title: Nix-mediated apoptosis links myocardial fibrosis, cardiac remodeling, and hypertrophy decompensation.
abstract: BACKGROUND
  Pathological cardiac hypertrophy inevitably remodels, leading to functional decompensation. Although modulation of apoptosis-regulating genes occurs in cardiac hypertrophy, a causal role for programmed cardiomyocyte death in left ventricular (LV) remodeling has not been established.
  
  
  RESULTS
  We targeted the gene for proapoptotic Nix, which is transcriptionally upregulated in pressure overload and Gq-dependent hypertrophies, in the mouse germ line or specifically in cardiomyocytes (knockout [KO]) and conditionally overexpressed it in the heart (transgenic [TG]). Conditional forced Nix expression acted synergistically with the prohypertrophic Gq transgene to increase cardiomyocyte apoptosis (0.8+/-0.1% in GqTG versus 7.8+/-0.6% in GqTG+NixTG; P<0.001), causing lethal cardiomyopathy with LV dilation and depressed systolic function (percent fractional shortening, 39+/-4 versus 23+/-4; P=0.042). In the reciprocal experiment, germ-line Nix ablation significantly reduced cardiomyocyte apoptosis (4.8+/-0.2% in GqTG+NixKO versus 8.4+/-0.5% in GqTG; P=0.001), which improved percent fractional shortening (43+/-3% versus 27+/-3%; P=0.017), attenuated LV remodeling, and largely prevented lethality in the Gq peripartum model of apoptotic cardiomyopathy. Cardiac-specific (Nkx2.5-Cre) Nix KO mice subjected to transverse aortic constriction developed significantly less LV dilation by echocardiography and magnetic resonance imaging, maintained concentric remodeling, and exhibited preserved LV ejection fraction (61+/-2% in transverse aortic constriction cardiac Nix KO versus 36+/-6% in transverse aortic constriction wild-type mice; P=0.003) at 9 weeks, with reduced cardiomyocyte apoptosis at day 4 (1.70+/-0.21% versus 2.73+/-0.35%; P=0.032).
  
  
  CONCLUSIONS
  Nix-induced cardiomyocyte apoptosis is a major determinant of adverse remodeling in pathological hypertrophies, a finding that suggests therapeutic value for apoptosis inhibition to prevent cardiomyopathic decompensation.
authors.affiliation: Center for Molecular Cardiovascular Research, University of Cincinnati, Cincinnati, OH 45267-0839, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Diwan
authors.forename: Janaka
authors.initials: J
authors.lastname: Wansapura
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Syed
authors.forename: Scot J
authors.initials: SJ
authors.lastname: Matkovich
authors.forename: John N
authors.initials: JN
authors.lastname: Lorenz
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Dorn
mesh_terms: D000818:Animals; D017209:Apoptosis; D005355:Fibrosis / Q000209:etiology / Q000473:pathology*; D006333:Heart Failure; D006801:Humans; D006984:Hypertrophy / Q000209:etiology / Q000473:pathology*; D008565:Membrane Proteins / Q000502:physiology; D051379:Mice; D009206:Myocardium / Q000473:pathology*; D032383:Myocytes, Cardiac / Q000473:pathology; D011518:Proto-Oncogene Proteins / Q000502:physiology*; D025521:Tumor Suppressor Proteins / Q000502:physiology; D020257:Ventricular Remodeling
chemical_list: C116838:BNIP3L protein, human; D008565:Membrane Proteins; D011518:Proto-Oncogene Proteins; D025521:Tumor Suppressor Proteins