Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.
Sci Transl Med. 2019 Mar 6;11(482). doi: 10.1126/scitranslmed.aau8680.
Activin type II receptor (ActRII) ligands have been implicated in muscle wasting in aging and disease. However, the role of these ligands and ActRII signaling in the heart remains unclear. Here, we investigated this catabolic pathway in human aging and heart failure (HF) using circulating follistatin-like 3 (FSTL3) as a potential indicator of systemic ActRII activity. FSTL3 is a downstream regulator of ActRII signaling, whose expression is up-regulated by the major ActRII ligands, activin A, circulating growth differentiation factor-8 (GDF8), and GDF11. In humans, we found that circulating FSTL3 increased with aging, frailty, and HF severity, correlating with an increase in circulating activins. In mice, increasing circulating activin A increased cardiac ActRII signaling and FSTL3 expression, as well as impaired cardiac function. Conversely, ActRII blockade with either clinical-stage inhibitors or genetic ablation reduced cardiac ActRII signaling while restoring or preserving cardiac function in multiple models of HF induced by aging, sarcomere mutation, or pressure overload. Using unbiased RNA sequencing, we show that activin A, GDF8, and GDF11 all induce a similar pathologic profile associated with up-regulation of the proteasome pathway in mammalian cardiomyocytes. The E3 ubiquitin ligase, Smurf1, was identified as a key downstream effector of activin-mediated ActRII signaling, which increased proteasome-dependent degradation of sarcoplasmic reticulum Ca ATPase (SERCA2a), a critical determinant of cardiomyocyte function. Together, our findings suggest that increased activin/ActRII signaling links aging and HF pathobiology and that targeted inhibition of this catabolic pathway holds promise as a therapeutic strategy for multiple forms of HF.
激活素 II 型受体 (ActRII) 配体已被牵连到衰老和疾病中的肌肉消耗中。然而,这些配体和 ActRII 信号在心脏中的作用仍不清楚。在这里,我们使用循环卵泡抑素样 3 (FSTL3) 作为系统性 ActRII 活性的潜在指标,研究了这种代谢途径在人类衰老和心力衰竭 (HF) 中的作用。FSTL3 是 ActRII 信号的下游调节剂,其表达受主要的 ActRII 配体激活素 A、循环生长分化因子-8 (GDF8) 和 GDF11 的上调。在人类中,我们发现循环 FSTL3 随着衰老、虚弱和 HF 严重程度的增加而增加,与循环激活素的增加相关。在小鼠中,增加循环激活素 A 会增加心脏 ActRII 信号和 FSTL3 的表达,并损害心脏功能。相反,用临床阶段抑制剂或基因敲除来阻断 ActRII,可减少心脏 ActRII 信号,同时恢复或保留因衰老、肌节突变或压力超负荷引起的多种 HF 模型中的心脏功能。通过使用无偏 RNA 测序,我们表明激活素 A、GDF8 和 GDF11 均诱导与哺乳动物心肌细胞中蛋白酶体途径上调相关的相似病理谱。E3 泛素连接酶 Smurf1 被鉴定为激活素介导的 ActRII 信号的关键下游效应物,它增加了肌浆网 Ca ATP 酶 (SERCA2a) 的蛋白酶体依赖性降解,SERCA2a 是心肌细胞功能的关键决定因素。总之,我们的研究结果表明,激活素/ActRII 信号的增加将衰老和 HF 的病理生理学联系起来,靶向抑制这种代谢途径有望成为多种形式 HF 的治疗策略。
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