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      Long‐Term miR‐669a Therapy Alleviates Chronic Dilated Cardiomyopathy in Dystrophic Mice

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          Abstract

          Background

          Dilated cardiomyopathy (DCM) is a leading cause of chronic morbidity and mortality in muscular dystrophy (MD) patients. Current pharmacological treatments are not yet able to counteract chronic myocardial wastage, thus novel therapies are being intensely explored. MicroRNAs have been implicated as fine regulators of cardiomyopathic progression. Previously, miR‐669a downregulation has been linked to the severe DCM progression displayed by Sgcb‐null dystrophic mice. However, the impact of long‐term overexpression of miR‐669a on muscle structure and functionality of the dystrophic heart is yet unknown.

          Methods and Results

          Here, we demonstrate that intraventricular delivery of adeno‐associated viral (AAV) vectors induces long‐term (18 months) miR‐669a overexpression and improves survival of Sgcb‐null mice. Treated hearts display significant decrease in hypertrophic remodeling, fibrosis, and cardiomyocyte apoptosis. Moreover, miR‐669a treatment increases sarcomere organization, reduces ventricular atrial natriuretic peptide (ANP) levels, and ameliorates gene/miRNA profile of DCM markers. Furthermore, long‐term miR‐669a overexpression significantly reduces adverse remodeling and enhances systolic fractional shortening of the left ventricle in treated dystrophic mice, without significant detrimental consequences on skeletal muscle wastage.

          Conclusions

          Our findings provide the first evidence of long‐term beneficial impact of AAV‐mediated miRNA therapy in a transgenic model of severe, chronic MD‐associated DCM.

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          Most cited references41

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          Therapeutic inhibition of miR-208a improves cardiac function and survival during heart failure.

          Diastolic dysfunction in response to hypertrophy is a major clinical syndrome with few therapeutic options. MicroRNAs act as negative regulators of gene expression by inhibiting translation or promoting degradation of target mRNAs. Previously, we reported that genetic deletion of the cardiac-specific miR-208a prevents pathological cardiac remodeling and upregulation of Myh7 in response to pressure overload. Whether this miRNA might contribute to diastolic dysfunction or other forms of heart disease is currently unknown. Here, we show that systemic delivery of an antisense oligonucleotide induces potent and sustained silencing of miR-208a in the heart. Therapeutic inhibition of miR-208a by subcutaneous delivery of antimiR-208a during hypertension-induced heart failure in Dahl hypertensive rats dose-dependently prevents pathological myosin switching and cardiac remodeling while improving cardiac function, overall health, and survival. Transcriptional profiling indicates that antimiR-208a evokes prominent effects on cardiac gene expression; plasma analysis indicates significant changes in circulating levels of miRNAs on antimiR-208a treatment. These studies indicate the potential of oligonucleotide-based therapies for modulating cardiac miRNAs and validate miR-208 as a potent therapeutic target for the modulation of cardiac function and remodeling during heart disease progression.
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            Targeted deletion of Dicer in the heart leads to dilated cardiomyopathy and heart failure.

            Cardiovascular disease is the leading cause of human morbidity and mortality. Dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy associated with heart failure. Here, we report that cardiac-specific knockout of Dicer, a gene encoding a RNase III endonuclease essential for microRNA (miRNA) processing, leads to rapidly progressive DCM, heart failure, and postnatal lethality. Dicer mutant mice show misexpression of cardiac contractile proteins and profound sarcomere disarray. Functional analyses indicate significantly reduced heart rates and decreased fractional shortening of Dicer mutant hearts. Consistent with the role of Dicer in animal hearts, Dicer expression was decreased in end-stage human DCM and failing hearts and, most importantly, a significant increase of Dicer expression was observed in those hearts after left ventricle assist devices were inserted to improve cardiac function. Together, our studies demonstrate essential roles for Dicer in cardiac contraction and indicate that miRNAs play critical roles in normal cardiac function and under pathological conditions.
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              The dystrophin glycoprotein complex: signaling strength and integrity for the sarcolemma.

              The dystrophin glycoprotein complex (DGC) is a specialization of cardiac and skeletal muscle membrane. This large multicomponent complex has both mechanical stabilizing and signaling roles in mediating interactions between the cytoskeleton, membrane, and extracellular matrix. Dystrophin, the protein product of the Duchenne and X-linked dilated cardiomyopathy locus, links cytoskeletal and membrane elements. Mutations in additional DGC genes, the sarcoglycans, also lead to cardiomyopathy and muscular dystrophy. Animal models of DGC mutants have shown that destabilization of the DGC leads to membrane fragility and loss of membrane integrity, resulting in degeneration of skeletal muscle and cardiomyocytes. Vascular reactivity is altered in response to primary degeneration in striated myocytes and arises from a vascular smooth muscle cell-extrinsic mechanism.
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                Author and article information

                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                ahaoa
                jah3
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                Blackwell Publishing Ltd
                2047-9980
                August 2013
                23 August 2013
                : 2
                : 4
                : e000284
                Affiliations
                [1 ]Translational Cardiomyology Lab, Stem Cell Biology and Embryology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium (M.Q., C.M., J.C., M.S.)
                [2 ]Division of Biochemistry and Molecular Biology, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy (M.Q., C.M., A.O.)
                [3 ]Experimental Cardiology Unit, CHUV, Lausanne, Switzerland (S.C.)
                [4 ]Division of Histology and Embriology, Department of Public Health, Neurosciences, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (A.I.C., A.C., A.C.)
                [5 ]Dubowitz Neuromuscular Centre, UCL Institute of Child Health, London, UK (L.B., J.M.)
                [6 ]Laboratory for Molecular Virology and Gene Therapy, KU Leuven, Leuven, Belgium (R.G.)
                [7 ]Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium (J.H., S.J.)
                [8 ]Department of Organ Systems, Department of Development and Regeneration, KU Leuven, Leuven, Belgium (J.T.)
                [9 ]Department of Cardiovascular Diseases, University Hospital Gasthuisberg, Leuven, Belgium (S.J.)
                [10 ]Division of Human Anatomy, Department of Public Health, Neurosciences, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy (M.S.)
                Author notes
                Correspondence to: Maurilio Sampaolesi, PhD, Translational Cardiomyology Lab – SCIL – Department of Development and Regeneration, KU Leuven, Herestraat 49 – O&N4 – bus 814, 3000 Leuven, Belgium. E‐mail: maurilio.sampaolesi@ 123456med.kuleuven.be

                Accompanying Figures S1 through S9 are available at http://jaha.ahajournals.org/content/2/4/e000284/suppl/DC1

                Article
                jah3268
                10.1161/JAHA.113.000284
                3828786
                23963759
                e2319e3d-7304-45c3-8755-837ae3e39237
                © 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley-Blackwell.

                This is an Open Access article under the terms of the Creative Commons Attribution Noncommercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 29 April 2013
                : 20 June 2013
                Categories
                Original Research
                Heart Failure

                Cardiovascular Medicine
                cardiomyopathy,micrornas,mirna therapy,muscular dystrophy
                Cardiovascular Medicine
                cardiomyopathy, micrornas, mirna therapy, muscular dystrophy

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