A mechanistic role for cardiac myocyte apoptosis in heart failure
Detlef Wencker, … , Robert C. Armstrong, Richard N. Kitsis
Detlef Wencker, … , Robert C. Armstrong, Richard N. Kitsis
Published May 15, 2003
Citation Information: J Clin Invest. 2003;111(10):1497-1504. https://doi.org/10.1172/JCI17664.
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A mechanistic role for cardiac myocyte apoptosis in heart failure

Abstract

Heart failure is a common, lethal condition whose pathogenesis is poorly understood. Recent studies have identified low levels of myocyte apoptosis (80–250 myocytes per 105 nuclei) in failing human hearts. It remains unclear, however, whether this cell death is a coincidental finding, a protective process, or a causal component in pathogenesis. Using transgenic mice that express a conditionally active caspase exclusively in the myocardium, we demonstrate that very low levels of myocyte apoptosis (23 myocytes per 105 nuclei, compared with 1.5 myocytes per 105 nuclei in controls) are sufficient to cause a lethal, dilated cardiomyopathy. Interestingly, these levels are four- to tenfold lower than those observed in failing human hearts. Conversely, inhibition of cardiac myocyte death in this murine model largely prevents the development of cardiac dilation and contractile dysfunction, the hallmarks of heart failure. To our knowledge, these data provide the first direct evidence that myocyte apoptosis may be a causal mechanism of heart failure, and they suggest that inhibition of this cell death process may constitute the basis for novel therapies.

Authors

Detlef Wencker, Madhulika Chandra, Khanh Nguyen, Wenfeng Miao, Stavros Garantziotis, Stephen M. Factor, Jamshid Shirani, Robert C. Armstrong, Richard N. Kitsis

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Very low levels of myocyte apoptosis are sufficient to cause a lethal, d...
Very low levels of myocyte apoptosis are sufficient to cause a lethal, dilated cardiomyopathy. (a) Kaplan-Meier survival curve of WT mice, and transgenic line 7, 169, and C360A mice that have never been treated with FK1012H2. P < 0.0001 for line 7 vs. WT, line C360A, or line 169. (b) Representative two-dimensionally directed M-mode echocardiograms through the interventricular septum (IVS) and left ventricular posterior wall (PW) from 9-week-old WT and transgenic line 7 mice in the absence of FK1012H2. The electrocardiogram is shown at the bottom of each echocardiogram. (c) Quantitation of M-mode echocardiographic parameters in conscious WT and transgenic line 7, 169, and C360A mice in the absence of FK1012H2. EDD, left ventricular end-diastolic dimension; FS, fractional shortening. *P < 0.01, **P < 0.001. (d) Left ventricular hemodynamics by cardiac catheterization in 9-week-old WT and transgenic line 7 mice under basal conditions or in response to isoproterenol (500 pg i.v.), in the absence of FK1012H2. LVEDP, left ventricular end-diastolic pressure. *P < 0.02, **P < 0.002. (e) Histological analysis of 9-week-old WT and transgenic line 7 mouse hearts in the absence of FK1012H2. Coronal sections stained with H&E (bar, 1 mm), and sections from the indicated area of the left ventricular free wall stained with Masson’s trichrome (bar, 25 μm). (f) Apoptotic cardiac myocytes in WT and transgenic mice in the absence of FK1012H2. Left panels: Double staining for TUNEL (green) and desmin (red, to identify myocytes) in paraffin sections from the hearts of 9-week-old WT and line 7 transgenic mice in the absence of FK1012H2. Bar, 10 μm. Right panel: Number of TUNEL-positive cardiac myocytes per 105 nuclei in 9-week-old WT and transgenic line 7 and C360A mice in the absence of FK1012H2. *P < 0.002, **P < 0.0003.