Key result
Coexistent diabetes and hypertension linked to ~13-fold more cardiac protein alterations than hypertension alone.
Why the study?
T2DM and HTN are major risk factors for heart failure that may induce synergetic cardiac alterations, and identifying key common molecular signaling could reveal new therapeutic targets.
Cross-Sectional (n=19)
Yes
The coexistence of hypertension and type 2 diabetes induces marked downregulation of mitochondrial respiration and lipid metabolism in the human heart, potentially mediated by the mTORC1-PGC1α-PPARα axis.
Greater cardiac proteomic disruption with comorbid hypertension and T2DM; hypothesis-generating for mTORC1-PGC1α-PPARα targeting.
Type-2 diabetes (T2DM) and arterial hypertension (HTN) are major risk factors for heart failure. Importantly, these pathologies could induce synergetic alterations in the heart, and the discovery of key common molecular signaling may suggest new targets for therapy. Intraoperative cardiac biopsies were obtained from patients with coronary heart disease and preserved systolic function, with or without HTN and/or T2DM, who underwent coronary artery bypass grafting (CABG). Control (n = 5), HTN (n = 7), and HTN + T2DM (n = 7) samples were analysed by proteomics and bioinformatics. Additionally, cultured rat cardiomyocytes were used for the analysis (protein level and activation, mRNA expression, and bioenergetic performance) of key molecular mediators under stimulation of main components of HTN and T2DM (high glucose and/or fatty acids and angiotensin-II). As results, in cardiac biopsies, we found significant alterations of 677 proteins and after filtering for non-cardiac factors, 529 and 41 were changed in HTN-T2DM and in HTN subjects, respectively, against the control. Interestingly, 81% of proteins in HTN-T2DM were distinct from HTN, while 95% from HTN were common with HTN-T2DM. In addition, 78 factors were differentially expressed in HTN-T2DM against HTN, predominantly downregulated proteins of mitochondrial respiration and lipid oxidation. Bioinformatic analyses suggested the implication of mTOR signaling and reduction of AMPK and PPARα activation, and regulation of PGC1α, fatty acid oxidation, and oxidative phosphorylation. In cultured cardiomyocytes, an excess of the palmitate activated mTORC1 complex and subsequent attenuation of PGC1α-PPARα transcription of β-oxidation and mitochondrial electron chain factors affect mitochondrial/glycolytic ATP synthesis. Silencing of PGC1α further reduced total ATP and both mitochondrial and glycolytic ATP. Thus, the coexistence of HTN and T2DM induced higher alterations in cardiac proteins than HTN. HTN-T2DM subjects exhibited a marked downregulation of mitochondrial respiration and lipid metabolism and the mTORC1-PGC1α-PPARα axis might account as a target for therapeutical strategies.
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Hang et al. (2023) conducted a cross-sectional in Coronary heart disease with preserved systolic function (n=19). Hypertension and Type 2 Diabetes vs. Hypertension alone or healthy controls was evaluated on Differentially expressed cardiac proteins compared to control (p=<0.05). The coexistence of hypertension and type 2 diabetes induced significantly greater alterations in cardiac protein expression than hypertension alone (529 vs 41 altered proteins), specifically downregulating mitochondrial respiration and lipid metabolism via the mTORC1-PGC1α-PPARα axis.
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