. In obese subgroup, there were 236 DE genes comparing LVH with NF; in lean subgroup, there were seven DE genes comparing LVH with NF. In female subgroup, we identified 1,320 significant genes comparing LVH with NF; in male subgroup, there were 1,383 significant genes comparing LVH with NF. There were seven significant genes comparing obese LVH with lean NF; comparing male obese LVH with male lean NF samples we found 106 significant genes; comparing female obese LVH with male lean NF, we found no significant genes. Using absolute value of log2 fold-change > 2 or extremely small P value (10-20) as a criterion, we identified nine significant genes (HBA1, HBB, HIST1H2AC, GSTT1, MYL7, NPPA, NPPB, PDK4, PLA2G2A) in LVH, also found in published data set for ischemic and dilated cardiomyopathy in heart failure. We identified a potential gene expression signature that distinguishes between patients with high BMI or between men and women with cardiac hypertrophy. Expression of established biomarkers atrial natriuretic peptide A (NPPA) and B (NPPB) were already significantly increased in hypertrophy compared with controls.
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Affiliation(s)
- Mackenzie S Newman
- Physiology and Pharmacology, West Virginia University, Morgantown, West Virginia
| | - Tina Nguyen
- Physiology and Pharmacology, West Virginia University, Morgantown, West Virginia
| | - Michael J Watson
- Department of Surgery, Duke University, Durham, North Carolina; and
| | - Robert W Hull
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Han-Gang Yu
- Physiology and Pharmacology, West Virginia University, Morgantown, West Virginia;
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Thomas RC, Singh A, Cowley P, Myagmar BE, Montgomery MD, Swigart PM, De Marco T, Baker AJ, Simpson PC. A Myocardial Slice Culture Model Reveals Alpha-1A-Adrenergic Receptor Signaling in the Human Heart. ACTA ACUST UNITED AC 2016; 1:155-167. [PMID: 27453955 PMCID: PMC4955869 DOI: 10.1016/j.jacbts.2016.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The authors used 52 nonfailing and failing human hearts to develop a simple, high throughput left ventricular myocardial slice model that is stable by ATP and viability assays for at least 3 days. The model supports studies of signaling, contraction, and viral transduction. They use the model to show for the first time that the alpha-1A-adrenergic receptor, which is present at very low abundance in the human myocardium, activates cardioprotective ERK with nanomolar EC50 in failing heart slices and stimulates a positive inotropic effect. This model should be useful for translational studies, to test whether molecules discovered in basic experiments are functional in the human heart. Model for translational studies Human LV slices Simple, high throughput, viable Assays signaling and contraction Supports viral transduction Useful for proof-of-concept in man Shows the α1A-AR functions in human heart
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Affiliation(s)
- R Croft Thomas
- Department of Medicine, VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco
| | - Abhishek Singh
- Department of Medicine, VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco
| | - Patrick Cowley
- Department of Medicine, VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco
| | - Bat-Erdene Myagmar
- Department of Medicine, VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco
| | - Megan D Montgomery
- Department of Medicine, VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco
| | | | - Teresa De Marco
- Department of Medicine, University of California, San Francisco
| | - Anthony J Baker
- Department of Medicine, VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco
| | - Paul C Simpson
- Department of Medicine, VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco
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Copik AJ, Baldys A, Nguyen K, Sahdeo S, Ho H, Kosaka A, Dietrich PJ, Fitch B, Raymond JR, Ford APDW, Button D, Milla ME. Isoproterenol acts as a biased agonist of the alpha-1A-adrenoceptor that selectively activates the MAPK/ERK pathway. PLoS One 2015; 10:e0115701. [PMID: 25606852 PMCID: PMC4301629 DOI: 10.1371/journal.pone.0115701] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/26/2014] [Indexed: 11/24/2022] Open
Abstract
The α1A-AR is thought to couple predominantly to the Gαq/PLC pathway and lead to phosphoinositide hydrolysis and calcium mobilization, although certain agonists acting at this receptor have been reported to trigger activation of arachidonic acid formation and MAPK pathways. For several G protein-coupled receptors (GPCRs) agonists can manifest a bias for activation of particular effector signaling output, i.e. not all agonists of a given GPCR generate responses through utilization of the same signaling cascade(s). Previous work with Gαq coupling-defective variants of α1A-AR, as well as a combination of Ca2+ channel blockers, uncovered cross-talk between α1A-AR and β2-AR that leads to potentiation of a Gαq-independent signaling cascade in response to α1A-AR activation. We hypothesized that molecules exist that act as biased agonists to selectively activate this pathway. In this report, isoproterenol (Iso), typically viewed as β-AR-selective agonist, was examined with respect to activation of α1A-AR. α1A-AR selective antagonists were used to specifically block Iso evoked signaling in different cellular backgrounds and confirm its action at α1A-AR. Iso induced signaling at α1A-AR was further interrogated by probing steps along the Gαq /PLC, Gαs and MAPK/ERK pathways. In HEK-293/EBNA cells transiently transduced with α1A-AR, and CHO_α1A-AR stable cells, Iso evoked low potency ERK activity as well as Ca2+ mobilization that could be blocked by α1A-AR selective antagonists. The kinetics of Iso induced Ca2+ transients differed from typical Gαq- mediated Ca2+ mobilization, lacking both the fast IP3R mediated response and the sustained phase of Ca2+ re-entry. Moreover, no inositol phosphate (IP) accumulation could be detected in either cell line after stimulation with Iso, but activation was accompanied by receptor internalization. Data are presented that indicate that Iso represents a novel type of α1A-AR partial agonist with signaling bias toward MAPK/ERK signaling cascade that is likely independent of coupling to Gαq.
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Affiliation(s)
- Alicja. J. Copik
- Biochemical Pharmacology, Inflammation Discovery, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - Aleksander Baldys
- Nephrology Division, Department of Medicine, Medical University of South Carolina, and Medical and Research Services, Ralph H Johnson Veterans Affairs Medical Center, Charleston, South Carolina 29425, United States of America
| | - Khanh Nguyen
- Discovery Technologies, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - Sunil Sahdeo
- Biochemical Pharmacology, Inflammation Discovery, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - Hoangdung Ho
- Discovery Technologies, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - Alan Kosaka
- Discovery Technologies, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - Paul J. Dietrich
- Discovery Technologies, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - Bill Fitch
- Discovery Technologies, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - John R. Raymond
- Nephrology Division, Department of Medicine, Medical University of South Carolina, and Medical and Research Services, Ralph H Johnson Veterans Affairs Medical Center, Charleston, South Carolina 29425, United States of America
| | - Anthony P. D. W. Ford
- Biochemical Pharmacology, Inflammation Discovery, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - Donald Button
- Biochemical Pharmacology, Inflammation Discovery, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
| | - Marcos E. Milla
- Biochemical Pharmacology, Inflammation Discovery, Roche Palo Alto LLC, 3401 Hillview Drive, Palo Alto, CA 94304, United States of America
- * E-mail:
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O'Connell TD, Jensen BC, Baker AJ, Simpson PC. Cardiac alpha1-adrenergic receptors: novel aspects of expression, signaling mechanisms, physiologic function, and clinical importance. Pharmacol Rev 2013; 66:308-33. [PMID: 24368739 DOI: 10.1124/pr.112.007203] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Adrenergic receptors (AR) are G-protein-coupled receptors (GPCRs) that have a crucial role in cardiac physiology in health and disease. Alpha1-ARs signal through Gαq, and signaling through Gq, for example, by endothelin and angiotensin receptors, is thought to be detrimental to the heart. In contrast, cardiac alpha1-ARs mediate important protective and adaptive functions in the heart, although alpha1-ARs are only a minor fraction of total cardiac ARs. Cardiac alpha1-ARs activate pleiotropic downstream signaling to prevent pathologic remodeling in heart failure. Mechanisms defined in animal and cell models include activation of adaptive hypertrophy, prevention of cardiac myocyte death, augmentation of contractility, and induction of ischemic preconditioning. Surprisingly, at the molecular level, alpha1-ARs localize to and signal at the nucleus in cardiac myocytes, and, unlike most GPCRs, activate "inside-out" signaling to cause cardioprotection. Contrary to past opinion, human cardiac alpha1-AR expression is similar to that in the mouse, where alpha1-AR effects are seen most convincingly in knockout models. Human clinical studies show that alpha1-blockade worsens heart failure in hypertension and does not improve outcomes in heart failure, implying a cardioprotective role for human alpha1-ARs. In summary, these findings identify novel functional and mechanistic aspects of cardiac alpha1-AR function and suggest that activation of cardiac alpha1-AR might be a viable therapeutic strategy in heart failure.
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Affiliation(s)
- Timothy D O'Connell
- VA Medical Center (111-C-8), 4150 Clement St., San Francisco, CA 94121. ; or Dr. Timothy D. O'Connell, E-mail:
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Who needs a transplant and when? Curr Opin Organ Transplant 2012; 17:531-9. [PMID: 22890042 DOI: 10.1097/mot.0b013e3283574185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Heart transplantation remains the treatment of choice for patients with advanced heart failure. We review the current definition of optimal therapy, prediction of prognosis and revisit contraindications for transplant. RECENT FINDINGS Clinical trials of eplerenone and ivabradine were associated with improved prognosis, whereas others (nesiritide) were disappointing. Advances in cardiac resynchronization therapy and ventricular assist devices (VAD) have resulted in an expansion of their indications. Advances in catheter ablation for ventricular tachycardia have made this an uncommon indication for heart transplantation. Surgical ventricular reconstruction and mitral valve intervention have not resulted in survival benefit. Bypass surgery was associated with a lower mortality from cardiovascular causes. Prognostic risk scores have been developed in heart failure patients; however, ongoing refinements are needed. Selected patients with diabetes, HIV and pretransplant malignancy, now have favourable outcomes after heart transplantation. VAD as bridge to candidacy is an option in heart failure patients with 'fixed' pulmonary hypertension. Alternate listing strategies have also been studied to provide high-risk patients with an opportunity for heart transplantation. SUMMARY Heart failure patients should be on current optimal medical and device therapy with a poor prognosis before consideration for heart transplantation. An individualized approach to heart transplantation assessment is recommended.
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Nagai T, Komuro I. Gene and cytokine therapy for heart failure: molecular mechanisms in the improvement of cardiac function. Am J Physiol Heart Circ Physiol 2012; 303:H501-12. [PMID: 22777420 DOI: 10.1152/ajpheart.00130.2012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite significant advances in pharmacological and clinical treatment, heart failure (HF) remains a leading cause of morbidity and mortality worldwide. Many new therapeutic strategies, including cell transplantation, gene delivery, and cytokines or other small molecules, have been explored to treat HF. Recent advancement of our understanding of the molecules that regulate cardiac function uncover many of the therapeutic key molecules to treat HF. Furthermore, a theory of paracrine mechanism, which underlies the beneficial effects of cell therapy, leads us to search novel target molecules for genetic or pharmacological strategy. Gene therapy means delivery of genetic materials into cells to achieve therapeutic effects. Recently, gene transfer technology in the cardiovascular system has been improved and several therapeutic target genes have been started to examine in clinical research, and some of the promising results have been emerged. Among the various bioactive reagents, cytokines such as granulocyte colony-stimulating factor and erythropoietin have been well examined, and a number of clinical trials for acute myocardial infarction and chronic HF have been conducted. Although further research is needed in both preclinical and clinical areas in terms of molecular mechanisms, safety, and efficiency, both gene and cytokine therapy have a great possibility to open the new era of the treatment of HF.
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Affiliation(s)
- Toshio Nagai
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Baker AJ. Refueling the heart: Using 2-deoxy-ATP to enhance cardiac contractility. J Mol Cell Cardiol 2011; 51:883-4. [PMID: 22001677 DOI: 10.1016/j.yjmcc.2011.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 09/29/2011] [Indexed: 11/25/2022]
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