Potential Role of SESN3 in Linking Heart Failure with Preserved Ejection Fraction and Chronic Obstructive Pulmonary Disease via Autophagy Dysregulation.

Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a systemic disorder, often coexisting with chronic obstructive pulmonary disease (COPD). This study aims to identify the shared pathogenic mechanisms between HFpEF and COPD and validate them in an experimental HFpEF model. Transcriptomic datasets from HFpEF cardiac tissue and COPD lung tissue were analyzed using differentially expressed gene (DEG) analysis, weighted gene co-expression network analysis (WGCNA), and functional enrichment analysis. Key genes were identified through least absolute shrinkage and selection operator (LASSO) regression. Immune cell infiltration was assessed using xCell and CIBERSORT, and single-cell RNA sequencing (scRNA-seq) was utilized to determine gene expression patterns across different cell populations. A high-fat diet and N[w]-nitro-L-arginine methyl ester (L-NAME)-induced HFpEF mouse model was established, and the expression of and autophagy-related markers was evaluated in both cardiac and pulmonary tissues using immunofluorescence, quantitative PCR (qPCR), Western blotting (WB), and transmission electron microscopy. DEG and WGCNA analyses identified 1243 and 131 core genes in HFpEF and COPD, respectively. Functional enrichment analysis highlighted autophagy as a common regulatory pathway in both conditions. Among the nine intersecting genes, was identified as a key candidate through LASSO regression. Immune infiltration analysis and scRNA-seq further demonstrated the involvement of in both cardiac and pulmonary pathophysiology. In vivo experiments showed that HFpEF mice exhibited significant lung injury. Furthermore, upregulation and autophagy dysregulation were observed in both heart and lung tissues, supporting a potential systemic role of -mediated autophagy in HFpEF-related pulmonary alterations. This study suggests that -mediated autophagy may represent a shared mechanism between HFpEF and COPD. Our findings suggest that HFpEF may be associated with pulmonary alterations beyond cardiac dysfunction alone. These results provide novel insights into the potential multi-organ involvement in HFpEF and support the role of SESN3 as a shared molecular target in both cardiac and pulmonary pathologies.