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心力衰竭大鼠肺、心、肾中 ACE2、furin、TMPRSS2 和 ADAM17 的分布:对 COVID-19 疾病的潜在影响。

Pulmonary, cardiac and renal distribution of ACE2, furin, TMPRSS2 and ADAM17 in rats with heart failure: Potential implication for COVID-19 disease.

机构信息

Department of Physiology and Biophysics, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Department of Internal Medicine, Rambam Medical Center, Haifa, Israel.

出版信息

J Cell Mol Med. 2021 Apr;25(8):3840-3855. doi: 10.1111/jcmm.16310. Epub 2021 Mar 4.

Abstract

Congestive heart failure (CHF) is often associated with kidney and pulmonary dysfunction. Activation of the renin-angiotensin-aldosterone system (RAAS) contributes to avid sodium retention, cardiac hypertrophy and oedema formation, including lung congestion. While the status of the classic components of RAAS such as renin, angiotensin converting enzyme (ACE), angiotensin II (Ang II) and angiotensin II receptor AT-1 is well studied in CHF, the expression of angiotensin converting enzyme-2 (ACE2), a key enzyme of angiotensin 1-7 (Ang 1-7) generation in the pulmonary, cardiac and renal systems has not been studied thoroughly in this clinical setting. This issue is of a special interest as Ang 1-7 counterbalance the vasoconstrictory, pro-inflammatory and pro-proliferative actions of Ang II. Furthermore, CHF predisposes to COVID-19 disease severity, while ACE2 also serves as the binding domain of SARS-CoV-2 in human host-cells, and acts in concert with furin, an important enzyme in the synthesis of BNP in CHF, in permeating viral functionality along TMPRSST2. ADAM17 governs ACE2 shedding from cell membranes. Therefore, the present study was designed to investigate the expression of ACE2, furin, TMPRSS2 and ADAM17 in the lung, heart and kidneys of rats with CHF to understand the exaggerated susceptibility of clinical CHF to COVID-19 disease. Heart failure was induced in male Sprague Dawley rats by the creation of a surgical aorto-caval fistula. Sham-operated rats served as controls. One week after surgery, the animals were subdivided into compensated and decompensated CHF according to urinary sodium excretion. Both groups and their controls were sacrificed, and their hearts, lungs and kidneys were harvested for assessment of tissue remodelling and ACE2, furin, TMPRSS2 and ADAM17 immunoreactivity, expression and immunohistochemical staining. ACE2 immunoreactivity and mRNA levels increased in pulmonary, cardiac and renal tissues of compensated, but not in decompensated CHF. Furin immunoreactivity was increased in both compensated and decompensated CHF in the pulmonary, cardiac tissues and renal cortex but not in the medulla. Interestingly, both the expression and abundance of pulmonary, cardiac and renal TMPRSS2 decreased in CHF in correlation with the severity of the disease. Pulmonary, cardiac and renal ADAM17 mRNA levels were also downregulated in decompensated CHF. Circulating furin levels increased in proportion to CHF severity, whereas plasma ACE2 remained unchanged. In summary, ACE2 and furin are overexpressed in the pulmonary, cardiac and renal tissues of compensated and to a lesser extent of decompensated CHF as compared with their sham controls. The increased expression of the ACE2 in heart failure may serve as a compensatory mechanism, counterbalancing the over-activity of the deleterious isoform, ACE. Downregulated ADAM17 might enhance membranal ACE2 in COVID-19 disease, whereas the suppression of TMPRSS2 in CHF argues against its involvement in the exaggerated susceptibility of CHF patients to SARS-CoV2.

摘要

充血性心力衰竭(CHF)常伴有肾脏和肺功能障碍。肾素-血管紧张素-醛固酮系统(RAAS)的激活导致钠的过度潴留、心脏肥大和水肿形成,包括肺充血。虽然 RAAS 的经典成分如肾素、血管紧张素转换酶(ACE)、血管紧张素 II(Ang II)和血管紧张素 II 受体 AT-1 在 CHF 中的状态已经得到了很好的研究,但在肺、心脏和肾脏系统中血管紧张素 1-7(Ang 1-7)生成的关键酶血管紧张素转换酶 2(ACE2)的表达在这种临床环境中尚未得到充分研究。这个问题特别有趣,因为 Ang 1-7 抵消了 Ang II 的血管收缩、促炎和促增殖作用。此外,CHF 易患 COVID-19 疾病的严重程度,而 ACE2 也是 SARS-CoV-2 在人类宿主细胞中的结合域,并与 furin 一起作用,furin 是 CHF 中 BNP 合成的重要酶,在沿着 TMPRSSST2 渗透病毒功能方面发挥作用。ADAM17 控制 ACE2 从细胞膜上脱落。因此,本研究旨在研究 ACE2、furin、TMPRSS2 和 ADAM17 在 CHF 大鼠肺、心脏和肾脏中的表达,以了解临床 CHF 对 COVID-19 疾病的易感性增加。雄性 Sprague Dawley 大鼠通过创建手术性腹主动脉-腔静脉瘘来诱导心力衰竭。假手术大鼠作为对照。手术后一周,根据尿钠排泄将动物分为代偿性和失代偿性 CHF。两组及其对照组均被处死,采集心脏、肺和肾脏进行组织重塑以及 ACE2、furin、TMPRSS2 和 ADAM17 免疫反应性、表达和免疫组织化学染色评估。代偿性 CHF 时肺、心脏和肾脏组织中的 ACE2 免疫反应性和 mRNA 水平增加,但失代偿性 CHF 时则没有。在代偿性和失代偿性 CHF 中,肺、心脏组织和肾脏皮质中的 furin 免疫反应性增加,但在髓质中则没有。有趣的是,CHF 中肺、心脏和肾脏 TMPRSS2 的表达和丰度均降低,与疾病的严重程度相关。失代偿性 CHF 中肺、心脏和肾脏的 ADAM17 mRNA 水平也下调。循环 furin 水平随 CHF 严重程度增加,而血浆 ACE2 不变。总之,与 sham 对照组相比,代偿性和代偿性 CHF 的肺、心脏和肾脏组织中 ACE2 和 furin 过度表达。心力衰竭时 ACE2 的表达增加可能是一种代偿机制,抵消有害同工酶 ACE 的过度活性。下调的 ADAM17 可能会增强 COVID-19 疾病中膜结合的 ACE2,而 CHF 中 TMPRSS2 的抑制则表明其不参与 CHF 患者对 SARS-CoV2 的易感性增加。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/89ee/8051748/4beaf4787b70/JCMM-25-3840-g007.jpg

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