Introduction: Therapeutic agents like doxorubicin, an anthracycline antibiotic drug, are widely used in cancer chemotherapy. The use of doxorubicin is limited however by an increased risk of cardiac damage as a side effect, and an increased cancer cell drug resistance mediated by efflux drug transporters. Strategies are needed to protect the heart and still allow the benefits of drug treatment. “Basic” fibroblast growth factor-2 (FGF-2) is a multi-functional protein. It is angiogenic and cardioprotective against ischemia-reperfusion injury. FGF-2 can also regulate cancer cell drug resistance or sensitivity, however, so far, there is no evidence that FGF-2 protects against doxorubicin-induced cardiac damage through effects on efflux drug transporter levels or function. Aims: To investigate whether: (1) FGF-2 can increase resistance to doxorubicin-induced neonatal rat cardiac myocyte damage; and if so whether (2) an effect on efflux drug transporters might contribute to this cardioprotection by FGF-2. Methods: Neonatal rat cardiac myocyte cultures were treated with doxorubicin in the absence or presence of pre-treatment with FGF-2. To assess cell damage: (i) culture medium was tested for lactate dehydrogenase (LDH) activity as an indication of plasma membrane disruption; (ii) cells were stained with fluorescent apoptosis and necrosis biomarkers as well as (iii) terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and acridine orange to assess DNA fragmentation or compaction. The role of FGF receptor (FGFR) or protein kinase C (PKC) was addressed through use of inhibitors including SU5402, or chelerythrine as well as bisindomaleimide. Multidrug resistance gene 1a and 1b (MDR1a, 1b), multidrug resistance gene 2 (MDR2) and multidrug resistance-related protein 1 (MRP1) gene expression, as well as the function of MDRs and MRPs protein products were assessed by real-time reverse transcriptase-polymerase chain reaction (qPCR), as well as retention/extrusion of (fluorescent) doxorubicin/calcein in cardiac myocytes, respectively. Efflux drug transporter inhibitors, including 20 µM cyclosporine A (CsA), 2 µM verapamil and 1 µM Tariquidar (XR9576) were used to asssess for a direct effect of FGF-2 on transporter function. Fluorescence-activated cell sorting (FACS) was used to measure fluorescent doxorubicin/calcein levels inside treated cardiac myocytes. Results: Doxorubicin increased the incidence of programmed cell death, DNA damage, and lysosome and LDH activity, while decreasing cell number at 24 hours. FGF-2 prevented the detrimental effects of doxorubicin. In turn, the protective effects of FGF-2 were blocked in the presence of FGFR or PKC inhibitors. FGF-2 treatment significantly increased MDR1a, MDR1b, MDR2, MRP1 RNA levels by qPCR, and protein levels as assessed by function, and specifically extrusion of doxorubicin/calcein, in the presence of doxorubicin when compared to doxorubicin treatment alone. Furthermore, inhibition of efflux drug transporters with CsA and Tariquidar (XR9576) significantly reduced the ability of FGF-2 to protect against doxorubicin-induced damage; the beneficial effect of FGF-2 was completely blocked by pretreatment with verapamil. Conclusion(s): These data indicate for the first time that exogenous FGF-2 can increase resistance to doxorubicin-induced neonatal rat cardiac myocyte damage, and implicate PKC and regulation of efflux transporter protein levels and/or function in the mechanism.

Introduction: Therapeutic agents like doxorubicin, an anthracycline antibiotic drug, are widely used in cancer chemotherapy. The use of doxorubicin is limited however by an increased risk of cardiac damage as a side effect, and an increased cancer cell drug resistance mediated by efflux drug transporters. Strategies are needed to protect the heart and still allow the benefits of drug treatment. “Basic” fibroblast growth factor-2 (FGF-2) is a multi-functional protein. It is angiogenic and cardioprotective against ischemia-reperfusion injury. FGF-2 can also regulate cancer cell drug resistance or sensitivity, however, so far, there is no evidence that FGF-2 protects against doxorubicin-induced cardiac damage through effects on efflux drug transporter levels or function. Aims: To investigate whether: (1) FGF-2 can increase resistance to doxorubicin-induced neonatal rat cardiac myocyte damage; and if so whether (2) an effect on efflux drug transporters might contribute to this cardioprotection by FGF-2. Methods: Neonatal rat cardiac myocyte cultures were treated with doxorubicin in the absence or presence of pre-treatment with FGF-2. To assess cell damage: (i) culture medium was tested for lactate dehydrogenase (LDH) activity as an indication of plasma membrane disruption; (ii) cells were stained with fluorescent apoptosis and necrosis biomarkers as well as (iii) terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and acridine orange to assess DNA fragmentation or compaction. The role of FGF receptor (FGFR) or protein kinase C (PKC) was addressed through use of inhibitors including SU5402, or chelerythrine as well as bisindomaleimide. Multidrug resistance gene 1a and 1b (MDR1a, 1b), multidrug resistance gene 2 (MDR2) and multidrug resistance-related protein 1 (MRP1) gene expression, as well as the function of MDRs and MRPs protein products were assessed by real-time reverse transcriptase-polymerase chain reaction (qPCR), as well as retention/extrusion of (fluorescent) doxorubicin/calcein in cardiac myocytes, respectively. Efflux drug transporter inhibitors, including 20 µM cyclosporine A (CsA), 2 µM verapamil and 1 µM Tariquidar (XR9576) were used to asssess for a direct effect of FGF-2 on transporter function. Fluorescence-activated cell sorting (FACS) was used to measure fluorescent doxorubicin/calcein levels inside treated cardiac myocytes. Results: Doxorubicin increased the incidence of programmed cell death, DNA damage, and lysosome and LDH activity, while decreasing cell number at 24 hours. FGF-2 prevented the detrimental effects of doxorubicin. In turn, the protective effects of FGF-2 were blocked in the presence of FGFR or PKC inhibitors. FGF-2 treatment significantly increased MDR1a, MDR1b, MDR2, MRP1 RNA levels by qPCR, and protein levels as assessed by function, and specifically extrusion of doxorubicin/calcein, in the presence of doxorubicin when compared to doxorubicin treatment alone. Furthermore, inhibition of efflux drug transporters with CsA and Tariquidar (XR9576) significantly reduced the ability of FGF-2 to protect against doxorubicin-induced damage; the beneficial effect of FGF-2 was completely blocked by pretreatment with verapamil. Conclusion(s): These data indicate for the first time that exogenous FGF-2 can increase resistance to doxorubicin-induced neonatal rat cardiac myocyte damage, and implicate PKC and regulation of efflux transporter protein levels and/or function in the mechanism.

Hypertrophie bezeichnet eine zelluläre Anpassungsleistung, die durch vermehrte Arbeitsbelastung ausgelöst wird und durch Zunahme von Zellgröße und Proteinsynthese sowie durch Veränderungen der Genexpression bei konstanter Zellzahl gekennzeichnet ist. Beim Ubiquitin-Proteasom-System handelt es sich um den wichtigsten intrazellulären Proteinabbaumechanismus eukaryontischer Zellen. Darüber hinaus spielt es eine wichtige Rolle im regulierten Abbau zellulärer Signalmediatoren und Transkriptionsfaktoren. In einem Hypertrophiemodell mit neonatalen Rattenkardiomyozyten wurde die Wirkung von Proteasominhibitoren auf die Ausbildung einer Hypertrophie untersucht. Behandlung mit Proteasominhibitoren (MG132, MG262) führte dabei zu einer dosisabhängigen Reduktion des Effekts der eingesetzten hypertrophieinduzierenden Agonisten (Isoproterenol, Angiotensin II, Phenylephrin). So konnte mit Hilfe morphometrischer Analysen Phalloidin-gefärbter Kardiomyozyten eine Verringerung des Zellwachstums gezeigt werden. Western Blots belegten eine verringerte Expression von Hypertrophiemarkerproteinen (beta-myosin heavy chain, alpha-sarcomeric actin, alpha-smooth muscle actin). Analog zu diesen Befunden konnte in einem Reportergenassay die Abnahme der Expression des brain natriuretic peptide (BNP) gezeigt werden. Eine reduzierte RNA- und Proteinsynthese konnte mit Hilfe der Inkorporation radioaktiver Substrate nachgewiesen werden. Als Nachweis für die effiziente Inhibition des Proteasoms durch MG132 dienten Western Blots akkumulierter, polyubiquitinierter Proteine, die reduzierte proteasomale Degradation fluorogener Substrate sowie die Akkumulation eines grün fluoreszierenden Proteins nach Transfektion mit einem Ubiquitin-GFP-Konstrukt. Als mögliche Mechanismen des antihypertrophen Effekts der Proteasominhibitoren konnten eine verringerte Aktivierbarkeit der MAP Kinasen ERK 1/2 (Western Blots) sowie eine reduzierte Aktivität des Transkriptionsfaktor NFkappaB (Reportergenassay) identifiziert werden. / Myocardial hypertrophy is an important adaptive response of the heart to increased workload. It is characterized by an increase in cell size and protein synthesis, and alterations in gene expression. The ubiquitin-proteasome-system is the major pathway for intracellular protein degradation in eucaryotic cells. It plays a major role in the regulated degradation of central signal mediators and transcription factors. In a model system of neonatal rat cardiomyocytes we investigated the effects of proteasome inhibitors on myocardial hypertrophy. Treatment with specific proteasome inhibitors reduced the hypertrophic effects of all used agonists (e.g. isoproterenol, phenylephrin) dose-dependently: 0.05-1 µM MG132 resulted in a marked reduction of cell size as determined by morphometric analysis of phalloidin-stained myocytes. Moreover, western blot analysis showed a concentration-dependently reduced expression of hypertrophic marker proteins (beta-myosin heavy chain, alpha-sarcomeric actin, alpha-smooth muscle actin). This correlated well with a suppressed expression of brain natriuretic peptide in reportergene assays. Reduced RNA and protein synthesis was determined by incorporation of radioactively labeled substrates. Efficient inhibition of the proteasome by MG132 was confirmed by increased accumulation of multi-ubiquitinated proteins in western blot analysis, by reduced degradation of fluorogenic substrates and by accumulation of a ubiquitin-conjugated variant of the green fluorescent protein. Suppression of cardiomyocyte hypertrophy by proteasome inhibition corresponded to reduced ERK 1/2 activation (determined by phospho-specific antibodies) and decreased NFkappaB activation (determined by luciferase assays).

Die Präeklampsie ist eine schwangerschaftsspezifische Bluthochdruck-Erkrankung, die im Allgemeinen nach der 20. Schwangerschaftswoche auftritt. Neben der Hypertonie sind die Proteinurie und die Ödembildung charakteristische Symptome der Präeklampsie. Obwohl heute die Pathophysiologie der Präeklampsie zum großen Teil verstanden ist, ist die Ätiologie dieser Erkrankung noch unklar. 1999 konnten wir in den Seren von Präeklampsie-Patientinnen agonistische Autoantikörper, die gegen den Angiotensin II AT1-Rezeptor gerichtet sind (AT1-AAK), nachweisen. Diese AT1-AAK gehören zur Antikörpersubklasse IgG3.<br /> Die AT1-AAK führen in Kulturen neonataler Rattenkardiomyozyten AT1-Rezeptor spezifisch zu einem positiv chronotropen Effekt. Mittels Immunpräzipitation wurde gezeigt, dass AT1-AAK spezifisch den AT1-Rezeptor präzipitieren. Kontrollproben, aus denen die AT1-AAK entfernt wurden, führen zu keiner Präzipitation des AT1-Rezeptors. Die Präzipitation des AT1-Rezeptors bleibt ebenfalls aus, wenn die AT1-AAK mit einem Peptid, welches der Aminosäuresequenz des zweiten extrazellulären Loops des humanen AT1-Rezeptors entspricht, behandelt wurden. Eine Langzeitbehandlung der Kulturen neonataler Rattenherzzellen mit AT1-AAK vermindert die funktionelle Ansprechbarkeit der Zellen auf einen erneuten AT1-Rezeptor-Stimulus.<br /> Eine veränderte AT1-Rezeptorexpression wurde nicht nachgewiesen. In guter Übereinstimmung mit den in vitro-Expressionsdaten wurde gezeigt, dass die plazentare AT1-Rezeptorexpression bei Präeklampsie-Patientinnen nicht verschieden von der plazentaren AT1-Rezeptorexpression gesunder Schwangerer mit nicht pathogen verändertem Blutdruck ist. Im Zellsystem der neonatalen Rattenherzzellen führen die AT1-AAK zur Aktivierung von Gi-Proteinen und zu verringerten intrazellulären cAMP-Spiegeln.<br /> Des Weiteren wurde gezeigt, dass die AT1-AAK in Kulturen neonataler Rattenherzzellen die Transkriptionsfaktoren AP-1 und NFkB aktivieren. Die Aktivierung des Transkriptionsfaktors NFkB wurde vornehmlich in den Nicht-Myozyten der Rattenherzzellkultur nachgewiesen. Generell wurde festgestellt, dass sich die AT1-AAK pharmakologisch wie der natürliche Agonist des AT1-Rezeptors, Angiotensin II, verhalten.<br /> Erste Daten dieser Arbeit deuten auf einen eventuellen Einfluss der AT1-AAK auf die Expression von Komponenten der extrazellulären Matrix bzw. assoziierter Faktoren (Kollagen III, MMP-2, TIMP-2, Colligin) hin. In allen in dieser Arbeit untersuchten Seren von klinisch diagnostizierten Präeklampsie-Patientinnen wurden agonistische AT1-AAK nachgewiesen. Wir vermuten daher, dass die AT1-AAK möglicherweise bedeutend in der Pathogenese der Präeklampsie sind. / Preeclampsia is a serious, pregnancy-specific disorder that usually occurs after week 20 of gestation and is characterized by hypertension, proteinuria, and oedema. While the pathophysiology is clear, little is known about etiology of preeclampsia.<br /> In 1999, we showed that sera from preeclamptic patients contain autoantibodies directed against angiotensin II AT1 receptor (AT1-AAB). These autoantibodies are immunoglobuliens of the IgG3 subclass.<br /> AT1-AAB accelerate the beating rate of neonatal rat cardiomyocytes. The agonistic effect can be blocked with the AT1 receptor blocker losartan.<br /> Co-immunoprecipitation studies have shown that AT1-AAB specifically precipitate the AT1 receptor while control samples lacking AT1-AAB do not. The AT1 receptor could not be precipitated following neutralization of the AT1-AAB by a peptide corresponding to the AT1 receptors second extracellular loop. In further studies on neonatal rat heart cells, we showed long-term stimulation of the AT1 receptor whereby AT1-AAB down-regulated the AT1 receptor-mediated response to a second agonistic receptor-stimulation.<br /> After long-term stimulation of neonatal rat heart cells, no changes in AT1 receptor expression could be identified. Corresponding to these in vitro-expression data, no difference was seen in placental AT1 receptor expression between patients with preeclampsia and healthy pregnant women. Next, we tested if the AT1-AAB lead to activation of AT1 receptor signaling in angiotensin II fashion. In neonatal rat heart cell cultures, AT1-AAB lead to activation of Gi-protein with reduced cAMP levels. AT1-AAB are able to activate the transcription factors AP-1 and NFkB in this cell system. In all observations, the agonistic AT1-AAB behave pharmacologically in a similar fashion to angiotensin II.<br /> Initial data suggest that AT1-AAB may have an effect on extracellular matrix components (ECM).<br /> We have found AT1-AAB in all women meeting the clinical criteria of preeclampsia and, therefore, suggest that AT1-AAB may be important to the pathogenesis of the disease.