Hanai Jun-ichi, Cao Peirang, Tanksale Preeti, Imamura Shintaro, Koshimizu Eriko, Zhao Jinghui, Kishi Shuji, Yamashita Michiaki, Phillips Paul S, Sukhatme Vikas P, Lecker Stewart H
Renal Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
J Clin Invest. 2007 Dec;117(12):3940-51. doi: 10.1172/JCI32741.
Statins inhibit HMG-CoA reductase, a key enzyme in cholesterol synthesis, and are widely used to treat hypercholesterolemia. These drugs can lead to a number of side effects in muscle, including muscle fiber breakdown; however, the mechanisms of muscle injury by statins are poorly understood. We report that lovastatin induced the expression of atrogin-1, a key gene involved in skeletal muscle atrophy, in humans with statin myopathy, in zebrafish embryos, and in vitro in murine skeletal muscle cells. In cultured mouse myotubes, atrogin-1 induction following lovastatin treatment was accompanied by distinct morphological changes, largely absent in atrogin-1 null cells. In zebrafish embryos, lovastatin promoted muscle fiber damage, an effect that was closely mimicked by knockdown of zebrafish HMG-CoA reductase. Moreover, atrogin-1 knockdown in zebrafish embryos prevented lovastatin-induced muscle injury. Finally, overexpression of PGC-1alpha, a transcriptional coactivator that induces mitochondrial biogenesis and protects against the development of muscle atrophy, dramatically prevented lovastatin-induced muscle damage and abrogated atrogin-1 induction both in fish and in cultured mouse myotubes. Collectively, our human, animal, and in vitro findings shed light on the molecular mechanism of statin-induced myopathy and suggest that atrogin-1 may be a critical mediator of the muscle damage induced by statins.
他汀类药物可抑制3-羟基-3-甲基戊二酰辅酶A还原酶(HMG-CoA还原酶),这是胆固醇合成中的一种关键酶,被广泛用于治疗高胆固醇血症。这些药物会在肌肉中引发多种副作用,包括肌纤维分解;然而,他汀类药物导致肌肉损伤的机制仍知之甚少。我们报告称,洛伐他汀在患有他汀类药物肌病的人类、斑马鱼胚胎以及体外培养的小鼠骨骼肌细胞中,均可诱导atrogin-1的表达,atrogin-1是参与骨骼肌萎缩的关键基因。在培养的小鼠肌管中,洛伐他汀处理后atrogin-1的诱导伴随着明显的形态学变化,而在atrogin-1基因缺失的细胞中这种变化基本不存在。在斑马鱼胚胎中,洛伐他汀会促进肌纤维损伤,敲低斑马鱼HMG-CoA还原酶可紧密模拟这一效应。此外,在斑马鱼胚胎中敲低atrogin-1可预防洛伐他汀诱导的肌肉损伤。最后,过表达PGC-1α(一种诱导线粒体生物合成并防止肌肉萎缩发展的转录共激活因子)可显著预防洛伐他汀诱导的肌肉损伤,并消除鱼类和培养的小鼠肌管中atrogin-1的诱导。总体而言,我们在人体、动物和体外实验中的研究结果揭示了他汀类药物诱导肌病的分子机制,并表明atrogin-1可能是他汀类药物诱导肌肉损伤的关键介质。