Suppression of autophagy is protective in high glucose-induced cardiomyocyte injury

Hyperglycemia is linked to increased heart failure among diabetic patients. However, the mechanisms that mediate hyperglycemia-induced cardiac damage remain poorly understood. Autophagy is a cellular degradation pathway that plays important roles in cellular homeostasis. Autophagic activity is altered in the diabetic heart, but its functional role has been unclear. In this study, we determined if mimicking hyperglycemia in cultured cardiomyocytes from neonatal rats and adult mice could affect autophagic activity and myocyte viability. High glucose (17 or 30 mM) reduced autophagic flux compared with normal glucose (5.5 mM) as indicated by the difference in protein levels of LC3-II (microtubule-associated protein 1 light chain 3 form II) or the changes of punctate fluorescence patterns of GFP-LC3 and mRFP-LC3 in the absence and presence of the lysosomal inhibitor bafilomycin A(1). Unexpectedly, the inhibited autophagy turned out to be an adaptive response that functioned to limit high glucose cardiotoxicity. Indeed, suppression of autophagy by 3-methyladenine or short hairpin RNA-mediated silencing of the Becn1 or Atg7 gene attenuated high glucose-induced cardiomyocyte death. Conversely, upregulation of autophagy with rapamycin or overexpression of Becn1 or Atg7 predisposed cardiomyocytes to high glucose toxicity. Mechanistically, the high glucose-induced inhibition of autophagy was mediated at least partly by increased mTOR signaling that likely inactivated ULK1 through phosphorylation at serine 467. Together, these findings demonstrate that high glucose inhibits autophagy, which is a beneficial adaptive response that protects cardiomyocytes against high glucose toxicity. Future studies are warranted to determine if autophagy plays a similar role in diabetic heart in vivo.     

Suppression of autophagy is protective in high glucose-induced cardiomyocyte injury

Hyperglycemia is linked to increased heart failure among diabetic patients. However, the mechanisms that mediate hyperglycemia-induced cardiac damage remain poorly understood. Autophagy is a cellular degradation pathway that plays important roles in cellular homeostasis. Autophagic activity is altered in the diabetic heart, but its functional role has been unclear. In this study, we determined if mimicking hyperglycemia in cultured cardiomyocytes from neonatal rats and adult mice could affect autophagic activity and myocyte viability. High glucose (17 or 30 mM) reduced autophagic flux compared with normal glucose (5.5 mM) as indicated by the difference in protein levels of LC3-II (microtubule-associated protein 1 light chain 3 form II) or the changes of punctate fluorescence patterns of GFP-LC3 and mRFP-LC3 in the absence and presence of the lysosomal inhibitor bafilomycin A₁. Unexpectedly, the inhibited autophagy turned out to be an adaptive response that functioned to limit high glucose cardiotoxicity. Indeed, suppression of autophagy by 3-methyladenine or short hairpin RNA-mediated silencing of the Becn1 or Atg7 gene attenuated high glucose-induced cardiomyocyte death. Conversely, upregulation of autophagy with rapamycin or overexpression of Becn1 or Atg7 predisposed cardiomyocytes to high glucose toxicity. Mechanistically, the high glucose-induced inhibition of autophagy was mediated at least partly by increased mTOR signaling that likely inactivated ULK1 through phosphorylation at serine 467. Together, these findings demonstrate that high glucose inhibits autophagy, which is a beneficial adaptive response that protects cardiomyocytes against high glucose toxicity. Future studies are warranted to determine if autophagy plays a similar role in diabetic heart in vivo.     

Regulation of interplay between autophagy and apoptosis in the diabetic heart

Diabetes induces cardiomyocyte apoptosis and suppresses cardiac autophagy, indicating that the interplay between autophagy and apoptotic cell death pathways is important in the pathogenesis of diabetic cardiomyopathy. The potential mechanism, however, remains unknown. We recently reported that diabetes depresses AMP-activated protein kinase (AMPK) activity, inhibits MAPK8/JNK1-BCL2 signaling, and promotes the interaction between BECN1 and BCL2. Concomitantly, diabetes induces cardiomyocyte apoptosis and suppresses cardiac autophagy. Activation of AMPK directly phosphorylates MAPK8, which mediates BCL2 phosphorylation and subsequent BECN1-BCL2 dissociation, leading to restoration of cardiac autophagy, protection against cardiac apoptosis, and ultimately improvement in cardiac structure and function. We conclude that dissociation of BCL2 from BECN1 through activation of MAPK8-BCL2 signaling may be an important mechanism by which AMPK activation restores autophagy, protects against cardiac apoptosis, and prevents diabetic cardiomyopathy.     

Autophagy Attenuates Diabetic Glomerular Damage through Protection of Hyperglycemia-Induced Podocyte Injury

Despite the recent attention focused on the important role of autophagy in maintaining podocyte homeostasis, little is known about the changes and mechanisms of autophagy in podocyte dysfunction under diabetic condition. In this study, we investigated the role of autophagy in podocyte biology and its involvement in the pathogenesis of diabetic nephropathy. Podocytes had a high basal level of autophagy. And basal autophagy inhibition either by 3-methyladenenine (3-MA) or by Beclin-1 siRNA was detrimental to its architectural structure. However, under diabetic condition in vivo and under high glucose conditions in vitro, high basal level of autophagy in podocytes became defective and defective autophagy facilitated the podocyte injury. Since the dynamics of endoplasmic reticulum(ER) seemed to play a vital role in regulating the autophagic flux, the results that Salubrinal/Tauroursodeoxycholic acid (TUDCA) could restore defective autophagy further indicated that the evolution of autophagy may be mediated by the changes of cytoprotective output in the ER stress. Finally, we demonstrated in vivo that the autophagy of podocyte was inhibited under diabetic status and TUDCA could improve defective autophagy. Taken together, these data suggested that autophagy might be interrupted due to the failure of ER cytoprotective capacity upon high glucose induced unmitigated stress, and the defective autophagy might accelerate the irreparable progression of diabetic nephropathy.     

Activation of HIF-1 by metallothionein contributes to cardiac protection in the diabetic heart

Metallothionein (MT) protects against heavy metal-induced cellular damage and may participate in other fundamental physiological and pathological processes, such as antioxidation, proliferation, and cell survival. Previously, we have shown that elevation of MT by transgene or by induction with zinc protects the heart against diabetic cardiomyopathy by mechanisms such as antidiabetes-induced oxidative stress and inactivation of glycogen synthase kinase-3, which mediates glucose metabolism. We also reported that MT overexpression rescued the diabetic-induced reduction of hypoxia-inducible factor (HIF)-1α, which plays an important role in glucose utilization and angiogenesis. Here, we showed that overexpression of MT increased hexokinase (HK)-II expression under control conditions and attenuated diabetes-decreased HK-II expression. Glycolytic flux assay demonstrated that MT increased glycolysis output in high glucose-containing media-cultured H9c2 cells. The diabetes-induced reduction in cardiac capillaries was also attenuated by MT overexpression. Furthermore, MT induction significantly increased HIF-1 expression under both control and diabetic conditions. Moreover, in the present study, we demonstrated that MT-enhanced HIF-1α activity is likely through a mechanism of protein nuclear translocation. These results suggest that MT induces HIF-1α expression, leading to increased HK-II in the diabetic heart.     

Autophagic adaptations in diabetic cardiomyopathy differ between type 1 and type 2 diabetes

Little is known about the association between autophagy and diabetic cardiomyopathy. Also unknown are possible distinguishing features of cardiac autophagy in type 1 and type 2 diabetes. In hearts from streptozotocin-induced type 1 diabetic mice, diastolic function was impaired, though autophagic activity was significantly increased, as evidenced by increases in microtubule-associated protein 1 light chain 3/LC3 and LC3-II/-I ratios, SQSTM1/p62 (sequestosome 1) and CTSD (cathepsin D), and by the abundance of autophagic vacuoles and lysosomes detected electron-microscopically. AMP-activated protein kinase (AMPK) was activated and ATP content was reduced in type 1 diabetic hearts. Treatment with chloroquine, an autophagy inhibitor, worsened cardiac performance in type 1 diabetes. In addition, hearts from db/db type 2 diabetic model mice exhibited poorer diastolic function than control hearts from db/+ mice. However, levels of LC3-II, SQSTM1 and phosphorylated MTOR (mechanistic target of rapamycin) were increased, but CTSD was decreased and very few lysosomes were detected ultrastructurally, despite the abundance of autophagic vacuoles. AMPK activity was suppressed and ATP content was reduced in type 2 diabetic hearts. These findings suggest the autophagic process is suppressed at the final digestion step in type 2 diabetic hearts. Resveratrol, an autophagy enhancer, mitigated diastolic dysfunction, while chloroquine had the opposite effects in type 2 diabetic hearts. Autophagy in the heart is enhanced in type 1 diabetes, but is suppressed in type 2 diabetes. This difference provides important insight into the pathophysiology of diabetic cardiomyopathy, which is essential for the development of new treatment strategies.     

AMP-activated protein kinase modulates cardiac autophagy in diabetic cardiomyopathy

We have recently shown that in diabetic OVE26 mice (type I diabetes), the AMP-activated protein kinase (AMPK) is reduced along with cardiac dysfunction and decreased cardiac autophagy. Genetic inhibition of AMPK in cardiomyocytes attenuates cardiac autophagy, exacerbates cardiac dysfunction and increases mortality in diabetic mice. More importantly, we have found chronic AMPK activation with metformin, one of the most used antidiabetes drugs and a well-characterized AMPK activator, significantly enhances autophagic activity, preserves cardiac function and prevents most of the primary characteristics of diabetic cardiomyopathy in OVE26 mice, but not in dominant negative-AMPK diabetic mice. We conclude that AMPK activation protects cardiac structure and function by increasing cardiac autophagy in the diabetic heart.     

AMP-activated protein kinase modulates cardiac autophagy in diabetic cardiomyopathy

We have recently shown that in diabetic OVE26 mice (type I diabetes), the AMP-activated protein kinase (AMPK) is reduced along with cardiac dysfunction and decreased cardiac autophagy. Genetic inhibition of AMPK in cardiomyocytes attenuates cardiac autophagy, exacerbates cardiac dysfunction and increases mortality in diabetic mice. More importantly, we have found chronic AMPK activation with metformin, one of the most used antidiabetes drugs and a well-characterized AMPK activator, significantly enhances autophagic activity, preserves cardiac function and prevents most of the primary characteristics of diabetic cardiomyopathy in OVE26 mice, but not in dominant negative-AMPK diabetic mice. We conclude that AMPK activation protects cardiac structure and function by increasing cardiac autophagy in the diabetic heart.     

The role of thrombospondin-1-mediated TGF-��1 on collagen type III synthesis induced by high glucose

Transforming growth factor-β1 (TGF-β1) has been thought to play a major role during cardiac fibrosis in the development of diabetic cardiomyopathy, and cardiac fibrosis mainly as a result of an increase of collagen type III occurs in the human hearts with diabetes. Thrombospondin-1 (TSP-1) has been reported to activate the latent complex of TGF-β1. We examined the effects of TSP-1 on the expression of TGF-β1 and collagen type III by rat cardiac fibroblasts in high ambient glucose. We demonstrated that high glucose induces the mRNA and protein expression of collagen type III, TGF-β1, and TSP-1. Furthermore, the mRNA and protein expression of collagen type III induced by high glucose was downregulated after treatment with TGF-β1 antibody, or TSP-1 siRNA. The expression of TGF-β1 increased by high glucose was also reversed after treatment with TSP-1 siRNA. Our findings suggest that the TSP-1 participates in the upregulation of TGF-β1, collagen type III by high glucose and may provide new therapeutic strategies for diabetic cardiomyopathy.     

硫氧还蛋白相互作用蛋白在糖尿病及其并发症中的作用

硫氧还蛋白相互作用蛋白(thioredoxin-interacting protein,TXNIP)又称维生素D₃上调蛋白1,因其能够与硫氧还蛋白(thioredoxin,Trx)结合并抑制其活性和表达而得名。本文概述了TXNIP的发现与结构,及其自身通过发挥调节糖脂代谢的作用进而影响糖尿病前期的发生发展。并在此基础上总结了TXNIP参与糖尿病发生发展的2条主要途径:TXNIP通过拮抗Trx的抗凋亡作用来激发细胞凋亡信号导致胰岛细胞凋亡;TXNIP过表达促使胰岛细胞磷酸化,进而使抑癌相关蛋白质表达增加,最终引起胰岛细胞衰老。进一步重点阐述了TXNIP在糖尿病心肌病、糖尿病肾病、糖尿病性视网膜病等糖尿病并发症中的作用:TXNIP能通过各种间接途径干预信号通路,进一步参与氧化应激、细胞凋亡、激活炎症、细胞自噬及糖脂代谢等生理生化过程。TXNIP具有极其重要的生物学功能,深入了解TXNIP在糖尿病及其并发症中的影响机制,对糖尿病及其并发症的治疗具有重要意义。最后对TXNIP的研究进行了展望,未来可进一步着手研究TXNIP基因是如何与其他基因或危险因素协同作用,进而共同参与糖尿病及其并发症的发生发展,且TXNIP单个基因甲基化尚不能全面揭示糖尿病及其并发症发生的分子机制,这些后续的深入研究,将为在糖尿病及其并发症的诊断与治疗中作为靶标分子的应用奠定基础。     

谷氧还蛋白1调节高糖诱导的心肌细胞自噬

谷氧还蛋白1（Grx1）在体内具有广泛的抗氧化、抗凋亡作用,与氧化应激损伤导致的糖尿病和心肌病等多种疾病的发病机制密切相关. 研究表明,糖尿病心血管病与自噬调节异常密切相关,但糖尿病心血管病变时自噬水平如何调节才能够保护受损的心肌还尚未定论.为研究自噬在高糖诱导心肌细胞凋亡中的作用及其与Grx1的关系,以明确Grx1对高糖诱导的心肌细胞凋亡的抑制作用及相关机制,本研究以高糖诱导大鼠心肌细胞H9c2建立高糖损伤模型,采用氧化还原蛋白免疫印迹法检测蛋白质的氧化水平.免疫印迹检测活性caspase 3蛋白和自噬蛋白Beclin1和LC3以及抗凋亡蛋白Bcl 2的表达水平.研究发现,高糖可诱导蛋白质的氧化水平增加,而Grx1可拮抗高糖诱导的H9c2细胞中蛋白质的氧化.并且含血清的高糖（25和50 mmol/L）作用H9c2心肌细胞后,自噬蛋白Beclin 1表达水平在6～48 h显著上调.同时发现,活性caspase 3水平也呈时间依赖性表达上调,caspase 3和自噬蛋白表达水平的同趋势增加,说明升高的自噬水平与心肌细胞凋亡的调节有关.Grx1保护组的自噬蛋白及活性caspase 3表达水平均显著下调,Grx1抑制剂镉组可拮抗Grx1调节的自噬蛋白和凋亡蛋白水平,说明Grx 1通过抑制自噬及caspase 3水平抑制高糖诱导的心肌细胞凋亡.以上研究结果提示,通过提高Grx1/GSH抗氧化系统功能,调节氧化还原稳态,可以有效减少高糖诱导的心肌损伤,保护糖尿病心脏功能.     

Exosomal Mst1 transfer from cardiac microvascular endothelial cells to cardiomyocytes deteriorates diabetic cardiomyopathy

Diabetic cardiomyopathy (DCM) is characterized by cardiac microvascular endothelial cells (CMECs) injury and cardiomyocyte (CM) dysfunction. Exosomes mediated cellular communication between CMECs and CM has emerging roles in the pathogenesis of DCM, but the underlining mechanisms are unclear. Mammalian sterile 20-like kinase 1 (Mst1), a key component in Hippo pathway which participates in regulating organ size, apoptosis and autophagy, is involved in the development of DCM. We generated the endothelial-specific Mst1 transgenic mice (Tg-Mst1^EC) and constructed diabetic model with streptozotocin (STZ). Interestingly, Tg-Mst1^EC mice suffered from worse cardiac function and aggravated insulin resistance compared with non-transgenic (NTg) diabetic mice. The content of Mst1 protein was increased, while Mst1 mRNA had no significant change in CM isolated from diabetic Tg-Mst1^EC mice. In vitro, CMECs-derived exosomes were taken up by CM and increased Mst1 protein content which inhibited autophagy, as well as enhanced apoptosis in high glucose (HG) cultured CM as evidenced by immunofluorescence and western blot analysis. In addition, Mst1 inhibited glucose uptake under diabetic condition by disrupting the glucose transporter type 4 (GLUT4) membrane translocation through decreasing the interaction between Daxx and GLUT4, as well as enhancing the association of Mst1 and Daxx. Our study exemplifies pleiotropic effects of Mst1-enriched exosomes released from CMECs on inhibiting autophagy, promoting apoptosis and suppressing the glucose metabolism in CM.     

糖尿病心肌病发病机制的研究进展

糖尿病心肌病是一种特异性心肌病,病理表现为心肌肥厚和心肌纤维化。其发病机制复杂,可能涉及代谢紊乱(如葡萄糖转运子活性下降、游离脂肪酸增加、钙平衡调节异常、铜代谢紊乱、胰岛素抵抗)、心肌纤维化(与高血糖、心肌细胞凋亡、血管紧张素Ⅱ、胰岛素样生长因子-1、炎性细胞因子和基质金属蛋白酶等有关)、心脏自主神经病变和干细胞等多种因素。本文对近年来国内外有关糖尿病心肌病机制研究的进展予以综述,以期为临床有效防治提供依据。     

Autophagy anomalies in the diabetic myocardium

The prominent occurrence of autophagy in fetal/neonatal myocardial tissue has been recognized for more than three decades as a key process in managing the period of perinatal nutrient deprivation. Fasting-induced autophagy has similarly been characterized as an expedient short-term cardiomyocyte response to nutrient restriction. Discerning how autophagy operates in the heart in disease contexts of substrate dysregulation is proving to be a much more complex challenge. Recent studies relating to insulin signaling and cardiac autophagy activation have provided new insights—and generated new contradictions. We highlight several anomalies and pose a number of questions, which emerge from these studies. How can myocardial autophagy induction be associated with both PtdIns3K-Akt activation (in ischemia) and suppression (in insulin resistance)? What is the explanation for the contrasting findings that myocardial autophagy is elevated in a murine model of type 2 diabetes, yet suppressed in the type 1 diabetic state? And finally, in the type 1 diabetic setting, what could be the basis for downregulated cardiac AMP-activated protein kinase (AMPK)-driven autophagic activity, when activation of this ‘energy stress’ kinase is usually integral to the cellular response to glucose deficit? We summarize and discuss these interesting ambiguities of myocardial autophagy regulation.     

Molecular mechanisms of cardiac pathology in diabetes – Experimental insights

Diabetic cardiomyopathy is a distinct pathology independent of co-morbidities such as coronary artery disease and hypertension. Diminished glucose uptake due to impaired insulin signaling and decreased expression of glucose transporters is associated with a shift towards increased reliance on fatty acid oxidation and reduced cardiac efficiency in diabetic hearts. The cardiac metabolic profile in diabetes is influenced by disturbances in circulating glucose, insulin and fatty acids, and alterations in cardiomyocyte signaling. In this review, we focus on recent preclinical advances in understanding the molecular mechanisms of diabetic cardiomyopathy. Genetic manipulation of cardiomyocyte insulin signaling intermediates has demonstrated that partial cardiac functional rescue can be achieved by upregulation of the insulin signaling pathway in diabetic hearts. Inconsistent findings have been reported relating to the role of cardiac AMPK and β-adrenergic signaling in diabetes, and systemic administration of agents targeting these pathways appear to elicit some cardiac benefit, but whether these effects are related to direct cardiac actions is uncertain. Overload of cardiomyocyte fuel storage is evident in the diabetic heart, with accumulation of glycogen and lipid droplets. Cardiac metabolic dysregulation in diabetes has been linked with oxidative stress and autophagy disturbance, which may lead to cell death induction, fibrotic ‘backfill’ and cardiac dysfunction. This review examines the weight of evidence relating to the molecular mechanisms of diabetic cardiomyopathy, with a particular focus on metabolic and signaling pathways. Areas of uncertainty in the field are highlighted and important knowledge gaps for further investigation are identified. This article is part of a Special issue entitled Cardiac adaptations to obesity, diabetes and insulin resistance, edited by Professors Jan F.C. Glatz, Jason R.B. Dyck and Christine Des Rosiers.     

Autophagy anomalies in the diabetic myocardium

The prominent occurrence of autophagy in fetal/neonatal myocardial tissue has been recognized for more than three decades as a key process in managing the period of perinatal nutrient deprivation. Fasting-induced autophagy has similarly been characterized as an expedient short-term cardiomyocyte response to nutrient restriction. Discerning how autophagy operates in the heart in disease contexts of substrate dysregulation is proving to be a much more complex challenge. Recent studies relating to insulin signaling and cardiac autophagy activation have provided new insights-and generated new contradictions. We highlight several anomalies and pose a number of questions, which emerge from these studies. How can myocardial autophagy induction be associated with both PtdIns3K-Akt activation (in ischemia) and suppression (in insulin resistance)? What is the explanation for the contrasting findings that myocardial autophagy is elevated in a murine model of type 2 diabetes, yet suppressed in the type 1 diabetic state? And finally, in the type 1 diabetic setting, what could be the basis for downregulated cardiac AMP-activated protein kinase (AMPK)-driven autophagic activity, when activation of this 'energy stress' kinase is usually integral to the cellular response to glucose deficit? We summarize and discuss these interesting ambiguities of myocardial autophagy regulation.     

Platelet-neutrophil conjugate formation is increased in diabetic women with cardiovascular disease

 

Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure.

The studies linking diabetes mellitus (DM) with heart failure (HF)

The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy.

Treatment of heart failure in diabetic patients

The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients.     

The Prevention of Diabetic Cardiomyopathy by Non-Mitogenic Acidic Fibroblast Growth Factor Is Probably Mediated by the Suppression of Oxidative Stress and Damage

Background

Emerging evidence showed the beneficial effect of acidic fibroblast growth factor (aFGF) on heart diseases. The present study investigated whether non-mitogenic aFGF (nm-aFGF) can prevent diabetic cardiomyopathy and the underlying mechanisms, if any.

Methodology/Principal Findings

Type 1 diabetes was induced in mice by multiple intraperitoneal injections of low-dose streptozotocin. Hyperglycemic and age-matched control mice were treated with or without nm-aFGF at 10 µg/kg daily for 1 and 6 months. Blood pressure and cardiac function were assessed. Cardiac H9c2 cell, human microvascular endothelial cells, and rat cardiomyocytes were exposed to high glucose (25 mM) for mimicking an in vitro diabetic condition for mechanistic studies. Oxidative stress, DNA damage, cardiac hypertrophy and fibrosis were assessed by real-time qPCR, immunofluorescent staining, Western blotting, and pathological examination. Nm-aFGF significantly prevented diabetes-induced hypertension and cardiac dysfunction at 6 months. Mechanistic studies demonstrated that nm-aFGF showed the similar preventive effect as the native aFGF on high glucose-induced oxidative stress (increase generation of reactive oxygen species) and damage (cellular DNA oxidation), cell hypertrophy, and fibrotic response (increased mRNA expression of fibronectin) in three kinds of cells. These in vitro findings were recaptured by examining the heart of the diabetic mice with and without nm-aFGF.

Conclusions

These results suggest that nm-aFGF can prevent diabetic cardiomyopathy, probably through attenuation of cardiac oxidative stress, hypertrophy, and fibrosis.