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Die Aktivierung der löslichen Guanylatzyklase (sGC) durch Stickstoffmonoxid (NO) ist ein zentraler Mechanismus im NO/sGC/cGMP-Signalweg. Beim Syndrom der chronischen Herzinsuffizienz ist die Signalübertragung durch NO jedoch gestört. Daher untersuchten wir die Effekte des NO-unabhängigen sGC-Aktivators Ataciguat-Natrium (vormals HMR1766) auf Hämodynamik und linksventrikuläres Remodeling in der Postinfarktphase bei Ratten, alleine und in Kombination mit dem ACE-Hemmer Ramipril. 10 Tage nach experimentellem Myokardinfarkt wurden die Tiere für 9 Wochen über eine Sonde entweder mit Placebo, Ataciguat (10 mg/kg, zweimal täglich), Ramipril (1 mg/kg/Tag) oder einer Kombination aus beidem gefüttert. Die Infarktgröße war in allen Gruppen vergleichbar. Die Monotherapie mit Ataciguat bzw. Ramipril verbesserte die linksventrikuläre Funktion und führte zu einem geringeren Anstieg des linksventrikulären Füllungsdruckes (LVEDP) und –volumens (LVEDV) im Vergleich zu Placebo. Die Kombinationstherapie war den Monotherapien überlegen. Weiterhin konnten sowohl die Ventrikelkontraktilität (LV dP/dtmax/IP), als auch -relaxationsfähigkeit (LV dP/dtmin) verbessert werden und die Lungenflüssigkeit sowie die rechtsventrikuläre Hypertrophie signifikant durch die Monotherapien, bzw. noch weiter durch die Kombination gesenkt werden. Die in der Placebo-Gruppe erhöhten Werte für Myozytenquerschnitt und interstitielle Fibrose waren in der Ramipril- und Ataciguat-Gruppe signifikant und in der Kombination noch weiter vermindert. Zusätzlich konnte auch der Superoxidanionenspiegel im kardialen Gewebe am besten durch die Kombinationstherapie gesenkt werden. Dabei zeigte sich eine Beeinflussung der NADPH-Oxidase-Untereinheit gp91phox und des mitochondrialen Enzyms UCP3. Eine Langzeitbehandlung mit Ataciguat verbesserte also die linksventrikuläre Dysfunktion und das kardiale Remodeling bei Ratten nach Myokardinfarkt in vergleichbarem Ausmaß wie die Therapie mit Ramipril. Die Kombination aus Ataciguat und ACE-Hemmer war jedoch wesentlich effektiver. Folglich stellt die sGC-Aktivierung einen vielversprechenden Therapieansatz zur Prävention von kardialem Remodeling und Herzinsuffizienz nach Herzinfarkt dar.
The massive remodeling of the heart tissue, as observed in response to pressure overload or myocardial infarction, is considered to play a causative role in the development of heart failure. Alterations in the heart architecture clearly affect the mechanical properties of the heart muscle, but they are rooted in changes at the cellular level including modulation of gene expression. Together with integrins, the transmembrane receptors linking the extracellular environment to the cytoskeleton, extracellular matrix (ECM) proteins and matricellular proteins are key components of the remodeling process in the heart. Therefore, this thesis was aimed at analysing the role of integrins in the regulation of gene expression and heart muscle performance during cardiac wound repair induced by pressure overload or myocardial infarction (MI). To investigate the contribution of integrin Beta 1, we characterised the response of mice with a conditional, cardiac-specific deletion of the integrin Beta 1 gene in an experimental model of pressure overload by aortic banding (AB). In particular, we measured physiological alterations and gene expression events in the stressed heart in the presence or absence of integrin Beta 1. Interestingly, mice containing a knock-out allele and the ventricular myocyte-specific conditional allele of the integrin Beta 1 gene were born and grew up to adulthood. Though these animals still exhibited minor amounts of integrin Beta1 in the heart (expressed by non-myocytes), these mice displayed abnormal cardiac function and were highly sensitive to AB. Whereas a compensatory hypertrophic response to pressure overload was observed in wildtype mice, the integrin Beta 1-deficient mice were not able to undergo heart tissue remodeling. Furthermore, ECM gene expression was altered and, in particular, the increased expression of the matricellular protein SPARC after AB was abolished in integrin Beta 1–deficient mice. Interestingly, we also found a transient upregulation of SPARC mRNA during heart remodeling after MI using cDNA macroarrays. Indeed, increased SPARC protein levels were observed starting at day 2 (2.55±0.21fold, p<0.01), day 7 (3.72±0.28 fold, p<0.01) and 1 month (1.9±0.16 fold, p<0.01) after MI, which could be abolished by using an integrin alpha v inhibitor in vivo. Immunofluorescence analysis of heart tissue demonstrated that the increased SPARC expression was confined to the infarcted area and occurred together with the influx of fibroblasts into the heart. In vitro, either TGF-Beta 1 or PDGF-BB stimulated SPARC expression by fibroblasts. Inhibition of integrin alpha v did not interfere with TGF-Beta1 or PDGF induced SPARC secretion as determined by ELISA assays or Western blot. However, secretion of TGF-Beta1 and PDGF-BB by cardiomyocytes was induced by vitronectin, a ligand of integrin alpha v, and this response was blocked by the integrin alpga v inhibitor. Functionally, SPARC modulated the migratory response of fibroblasts towards ECM proteins suggesting that the local deposition of SPARC following MI contributes to scar formation. Taken together, our combined in vivo and in vitro data demonstrate that several integrin subunits play critical roles during tissue remodeling in the injured heart. Integrin-dependent gene expression events such as the upregulation of SPARC following MI are critical to orchestrate the healing response. These processes appear to involve complex cross-talk between different cell types such as cardiomyocytes and fibroblasts to allow for locally confined scar formation. The elucidation of the sophisticated interplay between integrins, matricellular proteins such as SPARC, and growth factors will undoubtedly provide us with a better and clinically useful understanding of the molecular mechanisms governing heart remodeling.