糖尿病心肌病相关信号通路的研究进展

糖尿病心肌病是一种独立、特异的心肌病,与糖尿病患者发生心力衰竭和死亡率升高密切相关。其病理表现为心肌肥厚和心肌纤维化,发病机制复杂,可能涉及心肌细胞代谢障碍、心肌微血管病变、自主神经病变、胰岛素抵抗及细胞因子异常等多个方面。本文综述了糖尿病心肌病发病机制中研究较多的几条信号通路,为糖尿病心肌病的治疗提供理论依据。     

糖尿病心肌病相关信号通路的研究进展

糖尿病心肌病是一种独立、特异的心肌病,与糖尿病患者发生心力衰竭和死亡率升高密切相关。高血糖引起的心血管并发症涉及心肌病变和血管病变、心肌细胞结构的改变、信号通路和炎症因子的改变等,导致心肌纤维化、心肌肥厚、心脏肥大、心力衰竭和心律失常。综述了糖尿病心肌病发病机制中研究较多的几条信号通路,探究各信号通路在糖尿病心肌病发生、发展过程中对心脏的保护(损伤)作用的相关研究进展。     

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。     

心肌肥厚中L-型钙通道与ryanodine受体分子间信号耦联的衰退

心脏压力负荷导致心肌肥厚的过程是心衰发生的关键环节。已有研究表明,控制心脏收缩的细胞钙致钙释放过程在心肌肥厚及心衰状态下发生缺损,但分子机制尚未阐明。我们以主动脉结扎手术建立压力负荷的大鼠心肌肥厚模型：实验组分为假手术组、代偿性肥厚组（CHT）和失代偿性肥厚组（DHT）,以松钳一共聚焦成像技术研究单个L-型钙通道（LCC）与ryanodine受体（RyR）间的钙信号耦联。我们发现DHT中LCC—RyR分子耦联潜伏期延长49％,耦联成功率降低47％,失败概率提高72％,证明DHT进入了一种“分子间衰退”状态。出人意料的是,心功能正常的CHT也发生分子间衰退,并与锚定肌质网与细胞膜的junctophilin蛋白表达下降有关,表明分子间耦联衰退在细胞功能变化显现之前已经潜性地发生。与此一致,细胞兴奋期钙释放同步性降低,但钙释放总量和细胞钙瞬变在CHT并无变化。这些结果提示,在一个我们称为“稳定余量”（stability margin）的范围内,分子间耦联衰退不会影响细胞兴奋收缩耦联能力,只有分子间耦联衰退超出稳定余量,心衰才会发生。潜性的分子间耦联衰退的发现对早期防治心衰有重要意义。     

糖尿病心肌病发病机制，靶点和中药治疗

高血糖诱发心肌代谢紊乱,引起心肌肥大和纤维化,使心脏舒张和收缩功能发生异常,诱发心衰,造成糖尿病心肌病。其病理过程可能与心肌中激活NADPH氧化酶、内质网应激、内皮素和活性氧通路等炎症因子有关。本文综述糖尿病心肌病的主要机制,相关靶点及中药治疗,为中药治疗糖尿病提供理论依据。     

大鼠不同心肌肥厚模型左心室基因表达谱变化的比较

为了解心肌肥厚时基因表达谱的变化规律,本实验复制了三种大鼠心肌肥厚模型：肾上腹主动脉缩窄(suprarenal abdominal aortic stenosis,SRS)、动静脉瘘(arterial-vein fistula,AVF)和去甲。肾上腺素持续静脉输注(jugular vein infusion of norepinephrine,NEi),并应用组织化学方法和超声心动术检测大鼠心脏结构和功能指标,应用cDNA基因芯片技术检测心脏基因表达水平的变化。SRS和NEi引起大鼠向心性心肌肥厚,AVF引起大鼠离心性心肌肥厚,其中NEi大鼠心肌纤维化明显。对不同心肌肥厚模型间大鼠左心室基因表达谱的变化进行两两比较。结果显示,有部分基因在不同模型中表达水平均发生变化,其中多数基因在两种模型中表达水平改变的方向相同,也有少部分基因在两种模型中表达水平改变方向相反。综合比较三种心肌肥厚模型的基因表达谱,各种模型都有特异的基因表达变化,但是有19个基因在三种心肌肥厚模型中表达水平均发生改变。研究结果有可能成为心肌肥厚的标志性基因或治疗靶点,为心肌肥厚发生机制的深入研究提供了新的线索。     

PI3K和Akt蛋白在异丙肾上腺素所致大鼠心肌肥厚中的表达

目的研究异丙肾上腺素(ISO)致大鼠心肌肥厚中PI3K和Akt在心肌组织中的表达,为探讨心肌肥厚的信号转导机制和逆转心肌肥厚提供形态学资料.方法健康成年SD大鼠20只,随机分为实验组、对照组,每组10只.实验组给予异丙肾上腺素处理.1周后处死大鼠,取心肌组织,常规石蜡切片,HE染色,观察心肌组织的病理变化,测量心肌肥厚指标;免疫组织化学染色和免疫荧光染色,检测p-PI3K和p-Akt的表达及分布.结果实验组大鼠心肌肥厚指标与对照组相比均明显升高;免疫组织化学检测显示,实验组心肌组织p-PI3K和p-Akt蛋白表达面积和平均光密度较对照组高.免疫荧光检测实验组心肌组织p-PI3K和p-Akt蛋白表达较对照组高.结论小剂量持续给予 ISO 能建立大鼠心肌肥厚模型;p-PI3K和p-Akt蛋白表达均与心肌肥厚的发生和发展过程相关,PI3K/Akt信号通路激活,可能是导致心肌肥厚的机制之一.     

清栓酶治疗梗阻性心肌病并下肢动脉栓塞1例

清栓酶治疗梗阻性心肌病并下肢动脉栓塞１例丁素贞法秀芝山东青岛商业职工医院２６６０１１我们用清栓酶治疗肥厚性梗阻性心肌病,房颤并下肢动脉栓塞１例,收到了良好的效果。现报告如下：患者阚某,女,４６岁,工人,因左下肢疼痛１月余就医。患者原有肥厚性梗阻性心肌...     

PTEN在心肌肥厚中的作用初探

目的：观察肿瘤抑制因子PTEN mRNA在腹主动脉狭窄大鼠及卡托普利处理的腹主动脉狭窄大鼠左心室肌中的表达,以探讨PTEN在心肌肥厚发生发展中的可能作用。方法：采用腹主动脉狭窄术制备压力超负荷心肌肥厚动物模型,于术后4周应用逆转录—聚合酶链式反应(RT—PCR)方法,分别检测和观察对照组、心肌肥厚组和卡托普利组大鼠左心室PTEN mRNA表达的变化。结果：①与对照组相比,心肌肥厚组大鼠左心室肌PTEN mRNA表达减少;②与心肌肥厚组相比,卡托普利组大鼠左心室肌PTEN mRNA表达增加,接近对照组。结论：PTEN在心肌肥厚发生发展中可能起负调控作用,该作用与肾素—血管紧张素系统密切相关。     

APJ受体作为心肌细胞压力感受器诱导心肌肥厚的形成

美国桑福德-伯纳姆医学研究所和斯坦福大学医学院的研究人员Pilar Ruiz-Lozano博士等于2012年8月16日在《自然》杂志(Nature)上发表了一篇关于APJ与心肌肥厚的关系及其机制研究的论文,发现在主动脉缩窄术构建的压力负荷大鼠模型中,APJ基因敲除的大鼠和apelin基因敲除的大鼠表现出不同的心肌肥厚和心力衰竭进程[1].该研     

ndufa7 plays a critical role in cardiac hypertrophy

Cardiac hypertrophy is a common pathological change in patients with progressive cardiac function failure, which can be caused by hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) or arterial hypertension. Despite years of study, there is still limited knowledge about the underlying molecular mechanisms for cardiac hypertrophy. NDUFA7, a subunit of NADH:ubiquinone oxidoreductase (complex I), has been reported to be a novel HCM associated gene. However, the biological role of NDUFA7 in heart remains unknown. In this study, we found that NDUFA7 exhibited high expression in the heart, and its level was significantly decreased in mice model of cardiac hypertrophy. Moreover, we demonstrated that ndufa7 knockdown in developing zebrafish embryos resulted in cardiac development and functional defects, associated with increased expression of pathological hypertrophy biomarkers nppa (ANP) and nppb (BNP). Mechanistic study demonstrated that ndufa7 depletion promoted ROS production and calcineurin signalling activation. Moreover, NDUFA7 depletion contributed to cardiac cell hypertrophy. Together, these results report for the first time that ndufa7 is implicated in pathological cardiac hypertrophy.     

A novel mouse model of X-linked cardiac hypertrophy

We recovered a novel mouse mutant exhibiting neonatal lethality associated with severe fetal cardiac hypertrophy and with some adult mice dying suddenly with left ventricular hypertrophic cardiomyopathy. Using Doppler echocardiography, we screened surviving adult mice in this mutant line for cardiac hypertrophy. Cardiac dimensions were obtained either from two-dimensional images collected using a novel ECG-gated ultra-high-frequency ultrasound system or by traditional M-mode imaging on a clinical ultrasound system. These analyses identified, among the littermates, two populations of mice: those with apparent cardiac hypertrophy with hypercontractile function characterized by ejection fraction of 75-80%, and normal littermates with ejection fraction of 53-55%. Analysis of the ECG-gated two-dimensional cines indicated that the hypertrophy was of the nonobstructive type. Further analysis of heart-to-body weight ratio confirmed the ultrasound diagnosis of left ventricular hypertrophic cardiomyopathy. Histopathology showed increased ventricular wall thickness, enlarged myocyte size, and mild myofiber disarray. Ultrastructural analysis by electron microscopy revealed mitochondria hyperproliferation and dilated sarcoplasmic reticulum. Genome scanning using microsatellite DNA markers mapped the mutation to the X chromosome. DNA sequencing showed no mutations in the coding regions of several candidate genes on the X chromosome, including several known to be associated with left ventricular hypertrophic cardiomyopathy. These findings suggest that this mouse line may harbor a mutation in a novel gene causing X-linked cardiomyopathy.     

The calcium release-activated calcium channel Orai1 represents a crucial component in hypertrophic compensation and the development of dilated cardiomyopathy

As exceptionally calcium selective store-operated channels, Orai channels play a prominent role in cellular calcium signaling. While most studied in the immune system, we are beginning to recognize that Orai1 provides unique calcium signaling pathways in numerous tissue contexts. To assess the involvement of Orai1 in cardiac hypertrophy we used transverse aortic constriction to model pressure overload cardiac hypertrophy and heart failure in Orai1 deficient mice. We demonstrate that Orai1 deficient mice have significantly decreased survival in this pressure overload model. Transthoracic echocardiography reveals that Orai1 deficient mice develop rapid dilated cardiomyopathy, with greater loss of function, and histological and molecular data indicate that this pathology is associated with significant apoptosis, but not major differences in cellular hypertrophy, fibrosis, and some major hypertrophic makers. Orai1 represents a crucial calcium entry mechanism in the compensation of the heart to pressure overload over-load, and the development of dilated cardiomyopathy.     

The calcium release-activated calcium channel Orai1 represents a crucial component in hypertrophic compensation and the development of dilated cardiomyopathy

As exceptionally calcium selective store-operated channels, Orai channels play a prominent role in cellular calcium signaling. While most studied in the immune system, we are beginning to recognize that Orai1 provides unique calcium signaling pathways in numerous tissue contexts. To assess the involvement of Orai1 in cardiac hypertrophy we used transverse aortic constriction to model pressure overload cardiac hypertrophy and heart failure in Orai1 deficient mice. We demonstrate that Orai1 deficient mice have significantly decreased survival in this pressure overload model. Transthoracic echocardiography reveals that Orai1 deficient mice develop rapid dilated cardiomyopathy, with greater loss of function, and histological and molecular data indicate that this pathology is associated with significant apoptosis, but not major differences in cellular hypertrophy, fibrosis, and some major hypertrophic makers. Orai1 represents a crucial calcium entry mechanism in the compensation of the heart to pressure overload over-load, and the development of dilated cardiomyopathy.     

Hepatocyte growth factor prevents tissue fibrosis, remodeling, and dysfunction in cardiomyopathic hamster hearts

Structural remodeling of the myocardium, including myocyte hypertrophy, myocardial fibrosis, and dilatation, drives functional impairment in various forms of acquired and hereditary cardiomyopathy. Using cardiomyopathic Syrian hamsters with a genetic defect in delta-sarcoglycan, we investigated the potential involvement of hepatocyte growth factor (HGF) in the pathophysiology and therapeutics related to dilated cardiomyopathy, because HGF has previously been shown to be cytoprotective and to have benefits in acute heart injury. Late-stage TO-2 cardiomyopathic hamsters showed severe cardiac dysfunction and fibrosis, accompanied by increases in myocardial expression of transforming growth factor-beta1 (TGF-beta1), a growth factor responsible for tissue fibrosis. Conversely, HGF was downregulated in late-stage myopathic hearts. Treatment with recombinant human HGF for 3 wk suppressed cardiac fibrosis, accompanied by a decreased expression of TGF-beta1 and type I collagen. Suppression of TGF-beta1 and type I collagen by HGF was also shown in cultured cardiac myofibroblasts. Likewise, HGF suppressed myocardial hypertrophy, apoptosis in cardiomyocytes, and expression of atrial natriuretic polypeptide, a molecular marker of hypertrophy. Importantly, downregulation of the fibrogenic and hypertrophic genes by HGF treatment was associated with improved cardiac function. Thus the decrease in endogenous HGF levels may participate in the susceptibility of cardiac tissue to hypertrophy and fibrosis, and exogenous HGF led to therapeutic benefits in case of dilated cardiomyopathy in this model, even at the late-stage treatment.     

Direct, convergent hypersensitivity of calcium-activated force generation produced by hypertrophic cardiomyopathy mutant alpha-tropomyosins in adult cardiac myocytes

Familial hypertrophic cardiomyopathy is a clinically and genetically diverse autosomal dominant disorder characterized by ventricular hypertrophy and myocyte disarray in the absence of known hypertrophic stimuli. It has been linked to many cardiac contractile proteins, including four point mutations in alpha-tropomyosin (Tm). Here we use adenoviral-mediated gene transfer into adult cardiac myocytes in vitro to show that all four hypertrophic cardiomyopathy alpha-Tm proteins can be expressed and incorporated into normal sarcomeric structures in cardiac myocytes at similar levels as normal alpha-Tm proteins after 5-6 days in culture. Isometric force recordings of single cardiac myocytes demonstrated inappropriate increased force output at submaximal calcium concentration with a specific mutant allele hierarchy. These data indicate that the severity of direct calcium-sensitizing effect of mutations in alpha-Tm may predict the clinical severity of mutant alpha-Tm-associated hypertrophic cardiomyopathy.     

Activated MEK5 induces serial assembly of sarcomeres and eccentric cardiac hypertrophy

Mitogen-activated protein kinase (MAPK) pathways couple intrinsic and extrinsic signals to hypertrophic growth of cardiomyocytes. The MAPK kinase MEK5 activates the MAPK ERK5. To investigate the potential involvement of MEK5-ERK5 in cardiac hypertrophy, we expressed constitutively active and dominant-negative forms of MEK5 in cardiomyocytes in vitro. MEK5 induced a form of hypertrophy in which cardiomyocytes acquired an elongated morphology and sarcomeres were assembled in a serial manner. The cytokine leukemia inhibitory factor (LIF), which stimulates MEK5 activity, evoked a similar response. Moreover, a dominant-negative MEK5 mutant specifically blocked LIF-induced elongation of cardiomyocytes and reduced expression of fetal cardiac genes without blocking other aspects of LIF-induced hypertrophy. Consistent with the ability of MEK5 to induce serial assembly of sarcomeres in vitro, cardiac-specific expression of activated MEK5 in transgenic mice resulted in eccentric cardiac hypertrophy that progressed to dilated cardiomyopathy and sudden death. These findings reveal a specific role for MEK5-ERK5 in the induction of eccentric cardiac hypertrophy and in transduction of cytokine signals that regulate serial sarcomere assembly.     

MiR-221 promotes cardiac hypertrophy in vitro through the modulation of p27 expression

Cardiac hypertrophy has been known as an independent predictor for cardiovascular morbidity and mortality. Molecular mechanisms underlying the development of heart failure remain elusive. Recently, microRNAs (miRs) have been established as important regulators in cardiac hypertrophy. Here, we reported miR-221 was up-regulated in both transverse aortic constricted mice and patients with hypertrophic cardiomyopathy (HCM). Forced expression of miR-221 by transfection of miR-221 mimics increased myocyte cell size and induced the re-expression of fetal genes, which were inhibited by the knockdown of endogenous miR-221 in cardiomyocytes. The TargetScan algorithm-based prediction identified that p27, a cardiac hypertrophic suppressor, is the putative target of miR-221, which was confirmed by luciferase assay and Western blotting. In conclusion, our results demonstrated that miR-221 regulated cardiomyocyte hypertrophy probably through down-regulation of p27, suggesting that miR-221 may be a new intervention target for cardiac hypertrophy.