BACKGROUND. In dilated cardiomyopathies (DCMs) changes in expression of protein-coding genes are associated with reverse remodeling, and these changes can be regulated by microRNAs (miRs). We tested the general hypothesis that dynamic changes in myocardial miR expression are predictive of β-blocker–associated reverse remodeling.
METHODS. Forty-three idiopathic DCM patients (mean left ventricular ejection fraction 0.24 ± 0.09) were treated with β-blockers. Serial ventriculography and endomyocardial biopsies were performed at baseline, and after 3 and 12 months of treatment. Changes in RT-PCR (candidate miRs) or array-measured miRs were compared based on the presence (R) or absence (NR) of a reverse-remodeling response, and a miR-mRNA-function pathway analysis (PA) was performed.
RESULTS. At 3 months, 2 candidate miRs were selectively changed in Rs, decreases in miR-208a-3p and miR-591. PA revealed changes in miR-mRNA interactions predictive of decreased apoptosis and myocardial cell death. At 12 months, 5 miRs exhibited selective changes in Rs (decreases in miR-208a-3p, -208b-3p, 21-5p, and 199a-5p; increase in miR-1-3p). PA predicted decreases in apoptosis, cardiac myocyte cell death, hypertrophy, and heart failure, with increases in contractile and overall cardiac functions.
CONCLUSIONS. In DCMs, myocardial miRs predict the time-dependent reverse-remodeling response to β-blocker treatment, and likely regulate the expression of remodeling-associated miRs.
TRIAL REGISTRATION. ClinicalTrials.gov NCT01798992.
FUNDING. NIH 2R01 HL48013, 1R01 HL71118 (Bristow, PI); sponsored research agreements from Glaxo-SmithKline and AstraZeneca (Bristow, PI); NIH P20 HL101435 (Lowes, Port multi-PD/PI); sponsored research agreement from Miragen Therapeutics (Port, PI).
Carmen C. Sucharov, David P. Kao, J. David Port, Anis Karimpour-Fard, Robert A. Quaife, Wayne Minobe, Karin Nunley, Brian D. Lowes, Edward M. Gilbert, Michael R. Bristow
Box-and-whisker plots of RT-PCR RNA abundance data for a subset of candidate miRs as described in the text.
Boxes delineate 1st (lower border) and 3rd (upper border) quartiles from the median; the length of the whiskers is 1.5 times the interquartile distance (IQD), with values beyond the IQD plotted as outliers. miR expression was normalized to the combination of the small RNA U6 and miR-103, and is represented as fold difference from baseline. Comparisons were made to Non-Responder (NR) and Responder (R) as described in the Figure. (