Remodelado miocárdico y activación inmunitaria en pacientes con insuficiencia cardiaca

Plasma fibroblast activation protein is decreased in acute heart failure despite cardiac tissue upregulation

BACKGROUND

Cardiac fibroblast activation protein (FAP) has an emerging role in heart failure (HF). A paradoxical reduction in its levels in pathological conditions associated with acute processes has been observed. We aimed to identify FAP cardiac tissue expression and its relationship with the main cardiac fibrosis-related signaling pathways, and to compare plasma FAP levels in acute and chronic HF patients.

METHODS

Transcriptomic changes were assessed via mRNA/ncRNA-seq in left ventricle tissue from HF patients (n = 57) and controls (n = 10). Western blotting and immunohistochemistry were used to explore FAP protein levels and localization in cardiac tissue. ELISA was performed to examine plasma FAP levels in acute HF (n = 48), chronic HF (n = 15) and control samples (n = 7).

RESULTS

FAP overexpression in cardiac tissue is related to the expression of molecules directly involved in cardiac fibrosis, such as POSTN, THBS4, MFAP5, COL1A2 and COL3A1 (P < 0.001), and is directly and inversely related to pro- and antifibrotic microRNAs, respectively. The observed FAP overexpression is not reflected in plasma. Circulating FAP levels were lower in acute HF patients than in controls (P < 0.05), while chronic HF patients did not show significant changes. The clinical variables analyzed, such as functional class or etiology, do not affect plasma FAP concentrations.

CONCLUSIONS

We determined that in HF cardiac tissue, FAP is related to the main cardiac fibrosis signaling pathways as well as to pro- and antifibrotic microRNAs. Additionally, an acute phase of HF decreases plasma FAP levels despite the upregulation observed in cardiac tissue and regardless of other clinical conditions.

Role of microRNAs in cardiac remodelling: new insights and future perspectives

Cardiac remodelling is a key process in the progression of cardiovascular disease, implemented in myocardial infarction, valvular heart disease, myocarditis, dilated cardiomyopathy, atrial fibrillation and heart failure. Fibroblasts, extracellular matrix proteins, coronary vasculature, cardiac myocytes and ionic channels are all involved in this remodelling process. MicroRNAs (miRNAs) represent a sizable sub-group of small non-coding RNAs, which degrade or inhibit the translation of their target mRNAs, thus regulating gene expression and play an important role in a wide range of biologic processes. Recent studies have reported that miRNAs are aberrantly expressed in the cardiovascular system under some pathological conditions. Indeed, in vitro and in vivo models have revealed that miRNAs are essential for cardiac development and remodelling. Clinically, there is increasing evidence of the potential diagnostic role of miRNAs as potential diagnostic biomarkers and they may represent a novel therapeutic target in several cardiovascular disorders. This paper provides an overview of the impact of several miRNAs in electrical and structural remodelling of the cardiac tissue, and the diagnostic and therapeutic potential of miRNA in cardiovascular disease.

[Relationship between myocardial modelling and diastolic function in patients with essential hypertension]

BACKGROUND AND OBJECTIVES

To analyze the relationship between sFas and soluble TNF receptor 1 (sTNF-R1) with type iii (PIIINP) and i (PINP) amino-terminal propeptide procollagens, and diastole in hypertension (HT).

PATIENTS AND METHODS

A group of 253 Caucasian asymptomatic hypertensive patients (age 60±13 years, 139 males) were studied, in whom a physical examination, laboratory analyses (determination of serum PIIINP, PINP, sFas and by radioimmunoassay and ELISA, respectively), and echo-Doppler study were performed.

RESULTS

Serum PINP and PIIINP were increased in left ventricular hypertrophy compared to non-hypertrophy [41 (31-52) vs. 35 (28-47) μg/l, P=.010; and 4.33 (3.71-5.29) vs. 3.98 (3.49-4.58) μg/l, P=.005, respectively]. Furthermore, sFas and sTNF-R1 were also elevated [1.47 (1.2-1.77) vs. 1.37 (1.1-1.59), P=.012; and 466 (331-657) vs. 317 (260-427) μg/l, P<.0001, respectively]. Moreover, serum PIIINP was associated with sFas (r=.386, P<.0001) and sTNF-R1 (r=.298, P<.001); PINP was also associated with these cytokines (r=0.158, P=.011 and r=.241, P<.0001, respectively). Multivariable analyses included sFas (P<.0001) and sTNF-R1 (P<.0001) as independent factors related with serum PIIINP. Finally, marker concentrations were significantly related with left ventricular diastolic function parameters.

CONCLUSION

Procollagen and anti-apoptotic cytokine levels were increased in our hypertrophic patients. Furthermore, sFas and sTNF-R1 are independent related factors of serum PIIINP. Diastolic parameters were associated with myocardial fibrosis and anti-apoptotic cytokines.

Pro/Anti-inflammatory cytokine imbalance in postischemic left ventricular remodeling

OBJECTIVES

Cytokines play an important role in left ventricular remodeling consequent to myocardial ischemia. The aim of this study was to correlate cytokine production and lymphocyte apoptosis to post-ischemic left ventricular remodeling in patients affected by acute myocardial infarction (AMI) undergoing primary cutaneous angioplasty (PCI).

METHODS

In 40 patients, affected by AMI and undergoing PCI, we evaluated peripheral blood mononuclear cells (PBMCs), tumor necrosis factor-alpha (TNF-alpha) and interleukin 10 (IL10) production and apoptosis on day 1, day 3, day 7, 1 month and 6 months after PCI. Patients were divided into two subgroups of remodeling or not remodeling by echocardiographic criteria.

RESULTS

In the subgroup of remodeling patients, at each timepoint TNF-alpha production was increased significantly in comparison with the subgroup of not remodeling patients. IL10 production was statistically lower in remodeling subjects than in not remodeling ones 1 and 6 months after reperfusion. There were no differences between the two groups as regards lymphomonocyte apoptosis.

CONCLUSIONS

We found an increased production of pro-inflammatory cytokine TNF-alpha and a corresponding decrease of anti-inflammatory/regulatory cytokine IL10 in remodeling patients and we concluded that this cytokine imbalance resulted in pro-inflammatory effects which might contribute to the progression of left ventricular remodeling.