Texas Heart Institute, Houston, TX, USA.
Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA.
Sci Transl Med. 2021 Jun 30;13(600). doi: 10.1126/scitranslmed.abd6892.
Human heart failure, a leading cause of death worldwide, is a prominent example of a chronic disease that may result from poor cell renewal. The Hippo signaling pathway is an inhibitory kinase cascade that represses adult heart muscle cell (cardiomyocyte) proliferation and renewal after myocardial infarction in genetically modified mice. Here, we investigated an adeno-associated virus 9 (AAV9)-based gene therapy to locally knock down the Hippo pathway gene Salvador () in border zone cardiomyocytes in a pig model of ischemia/reperfusion-induced myocardial infarction. Two weeks after myocardial infarction, when pigs had left ventricular systolic dysfunction, we administered AAV9--short hairpin RNA (shRNA) or a control AAV9 viral vector carrying green fluorescent protein (GFP) directly into border zone cardiomyocytes via catheter-mediated subendocardial injection. Three months after injection, pig hearts treated with a high dose of AAV9--shRNA exhibited a 14.3% improvement in ejection fraction (a measure of left ventricular systolic function), evidence of cardiomyocyte division, and reduced scar sizes compared to pigs receiving AAV9-GFP. AAV9-shRNA-treated pig hearts also displayed increased capillary density and reduced cardiomyocyte ploidy. AAV9--shRNA gene therapy was well tolerated and did not induce mortality. In addition, liver and lung pathology revealed no tumor formation. Local delivery of AAV9--shRNA gene therapy to border zone cardiomyocytes in pig hearts after myocardial infarction resulted in tissue renewal and improved function and may have utility in treating heart failure.
人类心力衰竭是全球主要的致死病因之一,它是一种突出的慢性疾病,可能源于细胞更新不良。Hippo 信号通路是一种抑制性激酶级联反应,可在基因修饰小鼠的心肌梗死后抑制成年心肌细胞(心肌细胞)的增殖和更新。在这里,我们研究了一种基于腺相关病毒 9(AAV9)的基因治疗方法,通过导管介导的心内膜下注射,将 Hippo 通路基因 Salvador()的短发夹 RNA(shRNA)局部敲低到缺血/再灌注诱导的心肌梗死猪模型的边缘区心肌细胞中。心肌梗死后 2 周,当猪出现左心室收缩功能障碍时,我们将 AAV9--短发夹 RNA(shRNA)或携带绿色荧光蛋白(GFP)的对照 AAV9 病毒载体直接注入边缘区心肌细胞。注射后 3 个月,与接受 AAV9-GFP 的猪相比,接受高剂量 AAV9--shRNA 治疗的猪的射血分数(左心室收缩功能的一种测量)提高了 14.3%,有证据表明心肌细胞分裂和减少了疤痕大小。AAV9--shRNA 治疗的猪心脏还显示出毛细血管密度增加和心肌细胞倍性降低。AAV9--shRNA 基因治疗耐受性良好,不会引起死亡率。此外,肝脏和肺部病理学未发现肿瘤形成。心肌梗死后,将 AAV9--shRNA 基因治疗递送到猪心脏的边缘区心肌细胞,可导致组织更新和功能改善,可能对治疗心力衰竭具有实用价值。