Key result
PKP2 haploinsufficiency exacerbates post-myocarditis subepicardial fibrosis to ~14% vs. ~6% in wildtype mice.
Why the study?
ACM penetrance is low, and it remains uncertain which genetic and environmental modifiers are crucial for developing the cardiomyopathy.
Does PKP2 haploinsufficiency modulate the cardiac response to exercise, pressure overload, and inflammation in a murine model?
Does PKP2 haploinsufficiency modulate the cardiac response to exercise, pressure overload, and inflammation in a murine model?
Absolute Event Rate: 14.16% vs 6.24%
p-value: p=≤0.05
PKP2 haploinsufficiency in mice exacerbates pro-arrhythmic remodeling in response to exercise and worsens fibrotic and inflammatory responses to pathophysiological stress, providing mechanistic insights into arrhythmogenic cardiomyopathy.
Hypothesis-generating for PKP2-mediated arrhythmogenesis under stress in mice; leaves open human translation to arrhythmogenic cardiomyopathy.
Human variants in plakophilin-2 (PKP2) associate with most cases of familial arrhythmogenic cardiomyopathy (ACM). Recent studies show that PKP2 not only maintains intercellular coupling, but also regulates transcription of genes involved in Ca2+ cycling and cardiac rhythm. ACM penetrance is low and it remains uncertain, which genetic and environmental modifiers are crucial for developing the cardiomyopathy. In this study, heterozygous PKP2 knock-out mice (PKP2-Hz) were used to investigate the influence of exercise, pressure overload, and inflammation on a PKP2-related disease progression. In PKP2-Hz mice, protein levels of Ca2+-handling proteins were reduced compared to wildtype (WT). PKP2-Hz hearts exposed to voluntary exercise training showed right ventricular lateral connexin43 expression, right ventricular conduction slowing, and a higher susceptibility towards arrhythmias. Pressure overload increased levels of fibrosis in PKP2-Hz hearts, without affecting the susceptibility towards arrhythmias. Experimental autoimmune myocarditis caused more severe subepicardial fibrosis, cell death, and inflammatory infiltrates in PKP2-Hz hearts than in WT. To conclude, PKP2 haploinsufficiency in the murine heart modulates the cardiac response to environmental modifiers via different mechanisms. Exercise upon PKP2 deficiency induces a pro-arrhythmic cardiac remodeling, likely based on impaired Ca2+ cycling and electrical conduction, versus structural remodeling. Pathophysiological stimuli mainly exaggerate the fibrotic and inflammatory response.
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Opbergen et al. (2019) studied Arrhythmogenic right ventricular cardiomyopathy (ACM). Exercise, transverse aortic constriction, or experimental autoimmune myocarditis vs. Wildtype mice exposed to the same stressors was evaluated on Subepicardial fibrosis 6 weeks after experimental autoimmune myocarditis induction (p=≤0.05). PKP2 haploinsufficiency in mice reduced calcium-handling protein expression, induced a 40% arrhythmia incidence following voluntary exercise, and exacerbated subepicardial fibrosis to 14.16% after autoimmune myocarditis compared to 6.24% in wildtype mice.
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