Stadiotti Ilaria, Santoro Rosaria, Scopece Alessandro, Pirola Sergio, Guarino Anna, Polvani Gianluca, Maione Angela Serena, Ascione Flora, Li Qingsen, Delia Domenico, Foiani Marco, Pompilio Giulio, Sommariva Elena
Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy.
Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy.
Front Cardiovasc Med. 2022 Jun 23;9:878268. doi: 10.3389/fcvm.2022.878268. eCollection 2022.
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome characterized by impaired left ventricular (LV) diastolic function, with normal LV ejection fraction. Aortic valve stenosis can cause an HFpEF-like syndrome by inducing sustained pressure overload (PO) and cardiac remodeling, as cardiomyocyte (CM) hypertrophy and fibrotic matrix deposition. Recently, studies linked PO maladaptive myocardial changes and DNA damage response (DDR) activation: DDR-persistent activation contributes to mouse CM hypertrophy and inflammation, promoting tissue remodeling, and HF. Despite the wide acknowledgment of the pivotal role of the stromal compartment in the fibrotic response to PO, the possible effects of DDR-persistent activation in cardiac stromal cell (C-MSC) are still unknown. Finally, this novel mechanism was not verified in human samples. This study aims to unravel the effects of PO-induced DDR on human C-MSC phenotypes. Human LV septum samples collected from severe aortic stenosis with HFpEF-like syndrome patients undergoing aortic valve surgery and healthy controls (HCs) were used both for histological tissue analyses and C-MSC isolation. PO-induced mechanical stimuli were simulated by cyclic unidirectional stretch. Interestingly, HFpEF tissue samples revealed DNA damage both in CM and C-MSC. DDR-activation markers γH2AX, pCHK1, and pCHK2 were expressed at higher levels in HFpEF total tissue than in HC. Primary C-MSC isolated from HFpEF and HC subjects and expanded confirmed the increased γH2AX and phosphorylated checkpoint protein expression, suggesting a persistent DDR response, in parallel with a higher expression of pro-fibrotic and pro-inflammatory factors respect to HC cells, hinting to a DDR-driven remodeling of HFpEF C-MSC. Pressure overload was simulated , and persistent activation of the CHK1 axis was induced in response to mechanical stretching, which also increased C-MSC secreted pro-inflammatory and pro-fibrotic molecules. Finally, fibrosis markers were reverted by the treatment with a CHK1/ATR pathway inhibitor, confirming a cause-effect relationship. In conclusion we demonstrated that, in severe aortic stenosis with HFpEF-like syndrome patients, PO induces DDR-persistent activation not only in CM but also in C-MSC. In C-MSC, DDR activation leads to inflammation and fibrosis, which can be prevented by specific DDR targeting.
射血分数保留的心力衰竭(HFpEF)是一种异质性综合征,其特征为左心室(LV)舒张功能受损,而LV射血分数正常。主动脉瓣狭窄可通过诱导持续性压力超负荷(PO)和心脏重塑,如心肌细胞(CM)肥大和纤维化基质沉积,导致类似HFpEF的综合征。最近,研究将PO适应性不良的心肌变化与DNA损伤反应(DDR)激活联系起来:DDR的持续激活导致小鼠CM肥大和炎症,促进组织重塑和心力衰竭。尽管人们广泛认识到基质区室在对PO的纤维化反应中的关键作用,但DDR持续激活对心脏基质细胞(C-MSC)的可能影响仍不清楚。最后,这一新机制尚未在人类样本中得到验证。本研究旨在揭示PO诱导的DDR对人C-MSC表型的影响。从患有类似HFpEF综合征的严重主动脉瓣狭窄且接受主动脉瓣手术的患者以及健康对照(HC)中收集的人LV间隔样本用于组织学组织分析和C-MSC分离。通过周期性单向拉伸模拟PO诱导的机械刺激。有趣的是,HFpEF组织样本在CM和C-MSC中均显示出DNA损伤。DDR激活标志物γH2AX、pCHK1和pCHK2在HFpEF全组织中的表达水平高于HC。从HFpEF和HC受试者中分离并扩增的原代C-MSC证实γH2AX和磷酸化检查点蛋白表达增加,表明DDR反应持续存在,同时与HC细胞相比促纤维化和促炎因子的表达更高,提示HFpEF C-MSC存在DDR驱动的重塑。模拟压力超负荷,并在机械拉伸后诱导CHK1轴的持续激活,这也增加了C-MSC分泌的促炎和促纤维化分子。最后,用CHK1/ATR途径抑制剂治疗可使纤维化标志物恢复,证实了因果关系。总之,我们证明,在患有类似HFpEF综合征的严重主动脉瓣狭窄患者中,PO不仅在CM中诱导DDR持续激活,而且在C-MSC中也诱导DDR持续激活。在C-MSC中,DDR激活导致炎症和纤维化,通过特异性靶向DDR可预防这种情况。
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