Yves Schymura

5-HT2B Receptor Antagonists Inhibit Fibrosis and Protect from RV Heart Failure

Objective. The serotonin (5-HT) pathway was shown to play a role in pulmonary hypertension (PH), but its functions in right ventricular failure (RVF) remain poorly understood. The aim of the current study was to investigate the effects of Terguride (5-HT2A and 2B receptor antagonist) or SB204741 (5-HT2B receptor antagonist) on right heart function and structure upon pulmonary artery banding (PAB) in mice. Methods. Seven days after PAB, mice were treated for 14 days with Terguride (0.2 mg/kg bid) or SB204741 (5 mg/kg day). Right heart function and remodeling were assessed by right heart catheterization, magnetic resonance imaging (MRI), and histomorphometric methods. Total secreted collagen content was determined in mouse cardiac fibroblasts isolated from RV tissues. Results. Chronic treatment with Terguride or SB204741 reduced right ventricular fibrosis and showed improved heart function in mice after PAB. Moreover, 5-HT2B receptor antagonists diminished TGF-beta1 induced collagen synthesis of RV cardiac fibroblasts in vitro. Conclusion. 5-HT2B receptor antagonists reduce collagen deposition, thereby inhibiting right ventricular fibrosis. Chronic treatment prevented the development and progression of pressure overload-induced RVF in mice. Thus, 5-HT2B receptor antagonists represent a valuable novel therapeutic approach for RVF.

Pressure overload leads to an increased accumulation and activity of mast cells in the right ventricle

Right ventricular (RV) remodeling represents a complex set of functional and structural adaptations in response to chronic pressure or volume overload due to various inborn defects or acquired diseases and is an important determinant of patient outcome. However, the underlying molecular mechanisms remain elusive. We investigated the time course of structural and functional changes in the RV in the murine model of pressure overload‐induced RV hypertrophy in C57Bl/6J mice. Using magnetic resonance imaging, we assessed the changes of RV structure and function at different time points for a period of 21 days. Pressure overload led to significant dilatation, cellular and chamber hypertrophy, myocardial fibrosis, and functional impairment of the RV. Progressive remodeling of the RV after pulmonary artery banding (PAB) in mice was associated with upregulation of myocardial gene markers of hypertrophy and fibrosis. Furthermore, remodeling of the RV was associated with accumulation and activation of mast cells in the RV tissue of PAB mice. Our data suggest possible involvement of mast cells in the RV remodeling process in response to pressure overload. Mast cells may thus represent an interesting target for the development of new therapeutic approaches directed specifically at the RV.

Effect of Riociguat and Sildenafil on Right Heart Remodeling and Function in Pressure Overload Induced Model of Pulmonary Arterial Banding

Pulmonary arterial hypertension (PAH) is a progressive disorder characterized by remodeling of the pulmonary vasculature and a rise in right ventricular (RV) afterload. The increased RV afterload leads to right ventricular failure (RVF) which is the reason for the high morbidity and mortality in PAH patients. The objective was to evaluate the therapeutic efficacy and antiremodeling potential of the phosphodiesterase type 5 (PDE5) inhibitor sildenafil and the soluble guanylate cyclase stimulator riociguat in a model of pressure overload RV hypertrophy induced by pulmonary artery banding (PAB). Mice subjected to PAB, one week after surgery, were treated with either sildenafil (100 mg/kg/d, n = 5), riociguat (30 mg/kg/d, n = 5), or vehicle (n = 5) for 14 days. RV function and remodeling were assessed by right heart catheterization, magnetic resonance imaging (MRI), and histomorphometry. Both sildenafil and riociguat prevented the deterioration of RV function, as determined by a decrease in RV dilation and restoration of the RV ejection fraction (EF). Although both compounds did not decrease right heart mass and cellular hypertrophy, riociguat prevented RV fibrosis induced by PAB. Both compounds diminished TGF-beta1 induced collagen synthesis of RV cardiac fibroblasts in vitro. Treatment with either riociguat or sildenafil prevented the progression of pressure overload-induced RVF, representing a novel therapeutic approach.

Improvement of right heart structure and function by BAY 41-8543 in pulmonary artery banded mice

Background Receptors for the natriuretic peptides (NPs) ANP, BNP and CNP are highly expressed in lung, suggesting that this organ is an important physiological target for NP signalling. By stimulating vasoand bronchodilation and inhibiting cell proliferation and fibrotic processes, NPs may have therapeutic potential in various lung diseases. Mechanisms responsible for the relatively short half-life (few min) of NPs and the control of their local concentrations include (i) receptor-mediated internalization by the so called clearance receptor (NPR-C) and (ii) degradation by a membrane metalloprotease, called neutral endopeptidase (NEP) or neprilysin [1]. The velocity of peptide degradation/inactivation differs between ANP, BNP and CNP. Interestingly, cleavage of NPs by insulindegrading enzyme (IDE) [2] may have a particular role in NP signalling by generating peptide fragments that are hyperactive in receptor stimulation [3]. The physiological significance of NEP was supported by several studies in rodents showing that NEP inhibition leads to increased NP concentrations and activity. Moreover, we found that NEP inhibition is necessary and sufficient for detection of GC-A and GC-B by affinity labelling experiments with radioactive ANP or CNP in mouse and rat lung membrane preparations. Analogous assays, however, failed to label these receptors in human lung membranes, suggesting potent NP-degrading activity of NEP inhibitor-insensitive proteases. Methods and results ANP degradation by lung membranes in either the absence or presence of NEP inhibitors was analyzed by thin-layer-chromatography and mass spectrometry [2]. We found that NEP inhibition strongly reduces ANP degradation by rat and mouse but not human membranes. ANP-degrading activity in human lung membranes under conditions of NEP inhibition was very potent and even detectable with 1 ng of membrane protein. Like ANP, CNP was rapidly hydrolyzed. In both peptides, initial cleavage occurred at the same position within the conserved peptide ring structure being essential for biological activity. A second cleavage each was localized to the amino-terminus (behind Arg-4 or Lys-4, respectively). The cleavage sites are unrelated to those by NEP and IDE and indicate trypsin-like enzyme activity. Unlike ANP and CNP, BNP is a poor substrate and shows a completely different and complex cleavage pattern after prolonged incubation. The NEP inhibitor-insensitive protease was also detectable, albeit at much lower levels, in membranes from human aorta and mesenteric arteries, but not at all in placenta. Studies with various protease inhibitors revealed that leupeptin exposure potently inhibits NP degradation by this activity.

Correction: Improvement of right heart structure and function by BAY41-8543 in pulmonary artery banded mice.

P79 [1] was published in error and the correct text follows: Background Right heart failure is a prevalent mechanism of cardiovascular collapse and distinctly different from left heart failure. Afterload reduction has been the main focus to treat right ventricular (RV) dysfunction, but it cannot be achieved in many cases. A new strategy is to directly target increased RV hypertrophy. Pulmonary artery banding (PAB) is used to induce the RV hypertrophy, without any changes in the pulmonary vasculature. The nitric oxide (NO) pathway was shown to be crucially involved in the development of left ventricular hypertrophy. In this study we assessed the effects of the sGC stimulator BAY 41-8543, the PDE5 inhibitor sildenafil, and combination treatment on RV function and RV hypertrophy.