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UltraRapid Communication |
From the Institute of Molecular Biotechnology of the Austrian Academy of Sciences (K.K., Y.I., A.L., G.G.N., V.K., H.H., A.M., R.S., J.M.P.), Vienna; Medical Top Track Program (K.K.) and Department of Molecular Pathogenesis (A.K.), Medical Research Institute, Tokyo Medical and Dental University, Japan; Heart and Stroke/Richard Lewar Centre of Excellence and Toronto General Research Institute (L.Z., S.A., M.C., Y.M., M.N., X.C., F.D., K.M.W., R.S., E.C., P.P.L.), University Health Network, Ontario, Canada; Veterinary University of Vienna (M.L., M.M., U.K., J.T.), Austria; Division of Cardiology (J.S., B.M.), Medical University Innsbruck, Austria; and Institute for Experimental and Clinical Pharmacology and Toxicology (N.B., L.H.), University of Freiburg, Germany; Swiss Federal Institute of Technology (R.M., R.R.), Zurich, Switzerland.
Correspondence to Josef Penninger, MD, PhD, Institute of Molecular Biotechnology, Dr Bohr-Gasse 3, Vienna 1030, Austria. E-mail josef.penninger{at}oeaw.ac.at
| Abstract |
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Key Words: aging angiotensin cardiac failure cardiac function pressure overload
| Introduction |
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Accumulating experimental evidence has implicated Apelin in multiple organ functions, such as diuresis,18 fluid intake,19,20 obesity,21 food intake,22,23 body temperature control,24 and blood vessel formation.25,26 In Xenopus, antisense oligo-mediated downregulation of Apelin expression results in impaired development of the cardiovascular system.27,28 In rodents, Apelin treatment lowers blood pressure19,29 and exerts a potent positive inotropic action in hearts.30–32 In addition, correlative clinical studies in heart failure patients suggest a possible role of Apelin in heart failure.33,34 In mammals, however, gene targeting of APJ did not reveal any overt phenotypes in mice.35 APJ knockout mice grow normally, look apparently healthy, and show normal blood pressure and normal behavior for water intake. Functionally, APJ mutant mice have a slightly increased vasopressor response to angiotensin II administration, suggesting that Apelin may counterbalance angiotensin II–mediated pressor effects.35 Whereas infusion of exogenous Apelin can exert multiple effects, including heart function and blood pressure homeostasis, the physiological in vivo role of endogenous Apelin is virtually unknown.
To address the in vivo function of Apelin, we generated Apelin gene–targeted mice. Apelin knockout mice display normal heart structures and exhibit normal drinking behavior, food intake, and body weight as compared with controls. Interestingly, Apelin knockout mice display aging-associated reduced cardiac contractility, which becomes evident at
6 months of age. Furthermore, in a pressure overload–induced heart failure model, Apelin knockout mice develop severe impairment in heart contractility. These genetic data indicate that Apelin maintains cardiovascular homeostasis on pressure overload and aging.
| Materials and Methods |
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Feeding and Drinking Behaviors
For high-fat diet feeding, normal chow (6% fat; M-Z, energy rich) and high-fat (30% fat; EF1/22) diets were obtained from ssniff GmbH (Soest, Germany). Mice were fed the high-fat diet starting from 3 weeks of age until termination of the experiment. Drinking behavior was measured as described previously.37 Briefly, body weight loss of mice was measured after dehydration for 40 hours, followed by assessment of water consumption over a subsequent period of 3 hours.
mRNA and Protein Expression Analyses
Western blotting was performed as described previously with antibodies to the Apelin amino acids 42 to 77 (Phoenix Pharmaceuticals). Anti–β-actin (A-2066; Sigma) was used as a loading control. For real-time PCR analysis of atrial natriuretic factor (ANF), B-type natriuretic peptide (BNP), skeletal muscle actin, β-myosin heavy chain, ACE, ACE2, and angiotensinogen, 3 µg of DNase-treated total RNA extracted from hearts was reverse transcribed using First-Strand Beads (GE Healthcare) with random primers. SYBR green real-time PCR reactions were performed in 96-well plates using an iQ-Cycler (Bio-Rad).
Blood Pressure Measurements
Mice were anesthetized with pentobarbital (50 mg/kg IV) and tracheotomized.11 A catheter was then inserted into the right carotid artery to monitor blood pressures. All blood pressures were recorded (CardioMaxII, Harvard Apparatus) after 1 hour of equilibration. Conscious blood pressures were measured using telemetry; TA-PAC20 transmitters (DSI) were implanted into the right carotid artery, and blood pressures were measured by telemetry starting at 1 week after the surgery.38
Echocardiography and Invasive Hemodynamics
Echocardiographic and hemodynamic measurements were performed as described previously.39 Briefly, mice were anesthetized with isoflurane (1%)/O2, and echocardiography was performed using an Acuson Sequoia C256 equipped with a 15-MHz linear transducer. Fractional shortening (FS) was calculated as follows: FS=[(LVEDD–LVESD)/LVEDD]x100, where LVEDD is left ventricular end-diastolic diameter, and LVESD is left ventricular end-systolic diameter. Velocity of circumferential fiber shortening was calculated as FS per ejection time corrected for heart rate. We used 2D-guided M-mode measurements to determine percentage of FS. The heart was first imaged in 2D mode in the parasternal short-axis view. From this view, an M-mode cursor was positioned perpendicular to the interventricular septum and posterior wall of the LV at the level of the papillary muscles, and M-mode images were obtained for measurement of wall thickness and chamber dimensions with the use of the leading-edge convention adapted by the American Society of Echocardiography. For rescue experiments, osmotic minipumps (Alzet 1002) were loaded with Apelin 13 peptide (1 mg/kg per 24 hours) in saline or saline alone and implanted subcutaneously into the dorsal region of control wild-type or Apelin knockout mice. Mice were infused continuously for 2 weeks before echocardiography measurements were performed. For hemodynamic assessment, the right carotid artery was cannulated with a 1.4 French Millar catheter (Millar Inc, Houston, Tex) connected to an amplifier (TCP-500; Millar Inc). After insertion of the catheter into the carotid artery, the catheter was advanced into the aorta and then into the left ventricle to record aortic and ventricular pressures as well as volume conductance.
Aortic Banding
Eight- to 10-week-old (body weight, 24 to 26 g) control wild-type littermates and Apelin knockout mice were subjected to pressure overload by aortic banding (AB) through constriction of the descending aorta as described.39 The systolic pressure gradient was determined and was comparable between wild-type and Apelin knockout mice. The mice were monitored up to 12 weeks after surgery, and their heart functions were determined by echocardiography and invasive hemodynamics. For heart histology, hearts were arrested with 1 mol/L KCl, fixed with 10% formalin, and embedded in paraffin. For mRNA and protein analyses, hearts were snap-frozen in liquid nitrogen and stored at –80°C. For histological analysis, 5-µm-thick sections were cut and stained with hematoxylin/eosin. For detection of fibrotic areas, sections were stained with Masson trichrome.
Microarray Gene Expression Analysis
Total RNA was isolated from hearts of sham and aortic-banded control wild-type and littermate Apelin knockout mice. Three different heart samples for each genotype were analyzed. mRNA samples were prepared for hybridization according to standard protocols and performed at the Genomic Core Facility at the Hospital for Sick Children in Toronto using the MOE-430–2 mouse GeneChip set (Affymetrix, Santa Clara, Calif). Experimental design and data analysis were done in compliance with the Minimum Information About a Microarray Experiment guidelines.40
Hierarchical Clustering of Gene Expression
Scanned raw data were processed with Affymetrix GeneChip Operating software (GCOS) version 1.4. The intensity value for each probe set was calculated as the 75th percentile. To monitor the expression of genes, data obtained from GCOS absolute analyses of all the individual arrays were analyzed and clustered using GeneSpring software 7.0 (http://www.agilent.com). For statistical comparison, the parametric comparison for multiple groups (ANOVA) was performed to find the set of genes for which the specified comparison showed statistically significant differences in the mean normalized expression levels across all the groups. Calculations without the assumption of equality of variances are done using Welchs approximate t test, and ANOVA. probability values were adjusted for multiple testing by controlling for false-discovery rate using the Benjamini–Hochberg method. For hierarchical clustering, an average linkage algorithm was used. Briefly, the expression values for a gene across all samples were standardized to have mean 0 and standard deviation 1 by linear transformation, and the distance between 2 genes was defined as 1–r, where r is the standard correlation coefficient between the standardized values of 2 genes. Two genes with the closest distance were first merged into a supergene and connected by branches with length representing their distance and were then deleted for future merging. The expression level of the newly formed supergene is the average of standardized expression levels of the 2 genes (average linkage) for each sample. Then the next pair of genes (supergene) with the smallest distance was merged, and the process was repeated to cover all genes.
Quantitative Real-Time PCR
RNA was extracted using TRIzol reagent (Invitrogen) and cDNA synthesized using SuperscriptII reverse transcriptase (Invitrogen). Sequences of the forward and reverse primers of the genes studied are as follows: Tgfb2 forward, 5'-AGAAGCGCGCTTTGGATGCTGC-3'; reverse, 5'-TGGGACACACAGCAAGGGGAAG-3'; Postn forward, 5'-TGCTCTGCTGCTGCTGTTCCTG-3'; reverse 5'-TGCTGGAGGGCACAGACGTTTG-3'; Ltbp2 forward, 5'-AAATGGCCAGCTGGAGTGTCCC-3'; reverse, 5'-TTCACGCACTCCGAGTCCTTGC-3'; Lox forward, 5'-ACTTCTTACCAAGCCGCCCTCG-3'; reverse, 5'-TGTGCAGTGCAGCCAAAGCG-3'; Col8a1 forward, 5'-TCAGACTCATTCAGGCCGGTGC-3'; reverse, 5'-CGCGCAAACTGGCTAACGGTAC-3'. Htrp was used as loading control. PCR was run in 384-well plates using a LightCycler 480 SYBR Green I Master (Roche) according to the instructions of the manufacturer. Relative gene expression was quantified using the standard curve with the LightCycler 480 Relative Quantification Software Version 1.0 (Roche).
Statistical Analyses
Data are presented as mean values±SEM and were analyzed for differences between wild-type and Apelin knockout mice at discrete time points. Normally distributed data were analyzed by an unpaired t test. Data not normally distributed were analyzed using the Mann–Whitney test. P<0.05 was considered significant.
| Results |
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Apelin Has No Apparent Role in Feeding Behaviors and Obesity
Multiple experiments using exogenous administration of Apelin peptides have implicated the Apelin system in various organ functions such as diuresis, fluid and food intake, and obesity.15–17 To test these proposed functions genetically in Apelin mutant mice, we first performed water restriction experiments followed by fluid intake. Neither weight loss attributable to water restriction (Figure 2A) nor the subsequent fluid intake (Figure 2B) was altered in Apelin mutant mice as compared with wild-type controls. In addition, the body weights and weight gain of Apelin mutant and wild-type control mice were comparable at normal diet (Figure IA in the online data supplement) and at a high-fat diet (Figure 2C). Thus, in our experimental paradigms, genetic inactivation of Apelin has no apparent effect on feeding behaviors or diet-induced obesity.
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Normal Heart Development in Apelin-Deficient Mice
In Xenopus, Apelin has been implicated in development of the cardiovascular system.27,28 Because both Apelin and APJ are highly expressed in the vasculature of the heart and cardiomyocytes, we analyzed hearts of Apelin-deficient mice. Heart weights and heart to body weight (HW/BW) ratios were comparable between age-matched 3-, 6-, and 12-month-old Apelin–/y and Apelin+/y mice (Figure 2D and data not shown). Echocardiography confirmed that the left ventricular mass and its ratio to body weight were normal (Table 1). Moreover, we failed to observe overt structural changes (Figure 2E), and there was no indication of prototypical changes in ANF, BNP, β-myosin heavy chain, and skeletal muscle actin gene expression in the hearts of Apelin mutant mice (supplemental Figure IB). Thus, loss of Apelin expression had no apparent defect on heart development or heart structures.
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Loss of Apelin Results in Impaired Heart Contractility in Aging Mice
Pharmacological treatment of rodents with Apelin peptides has suggested a role for the Apelin–APJ system in the regulation of heart function and cardiac hypertrophy.30–32 Moreover, previous reports show that the infusion of Apelin peptide decreases blood pressure in rodents.19,29 Loss of Apelin, however, did not result in alteration of blood pressure in 3-month-old Apelin–/y mice as compared with their control littermates (Figure 2F). We next performed telemetry in 6-month-old mice to measure blood pressure in awake mice under physiological conditions. Whereas heart rates were comparable between mutant and control mice at different times of the day and night (Figure 3A), Apelin mutant mice exhibited a tendency for reduced blood pressure (Figure 3B). This trend for reduction in blood pressure, however, did not reach statistical significance.
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Because heart morphology appeared normal but blood pressures tended to be reduced in aged mice, we analyzed heart functions in Apelin mutant animals. Assessment of cardiac function by echocardiography revealed normal heart functions in 3-month-old Apelin mutant mice (Figure 3C), which is in line with normal blood pressure at that age (Figure 2F). However, at 6 months of age, all Apelin–/y male and Apelin–/– female mice exhibited a reduction in cardiac contractility, as determined by decreased left ventricle FS and increased left ventricular diameter in systole (Table 1 and Figure 3C and 3D). The decrease in heart function was found to be more severe in 6-month-old male than in age-matched female mice. In addition, 12-month-old mice had a more pronounced phenotype than 6-month-old male animals (Table 1 and Figure 3C), suggesting an age-related progression of the phenotype. To address whether the echocardiographic defects in cardiac function were attributable to developmental defects or to impairment of contractility per se, Apelin 13 peptide was continuously infused for 2 weeks into 6-month-old Apelin-null mice by using osmotic minipumps (Figure 3E). Infusion of Apelin 13 peptides had no apparent effect on FS in wild-type mice. However, the impaired cardiac contractility in Apelin–/y mice was entirely restored to wild-type levels by Apelin 13 peptide infusion (Table 1 and Figure 3E). Thus, the phenotype of reduced contractility in aged Apelin knockout mice was not caused by a secondary developmental defect but constituted an intrinsic and progressive impairment in heart function.
Severe Heart Failure in Apelin Knockout Mice in Response to Pressure Overload
The reduced heart contractility in aged Apelin knockout mice suggested a role of Apelin in heart failure. Indeed, exposure of wild-type mice to chronic pressure overload by surgical constriction of aorta (AB) resulted in the upregulation of Apelin expression in hearts of wild-type mice at 1 and 2 weeks after AB, whereas at 12 weeks after AB, Apelin expression levels went down to baseline levels (Figure 4A and data not shown). The mRNA expression of the APJ receptor was not affected (Figure 4A). After AB, HW/BW ratio increased in both Apelin+/y and Apelin–/y mice (Figure 4B). Of note, HW/BW ratio was always slightly higher in aortic-banded Apelin knockout mice than litter mate wild-type mice, but this difference did not reach statistic difference at any of the time points of analysis (Figure 4B). Expression of the cardiac hypertrophy markers ANF, BNP (Figure 4C), β-myosin heavy chain, and skeletal muscle actin (not shown) was also similar between Apelin knockout and littermate wild-type mice. Moreover, histologically, hearts from wild-type and Apelin mutant mice exhibited a comparable hypertrophic response (Figure 4D). Although we cannot exclude differences in the hypertrophic response, these data indicate that loss of Apelin has no marked effect on pressure overload–induced adaptive cardiac hypertrophy.
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Next, we assessed the heart function of wild-type and Apelin knockout mice following AB. In line with previous data,39 banded littermate wild-type mice showed a decrease in heart contractility (Table 2 and Figure 5A through 5C). Intriguingly, AB of Apelin–/y mice resulted in severe heart failure characterized by decreased FS and dilated left ventricle in echocardiography (Table 2 and Figure 5A through 5C). Invasive hemodynamics further demonstrated that both the maximum and minimum rates of change of left ventricular pressure, (dP/dt)max, and (dP/dt)min, as the ejection fraction, and the left ventricular end-systolic pressure were significantly reduced in Apelin–/y mice (Table 2 and Figure 5D). In line with this, we also observed a significant increase in left ventricular end-diastolic pressure in Apelin–/y mice (Table 2), thus confirming the impaired heart function in aortic-banded Apelin–/y mice.
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To further assess the molecular evidence of contraction impairment in Apelin–/y mice, we performed gene arrays experiments to analyze the effects of Apelin deficiency on a global genome basis (National Center for Biotechnology Information series entry GSE7781). Hierarchical clustering of differentially expressed genes in heart samples of Apelin–/y and Apelin+/y mice 12 weeks post AB showed concerted upregulation of defined sets of genes involved in extracellular matrix remodeling and fibrosis or genes regulating muscle contraction and stress fibers in Apelin–/y mice (Table 3
and Figure 5D). Upregulation of some of these genes, such as collagen type VIII
1 (Col8a), latent transforming growth factor β–binding protein 2 (Ltbp2), periostin (Postn), lysyl oxidase (Lox), and transforming growth factor β2 (Tgfb2) was confirmed using real-time PCR (Figure 6). In addition, genes involved in angiogenesis, blood pressure regulation, actin cytoskeleton, and muscle ankyrin repeat proteins were upregulated in banded Apelin–/y mice (Table 3
). On the other hand, the downregulated genes included mitogen-activated protein kinase, specifically Map4K4 and Mapk14, ion transporters, and metabolic genes including several phospholipases. Importantly, as predicted from our hierarchical clustering of extracellular matrix remodeling genes, Masson trichrome staining confirmed increased interstitial fibrosis in Apelin–/y mice following AB (Figure 5E). Therefore, AB of Apelin knockout mice results in marked alterations in the cardiac gene expression profile and impaired heart function.
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| Discussion |
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ACE2 is a key enzyme that proteolytically processes Apelin peptides with an efficacy as high as for angiotensin II.12 Previous analyses of C-terminal Apelin peptide deletions or mutations showed that such peptides lost their blood pressure effects, which leads to the assumption that ACE2 inactivates Apelin peptides.41,42 One might therefore speculate that Apelin knockout mice show the opposite phenotype of Ace2-deficient animals. However, our genetic results show that Apelin-deficient mice recapitulate some cardiac phenotypes observed in Ace2 mutant mice. For instance, similar to our Apelin mutant mice, Ace2 knockout mice have an aging-associated defect in heart contractility.7 Moreover, Yamamoto et al demonstrated in an independent Ace2 mutant mouse line that loss of ACE2 results in severe heart failure and lung congestion in pressure overload.8 Thus, in contrast to the predictions based on biochemistry, our genetic data in vivo indicate that ACE2 might be a positive regulator of Apelin peptide functions in vivo, at least in terms of cardiac functions. Importantly, our study suggests, for the first time, that the ACE2 in vivo functions might not be solely dependent on the renin–angiotensin system but ACE2 might actively influence other peptide systems. For instance, based on our results, one could speculate that Apelin might be involved in the inotropic effects of ACE2. Further studies are required to understand the relationships between Apelin and ACE2.
In APJ knockout mice, the only reported defect was increased (
10 mm Hg) blood pressure responses to angiotensin II infusion under conditions of ACE inhibition or an angiotensin II type 1 receptor mutant background.35 Moreover, several studies have shown blood pressure–lowering effects of Apelin peptide in rats and mice rodents.29,43 However, our Apelin mutant mice did not show an apparent increase in blood pressure; rather these mice exhibited a minor decrease in blood pressure under awake conditions, a phenomenon that appears to be secondary to the impaired heart function in aged knockout mice. We also performed similar angiotensin II infusion experiments in Apelin mutant mice but failed to observe a further increase in blood pressure (not shown). However, we cannot exclude that loss of Apelin affects blood pressure homeostasis under defined experimental conditions. Moreover, it would be interesting to test whether APJ mice develop heart failure in response to pressure overload and age-dependent contractility defects. Differences in blood pressure control and cardiac homeostasis between Apelin and APJ mutant mice could point to different ligands for APJ and/or additional Apelin peptide receptors.
In human patients, APJ, as well as Apelin, expression was found to be significantly upregulated after placement of a left ventricular assist device in 11 patients with heart failure.33 Increased levels of Apelin mRNA expression were also reported in patients with heart failure caused by both coronary heart disease and idiopathic dilated cardiomyopathy.34 Our data now show that Apelin is upregulated at 1 and 2 weeks after AB and that Apelin expression is normalized at 12 weeks. In line with our results in banded mice, in human patients, it has been reported that Apelin expression is normalized/decreased at later stages of heart failure.33 Thus, upregulation of Apelin expression might compensate for early cardiac stress, whereas reduced Apelin expression at later stages could contribute to the development of heart failure. This scenario is in line with previous data that infusion of Apelin has in vivo inotropic effects on failing hearts after myocardial infarction, as well as on normal hearts in rats.31 Furthermore, chronic infusion of Apelin into normal mice resulted in significant increases in the velocity of circumferential fiber shortening and cardiac output by echocardiography.44 Most importantly, our genetic data show that endogenous Apelin is indeed crucial to maintain cardiac contractility.
In this study, we report the first Apelin mutant mouse generated by homologous recombination. We show that Apelin knockout mice display aging-associated reduced cardiac contractility, which becomes evident at
6 months of age. Furthermore, in a pressure overload–induced heart failure model, Apelin knockout mice develop severe impairment in heart contractility. These genetic data indicate that Apelin maintains cardiovascular homeostasis on pressure overload and aging. Thus, Apelin might be a promising therapeutic target for the treatment of hypertension and aging-related heart failure.
| Acknowledgments |
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Sources of Funding
J.M.P. is supported by Institute of Molecular Biotechnology of the Austrian Academy of Sciences, the Austrian National Bank, the Austrian Ministry of Science and Education, and EuGeneHeart. K.K. is supported by the European Union network grant (EuGeneHeart) and the Special Coordination Funds for Promoting Science and Technology commissioned by the Ministry of Education, Culture, Sports, Science and Technology of Japan. P.P.L. is supported by the Heart and Stroke Foundation of Ontario, the Canadian Institutes of Health Research (CIHR), and the Team Research Program and Group Program from of the CIHR. P.P.L. is the Heart & Stroke/Polo Chair Professor of Medicine and Physiology (University of Toronto) and scientific director (Institute of Circulatory and Respiratory Health, Canadian Institutes of Health Research).
Disclosures
None.
| Footnotes |
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