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Neprilysin Inhibitors in Heart Failure: The Science, Mechanism of Action, Clinical Studies, and Unanswered Questions. JACC. BASIC TO TRANSLATIONAL SCIENCE 2022; 8:88-105. [PMID: 36777165 PMCID: PMC9911324 DOI: 10.1016/j.jacbts.2022.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022]
Abstract
This article provides a contemporary review and a new perspective on the role of neprilysin inhibition in heart failure (HF) in the context of recent clinical trials and addresses potential mechanisms and unanswered questions in certain HF patient populations. Neprilysin is an endopeptidase that cleaves a variety of peptides such as natriuretic peptides, bradykinin, adrenomedullin, substance P, angiotensin I and II, and endothelin. It has a broad role in cardiovascular, renal, pulmonary, gastrointestinal, endocrine, and neurologic functions. The combined angiotensin receptor and neprilysin inhibitor (ARNi) has been developed with an intent to increase vasodilatory natriuretic peptides and prevent counterregulatory activation of the angiotensin system. ARNi therapy is very effective in reducing the risks of death and hospitalization for HF in patients with HF and New York Heart Association functional class II to III symptoms, but studies failed to show any benefits with ARNi when compared with angiotensin-converting enzyme inhibitors or angiotensin receptor blocker in patients with advanced HF with reduced ejection fraction or in patients following myocardial infarction with left ventricular dysfunction but without HF. These raise the questions about whether the enzymatic breakdown of natriuretic peptides may not be a very effective solution in advanced HF patients when there is downstream blunting of the response to natriuretic peptides or among post-myocardial infarction patients in the absence of HF when there may not be a need for increased natriuretic peptide availability. Furthermore, there is a need for additional studies to determine the long-term effects of ARNi on albuminuria, obesity, glycemic control and lipid profile, blood pressure, and cognitive function in patients with HF.
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Key Words
- ACE, angiotensin-converting enzyme
- ANP, atrial natriuretic peptide
- ARB, angiotensin receptor blocker
- ARN, angiotensin receptor–neprilysin
- ARNi
- Aβ, amyloid beta
- BNP, brain natriuretic peptide
- BP, blood pressure
- CSF, cerebrospinal fluid
- EF, ejection fraction
- FDA, U.S. Food and Drug Administration
- GFR, glomerular filtration rate
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- NEP inhibitor
- NT-proBNP, N-terminal pro–brain natriuretic peptide
- NYHA, New York Heart Association
- PDE, phosphodiesterase
- RAAS, renin-angiotensin-aldosterone system
- UACR, urinary albumin/creatine ratio
- angiotensin receptor–neprilysin inhibitor
- cGMP, cyclic guanosine monophosphate
- eGFR, estimated glomerular filtration rate
- heart failure
- neprilysin
- neprilysin inhibitor
- sacubitril
- sacubitril/valsartan
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Nicotinamide Mononucleotide Alleviates Cardiomyopathy Phenotypes Caused by Short-Chain Enoyl-Coa Hydratase 1 Deficiency. JACC Basic Transl Sci 2022; 7:348-362. [PMID: 35540099 PMCID: PMC9079797 DOI: 10.1016/j.jacbts.2021.12.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
ECHS1 hydrates medium- and short-chain enoyl CoAs and catalyzes the oxidation of fatty acids and branched-chain amino acids. The mechanism driving ECHS1 deficiency–associated cardiomyopathy was investigated using conventional biochemistry and molecular biology methods, including immunoprecipitation and polymerase chain reaction. Echs1 heterogeneous knockout mice displayed cardiac dysfunction as evaluated by echocardiography. ECHS1 deficiency causes cardiomyopathy by enhancing p300-mediated H3K9ac. ECHS1 deficiency–induced cardiomyopathy can be prevented using an intervention approach targeting H3K9ac.
Short-chain enoyl-CoA hydratase 1 (ECHS1) deficiency plays a role in cardiomyopathy. Whether ECHS1 deficiency causes or is only associated with cardiomyopathy remains unclear. By using Echs1 heterogeneous knockout (Echs1+/-) mice, we found that ECHS1 deficiency caused cardiac dysfunction, as evidenced by diffuse myocardial fibrosis and upregulated fibrosis-related genes. Mechanistically, ECHS1 interacts with the p300 nuclear localization sequence, preventing its nuclear translocation in fibroblasts. ECHS1 deficiency promotes p300 nuclear translocation, leading to increased H3K9 acetylation, a known risk factor for cardiomyopathy. Nicotinamide mononucleotide–mediated acetylation targeting suppressed ECHS1 deficiency–induced cardiomyopathy phenotypes in Echs1+/- mice. Thus, enhancing p300-mediated H3K9ac is a potential interventional approach for preventing ECHS1 deficiency–induced cardiomyopathy.
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Key Words
- ANP, atrial natriuretic peptide
- BCAA, branched-chain amino acid
- BNP, brain natriuretic peptide
- DCM, dilated cardiomyopathy
- ECHS1, short-chain enoyl-CoA hydratase 1
- FA, fatty acid
- HCM, hypertrophic cardiomyopathy
- HFF, human foreskin fibroblast
- IVSd, interventricular septum in end-diastole
- IVSs, interventricular septum in end-systole
- LVEF, left ventricular ejection fraction
- LVFS, left ventricular fractional shortening
- LVIDd, left ventricular internal dimension in end-diastole
- LVIDs, left ventricular internal dimension in end-systole
- LVPWd, left ventricular posterior wall in end-diastole
- LVPWs, left ventricular posterior wall in end-systole
- NMN, nicotinamide mononucleotide
- acetylation of H3K9
- cardiomyopathy
- enoyl-CoA hydratase 1
- nicotinamide mononucleotide
- p300
- α-SMA, smooth muscle actin-α
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The poly(ADP-ribosyl)ation of BRD4 mediated by PARP1 promoted pathological cardiac hypertrophy. Acta Pharm Sin B 2021; 11:1286-1299. [PMID: 34094834 PMCID: PMC8148063 DOI: 10.1016/j.apsb.2020.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/18/2020] [Accepted: 10/13/2020] [Indexed: 12/02/2022] Open
Abstract
The bromodomain and extraterminal (BET) family member BRD4 is pivotal in the pathogenesis of cardiac hypertrophy. BRD4 induces hypertrophic gene expression by binding to the acetylated chromatin, facilitating the phosphorylation of RNA polymerases II (Pol II) and leading to transcription elongation. The present study identified a novel post-translational modification of BRD4: poly(ADP-ribosyl)ation (PARylation), that was mediated by poly(ADP-ribose)polymerase-1 (PARP1) in cardiac hypertrophy. BRD4 silencing or BET inhibitors JQ1 and MS417 prevented cardiac hypertrophic responses induced by isoproterenol (ISO), whereas overexpression of BRD4 promoted cardiac hypertrophy, confirming the critical role of BRD4 in pathological cardiac hypertrophy. PARP1 was activated in ISO-induced cardiac hypertrophy and facilitated the development of cardiac hypertrophy. BRD4 was involved in the prohypertrophic effect of PARP1, as implied by the observations that BRD4 inhibition or silencing reversed PARP1-induced hypertrophic responses, and that BRD4 overexpression suppressed the anti-hypertrophic effect of PARP1 inhibitors. Interactions of BRD4 and PARP1 were observed by co-immunoprecipitation and immunofluorescence. PARylation of BRD4 induced by PARP1 was investigated by PARylation assays. In response to hypertrophic stimuli like ISO, PARylation level of BRD4 was elevated, along with enhanced interactions between BRD4 and PARP1. By investigating the PARylation of truncation mutants of BRD4, the C-terminal domain (CTD) was identified as the PARylation modification sites of BRD4. PARylation of BRD4 facilitated its binding to the transcription start sites (TSS) of hypertrophic genes, resulting in enhanced phosphorylation of RNA Pol II and transcription activation of hypertrophic genes. The present findings suggest that strategies targeting inhibition of PARP1-BRD4 might have therapeutic potential for pathological cardiac hypertrophy.
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Key Words
- ANP, atrial natriuretic peptide
- BET, bromodomain and extraterminal domain
- BNP, brain natriuretic polypeptide
- BRD4
- BW, body weight
- CDK9, cyclin-dependent kinase 9
- Cardiac hypertrophy
- EF, ejection fraction
- FBS, fetal bovine serum
- FS, fractional shortening
- HATs, histone acetyltransferases
- HDACs, histone deacetylases
- HE, hematoxylin-eosin
- HW, heart weight
- Hypertrophic genes
- IF, immunofluorescence
- ISO, isoproterenol
- Isoproterenol
- LVAW, left ventricular anterior wall thickness
- LVID, left ventricular internal diameter
- LVPW, left ventricular posterior wall thickness
- NC, negative control
- NRCMs, neonatal rat cardiomyocytes
- NS, normal saline
- PARP1
- PARP1, poly(ADP-ribose)polymerase-1
- PARylation
- PBS, phosphate buffer solution
- PSR, picrosirius red
- RNA Pol II
- RNA Pol II, RNA polymerases II
- SD, Sprague–Dawley
- TL, tibia length
- TSS, transcription start sites
- Transcription activation
- WGA, wheat germ agglutinin
- co-IP, co-immunoprecipitation
- siRNA, small-interfering RNA
- β-AR, β-adrenergic receptor
- β-MHC, β-myosin heavy chain
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Cardiac Endocrinology: Heart-Derived Hormones in Physiology and Disease. ACTA ACUST UNITED AC 2020; 5:949-960. [PMID: 33015416 PMCID: PMC7524786 DOI: 10.1016/j.jacbts.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022]
Abstract
The heart plays a central role in the circulatory system and provides essential oxygen, nutrients, and growth factors to the whole organism. The heart can synthesize and secrete endocrine signals to communicate with distant target organs. Studies of long-known and recently discovered heart-derived hormones highlight a shared theme and reveal a unified mechanism of heart-derived hormones in coordinating cardiac function and target organ biology. This paper reviews the biochemistry, signaling, function, regulation, and clinical significance of representative heart-derived hormones, with a focus on the cardiovascular system. This review also discusses important and exciting questions that will advance the field of cardiac endocrinology.
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Key Words
- ANP, atrial natriuretic peptide
- ActR, activin receptor
- BNP, brain natriuretic peptide
- CNP, C-type natriuretic peptide
- FGF, fibroblast growth factor
- FSTL, follistatin-like
- GDF, growth differentiation factor
- GDF15
- GFRAL, GDNF family receptor α-like
- NPR, natriuretic peptide receptors
- PCSK, proprotein convertase subtilisin/kexin type
- ST2, suppression of tumorigenesis-2
- TGF, transforming growth factor
- cardiac endocrinology
- heart
- heart-derived hormones
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Heart Failure With Reduced Ejection Fraction Is Characterized by Systemic NEP Downregulation. ACTA ACUST UNITED AC 2020; 5:715-726. [PMID: 32760858 PMCID: PMC7393434 DOI: 10.1016/j.jacbts.2020.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022]
Abstract
The kidneys might play a crucial role in regulating systemic NEP actions based on 20 to 100 higher NEP content and activity of the kidneys compared with any other organ. Tissue NEP expression seems to be downregulated and translates into reduced tissue protein concentrations and activity in HF. Neither plasma or liquor NEP concentrations and activities reflect tissue NEP regulation; therefore, using NEP as a circulating biomarker seems to be questionable.
Based on the investigation of neprilysin (NEP) regulation in a translational porcine model of chronic heart failure (HF), this study concluded: 1) that kidneys might play a crucial part in systemic NEP regulation based on 20 to 100 higher NEP content and/or activity compared with any other organ; 2) NEP seems to be downregulated under HF conditions; and 3) that the value of plasma NEP concentrations and activity as biomarkers is questionable. For the first time, these data provide basic knowledge on HF-related pathophysiological alterations of the NEP system and contribute to understanding the mechanism of action of angiotensin-receptor neprilysin-inhibitors, which remains elusive despite broad clinical applications.
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Key Words
- ANP, atrial natriuretic peptide
- ARNI
- ARNI, angiotensin-receptor neprilysin-inhibitor
- BNP, B-type natriuretic peptide
- CMRI+LE, cardiac magnetic resonance and late enhancement
- HF, heart failure
- HFrEF, heart failure with reduced ejection fraction
- LV, left ventricular
- NEP, neprilysin
- NT-proBNP, N-terminal pro-B-type natriuretic peptide
- Q1 to Q3, 25th to 75th percentile
- RA, right atrial
- RV, right ventricular
- biomarker
- gene expression
- left atrial, left atrial
- mRNA, messenger RNA
- metalloproteinase
- neprilysin
- qPCR, real-time polymerase chain reaction
- translational model of heart failure
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Highly Reactive Isolevuglandins Promote Atrial Fibrillation Caused by Hypertension. JACC Basic Transl Sci 2020; 5:602-615. [PMID: 32613146 PMCID: PMC7315188 DOI: 10.1016/j.jacbts.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/11/2023]
Abstract
Oxidative damage is implicated in atrial fibrillation (AF), but antioxidants are ineffective therapeutically. The authors tested the hypothesis that highly reactive lipid dicarbonyl metabolites, or isolevuglandins (IsoLGs), are principal drivers of AF during hypertension. In a hypertensive murine model and stretched atriomyocytes, the dicarbonyl scavenger 2-hydroxybenzylamine (2-HOBA) prevented IsoLG adducts and preamyloid oligomers (PAOs), and AF susceptibility, whereas the ineffective analog 4-hydroxybenzylamine (4-HOBA) had minimal effect. Natriuretic peptides generated cytotoxic oligomers, a process accelerated by IsoLGs, contributing to atrial PAO formation. These findings support the concept of pre-emptively scavenging reactive downstream oxidative stress mediators as a potential therapeutic approach to prevent AF.
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Key Words
- 2-HOBA, 2-hydroxylbenzylamine
- 4-HOBA, 4-hydroxylbenzylamine
- AF, atrial fibrillation
- ANP, atrial natriuretic peptide
- B-type natriuretic peptide
- BNP, B-type natriuretic peptide
- BP, blood pressure
- ECG, electrocardiogram
- G/R, green/red ratio
- IsoLG, isolevuglandin
- PAO, preamyloid oligomer
- PBS, phosphate-buffered saline
- ROS, reactive oxygen species
- ang II, angiotensin II
- atrial fibrillation
- atrial natriuretic peptide
- hypertension
- isolevuglandins
- oxidative stress
- preamyloid oligomers
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Cardiac Versus Renal Response to Volume Expansion in Preclinical Systolic Dysfunction With PDEV Inhibition and BNP. ACTA ACUST UNITED AC 2020; 4:962-972. [PMID: 31909303 PMCID: PMC6939015 DOI: 10.1016/j.jacbts.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/11/2022]
Abstract
In preclinical systolic dysfunction, defined as left ventricular systolic dysfunction with no heart failure signs or symptoms, impairment in cardiorenal response to volume expansion may lead to symptomatic heart failure. Rescue of this impaired process in preclinical disease may prevent development of symptomatic heart failure. In preclinical systolic dysfunction, inhibition of phosphodiesterase-V in combination with exogenous B-type natriuretic peptide administration results in improved cardiac function but worsened renal function in response to acute volume expansion. Future studies are needed to further define the physiological effects and long-term outcomes of phosphodiesterase-V inhibition and exogenous BNP administration. Understanding the cardiorenal effects and outcomes of combination phosphodiesterase-V with exogenous B-type natriuretic peptide may affect the clinical management of patients with preclinical systolic dysfunction and renal dysfunction.
Impaired cardiorenal response to acute saline volume expansion in preclinical systolic dysfunction (PSD) may lead to symptomatic heart failure. The objective was to determine if combination phosphodiesterase-V inhibition and exogenous B-type natriuretic peptide (BNP) administration may enhance cardiorenal response. A randomized double-blinded, placebo-controlled study was conducted in 21 subjects with PSD and renal dysfunction. Pre-treatment with tadalafil and subcutaneous BNP resulted in improved cardiac function, as evidenced by improvement in ejection fraction, left atrial volume index, and left ventricular end-diastolic volume. However, there was reduced renal response with reduction in renal plasma flow, glomerular filtration rate, and urine flow. (Tadalafil and Nesiritide as Therapy in Pre-clinical Heart Failure; NCT01544998)
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Key Words
- ACC, American College of Cardiology
- AHA, American Heart Association
- ANP, atrial natriuretic peptide
- B-type natriuretic peptide
- BNP, B-type natriuretic peptide
- GFR, glomerular filtration rate
- HF, heart failure
- LAVI, left atrial volume index
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular end-systolic volume
- NP, natriuretic peptide
- PDEV, type V phosphodiesterase
- PSD, preclinical systolic dysfunction
- RPF, renal plasma flow
- SC, subcutaneous
- VE, acute saline volume expansion
- cGMP, cyclic guanosine monophosphate
- cardiorenal
- heart failure
- nesiritide
- phosphodiesterase inhibition
- systolic dysfunction
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Cardiac Nuclear High-Mobility Group Box 1 Ameliorates Pathological Cardiac Hypertrophy by Inhibiting DNA Damage Response. ACTA ACUST UNITED AC 2019; 4:234-247. [PMID: 31061925 PMCID: PMC6488753 DOI: 10.1016/j.jacbts.2018.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/19/2018] [Accepted: 11/19/2018] [Indexed: 01/12/2023]
Abstract
HMGB1 is a DNA-binding protein associated with nuclear homeostasis and DNA repair. Decreased nuclear HMGB1 expression is observed in human failing hearts, which is associated with cardiomyocyte hypertrophy and fibrosis. Cardiac nuclear HMGB1 overexpression ameliorates Ang II–induced pathological cardiac remodeling by inhibiting cardiomyocyte DNA damage and following ataxia telangiectasia mutated activation in mice. Ataxia telangiectasia mutated inhibitor treatment provided a cardioprotective effect on Ang II–induced cardiac remodeling in mice.
High-mobility group box 1 (HMGB1) is a deoxyribonucleic acid (DNA)–binding protein associated with DNA repair. Decreased nuclear HMGB1 expression and increased DNA damage response (DDR) were observed in human failing hearts. DNA damage and DDR as well as cardiac remodeling were suppressed in cardiac-specific HMGB1 overexpression transgenic mice after angiotensin II stimulation as compared with wild-type mice. In vitro, inhibition of HMGB1 increased phosphorylation of extracellular signal-related kinase 1/2 and nuclear factor kappa B, which was rescued by DDR inhibitor treatment. DDR inhibitor treatment provided a cardioprotective effect on angiotensin II–induced cardiac remodeling in mice.
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Key Words
- ANP, atrial natriuretic peptide
- ATM, ataxia telangiectasia mutated
- Ang II, angiotensin II
- BNP, brain natriuretic peptide
- CVF, collagen volume fraction
- DAMP, damage-associated molecular pattern
- DDR, deoxyribonucleic acid damage response
- DNA damage response
- DNA, deoxyribonucleic acid
- E/A ratio, ratio of early to atrial wave
- ERK1/2, extracellular signal-related kinase 1/2
- HMGB1
- HMGB1, high-mobility group box 1
- HMGB1-Tg, high-mobility group box 1 transgenic
- HW/TL, heart weight to tibial length
- IVSd, interventricular septum diameter
- LVDd, left ventricular diastolic dimension
- LVDs, left ventricular systolic dimension
- MyD, cardiomyocyte diameter
- NF-κB, nuclear factor kappa B
- NRCM, neonatal rat cardiomyocyte
- PWd, posterior wall diameter
- WT, wild-type
- p-ATM, phosphorylation of ataxia telangiectasia mutated
- pathological cardiac hypertrophy
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Empagliflozin Improves Diastolic Function in a Nondiabetic Rodent Model of Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci 2019; 4:27-37. [PMID: 30847416 PMCID: PMC6390677 DOI: 10.1016/j.jacbts.2018.11.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
Abstract
Recent studies send an unambiguous signal that the class of agents known as sodium-glucose-linked co-transporter-2 inhibitors (SGLT2i) prevent heart failure hospitalization in patients with type 2 diabetes. However, the mechanisms remain unclear. Herein the authors utilize a rodent model of heart failure with preserved ejection fraction (HFpEF), and demonstrate that treatment with the SGLT2i empagliflozin, reduces left ventricular mass, improving both wall stress and diastolic function. These findings extend the observation that the main mechanism of action of empagliflozin involves improved hemodynamics (i.e., reduction in preload and afterload) and provide a rationale for upcoming trials in patients with HFpEF irrespective of glycemic status.
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Pretreatment with an angiotensin II receptor blocker abolished ameliorating actions of adipose-derived stem cell sheets on cardiac dysfunction and remodeling after myocardial infarction. Regen Ther 2018; 9:79-88. [PMID: 30525078 PMCID: PMC6223028 DOI: 10.1016/j.reth.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/10/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction Cell sheets using myoblasts have been developed for the treatment of heart failure after myocardial infarction (MI) bridging to heart transplantation. Stem cells are supposed to be better than myoblasts as a source of cells, since they possess a potential to proliferate and differentiate into cardiomyocytes, and also have capacity to secrete angiogenic factors. Adipose-derived stem cells (ASCs) obtained from fat tissues are expected to be a new cell source for ASC sheet therapies. Administration of angiotensin II receptor blockers (ARBs) is a standard therapy for heart failure after MI. However, it is not known whether ARBs affect the cell sheet therapy. This study aimed to examine ameliorating effects of ASC sheets on heart failure and remodeling after MI, and how pretreatment with ARBs prior to the creation of MI and ASC sheet transplantation modifies the effects of ASC sheets. Methods ASCs were isolated from fat tissues of wild-type rats, and ASC sheets were engineered on temperature-responsive dishes. In in vitro studies using cultured cells, mRNA levels of vascular endothelial growth factor (VEGF) in ASCs were determined by RT-PCR in the presence of angiotensin II and/or an ARB, irbesartan, under normoxia and hypoxia; mRNA and protein levels of angiotensin II receptor type 1a (AT1aR), type 1b (AT1bR) and type 2 (AT2R) were also determined by RT-PCR and western blotting. In in vivo studies using a rat MI model, effects of transplanted ASC sheets and/or irbesartan on cardiac functions and remodeling after MI were evaluated by echocardiography, histological analysis and molecular biological techniques. Results In the in vitro studies, ASCs expressed higher levels of VEGF mRNA under hypoxia. They also expressed mRNA and protein of AT1aR but not AT1bR or AT2R. Under normoxia, angiotensin II increased the level of VEGF mRNA in ASCs, which was abolished by irbesartan. Under hypoxia, irbesartan reduced the level of VEGF mRNA in ASCs regardless of whether angiotensin II was present or not. In the in vivo studies, ASC sheets improved cardiac functions after MI, leading to decreased interstitial fibrosis and increased capillary density in border zones. These effects of ASC sheets were abolished by oral administration of irbesartan before MI and their transplantation. Conclusions ASC sheets ameliorated cardiac dysfunctions and remodeling after MI via increasing VEGF expression, which was abolished by pretreatment with irbesartan before the creation of MI and transplantation.
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Key Words
- ANP, atrial natriuretic peptide
- ARB, angiotensin receptor blocker
- ASC, adipose-derived stem cell
- AT1(2)R, angiotensin II receptor type 1(2)
- Adipose-derived stem cell sheet
- Angiotensin II
- CRT, cardiac resynchronization therapy
- EF, ejection fraction
- FGF, fibroblast growth factor
- FS, fractional shortening
- HGF, hepatocyte growth factor
- Irbesartan
- LVEDD, left ventricular end-diastolic diameter
- LVESD, left ventricular end-systolic diameter
- MI, myocardial infarction
- MSC, mesenchymal stem cell
- Myocardial infarction
- RAS, renin–angiotensin system
- VEGF
- VEGF, vascular endothelial growth factor
- vWF, von Willebrand factor
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Direct Thrombin Inhibitors Prevent Left Atrial Remodeling Associated With Heart Failure in Rats. JACC Basic Transl Sci 2016; 1:328-339. [PMID: 27642643 PMCID: PMC5012373 DOI: 10.1016/j.jacbts.2016.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 01/31/2023]
Abstract
The present study tested the hypothesis that thrombin participates in formation of left atrial remodeling and that direct oral anticoagulants, such as direct thrombin inhibitors (DTIs), can prevent its progression. In a rat model of heart failure associated with left atrial dilation, we found that chronic treatment with DTIs reduces the atrial remodeling and the duration of atrial fibrillation (AF) episodes induced by burst pacing by inhibiting myocardial hypertrophy and fibrosis. In addition to the prevention of thromboembolism complicating AF, DTIs may be of interest to slow down the progression of the arrhythmogenic substrate.
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Key Words
- AF, atrial fibrillation
- ANP, atrial natriuretic peptide
- BNP, brain natriuretic peptide
- CTGF, connective tissue growth factor
- DTI, direct thrombin inhibitor
- MHC, myosin heavy chain
- MI, myocardial infarction
- NFATc3, nuclear factor of activated T cells 3
- PAI, plasminogen activator inhibitor
- PAR, protease-activated receptor
- anticoagulant
- atrial arrhythmia
- direct thrombin inhibitor
- heart failure
- remodeling
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Glucagon-Like Peptide-1: A Promising Agent for Cardioprotection During Myocardial Ischemia. JACC Basic Transl Sci 2016; 1:267-276. [PMID: 30167515 PMCID: PMC6113423 DOI: 10.1016/j.jacbts.2016.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 01/07/2023]
Abstract
Glucagon-like peptide-1-(7-36) amide (GLP-1) is a human incretin hormone responsible for the release of insulin in response to food. Pre-clinical and human physiological studies have demonstrated cardioprotection from ischemia-reperfusion injury. It can reduce infarct size, ischemic left ventricular dysfunction, and myocardial stunning. GLP-1 receptor agonists have also been shown to reduce infarct size in myocardial infarction. The mechanism through which this protection occurs is uncertain but may include hijacking the subcellular pathways of ischemic preconditioning, modulation of myocardial metabolism, and hemodynamic effects including peripheral, pulmonary, and coronary vasodilatation. This review will assess the evidence for each of these mechanisms in turn. Challenges remain in successfully translating cardioprotective interventions from bench-to-bedside. The window of cardioprotection is short and timing of cardioprotection in the appropriate clinical setting is critically important. We will emphasize the need for high-quality, well-designed research to evaluate GLP-1 as a cardioprotective agent for use in real-world practice.
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Key Words
- AMI, acute myocardial infarction
- ANP, atrial natriuretic peptide
- ATP, adenosine triphosphate
- DPP, dipeptidyl-peptidase
- GLP-1
- GLP-1, glucagon-like peptide 1-(7-36) amide
- GLP-1R, GLP-1 receptor
- GLP-1RA, GLP-1 receptor agonist
- IC, ischemic conditioning
- IR, ischemia reperfusion
- PCI, percutaneous coronary intervention
- RISK, reperfusion injury survival kinase
- SAFE, survivor-activating factor enhancement
- STEMI, ST-segment elevation myocardial infarction
- glucagon-like peptide-1
- ischemia reperfusion injury
- ischemic heart disease
- percutaneous coronary intervention
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