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Am J Physiol Heart Circ Physiol 284: H268-H276, 2003. First published September 26, 2002; doi:10.1152/ajpheart.00707.2002
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Vol. 284, Issue 1, H268-H276, January 2003

Alterations in apoptotic signaling in human idiopathic cardiomyopathic hearts in failure

Charles Steenbergen1,*, Cynthia A. Afshari2,*, John G. Petranka3, Jennifer Collins2, Karla Martin2, Lee Bennett2, Astrid Haugen2, Pierre Bushel2, and Elizabeth Murphy3

1 Department of Pathology, Duke University Medical Center, Durham 27710; and 2 Microarray Center and 3 Laboratory of Signal Transduction, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina 27709


    ABSTRACT
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

Dilated cardiomyopathy, a disease of unknown etiology and pathogenesis, is associated with heart failure and compensatory hypertrophy. Although cell and animal models suggest a role for altered gene expression in the transition to heart failure, there is a paucity of data derived from the study of human heart tissue. In this study, we used DNA microarray profiling to investigate changes in the expression of genes involved in apoptosis that occur in human idiopathic dilated cardiomyopathic hearts that had progressed to heart failure. We observed altered gene expression consistent with a proapoptotic shift in the TNF-alpha signaling pathway. Specifically, we found decreased expression of TNF-alpha - and NF-kappa B-induced antiapoptotic genes such as growth arrest and DNA damage-inducible (GADD)45beta , Flice inhibitory protein (FLIP), and TNF-induced protein 3 (A20). Consistent with a role for apoptosis in heart failure, we also observed a significant decrease in phosphorylation of BAD at Ser-112. This study identifies several pathways that are altered in human heart failure and provides new targets for therapy.

TNF-alpha ; GADD45beta ; BAD; gene profiling


    INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

REDUCED CARDIAC FUNCTION and/or hemodynamic overload lead to cardiac hypertrophy, which is initially a compensatory response but eventually transitions to heart failure. The mechanism(s) responsible for the development of cardiomyopathy, hypertrophy, and the transition to heart failure is poorly understood (12). Although it has been suggested that an increase in apoptosis contributes to the transition to heart failure (21), there are questions about the role of apoptosis in heart failure (14, 23). Apoptosis is regulated by the balance between the activation of survival pathways versus proapoptotic pathways. Examining the apoptotic state in heart failure is complicated because there are a plethora of pro- and antiapoptotic genes. In addition, it is likely that a shift to a more proapoptotic state would result in compensatory changes to oppose apoptosis. Therefore, to assess the role of apoptosis, it is important to examine alterations in gene expression in a large panel of apoptotic genes. To address the role of apoptosis in heart failure, we used DNA microarray profiling to identify patterns of expression changes in a number of apoptotic genes. We reasoned that if increased apoptosis was causally important in the transition to heart failure, then there would be a proapoptotic shift in the expression of key apoptotic genes. Also, because there are multiple apoptotic pathways, an additional aim was to identify which apoptotic pathways are involved. Elucidation of these pathways would allow development of new targets for therapeutic intervention to reduce myocyte loss.

We performed DNA microarray profiling on four idiopathic cardiomyopathic hearts in failure versus five pooled control hearts. Interestingly, we found decreased expression of several antiapoptotic genes that are induced by TNF-alpha via activation of NF-kappa B. TNF-alpha is elevated in heart failure patients (28), and cardiac-specific overexpression of TNF-alpha results in a dilated cardiomyopathy (17). Furthermore, treatment with a soluble TNF receptor lowered TNF-alpha in patients and improved left ventricular function (4). TNF-alpha can stimulate apoptosis; however, an increase in TNF-alpha signaling does not lead to myocyte apoptosis when the NF-kappa B pathway is activated by TNF-alpha (16, 19), presumably because activation of NF-kappa B leads to increased expression of several antiapoptotic genes, such as growth arrest and DNA damage-inducible (GADD)45beta , Flice inhibitory protein (FLIP), and TNF-induced protein 3 (A20) (3). We report that failing human hearts have decreased expression of the TNF-alpha - and NF-kappa B-induced antiapoptotic genes GADD45beta , FLIP, and A20 and increased expression of TNF receptor superfamily member (TNFRSM) 10 [TNF-related apoptosis-inducing ligand (TRAIL)]. These data suggest that decreased expression of NF-kappa B-induced antiapoptotic genes may be important in the shift in TNF-alpha signaling toward enhanced apoptosis during heart failure.

We also examined the phosphorylation status of bcl-2 and BAD and found a significant decrease in phospho-BAD (Ser-112) in failing hearts. This decrease in phospho-BAD would also be consistent with a proapoptotic shift in heart failure. To our knowledge, this is the first report of decreased levels of phospho-BAD in failing human myocardium.


    METHODS
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ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

Tissue collection. Human left ventricular myocardium was obtained from explanted cardiomyopathic hearts from patients with end-stage heart failure undergoing heart transplantation, following Institutional Review Board guidelines. These patients were on a variety of medications that could alter gene expression. Heart tissue was snap frozen in liquid nitrogen within 15 min of excision and remained frozen in liquid nitrogen until RNA extraction. The microarray study samples were obtained from four idiopathic cardiomyopathic hearts (all males, mean age ± SE = 54 ± 4 yr). Table 1 provides details of the patient's age, sex, and diagnosis and the assays performed on each sample. One idiopathic failing heart (heart 004) was from a patient on a left ventricular assist device (LVAD). For the microarray study, we also included a pooled sample from seven ischemic dilated cardiomyopathic hearts (all males, 56 ± 3 yr). Samples were taken from the left ventricle in noninfarcted, nonfibrotic areas. For the real-time PCR validation, we also included an additional two idiopathic cardiomyopathic hearts from patients on LVADs for RT-PCR analysis (males, age 45 and 60 yr). For the phospho-BAD Western blot measurement, these two hearts from LVAD patients were also included along with an additional seven idiopathic cardiomyopathic hearts. Nonfailing left ventricular myocardium was obtained from donor hearts (National Disease Resource International; Philadelphia, PA) that could not be used for transplantation due to technical problems or the age of the donor. All nonfailing hearts were normal in size and had no grossly apparent infarcts. Random sections had normal histology. Nonfailing samples were obtained from five males and three females. Of the eight donor hearts, an echocardiogram was performed on three hearts and was normal in two of three hearts. The ejection fraction was 30% in the heart with the abnormal echocardiogram, and this patient was given dopamine after an intracranial hemorrhage. RNA was isolated from the tissue using a Qiagen RNeasy kit. Formaldehyde gel electrophoresis was run to assess RNA quality; for all samples, the 28S RNA band was twice the intensity of the 18S RNA band.

                              
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Table 1.   Patient characteristics and biochemical assays performed

Microarray hybridization experiments. cDNA microarray chips containing 1,920 human cDNAs were prepared using previously described protocols (9). cDNAs (Research Genetics; Huntsville, AL) were derived from the 3' end of the gene and ranged in size from 500 to 2,000 base pairs. Briefly, vector primers were used to amplify insert cDNAs from purified plasmid DNA in a 100-µl PCR. The PCR products were run on 2% agarose gels to ensure quality of the reactions and purified by ethanol precipitation. We routinely perform resequencing of our clones to confirm their identity. Updated clone information is available on the web site http://dir.niehs.nih.gov/mirroarray/clones. The purified cDNAs were resuspended in ArrayIt buffer (Telechem; San Jose, CA) and spotted in house onto poly-L-lysine-coated glass slides using a modified, robotic DNA arrayer (Beecher Instruments; Bethesda, MD). Total RNA (35 µg) was labeled with Cy3- and Cy5-conjugated dUTP (Amersham; Piscataway, NJ) using a reverse transcription reaction and hybridized to the cDNA microarray chip. cDNA chips were scanned using an Axon Scanner (Axon Instruments; Foster City, CA), and images were analyzed using the Array Suite Software (Scanalytics; Fairfax, VA). The relative fluorescence intensity with subtraction of the local background values was measured for each labeled RNA, and a ratio of the values for the intensity of each fluor bound to each probe was calculated. The amount of autofluorescence generated in the Cy3 channel was measured, and a minimum intensity cutoff was set just above this value. The distribution of the ratio of all of the genes was analyzed and normalized based on the median value of a panel of 84 control genes. The distribution of the ratio of all of the genes was then calculated, and intensity ratio values that differed from the median with a confidence interval >95.0% (7) were scored as significant changes.

The probability of detecting a change in gene expression by random chance was calculated by binomial probability (5). With the use of a microarray chip containing 1,920 genes, in a single hybridization, one would expect 240 outliers by random chance; triplicate hybridizations reduces this number to a value <1 occurring in all three hybridizations. Each RNA was labeled and hybridized in three or four independent reactions with each RNA sample labeled with each fluor (Cy3 and Cy5). The coefficient of variance for each hybridization was <0.2. A database tool, MAPS (11), was used to compile the overall list of genes that were consistently and significantly changed across the multiple hybridizations of failing versus nonfailing hearts.

To perform hybridizations of all five nonfailing hearts versus all four failing hearts in triplicate would require 60 hybridizations; because this was not feasible, we ran each failing heart versus the pooled nonfailing sample in triplicate or quadruplicate. The pooled nonfailing sample was composed of nonfailing hearts 001, 021, 026, 031, and 032. We evaluated the variability among the nonfailing hearts by hybridizing in duplicate each individual nonfailing heart against RNA from the same cardiomyopathic heart (failing heart 002). Hierarchical cluster analysis confirmed the similarity of the control hearts and was accomplished using the Cluster/Treeview package developed by Eisen et al. (11). We also performed quadruplicate hybridizations on a pooled sample from seven ischemic dilated cardiomyopathic hearts versus the pooled control.

Verification. Quantitative real-time PCR (RT-PCR) was used to verify altered expression of several of the apoptotic genes, including GADD45beta , heat shock protein (HSP)22 (protein kinase H11), TNFRSM 10 (TRAIL), TNF receptor 1A, A20, MAPK-activating death domain (MADD), p21, and cyclin D. The primer sequences used in RT-PCR are shown in Table 2. First-strand synthesis was conducted for 60 min at 48°C in a 10-µl reaction containing 100 ng total RNA, 5.5 mM MgCl2, 2.5 µM random hexamer primers, 2 µM dNTPs, 4 units RNase inhibitor, and 12.5 units murine leukemia virus reverse transcriptase. The real-time PCR reaction consisted of the first-strand synthesis reaction, to which was added 4 mM MgCl2, 0.8 mM dNTPs, 1× SYBR green PCR buffer (PE Biosystems), 0.4 µM gene-specific forward and reverse primers, and 2.5 units AmpliTaq Gold DNA polymerase (PE Biosystems). The reaction was monitored using an Applied Biosystems PRISM 7700 detection system. mRNA expression was normalized to that of glyceraldehyde-3-phosphate dehydrogenase (GAPDH).

                              
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Table 2.   Primer sequences used in RT-PCR

For Western blot analysis, ~0.5 g of tissue were homogenized in 2 ml of ice-cold lysis buffer, which contained 70 mmol/l NaCl, 20 mmol/l HEPES (pH 7.7), 2.5 mmol/l MgCl2, 0.1 mmol/L EDTA, 0.1% Triton X-100, 200 µg/ml PMSF, 20 mmol/l glycerophosphate, 0.5 mmol/l DTT, 0.1 mmol/l Na3VO4, 1 mmol/l NaF, 10 µg/ml aprotinin, and 4 µg/ml leupeptin. After 10 min on ice in lysis buffer, the samples were centrifuged at 20,000 g for 10 min at 4°C, and the supernatants were used for Western blots or immunoprecipitation. Protein amounts/concentrations were determined by the BCA method (Pierce). SDS-PAGE was performed as previously described (27).


    RESULTS
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

To determine the pattern of expression of apoptotic genes in failing hearts, we performed cDNA microrarray profiling of human hearts in failure compared with nonfailing hearts. We initially studied idiopathic dilated cardiomyopathic hearts because they lack ischemic/fibrotic areas that could complicate the analysis. However, we also included a pooled RNA group obtained from hearts with ischemic cardiomyopathy.

On the basis of data in the literature, we selected ~75 apoptosis-related genes for evaluation (see Fig. 1). To confirm that there was increased apoptosis in human failing hearts, we used an antibody that recognizes activated CPP32 (caspase 3). CPP32 is present in normal cells as a 32-kDa inactive precursor; cleavage of CPP32 results in an active p17 caspase (20). As shown in Fig. 2A, the CPP32 antibody detected the presence of p17 fragments in hearts from patients in heart failure but little or no detectable p17 fragments in nonfailing hearts. Figure 2B presents the average densitometry for active caspase-3 in nonfailing and failing hearts, showing a significant increase in active caspase-3 in failing hearts. These data are consistent with previous data showing apoptosis in failing hearts (20, 21).


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Fig. 1.   Cluster analysis for 4 idiopathic cardiomyopathic hearts in failure (hearts 002, 004, 008, and 016) and a sample from 7 pooled ischemic cardiomyopathic hearts in failure hybridized against a pooled nonfailing sample. Heart 002 was run individually against each of the controls, and the data were averaged. Increased expression is indicated by red and decreased expression is indicated by green. Eisen clustering of the sample indicates the close correlation of the gene expression profiles of the individual patients. Average ratio expression values for each sample are indicated across a group of genes functionally classified into apoptotic pathways. HSP, heat shock protein; CASP, caspase; FADD, Fas-associated death domain; TNFRSM, TNF receptor (TNFR) superfamily member.



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Fig. 2.   A: activated caspase 3 in failing hearts. A representative immunoblot in failing and nonfailing hearts is shown using polyclonal anti-CPP 32 antibody (1:200, sc-7148, Santa Cruz Biotechnology). N, nonfailing hearts (hearts 029, 021, 026, 033, and 034); F, idiopathic dilated cardiomyopathy (DCM) failing hearts (hearts 002, 003, 004, and 008). B: average densitometry data showing a significant increase in active caspase 3 in failing hearts. * Significantly different compared with nonfailing hearts.

The cluster analysis in Fig. 1 shows that there was no change in expression of many apoptotic genes, decreased expression of numerous apoptosis-related genes, and increased expression of a few genes. Many of the changes in the expression of apoptotic genes would reduce apoptosis and thus appear to be compensatory to attenuate the apoptotic response. For example, we found increased expression of the antiapoptotic genes bcl-2 and v-erb-b2. We also found decreased expression of several caspases (caspase 3 and 7), several proapoptotic members of the bcl-2 family [bcl-2 interacting killer (BIK) and bcl-2 antagonist killer (BAK)], and a slight decrease in Fas-associated death domain (FADD). We also found a decrease in p21. p21 Mediates p53-induced apoptosis and is therefore considered to be proapoptotic, but a mutant p21 that is resistant to caspase cleavage is reported to suppress apoptosis. Because a number of bcl-2 family members showed altered expression, we examined the phosphorylation status of bcl-2 and BAD because phosphorylation can regulate the apoptotic activity of these proteins. As shown in Fig. 3A, consistent with the increase in bcl-2 mRNA, we also observe an increase in the protein level of the antiapoptotic bcl-2. The densitometry data in Fig. 3B show that compared with nonfailing hearts, failing hearts had a significant increase in bcl-2. Phosphorylation of bcl-2 (Ser-70), under most conditions, inactivates bcl-2 and thus increases cell death (6). We observed no detectable phospho-bcl-2 in failing or nonfailing hearts (data not shown). To determine whether this increase in the antiapoptotic bcl-2 was offset by an increase in the proapoptotic BAD, which binds and sequesters bcl-2, we examined the levels of total and phospho-BAD. Consistent with an increase in apoptosis, a striking decrease in phospho-BAD (Ser-112) was observed in failing hearts (Fig. 4A). As shown in Fig. 4, there was no consistent difference in total BAD levels between failing and nonfailing hearts. The averaged densitometry data in Fig. 4B show a significant decrease in phospho-BAD (Ser-112) but no difference in the levels of total BAD. When phospho-BAD (Ser-112) was normalized to total BAD, a significant difference between failing and nonfailing hearts was also apparent (phospho-BAD/BAD in nonfailing hearts was 1.61 ± 0.40 vs. 0.15 ± 0.03 in failing hearts, P < 0.05). Antibodies against Ser-155 phospho-BAD showed only a faint band and no significant difference between failing and nonfailing hearts (data not shown). We were unable to detect any bands when we probed with antibodies directed against Ser-136 phospho-BAD (data not shown). Taken together, these data suggest that the proapoptotic shift in bcl-2 may be offset by a decrease in phospho-BAD in the failing heart, because dephosphorylated BAD will bind and inactivate bcl-2.


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Fig. 3.   Bcl-2 levels in failing and nonfailing hearts. A: representative immunoblot using anti-bcl-2 mAb (1:500, No. B46620, Transduction Laboratories). N, nonfailing hearts 029, 021, 026, 033, and 034; F, DCM failing hearts 002, 003, 004, and 008. B: average densitometry data showing a significant increase in bcl-2 average band density in failing hearts. * Significantly different compared with nonfailing hearts.



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Fig. 4.   Total and phospho-BAD levels in failing and nonfailing hearts. A: representative immunoblots of Ser-112 phospho-BAD (1:2,000, No. 9296, Cell Signaling) and total BAD (1:1,000, No. 9292, Cell Signaling) in failing and nonfailing hearts. The third failing heart in the top blot was from a heart on a left ventricular assist device (LVAD). Top: N, nonfailing hearts 029, 021, 026, 033, and 034; F, DCM failing hearts 002, 003, 004, and 008. Bottom: N, nonfailing heart 029 (a between-gel control); F, DCM failing hearts 003, 023, 028, 042, 039, 048, 046, and 050. B: average densitometry data. * Significantly different compared with nonfailing hearts.

We reasoned that if apoptosis is an important contributor in heart failure, there might be changes in gene expression in multiple signaling pathways that could contribute to a proapoptotic shift. The data in Fig. 1 show an increase in gene expression in proapoptotic TNFRSM 10 (TRAIL) and a decrease in the antiapoptotic genes GADD45beta , FLIP, A20, several mitochondrial HSPs, and TNF-alpha -inducible MADD. These changes in gene expression strongly suggest a proapoptotic shift in the TNF-alpha pathway during the transition to heart failure. The TNF-alpha pathway activates both pro- and antiapoptotic signals, and the balance determines whether TNF-alpha leads to apoptosis (3, 14, 16, 19). TNF-alpha activation of NF-kappa B mediates increased expression of GADD45beta , FLIP, and A20. Consistent with a lower expression of NF-kappa B-induced genes, we also found increased expression of TNFRSM 10 (TRAIL) and decreased expression of TNF-alpha receptor 1, which activates NF-kappa B. As illustrated in Fig. 5, these changes in gene expression would shift TNF-alpha signaling to a proapoptotic bias.


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Fig. 5.   The TNF-alpha signaling pathway and its relationship to NF-kappa B and apoptosis. TNF-alpha signaling via the TNFR results in binding of FADD, leading to recruitment of pro-caspase 8, but also binds receptor-interacting protein/TNFR-I-associated death domain, leading to activation of NF-kappa B and expression of antiapoptotic genes such as growth arrest and DNA damage-inducible (GADD)45beta , Flice inhibitory protein (FLIP), and TNF-induced protein 3 (A20). Failing hearts show a shift to TNF-alpha -related apoptosis-inducing ligand (TRAIL), which leads to recruitment of pro-caspase 8, but does not activate NF-kappa B, thus leading to apoptosis. MADD, MAPK-associated death domain gene.

To examine whether these changes in gene expression are specific to idiopathic cardiomyopathic hearts or more representative of changes associated with the transition to heart failure, we also examined changes in gene expression in seven pooled ischemic cardiomyopathic hearts versus the pooled control. As shown in Fig. 1, cluster analysis comparing four idiopathic cardiomyopathic hearts versus the nonfailing control and the pooled ischemic cardiomyopathic hearts versus the nonfailing control suggested a similar pattern of gene expression.

We used RT-PCR to confirm altered expression of GADD45beta , HSP22, TNFRSM 10, TNF receptor 1A, A20, p21, MADD, and cyclin D (see Fig. 6A). We also confirmed decreased expression of FLIP protein by Western blot analysis (Fig. 6B).


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Fig. 6.   A: RT-PCR data for GADD45beta , TNFRSM 10, TNFR 1A, heat shock protein (HSP)22, p21 MADD, A20, and cyclin D. Data are normalized to GAPDH and are expressed as the percentage of the pooled nonfailing control. B: FLIP protein levels are decreased in failing hearts (sc-5276, Santa Cruz Biotechnology). Western blot analysis (top) was used to measure FLIP levels in failing and nonfailing human hearts. N, nonfailing hearts 029, 021, 026, 033, and 034; F, DCM failing hearts 002, 003, 004, and 008. Mean densitometry data (bottom) are also shown for failing and nonfailing hearts. * Significantly different from nonfailing hearts.

One of the idiopathic cardiomyopathic hearts (heart 004) was from a patient on an assist device. Cluster analysis showed that this heart had a similar overall pattern of gene expression to other failing hearts. However, as shown in Fig. 1, GADD45beta , A20, TNF receptor 1A, and MADD were not downregulated in the heart on the assist device, and expression of rel A was higher in the assist device heart than other failing hearts (see Fig. 1). Expression of other apoptosis-related genes such as the mitochondrial HSPs, FLIP, and p21 were not different between the assist device heart and other failing hearts. These data suggest that in the presence of the LVAD, there is a normalization of NF-kappa B-regulated gene expression abnormalities observed in failing hearts. To examine whether this is a common response in LVAD hearts, we examined an additional two LVAD hearts using RT-PCR to measure the mRNA levels of GADD45beta , A20, TNF receptor 1A, and MADD. As shown in Fig. 7, mRNA for these genes was higher in failing LVAD hearts than in non-LVAD hearts.


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Fig. 7.   GADD45beta , MADD, and A20 are differentially expressed in LVAD (hearts 004, 012, and 058) vs. non-LVAD failing human hearts (hearts 002, 003, 008, and 016). * Significantly different from non-LVAD hearts. The P value for MADD was 0.06.

We also assessed whether phospho-BAD was increased in LVAD hearts. As shown in Fig. 8, the three LVAD hearts showed increased phospho-BAD compared with the non-LVAD failing hearts. We also included two nonfailing hearts for comparison. Phospho-BAD in the LVAD hearts recovered to a level intermediate between failing and nonfailing hearts.


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Fig. 8.   Phosphorylation of Ser-112 of BAD is increased in LVAD (F/L; hearts 004, 012, 058) vs. non-LVAD failing hearts (hearts 002, 003, and 008). Two nonfailing hearts (hearts 029 and 021) are shown for comparison.


    DISCUSSION
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

The data in this study suggest complex changes in gene expression of pro- and antiapoptotic signaling pathways, including a proapoptotic shift in the TNF-alpha signaling pathway in failing hearts. Several recent studies have shown an increase in the plasma levels of TNF-alpha and the TNF-alpha receptor in patients with cardiomyopathies (28). TNF-alpha is an important signal in inflammation, proliferation, differentiation, and apoptosis, and the balance between these pathways can be modulated by the relative activation of NF-kappa B (3). The data in the present study suggest that decreased expression of GADD45beta , A20, TNF receptor 1A, and FLIP and the increased expression of TNFRSM 10 (TRAIL) may be important in the shift in the TNF-alpha signaling toward enhanced apoptosis. An increase in TNF-alpha signaling does not lead to apoptosis when the NF-kappa B pathway is activated by TNF-alpha (3, 14, 16, 19), because activation of NF-kappa B leads to increased expression of several antiapoptotic genes, such as GADD45beta , FLIP, and A20. However, in the failing heart, we find decreased expression of these TNF-alpha - and NF-kappa B-induced antiapoptotic genes. We also find increased expression of TRAIL and decreased expression of TNF-alpha receptor 1, which activates NF-kappa B. These data suggest a shift in TNF-alpha signaling in failing hearts, such that NF-kappa B is not activated, thereby leading to a proapoptotic bias. Taken together, these data suggest that decreased expression of these antiapoptotic genes may be involved in apoptosis in failing hearts and the transition to heart failure.

As shown in Fig. 5, TNF-alpha binding to its receptor results in the recruitment of adapter proteins such as TNF receptor I-associated death domain (TRADD) and FADD to the receptor. FADD recruits pro-caspase 8, which is cleaved to active caspase 8. FLIP (also known as casper, usurpin, CASH, FLAME-1, I-FLICE, CLARP, and MRIT) inhibits the activation and/or recruitment of pro-caspase-8 to the complex, thereby antagonizing apoptosis (22). TRADD recruits receptor-interacting protein (RIP)1 and TNF receptor-associated factor (TRAF) to the complex and leads to activation of NF-kappa B and the JNK, ERK, and p38 MAPK pathways. Activation of NF-kappa B results in transcription of several antiapoptotic genes such as FLIP, A20, and GADD45beta .

Recent studies suggest an important role for GADD45beta in the prosurvival mechanism of NF-kappa B (8). Studies were done using a "death trap" screening in which NF-kappa B (relA) null cells were transfected with cDNA libraries derived from TNF-alpha -treated cells. Apoptosis was induced by TNF-alpha , and surviving cells were selected. GADD45beta was identified as a TNF-alpha -induced gene that protected NF-kappa B null cells from apoptosis. De Smaele et al. (8) further showed that in NF-kappa B null cells, the TNF-alpha -induced activation of JNK was sustained throughout the time course, whereas in NF-kappa B-containing cells or NF-kappa B null cells with GADD45beta , the TNF-alpha -induced activation of JNK was transient and returned to baseline after 40 min. It is suggested that termination of JNK activation is important in the prosurvival mechanism of NF-kappa B. Thus decreased expression of GADD45beta in failing hearts would allow TNF-alpha activation of apoptosis.

FLIP is also regulated by NF-kappa B, and it inhibits activation and/or recruitment of caspase 8 to the death-inducing signaling complex (22). We found decreased protein levels of FLIP in the failing hearts. MADD is reported to link TNF-alpha signaling with MAPK activation. Depending on the splice varient, MADD can be pro- or antiapoptotic (1). These data suggest that the decrease in FLIP, A20, and GADD45beta may shift the pro-/antiapoptotic balance toward increased apoptosis in end-stage heart failure.

We also observed a striking decrease in phosphorylation of BAD at Ser-112 in failing hearts. Unphosphorylated BAD binds to and sequesters bcl-2 and thereby inhibits its antiapoptotic function. Phosphorylation of BAD results in its dissociation from bcl-2, thereby promoting cell survival. Baines et al. (2) reported that overexpression of PKC-epsilon is cardioprotective and leads to increased phosphorylation of Ser-112 on BAD. BAD can be phosphorylated on Ser-112, -136, -155, and/or -170 (10, 15, 18, 24, 25, 29). The relative importance of phosphorylation at different sites is still unclear. There are data suggesting that phosphorylation at different sites may be additive (15, 29). Different phosphorylation sites may also be more important in different cell types. Activation of phosphatidylinositol 3-kinase (PI3K), via the downstream kinases PKB/Akt and/or p70 ribosomal protein S6 kinase, is reported to phosphorylate Ser-136 (13). However, there are studies reporting that at least in some cell types, activation of the PI3K-PKB pathway does not lead to phosphorylation of Ser-136 of BAD (18, 24). PKA appears to be the primary kinase responsible for phosphorylation of Ser-155 (18, 29). MAPK/p90rsk is emerging as the primary kinase responsible for phosphorylation of Ser-112 of BAD (18, 24, 25, 29). Previous studies have reported an increase in p90rsk activity in failing hearts (26); these data suggested that p90rsk is unlikely to be responsible for the decreased phosphorylation of Ser-112 of BAD in failing hearts. PKA levels are reported also to be similar in failing and nonfailing hearts. Thus, despite the increased activity of the BAD kinase p90rsk (26), there is decreased phosphorylation of Ser-112 or BAD in failing hearts. This raises the possibility that perhaps there is increased dephosphorylation of BAD. Alternatively, there could be altered subcellular targeting of the BAD kinase.

Interestingly, hearts that had been on an assist device did not show decreased expression of the NF-kappa B-regulated genes GADD45beta , MADD, A20, or TNF receptor 1A. These data suggest that the assist device might allow activation of NF-kappa B and production of antiapoptotic factors. We also observed that hearts from LVAD patients showed a recovery toward control levels of phospho-BAD.

In summary, this study shows that there is a proapoptotic shift in TNF-alpha signaling in failing hearts. In addition, LVAD patients have increased myocardial expression of TNF-alpha -regulated NF-kappa B genes, which may be important in the improvement in these LVAD patients. These data are consistent with the improvement observed in patients treated with inhibitors of TNF-alpha (4). Finally, these analyses indicate that therapies that enhance NF-kappa B activation could be beneficial.


    ACKNOWLEDGEMENTS

This study was supported by the Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health (NIH). C. Steenbergen was supported in part by NIH grant RO1-HL-39752.


    FOOTNOTES

* C. Steenbergen and C. A. Afshari contributed equally to this work.

Address for reprint requests and other correspondence: E. Murphy, Laboratory of Signal Transduction, NIEHS, Research Triangle Park, NC 27709 (E-mail: murphy1{at}niehs.nih.gov).

The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

First published September 26, 2002;10.1152/ajpheart.00707.2002

Received 13 August 2002; accepted in final form 20 September 2002.


    REFERENCES
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

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