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。     

非经典Wnt信号通路在心脏发育和干细胞向心肌分化中的作用机制

Wnt信号通路是一种哺乳动物进化保守的信号通路,在心脏发育和干细胞向心肌细胞分化中发挥重要的调控作用。经典Wnt信号通路主要调控早期心肌谱系提交,而非经典Wnt信号通路参与调控后续的心脏发育和分化。本文对非经典Wnt信号通路在心脏发育和干细胞向心肌细胞分化中的作用及其机制作一综述,以期为干细胞移植治疗缺血性心肌病提供参考策略。     

心肌JAK-STAT信号通路的研究进展

JAK-STAT信号通路介导心肌细胞的生长、存活和凋亡,并参与血管生成的调节,在心脏疾病的发生机制中发挥重要作用。压力负荷导致的心肌肥大、心力衰竭、缺血预处理诱导的心肌保护,以及缺血-再灌注引起的心功能障碍,都与这一信号通路密切相关。血管紧张素Ⅱ(ANGⅡ)与JAK-STAT信号通路相互作用加重缺血性心肌损伤;激活gpl30-STAT3信号通路对心力衰竭和缺血性心脏病的防治具有重要意义。     

氧化应激与糖尿病性心肌病的发生发展

糖尿病患者经常表现出一种独特的心脏表型,即糖尿病性心肌病（Diabetic cardiomyopathy,DCM）。由于在糖尿病患者中慢性炎症和氧化应激的发生,改变了机体代谢稳态,引发氧化还原失衡,从而诱发心肌代谢紊乱和心脏微血管病变,使心脏出现危险的氧化应激,致使了糖尿病性心肌病的发生。心肌细胞中脂肪的氧化与毒性增加以及微脉管系统中高水平的细胞血糖,让糖尿病患者体内的线粒体产生过量的活性氧（reactive oxygen species, ROS）。超氧阴离子自由基可增强己糖胺生物合成途径和多元醇通路,诱导活化蛋白激酶C(protein kinase C, PKC),增加晚期糖基化终产物（advanced glycation end products, AGEs）的形成并激活其受体（receptor for advanced glycation end products, RAGE）。这些生化级联反应同时也是ROS的其他额外来源。本文主要概述氧化应激在DCM中的作用及其涉及信号通路。同时,也简要提到了目前用于DCM的治疗方法。基于氧化应激在糖尿病性心肌病中的关键作用,新的抗氧化疗法的...     

干预DAG-PKC信号转导通路对糖尿病大鼠心肌细胞JNK1和IRS1基因表达的影响

目的干预二酰甘油-蛋白激酶C(DAG-PKC)信号转导通路后观察JNK1、IRS1等在糖尿病大鼠心肌中的表达情况。方法采用HE染色,masson染色、电镜观察大鼠心肌的病理变化,应用免疫组化、Real-Time PCR检测PKCβ2、JNK1及IRS1在大鼠心肌的表达情况。结果糖尿病模型组PKCβ2、JNK1、p-JNK、IRS1表达明显高于对照组,干预DAG-PKC信号转导通路后明显下调其表达水平。结论 DAG-PKC通路可能是通过G蛋白受体和胰岛素受体途径的共同信号点JNK1影响下游的信号传导而导致糖尿病心肌病的发生发展,DAG-PKC-JNK1-IRS1-Akt/PKB-mTOR-p70S6K1等一系列信号位点可能是DAG-PKC信号转导通路引起糖尿病心肌病可能的潜在途径。     

α-klotho与心脏保护

α-klotho(KL)是一种抗衰老蛋白,具有抗炎、抗氧化应激和调控离子通道等多种生物学功能。KL可作为一种激素循环作用于全身各个组织器官,心脏疾病与循环KL水平降低密切相关。KL对心肌有重要保护作用,敲除KL基因虽然不会引起心肌病理性重塑,但受到病理因素刺激后,KL基因敲除小鼠心肌组织受到的损伤比野生型小鼠更严重。过表达KL基因或用KL重组蛋白干预后可改善多种心脏疾病,包括心肌肥厚、尿毒症性心肌病、高血压性心肌病和糖尿病心肌病等。KL的心肌保护作用可通过多条信号通路实现,如调节离子通道降低细胞内钙离子浓度抑制细胞过度肥大、激活p38/c-Jun氨基末端激酶丝裂原活化蛋白激酶通路减轻内质网应激、抑制转化生长因子β1/Wnt改善心肌纤维化、调控丝裂原活化的蛋白激酶/核因子E2相关因子2通路减轻氧化应激以及通过抑制核因子活化B细胞κ轻链增强子的激活从而抑制炎症反应等。因此,KL有望成为防治相关心脏疾病的新靶点。     

阿托伐他汀通过RGS6改善糖尿病心肌病大鼠心功能的作用及其机制研究

目的:探讨阿托伐他汀通过调节RGS6/NAD(P)H氧化酶/活性氧生成通路保护糖尿病心肌病大鼠心功能的药理作用机制。方法:40只6周龄雄性Wistar大鼠按随机数字表法随机分为对照组,糖尿病心肌病模型组,低剂量阿托伐他汀组,高剂量阿托伐他汀组,每组10只。实验过程中动态监测大鼠体质量及血脂水平;实验结束后脉冲多普勒检测各组大鼠心功能指标;组织活性氧检测试剂盒检测心肌组织中活性氧的水平;免疫组化法检测大鼠心肌组织中RGS6的表达;Western blot法检测大鼠心肌组织中RGS6及NAD (P)H氧化酶活性亚单位p47phox和p67phox的水平。结果:与对照组相比,糖尿病心肌病模型大鼠体质量明显减少(P0.01),血脂水平明显升高(P0.01),心脏E/A、LVEF、FS值降低(P0.01),心肌组织活性氧生成明显增多(P0.01),心肌组织RGS6及p47phox、p67phox表达明显上调(P0.01),而不同剂量阿托伐他汀干预均可有效逆转上述指标的改变。结论:阿托伐他汀对糖尿病心肌病大鼠的心脏具有明显保护作用,其机制可能与对RGS6/NAD(P)H氧化酶/活性氧生成通路的抑制有关。     

心脏舒张异常及其临床意义

本文重点介绍评定心脏舒张性能的常用指标及其影响因素;阐述了心脏舒张性能在缺血性、心肌肥大性心脏病、充血性心肌病以及充血性心力衰竭等情况下的改变机制及其对诊断、预后和治疗的指导意义。     

心肌肥厚信号通路研究进展

病理性心肌肥厚是心肌细胞受到多种因素刺激后所产生的失代偿性反应,最终可演变为心力衰竭,甚至诱发猝死。鉴于其复杂的病理过程,具体发病机制至今尚未完全阐明,但既有研究已明确有丝分裂原活化蛋白激酶信号通路、Ca~(2+)介导的信号通路、蛋白激酶信号通路、Janus激酶/信号转导子和转录激活子信号通路和MicroRNAs信号通路在调控心肌肥厚的进程中起着至关重要的作用。现就相关信号通路在心肌肥厚发生、进展及预后中所起作用的最新研究进展予以综述。     

Cyclin D in Left Ventricle Hypertrophy

Left ventricle hypertrophy is induced by a number of stimuli and can lead to cardiomyopathy and heart failure. The hypertrophic response is achieved by enlargement of the cardiac myocytes and is regulated by multiple signaling pathways, with the D-type cyclins playing a crucial role. Induction of cyclin D in adult cardiac myocytes leads to activation of cyclin-dependent kinases 4 and 6 and a partial progress through the cell cycle. Therefore, these pathways are attractive therapeutic target for treatment of heart failure and hypertrophy. We discuss the activity of cyclin D and other cell cycle regulatory proteins in left ventricle hypertrophy and whether the hypertrophic signaling pathways converge at the D-type cyclins.     

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。     

Capacity for resolution of Ras-MAPK-initiated early pathogenic myocardial hypertrophy modeled in mice

Activation of Ras signaling in cardiomyocytes has been linked to pathogenic myocardial hypertrophy progression and subsequent heart failure. Whether cardiomyopathy can regress once initiated needs to be established more fully. A 'tet-off' system was used to regulate expression of H-Ras-G12V in myocardium to examine whether Ras-induced pathogenic myocardial hypertrophy could resolve after removal of Ras signaling in vivo. Ras activation at weaning for 2 wk caused hypertrophy, whereas activation for 4 to 8 wk led to cardiomyopathy and heart failure. Discontinuing H-Ras-G12V transgene expression after cardiomyopathy onset led to improved survival and cardiomyopathy lesion scores, with reduced heart:body weight ratios, demonstrating the reversibility of early pathogenic hypertrophy. Activation of Ras and downstream ERK 1/2 was associated with elevated expression of proliferating cell nuclear antigen and cyclins B1 and D1, indicating cell-cycle activation and reentry. Coordinate elevation of broad-spectrum cyclin-dependent kinase inhibitors (p21, p27, and p57) and Tyr15 phosphorylation of cdc2 signified the activation of cell-cycle checkpoints; absence of cell-cycle completion and cardiomyocyte replication were documented by using immunohistochemistry for mitosis and cytokinesis markers. After resolution of cardiomyopathy, cell-cycle activators and inhibitors examined returned to basal levels, a change that we interpreted as exit from the cell cycle. Cardiac cell-cycle regulation plays a role in recovery from pathogenic hypertrophy. The model we present provides a means to further explore the underlying mechanisms governing cell-cycle capacity in cardiomyocytes, as well as progression and regression of pathogenic cardiomyocyte hypertrophy.     

Oxymatrine and insulin resistance: Focusing on mechanistic intricacies involve in diabetes associated cardiomyopathy via SIRT1/AMPK and TGF-β signaling pathway

Cardiomyopathy (CDM) and related morbidity and mortality are increasing at an alarming rate, in large part because of the increase in the number of diabetes mellitus cases. The clinical consequence associated with CDM is heart failure (HF) and is considerably worse for patients with diabetes mellitus, as compared to nondiabetics. Diabetic cardiomyopathy (DCM) is characterized by structural and functional malfunctioning of the heart, which includes diastolic dysfunction followed by systolic dysfunction, myocyte hypertrophy, cardiac dysfunctional remodeling, and myocardial fibrosis. Indeed, many reports in the literature indicate that various signaling pathways, such as the AMP-activated protein kinase (AMPK), silent information regulator 1 (SIRT1), PI3K/Akt, and TGF-β/smad pathways, are involved in diabetes-related cardiomyopathy, which increases the risk of functional and structural abnormalities of the heart. Therefore, targeting these pathways augments the prevention as well as treatment of patients with DCM. Alternative pharmacotherapy, such as that using natural compounds, has been shown to have promising therapeutic effects. Thus, this article reviews the potential role of the quinazoline alkaloid, oxymatrine obtained from the Sophora flavescensin CDM associated with diabetes mellitus. Numerous studies have given a therapeutic glimpse of the role of oxymatrine in the multiple secondary complications related to diabetes, such as retinopathy, nephropathy, stroke, and cardiovascular complications via reductions in oxidative stress, inflammation, and metabolic dysregulation, which might be due to targeting signaling pathways, such as AMPK, SIRT1, PI3K/Akt, and TGF-β pathways. Thus, these pathways are considered central regulators of diabetes and its secondary complications, and targeting these pathways with oxymatrine might provide a therapeutic tool for the diagnosis and treatment of diabetes-associated cardiomyopathy.     

Phospholipid-mediated signaling systems as novel targets for treatment of heart disease

The phospholipases associated with the cardiac sarcolemmal (SL) membrane hydrolyze specific membrane phospholipids to generate important lipid signaling molecules, which are known to influence normal cardiac function. However, impairment of the phospholipases and their related signaling events may be contributory factors in altering cardiac function of the diseased myocardium. The identification of the changes in such signaling systems as well as understanding the contribution of phospholipid-signaling pathways to the pathophysiology of heart disease are rapidly emerging areas of research in this field. In this paper, I provide an overview of the role of phospholipid-mediated signal transduction processes in cardiac hypertrophy and congestive heart failure, diabetic cardiomyopathy, as well as in ischemia-reperfusion. From the cumulative evidence presented, it is suggested that phospholipid-mediated signal transduction processes could serve as novel targets for the treatment of the different types of heart disease.     

Implications of protease activation in cardiac dysfunction and development of genetic cardiomyopathy in hamsters

It has become evident that protein degradation by proteolytic enzymes, known as proteases, is partly responsible for cardiovascular dysfunction in various types of heart disease. Both extracellular and intracellular alterations in proteolytic activities are invariably seen in heart failure associated with hypertrophic cardiomyopathy, dilated cardiomyopathy, hypertensive cardiomyopathy, diabetic cardiomyopathy, and ischemic cardiomyopathy. Genetic cardiomyopathy displayed in different strains of hamsters provides a useful model for studying heart failure due to either cardiac hypertrophy or cardiac dilation. Alterations in the function of several myocardial organelles such as sarcolemma, sarcoplasmic reticulum, myofibrils, mitochondria, as well as extracellular matrix have been shown to be due to subcellular remodeling as a consequence of changes in gene expression and protein content in failing hearts from cardiomyopathic hamsters. In view of the increased activities of various proteases, including calpains and matrix metalloproteinases in the hearts of genetically determined hamsters, it is proposed that the activation of different proteases may also represent an important determinant of subcellular remodeling and cardiac dysfunction associated with genetic 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.