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Department of Internal Medicine, Touchstone Center for Diabetes Research, University of Texas Southwestern Medical Center, Dallas; and Veterans Affairs Medical Center, Dallas, Texas
Submitted 5 January 2004 ; accepted in final form 12 September 2004
| ABSTRACT |
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adenosine 5'-monophosphate-activated kinase; protein phosphatase 2C; heart; obesity; diabetes
(PPAR
) agonist, such as troglitazone (TGZ; see Ref. 30). Fryer et al. (7) have demonstrated that, in skeletal muscle cells, rosiglitazone, a thiazolidenedione drug related to TGZ, activates 5'-AMP-activated protein kinase (AMPK), a monitor of lipid and glucose metabolism in liver, skeletal muscle, heart, and adipose tissues (8, 14, 15, 1719, 21, 23, 2729). Because activation of AMPK inhibits fatty acid synthesis and stimulates fatty acid oxidation, the same action in cardiomyocytes might explain the preventive effect of TGZ therapy on the lipid overload and cardiomyopathy that occur in untreated obese rats. If so, myocardial AMPK activity of the untreated ZDF (fa/fa) rats should be lower than that of lean, wild-type (+/+) controls, and its subnormal activity should rise in response to TGZ treatment, thereby attenuating cardiac lipid accumulation.
This study was designed to test these predictions by evaluating the role of AMPK activity in the pathogenesis of cardiac lipotoxicity and in its prevention by TGZ. AMPK is activated by phosphorylation of Thr172 of its
-chain (28); therefore, we compared the levels of active phosphorylated AMPK (P-AMPK) in the hearts of normal lean rodents with those of the treated and untreated obese groups (fa/fa rats and ob/ob mice). In addition, the relationship of P-AMPK levels to the expression of protein phosphatase 2C (PP2C), an enzyme that was shown to inactivate it by dephosphorylation (5, 17), was also explored. Our results support a role for AMPK and PP2C in the altered cardiac lipid metabolism and lipotoxicity of leptin-unresponsive obese rats and its prevention by TGZ. They also suggest that the phosphorylation state of the enzyme may be influenced by the expression level of PP2C.
| MATERIALS AND METHODS |
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Cell culture.
Rat myocardium H9C2 cell line was purchased from ATCC (Manassas, VA) and was cultured in petri dishes in DMEM with 10% FBS at 37°C under normoxic conditions (5% CO2-20% O2), as recommended by the supplier. Cultured cells of
8090% confluence were starved in DMEM (5 mM glucose)-0.2% BSA without serum at 37°C for 46 h, followed by incubation with either glucose (5 or 20 mM) or fatty acid palmitate-BSA complexes (0.1, 0.5 or 1.5 mM palmitate at a 20.4:1 FFA-to-BSA molar ratio) and glucose (5 mM) for 20 h. After treatment, the cells were washed with cold PBS two times and then lysed with 1x cell lysis buffer (Cell Signaling Technology, Beverly, MA). After being spun for 10 min at 4°C, supernatants were saved for protein concentration assays and immunoblotting analysis (see below).
Real-time quantitative PCR. Total RNA from the hearts of lean +/+ or obese fa/fa rats, fed with or without TGZ, was extracted using TRIzol reagent (Life Technologies, Torrance, CA) following the manufacturer's protocol. For cDNA synthesis, 1 µg of rat heart total RNA was reverse transcribed with oligo(dT)18 and random hexamer primers by SuperScript II RT. Reactions were performed for 60 min at 42°C and terminated by incubating for 15 min at 70°C. Parallel reactions for each RNA sample were run in the absence of SuperScript II to assess the degree of any contaminating genomic DNA. TaqMan fluorogenic probes and oligonucleotide primers were designed using Primer Express software (Perkin-Elmer Applied Biosystems, Foster City, CA). Primers and probes were ordered from Integrated DNA Technologies (Coralville, IA). The probe and primer sequences used in this study were listed in Table 1. TaqMan PCR assays for each gene target were carried out in triplicate using cDNA samples described above in 384-well optical plates with an ABI Prism 7900HT Sequence Detection system (Perkin-Elmer Applied Biosystems). For each 10-µl TaqMan reaction, 2 µl cDNA were mixed with 1 µl sense primer (200 nM), 1 µl antisense primer (200 nM), and 1 µl TaqMan fluorogenic probe (100 nM). The PCR scheme used was 50°C for 2 min, 95°C for 10 min, and then 40 cycles of 95°C for 15 s and 60°C for 1 min. The housekeeping gene used for the subsequent normalization of data in each TaqMan assay was ribosomal RNA (18S; Perkin-Elmer Applied Biosystems) or 36B4 (12). For every PCR sample, an amplification plot was generated from the collected data and a threshold cycle (CT) value was calculated with the software suite. With the use of the standard curve, CT values for each gene of interest were used to calculate the initial quantity of this cDNA present in each input. To correct for RNA quality and quantity, data were then normalized by dividing copies of the target gene by the copies of the chosen housekeeping gene, as indicated above. Relative quantitation of PP2C mRNA against 36B4 was determined using the SYBR Green PCR Master Mix and total cDNA described above.
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(Thr172), anti-AMPK
(Cell Signaling Technology), anti-PP2C (Upstate, Lake Placid, NY), or anti-
-tubulin (Sigma, St. Louis, MO) in freshly prepared TBST-MLK at 4°C overnight with agitation, the membrane was washed two times with TBST buffer. This was followed by incubating with secondary anti-rabbit, -mouse, or -sheep horseradish peroxidase-conjugated Ig antibodies in TBST-MLK for 1 h at room temperature with agitation. The membrane was then washed three times with TBST buffer, and the proteins of interest on immunoblots were detected by an enhanced chemiluminescence detection system (Amersham Biosciences). The corresponding bands were quantified using NIH Image software (version 1.6; available at http://rsb.info.nih.gov/nih-image/). Plasma measurements. Plasma glucose was measured by the glucose oxidase method with a colorimetric Kit (Sigma). The levels of plasma triacylglycerol (TG) were determined by a GPO-Trinder triglyceride Kit (Sigma). Plasma free fatty acid (FFA) concentration was assayed with a Wako FFA C test kit (Wako Chemicals, Richmond, VA).
Echocardiographic evaluation. Echocardiographic analysis of fa/fa ZDF rats was carried out as described (30).
Statistical analysis. Results obtained in this study are presented as means ± SE for n = 36 samples per group and were evaluated with Student's t-test for statistical significance.
| RESULTS |
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-subunit (AMPK
) and active, phospho-AMPK
(P-AMPK
; phosphorylated at Thr172 of the AMPK
-subunit). As shown in Fig. 1A, top and middle, the mean P-AMPK
level in these 14-wk-old, leptin-unresponsive obese fa/fa hearts was 67% lower than that of lean wild-type (+/+) ZDF controls (P < 0.005). Total AMPK
protein was slightly reduced in fa/fa compared with lean hearts. There were no significant changes in the mRNA of AMPK
1-,
2 (Fig. 1A, bottom)-,
-, or
-subunits (data not shown).
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was present in the hearts of another unleptinized rodent model, the leptin-deficient ob/ob mice, we compared them with their wild-type (+/+) controls. P-AMPK
was 81% lower in ob/ob mice (P < 0.0005; Fig. 1B, top and middle). There were no changes in the mRNA of AMPK
1-,
2 (Fig. 1B, bottom)-,
-, or
-subunits (data not shown). Thus our results suggest that the reduction of cardiac AMPK activity could be a consequence of congenital lack of leptin action.
Effects of glucose and FFAs on AMPK activity of myocardial cells.
The lower cardiac AMPK activation could have been secondary to the metabolic abnormalities that constitute the ZDF (fa/fa) phenotype. Obese ZDF fa/fa and ob/ob rodents have higher plasma levels of glucose and FFA than their lean counterparts (13). To determine if the decreased AMPK activity in fa/fa and ob/ob hearts was secondary to the high concentrations of plasma glucose and/or FFA (in complexes with BSA), we examined the expression of AMPK
in the rat myocardial H9C2 cells cultured for 20 h with varying concentrations of these nutrients. There was no difference between P-AMPK
in cells cultured in 5 or 20 mM glucose (Fig. 2). However, in medium containing 5 mM glucose in the presence of 0.5 mM FFA-BSA or above, AMPK
protein and P-AMPK
were both greatly reduced (Fig. 2). This suggests that the elevation in intracellular fatty acids or their metabolites in the tissues of unleptinized rodents lowers cardiac AMPK activity and thus amplifies the consequences of a lipid surplus by interfering with their oxidation.
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0.005) in TGZ-treated fa/fa rats than those of untreated animals, consistent with our earlier results. In addition, we found that, compared with untreated fa/fa ZDF rats, cardiac P-AMPK
of TGZ-treated fa/fa ZDF rats is increased four- to fivefold (P < 0.016) with only modest change in total AMPK
protein (Fig. 3A). There was no change in the mRNA levels of AMPK
1-,
2-,
-, and
-subunits (data not shown). These results are consistent with the hypothesis that an increased AMPK activity contributes to the prevention of excess lipid accumulation in the fa/fa heart by TGZ.
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in mammals (5, 17). Therefore, it seemed possible that the reduction in active P-AMPK
in untreated ZDF fa/fa rats and its restoration toward near normal levels by TGZ treatment could be because of changes in this phosphatase. We therefore monitored the changes in cardiac PP2C mRNA and protein (Fig. 3, B and C) before and after TGZ treatment. PP2C expression was increased in the hearts of untreated ZDF rats compared with lean +/+ controls (Fig. 4A). After TGZ therapy, its mRNA and protein levels were decreased (P < 0.037 and 0.002, respectively; Fig. 3, B and C) concordantly with the rise in P-AMPK
levels (Fig. 3A). Similarly, administration to fa/fa rats for 2 mo of another PPAR
agonist, rosiglitazone, which was shown to reduce TG content in ob/ob hearts (20), led to a decrease in cardiac PP2C, an increase in P-AMPK
, and improved contractile performance in vivo (Table 3). These results are consistent with a role of PP2C in the change in cardiac AMPK activity in ZDF fa/fa rats. Because AMPK phosphorylation was also reduced in the hearts of obese ob/ob mice, we compared their cardiac PP2C with that of lean wild-type controls. As shown in Fig. 4B, PP2C was also increased in that obese unleptinized group. We further examined mRNA expression of cardiac PPAR
and found its levels were similar in fa/fa rats and lean littermates (1.34 ± 0.12 vs. 1.04 ± 0.28; P = 0.20) and were not altered in fa/fa rats by TGZ (1.06 ± 0.24 for TGZ-treated vs. 0.98 ± 0.4 for untreated animals).
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| DISCUSSION |
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agonist.
Our results revealed that the defects of cardiac AMPK and PP2C are associated with lipotoxic cardiomyopathy in obese rodents. Although the mechanisms remain to be elucidated, it is possible that changes in AMPK and PP2C activity are attributable to lipid overload in the heart rather than to, for example, reduced contractility. Several lines of evidence support this idea. First, incubation of myocardium H9C2 cells with fatty acid palmitate but not with glucose leads to a decrease in P-AMPK
, suggesting palmitate or its metabolites mediates the inhibition. Previously, the same fatty acid was also shown to impair AMPK and increase ceramide synthesis and apoptosis in rat neonatal cardiac myocytes (9). In addition, metformin, an activator of AMPK (14), can override this reduction in P-AMPK
in cultured cells by fatty acids (data not shown). These results thus support cardiac lipid accumulation as a contributor to the alteration in AMPK activity. Second, cardiac AMPK activity is depressed before overt contractile dysfunction appears. In the fa/fa rat model, the earliest time point at which there was uniform evidence of heart failure in all animals was 20 wk of age (30), at least 6 wk older than the ones with reduced cardiac P-AMPK
reported here. Similarly, we found that, at <18 wk of age, ob/ob hearts show excess lipid accumulation and decreased P-AMPK
but no contractile dysfunction (data not shown; see Ref. 2). Heart failure became evident only in 24-wk-old ob/ob mice (2). In this regard, it is conceivable that the accumulation of lipids, the loss of function, and the apoptosis are likely not happening simultaneously in all cells. The lipids accumulate in a few cells initially, and those are the cells that will deteriorate first. Only when a substantial dropout of cardiomyocytes has occurred will echocardiographic evidence of failure be evident.
Our findings in fa/fa and ob/ob hearts are different from that reported in insulin-resistant JCR:LA-cp rats, which showed slightly decreased cardiac AMPK activity in spite of elevated TG in the heart (1). The reasons for the discrepancy are not clear. Notable differences are that cp rats seem to have less dyslipidemia compared with fa/fa and ob/ob animals and have no cardiac dysfunction or diabetes (1). TGZ or metformin treatment did not affect plasma lipid profiles in these rats (24). Some technical issues also make the comparison less straightforward. For instance, in their study, AMPK activity was measured with cytosolic fractions recovered from polyethylene glycol precipitation (1).
The report by Fryer et al. (7) that rosiglitazone activates AMPK in skeletal muscle suggested that a similar mechanism might prevail cardiac muscle as well. Because the obese human heart, like the heart of obese ZDF rats, has increased intramyocellular lipids (25, 26), the present findings may have clinical therapeutic implications for obese humans (25).
In fact, a reduction in active P-AMPK
was observed in untreated ZDF rats and ob/ob mice in association with an increase in PP2C, a protein phosphatase that is known to inactivate it (5, 17). Treatment with TGZ or rosiglitazone increased P-AMPK
to near-normal levels, and PP2C was reduced. Thus PP2C was increased in both models, and, in the thiazolidinedione-treated ZDF rat, it declined toward normal as P-AMPK
increased. Because the fatty acid-induced increase in PP2C has been linked to apoptosis in cultured chick neurons (11), whereas AMPK activation inhibits ceramide synthesis and apoptosis in astrocytes (3) and apoptosis in INS-1 cells (6), suppression of PP2C activity in obesity might provide a useful therapeutic target.
It is not clear from these results if the TGZ effects on the heart represent a direct action in the cardiomyocytes or are secondary to the lipopenic action of the drug. TGZ may exert its effects on PP2C and AMPK directly at the level of the heart. Treatment with TGZ in rat myocardium H9C2 cells for 24 h showed a decrease in PP2C, concurrent with an increase in P-AMPK
(data not shown), the same as that seen in the hearts of TGZ or rosiglitazone-treated obese rodents. PPAR
agonist Wy-14643, however, has no effects on PP2C and P-AMPK
levels in H9C2 cells (data not shown). Furthermore, in skeletal muscle, AMPK can also be stimulated by rosiglitazone (7). These findings are concordant with the concept that thiazolidinediones can act directly on the cardiac myocytes via PPAR
-dependent pathways. It is noteworthy that a putative PPAR
RXR response sequence (AGGTCGAAGGGCA) can be identified on the rat PP2C promoter (located at 728 to 716 of transcription start site). The cardiac PPAR
pathway in obese rodents seems to be normal, since PPAR
mRNA is similar in fa/fa rats or ob/ob mice and lean controls. Alternatively, TGZ may modulate the fluxes of lipids through the heart of treated animals (10, 22) by which cardiac PP2C and AMPK activity somehow can be normalized. Stimulation of AMPK in turn would increase fatty acid oxidation (15, 16) and reduce lipid content in cardiac muscle. Further studies are needed to assess these possibilities.
In summary, our results support a role of AMPK and PP2C defects in the dysfunction of cardiac lipid metabolism in obesity and provide new insights as to the mechanisms of the liporegulatory disorder leading to lipotoxic cardiomyopathy.
| GRANTS |
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| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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