Gao Fu, Chen Qixin, Mori Makoto, Li Sufang, Ferrari Giovanni, Krane Markus, Fan Rong, Tellides George, Liu Yang, Geirsson Arnar
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA.
J Clin Invest. 2025 May 20;135(14). doi: 10.1172/JCI183558. eCollection 2025 Jul 15.
Mitral valve prolapse is often benign, but progression to mitral regurgitation may require invasive intervention and there is no specific medical therapy. An association of mitral valve prolapse with Marfan syndrome resulting from pathogenic FBN1 variants supports the use of hypomorphic fibrillin-1 mgR mice to investigate mechanisms and therapy for mitral valve disease. mgR mice developed severe myxomatous mitral valve degeneration with mitral regurgitation by 12 weeks of age. Persistent activation of TGF-β and mTOR signaling along with macrophage recruitment preceded histological changes at 4 weeks of age. Short-term mTOR inhibition with rapamycin from 4 to 5 weeks of age prevented TGF-β overactivity and leukocytic infiltrates, while long-term inhibition of mTOR or TGF-β signaling from 4 to 12 weeks of age rescued mitral valve leaflet degeneration. Transcriptomic analysis identified integrins as key receptors in signaling interactions, and serologic neutralization of integrin signaling or a chimeric integrin receptor altering signaling prevented mTOR activation. We confirmed increased mTOR signaling and a conserved transcriptome signature in human specimens of sporadic mitral valve prolapse. Thus, mTOR activation from abnormal integrin-dependent cell-matrix interactions drives TGF-β overactivity and myxomatous mitral valve degeneration, and mTOR inhibition may prevent disease progression of mitral valve prolapse.
二尖瓣脱垂通常是良性的,但进展为二尖瓣反流可能需要侵入性干预,且目前尚无特异性药物治疗。致病性FBN1变异导致的二尖瓣脱垂与马凡综合征相关,这支持使用低表达原纤维蛋白-1的mgR小鼠来研究二尖瓣疾病的发病机制和治疗方法。mgR小鼠在12周龄时出现严重的黏液瘤样二尖瓣退变并伴有二尖瓣反流。在4周龄时,TGF-β和mTOR信号的持续激活以及巨噬细胞募集先于组织学改变出现。在4至5周龄时用雷帕霉素进行短期mTOR抑制可防止TGF-β过度激活和白细胞浸润,而在4至12周龄时长期抑制mTOR或TGF-β信号可挽救二尖瓣小叶退变。转录组分析确定整合素是信号相互作用中的关键受体,整合素信号的血清学中和或改变信号的嵌合整合素受体可阻止mTOR激活。我们在散发性二尖瓣脱垂的人类标本中证实了mTOR信号增强和保守的转录组特征。因此,异常的整合素依赖性细胞-基质相互作用导致的mTOR激活驱动TGF-β过度激活和黏液瘤样二尖瓣退变,mTOR抑制可能预防二尖瓣脱垂的疾病进展。
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