Targeting Chondroitin Sulfate Glycosaminoglycans to Treat Cardiac Fibrosis in Pathological Remodeling.
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Authors
Zhao, Rong-Rong
Ackers-Johnson, Matthew
Stenzig, Justus
Chen, Chen
Ding, Tao
Zhou, Yue
Wang, Peipei
Ng, Shi Ling
Li, Peter Y
Teo, Gavin
Rudd, Pauline M
Foo, Roger SY
Publication Date
2018-06-05Journal Title
Circulation
ISSN
0009-7322
Publisher
Ovid Technologies (Wolters Kluwer Health)
Volume
137
Issue
23
Pages
2497-2513
Language
eng
Type
Article
This Version
AM
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Zhao, R., Ackers-Johnson, M., Stenzig, J., Chen, C., Ding, T., Zhou, Y., Wang, P., et al. (2018). Targeting Chondroitin Sulfate Glycosaminoglycans to Treat Cardiac Fibrosis in Pathological Remodeling.. Circulation, 137 (23), 2497-2513. https://doi.org/10.1161/CIRCULATIONAHA.117.030353
Abstract
BACKGROUND: Heart failure is a leading cause of mortality and morbidity, and the search for novel therapeutic approaches continues. In the monogenic disease mucopolysaccharidosis VI, loss-of-function mutations in arylsulfatase B lead to myocardial accumulation of chondroitin sulfate (CS) glycosaminoglycans, manifesting as myriad cardiac symptoms. Here, we studied changes in myocardial CS in nonmucopolysaccharidosis failing hearts and assessed its generic role in pathological cardiac remodeling. METHODS: Healthy and diseased human and rat left ventricles were subjected to histological and immunostaining methods to analyze glycosaminoglycan distribution. Glycosaminoglycans were extracted and analyzed for quantitative and compositional changes with Alcian blue assay and liquid chromatography-mass spectrometry. Expression changes in 20 CS-related genes were studied in 3 primary human cardiac cell types and THP-1-derived macrophages under each of 9 in vitro stimulatory conditions. In 2 rat models of pathological remodeling induced by transverse aortic constriction or isoprenaline infusion, recombinant human arylsulfatase B (rhASB), clinically used as enzyme replacement therapy in mucopolysaccharidosis VI, was administered intravenously for 7 or 5 weeks, respectively. Cardiac function, myocardial fibrosis, and inflammation were assessed by echocardiography and histology. CS-interacting molecules were assessed with surface plasmon resonance, and a mechanism of action was verified in vitro. RESULTS: Failing human hearts displayed significant perivascular and interstitial CS accumulation, particularly in regions of intense fibrosis. Relative composition of CS disaccharides remained unchanged. Transforming growth factor-β induced CS upregulation in cardiac fibroblasts. CS accumulation was also observed in both the pressure-overload and the isoprenaline models of pathological remodeling in rats. Early treatment with rhASB in the transverse aortic constriction model and delayed treatment in the isoprenaline model proved rhASB to be effective at preventing cardiac deterioration and augmenting functional recovery. Functional improvement was accompanied by reduced myocardial inflammation and overall fibrosis. Tumor necrosis factor-α was identified as a direct binding partner of CS glycosaminoglycan chains, and rhASB reduced tumor necrosis factor-α-induced inflammatory gene activation in vitro in endothelial cells and macrophages. CONCLUSIONS: CS glycosaminoglycans accumulate during cardiac pathological remodeling and mediate myocardial inflammation and fibrosis. rhASB targets CS effectively as a novel therapeutic approach for the treatment of heart failure.
Keywords
Myocardium, Heart Ventricles, Animals, Humans, Mice, Rats, Cardiomyopathies, Fibrosis, Chondroitin Sulfates, Ventricular Remodeling, Heart Failure
Sponsorship
European Research Council (294502)
Medical Research Council (MR/R004544/1)
Medical Research Council (MR/R004463/1)
Identifiers
External DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.030353
This record's URL: https://www.repository.cam.ac.uk/handle/1810/275695
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