1
|
Pușcașu C, Zanfirescu A, Negreș S, Șeremet OC. Exploring the Multifaceted Potential of Sildenafil in Medicine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2190. [PMID: 38138293 PMCID: PMC10744870 DOI: 10.3390/medicina59122190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Phosphodiesterase type 5 (PDE5) is pivotal in cellular signalling, regulating cyclic guanosine monophosphate (cGMP) levels crucial for smooth muscle relaxation and vasodilation. By targeting cGMP for degradation, PDE5 inhibits sustained vasodilation. PDE5 operates in diverse anatomical regions, with its upregulation linked to various pathologies, including cancer and neurodegenerative diseases. Sildenafil, a selective PDE5 inhibitor, is prescribed for erectile dysfunction and pulmonary arterial hypertension. However, considering the extensive roles of PDE5, sildenafil might be useful in other pathologies. This review aims to comprehensively explore sildenafil's therapeutic potential across medicine, addressing a gap in the current literature. Recognising sildenafil's broader potential may unveil new treatment avenues, optimising existing approaches and broadening its clinical application.
Collapse
Affiliation(s)
| | - Anca Zanfirescu
- Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Traian Vuia 6, 020956 Bucharest, Romania; (C.P.); (S.N.); (O.C.Ș.)
| | | | | |
Collapse
|
2
|
Smolgovsky S, Bayer AL, Kaur K, Sanders E, Aronovitz M, Filipp ME, Thorp EB, Schiattarella GG, Hill JA, Blanton RM, Cubillos-Ruiz JR, Alcaide P. Impaired T cell IRE1α/XBP1 signaling directs inflammation in experimental heart failure with preserved ejection fraction. J Clin Invest 2023; 133:e171874. [PMID: 37874641 PMCID: PMC10721145 DOI: 10.1172/jci171874] [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: 04/28/2023] [Accepted: 10/17/2023] [Indexed: 10/26/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a widespread syndrome with limited therapeutic options and poorly understood immune pathophysiology. Using a 2-hit preclinical model of cardiometabolic HFpEF that induces obesity and hypertension, we found that cardiac T cell infiltration and lymphoid expansion occurred concomitantly with cardiac pathology and that diastolic dysfunction, cardiomyocyte hypertrophy, and cardiac phospholamban phosphorylation were T cell dependent. Heart-infiltrating T cells were not restricted to cardiac antigens and were uniquely characterized by impaired activation of the inositol-requiring enzyme 1α/X-box-binding protein 1 (IRE1α/XBP1) arm of the unfolded protein response. Notably, selective ablation of XBP1 in T cells enhanced their persistence in the heart and lymphoid organs of mice with preclinical HFpEF. Furthermore, T cell IRE1α/XBP1 activation was restored after withdrawal of the 2 comorbidities inducing HFpEF, resulting in partial improvement of cardiac pathology. Our results demonstrated that diastolic dysfunction and cardiomyocyte hypertrophy in preclinical HFpEF were T cell dependent and that reversible dysregulation of the T cell IRE1α/XBP1 axis was a T cell signature of HFpEF.
Collapse
Affiliation(s)
- Sasha Smolgovsky
- Department of Immunology, Tufts University, Boston, Massachusetts, USA
| | - Abraham L. Bayer
- Department of Immunology, Tufts University, Boston, Massachusetts, USA
| | - Kuljeet Kaur
- Department of Immunology, Tufts University, Boston, Massachusetts, USA
| | - Erin Sanders
- Department of Immunology, Tufts University, Boston, Massachusetts, USA
| | - Mark Aronovitz
- Department of Immunology, Tufts University, Boston, Massachusetts, USA
| | - Mallory E. Filipp
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Edward B. Thorp
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gabriele G. Schiattarella
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Deutsches Herzzentrum der Charité, Charité – Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Joseph A. Hill
- Department of Internal Medicine (Cardiology) and
- Department of Molecular Biology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Robert M. Blanton
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - Juan R. Cubillos-Ruiz
- Department of Obstetrics and Gynecology and
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Graduate School of Medical Sciences, New York, New York, USA
| | - Pilar Alcaide
- Department of Immunology, Tufts University, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Mangmool S, Duangrat R, Parichatikanond W, Kurose H. New Therapeutics for Heart Failure: Focusing on cGMP Signaling. Int J Mol Sci 2023; 24:12866. [PMID: 37629047 PMCID: PMC10454066 DOI: 10.3390/ijms241612866] [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: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Current drugs for treating heart failure (HF), for example, angiotensin II receptor blockers and β-blockers, possess specific target molecules involved in the regulation of the cardiac circulatory system. However, most clinically approved drugs are effective in the treatment of HF with reduced ejection fraction (HFrEF). Novel drug classes, including angiotensin receptor blocker/neprilysin inhibitor (ARNI), sodium-glucose co-transporter-2 (SGLT2) inhibitor, hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker, soluble guanylyl cyclase (sGC) stimulator/activator, and cardiac myosin activator, have recently been introduced for HF intervention based on their proposed novel mechanisms. SGLT2 inhibitors have been shown to be effective not only for HFrEF but also for HF with preserved ejection fraction (HFpEF). In the myocardium, excess cyclic adenosine monophosphate (cAMP) stimulation has detrimental effects on HFrEF, whereas cyclic guanosine monophosphate (cGMP) signaling inhibits cAMP-mediated responses. Thus, molecules participating in cGMP signaling are promising targets of novel drugs for HF. In this review, we summarize molecular pathways of cGMP signaling and clinical trials of emerging drug classes targeting cGMP signaling in the treatment of HF.
Collapse
Affiliation(s)
- Supachoke Mangmool
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (S.M.); (R.D.)
| | - Ratchanee Duangrat
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (S.M.); (R.D.)
| | | | - Hitoshi Kurose
- Pharmacology for Life Sciences, Graduate School of Pharmaceutical Sciences, Tokushima University, Tokushima 770-8505, Japan
| |
Collapse
|
4
|
Roy S, Kloner RA, Salloum FN, Jovin IS. Cardiac Effects of Phosphodiesterase-5 Inhibitors: Efficacy and Safety. Cardiovasc Drugs Ther 2023; 37:793-806. [PMID: 34652581 PMCID: PMC9010479 DOI: 10.1007/s10557-021-07275-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 01/23/2023]
Abstract
The coexistence of cardiovascular disease and erectile dysfunction is widespread, possibly owing to underlying endothelial dysfunction in both diseases. Millions of patients with cardiovascular disease are prescribed phosphodiesterase-5 (PDE5) inhibitors for the management of erectile dysfunction. Although the role of PDE5 inhibitors in erectile dysfunction therapy is well established, their effects on the cardiovascular system are unclear. Preclinical studies investigating the effect of PDE5 inhibitors on ischemia-reperfusion injury, pressure overload-induced hypertrophy, and chemotoxicity suggested a possible clinical role for each of these medications; however, attempts to translate these findings to the bedside have resulted in mixed outcomes. In this review, we explore the biologic preclinical effects of PDE5 inhibitors in mediating cardioprotection. We then examine clinical trials investigating PDE5 inhibition in patients with heart failure, coronary artery disease, and ventricular arrhythmias and discuss why the studies likely have yet to show positive results and efficacy with PDE5 inhibition despite no safety concerns.
Collapse
Affiliation(s)
- Sumon Roy
- Pauley Heart Center, Virginia Commonwealth University Medical Center, McGuire VAMC, 1201 Broad Rock Boulevard, 111J, Richmond, VA, 23249, USA
| | - Robert A Kloner
- Huntington Medical Research Institute, Pasadena, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Fadi N Salloum
- Pauley Heart Center, Virginia Commonwealth University Medical Center, McGuire VAMC, 1201 Broad Rock Boulevard, 111J, Richmond, VA, 23249, USA
| | - Ion S Jovin
- Pauley Heart Center, Virginia Commonwealth University Medical Center, McGuire VAMC, 1201 Broad Rock Boulevard, 111J, Richmond, VA, 23249, USA.
- McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
| |
Collapse
|
5
|
Ajay A, Rasoul D, Abdullah A, Lee Wei En B, Mashida K, Al-Munaer M, Ajay H, Duvva D, Mathew J, Adenaya A, Lip GYH, Sankaranarayanan R. Augmentation of natriuretic peptide (NP) receptor A and B (NPR-A and NPR-B) and cyclic guanosine monophosphate (cGMP) signalling as a therapeutic strategy in heart failure. Expert Opin Investig Drugs 2023; 32:1157-1170. [PMID: 38032188 DOI: 10.1080/13543784.2023.2290064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Heart failure is a complex, debilitating condition and despite advances in treatment, it remains a significant cause of morbidity and mortality worldwide. Therefore, the need for alternative treatment strategies is essential. In this review, we explore the therapeutic strategies of augmenting natriuretic peptide receptors (NPR-A and NPR-B) and cyclic guanosine monophosphate (cGMP) in heart failure. AREAS COVERED We aim to provide an overview of the evidence of preclinical and clinical studies on novel heart failure treatment strategies. Papers collected in this review have been filtered and screened following PubMed searches. This includes epigenetics, modulating enzyme activity in natriuretic peptide (NP) synthesis, gene therapy, modulation of downstream signaling by augmenting soluble guanylate cyclase (sGC) and phosphodiesterase (PDE) inhibition, nitrates, c-GMP-dependent protein kinase, synthetic and designer NP and RNA therapy. EXPERT OPINION The novel treatment strategies mentioned above have shown great potential, however, large randomized controlled trials are still lacking. The biggest challenge is translating the results seen in preclinical trials into clinical trials. We recommend a multi-disciplinary team approach with cardiologists, geneticist, pharmacologists, bioengineers, researchers, regulators, and patients to improve heart failure outcomes. Future management can involve telemedicine, remote monitoring, and artificial intelligence to optimize patient care.
Collapse
Affiliation(s)
- Ashwin Ajay
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Debar Rasoul
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Alend Abdullah
- General Medicine, The Dudley Group NHS Foundation Trust Dudley, Dudley, United Kingdom
| | - Benjamin Lee Wei En
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Knievel Mashida
- Cedar House, University of Liverpool, Liverpool, United Kingdom
| | | | - Hanan Ajay
- General Medicine, Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom
| | - Dileep Duvva
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Jean Mathew
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Adeoye Adenaya
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Cedar House, University of Liverpool, Liverpool, United Kingdom
- Cardiology Department, Liverpool Heart & Chest Hospital NHS Trust, Liverpool, United Kingdom
- Cardiology Department, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rajiv Sankaranarayanan
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Cedar House, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
6
|
Chou C, Martin GL, Perera G, Awata J, Larson A, Blanton R, Chin MT. A novel αB-crystallin R123W variant drives hypertrophic cardiomyopathy by promoting maladaptive calcium-dependent signal transduction. Front Cardiovasc Med 2023; 10:1223244. [PMID: 37435054 PMCID: PMC10331725 DOI: 10.3389/fcvm.2023.1223244] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder affecting 1 in 500 people in the general population. Characterized by asymmetric left ventricular hypertrophy, cardiomyocyte disarray and cardiac fibrosis, HCM is a highly complex disease with heterogenous clinical presentation, onset and complication. While mutations in sarcomere genes can account for a substantial proportion of familial cases of HCM, 40%-50% of HCM patients do not carry such sarcomere variants and the causal mutations for their diseases remain elusive. Recently, we identified a novel variant of the alpha-crystallin B chain (CRYABR123W) in a pair of monozygotic twins who developed concordant HCM phenotypes that manifested over a nearly identical time course. Yet, how CRYABR123W promotes the HCM phenotype remains unclear. Here, we generated mice carrying the CryabR123W knock-in allele and demonstrated that hearts from these animals exhibit increased maximal elastance at young age but reduced diastolic function with aging. Upon transverse aortic constriction, mice carrying the CryabR123W allele developed pathogenic left ventricular hypertrophy with substantial cardiac fibrosis and progressively decreased ejection fraction. Crossing of mice with a Mybpc3 frame-shift model of HCM did not potentiate pathological hypertrophy in compound heterozygotes, indicating that the pathological mechanisms in the CryabR123W model are independent of the sarcomere. In contrast to another well-characterized CRYAB variant (R120G) which induced Desmin aggregation, no evidence of protein aggregation was observed in hearts expressing CRYABR123W despite its potent effect on driving cellular hypertrophy. Mechanistically, we uncovered an unexpected protein-protein interaction between CRYAB and calcineurin. Whereas CRYAB suppresses maladaptive calcium signaling in response to pressure-overload, the R123W mutation abolished this effect and instead drove pathologic NFAT activation. Thus, our data establish the CryabR123W allele as a novel genetic model of HCM and unveiled additional sarcomere-independent mechanisms of cardiac pathological hypertrophy.
Collapse
Affiliation(s)
- Chun Chou
- Department of Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Gregory L. Martin
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Gayani Perera
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Junya Awata
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Amy Larson
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Robert Blanton
- Department of Medicine, Tufts University School of Medicine, Boston, MA, United States
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Michael T. Chin
- Department of Medicine, Tufts University School of Medicine, Boston, MA, United States
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| |
Collapse
|
7
|
Cyclic nucleotide phosphodiesterases as therapeutic targets in cardiac hypertrophy and heart failure. Nat Rev Cardiol 2023; 20:90-108. [PMID: 36050457 DOI: 10.1038/s41569-022-00756-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 01/21/2023]
Abstract
Cyclic nucleotide phosphodiesterases (PDEs) modulate the neurohormonal regulation of cardiac function by degrading cAMP and cGMP. In cardiomyocytes, multiple PDE isozymes with different enzymatic properties and subcellular localization regulate local pools of cyclic nucleotides and specific functions. This organization is heavily perturbed during cardiac hypertrophy and heart failure (HF), which can contribute to disease progression. Clinically, PDE inhibition has been considered a promising approach to compensate for the catecholamine desensitization that accompanies HF. Although PDE3 inhibitors, such as milrinone or enoximone, have been used clinically to improve systolic function and alleviate the symptoms of acute HF, their chronic use has proved to be detrimental. Other PDEs, such as PDE1, PDE2, PDE4, PDE5, PDE9 and PDE10, have emerged as new potential targets to treat HF, each having a unique role in local cyclic nucleotide signalling pathways. In this Review, we describe cAMP and cGMP signalling in cardiomyocytes and present the various PDE families expressed in the heart as well as their modifications in pathological cardiac hypertrophy and HF. We also appraise the evidence from preclinical models as well as clinical data pointing to the use of inhibitors or activators of specific PDEs that could have therapeutic potential in HF.
Collapse
|
8
|
Cai Z, Wu C, Xu Y, Cai J, Zhao M, Zu L. The NO-cGMP-PKG Axis in HFpEF: From Pathological Mechanisms to Potential Therapies. Aging Dis 2023; 14:46-62. [PMID: 36818566 PMCID: PMC9937694 DOI: 10.14336/ad.2022.0523] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for almost half of all heart failure (HF) cases worldwide. Unfortunately, its incidence is expected to continue to rise, and effective therapy to improve clinical outcomes is lacking. Numerous efforts currently directed towards the pathophysiology of human HFpEF are uncovering signal transduction pathways and novel therapeutic targets. The nitric oxide-cyclic guanosine phosphate-protein kinase G (NO-cGMP-PKG) axis has been described as an important regulator of cardiac function. Suppression of the NO-cGMP-PKG signalling pathway is involved in the progression of HFpEF. Therefore, the NO-cGMP-PKG signalling pathway is a potential therapeutic target for HFpEF. In this review, we aim to explore the mechanism of NO-cGMP-PKG in the progression of HFpEF and to summarize potential therapeutic drugs that target this signalling pathway.
Collapse
Affiliation(s)
- Zhulan Cai
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.,Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, China.
| | - Cencen Wu
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.,Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, China.
| | - Yuan Xu
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.,Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, China.
| | - Jiageng Cai
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.,Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, China.
| | - Menglin Zhao
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.,Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, China.
| | - Lingyun Zu
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.,Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, China.,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, China.,Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China,Correspondence should be addressed to: Dr. Lingyun Zu, Department of Cardiology, Peking University Third Hospital, Beijing 100191, China. .
| |
Collapse
|
9
|
Murali M, Turner SR, Belke DD, Cole WC, MacDonald JA. Smoothelin-like 1 knockout mice display sex-dependent alterations in blood flow and cardiac function. Can J Physiol Pharmacol 2023; 101:27-40. [PMID: 36342379 DOI: 10.1139/cjpp-2022-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Smoothelin-like 1 (SMTNL1) modulates the contractile performance of smooth muscle and thus has a key role in vascular homeostasis. Elevated vascular tone, recognized as a contributor to the development of progressive cardiac dysfunction, was previously found with SMTNL1 deletion. In this study, we assessed cardiac morphology and function of male and female, wild-type (Smtnl1+/+) and global SMTNL1 knockout (Smtnl1-/-) mice at 10 weeks of age. Gross dissection revealed distinct cardiac morphology only in males; Smtnl1-/- hearts were significantly smaller than Smtnl1+/+, but the left ventricle (LV) proportion of heart mass was greater. Male Smtnl1-/- mice also displayed increased ejection fraction and fractional shortening, as well as elevated aortic and pulmonary flow velocities. The impact of cardiac stress with pressure overload by transverse aortic constriction (TAC) was examined in male mice. With TAC banding, systolic function was preserved, but the LV filling pressure was selectively elevated due to relaxation impairment. Smtnl1-/- mice displayed higher early/passive filling velocity of LV/early mitral annulus velocity ratio (E/E' ratio) and myocardial performance index along with a prolonged isovolumetric relaxation time. Taken together, the findings support a novel, sex-dimorphic role for SMTNL1 in modulating cardiac structure and function of mice.
Collapse
Affiliation(s)
- Megha Murali
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine,University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Sara R Turner
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine,University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Darrell D Belke
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, 1403-29 Street NWCalgary, AB T2N 2T9, Canada
| | - William C Cole
- Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Justin A MacDonald
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine,University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| |
Collapse
|
10
|
Ni L, Lin B, Hu L, Zhang R, Fu F, Shen M, Yang J, Shi D. Pyruvate Kinase M2 Protects Heart from Pressure Overload-Induced Heart Failure by Phosphorylating RAC1. J Am Heart Assoc 2022; 11:e024854. [PMID: 35656980 PMCID: PMC9238738 DOI: 10.1161/jaha.121.024854] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Heart failure, caused by sustained pressure overload, remains a major public health problem. PKM (pyruvate kinase M) acts as a rate‐limiting enzyme of glycolysis. PKM2 (pyruvate kinase M2), an alternative splicing product of PKM, plays complex roles in various biological processes and diseases. However, the role of PKM2 in the development of heart failure remains unknown. Methods and Results Cardiomyocyte‐specific Pkm2 knockout mice were generated by crossing the floxed Pkm2 mice with α‐MHC (myosin heavy chain)‐Cre transgenic mice, and cardiac specific Pkm2 overexpression mice were established by injecting adeno‐associated virus serotype 9 system. The results showed that cardiomyocyte‐specific Pkm2 deletion resulted in significant deterioration of cardiac functions under pressure overload, whereas Pkm2 overexpression mitigated transverse aortic constriction‐induced cardiac hypertrophy and improved heart functions. Mechanistically, we demonstrated that PKM2 acted as a protein kinase rather than a pyruvate kinase, which inhibited the activation of RAC1 (rho family, small GTP binding protein)‐MAPK (mitogen‐activated protein kinase) signaling pathway by phosphorylating RAC1 in the progress of heart failure. In addition, blockade of RAC1 through NSC23766, a specific RAC1 inhibitor, attenuated pathological cardiac remodeling in Pkm2 deficiency mice subjected to transverse aortic constriction. Conclusions This study revealed that PKM2 attenuated overload‐induced pathological cardiac hypertrophy and heart failure, which provides an attractive target for the prevention and treatment of cardiomyopathies.
Collapse
Affiliation(s)
- Le Ni
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| | - Bowen Lin
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| | - Lingjie Hu
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| | | | - Fengmei Fu
- Jinzhou Medical University Liaoning China
| | - Meiting Shen
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| | - Jian Yang
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China.,Department of Cell Biology Tongji University School of Medicine Shanghai China.,Institute of Medical Genetics Tongji University Shanghai China
| | - Dan Shi
- Department of Cardiology Shanghai East HospitalTongji University School of Medicine Shanghai China.,Key Laboratory of Arrhythmias of the Ministry of Education of China Shanghai East HospitalTongji University School of Medicine Shanghai China
| |
Collapse
|
11
|
Schwaerzer GK, Casteel DE, Cividini F, Kalyanaraman H, Zhuang S, Gu Y, Peterson KL, Dillmann W, Boss GR, Pilz RB, Pilz RB. Constitutive protein kinase G activation exacerbates stress-induced cardiomyopathy. Br J Pharmacol 2022; 179:2413-2429. [PMID: 34000062 PMCID: PMC9926932 DOI: 10.1111/bph.15530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Heart failure is associated with high morbidity and mortality, and new therapeutic targets are needed. Preclinical data suggest that pharmacological activation of protein kinase G (PKG) can reduce maladaptive ventricular remodelling and cardiac dysfunction in the stressed heart. However, clinical trial results have been mixed and the effects of long-term PKG activation in the heart are unknown. EXPERIMENTAL APPROACH We characterized the cardiac phenotype of mice carrying a heterozygous knock-in mutation of PKG1 (Prkg1R177Q/+ ), which causes constitutive, cGMP-independent activation of the kinase. We examined isolated cardiac myocytes and intact mice, the latter after stress induced by surgical transaortic constriction or angiotensin II (Ang II) infusion. KEY RESULTS Cardiac myocytes from Prkg1R177Q/+ mice showed altered phosphorylation of sarcomeric proteins and reduced contractility in response to electrical stimulation, compared to cells from wild type mice. Under basal conditions, young PKG1R177Q/+ mice exhibited no obvious cardiac abnormalities, but aging animals developed mild increases in cardiac fibrosis. In response to angiotensin II infusion or fixed pressure overload induced by transaortic constriction, young PKGR177Q/+ mice exhibited excessive hypertrophic remodelling with increased fibrosis and myocyte apoptosis, leading to increased left ventricular dilation and dysfunction compared to wild type litter mates. CONCLUSION AND IMPLICATIONS Long-term PKG1 activation in mice may be harmful to the heart, especially in the presence of pressure overload and neurohumoral stress. LINKED ARTICLES This article is part of a themed issue on cGMP Signalling in Cell Growth and Survival. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.11/issuetoc.
Collapse
Affiliation(s)
- Gerburg K. Schwaerzer
- Department of Medicine, University of California San Diego, La Jolla, California 92093,These three authors contributed equally to the work
| | - Darren E. Casteel
- Department of Medicine, University of California San Diego, La Jolla, California 92093,These three authors contributed equally to the work
| | - Federico Cividini
- Department of Medicine, University of California San Diego, La Jolla, California 92093,These three authors contributed equally to the work
| | - Hema Kalyanaraman
- Department of Medicine, University of California San Diego, La Jolla, California 92093
| | - Shunhui Zhuang
- Department of Medicine, University of California San Diego, La Jolla, California 92093
| | - Yusu Gu
- Department of Medicine, University of California San Diego, La Jolla, California 92093
| | - Kirk L. Peterson
- Department of Medicine, University of California San Diego, La Jolla, California 92093
| | - Wolfgang Dillmann
- Department of Medicine, University of California San Diego, La Jolla, California 92093
| | - Gerry R. Boss
- Department of Medicine, University of California San Diego, La Jolla, California 92093
| | - Renate B. Pilz
- Department of Medicine, University of California San Diego, La Jolla, California 92093,Correspondence should be addressed to R.B.P. ()
| | - Renate B Pilz
- Department of Medicine, University of California San Diego, La Jolla, California, 92093, USA
| |
Collapse
|
12
|
Calamaras TD, Pande S, Baumgartner RA, Kim SK, McCarthy JC, Martin GL, Tam K, McLaughlin AL, Wang GR, Aronovitz MJ, Lin W, Aguirre JI, Baca P, Liu P, Richards DA, Davis RJ, Karas RH, Jaffe IZ, Blanton RM. MLK3 mediates impact of PKG1α on cardiac function and controls blood pressure through separate mechanisms. JCI Insight 2021; 6:e149075. [PMID: 34324442 PMCID: PMC8492323 DOI: 10.1172/jci.insight.149075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
cGMP-dependent protein kinase 1α (PKG1α) promotes left ventricle (LV) compensation after pressure overload. PKG1-activating drugs improve heart failure (HF) outcomes but are limited by vasodilation-induced hypotension. Signaling molecules that mediate PKG1α cardiac therapeutic effects but do not promote PKG1α-induced hypotension could therefore represent improved therapeutic targets. We investigated roles of mixed lineage kinase 3 (MLK3) in mediating PKG1α effects on LV function after pressure overload and in regulating BP. In a transaortic constriction HF model, PKG activation with sildenafil preserved LV function in MLK3+/+ but not MLK3-/- littermates. MLK3 coimmunoprecipitated with PKG1α. MLK3-PKG1α cointeraction decreased in failing LVs. PKG1α phosphorylated MLK3 on Thr277/Ser281 sites required for kinase activation. MLK3-/- mice displayed hypertension and increased arterial stiffness, though PKG stimulation with sildenafil or the soluble guanylate cyclase (sGC) stimulator BAY41-2272 still reduced BP in MLK3-/- mice. MLK3 kinase inhibition with URMC-099 did not affect BP but induced LV dysfunction in mice. These data reveal MLK3 as a PKG1α substrate mediating PKG1α preservation of LV function but not acute PKG1α BP effects. Mechanistically, MLK3 kinase-dependent effects preserved LV function, whereas MLK3 kinase-independent signaling regulated BP. These findings suggest augmenting MLK3 kinase activity could preserve LV function in HF but avoid hypotension from PKG1α activation.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Kelly Tam
- Molecular Cardiology Research Institute and
| | | | | | | | - Weiyu Lin
- Molecular Cardiology Research Institute and
- Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts, USA
| | | | - Paulina Baca
- Molecular Cardiology Research Institute and
- Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts, USA
| | - Peiwen Liu
- Molecular Cardiology Research Institute and
- Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts, USA
| | | | - Roger J. Davis
- University of Massachusetts School of Medicine, Worchester, Massachusetts, USA
| | | | - Iris Z. Jaffe
- Molecular Cardiology Research Institute and
- Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts, USA
| | - Robert M. Blanton
- Molecular Cardiology Research Institute and
- Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts, USA
| |
Collapse
|
13
|
Garg R, Kumariya S, Katekar R, Verma S, Goand UK, Gayen JR. JNK signaling pathway in metabolic disorders: An emerging therapeutic target. Eur J Pharmacol 2021; 901:174079. [PMID: 33812885 DOI: 10.1016/j.ejphar.2021.174079] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 02/08/2023]
Abstract
Metabolic Syndrome is a multifactorial disease associated with increased risk of cardiovascular disorders, type 2 diabetes mellitus, fatty liver disease, etc. Various stress stimuli such as reactive oxygen species, endoplasmic reticulum stress, mitochondrial dysfunction, increased cytokines, or free fatty acids are known to aggravate progressive development of hyperglycemia and hyperlipidemia. Although the exact mechanism contributing to altered metabolism is unclear. Evidence suggests stress kinase role to be a crucial one in metabolic syndrome. Stress kinase, c-jun N-terminal kinase activation (JNK) is involved in various metabolic manifestations including obesity, insulin resistance, fatty liver disease as well as cardiometabolic disorders. It emerged as a foremost mediator in regulating metabolism in the liver, skeletal muscle, adipose tissue as well as pancreatic β cells. It has three isoforms each having a unique and tissue-specific role in altered metabolism. Current findings based on genetic manipulation or chemical inhibition studies identified JNK isoforms to play a central role in the regulation of whole-body metabolism, suggesting it to be a novel therapeutic target. Hence, it is imperative to elucidate its role in metabolic syndrome onset and progression. The purpose of this review is to elucidate in vitro and in vivo implications of JNK signaling along with the therapeutic strategy to inhibit specific isoform. Since metabolic syndrome is an array of diseases and complex pathway, carefully examining each tissue will be important for specific treatment strategies.
Collapse
Affiliation(s)
- Richa Garg
- Pharmaceutics & Pharmacokinetics, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow, 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Sanjana Kumariya
- Pharmaceutics & Pharmacokinetics, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow, 226031, India
| | - Roshan Katekar
- Pharmaceutics & Pharmacokinetics, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow, 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Saurabh Verma
- Pharmaceutics & Pharmacokinetics, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow, 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Umesh K Goand
- Pharmaceutics & Pharmacokinetics, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow, 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Jiaur R Gayen
- Pharmaceutics & Pharmacokinetics, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow, 226031, India; Pharmacology Division, CSIR-Central Drug Research Institute, Jankipuram Extension, Lucknow, 226031, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
| |
Collapse
|
14
|
Rüdebusch J, Benkner A, Nath N, Fleuch L, Kaderali L, Grube K, Klingel K, Eckstein G, Meitinger T, Fielitz J, Felix SB. Stimulation of soluble guanylyl cyclase (sGC) by riociguat attenuates heart failure and pathological cardiac remodelling. Br J Pharmacol 2020; 179:2430-2442. [PMID: 33247945 DOI: 10.1111/bph.15333] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/16/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Heart failure is associated with an impaired NO-soluble guanylyl cyclase (sGC)-cGMP pathway and its augmentation is thought to be beneficial for its therapy. We hypothesized that stimulation of sGC by the sGC stimulator riociguat prevents pathological cardiac remodelling and heart failure in response to chronic pressure overload. EXPERIMENTAL APPROACH Transverse aortic constriction or sham surgery was performed in C57BL/6N mice. After 3 weeks of transverse aortic constriction when heart failure was established, animals receive either riociguat or its vehicle for 5 additional weeks. Cardiac function was evaluated weekly by echocardiography. Eight weeks after surgery, histological analyses were performed to evaluate remodelling and the transcriptome of the left ventricles (LVs) was analysed by RNA sequencing. Cell culture experiments were used for mechanistically studies. KEY RESULTS Transverse aortic constriction resulted in a continuous decrease of LV ejection fraction and an increase in LV mass until week 3. Five weeks of riociguat treatment resulted in an improved LV ejection fraction and a decrease in the ratio of left ventricular mass to total body weight (LVM/BW), myocardial fibrosis and myocyte cross-sectional area. RNA sequencing revealed that riociguat reduced the expression of myocardial stress and remodelling genes (e.g. Nppa, Nppb, Myh7 and collagen) and attenuated the activation of biological pathways associated with cardiac hypertrophy and heart failure. Riociguat reversed pathological stress response in cultivated myocytes and fibroblasts. CONCLUSION AND IMPLICATIONS Stimulation of the sGC reverses transverse aortic constriction-induced heart failure and remodelling, which is associated with improved myocardial gene expression.
Collapse
Affiliation(s)
- Julia Rüdebusch
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Alexander Benkner
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Neetika Nath
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Lina Fleuch
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Lars Kaderali
- DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany.,Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Karina Grube
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Gertrud Eckstein
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jens Fielitz
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| |
Collapse
|
15
|
Carrillo-Salinas FJ, Anastasiou M, Ngwenyama N, Kaur K, Tai A, Smolgovsky SA, Jetton D, Aronovitz M, Alcaide P. Gut dysbiosis induced by cardiac pressure overload enhances adverse cardiac remodeling in a T cell-dependent manner. Gut Microbes 2020; 12:1-20. [PMID: 33103561 PMCID: PMC7588211 DOI: 10.1080/19490976.2020.1823801] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Despite the existing association of gut dysbiosis and T cell inflammation in heart failure (HF), whether and how gut microbes contribute to T cell immune responses, cardiac fibrosis and dysfunction in HF remains largely unexplored. Our objective was to investigate whether gut dysbiosis is induced by cardiac pressure overload, and its effect in T cell activation, adverse cardiac remodeling, and cardiac dysfunction. We used 16S rRNA sequencing of fecal samples and discovered that cardiac pressure overload-induced by transverse aortic constriction (TAC) results in gut dysbiosis, characterized by a reduction of tryptophan and short-chain fatty acids producing bacteria in WT mice, but not in T cell-deficient mice (Tcra-/- ) mice. These changes did not result in T cell activation in the gut or gut barrier disruption. Strikingly, microbiota depletion in WT mice resulted in decreased heart T cell infiltration, decreased cardiac fibrosis, and protection from systolic dysfunction in response to TAC. Spontaneous reconstitution of the microbiota partially reversed these effects. We observed decreased cardiac expression of the Aryl hydrocarbon receptor (AhR) and enzymes associated with tryptophan metabolism in WT mice, but not in Tcra-/- mice, or in mice depleted of the microbiota. These findings demonstrate that cardiac pressure overload induced gut dysbiosis and T cell immune responses contribute to adverse cardiac remodeling, and identify the potential contribution of tryptophan metabolites and the AhR to protection from adverse cardiac remodeling and systolic dysfunction in HF.
Collapse
Affiliation(s)
| | - Marina Anastasiou
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
- Department of Internal Medicine, University of Crete Medical School, Crete, Greece
| | - Njabulo Ngwenyama
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
- Department of Immunology, Tufts Graduate School for Biomedical Sciences Immunology Program, Tufts University School of Medicine, Boston, MA, USA
| | - Kuljeet Kaur
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
| | - Albert Tai
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
| | - Sasha A. Smolgovsky
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
- Department of Immunology, Tufts Graduate School for Biomedical Sciences Immunology Program, Tufts University School of Medicine, Boston, MA, USA
| | - David Jetton
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
- Department of Immunology, Tufts Graduate School for Biomedical Sciences Immunology Program, Tufts University School of Medicine, Boston, MA, USA
| | - Mark Aronovitz
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
| | - Pilar Alcaide
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
- Department of Immunology, Tufts Graduate School for Biomedical Sciences Immunology Program, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
16
|
Abstract
Cyclic GMP (cGMP) represents a classic intracellular second messenger molecule. Over the past 2 decades, important discoveries have identified that cGMP signaling becomes deranged in heart failure (HF) and that cGMP and its main kinase effector, protein kinase G, generally oppose the biological abnormalities contributing to HF, in experimental studies. These findings have influenced the design of clinical trials of cGMP-augmenting drugs in HF patients. At present, the trial results of cGMP-augmenting therapies in HF remain mixed. As detailed in this review, strong evidence now exists that protein kinase G opposes pathologic cardiac remodeling through regulation of diverse biological processes and myocardial substrates. Potential reasons for the failures of cGMP-augmenting drugs in HF may be related to biological mechanisms opposing cGMP or because of certain features of clinical trials, all of which are discussed.
Collapse
|
17
|
Abstract
Heart failure (HF) is a common consequence of several cardiovascular diseases and is understood as a vicious cycle of cardiac and hemodynamic decline. The current inventory of treatments either alleviates the pathophysiological features (eg, cardiac dysfunction, neurohumoral activation, and ventricular remodeling) and/or targets any underlying pathologies (eg, hypertension and myocardial infarction). Yet, since these do not provide a cure, the morbidity and mortality associated with HF remains high. Therefore, the disease constitutes an unmet medical need, and novel therapies are desperately needed. Cyclic guanosine-3',5'-monophosphate (cGMP), synthesized by nitric oxide (NO)- and natriuretic peptide (NP)-responsive guanylyl cyclase (GC) enzymes, exerts numerous protective effects on cardiac contractility, hypertrophy, fibrosis, and apoptosis. Impaired cGMP signaling, which can occur after GC deactivation and the upregulation of cyclic nucleotide-hydrolyzing phosphodiesterases (PDEs), promotes cardiac dysfunction. In this study, we review the role that NO/cGMP and NP/cGMP signaling plays in HF. After considering disease etiology, the physiological effects of cGMP in the heart are discussed. We then assess the evidence from preclinical models and patients that compromised cGMP signaling contributes to the HF phenotype. Finally, the potential of pharmacologically harnessing cardioprotective cGMP to rectify the present paucity of effective HF treatments is examined.
Collapse
|
18
|
Abstract
The cyclic nucleotides cyclic adenosine-3′,5′-monophosphate (cAMP) and cyclic guanosine-3′,5′-monophosphate (cGMP) maintain physiological cardiac contractility and integrity. Cyclic nucleotide–hydrolysing phosphodiesterases (PDEs) are the prime regulators of cAMP and cGMP signalling in the heart. During heart failure (HF), the expression and activity of multiple PDEs are altered, which disrupt cyclic nucleotide levels and promote cardiac dysfunction. Given that the morbidity and mortality associated with HF are extremely high, novel therapies are urgently needed. Herein, the role of PDEs in HF pathophysiology and their therapeutic potential is reviewed. Attention is given to PDEs 1–5, and other PDEs are briefly considered. After assessing the role of each PDE in cardiac physiology, the evidence from pre-clinical models and patients that altered PDE signalling contributes to the HF phenotype is examined. The potential of pharmacologically harnessing PDEs for therapeutic gain is considered.
Collapse
|
19
|
Tam K, Richards DA, Aronovitz MJ, Martin GL, Pande S, Jaffe IZ, Blanton RM. Sacubitril/Valsartan Improves Left Ventricular Function in Chronic Pressure Overload Independent of Intact Cyclic Guanosine Monophosphate-dependent Protein Kinase I Alpha Signaling. J Card Fail 2020; 26:769-775. [PMID: 32464187 DOI: 10.1016/j.cardfail.2020.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/18/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Combined angiotensin receptor/neprilysin inhibition with sacubitril/valsartan (Sac/Val) has emerged as a therapy for heart failure. The presumed mechanism of benefit is through prevention of natriuretic peptide degradation, leading to increased cyclic guanosine monophosphate (cGMP)-dependent protein kinase (PKG) signaling. However, the specific requirement of PKG for Sac/Val effects remains untested. METHODS AND RESULTS We examined Sac/Val treatment in mice with mutation of the cGMP-dependent protein kinase I (PKGI)α leucine zipper domain, which is required for cGMP-PKGIα antiremodeling actions in vivo. Wild-type (WT) or PKG leucine zipper mutant (LZM) mice were exposed to 56-day left ventricular (LV) pressure overload by moderate (26G) transaortic constriction (TAC). At day 14 after TAC, mice were randomized to vehicle or Sac/Val by oral gavage. TAC induced the same degree of LV pressure overload in WT and LZM mice, which was not affected by Sac/Val. Although LZM mice, but not WT, developed LV dilation after TAC, Sac/Val improved cardiac hypertrophy and LV fractional shortening to the same degree in both the WT and LZM TAC mice. CONCLUSION These findings indicate the beneficial effects of Sac/Val on LV structure and function in moderate pressure overload. The unexpected finding that PKGIα mutation does not abolish the Sac/Val effects on cardiac hypertrophy and on LV function suggests that signaling other than natriuretic peptide- cGMP-PKG mediates the therapeutic benefits of neprilysin inhibition in heart failure.
Collapse
Affiliation(s)
- Kelly Tam
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Daniel A Richards
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Mark J Aronovitz
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Gregory L Martin
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Suchita Pande
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Robert M Blanton
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts.
| |
Collapse
|
20
|
Methawasin M, Strom J, Borkowski T, Hourani Z, Runyan R, Smith JE, Granzier H. Phosphodiesterase 9a Inhibition in Mouse Models of Diastolic Dysfunction. Circ Heart Fail 2020; 13:e006609. [PMID: 32418479 DOI: 10.1161/circheartfailure.119.006609] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Low myocardial cGMP-PKG (cyclic guanosine monophosphate-protein kinase G) activity has been associated with increased cardiomyocyte diastolic stiffness in heart failure with preserved ejection fraction. Cyclic guanosine monophosphate is mainly hydrolyzed by PDE (phosphodiesterases) 5a and 9a. Importantly, PDE9a expression has been reported to be upregulated in human heart failure with preserved ejection fraction myocardium and chronic administration of a PDE9a inhibitor reverses preestablished cardiac hypertrophy and systolic dysfunction in mice subjected to transverse aortic constriction (TAC). We hypothesized that inhibiting PDE9a activity ameliorates diastolic dysfunction. METHODS To examine the effect of chronic PDE9a inhibition, 2 diastolic dysfunction mouse models were studied: (1) TAC-deoxycorticosterone acetate and (2) Leprdb/db. PDE9a inhibitor (5 and 8 mg/kg per day) was administered to the mice via subcutaneously implanted osmotic minipumps for 28 days. The effect of acute PDE9a inhibition was investigated in intact cardiomyocytes isolated from TAC-deoxycorticosterone acetate mice. Atrial natriuretic peptide together with PDE9a inhibitor were administered to the isolated intact cardiomyocytes through the cell perfusate. RESULTS For acute inhibition, no cellular stiffness reduction was found, whereas chronic PDE9a inhibition resulted in reduced left ventricular chamber stiffness in TAC-deoxycorticosterone acetate, but not in Leprdb/db mice. Passive cardiomyocyte stiffness was reduced by chronic PDE9a inhibition, with no differences in myocardial fibrosis or cardiac morphometry. PDE9a inhibition increased the ventricular-arterial coupling ratio, reflecting impaired systolic function. CONCLUSIONS Chronic PDE9a inhibition lowers left ventricular chamber stiffness in TAC-deoxycorticosterone acetate mice. However, the usefulness of PDE9a inhibition to treat high-diastolic stiffness may be limited as the required PDE9a inhibitor dose also impairs systolic function, observed as a decline in ventricular-arterial coordination, in this model.
Collapse
Affiliation(s)
- Mei Methawasin
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Joshua Strom
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Tomasz Borkowski
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Zaynab Hourani
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Ray Runyan
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - John E Smith
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| | - Henk Granzier
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, AZ
| |
Collapse
|
21
|
Molecular Mechanisms of Cardiac Remodeling and Regeneration in Physical Exercise. Cells 2019; 8:cells8101128. [PMID: 31547508 PMCID: PMC6829258 DOI: 10.3390/cells8101128] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 02/08/2023] Open
Abstract
Regular physical activity with aerobic and muscle-strengthening training protects against the occurrence and progression of cardiovascular disease and can improve cardiac function in heart failure patients. In the past decade significant advances have been made in identifying mechanisms of cardiomyocyte re-programming and renewal including an enhanced exercise-induced proliferational capacity of cardiomyocytes and its progenitor cells. Various intracellular mechanisms mediating these positive effects on cardiac function have been found in animal models of exercise and will be highlighted in this review. 1) activation of extracellular and intracellular signaling pathways including phosphatidylinositol 3 phosphate kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR), EGFR/JNK/SP-1, nitric oxide (NO)-signaling, and extracellular vesicles; 2) gene expression modulation via microRNAs (miR), in particular via miR-17-3p and miR-222; and 3) modulation of cardiac cellular metabolism and mitochondrial adaption. Understanding the cellular mechanisms, which generate an exercise-induced cardioprotective cellular phenotype with physiological hypertrophy and enhanced proliferational capacity may give rise to novel therapeutic targets. These may open up innovative strategies to preserve cardiac function after myocardial injury as well as in aged cardiac tissue.
Collapse
|
22
|
Blanton R, Gulati G, Kiernan M. Response by Blanton et al to Letter Regarding Article, "Preimplant Phosphodiesterase-5 Inhibitor Use Is Associated With Higher Rates of Severe Early Right Heart Failure After LVAD Implantation: An INTERMACS Analysis". Circ Heart Fail 2019; 12:e006465. [PMID: 31514516 DOI: 10.1161/circheartfailure.119.006465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert Blanton
- Cardiovascular Center, Division of Cardiology, Tufts Medical Center, Boston, MA (R.B., G.G., M.K.).,Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (R.B.)
| | - Gaurav Gulati
- Cardiovascular Center, Division of Cardiology, Tufts Medical Center, Boston, MA (R.B., G.G., M.K.)
| | - Michael Kiernan
- Cardiovascular Center, Division of Cardiology, Tufts Medical Center, Boston, MA (R.B., G.G., M.K.)
| |
Collapse
|
23
|
JNK and cardiometabolic dysfunction. Biosci Rep 2019; 39:BSR20190267. [PMID: 31270248 PMCID: PMC6639461 DOI: 10.1042/bsr20190267] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiometabolic syndrome (CMS) describes the cluster of metabolic and cardiovascular diseases that are generally characterized by impaired glucose tolerance, intra-abdominal adiposity, dyslipidemia, and hypertension. CMS currently affects more than 25% of the world’s population and the rates of diseases are rapidly rising. These CMS conditions represent critical risk factors for cardiovascular diseases including atherosclerosis, heart failure, myocardial infarction, and peripheral artery disease (PAD). Therefore, it is imperative to elucidate the underlying signaling involved in disease onset and progression. The c-Jun N-terminal Kinases (JNKs) are a family of stress signaling kinases that have been recently indicated in CMS. The purpose of this review is to examine the in vivo implications of JNK as a potential therapeutic target for CMS. As the constellation of diseases associated with CMS are complex and involve multiple tissues and environmental triggers, carefully examining what is known about the JNK pathway will be important for specificity in treatment strategies.
Collapse
|
24
|
Ngwenyama N, Salvador AM, Velázquez F, Nevers T, Levy A, Aronovitz M, Luster AD, Huggins GS, Alcaide P. CXCR3 regulates CD4+ T cell cardiotropism in pressure overload-induced cardiac dysfunction. JCI Insight 2019; 4:125527. [PMID: 30779709 DOI: 10.1172/jci.insight.125527] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
Heart failure (HF) is associated in humans and mice with increased circulating levels of CXCL9 and CXCL10, chemokine ligands of the CXCR3 receptor, predominantly expressed on CD4+ Th1 cells. Chemokine engagement of receptors is required for T cell integrin activation and recruitment to sites of inflammation. Th1 cells drive adverse cardiac remodeling in pressure overload-induced cardiac dysfunction, and mice lacking the integrin ligand ICAM-1 show defective T cell recruitment to the heart. Here, we show that CXCR3+ T cells infiltrate the heart in humans and mice with pressure overload-induced cardiac dysfunction. Genetic deletion of CXCR3 disrupts CD4+ T cell heart infiltration and prevents adverse cardiac remodeling. We demonstrate that cardiac fibroblasts and cardiac myeloid cells that include resident and infiltrated macrophages are the source of CXCL9 and CXCL10, which mechanistically promote Th1 cell adhesion to ICAM-1 under shear conditions in a CXCR3-dependent manner. To our knowledge, our findings identify a previously unrecognized role for CXCR3 in Th1 cell recruitment into the heart in pressure overload-induced cardiac dysfunction.
Collapse
Affiliation(s)
| | | | | | | | - Alexander Levy
- Molecular Cardiology Research Institute Tufts University, Boston, Massachusetts, USA
| | - Mark Aronovitz
- Molecular Cardiology Research Institute Tufts University, Boston, Massachusetts, USA
| | - Andrew D Luster
- Division of Rheumatology, Allergy and Immunology, Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gordon S Huggins
- Molecular Cardiology Research Institute Tufts University, Boston, Massachusetts, USA
| | | |
Collapse
|
25
|
Chrysant SG, Chrysant GS. Obesity-related heart failure with preserved ejection fraction: new treatment strategies. Hosp Pract (1995) 2019; 47:67-72. [PMID: 30712418 DOI: 10.1080/21548331.2019.1575662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Obesity has risen in the US and worldwide, and has become a major risk factor for type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease, and mostly HF with preserved ejection fraction (HFpEF). Also, the prevalence of HF is quite high in the US accounting for 6.6 million adults at present and is projected to reach 8.5 million by the year 2030 and is equally divided between HFpEF and heart failure reduced ejection fraction (HFrEF). Patients with HFpEF are resistant to treatment with drugs usually used for the treatment of HFrEF, but the reasons for this resistance are not clearly known. METHODS In order to get a better perspective on the current status of the underlying pathophysiology and treatment of patients with HFpEF, a Medline search of the English language literature was conducted between 2015 and 2018 using the terms obesity, HFpEF, diabetes, treatment, SGLT2 inhibitors, and neprilysin inhibitors and 24 pertinent papers were selected. RESULTS The review of these papers revealed that patients with HFpEF have expanded plasma volume, restricted left ventricular distension with increased end-diastolic volume and depressed natriuretic peptide levels. In this respect, drugs that cause increased diuresis and natriuresis should a reasonable choice to treat these patients. The recently FDA approved sodium-glucose cotransporter-2 (SGLT2) inhibitors for the treatment of T2DM, are a good choice, for the treatment of HFpEF, since they cause osmotic diuresis from glucose excretion and increase salt and water excretion and decrease plasma volume. In addition, they produce loss of calories leading to weight and blood pressure reduction and have shown to prevent the new onset HFpEF and decrease hospitalizations and death from this disease. CONCLUSION The results of this analysis has shown that HFpEF has different pathophysiology from HFrEF and is difficult to treat. Drugs that block renal tubular glucose reabsorption and cause osmotic diuresis and natriuresis could be a good choice to treat patients with HFpEF alone or in combination with diuretics and other drugs.
Collapse
Affiliation(s)
- Steven G Chrysant
- a Department of Cardiology , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - George S Chrysant
- b Department of Cardiology , INTEGRIS Baptist Medical Center , Oklahoma City , OK , USA
| |
Collapse
|
26
|
Calamaras TD, Baumgartner RA, Aronovitz MJ, McLaughlin AL, Tam K, Richards DA, Cooper CW, Li N, Baur WE, Qiao X, Wang GR, Davis RJ, Kapur NK, Karas RH, Blanton RM. Mixed lineage kinase-3 prevents cardiac dysfunction and structural remodeling with pressure overload. Am J Physiol Heart Circ Physiol 2019; 316:H145-H159. [PMID: 30362822 PMCID: PMC6383356 DOI: 10.1152/ajpheart.00029.2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022]
Abstract
Myocardial hypertrophy is an independent risk factor for heart failure (HF), yet the mechanisms underlying pathological cardiomyocyte growth are incompletely understood. The c-Jun NH2-terminal kinase (JNK) signaling cascade modulates cardiac hypertrophic remodeling, but the upstream factors regulating myocardial JNK activity remain unclear. In this study, we sought to identify JNK-activating molecules as novel regulators of cardiac remodeling in HF. We investigated mixed lineage kinase-3 (MLK3), a master regulator of upstream JNK-activating kinases, whose role in the remodeling process had not previously been studied. We observed increased MLK3 protein expression in myocardium from patients with nonischemic and hypertrophic cardiomyopathy and in hearts of mice subjected to transverse aortic constriction (TAC). Mice with genetic deletion of MLK3 (MLK3-/-) exhibited baseline cardiac hypertrophy with preserved cardiac function. MLK3-/- mice subjected to chronic left ventricular (LV) pressure overload (TAC, 4 wk) developed worsened cardiac dysfunction and increased LV chamber size compared with MLK3+/+ littermates ( n = 8). LV mass, pathological markers of hypertrophy ( Nppa, Nppb), and cardiomyocyte size were elevated in MLK3-/- TAC hearts. Phosphorylation of JNK, but not other MAPK pathways, was selectively impaired in MLK3-/- TAC hearts. In adult rat cardiomyocytes, pharmacological MLK3 kinase inhibition using URMC-099 blocked JNK phosphorylation induced by neurohormonal agents and oxidants. Sustained URMC-099 exposure induced cardiomyocyte hypertrophy. These data demonstrate that MLK3 prevents adverse cardiac remodeling in the setting of pressure overload. Mechanistically, MLK3 activates JNK, which in turn opposes cardiomyocyte hypertrophy. These results support modulation of MLK3 as a potential therapeutic approach in HF. NEW & NOTEWORTHY Here, we identified a role for mixed lineage kinase-3 (MLK3) as a novel antihypertrophic and antiremodeling molecule in response to cardiac pressure overload. MLK3 regulates phosphorylation of the stress-responsive JNK kinase in response to pressure overload and in cultured cardiomyocytes stimulated with hypertrophic agonists and oxidants. This study reveals MLK3-JNK signaling as a novel cardioprotective signaling axis in the setting of pressure overload.
Collapse
Affiliation(s)
- Timothy D Calamaras
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Robert A Baumgartner
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Mark J Aronovitz
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Angela L McLaughlin
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Kelly Tam
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Daniel A Richards
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Craig W Cooper
- Tufts University School of Medicine , Boston, Massachusetts
| | - Nathan Li
- Tufts Animal Histology Core, Boston, Massachusetts
| | - Wendy E Baur
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Xiaoying Qiao
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Guang-Rong Wang
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
| | - Roger J Davis
- University of Massachusetts Medical School , Worcester, Massachusetts
| | - Navin K Kapur
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Richard H Karas
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Robert M Blanton
- Molecular Cardiology Research Institute, Tufts Medical Center , Boston, Massachusetts
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
- Department of Developmental, Molecular, and Chemical Biology, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine , Boston, Massachusetts
| |
Collapse
|
27
|
Ledoux T, Aridgides D, Salvador R, Ngwenyama N, Panagiotidou S, Alcaide P, Blanton RM, Perrin MA. Trypanosoma cruzi Neurotrophic Factor Facilitates Cardiac Repair in a Mouse Model of Chronic Chagas Disease. J Pharmacol Exp Ther 2018; 368:11-20. [PMID: 30348750 DOI: 10.1124/jpet.118.251900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/18/2018] [Indexed: 12/14/2022] Open
Abstract
Most patients acutely infected with Trypanosoma cruzi undergo short-term structural and functional cardiac alterations that heal without sequelae. By contrast, in patients whose disease progresses to chronic infection, irreversible degenerative chronic Chagas cardiomyopathy (CCC) may develop. To account for the contrast between cardiac regeneration in high-parasitism acute infection and progressive cardiomyopathy in low-parasitism CCC, we hypothesized that T. cruzi expresses repair factors that directly facilitate cardiac regeneration. We investigated, as one such repair factor, the T. cruzi parasite-derived neurotrophic factor (PDNF), known to trigger survival of cardiac myocytes and fibroblasts and upregulate chemokine chemokine C-C motif ligand 2, which promotes migration of regenerative cardiac progenitor cells (CPCs). Using in vivo and in vitro models of Chagas disease, we tested whether T. cruzi PDNF promotes cardiac repair. Quantitative PCR and flow cytometry of heart tissue revealed that stem-cell antigen-1 (Sca-1+) CPCs expand in acute infection in parallel to parasitism. Recombinant PDNF induced survival and expansion of ex vivo CPCs, and intravenous administration of PDNF into naïve mice upregulated mRNA of cardiac stem-cell marker Sca-1. Furthermore, in CCC mice, a 3-week intravenous administration of PDNF protocol induced CPC expansion and reversed left ventricular T-cell accumulation and cardiac remodeling including fibrosis. Compared with CCC vehicle-treated mice, which developed severe atrioventricular block, PDNF-treated mice exhibited reduced frequency and severity of conduction abnormalities. Our findings are in support of the novel concept that T. cruzi uses PDNF to promote mutually beneficial cardiac repair in Chagas disease. This could indicate a possible path to prevention or treatment of CCC.
Collapse
Affiliation(s)
- Tamar Ledoux
- Program in Pharmacology and Experimental Therapeutics (T.L., S.P., M.P.) and Program in Immunology (D.A., R.S., N.N., P.A.), Sackler School of Graduate Biomedical Sciences and Departments of Developmental, Molecular and Chemical Biology (T.L., D.A., R.S., S.P., M.P.) and Immunology (N.N., P.A.), Tufts University, Boston, Massachusetts; and Molecular Cardiology Research Institute and Division of Cardiology (R.B.), Tufts Medical Center, Boston, Massachusetts
| | - Daniel Aridgides
- Program in Pharmacology and Experimental Therapeutics (T.L., S.P., M.P.) and Program in Immunology (D.A., R.S., N.N., P.A.), Sackler School of Graduate Biomedical Sciences and Departments of Developmental, Molecular and Chemical Biology (T.L., D.A., R.S., S.P., M.P.) and Immunology (N.N., P.A.), Tufts University, Boston, Massachusetts; and Molecular Cardiology Research Institute and Division of Cardiology (R.B.), Tufts Medical Center, Boston, Massachusetts
| | - Ryan Salvador
- Program in Pharmacology and Experimental Therapeutics (T.L., S.P., M.P.) and Program in Immunology (D.A., R.S., N.N., P.A.), Sackler School of Graduate Biomedical Sciences and Departments of Developmental, Molecular and Chemical Biology (T.L., D.A., R.S., S.P., M.P.) and Immunology (N.N., P.A.), Tufts University, Boston, Massachusetts; and Molecular Cardiology Research Institute and Division of Cardiology (R.B.), Tufts Medical Center, Boston, Massachusetts
| | - Njabulo Ngwenyama
- Program in Pharmacology and Experimental Therapeutics (T.L., S.P., M.P.) and Program in Immunology (D.A., R.S., N.N., P.A.), Sackler School of Graduate Biomedical Sciences and Departments of Developmental, Molecular and Chemical Biology (T.L., D.A., R.S., S.P., M.P.) and Immunology (N.N., P.A.), Tufts University, Boston, Massachusetts; and Molecular Cardiology Research Institute and Division of Cardiology (R.B.), Tufts Medical Center, Boston, Massachusetts
| | - Smaro Panagiotidou
- Program in Pharmacology and Experimental Therapeutics (T.L., S.P., M.P.) and Program in Immunology (D.A., R.S., N.N., P.A.), Sackler School of Graduate Biomedical Sciences and Departments of Developmental, Molecular and Chemical Biology (T.L., D.A., R.S., S.P., M.P.) and Immunology (N.N., P.A.), Tufts University, Boston, Massachusetts; and Molecular Cardiology Research Institute and Division of Cardiology (R.B.), Tufts Medical Center, Boston, Massachusetts
| | - Pilar Alcaide
- Program in Pharmacology and Experimental Therapeutics (T.L., S.P., M.P.) and Program in Immunology (D.A., R.S., N.N., P.A.), Sackler School of Graduate Biomedical Sciences and Departments of Developmental, Molecular and Chemical Biology (T.L., D.A., R.S., S.P., M.P.) and Immunology (N.N., P.A.), Tufts University, Boston, Massachusetts; and Molecular Cardiology Research Institute and Division of Cardiology (R.B.), Tufts Medical Center, Boston, Massachusetts
| | - Robert M Blanton
- Program in Pharmacology and Experimental Therapeutics (T.L., S.P., M.P.) and Program in Immunology (D.A., R.S., N.N., P.A.), Sackler School of Graduate Biomedical Sciences and Departments of Developmental, Molecular and Chemical Biology (T.L., D.A., R.S., S.P., M.P.) and Immunology (N.N., P.A.), Tufts University, Boston, Massachusetts; and Molecular Cardiology Research Institute and Division of Cardiology (R.B.), Tufts Medical Center, Boston, Massachusetts
| | - Mercio A Perrin
- Program in Pharmacology and Experimental Therapeutics (T.L., S.P., M.P.) and Program in Immunology (D.A., R.S., N.N., P.A.), Sackler School of Graduate Biomedical Sciences and Departments of Developmental, Molecular and Chemical Biology (T.L., D.A., R.S., S.P., M.P.) and Immunology (N.N., P.A.), Tufts University, Boston, Massachusetts; and Molecular Cardiology Research Institute and Division of Cardiology (R.B.), Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
28
|
Phosphodiesterase 2 inhibition preferentially promotes NO/guanylyl cyclase/cGMP signaling to reverse the development of heart failure. Proc Natl Acad Sci U S A 2018; 115:E7428-E7437. [PMID: 30012589 PMCID: PMC6077693 DOI: 10.1073/pnas.1800996115] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a shared manifestation of several cardiovascular pathologies, including hypertension and myocardial infarction, and a limited repertoire of treatment modalities entails that the associated morbidity and mortality remain high. Impaired nitric oxide (NO)/guanylyl cyclase (GC)/cyclic guanosine-3',5'-monophosphate (cGMP) signaling, underpinned, in part, by up-regulation of cyclic nucleotide-hydrolyzing phosphodiesterase (PDE) isozymes, contributes to the pathogenesis of HF, and interventions targeted to enhancing cGMP have proven effective in preclinical models and patients. Numerous PDE isozymes coordinate the regulation of cardiac cGMP in the context of HF; PDE2 expression and activity are up-regulated in experimental and human HF, but a well-defined role for this isoform in pathogenesis has yet to be established, certainly in terms of cGMP signaling. Herein, using a selective pharmacological inhibitor of PDE2, BAY 60-7550, and transgenic mice lacking either NO-sensitive GC-1α (GC-1α-/-) or natriuretic peptide-responsive GC-A (GC-A-/-), we demonstrate that the blockade of PDE2 promotes cGMP signaling to offset the pathogenesis of experimental HF (induced by pressure overload or sympathetic hyperactivation), reversing the development of left ventricular hypertrophy, compromised contractility, and cardiac fibrosis. Moreover, we show that this beneficial pharmacodynamic profile is maintained in GC-A-/- mice but is absent in animals null for GC-1α or treated with a NO synthase inhibitor, revealing that PDE2 inhibition preferentially enhances NO/GC/cGMP signaling in the setting of HF to exert wide-ranging protection to preserve cardiac structure and function. These data substantiate the targeting of PDE2 in HF as a tangible approach to maximize myocardial cGMP signaling and enhancing therapy.
Collapse
|
29
|
Hofmann F. A concise discussion of the regulatory role of cGMP kinase I in cardiac physiology and pathology. Basic Res Cardiol 2018; 113:31. [PMID: 29934662 DOI: 10.1007/s00395-018-0690-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/18/2018] [Accepted: 06/13/2018] [Indexed: 12/25/2022]
Abstract
The underlying cause of cardiac hypertrophy, fibrosis, and heart failure has been investigated in great detail using different mouse models. These studies indicated that cGMP and cGMP-dependent protein kinase type I (cGKI) may ameliorate these negative phenotypes in the adult heart. Recently, evidence has been published that cardiac mitochondrial BKCa channels are a target for cGKI and that activation of mitoBKCa channels may cause some of the positive effects of conditioning in ischemia/reperfusion injury. It will be pointed out that most studies could not present convincing evidence that it is the cGMP level and the activity cGKI in specific cardiac cells that reduces hypertrophy or heart failure. However, anti-fibrotic compounds stimulating nitric oxide-sensitive guanylyl cyclase may be an upcoming therapy for abnormal cardiac remodeling.
Collapse
Affiliation(s)
- Franz Hofmann
- Institut für Pharmakologie und Toxikologie, TU München, Biedersteiner Str. 29, 80802, Munich, Germany.
| |
Collapse
|
30
|
Salvador AM, Moss ME, Aronovitz M, Mueller KB, Blanton RM, Jaffe IZ, Alcaide P. Endothelial mineralocorticoid receptor contributes to systolic dysfunction induced by pressure overload without modulating cardiac hypertrophy or inflammation. Physiol Rep 2018. [PMID: 28637706 PMCID: PMC5492203 DOI: 10.14814/phy2.13313] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Heart Failure (HF) is associated with increased circulating levels of aldosterone and systemic inflammation. Mineralocorticoid receptor (MR) antagonists block aldosterone action and decrease mortality in patients with congestive HF. However, the molecular mechanisms underlying the therapeutic benefits of MR antagonists remain unclear. MR is expressed in all cell types in the heart, including the endothelial cells (EC), in which aldosterone induces the expression of intercellular adhesion molecule 1 (ICAM‐1). Recently, we reported that ICAM‐1 regulates cardiac inflammation and cardiac function in mice subjected to transverse aortic constriction (TAC). Whether MR specifically in endothelial cells (EC) contributes to the several mechanisms of pathological cardiac remodeling and cardiac dysfunction remains unclear. Basal cardiac function and LV dimensions were comparable in mice with MR selectively deleted from ECs (EC‐MR−/−) and wild‐type littermate controls (EC‐MR+/+). MR was specifically deleted in heart EC, and in EC‐containing tissues, but not in leukocytes of TAC EC‐MR−/− mice. While EC‐MR−/−TAC mice showed preserved systolic function and some alterations in the expression of fetal genes, the proinflammatory cytokine TNFα and the endothelin receptors in the LV as compared to EC‐MR+/+TAC mice, no difference was observed between both TAC groups in overall cardiac hypertrophy, ICAM‐1 LV expression and leukocyte infiltration, cardiac fibrosis or capillary rarefaction, all hallmarks of pathological cardiac remodeling. Our data indicate that EC‐MR contributes to the transition of cardiac hypertrophy to systolic dysfunction independently of other maladaptive changes induced by LV pressure overload.
Collapse
Affiliation(s)
- Ane M Salvador
- Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, Massachusetts.,Centro de Investigaciόn Biomédica, Universidad de Granada, Spain
| | - M Elizabeth Moss
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts.,Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Mark Aronovitz
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Kathleen B Mueller
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts.,Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Robert M Blanton
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Pilar Alcaide
- Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, Massachusetts .,Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts
| |
Collapse
|
31
|
Nevers T, Salvador AM, Velazquez F, Ngwenyama N, Carrillo-Salinas FJ, Aronovitz M, Blanton RM, Alcaide P. Th1 effector T cells selectively orchestrate cardiac fibrosis in nonischemic heart failure. J Exp Med 2017; 214:3311-3329. [PMID: 28970239 PMCID: PMC5679176 DOI: 10.1084/jem.20161791] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/13/2017] [Accepted: 08/21/2017] [Indexed: 12/20/2022] Open
Abstract
Despite emerging data indicating a role for T cells in profibrotic cardiac repair and healing after ischemia, little is known about whether T cells directly impact cardiac fibroblasts (CFBs) to promote cardiac fibrosis (CF) in nonischemic heart failure (HF). Recently, we reported increased T cell infiltration in the fibrotic myocardium of nonischemic HF patients, as well as the protection from CF and HF in TCR-α-/- mice. Here, we report that T cells activated in such a context are mainly IFN-γ+, adhere to CFB, and induce their transition into myofibroblasts. Th1 effector cells selectively drive CF both in vitro and in vivo, whereas adoptive transfer of Th1 cells, opposite to activated IFN-γ-/- Th cells, partially reconstituted CF and HF in TCR-α-/- recipient mice. Mechanistically, Th1 cells use integrin α4 to adhere to and induce TGF-β in CFB in an IFN-γ-dependent manner. Our findings identify a previously unrecognized role for Th1 cells as integrators of perivascular CF and cardiac dysfunction in nonischemic HF.
Collapse
Affiliation(s)
- Tania Nevers
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA
| | - Ane M Salvador
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA
| | - Francisco Velazquez
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA
| | - Njabulo Ngwenyama
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA
| | | | - Mark Aronovitz
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA
| | - Robert M Blanton
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA
| | - Pilar Alcaide
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA
| |
Collapse
|
32
|
McCarthy JC, Aronovitz M, DuPont JJ, Calamaras TD, Jaffe IZ, Blanton RM. Short-Term Administration of Serelaxin Produces Predominantly Vascular Benefits in the Angiotensin II/L-NAME Chronic Heart Failure Model. ACTA ACUST UNITED AC 2017; 2:285-296. [PMID: 30062150 PMCID: PMC6034497 DOI: 10.1016/j.jacbts.2017.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 12/25/2022]
Abstract
Temporary administration of recombinant relaxin-2 (serelaxin) in patients hospitalized with HF was associated with improved mortality 6 months after discharge. The specific effects of serelaxin on vascular and myocardial structure and function in HF have not been studied. In mice subjected to continuous 28-day heart failure stimulus of AngII and L-NAME, serelaxin was administered for 3 days (days 7 to 9), and both the acute effects during serelaxin infusion and the delayed effects after termination of serelaxin on cardiovascular structure and function were studied. Temporary serelaxin improved vascular fibrosis and myocardial capillary density and reduced resistance vessel constriction to potassium chloride during administration. These effects unexpectedly persisted 19 days after discontinuation of serelaxin, despite continued exposure to AngII/L-NAME. Serelaxin did not alter cardiac hypertrophy, geometry, or dysfunction at either time point. These findings support that serelaxin predominantly affects vascular structure and function in the setting of HF.
In patients hospitalized with acute heart failure, temporary serelaxin infusion reduced 6-month mortality through unknown mechanisms. This study therefore explored the cardiovascular effects of temporary serelaxin administration in mice subjected to the angiotensin II (AngII)/L-NG-nitroarginine methyl ester (L-NAME) heart failure model, both during serelaxin infusion and 19 days post–serelaxin infusion. Serelaxin administration did not alter AngII/L-NAME-induced cardiac hypertrophy, geometry, or dysfunction. However, serelaxin-treated mice had reduced perivascular left ventricular fibrosis and preserved left ventricular capillary density at both time points. Furthermore, resistance vessels from serelaxin-treated mice displayed decreased potassium chloride–induced constriction and reduced aortic fibrosis. These findings suggest that serelaxin improves outcomes in patients through vascular-protective effects.
Collapse
Affiliation(s)
| | | | | | | | | | - Robert M. Blanton
- Address for correspondence: Dr. Robert M. Blanton, Tufts Medical Center, 800 Washington Street, Box 80 Boston, Massachusetts 02111.
| |
Collapse
|
33
|
Shah SJ, Kitzman DW, Borlaug BA, van Heerebeek L, Zile MR, Kass DA, Paulus WJ. Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap. Circulation 2016; 134:73-90. [PMID: 27358439 DOI: 10.1161/circulationaha.116.021884] [Citation(s) in RCA: 679] [Impact Index Per Article: 84.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (EF; HFpEF) accounts for 50% of HF cases, and its prevalence relative to HF with reduced EF continues to rise. In contrast to HF with reduced EF, large trials testing neurohumoral inhibition in HFpEF failed to reach a positive outcome. This failure was recently attributed to distinct systemic and myocardial signaling in HFpEF and to diversity of HFpEF phenotypes. In this review, an HFpEF treatment strategy is proposed that addresses HFpEF-specific signaling and phenotypic diversity. In HFpEF, extracardiac comorbidities such as metabolic risk, arterial hypertension, and renal insufficiency drive left ventricular remodeling and dysfunction through systemic inflammation and coronary microvascular endothelial dysfunction. The latter affects left ventricular diastolic dysfunction through macrophage infiltration, resulting in interstitial fibrosis, and through altered paracrine signaling to cardiomyocytes, which become hypertrophied and stiff because of low nitric oxide and cyclic guanosine monophosphate. Systemic inflammation also affects other organs such as lungs, skeletal muscle, and kidneys, leading, respectively, to pulmonary hypertension, muscle weakness, and sodium retention. Individual steps of these signaling cascades can be targeted by specific interventions: metabolic risk by caloric restriction, systemic inflammation by statins, pulmonary hypertension by phosphodiesterase 5 inhibitors, muscle weakness by exercise training, sodium retention by diuretics and monitoring devices, myocardial nitric oxide bioavailability by inorganic nitrate-nitrite, myocardial cyclic guanosine monophosphate content by neprilysin or phosphodiesterase 9 inhibition, and myocardial fibrosis by spironolactone. Because of phenotypic diversity in HFpEF, personalized therapeutic strategies are proposed, which are configured in a matrix with HFpEF presentations in the abscissa and HFpEF predispositions in the ordinate.
Collapse
Affiliation(s)
- Sanjiv J Shah
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Dalane W Kitzman
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Barry A Borlaug
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Loek van Heerebeek
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Michael R Zile
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - David A Kass
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.)
| | - Walter J Paulus
- From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.).
| |
Collapse
|
34
|
Early echocardiographic predictors of outcomes in the mouse transverse aortic constriction heart failure model. J Pharmacol Toxicol Methods 2016; 84:93-101. [PMID: 27956205 DOI: 10.1016/j.vascn.2016.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Mouse transverse aortic constriction (TAC) is a widely-used model of pressure overload-induced heart failure. An intrinsic limitation of the model is variability in the response to pressure overload even when employing a standard severity of stenosis. Few literature studies have explicitly reported the use of entry criteria or early predictors to mitigate variability and enrich outcomes in this model. METHODS Eleven-week-old male C57BL/6J mice underwent TAC or sham surgery. Left ventricular (LV) function and dimensions were assessed by M-mode echocardiography at baseline (pre) and 3, 9 and 12weeks post-procedure (end-study). At 24h post-procedure, transverse aortic flow velocities were obtained for estimating trans-TAC pressure gradients. Invasive LV hemodynamic assessments were performed and terminal heart and lung weights obtained at end-study. RESULTS TAC mice displayed early development of LV hypertrophy and wall thickening followed by the later development of LV chamber dilation, and progressive development of LV systolic and diastolic dysfunction. The use of a pre-defined trans-TAC pressure gradient criterion of 45-60mmHg did not affect end-study organ weight, echocardiographic and invasive hemodynamic outcomes. A post-hoc receiver operator characteristic (ROC) analysis identified early 3week echocardiographic measures of LVmass(echo) and ejection fraction, with threshold changes of ~+30% and -10% normalized to baseline respectively, as good predictors for multiple end-study organ weight, echocardiographic and invasive hemodynamic outcomes. DISCUSSION This ROC analysis has identified early predictive threshold changes which may serve, alone or in combination, as entry criteria to enrich outcome in this model.
Collapse
|
35
|
PDE1C deficiency antagonizes pathological cardiac remodeling and dysfunction. Proc Natl Acad Sci U S A 2016; 113:E7116-E7125. [PMID: 27791092 DOI: 10.1073/pnas.1607728113] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cyclic nucleotide phosphodiesterase 1C (PDE1C) represents a major phosphodiesterase activity in human myocardium, but its function in the heart remains unknown. Using genetic and pharmacological approaches, we studied the expression, regulation, function, and underlying mechanisms of PDE1C in the pathogenesis of cardiac remodeling and dysfunction. PDE1C expression is up-regulated in mouse and human failing hearts and is highly expressed in cardiac myocytes but not in fibroblasts. In adult mouse cardiac myocytes, PDE1C deficiency or inhibition attenuated myocyte death and apoptosis, which was largely dependent on cyclic AMP/PKA and PI3K/AKT signaling. PDE1C deficiency also attenuated cardiac myocyte hypertrophy in a PKA-dependent manner. Conditioned medium taken from PDE1C-deficient cardiac myocytes attenuated TGF-β-stimulated cardiac fibroblast activation through a mechanism involving the crosstalk between cardiac myocytes and fibroblasts. In vivo, cardiac remodeling and dysfunction induced by transverse aortic constriction, including myocardial hypertrophy, apoptosis, cardiac fibrosis, and loss of contractile function, were significantly attenuated in PDE1C-knockout mice relative to wild-type mice. These results indicate that PDE1C activation plays a causative role in pathological cardiac remodeling and dysfunction. Given the continued development of highly specific PDE1 inhibitors and the high expression level of PDE1C in the human heart, our findings could have considerable therapeutic significance.
Collapse
|
36
|
Wang Y, Eldridge N, Metersky ML, Sonnenfeld N, Fine JM, Pandolfi MM, Eckenrode S, Bakullari A, Galusha DH, Jaser L, Verzier NR, Nuti SV, Hunt D, Normand SLT, Krumholz HM. Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction. J Am Heart Assoc 2016; 5:JAHA.116.003731. [PMID: 27405808 PMCID: PMC5015406 DOI: 10.1161/jaha.116.003731] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30‐day mortality and unplanned readmission rates for Medicare fee‐for‐service patients hospitalized for acute myocardial infarction (AMI). Methods and Results Using 2009–2013 medical record‐abstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixed‐effects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospital‐specific risk‐standardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospital‐specific 30‐day all‐cause risk‐standardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the risk‐standardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79–8.94) and 3.44% points (95% CI, 0.19–6.68) for the risk‐standardized mortality and unplanned readmission rates, respectively. Conclusions For Medicare fee‐for‐service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30‐day all‐cause mortality and on unplanned readmissions.
Collapse
Affiliation(s)
- Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Noel Eldridge
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD
| | - Mark L Metersky
- Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - Nancy Sonnenfeld
- Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Rockville, MD
| | - Jonathan M Fine
- Section of Pulmonary and Critical Care Medicine, Norwalk Hospital, Norwalk, CT
| | | | | | | | - Deron H Galusha
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Lisa Jaser
- Department of Pharmacy, Griffin Hospital, Derby, CT
| | | | - Sudhakar V Nuti
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - David Hunt
- Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, Rockville, MD
| | - Sharon-Lise T Normand
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT Department of Health Policy and Management, Yale School of Public Health, New Haven, CT Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| |
Collapse
|
37
|
Prysyazhna O, Burgoyne JR, Scotcher J, Grover S, Kass D, Eaton P. Phosphodiesterase 5 Inhibition Limits Doxorubicin-induced Heart Failure by Attenuating Protein Kinase G Iα Oxidation. J Biol Chem 2016; 291:17427-36. [PMID: 27342776 DOI: 10.1074/jbc.m116.724070] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Indexed: 01/25/2023] Open
Abstract
Phosphodiesterase 5 (PDE5) inhibitors limit myocardial injury caused by stresses, including doxorubicin chemotherapy. cGMP binding to PKG Iα attenuates oxidant-induced disulfide formation. Because PDE5 inhibition elevates cGMP and protects from doxorubicin-induced injury, we reasoned that this may be because it limits PKG Iα disulfide formation. To investigate the role of PKG Iα disulfide dimerization in the development of apoptosis, doxorubicin-induced cardiomyopathy was compared in male wild type (WT) or disulfide-resistant C42S PKG Iα knock-in (KI) mice. Echocardiography showed that doxorubicin treatment caused loss of myocardial tissue and depressed left ventricular function in WT mice. Doxorubicin also reduced pro-survival signaling and increased apoptosis in WT hearts. In contrast, KI mice were markedly resistant to the dysfunction induced by doxorubicin in WTs. In follow-on experiments the influence of the PDE5 inhibitor tadalafil on the development of doxorubicin-induced cardiomyopathy in WT and KI mice was investigated. In WT mice, co-administration of tadalafil with doxorubicin reduced PKG Iα oxidation caused by doxorubicin and also protected against cardiac injury and loss of function. KI mice were again innately resistant to doxorubicin-induced cardiotoxicity, and therefore tadalafil afforded no additional protection. Doxorubicin decreased phosphorylation of RhoA (Ser-188), stimulating its GTPase activity to activate Rho-associated protein kinase (ROCK) in WTs. These pro-apoptotic events were absent in KI mice and were attenuated in WTs co-administered tadalafil. PKG Iα disulfide formation triggers cardiac injury, and this initiation of maladaptive signaling can be blocked by pharmacological therapies that elevate cGMP, which binds kinase to limit its oxidation.
Collapse
Affiliation(s)
| | | | | | - Steven Grover
- the Academic Department of Surgery, King's College London, Cardiovascular Division, British Heart Foundation Centre of Excellence, St. Thomas' Hospital, London, SE1 7EH, United Kingdom and
| | - David Kass
- the Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205
| | | |
Collapse
|
38
|
Pradhan K, Sydykov A, Tian X, Mamazhakypov A, Neupane B, Luitel H, Weissmann N, Seeger W, Grimminger F, Kretschmer A, Stasch JP, Ghofrani HA, Schermuly RT. Soluble guanylate cyclase stimulator riociguat and phosphodiesterase 5 inhibitor sildenafil ameliorate pulmonary hypertension due to left heart disease in mice. Int J Cardiol 2016; 216:85-91. [PMID: 27140341 DOI: 10.1016/j.ijcard.2016.04.098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/11/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Presence of pulmonary hypertension (PH) and right ventricular dysfunction worsens prognosis in patients with chronic heart failure (CHF). Preclinical and clinical studies suggest a role for the impaired nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) signaling pathway in both PH and CHF. Hence, we examined the effects of the NO-sGC-cGMP pathway modulation by the PDE5 inhibitor sildenafil or sGC stimulator riociguat on pulmonary hemodynamics and heart function in a murine model of secondary PH induced by transverse aortic constriction. METHODS C57Bl/6N mice were subjected to transverse aortic constriction (TAC) for 6weeks to induce left heart failure and secondary PH and were subsequently treated with either sildenafil (100mg/kg/day) or riociguat (10mg/kg/day) or placebo for 2weeks. RESULTS Six weeks after surgery, TAC induced significant left ventricular hypertrophy and dysfunction associated with development of PH. Treatment with riociguat and sildenafil neither reduced left ventricular hypertrophy nor improved its function. However, both sildenafil and riociguat ameliorated PH, reduced pulmonary vascular remodeling and improved right ventricular function. CONCLUSIONS Thus, modulation of the NO-sGC-cGMP pathway by the PDE5 inhibitor sildenafil or sGC stimulator riociguat exerts direct beneficial effects on pulmonary hemodynamics and right ventricular function in the experimental model of secondary PH due to left heart disease and these drugs may offer a new therapeutic option for therapy of this condition.
Collapse
Affiliation(s)
- Kabita Pradhan
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Akylbek Sydykov
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Xia Tian
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Argen Mamazhakypov
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Balram Neupane
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Himal Luitel
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Norbert Weissmann
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Werner Seeger
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany; Max-Planck-Institute for Heart and Lung Research, Parkstraße 1, 61231 Bad Nauheim, Germany
| | - Friedrich Grimminger
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Axel Kretschmer
- Bayer HealthCare, Aprather Weg 18a, 42096, Wuppertal, Germany
| | | | - Hossein Ardeschir Ghofrani
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Ralph Theo Schermuly
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, Member of the German Lung Center, Justus Liebig University Giessen, Giessen, Germany.
| |
Collapse
|
39
|
Rodrigues PG, Leite-Moreira AF, Falcão-Pires I. Myocardial reverse remodeling: how far can we rewind? Am J Physiol Heart Circ Physiol 2016; 310:H1402-22. [PMID: 26993225 DOI: 10.1152/ajpheart.00696.2015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 03/04/2016] [Indexed: 12/19/2022]
Abstract
Heart failure (HF) is a systemic disease that can be divided into HF with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). HFpEF accounts for over 50% of all HF patients and is typically associated with high prevalence of several comorbidities, including hypertension, diabetes mellitus, pulmonary hypertension, obesity, and atrial fibrillation. Myocardial remodeling occurs both in HFrEF and HFpEF and it involves changes in cardiac structure, myocardial composition, and myocyte deformation and multiple biochemical and molecular alterations that impact heart function and its reserve capacity. Understanding the features of myocardial remodeling has become a major objective for limiting or reversing its progression, the latter known as reverse remodeling (RR). Research on HFrEF RR process is broader and has delivered effective therapeutic strategies, which have been employed for some decades. However, the RR process in HFpEF is less clear partly due to the lack of information on HFpEF pathophysiology and to the long list of failed standard HF therapeutics strategies in these patient's outcomes. Nevertheless, new proteins, protein-protein interactions, and signaling pathways are being explored as potential new targets for HFpEF remodeling and RR. Here, we review recent translational and clinical research in HFpEF myocardial remodeling to provide an overview on the most important features of RR, comparing HFpEF with HFrEF conditions.
Collapse
Affiliation(s)
- Patrícia G Rodrigues
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Adelino F Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| |
Collapse
|
40
|
Salvador AM, Nevers T, Velázquez F, Aronovitz M, Wang B, Abadía Molina A, Jaffe IZ, Karas RH, Blanton RM, Alcaide P. Intercellular Adhesion Molecule 1 Regulates Left Ventricular Leukocyte Infiltration, Cardiac Remodeling, and Function in Pressure Overload-Induced Heart Failure. J Am Heart Assoc 2016; 5:e003126. [PMID: 27068635 PMCID: PMC4943280 DOI: 10.1161/jaha.115.003126] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Left ventricular dysfunction and heart failure are strongly associated in humans with increased circulating levels of proinflammatory cytokines, T cells, and soluble intercellular cell adhesion molecule 1 (ICAM1). In mice, infiltration of T cells into the left ventricle contributes to pathological cardiac remodeling, but the mechanisms regulating their recruitment to the heart are unclear. We hypothesized that ICAM1 regulates cardiac inflammation and pathological cardiac remodeling by mediating left ventricular T‐cell recruitment and thus contributing to cardiac dysfunction and heart failure. Methods and Results In a mouse model of pressure overload–induced heart failure, intramyocardial endothelial ICAM1 increased within 48 hours in response to thoracic aortic constriction and remained upregulated as heart failure progressed. ICAM1‐deficient mice had decreased T‐cell and proinflammatory monocyte infiltration in the left ventricle in response to thoracic aortic constriction, despite having numbers of circulating T cells and activated T cells in the heart‐draining lymph nodes that were similar to those of wild‐type mice. ICAM1‐deficient mice did not develop cardiac fibrosis or systolic and diastolic dysfunction in response to thoracic aortic constriction. Exploration of the mechanisms regulating ICAM1 expression revealed that endothelial ICAM1 upregulation and T‐cell infiltration were not mediated by endothelial mineralocorticoid receptor signaling, as demonstrated in thoracic aortic constriction studies in mice with endothelial mineralocorticoid receptor deficiency, but rather were induced by the cardiac cytokines interleukin 1β and 6. Conclusions ICAM1 regulates pathological cardiac remodeling by mediating proinflammatory leukocyte infiltration in the left ventricle and cardiac fibrosis and dysfunction and thus represents a novel target for treatment of heart failure.
Collapse
Affiliation(s)
- Ane M Salvador
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA Centro de Investigaciόn Biomédica, Universidad de Granada, Spain
| | - Tania Nevers
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA
| | - Francisco Velázquez
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA Sackler School for Graduate studies, Tufts University School of Medicine, Boston, MA
| | - Mark Aronovitz
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA
| | - Bonnie Wang
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA
| | | | - Iris Z Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA Sackler School for Graduate studies, Tufts University School of Medicine, Boston, MA
| | - Richard H Karas
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA Sackler School for Graduate studies, Tufts University School of Medicine, Boston, MA
| | - Robert M Blanton
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA
| | - Pilar Alcaide
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA Sackler School for Graduate studies, Tufts University School of Medicine, Boston, MA
| |
Collapse
|
41
|
Thoonen R, Giovanni S, Govindan S, Lee DI, Wang GR, Calamaras TD, Takimoto E, Kass DA, Sadayappan S, Blanton RM. Molecular Screen Identifies Cardiac Myosin-Binding Protein-C as a Protein Kinase G-Iα Substrate. Circ Heart Fail 2015; 8:1115-22. [PMID: 26477830 DOI: 10.1161/circheartfailure.115.002308] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 10/08/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pharmacological activation of cGMP-dependent protein kinase G I (PKGI) has emerged as a therapeutic strategy for humans with heart failure. However, PKG-activating drugs have been limited by hypotension arising from PKG-induced vasodilation. PKGIα antiremodeling substrates specific to the myocardium might provide targets to circumvent this limitation, but currently remain poorly understood. METHODS AND RESULTS We performed a screen for myocardial proteins interacting with the PKGIα leucine zipper (LZ)-binding domain to identify myocardial-specific PKGI antiremodeling substrates. Our screen identified cardiac myosin-binding protein-C (cMyBP-C), a cardiac myocyte-specific protein, which has been demonstrated to inhibit cardiac remodeling in the phosphorylated state, and when mutated leads to hypertrophic cardiomyopathy in humans. GST pulldowns and precipitations with cGMP-conjugated beads confirmed the PKGIα-cMyBP-C interaction in myocardial lysates. In vitro studies demonstrated that purified PKGIα phosphorylates the cMyBP-C M-domain at Ser-273, Ser-282, and Ser-302. cGMP induced cMyBP-C phosphorylation at these residues in COS cells transfected with PKGIα, but not in cells transfected with LZ mutant PKGIα, containing mutations to disrupt LZ substrate binding. In mice subjected to left ventricular pressure overload, PKGI activation with sildenafil increased cMyBP-C phosphorylation at Ser-273 compared with untreated mice. cGMP also induced cMyBP-C phosphorylation in isolated cardiac myocytes. CONCLUSIONS Taken together, these data support that PKGIα and cMyBP-C interact in the heart and that cMyBP-C is an anti remodeling PKGIα kinase substrate. This study provides the first identification of a myocardial-specific PKGIα LZ-dependent antiremodeling substrate and supports further exploration of PKGIα myocardial LZ substrates as potential therapeutic targets for heart failure.
Collapse
Affiliation(s)
- Robrecht Thoonen
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - Shewit Giovanni
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - Suresh Govindan
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - Dong I Lee
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - Guang-Rong Wang
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - Timothy D Calamaras
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - Eiki Takimoto
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - David A Kass
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - Sakthivel Sadayappan
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.)
| | - Robert M Blanton
- From the Molecular Cardiology Research Institute (R.T., G.-R.W., T.D.C., R.M.B.) and Division of Cardiology (R.M.B.), Tufts Medical Center, Boston, MA; Tufts University School of Medicine, Boston, MA (S. Giovanni); Department of Cell and Molecular Physiology, Health Sciences Division, Loyola University Chicago, Maywood, IL (S. Govindan, S.S.); Johns Hopkins Medical Institutions, Baltimore, MD (D.I.L., E.T., D.A.K.); and Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan (E.T.).
| |
Collapse
|
42
|
Prysyazhna O, Eaton P. Redox regulation of cGMP-dependent protein kinase Iα in the cardiovascular system. Front Pharmacol 2015; 6:139. [PMID: 26236235 PMCID: PMC4505079 DOI: 10.3389/fphar.2015.00139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/22/2015] [Indexed: 11/13/2022] Open
Abstract
Elevated levels of oxidants in biological systems have been historically referred to as “oxidative stress,” a choice of words that perhaps conveys an imbalanced view of reactive oxygen species in cells and tissues. The term stress suggests a harmful role, whereas a contemporary view is that oxidants are also crucial for the maintenance of homeostasis or adaptive signaling that can actually limit injury. This regulatory role for oxidants is achieved in part by them inducing oxidative post-translational modifications of proteins which may alter their function or interactions. Such mechanisms allow changes in cell oxidant levels to be coupled to regulated alterations in enzymatic function (i.e., signal transduction), which enables “redox signaling.” In this review we focus on the role of cGMP-dependent protein kinase (PKG) Ia disulfide dimerisation, an oxidative modification that is induced by oxidants that directly activates the enzyme, discussing how this impacts on the cardiovascular system. Additionally, how this oxidative activation of PKG may coordinate with or differ from classical activation of this kinase by cGMP is also considered.
Collapse
Affiliation(s)
- Oleksandra Prysyazhna
- Cardiovascular Division, King's College London, The British Heart Foundation Centre of Excellence, The Rayne Institute, St Thomas' Hospital , London, UK
| | - Philip Eaton
- Cardiovascular Division, King's College London, The British Heart Foundation Centre of Excellence, The Rayne Institute, St Thomas' Hospital , London, UK
| |
Collapse
|
43
|
Straubinger J, Schöttle V, Bork N, Subramanian H, Dünnes S, Russwurm M, Gawaz M, Friebe A, Nemer M, Nikolaev VO, Lukowski R. Sildenafil Does Not Prevent Heart Hypertrophy and Fibrosis Induced by Cardiomyocyte Angiotensin II Type 1 Receptor Signaling. J Pharmacol Exp Ther 2015; 354:406-16. [PMID: 26157043 DOI: 10.1124/jpet.115.226092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/07/2015] [Indexed: 12/25/2022] Open
Abstract
Analyses of several mouse models imply that the phosphodiesterase 5 (PDE5) inhibitor sildenafil (SIL), via increasing cGMP, affords protection against angiotensin II (Ang II)-stimulated cardiac remodeling. However, it is unclear which cell types are involved in these beneficial effects, because Ang II may exert its adverse effects by modulating multiple renovascular and cardiac functions via Ang II type 1 receptors (AT1Rs). To test the hypothesis that SIL/cGMP inhibit cardiac stress provoked by amplified Ang II/AT1R directly in cardiomyocytes (CMs), we studied transgenic mice with CM-specific overexpression of the AT1R under the control of the α-myosin heavy chain promoter (αMHC-AT1R(tg/+)). The extent of cardiac growth was assessed in the absence or presence of SIL and defined by referring changes in heart weight to body weight or tibia length. Hypertrophic marker genes, extracellular matrix-regulating factors, and expression patterns of fibrosis markers were examined in αMHC-AT1R(tg/+) ventricles (with or without SIL) and corroborated by investigating different components of the natriuretic peptide/PDE5/cGMP pathway as well as cardiac functions. cGMP levels in heart lysates and intact CMs were measured by competitive immunoassays and Förster resonance energy transfer. We found higher cardiac and CM cGMP levels and upregulation of the cGMP-dependent protein kinase type I with AT1R overexpression. However, even a prolonged SIL treatment regimen did not limit the progressive CM growth, fibrosis, or decline in cardiac functions in the αMHC-AT1R(tg/+) model, suggesting that SIL does not interfere with the pathogenic actions of amplified AT1R signaling in CMs. Hence, the cardiac/noncardiac cells involved in the cross-talk between SIL-sensitive PDE activity and Ang II/AT1R still need to be identified.
Collapse
Affiliation(s)
- Julia Straubinger
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Verena Schöttle
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Nadja Bork
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Hariharan Subramanian
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Sarah Dünnes
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Michael Russwurm
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Meinrad Gawaz
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Andreas Friebe
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Mona Nemer
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Viacheslav O Nikolaev
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| | - Robert Lukowski
- Department of Pharmacology, Toxicology and Clinical Pharmacy, Institute of Pharmacy, University of Tübingen, Tübingen, Germany (J.S., V.S., N.B., R.L.); Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (H.S., V.O.N.); Physiologisches Institut I, Universität Würzburg, Würzburg, Germany (S.D., A.F.); Institut für Pharmakologie und Toxikologie, Ruhr-Universität Bochum, Bochum, Germany (M.R.); Internal Medicine III, Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany (M.G.); Laboratory of Cardiac Development and Differentiation, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada (M.N.); and Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada (M.N.)
| |
Collapse
|
44
|
Nevers T, Salvador AM, Grodecki-Pena A, Knapp A, Velázquez F, Aronovitz M, Kapur NK, Karas RH, Blanton RM, Alcaide P. Left Ventricular T-Cell Recruitment Contributes to the Pathogenesis of Heart Failure. Circ Heart Fail 2015; 8:776-87. [PMID: 26022677 DOI: 10.1161/circheartfailure.115.002225] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/15/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the emerging association between heart failure (HF) and inflammation, the role of T cells, major players in chronic inflammation, has only recently begun to be explored. Whether T-cell recruitment to the left ventricle (LV) participates in the development of HF requires further investigation to identify novel mechanisms that may serve for the design of alternative therapeutic interventions. METHODS AND RESULTS Real-time videomicroscopy of T cells from nonischemic HF patients or from mice with HF induced by transverse aortic constriction revealed enhanced adhesion to activated vascular endothelial cells under flow conditions in vitro compared with T cells from healthy subjects or sham mice. T cells in the mediastinal lymph nodes and the intramyocardial endothelium were both activated in response to transverse aortic constriction and the kinetics of LV T-cell infiltration was directly associated with the development of systolic dysfunction. In response to transverse aortic constriction, T cell-deficient mice (T-cell receptor, TCRα(-/-)) had preserved LV systolic and diastolic function, reduced LV fibrosis, hypertrophy and inflammation, and improved survival compared with wild-type mice. Furthermore, T-cell depletion in wild-type mice after transverse aortic constriction prevented HF. CONCLUSIONS T cells are major contributors to nonischemic HF. Their activation combined with the activation of the LV endothelium results in LV T-cell infiltration negatively contributing to HF progression through mechanisms involving cytokine release and induction of cardiac fibrosis and hypertrophy. Reduction of T-cell infiltration is thus identified as a novel translational target in HF.
Collapse
Affiliation(s)
- Tania Nevers
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Ane M Salvador
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Anna Grodecki-Pena
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Andrew Knapp
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Francisco Velázquez
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Mark Aronovitz
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Navin K Kapur
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Richard H Karas
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Robert M Blanton
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.)
| | - Pilar Alcaide
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (T.N., A.M.S., A.G.-P., A.K., F.V., M.A., N.K.K., R.H.K., R.M.B., P.A.); and the Program in Immunology, Sackler School for Graduate Studies, Department of Medicine, Tufts University School of Medicine, Boston, MA (F.V., R.H.K., P.A.).
| |
Collapse
|
45
|
Nakamura T, Ranek MJ, Lee DI, Shalkey Hahn V, Kim C, Eaton P, Kass DA. Prevention of PKG1α oxidation augments cardioprotection in the stressed heart. J Clin Invest 2015; 125:2468-72. [PMID: 25938783 DOI: 10.1172/jci80275] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/06/2015] [Indexed: 12/11/2022] Open
Abstract
The cGMP-dependent protein kinase-1α (PKG1α) transduces NO and natriuretic peptide signaling; therefore, PKG1α activation can benefit the failing heart. Disease modifiers such as oxidative stress may depress the efficacy of PKG1α pathway activation and underlie variable clinical results. PKG1α can also be directly oxidized, forming a disulfide bond between homodimer subunits at cysteine 42 to enhance oxidant-stimulated vasorelaxation; however, the impact of PKG1α oxidation on myocardial regulation is unknown. Here, we demonstrated that PKG1α is oxidized in both patients with heart disease and in rodent disease models. Moreover, this oxidation contributed to adverse heart remodeling following sustained pressure overload or Gq agonist stimulation. Compared with control hearts and myocytes, those expressing a redox-dead protein (PKG1α(C42S)) better adapted to cardiac stresses at functional, histological, and molecular levels. Redox-dependent changes in PKG1α altered intracellular translocation, with the activated, oxidized form solely located in the cytosol, whereas reduced PKG1α(C42S) translocated to and remained at the outer plasma membrane. This altered PKG1α localization enhanced suppression of transient receptor potential channel 6 (TRPC6), thereby potentiating antihypertrophic signaling. Together, these results demonstrate that myocardial PKG1α oxidation prevents a beneficial response to pathological stress, may explain variable responses to PKG1α pathway stimulation in heart disease, and indicate that maintaining PKG1α in its reduced form may optimize its intrinsic cardioprotective properties.
Collapse
|
46
|
Isidori AM, Cornacchione M, Barbagallo F, Di Grazia A, Barrios F, Fassina L, Monaco L, Giannetta E, Gianfrilli D, Garofalo S, Zhang X, Chen X, Xiang YK, Lenzi A, Pellegrini M, Naro F. Inhibition of type 5 phosphodiesterase counteracts β2-adrenergic signalling in beating cardiomyocytes. Cardiovasc Res 2015; 106:408-20. [PMID: 25852085 DOI: 10.1093/cvr/cvv123] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/20/2015] [Indexed: 12/31/2022] Open
Abstract
AIMS Compartmentalization of cAMP and PKA activity in cardiac muscle cells plays a key role in maintaining basal and enhanced contractility stimulated by sympathetic nerve activity. In cardiomyocytes, activation of adrenergic receptor increases cAMP production, which is countered by the hydrolytic activity of selective phosphodiesterases (PDEs). The intracellular regional dynamics of cAMP production and hydrolysis modulate downstream signals resulting in different biological responses. The interplay between beta receptors (βARs) signalling and phosphodiesterase 5 (PDE5) activity remains to be addressed. METHODS AND RESULTS Using combined strategies with pharmacological inhibitors and genetic deletion of PDEs and βAR isoforms, we revealed a specific pool of cAMP that is under dual regulation by PDE2 and, indirectly, PDE5 activity. Inhibition of PDE5 with sildenafil produces a cGMP-dependent activation of PDE2 that attenuates cAMP generation induced by βAR agonists, with concomitant modulation of stimulated contraction rate and calcium transients. PDE2 haploinsufficiency abolished the effects of sildenafil. The negative chronotropic effect of PDE5 inhibition through PDE2 activation was also observed in sinoatrial node tissue from adult mice. PDE5 inhibition selectively lowered contraction rate stimulated by β2AR, but not β1AR activation, supporting a compartmentalization of the cGMP-modulated pool of cAMP. CONCLUSION These data identify a new effect of PDE5 inhibitors on the modulation of cardiomyocyte response to adrenergic stimulation via PDE5-PDE2-mediated cross-talk.
Collapse
Affiliation(s)
- Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marisa Cornacchione
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Federica Barbagallo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Di Grazia
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University, Rome, Italy
| | - Florencia Barrios
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University, Rome, Italy
| | - Lorenzo Fassina
- Department of Industrial and Information Engineering, University of Pavia, Pavia, Italy
| | - Lucia Monaco
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Silvio Garofalo
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Xiaoxiao Zhang
- Department of Physiology, Temple University, Philadelphia, PA, USA
| | - Xiongwen Chen
- Department of Physiology, Temple University, Philadelphia, PA, USA
| | - Yang K Xiang
- Department of Pharmacology, University of California, Davis, CA, USA
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Manuela Pellegrini
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Fabio Naro
- Department of Anatomical, Histological, Forensic, and Orthopaedic Sciences, Sapienza University, Rome, Italy
| |
Collapse
|
47
|
|
48
|
Nakagawa H, Oberwinkler H, Nikolaev VO, Gaßner B, Umbenhauer S, Wagner H, Saito Y, Baba HA, Frantz S, Kuhn M. Atrial Natriuretic Peptide Locally Counteracts the Deleterious Effects of Cardiomyocyte Mineralocorticoid Receptor Activation. Circ Heart Fail 2014; 7:814-21. [DOI: 10.1161/circheartfailure.113.000885] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background—
The endocrine balance between atrial natriuretic peptide (ANP) and the renin–angiotensin–aldosterone system is critical for the maintenance of arterial blood pressure and volume homeostasis. This study investigated whether a cardiac imbalance between ANP and aldosterone, toward increased mineralocorticoid receptor (MR) signaling, contributes to adverse left ventricular remodeling in response to pressure overload.
Methods and Results—
We used the MR-selective antagonist eplerenone to test the role of MRs in mediating pressure overload–induced dilatative cardiomyopathy of mice with abolished local, cardiac ANP activity. In response to 21 days of transverse aortic constriction, mice with cardiomyocyte-restricted inactivation (knockout) of the ANP receptor (guanylyl cyclase [GC]-A) or the downstream cGMP-dependent protein kinase I developed enhanced left ventricular hypertrophy and fibrosis together with contractile dysfunction. Treatment with eplerenone (100 mg/kg/d) attenuated left ventricular hypertrophy and fully prevented fibrosis, dilatation, and failure. Transverse aortic constriction induced the cardiac expression of profibrotic connective tissue growth factor and attenuated the expression of SERCA2a (sarcoplasmic reticulum Ca
2+
-ATPase) in knockout mice, but not in controls. These genotype-dependent molecular changes were similarly prevented by eplerenone. ANP attenuated the aldosterone-induced nuclear translocation of MRs via GC-A/cGMP-dependent protein kinase I in transfected HEK 293 (human embryonic kidney) cells. Coimmunoprecipitation and fluorescence resonance energy transfer experiments demonstrated that a population of MRs were membrane associated in close interaction with GC-A and cGMP-dependent protein kinase I and, moreover, that aldosterone caused a conformational change of this membrane MR/GC-A protein complex which was prevented by ANP.
Conclusions—
ANP counter-regulates cardiac MR activation in hypertensive heart disease. An imbalance in cardiac ANP/GC-A (inhibition) and aldosterone/MR signaling (augmentation) favors adverse cardiac remodeling in chronic pressure overload.
Collapse
Affiliation(s)
- Hitoshi Nakagawa
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Heike Oberwinkler
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Viacheslav O. Nikolaev
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Birgit Gaßner
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Sandra Umbenhauer
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Helga Wagner
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Yoshihiko Saito
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Hideo A. Baba
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Stefan Frantz
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| | - Michaela Kuhn
- From the Institute of Physiology (H.N., H.O., B.G., M.K.) and Comprehensive Heart Failure Center (H.N., S.F., M.K.), University Würzburg, Würzburg, Germany; Emmy Noether Group of the Deutsche Forschungsgemeinschaft, Department of Cardiology and Pneumology, University Göttingen, Göttingen, Germany (V.O.N.); Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany (S.U., H.W, S.F.); First Department of Internal Medicine, Nara Medical University, Kashihara, Japan (Y.S.); and
| |
Collapse
|
49
|
Roles of cGMP-dependent protein kinase I (cGKI) and PDE5 in the regulation of Ang II-induced cardiac hypertrophy and fibrosis. Proc Natl Acad Sci U S A 2014; 111:12925-9. [PMID: 25139994 DOI: 10.1073/pnas.1414364111] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Conflicting results have been reported for the roles of cGMP and cGMP-dependent protein kinase I (cGKI) in various pathological conditions leading to cardiac hypertrophy and fibrosis. A cardioprotective effect of cGMP/cGKI has been reported in whole animals and isolated cardiomyocytes, but recent evidence from a mouse model expressing cGKIβ only in smooth muscle (βRM) but not in cardiomyocytes, endothelial cells, or fibroblasts has forced a reevaluation of the requirement for cGKI activity in the cardiomyocyte antihypertrophic effects of cGMP. In particular, βRM mice developed the same hypertrophy as WT controls when subjected to thoracic aortic constriction or isoproterenol infusion. Here, we challenged βRM and WT (Ctr) littermate control mice with angiotensin II (AII) infusion (7 d; 2 mg ⋅ kg(-1) ⋅ d(-1)) to induce hypertrophy. Both genotypes developed cardiac hypertrophy, which was more pronounced in Ctr animals. Cardiomyocyte size and interstitial fibrosis were increased equally in both genotypes. Addition of sildenafil, a phosphodiesterase 5 (PDE5) inhibitor, in the drinking water had a small effect in reducing myocyte hypertrophy in WT mice and no effect in βRM mice. However, sildenafil substantially blocked the increase in collagen I, fibronectin 1, TGFβ, and CTGF mRNA in Ctr but not in βRM hearts. These data indicate that, for the initial phase of AII-induced cardiac hypertrophy, lack of cardiomyocyte cGKI activity does not worsen hypertrophic growth. However, expression of cGKI in one or more cell types other than smooth muscle is necessary to allow the antifibrotic effect of sildenafil.
Collapse
|
50
|
Ramchandran R, Raghavan A, Geenen D, Sun M, Bach L, Yang Q, Raj JU. PKG-1α leucine zipper domain defect increases pulmonary vascular tone: implications in hypoxic pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 2014; 307:L537-44. [PMID: 25128522 DOI: 10.1152/ajplung.00093.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Pulmonary hypertension (PH) is a chronic disease characterized by a progressive increase in vasomotor tone, narrowing of the vasculature with structural remodeling, and increase in pulmonary vascular resistance. Current treatment strategies include nitric oxide therapy and methods to increase cGMP-mediated vasodilatation. cGMP-dependent protein kinases (PKG) are known mediators of nitric oxide- and cGMP-induced vasodilatation. Deletion of PKG-1 in mice has been shown to induce PH, however, the exact mechanisms by which loss of PKG-1 function leads to PH is not known. In a mouse model with a selective mutation in the NH2-terminus leucine zipper protein interaction domain of PKG-1α [leucine zipper mutant (LZM)], we found a progressive increase in right ventricular systolic pressure and right heart hypertrophy compared with wild-type (WT) mice and increased RhoA-GTPase activity in the lungs. When exposed to chronic hypoxia, LZM mice developed modestly enhanced right ventricular remodeling compared with WT mice. Tadalafil, a phosphodiesterase-5 inhibitor that increases cGMP levels, significantly attenuated hypoxia-induced cardiopulmonary remodeling in WT mice but had no effect in LZM mice. We conclude that a functional leucine zipper domain in PKG-1α is essential for maintenance of a low pulmonary vascular tone in normoxia and for cGMP-mediated beneficial effects of phosphodiesterase-5 inhibition in hypoxic cardiopulmonary remodeling.
Collapse
Affiliation(s)
- Ramaswamy Ramchandran
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois; and
| | - Aarti Raghavan
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois; and
| | - David Geenen
- Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois
| | - Miranda Sun
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois; and
| | - Laura Bach
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois; and
| | - Qiwei Yang
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois; and
| | - J Usha Raj
- Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois; and
| |
Collapse
|