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Federica del Monte, MD, PhD A Tangled Web Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant financial relationship exists

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Page 1: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Federica del Monte, MD, PhD

A Tangled WebIs Heart Failure Alzheimer’s of

the Heart?

FINANCIAL DISCLOSURE:No relevant financial relationship exists

Page 2: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Brain and Heart Amyloid

AL or Transtyretin-related

Page 3: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

*

iDCM plaques-& tangles-like

Page 4: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Gianni et Al Circulation 2010

7 variants in PSEN 120 variants in PSEN 2

Common and specific genetic variants

Page 5: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

0

0.5

1

1.5

2

2.5

LWW/LWD

*

0

0.003

0.006

0.009

0.012

HW/BW HW/TL

PS2KO mouse model

*

0.005

0.007

0.009

0.011

0.013

0.015

0.017

QRS Interval (s)

*

PS2KOWT

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40 *LVEDD

3mo 6mo 9mo9 9 7 9 11 15

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

* ** **

FS

3mo 6mo 9mo9 9 7 9 11 15

Page 6: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

SERCA2b and PS1/PS2 are co-localized and interact (Kim N; JBC)Cells lacking both presenilins exhibit a phenotype similar to SERCA knockdown and endogenous presenilins interact with SERCA (Green et al., 2008).

ER

SERCA RyRCa2+

Ca++L-type

Presenilin

Ca2+

Ca2+

ER Ca2+ reuptake

NF iDCM Supernatants GST

Presenilin 2

Presenilin-2 / SERCA2a direct binding

Page 7: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Sic L. JBC 2000

Presenilin have been shown to interact with the ryanodine receptor, via its N terminus, and to increase the open channel probability and mean current (Rybalchenko et al., 2008),

ER Ca2+ release

ER

SERCA RyRCa2+

Ca2+

L-type

Presenilin

Ca2+

Ca2+

WB: RYR2

NF iDCM

Presenilin 2/RYR2 Co-IP

Page 8: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

400

nmol

/L

5 s

PS2KO

WT

0

20

40

60

80

100

WT PS2KO

SR [C

a2+] (

mm

ol/l

cyt

osol

)

16 18

#

180

0.4

0.8

1.2

1.6

WT PS2KO

Twitc

h [C

a2+]

i/Ca

ffein

e Δ

[Ca2

+]i

16 18

#

30

40

50

40 50 60 70

tetr

acai

ne-s

ensi

tive

Ca2+

leak

(μm

ol/l

cyt

osol

)

SR Ca2+ (μmol/l cytosol)

WT PS2KO

##

02468

1012

WT PS2KO

leak

/loa

d (a

rbrit

ary)

16 18

##

SR Ca2+ Content

Page 9: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

PSEN

What forms iDCM aggregates

Page 10: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant
Page 11: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Cofilin

Page 12: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Hypo-phosyphorylation of Cofilin 1in neurons causes formation ofcofilin-actin rod precipitates

Cofilin in the pathogenesis of AD

Hyper-phosphorylation of Cofilin 1causes actin bundle accumulationwithin cell bodies and theformation of dystrophic neuritis.

Page 13: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Expression

0

0.5

1

1.5

2

2.5

Cof

ilin/

GA

PD

H R

atio

Inoluble

10 10 10 9

Soluble

*

p-co

filin

/GA

PD

H R

atio

0

0.5

1

1.5

2

2.5

10 910 10

InsolubleSoluble

***

iDCM

Donors

Activity

Cofilin in human iDCM

Page 14: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Soluble

Insoluble

Individual Donor Samples

Cof

ilin/L

oad

ratio

0

0.5

1

1.5

2

2.5

AVG

Individual iDCM samples

Cof

ilin/L

oad

ratio

0

0.5

1

1.5

2

2.5

3

AVGSubramanian et al JACC 2015

Cofilin & myocardial aging

Page 15: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

CSC2

αMHC-Cre

WT littermate

Fractional ShorteningEjection Fraction

%

0

10

20

30

40

50

60

70

80

90

100

7 7 33 11 11

*#

*#

0.0

1.0

2.0

3.0

4.0

LVEDd LVEDs

#

#*

7 3 11 7 3 11

mm

WT littermates

0

0.5

1

1.5

2

2.5

3 4

Cof

ilin/

tot E

RK

Rat

io

WT littermates CSC2

CSC2

*

Cofilin-2

Total ERK

20

37

MW (kDa)

Pankaj Agrawal E. Dale Abel

Cofilin-2 KO mouse model

Page 16: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

CSC2aMHC-CreWT Littermates

50 μm50 μm50 μm

100 nm

100 nm

100 nm100 nm

500 nm

CSC2

1

1

1

1

2

2

2

2

Human Nemaline iDCM

500 nm500 nm

500 nm

1

12

2

Page 17: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

DAPIα-Sarcomeric ActinRFPPhalloidin

Phosphomimetic cofilin

DAPIα-Sarcomeric ActinRFPPhalloidin

Constitutively active cofilin

DAPIα-Sarcomeric ActinRFPPhalloidin

Wild type cofilin

Cofilin phosphorylation induced stress fiber formation

Page 18: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

0

10

20

30

40

50

60

Non injected

WT CFLPhosphomimetic

Constit.active

FS

Cardiac function

Thick

WT + WT-COFCSC2 + P-COF

Dilated

Normal

WT

Adenoviral Expression of Phosphomimetic Cofilin

Page 19: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Aging a promisquous disease

Presenilin Cofilin

PAO Toxicity

Page 20: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Ca2+

AcquiredGeneticA

ggre

gate

inde

pend

ent

Agg

rega

te d

epen

dent

Cell death/dysfunction

A Tangled Web

Page 21: A Tangled Web Is Heart Failure Alzheimer’s of the Heart? · Federica del Monte, MD, PhD. A Tangled Web. Is Heart Failure Alzheimer’s of the Heart? FINANCIAL DISCLOSURE: No relevant

Davide GianniJoakim Chan

Jim BamburgPankaj Agrawal

Gordon Huggins

Thank you

Anna Kilianova

Cristina Balla

NicoleKoulizis

Asma Mahamud

Edi GohibergBernhard Hiring

E. Dale Abel

Erik Kohlbrenner

Roger Hajjar

Weiqing Wang

KhaushikSubramanian

Carlo Bortolotti Fabrizio Bernini Marco Borsari Marcello PignataroMarco BorsariElena

Castellini

Giulio Agnetti Jennifer Van Eyk Peipei Ping

AsmaMahmud