Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida, United States.
Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, United States.
Am J Physiol Heart Circ Physiol. 2023 Jun 1;324(6):H739-H750. doi: 10.1152/ajpheart.00601.2022. Epub 2023 Mar 10.
Heart failure (HF) with preserved ejection fraction (HFpEF) represents a major unmet medical need owing to its diverse pathophysiology and lack of effective therapies. Potent synthetic, agonists (MR-356 and MR-409) of growth hormone-releasing hormone (GHRH) improve the phenotype of models of HF with reduced ejection fraction (HFrEF) and in cardiorenal models of HFpEF. Endogenous GHRH exhibits a broad range of regulatory influences in the cardiovascular (CV) system and aging and plays a role in several cardiometabolic conditions including obesity and diabetes. Whether agonists of GHRH can improve the phenotype of cardiometabolic HFpEF remains untested and unknown. Here we tested the hypothesis that MR-356 can mitigate/reverse the cardiometabolic HFpEF phenotype. C57BL6N mice received a high-fat diet (HFD) plus the nitric oxide synthase inhibitor (l-NAME) for 9 wk. After 5 wk of HFD + l-NAME regimen, animals were randomized to receive daily injections of MR-356 or placebo during a 4-wk period. Control animals received no HFD + l-NAME or agonist treatment. Our results showed the unique potential of MR-356 to treat several HFpEF-like features including cardiac hypertrophy, fibrosis, capillary rarefaction, and pulmonary congestion. MR-356 improved cardiac performance by improving diastolic function, global longitudinal strain (GLS), and exercise capacity. Importantly, the increased expression of cardiac pro-brain natriuretic peptide (pro-BNP), inducible nitric oxide synthase (iNOS), and vascular endothelial growth factor-A (VEGF-A) was restored to normal levels suggesting that MR-356 reduced myocardial stress associated with metabolic inflammation in HFpEF. Thus, agonists of GHRH may be an effective therapeutic strategy for the treatment of cardiometabolic HFpEF phenotype. This randomized study used rigorous hemodynamic tools to test the efficacy of a synthetic GHRH agonist to improve cardiac performance in a cardiometabolic HFpEF. Daily injection of the GHRH agonist, MR-356, reduced the HFpEF-like effects as evidenced by improved diastolic dysfunction, reduced cardiac hypertrophy, fibrosis, and pulmonary congestion. Notably, end-diastolic pressure and end-diastolic pressure-volume relationship were reset to control levels. Moreover, treatment with MR-356 increased exercise capacity and reduced myocardial stress associated with metabolic inflammation in HFpEF.
心力衰竭(HF)合并射血分数保留(HFpEF)是一种主要的未满足的医学需求,因为它具有多种病理生理学机制,且缺乏有效的治疗方法。生长激素释放激素(GHRH)的强力合成激动剂(MR-356 和 MR-409)可改善射血分数降低的心力衰竭(HFrEF)模型和心力衰竭的心脏肾模型的表型。内源性 GHRH 在心血管(CV)系统和衰老中表现出广泛的调节作用,并在包括肥胖和糖尿病在内的几种心脏代谢疾病中发挥作用。GHRH 的激动剂是否可以改善心脏代谢性 HFpEF 的表型仍未得到测试和未知。在这里,我们测试了这样一个假设,即 MR-356 可以减轻/逆转心脏代谢性 HFpEF 的表型。C57BL6N 小鼠接受高脂肪饮食(HFD)加一氧化氮合酶抑制剂(l-NAME)治疗 9 周。在 HFD + l-NAME 方案 5 周后,动物被随机分配在 4 周期间接受每日 MR-356 或安慰剂注射。对照动物未接受 HFD + l-NAME 或激动剂治疗。我们的结果表明,MR-356 具有独特的潜力,可以治疗几种 HFpEF 样特征,包括心脏肥大、纤维化、毛细血管稀疏和肺充血。MR-356 通过改善舒张功能、整体纵向应变(GLS)和运动能力来改善心脏功能。重要的是,心脏脑钠肽前体(pro-BNP)、诱导型一氧化氮合酶(iNOS)和血管内皮生长因子-A(VEGF-A)的表达增加恢复到正常水平,这表明 MR-356 降低了与 HFpEF 代谢性炎症相关的心肌应激。因此,GHRH 的激动剂可能是治疗心脏代谢性 HFpEF 表型的有效治疗策略。这项随机研究使用严格的血液动力学工具来测试合成 GHRH 激动剂改善心脏代谢性 HFpEF 心脏功能的疗效。生长激素释放激素激动剂 MR-356 的每日注射减少了 HFpEF 样作用,表现为舒张功能障碍改善、心脏肥大、纤维化和肺充血减少。值得注意的是,舒张末期压力和舒张末期压力-容积关系恢复到对照水平。此外,MR-356 治疗增加了运动能力,并降低了与 HFpEF 代谢性炎症相关的心肌应激。