京都大学 / 新制・課程博士 / 博士(医学) / 甲第24999号 / 医博第5033号 / 新制||医||1070(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 小林 恭, 教授 尾野 亘 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Primary aldosteronism is the most common secondary cause of hypertension with a prevalence of about 10%. About half of PA cases are caused by aldosterone-producing adenomas (APA). Two APA subtypes, ZG-like and ZF-like APAs, have been described, according to the histological resemblance to normal zona glomerulosa (ZG) and zona fasciculata (ZF), underlying somatic mutations (KCNJ5 commonly found in ZF-like, CACN1AD, ATP1A1, ATP2B3, CTNNB1 in ZG-like APAs), and transcriptome profile. It is unknown if the process of tumorigenesis differs between ZG- and ZF-like APAs. In order to define ZG specific genes, we have compared the transcriptome of APAs and their adjacent adrenal glands by microarray assay. RNA was isolated by laser capture microdissection (LCM) from adjacent ZG, ZF and APAs from 14 patients with Conn’s and 7 patients with phaeocromocytoma. Two top hit genes from the comparison of ZG vs ZF were functionally studied, ANO4 and NEFM. NEFM, encoding neurofilament medium, was the fourth most up-regulated gene in ZG vs ZF, showing 14.8-fold-fold higher expression levels (p=9.16-12) in ZG than ZF. NEFM was also one of the most down-regulated genes in ZF-like vs ZG-like APAs. Immunohistochemistry (IHC) confirmed selective high expression of NEFM in ZG and ZG-like APAs. Silencing NEFM in H295R cells increased aldosterone secretion and cell proliferation. In addition, it increased stimulation and inhibition, respectively, of aldosterone secretion from H295R cells by the dopamine receptor D1R agonist fenoldopam and antagonist SCH23390. IHC showed predominantly intracellular staining for D1R in NEFM-rich ZG-like APAs, but membranous staining in NEFM-poor ZF-like APAs. Aldosterone secretion in response to fenoldopam in primary cells from ZG-like APAs was lower than in cells from ZF-like APAs. NEFM expression levels directly correlate with KCNJ5 phenotype: KCNJ5 mutations down-regulate NEFM mRNA and protein levels in H295R cells and in primary cells from ZG-like APAs. ANO4,encoding a Ca2+-activated chloride channel family member, was the third most upregulated gene, showing 19.9-fold higher expression levels (p=6.6x10-24) in ZG than ZF. IHC confirmed ZG selectivity of ANO4 protein in the adrenal cortex. The staining was mainly cytoplasmic. Unlike NEFM, there was no difference in expression of ANO4 between ZG- and ZF-like APAs, the levels being mid-way between those of ZF and ZG. Overexpression of ANO4 in H295R cells caused an increase in CYP11B2 and NR4A2 gene expression levels but basal aldosterone secretion was unchanged. In the presence of calcium agonists, ANO4 reduced aldosterone secretion. ANO4 subcellular localisation was confirmed as cytoplasmic by immunofluorescence microscopy of transfected cells. When exposed to calcium ionophores, ANO4 generated small chloride currents as detected by YFP assay. In summary, the comparison of transcriptome of ZG with paired ZF found unexpected up-regulated genes. Most of the highly up regulated genes in human ZG, including NEFM and ANO4, inhibit either basal or stimulated aldosterone secretion, and this may reflect an adaptive response to high salt intake. No clear-cut correspondence was found between transcriptome of APAs and their resembling zone of adrenal cortex. The down-regulation of NEFM following transfection of mutant KCNJ5 suggests that ZF-like properties may be a consequence of mutation, rather than tissue of origin.

Indiana University-Purdue University Indianapolis (IUPUI) / Adenosine is widely thought to elicit coronary vasodilation and attenuate smooth muscle cell (SMC) proliferation, thereby providing cardioprotection. We cloned the porcine adenosine A1 receptor (A1R) subtype and found that it paradoxically stimulated proliferation of cultured coronary SMC by the extracellular signal-regulated protein kinases 1 and 2 (ERK1/2) signaling pathways, thus suggesting A1R dysregulation could play a role in coronary artery disease (CAD), restenosis, and regulation of coronary blood flow (CBF). We utilized the Ossabaw swine model of metabolic syndrome (MetS) to test the hypothesis that A1R activation contributes to development of CAD, in-stent stenosis, and CBF regulation. Swine were fed standard chow (Lean) or excess calorie atherogenic diet for over 20 weeks, which elicited MetS characteristics and coronary atherosclerosis compared to Lean. We observed increased A1R in native CAD in MetS, which was reversed by exercise training, and upregulation of A1R expression and A1R-ERK1/2 activation in an in vitro organ culture model of CAD. Intracoronary stent deployment followed by different durations of recovery showed A1R upregulation occurred before maximal in-stent stenosis in vi vivo. More importantly, selective A1R antagonism with 8-cyclopentyl-1, 3-dipropylxanthine (DPCPX)-eluting stents decreased coronary ERK1/2 activation and reduced in-stent stenosis comparable to Taxus® (paclitaxel-eluting stents). A1R antagonism potentiated vasodilatory effects of some vasodilators other than adenosine in porcine coronary microcirculation under basal conditions. Short-term exercise training around stenting prevented stent-induced microvascular dysfunction and attenuated native atheroma in the genetically lean Yucatan swine. Conclusions: A1R upregulation and activation contributes to coronary in-stent stenosis in vivo in MetS, plays a role in the development of coronary atherosclerosis in vitro, and might involve in CBF dysregulation in dyslipidemia and stenting. Exercise training decreased A1R expression in atherosclerosis, reduced native atheroma, and prevented stent-induced microvascular dysfunction. Selective pharmacological antagonism of A1R holds promise for treatment of CAD.

No description available.

L’hyperaldostéronisme primaire [HAP] résulte d’une hypersécrétion d’aldostérone d’origine surrénale. La compréhension de la pathogénie de cette maladie, dont la prévalence est estimée à 10% de la population hypertendue, est essentielle pour le développement de nouveaux outils diagnostiques et thérapeutiques. Dans ce contexte, ce travail de doctorat avait pour but d’identifier de nouvelles orientations thérapeutiques en testant un inhibiteur de l’aldostérone synthase et de rechercher de nouveaux marqueurs diagnostiques par l’étude du profil d’expression des microARN [miRs]. Dans une étude de phase II, 14 patients présentant un HAP ont reçu un inhibiteur de l’aldostérone synthase : le LCI699 pendant 4 semaines. Nous avons ainsi pu montrer que le LCI699 permet de diminuer les concentrations d’aldostérone de 70 à 80% et de normaliser la kaliémie chez tous les patients. En revanche, il n’a qu’un effet modéré sur la pression artérielle et sur l’élévation des concentrations de rénine, et n’est que partiellement sélectif pour l’aldostérone synthase. De plus son efficacité est moindre que celle de l’éplérénone, antagoniste minéralocorticoide administré aux mêmes patients au décours du LCI699. Nous avons ensuite étudié l’expression de 754 miRs dans des adénomes produisant de l’aldostérone [APA] et dans des surrénales contrôles. L’hypothèse était qu’une dérégulation de leur expression pouvait être impliquée dans la tumorigénèse et la surproduction d’aldostérone. L’objectif secondaire était d’identifier des miRs utilisables en tant que biomarqueurs. Cette analyse par carte microfluidique a révélé que 27 miRs sont significativement sous exprimés dans les APA et un seul miR est surexprimé. L’expression différentielle de deux de ces miRs : miR 137 et miR 375 a pu être confirmée dans une cohorte de validation de 36 APA: Des résultats préliminaires in vitro indiquent que le miR 375 pourrait induire une diminution de la synthèse d’aldostérone. Enfin, l’analyse de l’expression de ces miRs dans le plasma a permis de mettre en évidence une sous-expression du miR 375 chez les patients atteints d’HAP en comparaison à des sujets sains. En conclusion, le blocage de la biosynthèse de l’aldostérone représente une nouvelle option thérapeutiques, cependant il est nécessaire de développer une seconde génération de molécules : plus puissantes et plus sélectives. Les analyses effectuées sur les APA ouvrent de nouvelles perspectives pour l’identification de nouveaux biomarqueurs tels que les miRs circulants / Primary aldosteronism [PA] results from the hypersecretion of aldosterone by the adrenals. Understanding the pathogenesis of the disease is essential for identifying new diagnostic and therapeutic tools. In this context the purpose of my PHD was to investigate the effects of an aldosterone synthase inhibitor and second to investigate new diagnostic options by the extensive study of microRNA [miRNA]. In a phase II clinical study, 14 patients with PA were administered an aldosterone synthase inhibitor: LCI699. Four weeks of treatment lead to a 70 to 80% decrease in aldosterone concentration, associated with the cure of hypokalemia. However, there was only a mild effect on blood pressure and volemia (reflected by renin concentration). In addition, these results demonstrated an incomplete selectivity of LCI699 for aldosterone synthase in vivo, and showed that LCI699 is less potent than the blocker of the mineralocorticoid receptor: eplerenone . We also characterized the miRNA profile of Aldosterone producing adenomas [APA]. The hypothesis was that a dysregulation of the expression of miRNA could induce tumorigenesis and increase the production of aldosterone. The secondary aim of the study was to identify miRNA that could be measured in plasma as biomarkers. miRNA profiling of 754 miRNA using quantitative PCR Low Density array, revealed 28 miRNA whose expression was significantly different in APA. The differential expression of two miRNA: miRNA 137 and miRNA 375 was confirmed in a validation cohort of 36 APA. Preliminary in vitro studies showed that up-regulation of intracellular levels of miR 375 may reduce aldosterone secretion in H295R cells. Lastly, circulating plasma levels of miR 375 are differentially expressed between patients with PA and healthy volunteers. In conclusion, the blocking of the aldosterone pathway in hypertensive patients is a novel therapeutic option but second-generation drugs more potent and more selective of aldosterone synthase are required. Profiling miRNA in APA offers new prospect for the development of biomarkers, such as measuring circulating miRNA in plasma

No description available.

Thesis (MScMed)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: In hypertrophic cardiomyopathy (HCM), an autosomal dominant disorder, hypertrophy is variable within and between families carrying the same causal mutation, suggesting a role for modifier genes. Associations between left ventricular hypertrophy and left ventricular pressure overload suggested that sequence variants in genes involved in the Renin-Angiotensin Aldosterone System (RAAS) may act as hypertrophy modifiers in HCM, but some of these studies may have been confounded by, amongst other things, lack of adjustment for hypertrophy covariates. To investigate this hypothesis, twenty one polymorphic loci spread across six genes (ACE1, AGT, AGTR1, CYP11B2, CMA and ACE2) of the RAAS were genotyped in 353 subjects from 22 South African HCM-families, in which founder mutations segregate. Genotypes were compared to 17 echocardiographically-derived hypertrophic indices of left ventricular wall thickness at 16 segments covering three longitudinal levels. Family-based association was performed by quantitative transmission disequilibrium testing (QTDT), and mixed effects models to analyse the X-linked gene ACE2, with concurrent adjustment for hypertrophy covariates (age, sex, systolic blood pressure (BP), diastolic BP, body surface area, heart rate and mutation status). Strong evidence of linkage in the absence of association was detected between polymorphisms at ACE1 and posterior and anterior wall thickness (PW and AW, respectively) at the papillary muscle level (pap) and apex level (apx). In single-locus analysis, statistically significant associations were generated between the CYP11B2 rs3097 polymorphism and PW at the mitral valve level (mit) and both PWpap and inferior wall thickness (IW)pap. Statistically significant associations were generated at three AGTR1 polymorphisms, namely, between rs2640539 and AWmit, rs 3772627 and anterior interventricular septum thickness at pap and rs5182 and both IWpap and AWapx. Furthermore, mixed effects model detected statistically significant association between the ACE2 rs879922 polymorphism and both posterior interventricular septum thickness and lateral wall thickness at mit in females only. These data indicate a role for RAAS gene variants, independent of hypertrophy covariates, in modifying the phenotypic expression of hypertrophy in HCM-affected individuals. / AFRIKAANSE OPSOMMING: Hipertrofiese kardiomiopatie (HCM), ‘n autosomale dominante afwyking, toon hoogs variërende hipertrofie binne en tussen families wat dieselfde siekte-veroorsakende mutasie het, hierdie dui op die moontlike betrokkenheid van geassosieerde modifiserende gene. Assosiasies tussen linker ventrikulêre hipertrofie en linker ventrikulêre druk-oorlading stel voor dat volgorde variasies in gene betrokke in die Renin-Angiotensin Aldosteroon Sisteem (RAAS) mag optree as hipertrofie modifiseerders in HCM. Sommige van hierdie soort studies is egter beperk omdat hulle nie gekompenseer het vir kovariante van hipertrofie nie. Om hierdie hipotese te ondersoek, is die genotipe bepaal by een-en-twintig polimorfiese lokusse, verspreid regoor ses RAAS gene (ACE1, AGT, AGTR1, CYP11B2, CMA and ACE2), in 353 kandidate vanuit 22 Suid-Afrikaanse HCM-families in wie stigter mutasies segregeer. Genotipes was vergelyk met 17 eggokardiografies afgeleide hipertrofiese indekse van linker ventrikulêre wanddikte by 16 segmente wat oor drie longitudinale vlakke strek. Familie-gebaseerde assosiasies was bestudeer deur kwantitatiewe transmissie disequilibrium toetsing (QTDT) en gemengde effek modelle om die X-gekoppelde geen ACE2 te analiseer, met gelyktydige kompensasie vir hipertrofie kovariate (ouderdom, geslag, sistoliese bloed druk (BP), diastoliese BP, liggaamsoppervlak area, hartritme en mutasie-status). Sterk indikasies van koppeling in die afwesigheid van assosiasie is waargeneem tussen ACE1 lokusse en posterior wanddikte (PW) asook anterior wanddikte (AW) by die papillêre spier vlak (pap) en die apeks vlak (apx). In enkel-lokus analises is statisties-betekenisvolle assosiasies gevind tussen die CYP11B2 rs3097 polimorfisme en PW by die mitraalklep vlak (mit) en beide die PWpap en inferior wanddikte (IW)pap. Statisties-betekenisvolle assosiasies was verder gevind by drie AGTR1 polimorfismes, naamlik, tussen rs2640539 polimorfisme en AWmit, rs3772627 en die anterior interventrikulêre septumdikte (aIVS) by die pap en rs5182 by beide die IWpap en AWapx. Gemengde-effek modelle het verder assosiasies aangetoon tussen die ACE2 rs879922 polimorfisme en die posterior interventrikulêre septumdikte en die laterale wanddikte by die mit, slegs in vrouens. Hierdie data dui op ‘n kovariaat-onafhanklike rol vir RAAS genetiese variante in die modifisering van die fenotipiese uitdrukking van hipertrofie in HCM-geaffekteerde individue.

High salt intake contributes to the development of hypertension in salt-sensitive humans and animals and the mechanistic causes are poorly understood. In Dahl salt-sensitive (S) but not salt-resistant (R) rats, high salt diet increases cerebrospinal fluid (CSF) [Na+] and activates an aldosterone-mineralocorticoid receptor-epithelial sodium channel-endogenous ouabain (MR-ENaC-EO) neuromodulatory pathway in the brain that enhances the activity of sympatho-excitatory angiotensinergic and glutamatergic pathways, leading to an increase in sympathetic nerve activity (SNA) and blood pressure (BP). We hypothesize that high salt diet in Dahl S rats enhances Ang II release in the paraventricular nucleus (PVN), causing a decrease in local nitric oxide (NO) action and an increase in local glutamate release thereby elevating SNA, BP and heart rate (HR). The present study evaluated the effects of agonists or blockers of MR, ENaC, EO, nitric oxide synthase (NOS) or glutamate and AT1-receptors on the BP and HR responses to acute infusions of Na+ rich aCSF, intracerebroventricularly (icv), or in the PVN of Dahl S, R or Wistar rats or to high salt diet in Dahl S and R rats. In Wistar rats, aldosterone in the PVN enhanced the BP and HR responses to infusion of Na+ rich aCSF in the PVN, but not in the CSF, and only the enhancement was prevented by blockers of MR, ENaC and EO in the PVN. AT1-receptor blockers in the PVN fully blocked the enhancement by aldosterone and the responses to infusion of Na+ rich aCSF icv, or in the PVN. Na+ rich aCSF in the PVN caused larger increases in BP and HR in Dahl S vs. R rats and the responses to Na+ were fully blocked by an AT1-receptor blocker in the PVN. BP and HR responses to a NOS blocker in the PVN were the same, but L-NAME enhanced Na+ effects more in Dahl R than S rats. High salt diet attenuated increases in BP from L-NAME in the PVN of Dahl S but not R rats. AT1 and glutamate receptor blockers candesartan and kynurenate in the PVN decreased BP in Dahl S but not R rats on high salt diet. At the peak BP response to candesartan, kynurenate in the PVN further decreased BP whereas candesartan did not further decrease BP at the peak BP response to kynurenate. Our findings indicate that both an acute increase in CSF [Na+] and high salt intake in Dahl S rats increases AT1-receptor activation and decreases NO action in the PVN thereby contributing to the pressor responses to Na+ and presumably, to dietary salt-induced hypertension. The increased BP response to AT1-receptor activation in the PVN of Dahl S is mediated by enhanced local glutamate receptor activation. An MR-ENaC-EO pathway in the PVN can be functionally active and further studies need to assess its role in Dahl S rats on high salt intake.

Em células endoteliais e músculo liso vascular, aldosterona regula processos associados ao remodelamento vascular como crescimento, expressão de marcadores inflamatórios e estresse oxidativo. Os mecanismos exatos desses efeitos ainda são desconhecidos, mas é sugerido que o influxo de Mg2+ através recém caracterizados TRPM7 seja importante. O objetivo de nosso estudo foi determinar o papel do Mg2+ na função celular e hipertensão induzida pela aldosterona em camundongos com níveis normais (MgH) e baixos (MgL) de Mg2+. A deficiência de Mg2+ e inibição do TRPM7 aumentaram a ativação de vias pró-inflamatórias e fibrogênicas induzidas pela aldosterona. Nós também demonstramos que a infusão de aldosterona é acompanhada de efeitos deletérios sobre o rim e coração, associados ao estresse oxidativo e alterações na concentração de eletrólitos. Esses resultados fornecem novos mecanismos pelos quais aldosterona modula a função celular e ressaltam a importância do Mg2+ e seus transportadores nesses processos e na hipertensão induzida pela aldosterona. / In vascular smooth muscle and endothelial cells, aldosterone induces growth, inflammation and oxidative stress. Exact mechanisms underlying aldo-mediated vascular effects remain unclear, but intracellular magnesium (Mg2+) influx through the novel Mg2+ transporter, TRPM7 may be important. Here we sought to determine the role of Mg2+ in cell function and in aldosterone-induced hypertension in mice genetically bred to have normal (MgH) or low (MgL) intracellular Mg2+ levels. Findings from the present study demonstrate that Mg2+ deficiency and inhibition of TRPM7 amplify aldosterone-induced activation of vascular inflammatory, fibrogenic and growth signaling pathways. We also show that aldosterone infusion in MgH and MgL mice are accompanied by end-organ damage, associated to oxidative stress and changes in electrolytes concentration. Our results provide novel insights into putative mechanisms whereby aldo influences VSMC and EC function and highlights the important role of Mg2+ in the development of aldosterone-induced hypertension.

L’utilisation d’antagonistes du récepteur aux minéralocorticoïdes (ARM) a prouvé son efficacité dans le traitement de l’insuffisance cardiaque (IC). Un des facteurs de risque majeur de l’IC, le syndrome métabolique (SMet), est également associé à une production augmentée d’aldostérone et une activation excessive de son récepteur. Dans ce contexte, nous avons émis l’hypothèse que l’utilisation des ARM pouvait être appliquée pour cibler les facteurs de risques du SMet et prévenir la progression subséquente vers l’IC. Dans ce projet, des rats Spontanément Hypertendus et développant une IC (rats SHHF) portant ou non une mutation du récepteur de la leptine (« cp ») conduisant à un SMet (respectivement SHHFcp/cp et SHHF+/+) ont été utilisés comme modèle expérimental. Les animaux ont reçu soit un placebo soit le traitement ARM (Eplérénone, Eplé) dès l’âge de 1.5 à 12.5 mois et leurs paramètres métaboliques et cardiovasculaires ont été régulièrement évalués. Les fonctions moléculaires altérées dans le coeur et le tissu adipeux lors du développement du SMet et la progression de l’IC, ainsi que celles modulées par l’action de l’Eplé ont été caractérisées par l’analyse du transcriptome et miRNome des animaux. Nos résultats montrent que les rats SHHFcp/cp développent à 12.5 mois une hypertrophie cardiaque excentrique associée à une dilatation du ventricule gauche (VG) et une fraction d’éjection diminuée comparés aux SHHF+/+. Alors que l’Eplé ne modifie pas les paramètres métaboliques et cardiovasculaires des SHHF+/+, Les rats Eple-SHHFcp/cp présentent une moindre prise de masse corporelle ainsi qu’une moindre dyslipidémie. Sans effet sur la pression artérielle (PA), ni le transcriptome et miRNome adipeux, les animaux SHHFcp/cp traités présentent en outre une moindre dilatation et hypertrophie de leur VG, une fraction d’éjection, un temps de relaxation isovolumique et un ratio E/A plus élevés. Les analyses du transcriptome et miRNome cardiaques révèlent que l’Eplé induit une diminution significative de l’expression de gènes impliqués dans le remodelage et l’inflammation myocardiques ainsi qu’une augmentation de l’expression de gènes relatifs à l’oxydation des acides gras dans le coeur. L’intégration et l’exploration bioinformatique des profils d’expression du transcriptome et du miRNome ont permis d’établir des réseaux de régulation de l’expression génique potentiellement impliqués dans les mécanismes physiopathologiques à l’oeuvre chez les rats SHHF obèses et dans ceux impactés par le traitement. Dans leur ensemble, nos données montrent que l’initiation d’un traitement ARM lors du développement du SMet permet d’atténuer l’obésité et la dyslipidémie et d’améliorer les paramètres de structure et fonction cardiaque. De façon intéressante, ces effets cardioprotecteurs sont obtenus via des mécanismes indépendants de la diminution de la PA, les analyses du transcriptome/miRNome cardiaque indiquent un mécanisme basé sur une diminution des processus de remodelage et d’inflammation ainsi qu’ une restauration de la fonction de métabolisme énergétique des acides gras au niveau myocardique / Mineralocorticoid Receptor Antagonists (MRA) are clinically beneficial in individuals with chronic heart failure (HF). One of the major risk factors for HF, the metabolic syndrome (MetS), has been also reported to be associated with increased aldosterone production and excessive MR activation. In this context, we hypothesized that the use of MRA could be applied to target the MetS features and prevent the subsequent progression towards HF. In this project, Spontaneously Hypertensive Heart failure rats (SHHF) carrying or not a mutation in the leptin receptor (« cp ») leading to MetS development (SHHFcp/cp and SHHF+/+respectively) were used as experimental model. Animals from both genotypes were given either the selective MRA (Eplerenone, Eple) or placebo from 1.5 to 12.5 months of age and their metabolic and cardiovascular parameters were regularly monitored. The molecular functions altered in the heart and visceral adipose tissues as MetS develops and progresses towards HF as well as those modulated by Eple action were characterized by the analysis of animal’s transcriptome and miRNome. Our data showed that SHHFcp/cp exbiting MetS developed at 12.5 months of age eccentric cardiac hypertrophy associated with left ventricular (LV) dilatation and reduced ejection fraction (EF) as compared to SHHF+/+. While Eple did not induced differences in metabolic and cardiovascular phenotypes in SHHF+/+ rats, Eple-SHHFcp/cp had lower body weight gain and less dyslipidemia. Without effects on blood pressure (BP) and adipose transcriptome and miRNome, Eple-SHHFcp/cp rats had lower LV dilatation and hypertrophy, higher ejection fraction, isovolumic relaxation time and E/A ratio. Transcriptome and miRNome analysis of cardiac tissues revealed that Eple markedly reduced the expression of several genes involved in cardiac remodeling and inflammatory processes and increased the expression of genes related to cardiac fatty acid oxidation and metabolism. The integration and the bioinformatic exploration of transcriptome and miRNome expression profiles allowed the construction of gene regulatory networks potentially involved in the physiopathological mechanisms occuring in the SHHFcp/cp rats and those impacted by the treatment. Altogether, our data demonstrated that treatment with Eple during MetS development attenuated SHHFcp/cp weight gain and dyslipidemia contributing to the amelioration of their cardiac structural and functional parameters. Interestingly, those beneficial cardioprotective effects were obtained via mechanisms independent of BP lowering, the analysis of cardiac transcriptome/miRnome revealed that Eple may have acted by depressing cardiac remodeling and inflammatory processes and restoring the function of fatty acid metabolism in the myocardium