Progressive attenuation of myocardial vascular endothelial growth factor expression is a seminal event in diabetic cardiomyopathy: restoration of microvascular homeostasis and recovery of cardiac function in diabetic cardiomyopathy after replenishment of local vascular endothelial growth factor.
BACKGROUND
Diabetic cardiomyopathy (DCM) is characterized by microvascular pathology and interstitial fibrosis, which leads to progressive heart failure; however, the pathogenesis of DCM remains uncertain.


RESULTS
Using the streptozotocin-induced diabetic rat model, we evaluated the natural course of DCM over a period of 1 year by serial echocardiography, Western blot analysis for vascular endothelial growth factor (VEGF), endothelial progenitor cell assays, myocardial blood flow measurements, and histopathologic analysis that included terminal dUTP nick end-labeling (TUNEL), capillary and cardiomyocyte density, and fibrosis area. Downregulation of myocardial VEGF expression preceded all other features of DCM and was followed by increased apoptosis of endothelial cells, decreased numbers of circulating endothelial progenitor cells, decreased capillary density, and impaired myocardial perfusion. Apoptosis and necrosis of cardiomyocytes ensued, along with fibrosis and progressive diastolic and then systolic dysfunction. To provide further evidence of the central role of VEGF in the pathophysiology of DCM, we replenished myocardial VEGF expression using naked DNA gene therapy via direct intramyocardial injection of plasmid DNA encoding VEGF (phVEGF165). VEGF-replenished rats showed increased capillary density, decreased endothelial cell and cardiomyocyte apoptosis, and in situ differentiation of bone marrow-derived endothelial progenitor cells into endothelial cells. These anatomic findings were accompanied by significant improvements in cardiac function.


CONCLUSIONS
These findings suggest that downregulation of VEGF may compromise microvascular homeostasis in the myocardium and thereby play a central role in the pathogenesis of DCM.
Yoon
Young-sup
YS
Division of Cardiovascular Research, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Mass 02135, USA. young.yoon@tufts.edu
Uchida
Shigeki
S
Masuo
Osamu
O
Cejna
Manfred
M
Park
Jong-Seon
JS
Gwon
Hyeon-cheol
HC
Kirchmair
Rudolf
R
Bahlman
Ferdinand
F
Walter
Dirk
D
Curry
Cynthia
C
Hanley
Allison
A
Isner
Jeffrey M
JM
Losordo
Douglas W
DW
D000818:Animals; D009202:Cardiomyopathies / Q000209:etiology* / Q000628:therapy; D048909:Diabetes Complications / Q000209:etiology* / Q000628:therapy; D003921:Diabetes Mellitus, Experimental; D015536:Down-Regulation; D005260:Female; D015316:Genetic Therapy; D006706:Homeostasis / Q000187:drug effects; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000503:physiopathology; D009206:Myocardium / Q000737:chemistry*; D051381:Rats; D011916:Rats, Inbred F344; D017207:Rats, Sprague-Dawley; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000008:administration & dosage* / Q000032:analysis* / Q000235:genetics
D042461:Vascular Endothelial Growth Factor A