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. 2020 Sep 18;15(9):e0237000.
doi: 10.1371/journal.pone.0237000. eCollection 2020.

Preoperative myocardial expression of E3 ubiquitin ligases in aortic stenosis patients undergoing valve replacement and their association to postoperative hypertrophy

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Preoperative myocardial expression of E3 ubiquitin ligases in aortic stenosis patients undergoing valve replacement and their association to postoperative hypertrophy

Fábio Trindade et al. PLoS One. .

Abstract

Currently, aortic valve replacement is the only treatment capable of relieving left ventricle pressure overload in patients with severe aortic stenosis. It aims to improve cardiac function and revert hypertrophy, by triggering myocardial reverse remodeling. Despite immediately relieving afterload, reverse remodeling turns out to be extremely variable. Among other factors, the extent of reverse remodeling may depend on how well ubiquitin-proteasome system tackle hypertrophy. Therefore, we assessed tagged ubiquitin and ubiquitin ligases in the left ventricle collected from patients undergoing valve replacement and tested their association to the degree of reverse remodeling. Patients were classified according to the regression of left ventricle mass (ΔLVM) and assigned to complete (ΔLVM≥15%) or incomplete (ΔLVM≤5%) reverse remodeling groups. No direct inter-group differences were observed. Nevertheless, correlation analysis supports a fundamental role of the ubiquitin-proteasome system during reverse remodeling. Indeed, total protein ubiquitination was associated to hypertrophic indexes such as interventricular septal thickness (r = 0.55, p = 0.03) and posterior wall thickness (r = 0.65, p = 0.009). No significant correlations were observed for Muscle Ring Finger 3. Surprisingly, though, higher levels of atrogin-1 were associated to postoperative interventricular septal thickness (r = 0.71, p = 0.005). In turn, Muscle Ring Finger 1 correlated negatively with this postoperative hypertrophy marker (r = -0.68, p = 0.005), suggesting a cardioprotective role during reverse remodeling. No significant correlations were found with left ventricle mass regression, although a trend for a negative association between the ligase Murine Double Minute 2 and mass regression (r = -0.44, p = 0.10) was found. Animal studies will be necessary to understand whether this ligase is protective or detrimental. Herein, we show, for the first time, an association between the preoperative myocardial levels of ubiquitin ligases and postoperative hypertrophy, highlighting the therapeutic potential of targeting ubiquitin ligases in incomplete reverse remodeling.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Myocardial ubiquitination profile and ubiquitin ligases expression in patients with complete or incomplete reverse remodeling.
Representative western blot scans are depicted for ubiquitin-tagged proteins (A) and for the E3 ubiquitin ligases Muscle Ring Finger (MuRF) 1 (B), MuRF3 (C), atrogin-1 (D) and Murine Double Minute 2 (MDM2) (E). Additional blots can be found in S1 Fig. In the latter, two bands are identified with arrows, referring to intact MDM2 (upper arrow) and its cleavage product (lower arrow), as reported in the datasheet. Quantification was based on the intact band only. The respective optical density-based semi-quantification is shown in (F), (G), (H), (I) and (J). T.C. designates the technical control. Samples 163, 586 and 603 are marked in red because these were excluded from the study a posteriori (aortic or mitral insufficiency was found to be more or as severe as aortic stenosis). cRR identifies patients with complete reverse remodeling and iRR denotes patients with incomplete reverse remodeling.

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The authors thank Portuguese Foundation for Science and Technology (FCT), European Union, Quadro de Referência Estratégico Nacional (QREN), Fundo Europeu de Desenvolvimento Regional (FEDER) and Programa Operacional de Competitividade (COMPETE) for funding iBiMED (UID/BIM/04501/2020 and POCI-01-0145-FEDER-007628) and UnIC (UIDB/00051/2020 and UIDP/00051/2020) research units. This project is supported by FEDER through COMPETE 2020 – Programa Operacional Competitividade E Internacionalização (POCI), the project DOCNET (NORTE-01-0145-FEDER-000003), supported by Norte Portugal regional operational programme (NORTE 2020), under the Portugal 2020 partnership agreement, through the European Regional Development Fund (ERDF), the project NETDIAMOND (POCI-01-0145-FEDER-016385, SAICTPAC/0047/2015), supported by European Structural And Investment Funds, Lisbon’s regional operational program 2020. HT is supported by the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 608473 and the Swedish Research Council. RV and FT are supported by IF/00286/2015 and SFRH/BD/111633/2015 fellowship grants, respectively. FS is supported by Universidade do Porto/FMUP and FSE-Fundo Social Europeu, NORTE 2020-Programa Operacional Regional do Norte, NORTE-08-5369-FSE-000024-Programas Doutorais. The authors would like also to address a special thanks to COST Action BM1307/PROTEOSTASIS for funding this work and granting FT with a short-term scientific mission stipend. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.