Skeletal muscle alterations in tachycardia-induced heart failure are linked to deficient natriuretic peptide signalling and are attenuated by RAS-/NEP-inhibition.

Abstract

BACKGROUND:

Heart failure induced cachexia is highly prevalent. Insights into disease progression are lacking.

METHODS:

Early state of left ventricular dysfunction (ELVD) and symptomatic systolic heart failure (HF) were both induced in rabbits by tachypacing. Tissue of limb muscle (LM) was subjected to histologic assessment. For unbiased characterisation of early and late myopathy, a proteomic approach followed by computational pathway-analyses was performed and combined with pathway-focused gene expression analyses. Specimen of thoracic diaphragm (TD) served as control for inactivity-induced skeletal muscle alterations. In a subsequent study, inhibition of the renin-angiotensin-system and neprilysin (RAS-/NEP) was compared to placebo.

RESULTS:

HF was accompanied by loss of protein content (8.7±0.4% vs. 7.0±0.5%, mean±SEM, control vs. HF, p<0.01) and a slow-to-fast fibre type switch, establishing hallmarks of cachexia. In ELVD, the enzymatic set-up of LM and TD shifted to a catabolic state. A disturbed malate-aspartate shuttle went well with increased enzymes of glycolysis, forming the enzymatic basis for enforced anoxic energy regeneration. The histological findings and the pathway analysis of metabolic results drew the picture of suppressed PGC-1α signalling, linked to the natriuretic peptide system. In HF, natriuretic peptide signalling was desensitised, as confirmed by an increase in the ratio of serum BNP to tissue cGMP (57.0±18.6pg/ml/nM/ml vs. 165.8±16.76pg/ml/nM/ml, p<0.05) and a reduced expression of natriuretic peptide receptor-A. In HF, combined RAS-/NEP-inhibition prevented from loss in protein content (8.7±0.3% vs. 6.0±0.6% vs. 8.3±0.9%, Baseline vs. HF-Placebo vs. HF-RAS/NEP, p<0.05 Baseline vs. HF-Placebo, p = 0.7 Baseline vs. HF-RAS/NEP).

CONCLUSIONS:

Tachypacing-induced heart failure entails a generalised myopathy, preceding systolic dysfunction. The characterisation of "pre-cachectic" state and its progression is feasible. Early enzymatic alterations of LM depict a catabolic state, rendering LM prone to futile substrate metabolism. A combined RAS-/NEP-inhibition ameliorates cardiac-induced myopathy independent of systolic function, which could be linked to stabilised natriuretic peptide/cGMP/PGC-1α signalling.

• Authors: Alexander Dietl, Ingrid Winkel, Gabriela Pietrzyk, Michael Paulus, Astrid Bruckmann, Josef A Schröder, Samuel Sossalla, Andreas Luchner, Lars S Maier, Christoph Birner
• Journal: PloS one (PLoS One) Vol. 14 Issue 12 Pg. e0225937 ( 2019) ISSN: 1932-6203 [Electronic] United States
• PMID: 31800630 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Natriuretic Peptides
• ras Proteins

Topics

• Animals
• Biological Transport
• Biomarkers
• Disease Models, Animal
• Echocardiography
• Gene Expression Profiling (methods)
• Heart Failure (diagnosis, etiology, metabolism)
• Mitochondria, Muscle (genetics, metabolism)
• Muscle, Skeletal (metabolism, pathology, ultrastructure)
• Natriuretic Peptides (genetics, metabolism)
• Proteomics (methods)
• Rabbits
• Signal Transduction
• Tachycardia (complications, diagnosis)
• ras Proteins (antagonists & inhibitors, metabolism)