Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
Nature. 2019 Apr;568(7752):351-356. doi: 10.1038/s41586-019-1100-z. Epub 2019 Apr 10.
Heart failure with preserved ejection fraction (HFpEF) is a common syndrome with high morbidity and mortality for which there are no evidence-based therapies. Here we report that concomitant metabolic and hypertensive stress in mice-elicited by a combination of high-fat diet and inhibition of constitutive nitric oxide synthase using N-nitro-L-arginine methyl ester (L-NAME)-recapitulates the numerous systemic and cardiovascular features of HFpEF in humans. Expression of one of the unfolded protein response effectors, the spliced form of X-box-binding protein 1 (XBP1s), was reduced in the myocardium of our rodent model and in humans with HFpEF. Mechanistically, the decrease in XBP1s resulted from increased activity of inducible nitric oxide synthase (iNOS) and S-nitrosylation of the endonuclease inositol-requiring protein 1α (IRE1α), culminating in defective XBP1 splicing. Pharmacological or genetic suppression of iNOS, or cardiomyocyte-restricted overexpression of XBP1s, each ameliorated the HFpEF phenotype. We report that iNOS-driven dysregulation of the IRE1α-XBP1 pathway is a crucial mechanism of cardiomyocyte dysfunction in HFpEF.
射血分数保留型心力衰竭(HFpEF)是一种常见的综合征,发病率和死亡率都很高,但目前尚无循证治疗方法。在这里,我们报告了在高脂肪饮食和使用 N-硝基-L-精氨酸甲酯(L-NAME)抑制组成型一氧化氮合酶的组合作用下,小鼠同时发生代谢和高血压应激,重现了人类 HFpEF 的许多全身和心血管特征。我们的啮齿动物模型和 HFpEF 患者的心肌中,未折叠蛋白反应效应物之一的剪接 X 盒结合蛋白 1(XBP1s)的表达减少。从机制上讲,XBP1s 的减少是由于诱导型一氧化氮合酶(iNOS)活性增加和内质网必需的蛋白 1α(IRE1α)的 S-亚硝基化,最终导致 XBP1 剪接缺陷。iNOS 的药理学或遗传学抑制,或心肌细胞特异性过表达 XBP1s,均可改善 HFpEF 表型。我们报告说,iNOS 驱动的 IRE1α-XBP1 通路失调是 HFpEF 中心肌细胞功能障碍的一个重要机制。
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