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Original Articles |
From the Abteilung Kardiologie und Pneumologie, Georg-August-Universität, Göttingen, Germany (K.J., H.K., C.G., T.S., P.N.V., G.H.); Abteilung Herz- und Thoraxchirurgie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany (G.T., R.K.); and Abteilung Medizinische Statistik (K.J.) and Kardiovaskuläre Molekulargenetik, Herzzentrum, Georg-August-Universität, Göttingen, Germany (R.K.).
Correspondence to Karl Toischer, MD, Abteilung Kardiologie und Pneumologie, Universität Göttingen, Robert-Koch-Str. 40, D – 37075 Göttingen, Germany. E-mail ktoischer{at}med.uni-goettingen.de
Received April 15, 2008; accepted August 26, 2008.
| Abstract |
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Methods and Results— Here we tested the hypothesis that afterload and neurohumoral activation would counterregulate preload-dependent SERCA upregulation through BNP, which finally results in decreased SERCA levels. We studied the effects of 6 hours preload, afterload, and isoproterenol stimulation on BNP and SERCA mRNA expression in rabbit and human failing muscles strips. Preload resulted in a pronounced upregulation of SERCA by 149% (isotonic versus slack, P<0.01). This upregulation was largely suppressed in afterloaded muscles (isometric versus slack: +32%; P<0.05). Similarly, presence of isoproterenol prevented SERCA upregulation in isotonic muscles. Afterload and isoproterenol resulted in a pronounced increase in BNP expression compared with slack by 225% (P<0.05) and 198% (P<0.01), respectively. Isoproterenol also increased expression of phospholamban by 84% (P<0.01). SERCA upregulation in preloaded muscles is associated with frequency-dependent potentiation of contractile force, which is absent in afterloaded muscles. In failing human myocardium, BNP expression was upregulated compared with nonfailing (+631%; P<0.05). Neither unloading nor preload or afterload induced a change in SERCA or BNP expression after 6 hours.
Conclusions— Afterload and neuroendocrine stimulation increase BNP expression thereby causing inhibition of preload-dependent SERCA upregulation. In failing human myocardium, high BNP expression may underlie the loss of preload-dependent upregulation of SERCA. BNP may thus contribute to adverse myocardial remodelling in heart failure.
Key Words: calcium heart failure mechanics natriuretic peptides sarcoplasmic reticulum
| Introduction |
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Clinical Perspective p 271
In contrast to this general scheme of load- and neurohumoral-induced reactivation of the fetal gene program with SERCA downregulation, we previously showed that isolated preload increases SERCA expression whereas BNP is not regulated after 6 hours. Moreover, preload-dependent upregulation of SERCA could be abolished by addition of exogenous BNP. This effect was transmitted via the BNP receptor guanylyl cyclase A (GC-A), elevation of cGMP and activation of protein kinase G.4 Protein kinase G can inhibit calcineurin activation5 and the preload-dependent upregulation of SERCA-expression could indeed be inhibited by cyclosporine A.
Because SERCA is upregulated with preload but downregulated in heart failure with generally high preload, high afterload, and neurohumoral activation, quality of load and neurohumoral activation may determine the net effect on SERCA regulation.
Accordingly, in the present study, we tested the hypothesis that afterload and neurohumoral activation counterregulate the preload-dependent upregulation of SERCA and that this is associated with an increase of BNP.
| Methods |
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In a subset of preparations, after the 6-hour incubation period, the frequency dependence of force development was assessed by recording isometric force at stimulation rates of 1 to 4 Hz. Muscle strips in both stretched groups (isotonic and isometric) muscle strips were unloaded. In isotonic preparations, the force-feedback motor unit was switched off. Preparations of all groups were then stretched over 30 minutes as described above to 3 mN/mm2 resting tension. Force development was allowed to reach steady state before the frequency protocol was initiated.
Stimulation With Isoproterenol
Because oxidative stress degrades isoproterenol (isoprenaline), it was dissolved with vitamin C and culture medium was changed every 30 minutes. Isoproterenol (Sigma, Taufkirchen, Germany) in a 30 nM concentration was dissolved with vitamin C (Sigma) at a concentration of 300 nM in the culture medium. This isoproterenol concentration closely approximates the EC50 of the inotropic effect of isoproterenol in rabbit muscles strips,8 and in consideration of the higher potency of isoproterenol compared with epinephrine, this concentration is equivalent to epinephrine plasma levels measured in human heart failure.9 For control, vitamin C only was dissolved in culture medium. This isoproterenol concentration increases the shortening of the isotonic stretched muscles by 137% (P<0.05). This increase remained constant during the entire experiment (6 hours: +153%, P<0.05). The diastolic function was comparable to controls and was not influenced by isoproterenol.
Human Myocardium
Ventricular muscle strips were dissected from 7 end-stage heart failure patients undergoing cardiac transplantation as a result of ischemic or dilated cardiomyopathy (6 men, 1 woman, age 56.3±2.6 years). Detailed patient characteristics are provided in the online Data Supplement. For comparison, samples from 4 nonfailing donor hearts (3 men, 1 woman, age 21.2±5.1 years) that could not be used for cardiac transplantation for technical reasons, were used as controls. None of these patients had a history of cardiac disease. The study was approved by the institutional ethics committee, and all patients provided written informed consent with the use of tissue samples.
Right ventricular muscles strips were dissected from the hearts and placed in the system as described above. Calcium concentration and culture medium were identical to those used in the rabbit experiments described above. The only difference was that the muscle strips were stretched to human isometric Lmax. This was the case at a resting tension of
12 mN/mm2. The isotonic shortening in half of the muscles was activated after reaching Lmax. Muscles were then treated as described above.
Quantitative mRNA Measurement in Rabbit and Human Myocardium
DNA-free total RNA was extracted from myocardial samples by a standard protocol with the RNeasy kit and RNase-free DNAse Set (Qiagen, Hilden, Germany). First-strand cDNA synthesis was carried out with iScript cDNA synthesis kit (BioRad, München, Germany) according to manufacturers instructions. Real-time polymerase chain reactions were performed on a Biorad iQ-Cycler in a volume of 20 µL in a 96-well plate. The reaction mixture consisted of 1 µL cDNA with 19-µL SYBR GRN SUPERMIX (BioRad, München, Germany). After initial denaturation for 60 s at 95°C, the cycling program consisted of 40 cycles of 95°C for 15 s, 60°C (SERCA, phospholamban [PLB]), 58°C (BNP) or 62°C (glycerol-aldehydephosphate-3-dehydrogenase) for 10 s, and 72°C for 15 s. Emission at 530 nm was measured at the end of each cycle. Primer sequences used are provided in the online Data Supplement. cDNAs with known concentrations were used to generate quantification standard curves. Expression data were normalized to glycerol-aldehydephosphate-3-dehydrogenase.
Western Immunoblot Analysis
Frozen muscle strips were thawed on ice in 50 µL of homogenization buffer and homogenized. Protein concentrations of the suspensions were determined and 20 µg of samples subjected to sodium dodecylsulfate polyacrylamide gel electrophoresis. Western blotting was carried out according to standard protocols, using antibodies against SERCA (monoclonal, Affinity Bioreagents) and glycerol-aldehydephosphate-3-dehydrogenase (monocolonal, Biotrend). For quantification an enhanced chemoluminescence detection system (Amersham) was used according to the manufacturers instructions. BNP secreted into the culture medium could not be detected because of dilution by a factor of 10 000.
Calculation and Statistical Analysis
Force values were transferred to tension by normalizing to the cross-sectional area of a preparation, which was calculated assuming an elliptical cross section using the formula cross-sectional area=D1/2xD2/2x
, with D1 and D2 representing width and thickness.
Gene- and protein-expression was analyzed using Student t test for unpaired samples and functional data (force-frequency relationship) using 2-way ANOVA, each test with a significance level of
=5%. Confidence intervals were calculated using a bootstrap procedure.10
The authors had full access to the data and take responsibility for their integrity. All authors have read and agree to the manuscript as written.
| Results |
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After 6 hours of isotonic stretch, SERCA mRNA expression was upregulated by 149% (95% CI, 100% to 203%) compared with slack myocardium (Figure 1A, isotonic versus slack P<0.001). In contrast, isometric afterload greatly blunted upregulation of SERCA mRNA expression (+37% [95% CI, 11% to 67%], isometric versus slack P=0.028). Protein expression of SERCA was regulated likewise (Figure 2A). Compared with slack muscle strips, isotonic stretch lead to an upregulation of SERCA protein expression by 51% (95% CI, 18% to 92%; isotonic versus slack P=0.046) and isometric stretch did not lead to a significant regulation of SERCA protein expression (Figure 2B).
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SERCA activity depends on the stoichiometry of association with the endogenous inhibitor PLB. PLB expression is reduced by preload compared with unloaded muscles strips (–22% [95% CI, –36% to –7%]), isotonic versus slack P=0.029). Additional afterload restores the expression of PLB in isometric stretched muscle strips to unloaded expression levels (isometric versus slack (P=0.333), isotonic versus isometric (+30% [95% CI, 12% to 45%] P=0.018); Figure 3).
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Inhibition of Preload-Induced SERCA Upregulation by Isoproterenol
Addition of isoproterenol induced an upregulation of BNP-expression (Figure 5A). Compared with control muscles, isoproterenol increased BNP by 198% in slack (95% CI, 61% to 614%; control slack versus isoproterenol slack P=0.006) and by 131% in isotonic (95% CI, 59% to 400%; control isotonic versus isoproterenol isotonic P=0.036) muscles. Isoproterenol abolished the dependent SERCA upregulation (Figure 5B; control: +71% [95% CI, 19% to 105%], control slack versus control isotonic P=0.015; isoproterenol: +9% [95% CI, –35% to +58%], isoproterenol slack versus isoproterenol isotonic P=0.7545).
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| Discussion |
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Regulation of SERCA by BNP in the Human Failing Heart
Upregulation of myocardial BNP expression by afterload or neuroendocrine stimulation with its subsequent autocrine/paracrine actions on cardiac myocytes may contribute to maladaptive remodelling via downregulation of SERCA and thereby depress contractility. Indeed, BNP is negatively correlated with SERCA expression in human heart failure. A meta-analysis of clinical trials, evaluating the acute effects of recombinant BNP in decompensated heart failure, identified a tendency of increased mortality in BNP-treated subjects.11 In our previous work, we demonstrated that BNP regulates SERCA expression. Exogenous recombinant BNP reduced dose-dependently the expression of SERCA in unstretched muscles strips, and also diminished the preload-dependent upregulation of SERCA.4
In human failing myocardium, an increase in preload did not increase the expression of SERCA during 6 hours from the diminished levels compared with nonfailing myocardium. In contrast to this result, we could previously show this mechanism in human patients with a left ventricular assist device. Improvement of SERCA expression could only be observed in the subgroup of left ventricular assist device patients, where BNP levels were reduced.4 This shows, that in human myocardium an improvement is only possible, when BNP levels are normalized. The stimulus of elevated load cannot lead to a maintenance or increase of SERCA expression. This finally leads to a reduction SERCA expression and progression of heart failure. The differences in the present experiments with isolated human muscle strips compared with the left ventricular assist device study can be easily explained by the experimental time. After unloading, the BNP levels decrease much slower to become relevant within the 6-hour period studied here. The period for normalization of BNP in left ventricular assist device-treated patients is several months.12,13 Thus, the still high level of BNP and subsequent stimulation of GC-A can explain, why an increase in SERCA expression was not visible in the preloaded human muscle strips. Looking at the missing upregulation of BNP in the isometric stretched muscle strips it could be argued that the level of stretch was not sufficient to activate signal pathways like in the rabbit muscle strips. This, however, can be ruled out, because both—rabbit and human—muscle strips were stretched to their respective Lmax and an upregulation of BNP in the failing human heart can only be induced by stretching the muscles above Lmax.14
Influence of Neuroendocrine Stimulation
Neuroendocrine stimulation can increase BNP and thereby suppress SERCA regulation. Isoproterenol increases BNP probably via the β2-receptor and involving Src, ras, and p42/p44 MAPK activation.15 Infusion of isoproterenol in rats also induced a downregulation of SERCA. BNP expression was not measured in these animals, but atrial natriuretic factor was highly upregulated by isoproterenol.16 Probably BNP is also upregulated in these animals and atrial natriuretic factor can also activate the GC-A, so that the downregulation of SERCA could be transmitted via BNP/atrial natriuretic factor and GC-A activation in these animals, too.
PLB showed a differential expression pattern between both stretched groups. A reduction of PLB expression in the isotonic group leads to a further increase in the SERCA/PLB ratio and would therefore further favor the calcium uptake into the sacroplasmic reticulum. A load-dependent downregulation of PLB was also found in the overloaded right ventricle of the monocrotaline rat model.17 In single cells PLB was not regulated by stretch.18 Upregulation of PLB was also achieved by isoproterenol stimulation. The PLB promoter possesses an MCAT binding site19 that can be stimulated by isoproterenol.15
Importance of the Type of Load
Load is an important factor for the expression of SERCA in the heart. Unloading the heart leads to a reduction of SERCA expression.4,20 The type of load (preversus afterload) is of particular importance and has different effects on hypertrophy, partially mediated via BNP. Here the different SERCA- and PLB-expression patterns between both stretched groups can also be explained by the influence of BNP. We previously showed that BNP—via the GC-A-cGMP-protein kinase G-pathway—has a negative effect on the preload-induced SERCA upregulation. In the isometric stretched muscles, the addition of afterload to the same preload as in isotonic stretched muscles reduced the SERCA upregulation markedly, but also increased BNP expression. BNP seems to be predominantly induced by afterload. Preload can as well induce BNP upregulation, but not so fast and not to the same extent. In vivo, an increase in afterload leads to a high and fast (hours) upregulation of BNP.21 In contrast, BNP upregulation in animal models of preload is slow and seen only after 3 days of large shunt or after 30 days of small shunt.22 In isolated paced cardiomyocytes, the activation of BNP was also higher when the stretch was performed during electric stimulation (in the presence of afterload) than when it was performed in the breaks between stimulation (presence of preload only).23 This is in line with our results of BNP being predominantly regulated by afterload.
The knowledge of how mechanical stress is sensed by the cardiomyocytes and transduced into intracellular signals is limited. Several mechanisms are currently being discussed. Some authors suggest pathways that involve auto- and/or paracrine factors released by mechanical stress such as endothelin-1 or angiotensin.24 Other authors have suggested pathways that are partially or completely independent from humoral or neuronal factors, but involve cellular mechanoreceptors like stretch activated channels,25 Na+/H+-exchanger,26 Z-disc proteins like MLP,27 or costamere proteins like melusin.28 MLP is thereby linked to the calcineurin signaling pathway.29
The Ca2+-dependent phosphatase calcineurin, via dephosphorylation of the transcription factor NFAT, has been implicated as an important mediator of hypertrophy.30,31 The SERCA promoter region possesses a consensus site for members of the GATA family of transcription factors,32 and NFAT is able to associate with GATA-4 to activate gene transcription. Transgenic mice overexpressing a constitutively active calcineurin indeed exhibited enhanced SERCA expression.33 We4 and others34 also demonstrated, that SERCA regulation was indeed calcineurin dependent. Load-dependent differences in calcineurin activation could—because of the lack of rabbit NFAT antibodies—not be proven here. But in single cardiomyocytes a lower but longer calcium transient was found in isotonic contractions compared to isometric contractions.35 This profile of the calcium transient would favor an increase in calcineurin activitiy.36 Taken together, these observations make it likely that calcineurin activation is enhanced and thereby SERCA mRNA expression is increased via calcineurin by preload conditions.
Also other signal pathways can influence the regulation of SERCA in hypertrophy. Especially GSK3β, which controls the nuclear export of NFAT,37 has an influence on SERCA expression: GSK3β overexpression leads to a reduction of SERCA.38 Also JNK- and p38-MAPK diminish the nuclear localization of NFAT39,40 and could participate in a load-specific regulation of the calcineurin-NFAT pathway. An influence of these signaling pathways in our experiments cannot be ruled out.
In summary, we have demonstrated that preload induces a cardiomyocyte phenotype with increased sarcoplasmic calcium cycling by increased expression of SERCA and diminished expression of PLB. Afterload and neuroendocrine stimulation increase BNP expression that again leads to an inhibition of the preload-dependent SERCA regulation by blockade of calcineurin via the GC-A-cGMP-protein kinase G signal pathway. These findings suggest that blocking neuroendocrine stimulation by β-blockers and reduction of afterload in patients could diminish the BNP levels and thereby contribute to an improvement of the cardiac function through upregulation of SERCA.
| Acknowledgments |
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Sources of Funding
This work was supported by the Deutsche Forschungsgemeinschaft (Grant KFO 155 TP1 [to G.H.], TP2 [to R.K.], TP3 [to T.S.]) and EUGeneHeart (project number LSHM-CT-2005-018833).
Disclosures
None.
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| Footnotes |
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The online-only Data Supplement is available at http://circep.ahajournals.org/cgi/content/full/CIRCEP.108.785279/DC1.
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