Citations

Marfan syndrome (MFS) is a genetic disease with a mutation for the microfibrillar constituent protein fibrillin-1 being the most prevalent. MFS is often associated with progressive aortic root dilation, ultimately progressing to aortic aneurysm and dissection. While recent work has shown that increased angiotensin-II receptor type-1 and transforming growth factor beta (TGF-β) signaling contributes to aneurysm formation in aorta, efficacious therapeutic targets remain elusive. Given previous reports of progeriod phenotypes in a subset of Marfan patients, we sought to determine whether there are molecular changes that are consistent with accelerated aging in a mouse model of Marfan syndrome. In mice carrying a loss-of-function mutation in fibrillin-1, we assessed aortic root dimensions by echocardiography and gene expression levels of TGF-β1-3, runt related transcription factor 2 (RUNX2), and the cellular senescent marker CDKN2A by quantitative real time PCR at 3 and 14 months of age. As expected, aortic sinus dimensions did not change significantly with aging in wild type mice, but increased dramatically in fibrillin-1 mutant mice compared to wild-type littermate controls and with age (p < 0.05 for both). TGF-β1 ligand expression paralleled age and disease-dependent changes in aortic dimensions, however TGF-β2 and TGF-β3 mRNA levels did not. Aortic dilatation was associated with increased gene expression of RUNX2 with aging and in marfanoid mice. Interestingly, fibrillin-1 mutant mice demonstrated marked increases in expression of the anti-proliferative cell-cycle checkpoint protein CDKN2A at both time points, and correlated with changes in TGF-β1 (R 2 =0.54) and RUNX2 (R 2 =0.69) mRNA. CDNK2A gene expression patterns, however, demonstrated a poor correlation with expression of TGF-β2 and TGF-β3 (R 2 =0.04 and 0.06. respectively). Collectively, these data lend insight into novel mechanisms that may regulate development of aortic root dilation in patients MFS and are the first to implicate increased senescent cell burden in Marfan syndrome. Furthermore, we propose that clearance of senescent cells could be a viable therapeutic intervention to slow progression aortic root-dilation and aneurysm in patients with Marfan syndrome.

Increasing age is the greatest risk factor for development and progression of calcific aortic valve disease (CAVD), and mitochondrial dysfunction has been implicated in the pathogenesis of cardiovascular calcification. Previous findings by our group suggested a significant reduction in expression of multiple sirtuin (SIRT) isoforms in normocholesterolemic aged mouse aortic valves, however, it is unclear if losses in SIRT3—a major mitochondrial SIRT isoform—modulates progression of aortic valve calcification. Therefore, we hypothesized that loss of SIRT3 in a hypercholesterolemic mouse model of CAVD will result in augmented calcium burden in aortic valve, increased osteogenic signaling, and impaired aortic valve function. To test this we used mice that were Ldlr -/- /ApoB 100/100 mice that were either wild-type (LA-SIRT3 +/+ ) or null for SIRT3 (LA-SIRT3 -/- ) and fed a western diet (TD88137) for 12 months. Alizarin red was used to quantitate calcium burden, qRT-PCR was used to measure changes in mRNA levels, and high-resolution echocardiography was used to assess aortic valve function (cusp separation distance). In line with our hypothesis, we observed a substantial increase in calcium burden in LA-SIRT3 -/- mice compared to their LA-SIRT3 +/+ littermates(11.7±4.0, 4.8±1.8; respectively). Interestingly, expression of Runx2 and osterix—classic markers of osteogenic differentiation—were decreased in LA-SIRT3 -/- mice compared to their LA-SIRT3 +/+ littermates. Expression of Msx2, were markedly increased in aortic valve tissue from LA-SIRT3-deficient mice. Despite these histological and molecular changes, SIRT3 deletion did not alter cusp separation distance (LA-SIRT3 +/+ = 0.81±0.04; LA-SIRT3 -/- = 0.81±0.02). Collectively, this data suggest losses in SIRT3 can contribute to accelerated valve calcification through unclear molecular mechanisms, but these changes are not sufficient to drive reductions in cusp separation distance. Additional experiments delineating the histopathological and molecular sequelae of SIRT3 deletion will be critical to understanding its role in the pathogenesis of CAVD.

Marfan syndrome is a connective tissue disorder frequently driven by mutations in the fibrillin-1 gene (Fbn1). This results in multiple aberrant cardiovascular phenotypes, including aortic aneurysm and mitral valve prolapse. While the molecular changes underlying aortic aneurysm formation have been extensively studied, the molecular underpinnings of mitral valve prolapse in this syndrome remain poorly understood. Therefore, we hypothesized that smad2/3 phosphorylation would be significantly increased in both aorta and mitral valve from Fbn1 +/1037G mice with Marfan syndrome and associated with impaired anti-inflammatory signaling in both tissues. We used young (3 months) mice that were wild-type (Fbn1 +/+ ) or fibrillin-1 mutant (Fbn1 +/1037G ) and fed a normal chow diet. qRT-PCR was used to measure mRNA levels in aortic arch and mitral valve tissue, and fluorescent immunohistochemistry to evaluate changes in canonical TGFβ signaling. Consistent with previous reports, TGF-β1 mRNA levels were increased in Fbn1 +/1037G compared to wild-type mice in both aorta and mitral valve. Interestingly, while p-SMAD2/3 protein levels were increased in aorta from Fbn1 +/1037G mice, we were surprised to find that p-SMAD2/3 protein levels were decreased in mitral valve from Fbn1 +/1037G mice compared their wild-type littermates. Given the emerging role of inflammatory signaling in accelerated development of Marfan phenotypes, we sought to determine whether there were compensatory or maladaptive changes in IL10 (a known inhibitor of p-SMAD2/3). In aorta, IL10 mRNA levels were decreased in Fbn1 +/1037G compared to Fbn1 +/+ mice, suggesting a maladaptive response. In contrast, IL10 levels in mitral valve tissue were significantly increased in Fbn1 +/1037G mice compared to their wild-type littermates, suggesting a compensatory/protective response. Collectively, these data suggest that tissue-specific changes in IL10 levels may modulate p-SMAD2/3 signaling in aorta and mitral valve, which may be a key permissive step in the onset of Marfan-related phenotypes. Future work to experimentally determine the role of IL10 in the regulation of canonical and non-canonical TGFβ signaling and the penetrance of Marfan-associated phenotypes is warranted.

Introduction: Hypertrophic cardiomyopathy (HCM) carries substantial lifelong morbidity. Mutations in sarcomeric proteins that lead to HCM cause excess contractility, poor relaxation, and inefficient energy utilization. Although obstructive physiology is a prominent feature of disease, approximately 30% of HCM patients experience symptoms in the context of non-obstructive HCM (nHCM). Management options are extremely limited with little other than cardiac transplantation to offer severely affected patients. Mavacamten (MAVA), a first-in-class small molecule, is a selective modulator of cardiac myosin that inhibits the cardiac myosin ATPase to reversibly attenuate cardiac contractility. In addition to its effects on contractility, MAVA has been shown to improve LV compliance in preclinical and clinical studies. The Phase 2 MAVERICK-HCM study is designed to evaluate safety and tolerability, and to provide pilot data on the effects of MAVA on biomarkers, cardiac function, and exercise capacity in nHCM. Methods: This double-blind study will enroll 60 individuals with nHCM (Left ventricular outflow tract gradient <30 mmHg; resting or provoked), NYHA Class II or III, and LVEF ≥55%. Subjects will be randomized 1:1:1 to one of two target plasma drug concentrations (Group 1: ~200 ng/mL and Group 2: ~500 ng/mL) or placebo for 16 weeks. The starting dose of MAVA is 5 mg, with one-step dose titration at Week 6 based on plasma drug concentration. Predefined criteria, including LVEF, will guide study drug discontinuation if indicated. Cardiopulmonary exercise testing will be performed at baseline and Week 16 to assess the impact on exercise capacity. The primary endpoint is the frequency and severity of treatment-emergent adverse events. The study design also includes multiple secondary endpoints including echocardiographic measures of diastolic function, NT-proBNP levels, patient reported outcomes, and physical activity by wearable accelerometer. An independent data monitoring committee will oversee safety. Conclusions: MAVERICK-HCM is testing a novel therapy to improve symptom burden in nHCM; a patient cohort currently lacking effective treatment. By targeting a core molecular mechanism of disease, MAVA has the potential to alter natural history.

Previous studies have reported increases in oxidative stress due to reductions in antioxidant enzymes in calcified regions of stenotic human aortic valves. Whether reductions in antioxidant enzymes are adaptive, maladaptive, or an epiphenomenon in calcifying aortic valves remains unclear. Thus, the purpose of this study was to test whether overexpression of catalase reduces valvular calcification and slows progression of aortic valve stenosis in mice. Wild type (WT) mice with calcific aortic valve disease (ldlr-deficient, apoB100-only) were crossed with transgenic mice that overexpress human catalase (TG). All mice were fed a western diet (TD88137; Harlan Teklad). Functional echocardiogram data was collected and analyzed at early (3 months) and advanced (12 months) stages of valve disease, and valves were OCT embedded, sectioned, and stained for calcium levels (Alizarin Red). The transgenic valves show a slight increase in calcification compared to wild type counterparts. While there were no differences in valve function between genotypes at the early time point, cusp separation was decreased in the transgenic mice (0.74 ± 0.02 mm) compared to their wild-type littermates (0.84 ± 0.03 mm) at the 12 month time point (p < 0.05). In a subset of animals, valve calcification also tended to increase in transgenic mice at both time points compared to their wild-type littermates. In conclusion, overexpression of catalase resulted in a surprising finding of accelerated valvular calcification and stenosis. Interestingly, this finding aligns with the findings from several negative clinical trials testing antioxidant therapies in humans with atherosclerosis, suggests that the net impact of changing redox balance on disease progression are highly context dependent, and that increasing antioxidant capacity may not be a viable strategy to slow progression of calcific aortic valve disease in humans.

Endothelial dysfunction and arterial stiffening major risk factors associated with progression of atherosclerosis and increased risk of acute coronary events. Recent data suggest sirtuins may play a role in protecting against a variety age-related diseases, and we recently reported that sirtuins are reduced in the aging vasculature. The roles of SIRT3 (a deacetylase that is largely restricted to the mitochondria) in the regulation of vasomotor function and arterial stiffness, however, remains poorly understood. Therefore, we hypothesized that genetic inactivation of SIRT3 in hypercholesterolemic mice will impair endothelial function and reduce vascular compliance compared to hypercholesterolemic mice with normal levels of SIRT3. We used Ldlr -/- /ApoB 100/100 (LA) mice that were either wild-type for SIRT3 (LA-SIRT3 +/+ ) or null for SIRT3 (LA-SIRT3 -/- ) and fed a western diet for 12 months. At time of sacrifice, aorta was removed for isolated organ chamber baths to measure changes in endothelium-dependent relaxation to acetylcholine (ACH), and carotid arteries were harvested to assess changes in vascular compliance using a pressurized cannulation system. Surprisingly, losses of SIRT3 did not impair relaxation to ACH in aorta compared to LA-SIRT3 +/+ mice (38.2±4.4%, 37.0±4.4%, respectively). Furthermore, reductions in SIRT3 did not impact vascular compliance or distensibility in carotid arteries from the same animals. In conclusion, in contrast to our hypothesis, inactivation of SIRT3 does not impact vasomotor function or conduit vessel compliance in advanced atherosclerosis. Importantly, this and may be explained by a “floor-effect”, and future work examining the effect of SIRT3 overexpression on vascular function and pathology will be instrumental in determining its biological role and ultimate therapeutic utility.

Activation of NADPH oxidase is a major contributor to hypertension, reactive oxygen species generation, endothelial dysfunction and increased vascular distensibility in angiotensin II (AngII)‐induced hypertension. Since exercise has been associated with increased antioxidant enzyme expression in blood vessels, we hypothesized that exercise training would improve endothelial function and vascular distensibility in mice with AngII‐induced hypertension. C57BL/6J mice received saline or AngII (1000 ng/kg/min) via osmotic minipumps, and were assigned to sedentary or treadmill exercise groups (13 m/min for 30 minutes, 5 days/week) for 14 days. Endothelium‐dependent relaxation in response to acetylcholine and arterial distensibility were assessed in carotid arteries using a pressurized arteriograph system. Gene expression was examined by qRT‐PCR. In AngII‐treated sedentary mice, endothelium‐dependent relaxation was impaired, while distensibility was higher than in saline‐infused sedentary mice. Compared to AngII‐infused sedentary mice, however, endothelium‐dependent relaxation was partially improved, and distensibility normalized in AngII‐infused exercised mice. In response to exercise, mRNA levels of SOD1 and SOD2 in aorta were increased, while mRNA levels of NOX2 were reduced. We conclude that exercise training can dramatically improve endothelial dysfunction and reverse derangements in carotid distensibility following prolonged AngII‐induced hypertension. Additional work examining mechanisms underlying our observed transcriptional changes will be critical to development of novel therapeutic targets.

We previously reported that MnSOD‐deficiency does not cause overt vasomotor dysfunction in aged or hypercholesterolemic mice. To determine whether increasing MnSOD protects against vasomotor dysfunction and deleterious molecular changes in atherosclerosis, we crossed hypercholesterolemic mice with mice overexpressing MnSOD to test the hypothesis that lifelong increases in MnSOD protect against vasomotor dysfunction. We used Ldlr ‐/‐ /ApoB 100/100 mice that were wild‐type (MnSOD 0/0 ) or transgenic (MnSOD Tg/0 ) and fed a western diet for 6 months. We used organ bath chambers to measure aortic endothelium‐dependent relaxation (relaxation to acetylcholine, Ach), and mRNA from aortic arch was used for qRT‐PCR. Surprisingly, relaxation to Ach was unchanged between MnSOD 0/0 and MnSOD Tg/0 mice, as was relaxation to sodium nitroprusside. As expected, gene expression of MnSOD was significantly increased in the MnSOD Tg/0 mice compared to MnSOD 0/0 mice. Unlike our findings in MnSOD +/‐ mice, however (where Nox2 was increased), Nox2 expression was unchanged between MnSOD 0/0 and MnSOD Tg/0 mice. Importantly, markers of osteogenesis such as Runx2 and BMP2 were unchanged between genotypes. Furthermore, MnSOD overexpression did not alter cellular senescence markers. Collectively, our data support the surprising conclusion that physiologically relevant increases in MnSOD do not significantly affect endothelial function or molecular regulators of histopathological changes in advanced atherosclerosis in hypercholesterolemic mice.

Physical resilience, defined as the ability to resist and respond to challenges and return to homeostasis, has been postulated to be a determinant of healthspan and lifespan. To test this premise, we have begun to optimize a standardized, clinically relevant battery of resilience challenges, including anesthesia and cisplatin chemotherapy, and recovery outcome measures in younger (2–3 month) and older (26–29 month) mice. We have also started to test whether interventions shown to increase murine lifespan‐acarbose, rapamycin, and 17a‐estradiol‐impact the resilience of older mice. Our preliminary data demonstrate that younger mice (n = 10) have faster dorsal to sternal recumbence recovery time compared to older mice (n = 8) (39 ± 1 sec vs. 67 ± 6 sec, p < 0.001) following a 5‐minute 4% isoflurane anesthesia challenge. In response to a 5‐day cisplatin (2 mg/kg/day) challenge, both younger (n=5) and older (n=4) mice lost a significant percent of their baseline body weight (younger mice −10.6 ± 0.8% and older mice −13.2 ± 2.1%, p = 0.26), however, older mice failed to regain body weight 11 days after the challenge (younger mice −0.9 ± 0.8% and older mice −9.8 ± 0.8%, p < 0.01). Changes in body weight in younger and older mice were largely attributable to the loss/regain of fat mass. Interestingly, 8 weeks of either acarbose (1,000 ppm) or 17α‐estradiol (14.4 ppm) administration to older female mice improved body weight recovery after the cisplatin challenge, while rapamycin (14 ppm) had no appreciable effect. Our preliminary results demonstrate that younger mice, as expected, have greater resilience than older mice to clinically relevant physical challenges. The age at which physical resilience starts to decline requires further investigation. Our early observations suggest interventions that extend health‐ and lifespan may impact resilience in older mice. Ultimately, a standardized battery of resilience challenges may provide a new framework for testing and translating interventions that target the fundamental biology of aging. Support or Funding Information This work was supported by grant AG52958 from the National Institutes of Health. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .

Sirtuin 3 (SIRT3)—a deacetylase localized to the mitochondria—deacetylates a number of mitochondria‐specific proteins, including the mitochondrial antioxidant enzyme MnSOD. We previously reported that genetic inactivation of SIRT3 impairs endothelial function and increases pro‐osteogenic markers in early stages of atherosclerosis. While recent data suggest that the molecular and phenotypic effects of SIRT enzyme inactivation can act in a highly sex‐dependent manner, we have not systematically studied sex differences in our unique mouse strains. Here, we report our first effort to explore the presence of molecular and phenotypic sex differences following inactivation of SIRT3 in hypercholesterolemic mice. We used female and male Ldlr −/− /ApoB 100/100 mice that were either wild‐type (LA‐SIRT3 +/+ ) or null for SIRT3 (LA‐SIRT3 −/− ). Following 3 months of western diet feeding, we assessed endothelial function of aorta using isolated organ bath chambers and measured changes in gene expression using qRT‐PCR. We did not observe sex differences at baseline in hypercholesterolemic mice, as endothelium‐dependent relaxation to acetylcholine (ACH) was similar between female LA‐SIRT3 +/+ and their male LA‐SIRT3 +/+ littermates (61.1%±2.2, 57.9%±2.7; respectively). Interestingly, genetic inactivation of SIRT3 did not impair responses to ACH in female LA‐SIRT3 −/− mice (61.1%±4.2), whereas responses to ACH were modestly impaired in male LA‐SIRT3 −/− mice (53.9%±1.9). Consistent with SIRT3's role as a post‐translational protein modifier, expression of MnSOD was unchanged across all sexes and genotypes. Expression of genes related to pathophysiological changes in atherosclerotic plaques did change in a highly sex‐dependent manner, however, as osterix gene expression levels (related to plaque calcification) were markedly increased in male LA‐SIRT3 −/− compared to their sex‐matched wild‐type littermates and to their female counterparts. Surprisingly, while female LA‐SIRT3 −/− mice showed dramatic increases in expression of interleukin 6 (related to inflammation) compared to their wild‐type littermates, male LA‐SIRT3 −/− had robust reductions in expression in interleukin 6 compared to their LA‐SIRT3 +/+ littermates. Collectively, these data suggest there are significant, sex‐dependent molecular and phenotypic effects of SIRT3 inactivation in hypercholesterolemic mice, which may also drive a paradoxical dissociation between pro‐osteogenic and pro‐inflammatory signaling under conditions of mitochondrial dysfunction. Support or Funding Information NHLBI R01‐HL111121 This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .