Abstract
Rosiglitazone (RSG) is a synthetic agonist of peroxisome proliferator-activated receptor-γ (PPARγ), which plays a central role in the regulation of metabolism. Meta-analyses have suggested that RSG is associated with increased cardiovascular risk. However, the mechanisms underlying such adverse cardiac effects are still poorly understood. Here, we found that activation of PPARγ by RSG stimulated the endocannabinoid system (ECS), a membrane lipid signaling system, which induced cardiac hypertrophy. In neonatal rat cardiomyocytes, RSG increased the level of anandamide (AEA); upregulated the expression of N-acyl phosphatidylethanolamine phospholipase D (NapePLD), a key enzyme for AEA synthesis; and downregulated the expression of fatty acid amide hydrolase (FAAH), the enzyme responsible for the degradation of AEA. Importantly, PPARγ activation increased the expression of cannabinoid receptor type 1 (CB1) through an identified binding site for PPARγ in the CB1 promoter region. Moreover, both the in vitro and in vivo results showed that inhibition of the ECS by rimonabant, an antagonist of CB1, attenuated RSG-induced cardiac hypertrophy, as indicated by decreased expression of cardiac hypertrophy markers (ANP and BNP), deactivation of the mTOR pathway, and decreased cardiomyocyte size. Thus, these results demonstrated that the ECS functions as a novel target of PPARγ and that the AEA/CB1/mTOR axis mediates RSG-induced cardiac remodeling.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Engeli S, Böhnke J, Feldpausch M, Gorzelniak K, Janke J, Bátkai S, et al. Activation of the peripheral endocannabinoid system in human obesity. Diabetes. 2005;54:2838–43.
Singla S, Sachdeva R, Mehta JL. Cannabinoids and atherosclerotic coronary heart disease. Clin Cardiol. 2012;35:329–35.
Alfulaij N, Meiners F, Michalek J, Small-Howard AL, Turner HC, Stokes AJ. Cannabinoids, the heart of the matter. J Am Heart Assoc. 2018;7:e009099.
Sarzani R. Endocannabinoids, blood pressure and the human heart. J Neuroendocrinol. 2008;20:58–62.
Montecucco F, Di Marzo V. At the heart of the matter: the endocannabinoid system in cardiovascular function and dysfunction. Trends Pharmacol Sci. 2012;33:331–40.
Duerr GD, Heinemann JC, Dunkel S, Zimmer A, Lutz B, Lerner R, et al. Myocardial hypertrophy is associated with inflammation and activation of endocannabinoid system in patients with aortic valve stenosis. Life Sci. 2013;92:976–83.
Mukhopadhyay P, Bátkai S, Rajesh M, Czifra N, Harvey-White J, Haskó G, et al. Pharmacological inhibition of CB1 cannabinoid receptor protects against doxorubicin-induced cardiotoxicity. J Am Coll Cardiol. 2007;50:528–36.
Bátkai S, Mukhopadhyay P, Harvey-White J, Kechrid R, Pacher P, Kunos G. Endocannabinoids acting at CB1 receptors mediate the cardiac contractile dysfunction in vivo in cirrhotic rats. Am J Physiol-Heart Circ Physiol. 2007;293:H1689–H95.
Rajesh M, Bátkai S, Kechrid M, Mukhopadhyay P, Lee W-S, Horváth B, et al. Cannabinoid 1 receptor promotes cardiac dysfunction, oxidative stress, inflammation, and fibrosis in diabetic cardiomyopathy. Diabetes. 2012;61:716–27.
Lin C-Y, Hsu Y-J, Hsu S-C, Chen Y, Lee H-S, Lin S-H, et al. CB1 cannabinoid receptor antagonist attenuates left ventricular hypertrophy and Akt-mediated cardiac fibrosis in experimental uremia. J Mol Cell Cardiol. 2015;85:249–61.
Mukhopadhyay P, Rajesh M, Bátkai S, Patel V, Kashiwaya Y, Liaudet L, et al. CB1 cannabinoid receptors promote oxidative stress and cell death in murine models of doxorubicin-induced cardiomyopathy and in human cardiomyocytes. Cardiovasc Res. 2009;cvp369.
Lepicier P, Bouchard JF, Lagneux C, Lamontagne D. Endocannabinoids protect the rat isolated heart against ischaemia. Br J Pharmacol. 2003;139:805–15.
Montecucco F, Lenglet S, Braunersreuther V, Burger F, Pelli G, Bertolotto M, et al. CB(2) cannabinoid receptor activation is cardioprotective in a mouse model of ischemia/reperfusion. J Mol Cell Cardiol. 2009;46:612–20.
Defer N, Wan J, Souktani R, Escoubet B, Perier M, Caramelle P, et al. The cannabinoid receptor type 2 promotes cardiac myocyte and fibroblast survival and protects against ischemia/reperfusion-induced cardiomyopathy. FASEB J. 2009;23:2120–30.
Duerr GD, Heinemann JC, Suchan G, Kolobara E, Wenzel D, Geisen C, et al. The endocannabinoid-CB2 receptor axis protects the ischemic heart at the early stage of cardiomyopathy. Basic Res Cardiol. 2014;109:425.
Lehmann JM, Moore LB, Smith-Oliver TA, Wilkison WO, Willson TM, Kliewer SA. An antidiabetic thiazolidinedione is a high affinity ligand for peroxisome proliferator-activated receptor gamma (PPAR gamma). J Biol Chem. 1995;270:12953–6.
Ibrahimi A, Teboul L, Gaillard D, Amri EZ, Ailhaud G, Young P, et al. Evidence for a common mechanism of action for fatty acids and thiazolidinedione antidiabetic agents on gene expression in preadipose cells. Mol Pharmacol. 1994;46:1070–6.
Wang N, Yin R, Liu Y, Mao G, Xi F. Role of peroxisome proliferator-activated receptor-GAMMA in atherosclerosis—an update. Circ J. 2011;75:528–35.
Winterstein A. Rosiglitazone and the risk of adverse cardiovascular outcomes. Clin Pharmacol Ther. 2011;89:776–8.
Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356:2457–71.
Singh S, Loke YK, Furberg CD. Long-term risk of cardiovascular events with rosiglitazone: a meta-analysis. JAMA. 2007;298:1189–95.
Wallach JD, Wang K, Zhang AD, Cheng D, Grossetta Nardini HK, Lin H, et al. Updating insights into rosiglitazone and cardiovascular risk through shared data: individual patient and summary level meta-analyses. BMJ. 2020;368:l7078.
Davidson MA, Mattison DR, Azoulay L, Krewski D. Thiazolidinedione drugs in the treatment of type 2 diabetes mellitus: past, present and future. Crit Rev Toxicol. 2018;48:52–108.
Hunter JJ, Chien KR. Signaling pathways for cardiac hypertrophy and failure. N Engl J Med. 1999;341:1276–83.
Pharmaceuticals T. Actos [piogltiazone hydrochloride] prescribing information. 2007. http://www.actos.com/actospro/prescribniginto.aspx. 2007.
GlaxoSmithKline. Avandia (rosiglitazone maleate) [prescribing information]. 2007. http://us.gsk.com/products/assets/us_avandia.pdf.
Sena S, Rasmussen IR, Wende AR, McQueen AP, Theobald HA, Wilde N, et al. Cardiac hypertrophy caused by peroxisome proliferator-activated receptor-gamma agonist treatment occurs independently of changes in myocardial insulin signaling. Endocrinology. 2007;148:6047–53.
Edgley AJ, Thalen PG, Dahllof B, Lanne B, Ljung B, Oakes ND. PPARgamma agonist induced cardiac enlargement is associated with reduced fatty acid and increased glucose utilization in myocardium of Wistar rats. Eur J Pharmacol. 2006;538:195–206.
Duan SZ, Ivashchenko CY, Russell MW, Milstone DS, Mortensen RM. Cardiomyocyte-specific knockout and agonist of peroxisome proliferator-activated receptor-gamma both induce cardiac hypertrophy in mice. Circ Res. 2005;97:372–9.
Bouaboula M, Hilairet S, Marchand J, Fajas L, Le Fur G, Casellas P. Anandamide induced PPARgamma transcriptional activation and 3T3-L1 preadipocyte differentiation. Eur J Pharmacol. 2005;517:174–81.
Ahn S, Yi S, Seo WJ, Lee MJ, Song YK, Baek SY, et al. A cannabinoid receptor agonist N-arachidonoyl dopamine inhibits adipocyte differentiation in human mesenchymal stem cells. Biomol Ther. 2015;23:218–24.
Roche M, Kelly JP, O’Driscoll M, Finn DP. Augmentation of endogenous cannabinoid tone modulates lipopolysaccharide-induced alterations in circulating cytokine levels in rats. Immunology. 2008;125:263–71.
O’Sullivan SE, Kendall DA, Randall MD. Time-dependent vascular effects of Endocannabinoids mediated by peroxisome proliferator-activated receptor gamma (PPARgamma). PPAR Res. 2009;2009:425289.
Rockwell CE, Snider NT, Thompson JT, Vanden Heuvel JP, Kaminski NE. Interleukin-2 suppression by 2-arachidonyl glycerol is mediated through peroxisome proliferator-activated receptor gamma independently of cannabinoid receptors 1 and 2. Mol Pharmacol. 2006;70:101–11.
Zhang J, Hu M, Teng Z, Tang YP, Chen C. Synaptic and cognitive improvements by inhibition of 2-AG metabolism are through upregulation of microRNA-188-3p in a mouse model of Alzheimer’s disease. J Neurosci. 2014;34:14919–33.
Li L, Zhang Z-G, Lei H, Wang C, Wu L-P, Wang J-Y, et al. Angiotensin II reduces cardiac AdipoR1 expression through AT1 receptor/ROS/ERK1/2/c-Myc pathway. PLoS ONE. 2013;8:e49915.
Wang X, Liu X, Zhan Y, LaVallie ER, DiBlasio-Smith L, Collins-Racie L, et al. Pharmacogenomic, physiological, and biochemical investigations on safety and efficacy biomarkers associated with the peroxisome proliferator-activated receptor-γ activator rosiglitazone in rodents: a translational medicine investigation. J Pharmacol Exp Ther. 2010;334:820–9.
Liu Y, Yan X, Mao G, Fang L, Zhao B, Liu Y, et al. Metabonomic profiling revealed an alteration in purine nucleotide metabolism associated with cardiac hypertrophy in rats treated with thiazolidinediones. J Proteome Res. 2013;12:5634–41.
Mao G, Liu Y, Fang X, Liu Y, Fang L, Lin L, et al. Tumor-derived microRNA-494 promotes angiogenesis in non-small cell lung cancer. Angiogenesis. 2015;18:373–82.
Pacher P, Bátkai S, Osei-Hyiaman D, Offertáler L, Liu J, Harvey-White J, et al. Hemodynamic profile, responsiveness to anandamide, and baroreflex sensitivity of mice lacking fatty acid amide hydrolase. Am J Physiol-Heart Circ Physiol. 2005;289:H533–H41.
Han B, Wright R, Kirchhoff AM, Chester JA, Cooper BR, Davisson VJ, et al. Quantitative LC–MS/MS analysis of arachidonoyl amino acids in mouse brain with treatment of FAAH inhibitor. Anal Biochem. 2013;432:74–81.
Yan B, A J, Hao H, Wang G, Zhu X, Zha W, et al. Metabonomic phenotype Identification of “heart blood stasis obstruction pattern” and “qi and yin deficiency pattern” of myocardial ischemia rat models. Sci China C Life Sci. 2009;52:1081–90.
Wang N, Verna L, Chen NG, Chen J, Li H, Forman BM, et al. Constitutive activation of peroxisome proliferator-activated receptor-gamma suppresses pro-inflammatory adhesion molecules in human vascular endothelial cells. J Biol Chem. 2002;277:34176–81.
Lichtman AH, Hawkins EG, Griffin G, Cravatt BF. Pharmacological activity of fatty acid amides is regulated, but not mediated, by fatty acid amide hydrolase in vivo. J Pharmacol Exp Ther. 2002;302:73–9.
Basavarajappa BS. Critical enzymes involved in endocannabinoid metabolism. Protein Pept Lett. 2007;14:237.
Huang JV, Greyson CR, Schwartz GG. PPAR-γ as a therapeutic target in cardiovascular disease: evidence and uncertainty Thematic Review Series: new lipid and lipoprotein targets for the treatment of cardiometabolic diseases. J Lipid Res. 2012;53:1738–54.
Hoffmann BR, El-Mansy MF, Sem DS, Greene AS. Chemical proteomics-based analysis of off-target binding profiles for rosiglitazone and pioglitazone: clues for assessing potential for cardiotoxicity. J Med Chem. 2012;55:8260–71.
Di Marzo V, Maccarrone M. FAAH and anandamide: is 2-AG really the odd one out? Trends Pharmacol Sci. 2008;29:229–33.
Cunha P, Romao AM, Mascarenhas-Melo F, Teixeira HM, Reis F. Endocannabinoid system in cardiovascular disorders—new pharmacotherapeutic opportunities. J Pharm Bioallied Sci. 2011;3:350–60.
Al Kury LT, Voitychuk OI, Ali RM, Galadari S, Yang K-HS, Howarth FC, et al. Effects of endogenous cannabinoid anandamide on excitation–contraction coupling in rat ventricular myocytes. Cell Calcium. 2014;55:104–18.
Krylatov A, Maslov L, Ermakov SY, Lasukova O, Barzakh E, Crawford D, et al. Significance of cardiac cannabinoid receptors in regulation of cardiac rhythm, myocardial contractility, and electrophysiologic processes in heart. Biol Bull. 2007;34:28–35.
Oz M, Tchugunova YB, Dunn SM. Endogenous cannabinoid anandamide directly inhibits voltage-dependent Ca2+ fluxes in rabbit T-tubule membranes. Eur J Pharmacol. 2000;404:13–20.
Berridge MJ, Bootman MD, Roderick HL. Calcium signalling: dynamics, homeostasis and remodelling. Nat Rev Mol Cell Biol. 2003;4:517–29.
Mukhopadhyay P, Horváth B, Rajesh M, Matsumoto S, Saito K, Bátkai S, et al. Fatty acid amide hydrolase is a key regulator of endocannabinoid-induced myocardial tissue injury. Free Radic Biol Med. 2011;50:179–95.
Garza-Cervantes JA, Ramos-Gonzalez M, Lozano O, Jerjes-Sanchez C, Garcia-Rivas G. Therapeutic applications of cannabinoids in cardiomyopathy and heart failure. Oxid Med Cell Longev. 2020;2020:4587024.
Kaschina E. Cannabinoid CB1/CB2 receptors in the heart: expression, regulation, and function. In: Cannabinoids in health and disease. Cannabinoids in Health and Disease. 2016.
Pi-Sunyer FX, Aronne LJ, Heshmati HM, Devin J, Rosenstock J, Group, et al. Effect of rimonabant, a cannabinoid−1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial. JAMA. 2006;295:761–75.
Lim SY, Davidson SM, Yellon DM, Smith CC. The cannabinoid CB1 receptor antagonist, rimonabant, protects against acute myocardial infarction. Basic Res Cardiol. 2009;104:781–92.
Borrelli F, Izzo AA. Role of acylethanolamides in the gastrointestinal tract with special reference to food intake and energy balance. Best Pract Res Clin Endocrinol Metab. 2009;23:33–49.
Langenickel T, Pagel I, Hohnel K, Dietz R, Willenbrock R. Differential regulation of cardiac ANP and BNP mRNA in different stages of experimental heart failure. Am J Physiol Heart Circ Physiol. 2000;278:H1500–6.
Dorn GW. Protein kinase cascades in the regulation of cardiac hypertrophy. J Clin Invest. 2005;115:527.
Proud CG. Ras, PI3-kinase and mTOR signaling in cardiac hypertrophy. Cardiovasc Res. 2004;63:403–13.
Festuccia WT, Laplante M, Brûlé S, Houde VP, Achouba A, Lachance D, et al. Rosiglitazone-induced heart remodelling is associated with enhanced turnover of myofibrillar protein and mTOR activation. J Mol Cell Cardiol. 2009;47:85–95.
McMullen JR, Sherwood MC, Tarnavski O, Zhang L, Dorfman AL, Shioi T, et al. Inhibition of mTOR signaling with rapamycin regresses established cardiac hypertrophy induced by pressure overload. Circulation. 2004;109:3050–5.
Gao X-M, Wong G, Wang B, Kiriazis H, Moore X-L, Su Y-D, et al. Inhibition of mTOR reduces chronic pressure-overload cardiac hypertrophy and fibrosis. J Hypertens. 2006;24:1663–70.
Puighermanal E, Marsicano G, Busquets-Garcia A, Lutz B, Maldonado R, Ozaita A. Cannabinoid modulation of hippocampal long-term memory is mediated by mTOR signaling. Nat Neurosci. 2009;12:1152–8.
Senin LL, Al-Massadi O, Folgueira C, Castelao C, Pardo M, Barja-Fernandez S, et al. The gastric CB1 receptor modulates ghrelin production through the mTOR pathway to regulate food intake. PLoS ONE. 2013;8:e80339.
Acknowledgements
This study was supported by grants from the National Key R&D Program of China [2018YFA0800600] and National Science Foundation of China [81830015, 82170422 and 81670408].
Author information
Authors and Affiliations
Contributions
NPW and YHL conceived the study and designed the experiments. YHL, YL, XZ, and BLZ performed the experiments. LF helped perform analysis. NPW, YHL, and YL wrote the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Supplementary information is available at the website of Acta Pharmacologica Sinica
Supplementary information
Rights and permissions
About this article
Cite this article
Liu, Yh., Liu, Y., Zhang, X. et al. Activation of the endocannabinoid system mediates cardiac hypertrophy induced by rosiglitazone. Acta Pharmacol Sin 43, 2302–2312 (2022). https://doi.org/10.1038/s41401-022-00858-x
Received:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41401-022-00858-x


