Citations

Myxomatous mitral valve disease (MMVD) is associated with increases in valvular fibrosis, matrix remodeling, and transforming growth factor beta (TGF β) signaling. While interleukin 10 (IL‐10) can suppress tissue fibrosis and matrix metalloproteinase (MMP) expression, its role in MMVD is unknown. We tested the hypotheses that reduced IL‐10 expression contributes to increased tissue fibrosis in MMVD, and that IL‐10 tonically suppresses TGF‐β signaling in normal mitral valves. We used qRT‐PCR to measure expression of IL10, TGF‐β1, MMP 2 and 9, and connective tissue growth factor (CTGF) in normal and myxomatous human mitral valves and in mitral and tricuspid valves from wild‐type and IL‐10 knockout mice. IL‐10 expression was significantly reduced in human myxomatous valves compared to normal valves (53± 12%), and was associated with increases in TGFβ, CTGF, and MMP2. Mitral valve gene expression patterns in IL‐10 −/− mice favored fibrosis and matrix remodeling compared to wild‐type littermates, with increases in TGF β (132±7%), CTGF (154±3%), and MMP9 (259±7%) (p< 0.05 for all), but not MMP2. Interestingly, expression of these genes was not altered in tricuspid valves from IL‐10 −/− mice. Collectively, these data are the first to show that IL‐10 tonically suppresses TGF β signaling in normal mitral valves and that deficiency of IL‐10 is likely to contribute to fibrosis and matrix remodeling in MMVD. NHLBI

Myxomatous mitral valve disease is characterized by fibrosis and matrix degradation and increases in transforming growth factor beta‐1 (TGFbeta‐1). Little is known, however, about changes in molecules that regulate TGFbeta‐1 signaling in myxomatous valves. Thus, we tested the hypothesis that TGFbeta‐1 promotes valvular fibrosis and matrix remodeling in myxomatous valves through canonical Smad2 signaling and permissive reductions in Smad inhibitors. Expression of TGFbeta‐1, TGFbeta‐1 target genes (connective tissue growth factor, matrix metalloproteinases 2/9), E3 ubiquitin‐protein ligases (Smurf 1/2, which degrade Smad2), and NAD(P)H oxidase catalytic subunits (Nox 2, 4, and 5) was measured using quantitative real‐time RT‐PCR. Phospho‐Smad2 levels were measured using western blotting. TGFbeta‐1 expression was higher in myxomatous valves (138.3 ± 12.5% of control, n = 24 per group; p < 0.05), while CTGF and MMP2 were increased by 5‐ and 2‐fold, respectively. Surprisingly, phospho‐Smad2 levels were unchanged between myxomatous and control tissue due to selective increases in Smurf2 expression in myxomatous valve tissue (165.2 ± 17.7% of control, p < 0.05), as Smurf1 expression was unchanged. Expression of Nox2 and Nox4—which can drive pro‐fibrotic and matrix remodeling gene expression in other tissues—were significantly elevated in myxomatous valves (211 ± 44% and 224 ± 35 % of control, respectively; p < 0.05). In conclusion, our data suggest that canonical TGFbeta‐1/Smad2 signaling is not required for progression of myxomatous valve disease, and that reducing Nox2‐and Nox4‐derived reactive oxygen species may be a novel intervention to slow progression of fibrosis and matrix remodeling in myxomatous valves.