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Cappola AR, Desai AS, Medici M, Cooper LS, Egan D, Sopko G, Fishman GI, Goldman S, Cooper DS, Mora S, Kudenchuk PJ, Hollenberg AN, McDonald CL, Ladenson PW. Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment. Circulation 2019; 139:2892-2909. [PMID: 31081673 PMCID: PMC6851449 DOI: 10.1161/circulationaha.118.036859] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Thyroid hormones have long been known to have a range of effects on the cardiovascular system. However, significant knowledge gaps exist concerning the precise molecular and biochemical mechanisms governing these effects and the optimal strategies for management of abnormalities in thyroid function in patients with and without preexisting cardiovascular disease. In September 2017, the National Heart, Lung, and Blood Institute convened a Working Group with the goal of developing priorities for future scientific research relating thyroid dysfunction to the progression of cardiovascular disease. The Working Group reviewed and discussed the roles of normal thyroid physiology, the consequences of thyroid dysfunction, and the effects of therapy in 3 cardiovascular areas: cardiac electrophysiology and arrhythmias, the vasculature and atherosclerosis, and the myocardium and heart failure. This report describes the current state of the field, outlines barriers and challenges to progress, and proposes research opportunities to advance the field, including strategies for leveraging novel approaches using omics and big data. The Working Group recommended research in 3 broad areas: (1) investigation into the fundamental biology relating thyroid dysfunction to the development of cardiovascular disease and into the identification of novel biomarkers of thyroid hormone action in cardiovascular tissues; (2) studies that define subgroups of patients with thyroid dysfunction amenable to specific preventive strategies and interventional therapies related to cardiovascular disease; and (3) clinical trials focused on improvement in cardiovascular performance and cardiovascular outcomes through treatment with thyroid hormone or thyromimetic drugs.
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Affiliation(s)
- Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Akshay S. Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Marco Medici
- Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Debra Egan
- Office of Clinical and Regulatory Affairs, National Center for Complementary and Integrative Health, Bethesda, MD
| | - George Sopko
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | | | | | - David S. Cooper
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Samia Mora
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Peter J. Kudenchuk
- Division of Cardiology, Arrhythmia Services, the University of Washington, Seattle, WA
| | | | - Cheryl L. McDonald
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Paul W. Ladenson
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
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Cappola AR, Desai AS, Medici M, Cooper LS, Egan D, Sopko G, Fishman GI, Goldman S, Cooper DS, Mora S, Kudenchuk PJ, Hollenberg AN, McDonald CL, Ladenson PW. Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment. Thyroid 2019; 29:760-777. [PMID: 31081722 PMCID: PMC6913785 DOI: 10.1089/thy.2018.0416] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Thyroid hormones have long been known to have a range of effects on the cardiovascular system. However, significant knowledge gaps exist concerning the precise molecular and biochemical mechanisms governing these effects and the optimal strategies for management of abnormalities in thyroid function in patients with and without preexisting cardiovascular disease. In September 2017, The National Heart, Lung, and Blood Institute convened a Working Group with the goal of developing priorities for future scientific research relating thyroid dysfunction to the progression of cardiovascular disease. The Working Group reviewed and discussed the roles of normal thyroid physiology, the consequences of thyroid dysfunction, and the effects of therapy in three cardiovascular areas: cardiac electrophysiology and arrhythmias, the vasculature and atherosclerosis, and the myocardium and heart failure. This report describes the current state of the field, outlines barriers and challenges to progress, and proposes research opportunities to advance the field, including strategies for leveraging novel approaches using omics and big data. The Working Group recommended research in three broad areas: 1) investigation into the fundamental biology relating thyroid dysfunction to the development of cardiovascular disease and into the identification of novel biomarkers of thyroid hormone action in cardiovascular tissues; 2) studies that define subgroups of patients with thyroid dysfunction amenable to specific preventive strategies and interventional therapies related to cardiovascular disease; and 3) clinical trials focused on improvement in cardiovascular performance and cardiovascular outcomes through treatment with thyroid hormone or thyromimetic drugs.
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Affiliation(s)
- Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Address correspondence to: Anne R. Cappola, MD, MSc, Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104
| | - Akshay S. Desai
- Cardiovascular Division; Brigham and Women's Hospital, Boston, Massachusetts
| | - Marco Medici
- Department of Internal Medicine and Erasmus MC Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Debra Egan
- Office of Clinical and Regulatory Affairs, National Center for Complementary and Integrative Health, Bethesda, Maryland
| | - George Sopko
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Glenn I. Fishman
- Division of Cardiology, NYU School of Medicine, New York, New York
| | - Steven Goldman
- Sarver Heart Center, University of Arizona, Tucson, Arizona
| | - David S. Cooper
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samia Mora
- Divisions of Preventive and Cardiovascular Medicine; Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter J. Kudenchuk
- Division of Cardiology, Arrhythmia Services, University of Washington, Seattle, Washington
| | | | - Cheryl L. McDonald
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Paul W. Ladenson
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hopper I, Kotecha D, Chin KL, Mentz RJ, von Lueder TG. Comorbidities in Heart Failure: Are There Gender Differences? Curr Heart Fail Rep 2016; 13:1-12. [DOI: 10.1007/s11897-016-0280-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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The emerging role of TRα1 in cardiac repair: potential therapeutic implications. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:481482. [PMID: 24683435 PMCID: PMC3941156 DOI: 10.1155/2014/481482] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/31/2013] [Indexed: 02/06/2023]
Abstract
Thyroid hormone (TH) is critical for adapting living organisms to environmental stress. Plasma circulating tri-iodothyronine (T3) levels drop in most disease states and are associated with increased oxidative stress. In this context, T3 levels in plasma appear to be an independent determinant for the recovery of cardiac function after myocardial infarction in patients. Thyroid hormone receptor α1 (TRα1) seems to be crucial in this response; TRα1 accumulates to cell nucleus upon activation of stress induced growth kinase signaling. Furthermore, overexpression of nuclear TRα1 in cardiomyocytes can result in pathological or physiological growth (dual action) in absence or presence of its ligand, respectively. Accordingly, inactivation of TRα1 receptor prevents reactive hypertrophy after myocardial infarction and results in heart failure with increased phospholamban (PLB) expression and marked activation of p38MAPK. In line with this evidence, TH is shown to limit ischemia/reperfusion injury and convert pathologic to physiologic growth after myocardial infarction via TRα1 receptor. TRα1 receptor may prove to be a novel pharmacological target for cardiac repair/regeneration therapies.
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Pantos C, Mourouzis I, Markakis K, Tsagoulis N, Panagiotou M, Cokkinos DV. Long-term thyroid hormone administration reshapes left ventricular chamber and improves cardiac function after myocardial infarction in rats. Basic Res Cardiol 2008; 103:308-18. [DOI: 10.1007/s00395-008-0697-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 01/11/2008] [Indexed: 10/22/2022]
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Modesti PA, Marchetta M, Gamberi T, Lucchese G, Maccherini M, Chiavarelli M, Modesti A. Reduced expression of thyroid hormone receptors and beta-adrenergic receptors in human failing cardiomyocytes. Biochem Pharmacol 2007; 75:900-6. [PMID: 18031713 DOI: 10.1016/j.bcp.2007.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 10/06/2007] [Accepted: 10/09/2007] [Indexed: 11/18/2022]
Abstract
An altered thyroid hormone profile has been reported in patients with congestive heart failure. However, information regarding the status of thyroid hormone receptors in human failing cardiomyocytes is lacking. Therefore the expression of thyroid hormone and beta-adrenergic receptors was investigated in human ventricular cardiomyocytes isolated from patients with end-stage heart failure (FM, n=12), or from tentative donors (C, n=4). The expression of thyroid (TRalpha1, and TRbeta1) and beta-adrenergic receptors (ARB1 and ARB2) was measured at both the gene, and at the protein level. In FM the reduced mRNA expression of ARB1 (p<0.05, -37%) and ARB2 (p<0.05, -42%) was associated with a reduction of the messenger for TRalpha1 (p<0.05, -85%) and TRalpha2 (p<0.05, -73%). These findings were confirmed at the protein level for ARB1, ARB2 and TRalpha1. These data reveal that in human heart failure the reduction of beta-adrenergic receptors is associated with reduced expression of both TRalpha1 and TRalpha2 isoforms of thyroid hormone receptors.
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MESH Headings
- Cardiomyopathy, Dilated/metabolism
- Cardiomyopathy, Dilated/physiopathology
- Down-Regulation
- Gene Expression
- Heart Ventricles/metabolism
- Humans
- Middle Aged
- Myocytes, Cardiac/metabolism
- Receptors, Adrenergic, beta-1/biosynthesis
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-2/biosynthesis
- Receptors, Adrenergic, beta-2/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Thyroid Hormone Receptors alpha/biosynthesis
- Thyroid Hormone Receptors alpha/genetics
- Thyroid Hormone Receptors beta/biosynthesis
- Thyroid Hormone Receptors beta/genetics
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Affiliation(s)
- Pietro Amedeo Modesti
- Department of Critical Care Medicine, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
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Athéa Y, Garnier A, Fortin D, Bahi L, Veksler V, Ventura-Clapier R. Mitochondrial and energetic cardiac phenotype in hypothyroid rat. Relevance to heart failure. Pflugers Arch 2007; 455:431-42. [PMID: 17638011 PMCID: PMC4710782 DOI: 10.1007/s00424-007-0307-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 05/16/2007] [Accepted: 06/11/2007] [Indexed: 12/24/2022]
Abstract
Changes in thyroid status are associated with profound alterations in biochemical and physiological functioning of cardiac muscle, although its impact on cardiac energy metabolism is still debated. Similarities between the changes in cardiac gene expression in pathological hypertrophy leading to heart failure and hypothyroidism prompted scientists to suggest a role for thyroid hormone status in the development of metabolic and functional alterations in this disease. We thus investigated the effects of hypothyroidism on cardiac energy metabolism. Hypothyroid state (HYPO) was induced by thyroidectomy and propyl-thio-uracyl in male rats for 3 weeks. We examined the effects of hypothyroid state on oxidative capacity and mitochondrial substrate utilization by measuring oxygen consumption of saponin permeabilized cardiac fibers, mitochondrial biogenesis by reverse transcription polymerase chain reaction and energy metabolism, and energy transfer enzymes by spectrophotometry. The results show that maximal oxidative capacity of the myocardium was decreased from 24.9 +/- 0.9 in control (CT) to 19.3 +/- 0.7 micromol O(2) min(-1) g dry weight(-1) in HYPO. However, protein content and messenger RNA (mRNA) of PGC-1alpha and mRNA of its transcription cascade that is thought to control mitochondrial content in normal myocardium and heart failure, were unchanged in HYPO. Mitochondrial utilization of glycerol-3P (-70%), malate (-45%), and octanoate (-24%) but not pyruvate was decreased in HYPO. Moreover, the creatine kinase system and energy transfer were hardly affected in HYPO. Besides, hypothyroidism decreased the activation of other signaling pathways like p38 mitogen-activated protein kinases, AMP-activated protein kinase, and calcineurin. These results show that cellular hypothyroidism can hardly account for the specific energetic alterations of heart failure.
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Affiliation(s)
- Yoni Athéa
- Signalisation et Physiopathologie Cardiaque
INSERMUniversité Paris-Sud - Paris 11IFR141Faculté de Pharmacie 5 Rue Jean-Baptiste Clément 92296 Chatenay Malabry Cedex
| | - Anne Garnier
- Signalisation et Physiopathologie Cardiaque
INSERMUniversité Paris-Sud - Paris 11IFR141Faculté de Pharmacie 5 Rue Jean-Baptiste Clément 92296 Chatenay Malabry Cedex
| | - Dominique Fortin
- Signalisation et Physiopathologie Cardiaque
INSERMUniversité Paris-Sud - Paris 11IFR141Faculté de Pharmacie 5 Rue Jean-Baptiste Clément 92296 Chatenay Malabry Cedex
| | - Lahoucine Bahi
- Signalisation et Physiopathologie Cardiaque
INSERMUniversité Paris-Sud - Paris 11IFR141Faculté de Pharmacie 5 Rue Jean-Baptiste Clément 92296 Chatenay Malabry Cedex
| | - Vladimir Veksler
- Signalisation et Physiopathologie Cardiaque
INSERMUniversité Paris-Sud - Paris 11IFR141Faculté de Pharmacie 5 Rue Jean-Baptiste Clément 92296 Chatenay Malabry Cedex
| | - Renée Ventura-Clapier
- Signalisation et Physiopathologie Cardiaque
INSERMUniversité Paris-Sud - Paris 11IFR141Faculté de Pharmacie 5 Rue Jean-Baptiste Clément 92296 Chatenay Malabry Cedex
- * Correspondence should be addressed to Renée Ventura-Clapier
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