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Martin TG, Leinwand LA. Hearts apart: sex differences in cardiac remodeling in health and disease. J Clin Invest 2024; 134:e180074. [PMID: 38949027 PMCID: PMC11213513 DOI: 10.1172/jci180074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Biological sex is an important modifier of physiology and influences pathobiology in many diseases. While heart disease is the number one cause of death worldwide in both men and women, sex differences exist at the organ and cellular scales, affecting clinical presentation, diagnosis, and treatment. In this Review, we highlight baseline sex differences in cardiac structure, function, and cellular signaling and discuss the contribution of sex hormones and chromosomes to these characteristics. The heart is a remarkably plastic organ and rapidly responds to physiological and pathological cues by modifying form and function. The nature and extent of cardiac remodeling in response to these stimuli are often dependent on biological sex. We discuss organ- and molecular-level sex differences in adaptive physiological remodeling and pathological cardiac remodeling from pressure and volume overload, ischemia, and genetic heart disease. Finally, we offer a perspective on key future directions for research into cardiac sex differences.
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Affiliation(s)
- Thomas G. Martin
- Department of Molecular, Cellular, and Developmental Biology and
- BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
| | - Leslie A. Leinwand
- Department of Molecular, Cellular, and Developmental Biology and
- BioFrontiers Institute, University of Colorado Boulder, Boulder, Colorado, USA
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Abbas H, Younis A, Goldenberg I, McNitt S, Aktas MK, Tabaja C, Ojo A. Association of device detected atrial and ventricular tachyarrhythmia with adverse events in patients with an implantable cardioverter-defibrillator. J Cardiovasc Electrophysiol 2024; 35:1203-1211. [PMID: 38606650 DOI: 10.1111/jce.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Heart failure patients with a history of atrial fibrillation (AF) and ventricular tachycardia/ventricular fibrillation (VT/VF) are known to have worse outcomes. However, there are limited data on the temporal relationship between development of these arrhythmias and the risk of subsequent congestive heart failure (CHF) exacerbation and death. METHODS The study cohort comprised 5511 patients implanted with an implantable cardioverter-defibrillator (ICD) in landmark clinical trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, and RAID) who were in sinus rhythm at enrollment. Multivariate cox analysis was performed to evaluate the time-dependent association between development of in-trial device detected AF and VT/VF with subsequent CHF exacerbation and death. RESULTS Multivariate analysis showed that AF occurrence and VT/VF occurrence were both associated with a similar magnitude of risk for subsequent CHF exacerbation (HR = 1.73 and 1.87 respectively, p < .001 for both). In contrast, only in-trial VT/VF was associated with a significant > two-fold increase in the risk of subsequent mortality (HR = 2.13, p < .001) whereas AF occurrence was not associated with a significant mortality increase after adjustment for in-trial VT/VF (HR = 1.36, p = .096). CONCLUSION Our findings from a large cohort of ICD recipients enrolled in landmark clinical trials show that device detected AF and VT/VF can be used to identify patients with increased risk for CHF exacerbation and mortality. These findings suggest a need for early intervention in CHF patients who develop device-detected atrial and ventricular tachyarrhythmias.
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Affiliation(s)
- Hassan Abbas
- Department of Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Arwa Younis
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Mehmet K Aktas
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Chadi Tabaja
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amole Ojo
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
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Krzowski B, Kutyifa V, Vloka M, Huang DT, Attari M, Aktas M, Shah AH, Musat D, Rosenthal L, McNitt S, Polonsky B, Schuger C, Natale A, Ziv O, Beck C, Daubert JP, Goldenberg I, Zareba W. Sex-Related Differences in Ventricular Tachyarrhythmia Events in Patients With Implantable Cardioverter-Defibrillator and Prior Ventricular Tachyarrhythmias. JACC Clin Electrophysiol 2024; 10:284-294. [PMID: 38032582 DOI: 10.1016/j.jacep.2023.09.028] [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: 04/21/2023] [Revised: 08/24/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Data on the risk of ventricular tachycardia (VT), ventricular fibrillation (VF), and death by sex in patients with prior VT/VF are limited. OBJECTIVES This study aimed to assess sex-related differences in implantable cardioverter-defibrillator (ICD)-treated VT/VF events and death in patients implanted for secondary prevention or primary prevention ICD indications who experienced VT/VF before enrollment in the RAID (Ranolazine Implantable Cardioverter-Defibrillator) trial. METHODS Sex-related differences in the first and recurrent VT/VF requiring antitachycardia pacing or ICD shock and death were evaluated in 714 patients. RESULTS There were 124 women (17%) and 590 men observed during a mean follow-up of 26.81 ± 14.52 months. Compared to men, women were at a significantly lower risk of VT/VF/death (HR: 0.67; P = 0.029), VT/VF (HR: 0.68; P = 0.049), VT/VF treated with antitachycardia pacing (HR: 0.59; P = 0.019), and VT/VF treated with ICD shock (HR: 0.54; P = 0.035). The risk of recurrent VT/VF was also significantly lower in women (HR: 0.35; P < 0.001). HR for death was similar to the other endpoints (HR: 0.61; P = 0.162). In comparison to men, women presented with faster VT rates (196 ± 32 beats/min vs 177 ± 30 beats/min, respectively; P = 0.002), and faster shock-requiring VT/VF rates (258 ± 56 beats/min vs 227 ± 57 beats/min, respectively; P = 0.30). There was a significant interaction for the risk of VT/VF by race (P = 0.013) with White women having significantly lower risk than White men (HR: 0.36; P < 0.001), whereas Black women had a similar risk to Black men (HR: 1.06; P = 0.851). CONCLUSIONS Women with a history of prior VT/VF experienced a lower risk recurrent VT/VF requiring ICD therapy when compared to men. Black Women had a risk similar to men, whereas the lower risk for VT/VF in women was observed primarily in White women. (Ranolazine Implantable Cardioverter-Defibrillator Trial; NCT01215253).
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Affiliation(s)
- Bartosz Krzowski
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Valentina Kutyifa
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Margot Vloka
- Cardiology Division, Saint Alphonsus Health System, Boise, Idaho, USA
| | - David T Huang
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Mehmet Aktas
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Abrar H Shah
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Dan Musat
- Valley Health System, Ridgewood, New Jersey, USA
| | - Lawrance Rosenthal
- University of Massachusetts Memorial Health, Worcester, Massachusetts, USA
| | - Scott McNitt
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Bronislava Polonsky
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Ohad Ziv
- Heart and Vascular Center, Metro Health Medical Center, Cleveland, Ohio, USA
| | - Christopher Beck
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Ilan Goldenberg
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Wojciech Zareba
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.
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Ichiki T, Cannone V, Scott CG, Iyer SR, Sangaralingham SJ, Bailey KR, Goetze JP, Tsuji Y, Rodeheffer RJ, Burnett JC. Sex-based differences in metabolic protection by the ANP genetic variant rs5068 in the general population. Am J Physiol Heart Circ Physiol 2023; 325:H545-H552. [PMID: 37417873 PMCID: PMC10538992 DOI: 10.1152/ajpheart.00321.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are produced in the heart and secreted into the circulation. As hormones, both peptides activate the guanylyl cyclase receptor A (GC-A), playing a role in blood pressure (BP) regulation. A significant role for ANP and BNP includes favorable actions in metabolic homeostasis. Sex-based high prevalence of risk factors for cardiovascular disease in males compared with females is well established, but sex-based differences on cardiometabolic protection have not been investigated in relation to ANP (NPPA) and BNP (NPPB) gene variants. We included 1,146 subjects in the general population from Olmsted County, Minnesota. Subjects were genotyped for the ANP gene variant rs5068 and BNP gene variant rs198389. Cardiometabolic parameters and medical records were reviewed. In the presence of the minor allele of rs5068, diastolic BP, creatinine, body mass index (BMI), waist measurement, insulin, and prevalence of obesity and metabolic syndrome were lower, whereas HDL was higher in males with only trends observed in females. We observed no associations of the minor allele with echocardiographic parameters in either males or females. Regarding rs198389 genotype, the minor allele was not associated with any BP, metabolic, renal, or echocardiographic parameters in either sex. In the general community, the minor allele of the ANP gene variant rs5068 is associated with a favorable metabolic phenotype in males. No associations were observed with the BNP gene variant rs198389. These studies support a protective role of the ANP pathway on metabolic function and underscore the importance of sex in relationship to natriuretic peptide responses.NEW & NOTEWORTHY Males are characterized by lower ANP and BNP with greater prevalence of cardiometabolic disease. The ANP genetic variant rs5068 was associated with less metabolic dysfunction in males, whereas no metabolic profile was related to the BNP genetic variant rs198389 in the general population. ANP may play a more biological role in metabolic homeostasis compared with BNP in the general population with greater physiological metabolic actions in males compared with females.
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Affiliation(s)
- Tomoko Ichiki
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Community and General Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Valentina Cannone
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Christopher G Scott
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Seethalakshmi R Iyer
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - S Jeson Sangaralingham
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Kent R Bailey
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Yoshihisa Tsuji
- Department of Community and General Medicine, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Richard J Rodeheffer
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - John C Burnett
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Schafstedde M, Nordmeyer S. The role of androgens in pressure overload myocardial hypertrophy. Front Endocrinol (Lausanne) 2023; 14:1112892. [PMID: 36817598 PMCID: PMC9929540 DOI: 10.3389/fendo.2023.1112892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023] Open
Abstract
Pressure overload hypertrophy of the left ventricle is a common result of many cardiovascular diseases. Androgens show anabolic effects in skeletal muscles, but also in myocardial hypertrophy. We carefully reviewed literature regarding possible effects of androgens on specific left ventricular hypertrophy in pressure overload conditions excluding volume overload conditions or generel sex differences.
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Affiliation(s)
- Marie Schafstedde
- Department of Congenital Heart Disease – Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Nordmeyer
- Department of Congenital Heart Disease – Pediatric Cardiology, Deutsches Herzzentrum der Charité – Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Partner Site Berlin, German Center for Cardiovascular Research (DZHK), Berlin, Germany
- *Correspondence: Sarah Nordmeyer,
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Tamirisa KP, Al-Khatib SM. Sex Differences in Sustained Ventricular Arrhythmias: A Continuing Dialogue. JACC Clin Electrophysiol 2022; 8:1563-1565. [PMID: 36543506 DOI: 10.1016/j.jacep.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
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Schafstedde M, Nordmeyer J, Berger F, Knosalla C, Mertins P, Ziehm M, Kirchner ML, Regitz-Zagrosek V, Kuehne T, Kraus M, Nordmeyer S. Serum dihydrotestosterone levels are associated with adverse myocardial remodeling in patients with severe aortic valve stenosis before and after aortic valve replacement. Am J Physiol Heart Circ Physiol 2022; 323:H949-H957. [PMID: 36206048 PMCID: PMC9621711 DOI: 10.1152/ajpheart.00288.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Animal studies show a pivotal role of dihydrotestosterone (DHT) in pressure overload-induced myocardial hypertrophy and dysfunction. The aim of our study was to evaluate the role of DHT levels and myocardial hypertrophy and myocardial protein expression in patients with severe aortic valve stenosis (AS). Forty-three patients [median age 68 (41-80) yr] with severe AS and indication for surgical aortic valve replacement (SAVR) were prospectively enrolled. Cardiac magnetic resonance imaging including analysis of left ventricular muscle mass (LVM), fibrosis and function, and laboratory tests including serum DHT levels were performed before and after SAVR. During SAVR, left ventricular (LV) biopsies were performed for proteomic profiling. Serum DHT levels correlated positively with indexed LVM (LVMi, R = 0.64, P = 0.0001) and fibrosis (R = 0.49, P = 0.0065) and inversely with LV function (R = -0.42, P = 0.005) in patients with severe AS. DHT levels were associated with higher abundance of the hypertrophy (moesin, R = 0.52, P = 0.0083)- and fibrosis (vimentin, R = 0.41, P = 0.039)-associated proteins from LV myocardial biopsies. Higher serum DHT levels preoperatively were associated with reduced LV function (ejection fraction, R = -0.34, P = 0.035; circulatory efficiency, R = -0.46, P = 0.012; and global longitudinal strain, R = 0.49, P = 0.01) and increased fibrosis (R = 0.55, P = 0.0022) after SAVR. Serum DHT levels were associated with adverse myocardial remodeling and higher abundance in hypertrophy- and fibrosis-associated proteins in patients with severe AS. DHT may be a target to prevent or attenuate adverse myocardial remodeling in patients with pressure overload due to AS.NEW & NOTEWORTHY Serum dihydrotestosterone (DHT) levels correlated positively with the degree of hypertrophy, fibrosis, and dysfunction from cardiac magnetic resonance imaging in female and male patients with aortic valve stenosis. Left ventricular proteome profiling had been performed in this patient cohort and an association between serum DHT levels and the abundance of the hypertrophy-associated protein moesin and the fibrosis-associated protein vimentin was found.
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Affiliation(s)
- Marie Schafstedde
- 1Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany,2Institute of Computer-assisted Cardiovascular Medicine, Charité-Universitätsmedizin, Berlin, Germany,3German Center for Cardiovascular Research (DZHK), Berlin, Germany,4Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Nordmeyer
- 1Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Felix Berger
- 1Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany,3German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Christoph Knosalla
- 3German Center for Cardiovascular Research (DZHK), Berlin, Germany,5Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
| | - Philipp Mertins
- 4Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany,6Proteomics Platform, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Matthias Ziehm
- 4Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany,6Proteomics Platform, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Marie-Luise Kirchner
- 4Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany,6Proteomics Platform, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Vera Regitz-Zagrosek
- 3German Center for Cardiovascular Research (DZHK), Berlin, Germany,7Institute for Gender in Medicine, Center for Cardiovascular Research, Berlin, Germany
| | - Titus Kuehne
- 1Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany,2Institute of Computer-assisted Cardiovascular Medicine, Charité-Universitätsmedizin, Berlin, Germany,3German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Milena Kraus
- 8Digital Health Center, Hasso Plattner Institute for
Digital Engineering, University of Potsdam, Potsdam, Germany
| | - Sarah Nordmeyer
- 1Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany,2Institute of Computer-assisted Cardiovascular Medicine, Charité-Universitätsmedizin, Berlin, Germany,3German Center for Cardiovascular Research (DZHK), Berlin, Germany
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Ojo A, Younis A, Saxena S, Kutyifa V, Chen AY, McNitt S, Polonsky B, Aktas MK, Huang DT, Rosero S, Vidula H, Diamond A, Sampath R, Klein H, Steiner H, Zareba W, Goldenberg I. Comparison of Frequency of Ventricular Tachyarrhythmia in Men-Versus-Women in Patients with Implantable Cardioverter-Defibrillator for Primary Prevention. Am J Cardiol 2022; 176:43-50. [PMID: 35606170 DOI: 10.1016/j.amjcard.2022.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
Abstract
Current guidelines do not account for possible sex differences in the risk of ventricular tachyarrhythmia (VTA). We sought to identify specific factors associated with increased risk for VTA in women implanted with a primary prevention implantable cardioverter-defibrillator (ICD). Our study cohort consisted of 4,506 patients with an ICD or cardiac resynchronization therapy-defibrillator who were enrolled in the 4 landmark MADIT studies - MADIT-II, MADIT-RISK, MADIT-CRT and MADIT-RIT (1,075 women [24%]). Fine and Gray regression models were used to identify female-specific risk factors for the primary end point of VTA, defined as ICD-recorded, treated, or monitored, sustained ventricular tachycardia ≥170 beats per minute or ventricular fibrillation. At 3.5 years of follow-up, the cumulative incidence of VTA was significantly lower in women than men (17% vs 26%, respectively; p <0.001 for the entire follow-up). Use of amiodarone at enrollment, Black race, and history of previous myocardial infarction without previous revascularization was found to be independent risk factors of VTA in women. Of these factors, only Black race was associated with a statistically significant risk increase in men. At 3.5 years, the cumulative incidence of VTA in women with one or more of these risk factors was 27% compared with 14% in women with none of the risk factors (hazard ratio [confidence interval] = 2.08 [1.49 to 2.91]). In conclusion, our study, comprising 4 landmark ICD clinical trials, shows that sex and race have the potential to be used for improved risk stratification of patients who are candidates for primary prevention ICD.
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Affiliation(s)
- Amole Ojo
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York.
| | - Arwa Younis
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio
| | - Shireen Saxena
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Anita Y Chen
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York; Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Mehmet K Aktas
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - David T Huang
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Spencer Rosero
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Himabindu Vidula
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Alexander Diamond
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Ramya Sampath
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Helmut Klein
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Hillel Steiner
- Department of Cardiology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
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Saxena S, Goldenberg I, McNitt S, Hsich E, Kutyifa V, Bragazzi NL, Polonsky B, Aktas MK, Huang DT, Rosero S, Klein H, Zareba W, Younis A. Sex Differences in the Risk of First and Recurrent Ventricular Tachyarrhythmias Among Patients Receiving an Implantable Cardioverter-Defibrillator for Primary Prevention. JAMA Netw Open 2022; 5:e2217153. [PMID: 35699956 PMCID: PMC9198764 DOI: 10.1001/jamanetworkopen.2022.17153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/18/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Current guidelines for primary implantable cardioverter-defibrillator (ICD) therapy do not account for sex differences in arrhythmic risk in ICD candidates. Objective To evaluate the association between sex and risk of ventricular tachyarrhythmia (VTA) and mortality. Design, Setting, and Participants This cohort study compared differences in the risk of VTA and mortality between 4506 men and women enrolled in the 4 Multicenter Automatic Defibrillator Implantation Trials (MADIT) between July 1, 1997, and December 31, 2011. Data from prospective randomized controlled multicenter studies were analyzed retrospectively. Men and women with an ICD or cardiac resynchronization therapy defibrillator who were enrolled in all MADIT studies were included. Data were analyzed between January 10 and June 10, 2021. Exposures ICD implant. Main Outcomes and Measures The primary end point was sustained VTA, defined as ICD-recorded, treated or monitored VTA at least 170/min or ventricular fibrillation. Secondary VTA end points included VTA at least 200/min, appropriate ICD shocks, and appropriate antitachycardia pacing. All end points were included in a first and recurrent event analysis. Results Of the 4506 study participants, 3431 were men (76%). Mean (SD) age of the cohort was 64 (12) years. For women vs men, the mean (SD) age (64 [12] years vs 64 [11] years) and left ventricular ejection fraction (24% vs 25%) were similar, but women exhibited a higher frequency of nonischemic cardiomyopathy (454 of 1075 women [42%] vs 2535 of 3431 men [74%]). Women had significantly lower 3-year cumulative probability of sustained VTA (16% vs 26%), fast VTA (9% vs 17%), and appropriate ICD shocks (7% vs 15%) compared with men (P < .001 for all). Multivariable analysis showed that female sex was independently associated with at least 40% lower risk of all first and recurrent VTA end points (P < .001 for all), including the primary end point (first event, HR = 60 [95% CI, 50-73], P < .001; recurrent event, HR = 49 [95% CI, 43-55], P < .001), after accounting for the competing risk of all-cause mortality and nonarrhythmic mortality. The lower VTA risk associated with female sex was consistent in risk subsets but was significantly more pronounced in patients with nonischemic cardiomyopathy (female vs male in the ischemic group: hazard ratio, 0.73 [95% CI, 0.56-0.95], P = .02; nonischemic group: hazard ratio, 0.50 [95% CI, 0.38-0.66], P < .001; P = .03 for interaction between female sex and cardiomyopathy). Conclusions and Relevance Findings suggest that women display a significantly lower risk of first and recurrent life-threatening VTA events than men, and that it is more pronounced in patients with nonischemic cardiomyopathy, suggesting a need for sex-specific risk assessment for primary prevention ICD therapy.
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Affiliation(s)
- Shireen Saxena
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Eileen Hsich
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Center for Disease Modeling, York University, Toronto, Ontario, Canada
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Mehmet K. Aktas
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - David T. Huang
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Spencer Rosero
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Helmut Klein
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
| | - Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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10
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Wagner BM, Robinson JW, Healy CL, Gauthier M, Dickey DM, Yee SP, Osborn JW, O’Connell TD, Potter LR. Guanylyl cyclase-A phosphorylation decreases cardiac hypertrophy and improves systolic function in male, but not female, mice. FASEB J 2022; 36:e22069. [PMID: 34859913 PMCID: PMC8826535 DOI: 10.1096/fj.202100600rrr] [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: 04/08/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 01/03/2023]
Abstract
Atrial natriuretic peptide (NP) and BNP increase cGMP, which reduces blood pressure and cardiac hypertrophy by activating guanylyl cyclase (GC)-A, also known as NPR-A or Npr1. Although GC-A is highly phosphorylated, and dephosphorylation inactivates the enzyme, the significance of GC-A phosphorylation to heart structure and function remains unknown. To identify in vivo processes that are regulated by GC-A phosphorylation, we substituted glutamates for known phosphorylation sites to make GC-A8E/8E mice that express an enzyme that cannot be inactivated by dephosphorylation. GC-A activity, but not protein, was increased in heart and kidney membranes from GC-A8E/8E mice. Activities were threefold higher in female compared to male cardiac ventricles. Plasma cGMP and testosterone were elevated in male and female GC-A8E/8E mice, but aldosterone was only increased in mutant male mice. Plasma and urinary creatinine concentrations were decreased and increased, respectively, but blood pressure and heart rate were unchanged in male GC-A8E/8E mice. Heart weight to body weight ratios for GC-A8E/8E male, but not female, mice were 12% lower with a 14% reduction in cardiomyocyte cross-sectional area. Subcutaneous injection of fsANP, a long-lived ANP analog, increased plasma cGMP and decreased aldosterone in male GC-AWT/WT and GC-A8E/8E mice at 15 min, but only GC-A8E/8E mice had elevated levels of plasma cGMP and aldosterone at 60 min. fsANP reduced ventricular ERK1/2 phosphorylation to a greater extent and for a longer time in the male mutant compared to WT mice. Finally, ejection fractions were increased in male but not female hearts from GC-A8E/8E mice. We conclude that increased phosphorylation-dependent GC-A activity decreases cardiac ERK activity, which results in smaller male hearts with improved systolic function.
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Affiliation(s)
- Brandon M. Wagner
- Department of Integrative Biology and Physiology, University of Minnesota, Medical School, Minneapolis, MN 55455 USA
| | - Jerid W. Robinson
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Medical School, Minneapolis, MN 55455 USA
| | - Chastity L. Healy
- Department of Integrative Biology and Physiology, University of Minnesota, Medical School, Minneapolis, MN 55455 USA
| | - Madeline Gauthier
- Department of Integrative Biology and Physiology, University of Minnesota, Medical School, Minneapolis, MN 55455 USA
| | - Deborah M. Dickey
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Medical School, Minneapolis, MN 55455 USA
| | - Siu-Pok Yee
- Department of Cell Biology at the University of Connecticut Health Center, Farmington, CT 06030 USA
| | - John W. Osborn
- Department of Surgery at the University of Minnesota, Medical School, Minneapolis, MN 55455 USA
| | - Timothy D. O’Connell
- Department of Integrative Biology and Physiology, University of Minnesota, Medical School, Minneapolis, MN 55455 USA,,Corresponding authors: Timothy D O’Connell , Lincoln R Potter
| | - Lincoln R. Potter
- Department of Integrative Biology and Physiology, University of Minnesota, Medical School, Minneapolis, MN 55455 USA,,Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Medical School, Minneapolis, MN 55455 USA,,Corresponding authors: Timothy D O’Connell , Lincoln R Potter
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11
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Banga S, Heinze-Milne SD, Godin J, Howlett SE. Signs of diastolic dysfunction are graded by serum testosterone levels in aging C57BL/6 male mice. Mech Ageing Dev 2021; 198:111523. [PMID: 34166687 DOI: 10.1016/j.mad.2021.111523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
We investigated whether maladaptive, age-associated changes in heart structure and function were linked to circulating testosterone levels. Male C57BL/6 mice had a gonadectomy (GDX) or sham surgery at 4 weeks and effects of GDX on the heart were examined with echocardiography. Serum testosterone was measured with ELISA. Left ventricular (LV) mass increased with age but was smaller in GDX mice than sham at 18 months (144.0 ± 8.7 vs 118.2 ± 11.9 mg; p = 0.009). The isovolumic relaxation time (IVRT) declined with age but was prolonged in GDX mice at 18 months (10.5 ± 0.8 vs 12.5 ± 0.5 msec, p = 0.008). Ejection fraction did not change with age or GDX, but E/A ratios were lower in GDX mice than controls at 18 months (1.6 ± 0.2 vs 1.3 ± 0.1, p = 0.021). When links between serum testosterone and cardiac parameters were examined longitudinally in 18-24-month-old mice, LV mass declined with decreasing testosterone (β = 37.70, p = 0.016), however IVRT increased as testosterone decreased (β=-2.69, p = 0.036). Since longer IVRT and lower E/A ratios are signs of diastolic dysfunction, low circulating testosterone may promote or exacerbate diastolic dysfunction in older males. These findings suggest that lower testosterone directly modifies heart structure and function to promote maladaptive remodeling and diastolic dysfunction in the aging heart.
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Affiliation(s)
- Shubham Banga
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
| | | | - Judith Godin
- Geriatric Medicine Research, Division of Geriatric Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada; Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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12
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Jianshu C, Qiongying W, Ying P, Ningyin L, Junchen H, Jing Y. Association of free androgen index and sex hormone-binding globulin and left ventricular hypertrophy in postmenopausal hypertensive women. J Clin Hypertens (Greenwich) 2021; 23:1413-1419. [PMID: 34105885 PMCID: PMC8678740 DOI: 10.1111/jch.14301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/04/2022]
Abstract
The aim of the present study was to explore the relationship between androgen and LVH in postmenopausal hypertensive women. Enrolled in this study were 378 postmenopausal hypertensive women who were admitted to the department of cardiology between December 2018 and December 2020. According to left ventricular mass index (LVMI) evaluated by echocardiography, the patients were divided into LVH group (n = 172) and non‐LVH group (n = 206). Their clinical characteristics were collected. Based on the result of propensity score matching analysis, 160 cases in each group were matched successfully. After correcting for confounding factors by various models, the results showed that free androgen index (FAI) and sex hormone–binding globulin (SHBG) were the influencing factors of LVH in postmenopausal women with hypertension. Patients with elevated SHBG were 5% less likely to develop LVH than those without elevated SHBG (OR: 0.950, 95% CI 0.922‐1.578). Postmenopausal hypertensive patients with elevated FAI were 16% more likely to have LVH than those without elevated FAI (OR: 1.608, 95% CI 0.807‐3.202). Multiple linear regression showed that LVMI increased by 61.82g/m2 for every 1 unit increase in FAI. In addition, SHBG decreased by 1 nmol/l, and LVMI increased by 0.177g/m2. Subgroup analysis showed that patients in the controlled BP group had a lower risk of LVH for every additional unit of SHBG compared with the uncontrolled BP group. The risk of LVH for each additional unit of FAI in the uncontrolled BP group was higher than that in the controlled BP group. The results of this present study showed that the occurrence of LVH was positively correlated with FAI and negatively correlated with SHBG in postmenopausal women with hypertension. The increase in FAI level and the decrease in SHBG level may be related to the occurrence and development of LVH in postmenopausal hypertension.
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Affiliation(s)
- Chen Jianshu
- Lanzhou University Second College of Clinical Medicine, Lanzhou, China
| | - Wang Qiongying
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Pei Ying
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Li Ningyin
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Han Junchen
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Yu Jing
- Lanzhou University Second College of Clinical Medicine, Lanzhou, China.,Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
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13
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Diaconu R, Donoiu I, Mirea O, Bălşeanu TA. Testosterone, cardiomyopathies, and heart failure: a narrative review. Asian J Androl 2021; 23:348-356. [PMID: 33433530 PMCID: PMC8269837 DOI: 10.4103/aja.aja_80_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Testosterone exerts an important regulation of cardiovascular function through genomic and nongenomic pathways. It produces several changes in cardiomyocytes, the main actor of cardiomyopathies, which are characterized by pathological remodeling, eventually leading to heart failure. Testosterone is involved in contractility, in the energy metabolism of myocardial cells, apoptosis, and the remodeling process. In myocarditis, testosterone directly promotes the type of inflammation that leads to fibrosis, and influences viremia with virus localization. At the same time, testosterone exerts cardioprotective effects that have been observed in different studies. There is increasing evidence that low endogenous levels of testosterone have a negative impact in some cardiomyopathies and a protective impact in others. This review focuses on the interrelationships between testosterone and cardiomyopathies and heart failure.
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Affiliation(s)
- Rodica Diaconu
- Department of Cardiology, University of Medicine and Pharmacy, Craiova 200349, Romania
| | - Ionuţ Donoiu
- Department of Cardiology, University of Medicine and Pharmacy, Craiova 200349, Romania
| | - Oana Mirea
- Department of Cardiology, University of Medicine and Pharmacy, Craiova 200349, Romania
| | - Tudor Adrian Bălşeanu
- Department of Physiology, University of Medicine and Pharmacy, Craiova 200349, Romania
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14
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Dschietzig TB, Rosano GM, Anker SD. The (apparent) sacubitril/valsartan sex interaction in heart failure with preserved ejection fraction: not the result of relaxin effects but of BNP action?! ESC Heart Fail 2020; 7:3274-3277. [PMID: 33320445 PMCID: PMC7754773 DOI: 10.1002/ehf2.13170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Thomas Bernd Dschietzig
- Relaxera GmbH & Co. KGBensheimGermany
- MHB Medizinische Hochschule BrandenburgNeuruppinGermany
| | | | - Stefan D. Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT)German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin BerlinBerlinGermany
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15
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Otani K, Tokudome T, Kamiya CA, Mao Y, Nishimura H, Hasegawa T, Arai Y, Kaneko M, Shioi G, Ishida J, Fukamizu A, Osaki T, Nagai-Okatani C, Minamino N, Ensho T, Hino J, Murata S, Takegami M, Nishimura K, Kishimoto I, Miyazato M, Harada-Shiba M, Yoshimatsu J, Nakao K, Ikeda T, Kangawa K. Deficiency of Cardiac Natriuretic Peptide Signaling Promotes Peripartum Cardiomyopathy-Like Remodeling in the Mouse Heart. Circulation 2019; 141:571-588. [PMID: 31665900 DOI: 10.1161/circulationaha.119.039761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The maternal circulatory system and hormone balance both change dynamically during pregnancy, delivery, and the postpartum period. Although atrial natriuretic peptides and brain natriuretic peptides produced in the heart control circulatory homeostasis through their common receptor, NPR1, the physiologic and pathophysiologic roles of endogenous atrial natriuretic peptide/brain natriuretic peptide in the perinatal period are not fully understood. METHODS To clarify the physiologic and pathophysiologic roles of the endogenous atrial natriuretic peptide/brain natriuretic peptide-NPR1 system during the perinatal period, the phenotype of female wild-type and conventional or tissue-specific Npr1-knockout mice during the perinatal period was examined, especially focusing on maternal heart weight, blood pressure, and cardiac function. RESULTS In wild-type mice, lactation but not pregnancy induced reversible cardiac hypertrophy accompanied by increases in fetal cardiac gene mRNAs and ERK1/2 (extracellular signaling-regulated kinase) phosphorylation. Npr1-knockout mice exhibited significantly higher plasma aldosterone level than did wild-type mice, severe cardiac hypertrophy accompanied by fibrosis, and left ventricular dysfunction in the lactation period. Npr1-knockout mice showed a high mortality rate over consecutive pregnancy-lactation cycles. In the hearts of Npr1-knockout mice during or after the lactation period, an increase in interleukin-6 mRNA expression, phosphorylation of signal transducer and activator of transcription 3, and activation of the calcineurin-nuclear factor of the activated T cells pathway were observed. Pharmacologic inhibition of the mineralocorticoid receptor or neuron-specific deletion of the mineralocorticoid receptor gene significantly ameliorated cardiac hypertrophy in lactating Npr1-knockout mice. Anti-interleukin-6 receptor antibody administration tended to reduce cardiac hypertrophy in lactating Npr1-knockout mice. CONCLUSIONS These results suggest that the characteristics of lactation-induced cardiac hypertrophy in wild-type mice are different from exercise-induced cardiac hypertrophy, and that the endogenous atrial natriuretic peptide/brain natriuretic peptide-NPR1 system plays an important role in protecting the maternal heart from interleukin-6-induced inflammation and remodeling in the lactation period, a condition mimicking peripartum cardiomyopathy.
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Affiliation(s)
- Kentaro Otani
- Departments of Regenerative Medicine and Tissue Engineering (K.O., M.H.-S., T.I.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Takeshi Tokudome
- Biochemistry (T.T., Y.M., H.N., T.E., J.H., I.K., M.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Chizuko A Kamiya
- Division of Perinatology and Gynecology (C.A.K., J.Y.), Osaka, Japan
| | - Yuanjie Mao
- Biochemistry (T.T., Y.M., H.N., T.E., J.H., I.K., M.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.,Diabetes Institute, Ohio University, Athens (Y.M.)
| | - Hirohito Nishimura
- Biochemistry (T.T., Y.M., H.N., T.E., J.H., I.K., M.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Takeshi Hasegawa
- Exploratory Research Section II, Exploratory Research Laboratories, TOA EIYO Ltd, Fukushima, Japan (T.H.)
| | - Yuji Arai
- Bioscience and Genetics (Y.A.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Mari Kaneko
- Animal Resource Development Unit (M.K.), RIKEN Center for Life Science Technologies, Hyogo, Japan.,Genetic Engineering Team (M.K., G.S.), RIKEN Center for Life Science Technologies, Hyogo, Japan
| | - Go Shioi
- Genetic Engineering Team (M.K., G.S.), RIKEN Center for Life Science Technologies, Hyogo, Japan
| | - Junji Ishida
- Life Science Center for Survival Dynamics, Tsukuba Advanced Research Alliance, University of Tsukuba, Ibaraki, Japan (J.I., A.F.)
| | - Akiyoshi Fukamizu
- Life Science Center for Survival Dynamics, Tsukuba Advanced Research Alliance, University of Tsukuba, Ibaraki, Japan (J.I., A.F.)
| | - Tsukasa Osaki
- Molecular Pharmacology (T.O., C.N.-O., N.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Chiaki Nagai-Okatani
- Molecular Pharmacology (T.O., C.N.-O., N.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Naoto Minamino
- Molecular Pharmacology (T.O., C.N.-O., N.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Takuya Ensho
- Biochemistry (T.T., Y.M., H.N., T.E., J.H., I.K., M.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Jun Hino
- Biochemistry (T.T., Y.M., H.N., T.E., J.H., I.K., M.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Shunsuke Murata
- Preventive Medicine and Epidemiology (S.M., M.T., K.N.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Misa Takegami
- Preventive Medicine and Epidemiology (S.M., M.T., K.N.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Kunihiro Nishimura
- Preventive Medicine and Epidemiology (S.M., M.T., K.N.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Ichiro Kishimoto
- Biochemistry (T.T., Y.M., H.N., T.E., J.H., I.K., M.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Mikiya Miyazato
- Biochemistry (T.T., Y.M., H.N., T.E., J.H., I.K., M.M.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Mariko Harada-Shiba
- Departments of Regenerative Medicine and Tissue Engineering (K.O., M.H.-S., T.I.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.,Molecular Innovation in Lipidology (M.H.-S.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Jun Yoshimatsu
- Division of Perinatology and Gynecology (C.A.K., J.Y.), Osaka, Japan
| | - Kazuwa Nakao
- Kyoto University Graduate School of Medicine Medical Innovation Center, Kyoto, Japan (K.N.)
| | - Tomoaki Ikeda
- Departments of Regenerative Medicine and Tissue Engineering (K.O., M.H.-S., T.I.), National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.,Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Japan (T.I.)
| | - Kenji Kangawa
- National Cerebral and Cardiovascular Center (K.K.), Osaka, Japan
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16
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Wang TY, Arking DE, Maleszewski JJ, Fox-Talbot K, Nieuwenhuis TO, Santhanam L, Virmani R, Rosenberg AZ, Halushka MK. Human cardiac myosin light chain 4 (MYL4) mosaic expression patterns vary by sex. Sci Rep 2019; 9:12681. [PMID: 31481666 PMCID: PMC6722118 DOI: 10.1038/s41598-019-49191-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/21/2019] [Indexed: 11/17/2022] Open
Abstract
Sex disparities modulate cardiac function, although the proteins and mechanisms remain to be elucidated. We recently demonstrated a mosaic pattern of protein expression in the heart for over 100 proteins. Here we investigate one of these proteins, myosin light chain 4 (MYL4), which is important for contractile functions by increasing force production. We assayed the expression pattern of MYL4 across 756 ventricular myocardial samples from 668 individuals utilizing a semi-automated Cell Profiler method on five tissue microarrays (TMAs) of cardiac tissues across a diverse set of diseases. The percentage of MYL4 positive cells was significantly higher in male subjects independently across all five TMAs, regardless of disease state (p = 8.66e-15). Higher MYL4 expression was also modestly associated with hypertrophic cardiomyopathy (p = 6.3e-04). MYL4 expression did not associate with sudden cardiac death or other cardiomyopathies. This study demonstrates a new mosaic pattern of protein expression that underlies sex disparities in the human heart.
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Affiliation(s)
- Tony Y Wang
- Division of Cardiovascular Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karen Fox-Talbot
- Division of Cardiovascular Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tim O Nieuwenhuis
- Division of Cardiovascular Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lakshmi Santhanam
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Avi Z Rosenberg
- Division of Renal Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marc K Halushka
- Division of Cardiovascular Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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17
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Wu J, Dai F, Li C, Zou Y. Gender Differences in Cardiac Hypertrophy. J Cardiovasc Transl Res 2019; 13:73-84. [PMID: 31418109 DOI: 10.1007/s12265-019-09907-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022]
Abstract
Cardiac hypertrophy is an adaptive response to abnormal physiological and pathological stimuli, which can be classified into concentric and eccentric hypertrophy, induced by pressure overload or volume overload, respectively. In both physiological and pathological scenarios, females generally show a more favorable form of hypertrophy compared with their male counterparts. However once established, cardiac hypertrophy is a stronger risk factor for heart failure in females. Pre-menopausal women are better protected against cardiac hypertrophy compared with men, but this protection is abolished following menopause and is partially restored after estrogen replacement therapy. Estrogen exerts its protection by counteracting pro-hypertrophy signaling pathways, whereas androgen mostly plays an opposite role in cardiac hypertrophy. We here summarize the progress in the understanding of sexual dimorphisms in cardiac hypertrophy and highlight recent breakthroughs in the regulatory role of sex hormones and their intricate molecular networks, in order to shed light on gender-oriented therapeutic efficacy for pathological hypertrophy.
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Affiliation(s)
- Jian Wu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, 180 Feng Lin Road, Shanghai, 200032, China.
| | - Fangjie Dai
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, 180 Feng Lin Road, Shanghai, 200032, China
| | - Chang Li
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, 180 Feng Lin Road, Shanghai, 200032, China
| | - Yunzeng Zou
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital and Institutes of Biomedical Sciences, Fudan University, 180 Feng Lin Road, Shanghai, 200032, China.
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18
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Cruz-Topete D, Oakley RH, Carroll NG, He B, Myers PH, Xu X, Watts MN, Trosclair K, Glasscock E, Dominic P, Cidlowski JA. Deletion of the Cardiomyocyte Glucocorticoid Receptor Leads to Sexually Dimorphic Changes in Cardiac Gene Expression and Progression to Heart Failure. J Am Heart Assoc 2019; 8:e011012. [PMID: 31311395 PMCID: PMC6761632 DOI: 10.1161/jaha.118.011012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The contribution of glucocorticoids to sexual dimorphism in the heart is essentially unknown. Therefore, we sought to determine the sexually dimorphic actions of glucocorticoid signaling in cardiac function and gene expression. To accomplish this goal, we conducted studies on mice lacking glucocorticoid receptors (GR) in cardiomyocytes (cardioGRKO mouse model). Methods and Results Deletion of cardiomyocyte GR leads to an increase in mortality because of the development of spontaneous cardiac pathology in both male and female mice; however, females are more resistant to GR signaling inactivation in the heart. Male cardioGRKO mice had a median survival age of 6 months. In contrast, females had a median survival age of 10 months. Transthoracic echocardiography data showed phenotypic differences between male and female cardioGRKO hearts. By 3 months of age, male cardioGRKO mice exhibited left ventricular systolic dysfunction. Conversely, no significant functional deficits were observed in female cardioGRKO mice at the same time point. Functional sensitivity of male hearts to the loss of cardiomyocyte GR was reversed following gonadectomy. RNA‐Seq analysis showed that deleting GR in the male hearts leads to a more profound dysregulation in the expression of genes implicated in heart rate regulation (calcium handling). In agreement with these gene expression data, cardiomyocytes isolated from male cardioGRKO hearts displayed altered intracellular calcium responses. In contrast, female GR‐deficient cardiomyocytes presented a response comparable with controls. Conclusions These data suggest that GR regulates calcium responses in a sex‐biased manner, leading to sexually distinct responses to stress in male and female mice hearts, which may contribute to sex differences in heart disease, including the development of ventricular arrhythmias that contribute to heart failure and sudden death.
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Affiliation(s)
- Diana Cruz-Topete
- Department of Molecular and Cellular Physiology LSU Health Sciences Center Shreveport LA.,Center for Cardiovascular Diseases and Sciences LSU Health Sciences Center Shreveport LA
| | - Robert H Oakley
- Signal Transduction Laboratory National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
| | - Natalie G Carroll
- Department of Molecular and Cellular Physiology LSU Health Sciences Center Shreveport LA
| | - Bo He
- Signal Transduction Laboratory National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
| | - Page H Myers
- Comparative Medicine Branch National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
| | - Xiaojiang Xu
- Laboratory of Integrative Bioinformatics National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
| | - Megan N Watts
- Department of Cardiology LSU Health Sciences Center Shreveport LA
| | - Krystle Trosclair
- Department of Cellular Biology and Anatomy LSU Health Sciences Center Shreveport LA
| | - Edward Glasscock
- Department of Cellular Biology and Anatomy LSU Health Sciences Center Shreveport LA.,Center for Cardiovascular Diseases and Sciences LSU Health Sciences Center Shreveport LA
| | - Paari Dominic
- Department of Cardiology LSU Health Sciences Center Shreveport LA.,Center for Cardiovascular Diseases and Sciences LSU Health Sciences Center Shreveport LA
| | - John A Cidlowski
- Signal Transduction Laboratory National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
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19
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Bai Y, Shi XB, Zhang YQ, Wang YL, Liu XY, Esteve-Pastor MA. Differences of Matrix Metalloproteinase 2 Expression between Left and Right Ventricles in Response to Nandrolone Decanoate and/or Swimming Training in Mice. Chin Med J (Engl) 2018; 131:207-212. [PMID: 29336370 PMCID: PMC5776852 DOI: 10.4103/0366-6999.222330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Matrix metalloproteinase (MMP)-2 plays an important role in the remodeling of left ventricles (LVs) and right ventricles (RVs). We investigated the differences of MMP-2 expression between LV and RV in response to nandrolone decanoate (ND), swimming training (ST), and combined ND and ST (NS) in mice, based on their structural, functional, and biochemical characteristics. Methods: Totally 28 male C57B1 mice (6 weeks old; 20–23 g) were divided into four groups, including the control (n = 7), ND (n = 6), ST (n = 8), and NS (n = 7) groups. After respective treatments for 8 weeks, echocardiographic examination was used to assess the cardiac structure and function. Van Gieson stain was used to examine the fibrosis of LV and RV in response to different treatments, and Western blotting analysis was performed to explore different MMP-2 expressions between LV and RV in response to ND and/or ST. Analysis of variance was used for comparing the four groups. Results: At 8 weeks, right ventricular dimension/body weight in the ND group was larger than the other three groups (F = 7.12, P < 0.05) according to the echocardiographic examination. Fibrosis induced by ND administration was increased more in RV (2.59%) than that in LV (2.21%). MMP-2 expression of the ND group in RV was significantly greater than the control and NS groups in RV and the corresponding ND group in LV. Conclusion: The experimental data support the hypothesis that ND administration induces greater MMP-2 expression increase in RV compared to LV, leading to consequent RV dilation.
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Affiliation(s)
- Ying Bai
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xu-Bo Shi
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yu-Qiong Zhang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yue-Li Wang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - Xin-Yao Liu
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia 30120, Spain
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20
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Aimo A, Vergaro G, Castiglione V, Barison A, Pasanisi E, Petersen C, Chubuchny V, Giannoni A, Poletti R, Maffei S, Januzzi JL, Passino C, Emdin M. Effect of Sex on Reverse Remodeling in Chronic Systolic Heart Failure. JACC-HEART FAILURE 2018; 5:735-742. [PMID: 28958348 DOI: 10.1016/j.jchf.2017.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/13/2017] [Accepted: 07/27/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This study sought to investigate sex-related differences in reverse remodeling (RR). BACKGROUND RR, that is, the recovery from left ventricular (LV) dilation and dysfunction in response to treatment for heart failure (HF), is associated with improved prognosis. METHODS Data from patients with stable systolic HF (LV ejection fraction [LVEF] of <50%) undergoing 2 transthoracic echocardiograms within 12 ± 2 months were analyzed. Reverse remodeling was defined as a ≥15% reduction in LV end-systolic volume index. RESULTS A total of 927 patients were evaluated (68 ± 12 years; median LVEF = 35% [interquartile range: 30% to 43%]; 27% women). Ischemic HF was less often encountered in women (33% vs. 60%, respectively; p < 0.001), whereas most characteristics did not differ with regard to sex. Women showed a higher incidence of RR (41% vs. 27%, respectively; p < 0.001), despite similar baseline LV volume and function. RR was more frequent among women in the subgroups with either ischemic or nonischemic HF, as well as in all categories of systolic dysfunction (LVEF ≤35% or >35%, according to current indication for device implantation, and LVEF <40% or 40% to 50% according to the definition of HF with reduced or mid-range EF). In the whole population, female sex was an independent predictor of RR (hazard ratio: 1.54; 95% confidence interval: 1.11 to 2.14; p = 0.011), together with cause of HF, disease duration, and left bundle branch block. Female sex was again an independent predictor of RR in all LVEF categories. CONCLUSIONS Reverse remodeling is more frequent among women, regardless of cause and severity of LV dysfunction. Female sex is an independent predictor of RR in all categories of LV systolic dysfunction.
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Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Emilio Pasanisi
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Christina Petersen
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Alberto Giannoni
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Roberta Poletti
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Silvia Maffei
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Clinical Research Institute, Boston, Massachusetts
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
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21
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Nishiuchi S, Makiyama T, Aiba T, Nakajima K, Hirose S, Kohjitani H, Yamamoto Y, Harita T, Hayano M, Wuriyanghai Y, Chen J, Sasaki K, Yagihara N, Ishikawa T, Onoue K, Murakoshi N, Watanabe I, Ohkubo K, Watanabe H, Ohno S, Doi T, Shizuta S, Minamino T, Saito Y, Oginosawa Y, Nogami A, Aonuma K, Kusano K, Makita N, Shimizu W, Horie M, Kimura T. Gene-Based Risk Stratification for Cardiac Disorders in
LMNA
Mutation Carriers. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.116.001603. [DOI: 10.1161/circgenetics.116.001603] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/25/2017] [Indexed: 01/01/2023]
Abstract
Background—
Mutations in
LMNA
(
lamin A/C
), which encodes lamin A and C, typically cause age-dependent cardiac phenotypes, including dilated cardiomyopathy, cardiac conduction disturbance, atrial fibrillation, and malignant ventricular arrhythmias. Although the type of
LMNA
mutations have been reported to be associated with susceptibility to malignant ventricular arrhythmias, the gene-based risk stratification for cardiac complications remains unexplored.
Methods and Results—
The multicenter cohort included 77
LMNA
mutation carriers from 45 families; cardiac disorders were retrospectively analyzed. The mean age of patients when they underwent genetic testing was 45±17, and they were followed for a median 49 months. Of the 77 carriers, 71 (92%) were phenotypically affected and showed cardiac conduction disturbance (81%), low left ventricular ejection fraction (<50%; 45%), atrial arrhythmias (58%), and malignant ventricular arrhythmias (26%). During the follow-up period, 9 (12%) died, either from end-stage heart failure (n=7) or suddenly (n=2). Genetic analysis showed truncation mutations in 58 patients from 31 families and missense mutations in 19 patients from 14 families. The onset of cardiac disorders indicated that subjects with truncation mutations had an earlier occurrence of cardiac conduction disturbance and low left ventricular ejection fraction, than those with missense mutations. In addition, the truncation mutation was found to be a risk factor for the early onset of cardiac conduction disturbance and the occurrence of atrial arrhythmias and low left ventricular ejection fraction, as estimated using multivariable analyses.
Conclusions—
The truncation mutations were associated with manifestation of cardiac phenotypes in
LMNA
-related cardiomyopathy, suggesting that genetic analysis might be useful for diagnosis and risk stratification.
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22
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Pedernera E, Gómora MJ, Meneses I, De Ita M, Méndez C. Androgen receptor is expressed in mouse cardiomyocytes at prenatal and early postnatal developmental stages. BMC PHYSIOLOGY 2017; 17:7. [PMID: 28806941 PMCID: PMC5557468 DOI: 10.1186/s12899-017-0033-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/03/2017] [Indexed: 11/10/2022]
Abstract
Background Previous studies show that androgens are involved in hypertrophy and excitability of cardiomyocytes and that their effects are mediated through their receptor. The aim of this study was to evaluate the presence of androgen receptor (AR) in mouse heart during prenatal and early postnatal stages. Results The expression of AR and related genes, alpha myosin heavy chain -Myh6-, beta myosin heavy chain -Myh7- and atrial natriuretic factor –Nppa- was simultaneously evaluated by semiquantitative RT-PCR. AR was also detected by immunohistochemistry. Androgen receptor mRNA was detected in hearts from 10.5 days post coitum to 16 postnatal days. A higher expression of AR mRNA in atria compared to ventricles was observed in neonatal mouse. A positive correlation between mRNA levels of AR and Nppa was observed in mouse heart at early postnatal development. Androgen receptor expression is similar in males and females during cardiac development. Finally, androgen receptor protein was observed by immunohistochemistry in myocardial cells of atria and ventricles from 12.5 days onwards and restricted after 16.5 days post-coitum to nuclei of cardiomyocytes. Conclusion Present results provide evidence that androgen receptor is expressed from prenatal stages in mouse heart, supporting the proposition that androgens could be involved in mammalian heart development.
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Affiliation(s)
- Enrique Pedernera
- Facultad de Medicina, Edificio E, Universidad Nacional Autónoma de México, Av. Universidad #3000, Coyoacán, 04510, Cd. de México, CP, Mexico
| | - María José Gómora
- Facultad de Medicina, Edificio E, Universidad Nacional Autónoma de México, Av. Universidad #3000, Coyoacán, 04510, Cd. de México, CP, Mexico
| | - Iván Meneses
- Facultad de Medicina, Edificio E, Universidad Nacional Autónoma de México, Av. Universidad #3000, Coyoacán, 04510, Cd. de México, CP, Mexico
| | - Marlon De Ita
- Facultad de Medicina, Edificio E, Universidad Nacional Autónoma de México, Av. Universidad #3000, Coyoacán, 04510, Cd. de México, CP, Mexico
| | - Carmen Méndez
- Facultad de Medicina, Edificio E, Universidad Nacional Autónoma de México, Av. Universidad #3000, Coyoacán, 04510, Cd. de México, CP, Mexico.
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23
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Regitz-Zagrosek V, Kararigas G. Mechanistic Pathways of Sex Differences in Cardiovascular Disease. Physiol Rev 2017; 97:1-37. [PMID: 27807199 DOI: 10.1152/physrev.00021.2015] [Citation(s) in RCA: 395] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Major differences between men and women exist in epidemiology, manifestation, pathophysiology, treatment, and outcome of cardiovascular diseases (CVD), such as coronary artery disease, pressure overload, hypertension, cardiomyopathy, and heart failure. Corresponding sex differences have been studied in a number of animal models, and mechanistic investigations have been undertaken to analyze the observed sex differences. We summarize the biological mechanisms of sex differences in CVD focusing on three main areas, i.e., genetic mechanisms, epigenetic mechanisms, as well as sex hormones and their receptors. We discuss relevant subtypes of sex hormone receptors, as well as genomic and nongenomic, activational and organizational effects of sex hormones. We describe the interaction of sex hormones with intracellular signaling relevant for cardiovascular cells and the cardiovascular system. Sex, sex hormones, and their receptors may affect a number of cellular processes by their synergistic action on multiple targets. We discuss in detail sex differences in organelle function and in biological processes. We conclude that there is a need for a more detailed understanding of sex differences and their underlying mechanisms, which holds the potential to design new drugs that target sex-specific cardiovascular mechanisms and affect phenotypes. The comparison of both sexes may lead to the identification of protective or maladaptive mechanisms in one sex that could serve as a novel therapeutic target in one sex or in both.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Georgios Kararigas
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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24
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Bell JR, Curl CL, Harding TW, Vila Petroff M, Harrap SB, Delbridge LMD. Male and female hypertrophic rat cardiac myocyte functional responses to ischemic stress and β-adrenergic challenge are different. Biol Sex Differ 2016; 7:32. [PMID: 27390618 PMCID: PMC4936311 DOI: 10.1186/s13293-016-0084-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/22/2016] [Indexed: 01/19/2023] Open
Abstract
Background Cardiac hypertrophy is the most potent cardiovascular risk factor after age, and relative mortality risk linked with cardiac hypertrophy is greater in women. Ischemic heart disease is the most common form of cardiovascular pathology for both men and women, yet significant differences in incidence and outcomes exist between the sexes. Cardiac hypertrophy and ischemia are frequently occurring dual pathologies. Whether the cellular (cardiomyocyte) mechanisms underlying myocardial damage differ in women and men remains to be determined. In this study, utilizing an in vitro experimental approach, our goal was to examine the proposition that responses of male/female cardiomyocytes to ischemic (and adrenergic) stress may be differentially modulated by the presence of pre-existing cardiac hypertrophy. Methods We used a novel normotensive custom-derived hypertrophic heart rat (HHR; vs control strain normal heart rat (NHR)). Cardiomyocyte morphologic and electromechanical functional studies were performed using microfluorimetric techniques involving simulated ischemia/reperfusion protocols. Results HHR females exhibited pronounced cardiac/cardiomyocyte enlargement, equivalent to males. Under basal conditions, a lower twitch amplitude in female myocytes was prominent in normal but not in hypertrophic myocytes. The cardiomyocyte Ca2+ responses to β-adrenergic challenge differed in hypertrophic male and female cardiomyocytes, with the accentuated response in males abrogated in females—even while contractile responses were similar. In simulated ischemia, a marked and selective elevation of end-ischemia Ca2+ in normal female myocytes was completely suppressed in hypertrophic female myocytes—even though all groups demonstrated similar shifts in myocyte contractile performance. After 30 min of simulated reperfusion, the Ca2+ desensitization characterizing the male response was distinctively absent in female cardiomyocytes. Conclusions Our data demonstrate that cardiac hypertrophy produces dramatically different basal and stress-induced pathophenotypes in female- and male-origin cardiomyocytes. The lower Ca2+ operational status characteristic of female (vs male) cardiomyocytes comprising normal hearts is not exhibited by myocytes of hypertrophic hearts. After ischemia/reperfusion, availability of activator Ca2+ is suppressed in female hypertrophic myocytes, whereas sensitivity to Ca2+ is blunted in male hypertrophic myocytes. These findings demonstrate that selective intervention strategies should be pursued to optimize post-ischemic electromechanical support for male and female hypertrophic hearts. Electronic supplementary material The online version of this article (doi:10.1186/s13293-016-0084-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James R Bell
- Department of Physiology, University of Melbourne, Melbourne, Victoria Australia
| | - Claire L Curl
- Department of Physiology, University of Melbourne, Melbourne, Victoria Australia
| | - Tristan W Harding
- Department of Physiology, University of Melbourne, Melbourne, Victoria Australia
| | - Martin Vila Petroff
- Centro de Investigaciones Cardiovasculares, Centro Cientifico Tecnologico La Plata, Facultad de Ciencias Medicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Stephen B Harrap
- Department of Physiology, University of Melbourne, Melbourne, Victoria Australia
| | - Lea M D Delbridge
- Department of Physiology, University of Melbourne, Melbourne, Victoria Australia.,Cardiac Phenomics Laboratory, Department of Physiology, University of Melbourne, Melbourne, Victoria 3010 Australia
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25
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Wakefield L, Cornish V, Broackes-Carter F, Sim E. ArylamineN-acetyltransferase 2 Expression in the Developing Heart. J Histochem Cytochem 2016; 53:583-92. [PMID: 15872051 DOI: 10.1369/jhc.4a6496.2005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Murine arylamine N-acetyltransferase 2 (NAT2) is expressed in the developing heart and in the neural tube at the time of closure. Classically described as a xenobiotic metabolizing enzyme, there is increasing evidence for a distinct biological role for murine NAT2. We have characterized the expression of arylamine N-acetyltransferase 2 during cardiogenesis, mapping its expression in vivo, using a lacZ insertion deletion, and also in vitro, by measuring NAT2 enzyme activity. These findings show that cardiac Nat2 expression is both temporally and spatially regulated during development. In neonatal mice, cardiac Nat2 expression is most extensive in the central fibrous body and is evident in the atrioventricular valves and the valves of the great vessels. Whereas Nat2 expression is not detected in ventricular myocardial cells, Nat2 is strongly expressed in scattered cells in the region of the sinus node, the epicardium of the right atrial appendage, and in the pulmonary artery. Expression of active NAT2 protein is maximal when the developing heart attains the adult circulation pattern and moves from metabolizing glucose to fatty acids. NAT2 acetylating activity in cardiac tissue from Nat2−/-and Nat2+/-mice indicates a lack of compensating acetylating activity either from other acetylating enzymes or by NAT2 encoded by the wild-type Nat2 allele in Nat2+/-heterozygotes. The temporal and spatial control of murine Nat2 expression points to an endogenous role distinct from xenobiotic metabolism and indicates that Nat2 expression may be useful as a marker in cardiac development.
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Affiliation(s)
- Larissa Wakefield
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK
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26
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Huang CK, Lee SO, Chang E, Pang H, Chang C. Androgen receptor (AR) in cardiovascular diseases. J Endocrinol 2016; 229:R1-R16. [PMID: 26769913 PMCID: PMC4932893 DOI: 10.1530/joe-15-0518] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/13/2016] [Indexed: 01/13/2023]
Abstract
Cardiovascular diseases (CVDs) are still the highest leading cause of death worldwide. Several risk factors have been linked to CVDs, including smoking, diabetes, hyperlipidemia, and gender among others. Sex hormones, especially the androgen and its receptor, androgen receptor (AR), have been linked to many diseases with a clear gender difference. Here, we summarize the effects of androgen/AR on CVDs, including hypertension, stroke, atherosclerosis, abdominal aortic aneurysm (AAA), myocardial hypertrophy, and heart failure, as well as the metabolic syndrome/diabetes and their impacts on CVDs. Androgen/AR signaling exacerbates hypertension, and anti-androgens may suppress hypertension. Androgen/AR signaling plays dual roles in strokes, depending on different kinds of factors; however, generally males have a higher incidence of strokes than females. Androgen and AR differentially modulate atherosclerosis. Androgen deficiency causes elevated lipid accumulation to enhance atherosclerosis; however, targeting AR in selective cells without altering serum androgen levels would suppress atherosclerosis progression. Androgen/AR signaling is crucial in AAA development and progression, and targeting androgen/AR profoundly restricts AAA progression. Men have increased cardiac hypertrophy compared with age-matched women that may be due to androgens. Finally, androgen/AR plays important roles in contributing to obesity and insulin/leptin resistance to increase the metabolic syndrome.
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Affiliation(s)
- Chiung-Kuei Huang
- George Whipple Lab for Cancer ResearchDepartments of Pathology, Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Soo Ok Lee
- George Whipple Lab for Cancer ResearchDepartments of Pathology, Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Eugene Chang
- George Whipple Lab for Cancer ResearchDepartments of Pathology, Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA Department of MedicineCase Cardiovascular Institute Research Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Haiyan Pang
- George Whipple Lab for Cancer ResearchDepartments of Pathology, Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Chawnshang Chang
- George Whipple Lab for Cancer ResearchDepartments of Pathology, Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA Sex Hormone Research CenterChina Medical University/Hospital, Taichung, Taiwan
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27
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Rafikova O, Rafikov R, Meadows ML, Kangath A, Jonigk D, Black SM. The sexual dimorphism associated with pulmonary hypertension corresponds to a fibrotic phenotype. Pulm Circ 2015; 5:184-97. [PMID: 25992281 DOI: 10.1086/679724] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/18/2014] [Indexed: 01/23/2023] Open
Abstract
Although female predominance in the development of all types of pulmonary hypertension (PH) is well established, many clinical studies have confirmed that females have better prognosis and higher survival rate than males. There is no clear explanation of why sex influences the pathogenesis and progression of PH. Using a rat angioproliferative model of PH, which closely resembles the primary pathological changes observed in humans, we evaluated the role of sex in the development and progression of PH. Female rats had a more pronounced increase in medial thickness in the small pulmonary arteries. However, the infiltration of small pulmonary arteries by inflammatory cells was found only in male rats, and this corresponded to increased myeloperoxidase activity and abundant adventitial and medial fibrosis that were not present in female rats. Although the level of right ventricle (RV) peak systolic pressure was similar in both groups, the survival rate in male rats was significantly lower. Moreover, male rats presented with a more pronounced increase in RV thickness that correlated with diffuse RV fibrosis and significantly impaired right cardiac function. The reduction in fibrosis in female rats correlated with increased expression of caveolin-1 and reduced endothelial nitric oxide synthase-derived superoxide. We conclude that, in the pathogenesis of PH, female sex is associated with greater remodeling of the pulmonary arteries but greater survival. Conversely, in males, the development of pulmonary and cardiac fibrosis leads to early and severe RV failure, and this may be an important reason for the lower survival rate among males.
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Affiliation(s)
- Olga Rafikova
- Pulmonary Vascular Disease Program, Vascular Biology Center, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA ; These authors contributed equally to this study
| | - Ruslan Rafikov
- Pulmonary Vascular Disease Program, Vascular Biology Center, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA ; These authors contributed equally to this study
| | - Mary Louise Meadows
- Pulmonary Vascular Disease Program, Vascular Biology Center, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
| | - Archana Kangath
- Pulmonary Vascular Disease Program, Vascular Biology Center, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hanover, Germany
| | - Stephen M Black
- Pulmonary Vascular Disease Program, Vascular Biology Center, Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
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28
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Zwadlo C, Schmidtmann E, Szaroszyk M, Kattih B, Froese N, Hinz H, Schmitto JD, Widder J, Batkai S, Bähre H, Kaever V, Thum T, Bauersachs J, Heineke J. Antiandrogenic therapy with finasteride attenuates cardiac hypertrophy and left ventricular dysfunction. Circulation 2015; 131:1071-81. [PMID: 25632043 DOI: 10.1161/circulationaha.114.012066] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In comparison with men, women have a better prognosis when experiencing aortic valve stenosis, hypertrophic cardiomyopathy, or heart failure. Recent data suggest that androgens like testosterone or the more potent dihydrotestosterone contribute to the development of cardiac hypertrophy and failure. Therefore, we analyzed whether antiandrogenic therapy with finasteride, which inhibits the generation of dihydrotestosterone by the enzyme 5-α-reductase, improves pathological ventricular remodeling and heart failure. METHODS AND RESULTS We found a strongly induced expression of all 3 isoforms of the 5-α-reductase (Srd5a1 to Srd5a3) in human and mouse hearts with pathological hypertrophy, which was associated with increased myocardial accumulation of dihydrotestosterone. Starting 1 week after the induction of pressure overload by transaortic constriction, mice were treated with finasteride for 2 weeks. Cardiac function, hypertrophy, dilation, and fibrosis were markedly improved in response to finasteride treatment in not only male, but also in female mice. In addition, finasteride also very effectively improved cardiac function and mortality after long-term pressure overload and prevented disease progression in cardiomyopathic mice with myocardial Gαq overexpression. Mechanistically, finasteride, by decreasing dihydrotestosterone, potently inhibited hypertrophy and Akt-dependent prohypertrophic signaling in isolated cardiac myocytes, whereas the introduction of constitutively active Akt blunted these effects of finasteride. CONCLUSIONS Finasteride, which is currently used in patients to treat prostate disease, potently reverses pathological cardiac hypertrophy and dysfunction in mice and might be a therapeutic option for heart failure.
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Affiliation(s)
- Carolin Zwadlo
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Elisa Schmidtmann
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Malgorzata Szaroszyk
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Badder Kattih
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Natali Froese
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Hebke Hinz
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Jan Dieter Schmitto
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Julian Widder
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Sandor Batkai
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Heike Bähre
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Volkhard Kaever
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Thomas Thum
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Johann Bauersachs
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.)
| | - Joerg Heineke
- From Medizinische Hochschule Hannover, Klinik für Kardiologie und Angiologie, Hanover, Germany (C.Z., E.S., M.S., B.K., N.F., H.H., J.W., J.B., J.H.); Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hanover, Germany (J.D.S.); Institut für Molekulare und Translationale Therapiestrategien (IMTTS), Hannover, Germany (S.B., T.T.); National Heart and Lung Institute, Imperial College, London, United Kingdom (T.T.); and Medizinische Hochschule Hannover, Zentrale Forschungseinrichtung Metabolomics, Institut für Pharmakologie, Hannover, Germany (H.B., V.K.).
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Prévilon M, Pezet M, Vinet L, Mercadier JJ, Rouet-Benzineb P. Gender-specific potential inhibitory role of Ca2+/calmodulin dependent protein kinase phosphatase (CaMKP) in pressure-overloaded mouse heart. PLoS One 2014; 9:e90822. [PMID: 24608696 PMCID: PMC3946626 DOI: 10.1371/journal.pone.0090822] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/04/2014] [Indexed: 01/08/2023] Open
Abstract
Background Ca2+/calmodulin-dependent protein kinase phosphatase (CaMKP) has been proposed as a potent regulator of multifunctional Ca2+/calmodulin-dependent protein kinases (i.e., CaMKII). The CaMKII-dependent activation of myocyte enhancer factor 2 (MEF2) disrupts interactions between MEF2-histone deacetylases (HDACs), thereby de-repressing downstream gene transcription. Whether CaMKP modulates the CaMKII- MEF2 pathway in the heart is unknown. Here, we investigated the molecular and functional consequences of left ventricular (LV) pressure overload in the mouse of both genders, and in particular we evaluated the expression levels and localization of CaMKP and its association with CaMKII-MEF2 signaling. Methodology and Principal Findings Five week-old B6D1/F1 mice of both genders underwent a sham-operation or thoracic aortic constriction (TAC). Thirty days later, TAC was associated with pathological LV hypertrophy characterized by systolic and diastolic dysfunction. Gene expression was assessed by real-time PCR. Fetal gene program re-expression comprised increased RNA levels of brain natriuretic peptide and alpha-skeletal actin. Mouse hearts of both genders expressed both CaMKP transcript and protein. Activation of signalling pathways was studied by Western blot in LV lysates or subcellular fractions (nuclear and cytoplasmic). TAC was associated with increased CaMKP expression in male LVs whereas it tended to be decreased in females. The DNA binding activity of MEF2 was determined by spectrophotometry. CaMKP compartmentalization differed according to gender. In male TAC mice, nuclear CaMKP was associated with inactive CaMKII resulting in less MEF2 activation. In female TAC mice, active CaMKII (phospho-CaMKII) detected in the nuclear fraction, was associated with a strong MEF2 transcription factor-binding activity. Conclusions/Significance Gender-specific CaMKP compartmentalization is associated with CaMKII-mediated MEF2 activation in pressure-overloaded hearts. Therefore, CaMKP could be considered as an important novel cellular target for the development of new therapeutic strategies for heart diseases.
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Affiliation(s)
- Miresta Prévilon
- Inserm, UMRS-698, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Mylène Pezet
- CEFI-Institut Claude Bernard-IFR02, Paris, France
- Inserm, U823, Plateforme de Microscopie Photonique – Cytométrie en Flux, Institut Albert Bonniot Site Santé BP170–38042, Grenoble, France
| | - Laurent Vinet
- Inserm, UMRS-698, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Department of Cell Physiology and Metabolism, University of Geneva, Medical School, Genève, Switzerland
| | - Jean-Jacques Mercadier
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Inserm, UMRS-769, Université Paris-Sud, IFR141, LabEx LERMIT, Châtenay-Malabry, France
- AP-HP, Hôpital Bichat, Paris, France
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Meyer S, van der Meer P, van Tintelen JP, van den Berg MP. Sex differences in cardiomyopathies. Eur J Heart Fail 2014; 16:238-47. [PMID: 24464619 DOI: 10.1002/ejhf.15] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/26/2013] [Accepted: 10/01/2013] [Indexed: 12/16/2022] Open
Abstract
Cardiomyopathies are a heterogeneous group of heart muscle diseases with a variety of specific phenotypes. According to the contemporary European Society of Cardiology classification, they are classified into hypertrophic (HCM), dilated (DCM), arrhythmogenic right ventricular (ARVC), restrictive (RCM), and unclassified cardiomyopathies. Each class is aetiologically further categorized into inherited (familial) and non-inherited (non-familial) forms. There is substantial evidence that biological sex is a strong modulator of the clinical manifestation of these cardiomyopathies, and sex-specific characteristics are detectable in all classes. For the clinician, it is important to know the sex-specific aspects of clinical disease expression and the potential modes of inheritance or the hereditary influences underlying the development of cardiomyopathies, since these may aid in diagnosing such diseases in both sexes.
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Affiliation(s)
- Sven Meyer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Gender-specific differences in left ventricular remodelling and fibrosis in hypertrophic cardiomyopathy: Insights from cardiovascular magnetic resonance. Eur J Heart Fail 2014; 10:850-4. [DOI: 10.1016/j.ejheart.2008.06.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 04/23/2008] [Accepted: 06/09/2008] [Indexed: 11/21/2022] Open
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Bell JR, Bernasochi GB, Varma U, Raaijmakers AJA, Delbridge LMD. Sex and sex hormones in cardiac stress--mechanistic insights. J Steroid Biochem Mol Biol 2013; 137:124-35. [PMID: 23770428 DOI: 10.1016/j.jsbmb.2013.05.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 01/14/2023]
Abstract
Important sex differences in the onset and characteristics of cardiovascular disease are evident, yet the mechanistic details remain unresolved. Men are more susceptible to cardiovascular disease earlier in life, though younger women who have a cardiovascular event are more likely to experience adverse outcomes. Emerging evidence is prompting a re-examination of the conventional view that estrogen is protective and testosterone a liability. The heart expresses both androgen and estrogen receptors and is functionally responsive to circulating sex steroids. New evidence of cardiac aromatase expression indicates local estrogen production may also exert autocrine/paracrine actions in the heart. Cardiomyocyte contractility studies suggest testosterone and estrogen have contrasting inotropic actions, and modulate Ca(2+) handling and transient characteristics. Experimentally, sex differences are also evident in cardiac stress responses. Female hearts are generally less susceptible to acute ischemic damage and associated arrhythmias, and generally are more resistant to stress-induced hypertrophy and heart failure, attributed to the cardioprotective actions of estrogen. However, more recent data show that testosterone can also improve acute post-ischemic outcomes and facilitate myocardial function and survival in chronic post-infarction. The myocardial actions of sex steroids are complex and context dependent. A greater mechanistic understanding of the specific actions of systemic/local sex steroids in different cardiovascular disease states has potential to lead to the development of cardiac therapies targeted specifically for men and women.
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Affiliation(s)
- James R Bell
- Department of Physiology, University of Melbourne, Victoria, Australia.
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Arimura T, Onoue K, Takahashi-Tanaka Y, Ishikawa T, Kuwahara M, Setou M, Shigenobu S, Yamaguchi K, Bertrand AT, Machida N, Takayama K, Fukusato M, Tanaka R, Somekawa S, Nakano T, Yamane Y, Kuba K, Imai Y, Saito Y, Bonne G, Kimura A. Nuclear accumulation of androgen receptor in gender difference of dilated cardiomyopathy due to lamin A/C mutations. Cardiovasc Res 2013; 99:382-94. [DOI: 10.1093/cvr/cvt106] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hemnes AR, Maynard KB, Champion HC, Gleaves L, Penner N, West J, Newman JH. Testosterone negatively regulates right ventricular load stress responses in mice. Pulm Circ 2012; 2:352-8. [PMID: 23130103 PMCID: PMC3487303 DOI: 10.4103/2045-8932.101647] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Right ventricular (RV) function is the major determinant of mortality in pulmonary arterial hypertension and male sex is a strong predictor of mortality in this disease. The effects of testosterone on RV structure and function in load stress are presently unknown. We tested whether testosterone levels affect RV hypertrophic responses, fibrosis, and function. Male C57BL/6 mice underwent castration or sham followed by pulmonary artery banding (PAB) or sham. After recovery, testosterone pellets were placed in a subset of the castrated mice and mice were maintained for at least two weeks, when they underwent hemodynamic measurements and tissues were harvested. Plasma levels of testosterone were reduced by castration and repleted by testosterone administration. In PAB, castration resulted in lower right ventricle/left ventricle + septum (RV/LV+S), and myocyte diameter (P < 0.05). Replacement of testosterone normalized these parameters and increased RV fibrosis (P < 0.05). Two weeks of PAB resulted in increased RV systolic pressure in all groups with decreased markers of RV systolic and diastolic function, specifically reduced ejection fraction and increased time constant, and dPdt minimum (P < 0.05), though there was minimal effect of testosterone on hemodynamic parameters. Survival was improved in mice that underwent castration with PAB compared with PAB alone (P < 0.05). Testosterone affects RV hypertrophic response to load stress through increased myocyte size and increased fibrosis in mice. Castration and testosterone replacement are not accompanied by significant alterations in RV in vivo hemodynamics, but testosterone deprivation appears to improve survival in PAB. Further study of the role of testosterone in RV dysfunction is warranted to better understand these findings in the context of human disease.
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Affiliation(s)
- Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Pandey KN. Emerging Roles of Natriuretic Peptides and their Receptors in Pathophysiology of Hypertension and Cardiovascular Regulation. ACTA ACUST UNITED AC 2012; 2:210-26. [PMID: 19746200 DOI: 10.1016/j.jash.2008.02.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Thus far, three related natriuretic peptides (NPs) and three distinct receptors have been identified, which have advanced our knowledge towards understanding the control of high blood pressure, hypertension, and cardiovascular disorders to a great extent. Biochemical and molecular studies have been advanced to examine receptor function and signaling mechanisms and the role of second messenger cGMP in pathophysiology of hypertension, renal hemodynamics, and cardiovascular functions. The development of gene-knockout and gene-duplication mouse models along with transgenic mice have provided a framework for understanding the importance of the antagonistic actions of natriuretic peptides receptor in cardiovascular events at the molecular level. Now, NPs are considered as circulating markers of congestive heart failure, however, their therapeutic potential for the treatment of cardiovascular diseases such as hypertension, renal insufficiency, cardiac hypertrophy, congestive heart failure, and stroke has just begun to unfold. Indeed, the alternative avenues of investigations in this important are need to be undertaken, as we are at the initial stage of the molecular therapeutic and pharmacogenomic implications.
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Affiliation(s)
- Kailash N Pandey
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA 70112
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Abstract
Androgens, the male sex hormones, exert various biological effects on many target organs through the transcriptional effects of the nuclear androgen receptor (AR). ARs are expressed not only in classical target organs, such as the brain, genital organs, bone, and skeletal muscles, but also in the cardiovascular system. Because the female sex hormones estrogens are well-known to protect against cardiovascular disease, sex has been considered to have a significant clinical impact on cardiovascular mortality. However, the influence of androgens on the cardiovascular system has not been fully elucidated. To clarify this issue, we analyzed the effects of administration of angiotensin II and doxorubicin, an anticancer agent, in a loading model in male wild-type and AR-deficient mice. In this review, we focus on the actions of androgens as potential targets for the prevention of cardiovascular diseases in males.
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Affiliation(s)
- Yasumasa Ikeda
- Department of Pharmacology, The University of Tokushima, Graduate School of Health Biosciences, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
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Montalvo C, Villar AV, Merino D, García R, Ares M, Llano M, Cobo M, Hurlé MA, Nistal JF. Androgens contribute to sex differences in myocardial remodeling under pressure overload by a mechanism involving TGF-β. PLoS One 2012; 7:e35635. [PMID: 22558184 PMCID: PMC3338422 DOI: 10.1371/journal.pone.0035635] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 03/19/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In clinical studies, myocardial remodeling in aortic valve stenosis appears to be more favorable in women than in men, even after menopause. In the present study, we assessed whether circulating androgens contribute to a less favorable myocardial remodeling under pressure overload in males. We examined sex-related differences in one-year-old male and female mice. Whereas male mice at this age exhibited circulating androgen levels within the normal range for young adults, the circulating estrogens in females were reduced. The contribution of gonadal androgens to cardiac remodeling was analyzed in a group of same-age castrated mice. METHODOLOGY/PRINCIPAL FINDINGS Animals were subjected to transverse aortic constriction (TAC). Echocardiography was performed 2 weeks after TAC and myocardial mRNA levels of TGF-βs, Smads 2 and 3, collagens, fibronectin, β-myosin heavy chain and α-myosin heavy chain were determined by q-PCR. Protein detection of p-SMAD2/3 was performed by Western Blot. Histological staining of fibrosis was performed with picrosirius red and Masson's trichrome. Compared with females, males developed more severe tissue fibrosis, LV dilation and hemodynamic dysfunction. TAC-males showed higher myocardial expression levels of TGF-βs and the treatment with a neutralizing antibody to TGF-β prevented myocardial fibrosis development. Orchiectomy diminished TAC-induced up-regulation of TGF-βs and TGF-β target genes, and it also reduced fibrosis and hemodynamic dysfunction. The capability of androgens to induce TGF-β expression was confirmed in NIH-3T3 fibroblasts and H9C2 cardiomyocytes exposed to dihydrotestosterone. CONCLUSIONS/SIGNIFICANCE Our results indicate that circulating androgens are responsible for the detrimental effects in the myocardium of older male mice subjected to pressure overload through a mechanism involving TGF-βs.
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Affiliation(s)
- Cecilia Montalvo
- Departamento de Fisiología y Farmacología, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
| | - Ana V. Villar
- Departamento de Fisiología y Farmacología, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
| | - David Merino
- Departamento de Fisiología y Farmacología, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
| | - Raquel García
- Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
| | - Miguel Ares
- Hospital Comarcal de Laredo, Cantabria, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
| | - Miguel Llano
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
| | - Manuel Cobo
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
| | - María A. Hurlé
- Departamento de Fisiología y Farmacología, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
- * E-mail:
| | - J. Francisco Nistal
- Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain
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Tissue-specific splicing of an Ndufs6 gene-trap insertion generates a mitochondrial complex I deficiency-specific cardiomyopathy. Proc Natl Acad Sci U S A 2012; 109:6165-70. [PMID: 22474353 DOI: 10.1073/pnas.1113987109] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Mitochondrial complex I (CI) deficiency is the most common mitochondrial enzyme defect in humans. Treatment of mitochondrial disorders is currently inadequate, emphasizing the need for experimental models. In humans, mutations in the NDUFS6 gene, encoding a CI subunit, cause severe CI deficiency and neonatal death. In this study, we generated a CI-deficient mouse model by knockdown of the Ndufs6 gene using a gene-trap embryonic stem cell line. Ndufs6(gt/gt) mice have essentially complete knockout of the Ndufs6 subunit in heart, resulting in marked CI deficiency. Small amounts of wild-type Ndufs6 mRNA are present in other tissues, apparently due to tissue-specific mRNA splicing, resulting in milder CI defects. Ndufs6(gt/gt) mice are born healthy, attain normal weight and maturity, and are fertile. However, after 4 mo in males and 8 mo in females, Ndufs6(gt/gt) mice are at increased risk of cardiac failure and death. Before overt heart failure, Ndufs6(gt/gt) hearts show decreased ATP synthesis, accumulation of hydroxyacylcarnitine, but not reactive oxygen species (ROS). Ndufs6(gt/gt) mice develop biventricular enlargement by 1 mo, most pronounced in males, with scattered fibrosis and abnormal mitochondrial but normal myofibrillar ultrastructure. Ndufs6(gt/gt) isolated working heart preparations show markedly reduced left ventricular systolic function, cardiac output, and functional work capacity. This reduced energetic and functional capacity is consistent with a known susceptibility of individuals with mitochondrial cardiomyopathy to metabolic crises precipitated by stresses. This model of CI deficiency will facilitate studies of pathogenesis, modifier genes, and testing of therapeutic approaches.
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Gan L, Jiang W, Xiao YF, Deng L, Gu LD, Guo ZY, Zhou ZC, Wu D, Xin HB. Disruption of CD38 gene enhances cardiac functions by elevating serum testosterone in the male null mice. Life Sci 2011; 89:491-7. [PMID: 21840325 DOI: 10.1016/j.lfs.2011.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 06/15/2011] [Accepted: 07/19/2011] [Indexed: 02/05/2023]
Abstract
AIMS Gender-related phenotypes in the cardiovascular system have been observed in various genetically modified mice. Here, we report that cardiac functions are significantly improved only in male CD38-null mice and we explore the potential mechanisms of the sexual dimorphism mediated by CD38 deficiency. MAIN METHODS Cardiac functions of mice were measured by pressure-volume conductance catheter technique and echocardiography. Serum sex steroids were determined by radioimmunoassay. Relative mRNA levels of myocardial contractile-associated proteins in cardiomyocytes were analyzed by real-time PCR analysis. To clarify the effects of testosterone on the sexual dimorphism, flutamide, an androgen receptor antagonist, was subcutaneously infused into the male null mice for 6 weeks with an osmotic mini-pump. KEY FINDINGS The myocardial contractility, contraction and relaxation velocities were significantly enhanced only in male CD38-null mice, in which the levels of serum testosterone were markedly elevated. The elevated testosterone levels in the null mice were correlated to an obvious decrease in expression of androgen receptor and dramatic increases in expressions of major genes involved in myocardial contraction, including ryanodine receptor type 2 (RyR2), sarcoplasmic reticular Ca(2+) ATPase (SERCA2) and Na(+)/Ca(2+)-exchanger protein 1 (NCX1), and α myosin heavy chain (α-MHC). More importantly, all of the alternations that were observed in the male null mice were almost completely restored by flutamide administration. SIGNIFICANCE Elevated serum level of testosterone in the male CD38(-/-) mice enhances cardiac functions through upregulation of major calcium regulatory proteins, which improve our understanding on sex disparities and molecular mechanisms in the incidence and manifestation of heart diseases.
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Affiliation(s)
- Lu Gan
- Laboratory of Cardiovascular Disease, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
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Redente EF, Jacobsen KM, Solomon JJ, Lara AR, Faubel S, Keith RC, Henson PM, Downey GP, Riches DWH. Age and sex dimorphisms contribute to the severity of bleomycin-induced lung injury and fibrosis. Am J Physiol Lung Cell Mol Physiol 2011; 301:L510-8. [PMID: 21743030 DOI: 10.1152/ajplung.00122.2011] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Fibrotic interstitial pneumonias are more prevalent in males of advancing age, although little is known about the underlying mechanisms. To evaluate the contributions of age and sex to the development of pulmonary fibrosis, we intratracheally instilled young (8-12 wk) and aged (52-54 wk) male and female mice with bleomycin and assessed the development and severity of fibrotic lung disease by measurements of lung collagen levels, static compliance, leukocyte infiltration, and stereological quantification of fibrotic areas in histological sections. We also quantified proinflammatory and profibrotic chemokine and cytokine levels in the bronchoalveolar lavage fluid. Aged male mice developed more severe lung disease, indicated by increased mortality, increased collagen deposition, and neutrophilic alveolitis compared with aged female mice or young mice of either sex. Aged male mice also exhibited increased levels of transforming growth factor-β, IL-17A, and CXCL1 in their bronchoalveolar lavage fluid. Young male mice developed a more fibrotic disease after bleomycin instillation compared with female mice, regardless of age. There was no difference in fibrosis between young and aged female mice. Taken together, these findings suggest that the variables of advanced age and male sex contribute to the severity of pulmonary fibrosis in this model. Our findings also emphasize the importance of stratifying experimental groups on the basis of age and sex in experimental and epidemiological studies of this nature.
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Affiliation(s)
- Elizabeth F Redente
- Program in Cell Biology, Department of Pediatrics, National Jewish Health, Denver, CO 80206, USA
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42
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Saito Y, Kishimoto I, Nakao K. Roles of guanylyl cyclase--a signaling in the cardiovascular system. Can J Physiol Pharmacol 2011; 89:551-6. [PMID: 21671770 DOI: 10.1139/y11-022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are cardiac hormones synthesized in and secreted from the heart. ANP and BNP bind the common receptor guanylyl cyclase-A (GC-A) and possess biological actions. Based on their diuretic, natriuretic, and vasodilating activities, they are now widely used as therapeutic agents for heart failure. Roles of endogenous ANP and BNP have been investigated using mice lacking the gene encoding GC-A. Here we describe the recent understanding of roles of GC-A in the cardiovascular system.
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Affiliation(s)
- Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan.
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43
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Campbell DJ, Somaratne JB, Jenkins AJ, Prior DL, Yii M, Kenny JF, Newcomb AE, Kelly DJ, Black MJ. Differences in myocardial structure and coronary microvasculature between men and women with coronary artery disease. Hypertension 2010; 57:186-92. [PMID: 21135353 DOI: 10.1161/hypertensionaha.110.165043] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Women younger than 75 years with stable angina or acute coronary syndrome have higher cardiac mortality than similarly aged men, despite less obstructive coronary artery disease. To determine whether the myocardial structure and coronary microvasculature of women differs from that of men, we performed histological analysis of biopsies from nonischemic left ventricular myocardium from 46 men and 11 women undergoing coronary artery bypass graft surgery who did not have previous cardiac surgery, myocardial infarction, heart failure, atrial fibrillation, or furosemide therapy. The 2 patient groups had similar clinical characteristics, apart from a lower body surface area (BSA) in women (P = 0.0015). Women had less interstitial fibrosis than men (P = 0.019) but similar perivascular fibrosis. Arteriolar wall area/circumference ratio, a measure of arteriolar wall thickness, was 47% greater in women than men (P = 0.012). Cardiomyocyte width and diffusion radius were positively correlated, and capillary length density was negatively correlated with BSA (P < 0.05). Whereas cardiomyocyte width, capillary length density, diffusion radius, and cardiomyocyte width/BSA ratio were similar for men and women, women had a greater diffusion radius/BSA ratio (P = 0.0038) and a greater diffusion radius/cardiomyocyte width ratio (P = 0.027). Women also had lower vascular endothelial growth factor (VEGF) receptor-1 levels (P = 0.048) and VEGF receptor-1/VEGF-A ratio (P = 0.024) in plasma. We conclude that women with extensive coronary artery disease have greater arteriolar wall thickness and diffusion radius relative to BSA and to cardiomyocyte width than men, which may predispose to myocardial ischemia. Additional studies of larger numbers of women with less extensive coronary artery disease are required to confirm these findings.
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Affiliation(s)
- Duncan J Campbell
- St. Vincent's Institute of Medical Research, Victoria 3065, Australia.
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44
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Bhupathy P, Haines CD, Leinwand LA. Influence of sex hormones and phytoestrogens on heart disease in men and women. ACTA ACUST UNITED AC 2010; 6:77-95. [PMID: 20088732 DOI: 10.2217/whe.09.80] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular disease (CVD) is the number one cause of morbidity and mortality in men and women worldwide. According to the WHO, by 2015, almost 20 million people will die from CVD each year. It is well established that men and women differ not only in baseline cardiac parameters, but also in the clinical presentation, diagnosis and treatment outcomes of CVD. Women tend to develop heart disease later in life than men. This difference has been attributed to the loss of estrogen during the menopausal transition; however, the biological explanations for the sexual dimorphism in CVD are more complex and seem unlikely to be due to estrogen alone. The current controversy that has arisen regarding the effects of HRT on CVD in women is a case in point. In this review, the sex-based differences in cardiac (patho-) physiology are discussed with emphasis on the impact of sex hormones, hormone receptors and diet on heart disease.
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Affiliation(s)
- Poornima Bhupathy
- Department of Molecular, Cellular & Developmental Biology, University of Colorado, Boulder, CO 80309-80347, USA.
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45
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Thireau J, Aimond F, Poisson D, Zhang B, Bruneval P, Eder V, Richard S, Babuty D. New insights into sexual dimorphism during progression of heart failure and rhythm disorders. Endocrinology 2010; 151:1837-45. [PMID: 20176721 DOI: 10.1210/en.2009-1184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neurohormonal imbalance is a key determinant of the progression of heart failure (HF), which results in an elevated risk of mortality. A better understanding of mechanisms involved may influence treatment strategies. The incidence and prevalence of HF are lower in women. We explored sexual dimorphism in the progression of HF using a mice model of neurohormonal-dependent HF. Male and female mice overexpressing the human beta2-adrenergic receptor (TG4 strain) develop HF. We compared TG4 animals with age-matched wild-type controls. Cardiac function was studied in vivo by echocardiography and electrocardiography. Histological studies were performed. Conduction parameters were assessed by intracardiac electrophysiological exploration, as was the occurrence of spontaneous and inducible arrhythmias. The patch-clamp technique was used to determine the cellular electrophysiological profile. The role of hormonal status in HF progression was investigated by surgical gonadectomy. High mortality rate was observed in TG4 mice with a dramatic difference between males and females. Male TG4 mice exhibited intraventricular conduction abnormalities, as measured by infrahisian interval and QRS durations potentially determining reentrant circuits and increasing susceptibility to arrhythmia. The severity of HF was correlated with the degree of fibrosis, which was modulated by the gonadal hormones. Action potentials recorded from male and female left ventricular cardiomyocytes were indistinguishable, although both sexes exhibited delayed repolarization when compared with their wild-type counterparts. In conclusion, female TG4 mice were better protected than males against cardiac remodeling and rhythm disorders. A link between fibrosis, conduction time, and mortality was established in relation with sex hormones.
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Affiliation(s)
- Jérôme Thireau
- Centre National de la Recherche Scientifique FRE3092, Université François-Rabelais, F-37041 Tours, France
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Li Y, Saito Y, Kuwahara K, Rong X, Kishimoto I, Harada M, Horiuchi M, Murray M, Nakao K. Vasodilator therapy with hydralazine induces angiotensin AT receptor-mediated cardiomyocyte growth in mice lacking guanylyl cyclase-A. Br J Pharmacol 2010; 159:1133-42. [PMID: 20136844 PMCID: PMC2839271 DOI: 10.1111/j.1476-5381.2009.00619.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 09/07/2009] [Accepted: 10/09/2009] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Recent clinical guidelines advocate the use of the isosorbide dinitrate/hydralazine combination in treatment for heart failure. However, clinical and laboratory evidence suggest that some vasodilators may induce cardiac hypertrophy under uncertain conditions. This study investigated the effects and underlying mechanism of action of the vasodilator hydralazine on cardiac growth. EXPERIMENTAL APPROACH Wild-type mice and animals deficient in guanylyl cyclase-A (GCA) and/or angiotensin receptors (AT(1) and AT(2) subtypes) were treated with hydralazine ( approximately 24 mg.kg(-1).day(-1) in drinking water) for 5 weeks. Cardiac mass and/or cardiomyocyte cross-sectional area, fibrosis (van Giessen-staining) and cardiac gene expression (real-time RT-PCR) were measured. KEY RESULTS Hydralazine lowered blood pressure in mice of all genotypes. However, this treatment increased the heart and left ventricular to body weight ratios, as well as cardiomyocyte cross-sectional area, and cardiac expression of atrial natriuretic peptide mRNA in mice lacking GCA. Hydralazine did not affect cardiac hypertrophy in wild-type mice and mice lacking either AT(1) or AT(2) receptors alone. However, the pro-hypertrophic effect of hydralazine was prevented in mice lacking both GCA and AT(2), but not GCA and AT(1) receptors. However, hydralazine did decrease cardiac collagen deposition and collagen I mRNA (signs of cardiac fibrosis) in mice that were deficient in GCA, or both GCA and AT(2) receptors. CONCLUSIONS AND IMPLICATIONS The vasodilator hydralazine induced AT(2) receptor-mediated cardiomyocyte growth under conditions of GCA deficiency. However, attenuation of cardiac fibrosis by hydralazine could be beneficial in the management of cardiac diseases.
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Affiliation(s)
- Y Li
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Japan.
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Abstract
Atrial and brain natriuretic peptides (ANP and BNP, respectively) are cardiac hormones. During cardiac development, their expression is a maker of cardiomyocyte differentiation and is under tight spatiotemporal regulation. After birth, however, their ventricular expression is only up-regulated in response to various cardiovascular diseases. As a result, analysis of ANP and BNP gene expression has led to discoveries of transcriptional regulators and signaling pathways involved in both cardiac differentiation and cardiac disease. Studies using genetically engineered mice have shed light on the molecular mechanisms regulating ANP and BNP gene expression, as well as the physiological and pathophysiological relevance of the cardiac natriuretic peptide system. In this review we will summarize what is currently known about their regulation and the significance of ANP and BNP as hormones derived from the heart.
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Affiliation(s)
- Koichiro Kuwahara
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan.
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48
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Li Y, Saito Y, Kuwahara K, Rong X, Kishimoto I, Harada M, Adachi Y, Nakanishi M, Kinoshita H, Horiuchi M, Murray M, Nakao K. Guanylyl cyclase-A inhibits angiotensin II type 2 receptor-mediated pro-hypertrophic signaling in the heart. Endocrinology 2009; 150:3759-65. [PMID: 19372206 DOI: 10.1210/en.2008-1353] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Angiotensin II plays a key role in the development of cardiac hypertrophy. The contribution of the angiotensin II type 1 receptor (AT1) in angiotensin II-induced cardiac hypertrophy is well established, but the role of AT2 signaling remains controversial. Previously, we have shown that natriuretic peptide receptor/guanylyl cyclase-A (GCA) signaling protects the heart from hypertrophy at least in part by inhibiting AT1-mediated pro-hypertrophic signaling. Here, we investigated the role of AT2 in cardiac hypertrophy observed in mice lacking GCA. Real-time RT-PCR and immunoblotting approaches indicated that the cardiac AT2 gene was overexpressed in GCA-deficient mice. Mice lacking AT2 alone did not exhibit an abnormal cardiac phenotype. In contrast, GCA-deficiency-induced increases in heart to body weight ratio, cardiomyocyte cross-sectional area, and collagen accumulation as evidenced by van Gieson staining were attenuated when AT2 was absent. Furthermore, the up-regulated cardiac expression of hypertrophy-related genes in GCA-null animals was also suppressed. Pharmacological blockade of AT2 with PD123319 similarly attenuated cardiac hypertrophy in GCA-deficient mice. In addition, whereas the AT1 antagonist olmesartan attenuated cardiac hypertrophy in GCA-deficient mice, this treatment was without effect on cardiac hypertrophy in GCA/AT2-double null mice, notwithstanding its potent antihypertensive effect in these animals. These results suggest that the interplay of AT2 and AT1 may be important in the development of cardiac hypertrophy. Collectively, our findings support the assertion that GCA inhibits AT2-mediated pro-hypertrophic signaling in heart and offer new insights into endogenous cardioprotective mechanisms during disease pathogenesis.
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MESH Headings
- Angiotensin II Type 2 Receptor Blockers
- Animals
- Body Weight/drug effects
- Body Weight/genetics
- Cardiomegaly/metabolism
- Collagen/metabolism
- Heart/drug effects
- Heart/physiology
- Imidazoles/pharmacology
- Immunoblotting
- Male
- Mice
- Mice, Knockout
- Myocardium/metabolism
- Organ Size
- Pyridines/pharmacology
- Receptor, Angiotensin, Type 1/agonists
- Receptor, Angiotensin, Type 1/physiology
- Receptor, Angiotensin, Type 2/genetics
- Receptor, Angiotensin, Type 2/metabolism
- Receptors, Atrial Natriuretic Factor/genetics
- Receptors, Atrial Natriuretic Factor/physiology
- Reverse Transcriptase Polymerase Chain Reaction
- Tetrazoles/pharmacology
- Vasoconstrictor Agents/pharmacology
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Affiliation(s)
- Yuhao Li
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan.
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Li Y, Qi Y, Kim MS, Xu KZY, Huang THW, Rong X, Murray M, Yamahara J. Increased renal collagen cross-linking and lipid accumulation in nephropathy of Zucker diabetic fatty rats. Diabetes Metab Res Rev 2008; 24:498-506. [PMID: 18613221 DOI: 10.1002/dmrr.874] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Zucker diabetic fatty (ZDF) rat is a genetic model of type 2 diabetes and obesity. The mechanism underlying nephropathy in ZDF rats, however, remains unclear. METHODS ZDF rats were compared to age-matched Zucker lean (ZL) rats. Physiological and blood biochemical parameters, renal glomerular cross-sectional area (hematoxylin-eosin staining), fibrosis (van Giesen staining), collagen composition (Sircol Collagen Assay), lipids (enzymatic method) and mRNA expression (RT-PCR) were determined. RESULTS ZDF rats showed an increase in renal-insoluble collagen content and the ratio of renal-insoluble to salt-soluble collagen (2- and 1.5-fold of the control animals). There were increases in renal glomerulosclerosis and interstitial fibrosis in ZDF rats (increased to 2-fold) in the glomerular mesangium and tubulointerstitium, and increased glomerular area. Renal triglyceride accumulated to greater than 2-fold of those levels in ZL rats. These changes were accompanied by hypoalbuminemia, and elevated plasma blood urea nitrogen and uric acid levels. Gene profiling showed increased expression of transcripts encoding the glomerulosclerotic mediator collagens I and IV, plasminogen activator inhibitor-1, transforming growth factor-beta1, and angiotensin II type 1 receptor in ZDF rat kidney. Moreover, renal expression of mRNAs encoding sterol regulatory element-binding protein-1, a nuclear transcription factor that activates genes involved in fatty acid synthesis, and acetyl-CoA carboxylase, a key enzyme that mediates fatty acid synthesis, was increased in ZDF rats. CONCLUSIONS Our findings suggest that dysregulated gene expression may result in increased renal collagen cross-linking and lipid accumulation, that may be associated with development of nephropathy in the animal model of type 2 diabetes and obesity.
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Affiliation(s)
- Yuhao Li
- Faculty of Pharmacy, The University of Sydney, NSW, Australia.
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50
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Huang TH, He L, Qin Q, Yang Q, Peng G, Harada M, Qi Y, Yamahara J, Roufogalis BD, Li Y. Salacia oblonga root decreases cardiac hypertrophy in Zucker diabetic fatty rats: inhibition of cardiac expression of angiotensin II type 1 receptor. Diabetes Obes Metab 2008; 10:574-85. [PMID: 17645561 DOI: 10.1111/j.1463-1326.2007.00750.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS We investigated the effect of the water extract of Salacia oblonga (SOE), an ayurvedic antidiabetic and antiobesity medicine, on obesity and diabetes-associated cardiac hypertrophy and discuss the role of modulation of cardiac angiotensin II type 1 receptor (AT(1)) expression in the effect. METHODS SOE (100 mg/kg) was given orally to male Zucker diabetic fatty (ZDF) rats for 7 weeks. At the end-point of the treatment, the hearts and left ventricles were weighed, cardiomyocyte cross-sectional areas were measured, and cardiac gene profiles were analysed. On the other hand, angiotensin II-stimulated embryonic rat heart-derived H9c2 cells and neonatal rat cardiac fibroblasts were pretreated with SOE and one of its prominent components mangiferin (MA), respectively. Atrial natriuretic peptide (ANP) mRNA expression and protein synthesis and [(3)H]thymidine incorporation were determined. RESULTS SOE-treated ZDF rats showed less cardiac hypertrophy (decrease in weights of the hearts and left ventricles and reduced cardiomyocyte cross-sectional areas). SOE treatment suppressed cardiac overexpression of ANP, brain natriuretic peptide (BNP) and AT(1) mRNAs and AT(1) protein in ZDF rats. SOE (50-100 microg/ml) and MA (25 micromol) suppressed angiotensin II-induced ANP mRNA overexpression and protein synthesis in H9c2 cells. They also inhibited angiotensin II-stimulated [(3)H]thymidine incorporation by cardiac fibroblasts. CONCLUSIONS Our findings demonstrate that SOE decreases cardiac hypertrophy in ZDF rats, at least in part by inhibiting cardiac AT(1) overexpression. These studies provide insights into a potential cardioprotective role of a traditional herb, which supports further clinical evaluation in obesity and diabetes-associated cardiac hypertrophy.
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Affiliation(s)
- T H Huang
- Faculty of Pharmacy, University of Sydney, Australia
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