Abstract
Cardiomyopathy is a primary cause of mortality in Duchenne muscular dystrophy (DMD) patients. Mechanistic understanding of cardiac fibrosis holds the key to effective DMD cardiomyopathy treatments. Here we demonstrate that upregulation of Wilms’ tumor 1 (Wt1) gene in epicardial cells increased cardiac fibrosis and impaired cardiac function in 8-month old mdx mice lacking the RNA component of telomerase (mdx/mTR−/−). Levels of phosphorylated IƙBα and p65 significantly rose in mdx/mTR−/− dystrophic hearts and Wt1 expression declined in the epicardium of mdx/mTR−/− mice when nuclear factor κB (NF-κB) and inflammation were inhibited by metformin. This demonstrates that Wt1 expression in epicardial cells is dependent on inflammation-triggered NF-κB activation. Metformin effectively prevented cardiac fibrosis and improved cardiac function in mdx/mTR−/− mice. Our study demonstrates that upregulation of Wt1 in epicardial cells contributes to fibrosis in dystrophic hearts and metformin-mediated inhibition of NF-κB can ameliorate the pathology, and thus showing clinical potential for dystrophic cardiomyopathy. Translational Perspective: Cardiomyopathy is a major cause of mortality in Duchenne muscular dystrophy (DMD) patients. Promising exon-skipping treatments are moving to the clinic, but getting sufficient dystrophin expression in the heart has proven challenging. The present study shows that Wilms’ Tumor 1 (Wt1) upregulation in epicardial cells is primarily responsible for cardiac fibrosis and dysfunction of dystrophic mice and likely of DMD patients. Metformin effectively prevents cardiac fibrosis and improves cardiac function in dystrophic mice, thus representing a treatment option for DMD patients on top of existing therapies.
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Acknowledgements
The authors acknowledge Dr. Yiqi Seow (Biomedical Sciences Institutes, A*STAR, Singapore) for critical review of the manuscript and Dr. Wenyan Niu (Tianjin Metabolic Disease Hospital, Tianjin Medical University, Tianjin, China) for assistance with the clinical biochemistry assays.
Funding
This study is supported by National Key R&D Program of China (Grant No.2017YFC1001902), National Natural Science Foundation of China (Grant No. 81672124 and 81802124), Tianjin Research Innovation Project for Postgraduate Students (2020YJSB159), and Tianjin Municipal 13th five-year plan (Tianjin Medical University Talent Project).
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HY and ZG designed the project; ZG, MG, YH, GH, RJ, CL, XZ, and MZ. carried out the experiments; GF provided help with cardiac function test; FW helped with mouse breeding; ZG, MG, and HY analyzed the data; HY, ZG, and MG wrote the paper with the input from all authors.
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Guo, Z., Geng, M., Huang, Y. et al. Upregulation of Wilms’ Tumor 1 in epicardial cells increases cardiac fibrosis in dystrophic mice. Cell Death Differ 29, 1928–1940 (2022). https://doi.org/10.1038/s41418-022-00979-0
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DOI: https://doi.org/10.1038/s41418-022-00979-0
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