在一项慢性恰加斯心脏病的临床前研究中,TGF-β 抑制剂治疗可减少纤维化并刺激心脏改善。

TGF-β inhibitor therapy decreases fibrosis and stimulates cardiac improvement in a pre-clinical study of chronic Chagas' heart disease.

机构信息

Laboratório de Genômica Funcional e Bioinformática-Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro RJ, Brasil.

Laboratório de Biologia das Interações-Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro RJ, Brasil.

出版信息

PLoS Negl Trop Dis. 2019 Jul 31;13(7):e0007602. doi: 10.1371/journal.pntd.0007602. eCollection 2019 Jul.

Abstract

TGF-β involvement in Chagas disease cardiomyopathy has been clearly demonstrated. The TGF-β signaling pathway is activated in the cardiac tissue of chronic phase patients and is associated with an increase in extracellular matrix protein expression. The aim of this study was to investigate the effect of GW788388, a selective inhibitor of TβR1/ALK5, on cardiac function in an experimental model of chronic Chagas' heart disease. To this end, C57BL/6 mice were infected with Trypanosoma cruzi (102 parasites from the Colombian strain) and treated orally with 3mg/kg GW788388 starting at 120 days post-infection (dpi), when 100% of the infected mice show cardiac damage, and following three distinct treatment schedules: i) single dose; ii) one dose per week; or iii) three doses per week during 30 days. The treatment with GW788388 improved several cardiac parameters: reduced the prolonged PR and QTc intervals, increased heart rate, and reversed sinus arrhythmia, and atrial and atrioventricular conduction disorders. At 180 dpi, 30 days after treatment interruption, the GW3x-treated group remained in a better cardiac functional condition. Further, GW788388 treatment reversed the loss of connexin-43 enriched intercellular plaques and reduced fibrosis of the cardiac tissue. Inhibition of the TGF-β signaling pathway reduced TGF-β/pSmad2/3, increased MMP-9 and Sca-1, reduced TIMP-1/TIMP-2/TIMP-4, and partially restored GATA-6 and Tbox-5 transcription, supporting cardiac recovery. Moreover, GW788388 administration did not modify cardiac parasite load during the infection but reduced the migration of CD3+ cells to the heart tissue. Altogether, our data suggested that the single dose schedule was not as effective as the others and treatment three times per week during 30 days seems to be the most effective strategy. The therapeutic effects of GW788388 are promising and suggest a new possibility to treat cardiac fibrosis in the chronic phase of Chagas' heart disease by TGF-β inhibitors.

摘要

TGF-β 在恰加斯病心肌病中的作用已得到明确证实。TGF-β 信号通路在慢性期患者的心脏组织中被激活,并与细胞外基质蛋白表达增加相关。本研究旨在探讨 TβR1/ALK5 选择性抑制剂 GW788388 对慢性恰加斯心脏病实验模型中心脏功能的影响。为此,C57BL/6 小鼠感染了锥虫(来自哥伦比亚株的 102 个寄生虫),并从感染后 120 天(dpi)开始口服 3mg/kg GW788388 治疗,此时 100%的感染小鼠出现心脏损伤,并采用三种不同的治疗方案:i)单次剂量;ii)每周一次剂量;或 iii)每周三次剂量,持续 30 天。GW788388 治疗改善了多项心脏参数:缩短了延长的 PR 和 QTc 间隔,增加了心率,并逆转了窦性心律失常、心房和房室传导障碍。在 180 dpi,即治疗中断后 30 天,GW3x 治疗组仍保持更好的心脏功能状态。此外,GW788388 治疗逆转了连接蛋白 43 丰富的细胞间斑块的丢失,并减少了心脏组织的纤维化。TGF-β 信号通路的抑制减少了 TGF-β/pSmad2/3,增加了 MMP-9 和 Sca-1,减少了 TIMP-1/TIMP-2/TIMP-4,并部分恢复了 GATA-6 和 Tbox-5 的转录,支持心脏恢复。此外,GW788388 给药在感染期间并未改变心脏寄生虫负荷,但减少了 CD3+细胞向心脏组织的迁移。综上所述,我们的数据表明,单次剂量方案不如其他方案有效,每周三次治疗 30 天似乎是最有效的策略。GW788388 的治疗效果很有前景,为使用 TGF-β 抑制剂治疗恰加斯心脏病慢性期的心脏纤维化提供了新的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fca/6690554/45fcbaefd8b4/pntd.0007602.g001.jpg

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