Transcriptional regulation of macrophage inflammation in the heart failure with preserved ejection fraction

Abstract Funding Acknowledgements None. Introduction Heart failure with preserved ejection fraction (HFpEF) is a global public health problem with no effective treatment available. Pro-inflammatory cardiac macrophages are emerging as key determinants of adverse left ventricular remodeling; however, their role in HFpEF remains poorly understood. Mechanistically, the recruitment and activation of macrophages represent a key event in maladaptive myocardial remodeling in HFpEF patients. Evidence suggests that remodeling processes in HFpEF hearts are orchestrated and amplified by cardiac macrophages which regulate cardiomyocyte function, endothelial cell activation and fibroblast differentiation. Here we sought to determine the role of macrophage inflammation in experimental and human HFpEF. Methods Experiments were performed in rat cardiomyocytes (H9c2), human endothelial cells (HAECS), transgenic mice, and left ventricular (LV) myocardial samples from patients with HFpEF. H9c2 and HAECS treated with pro-inflammatory macrophage-like cells (RAW 264.7) conditional media in the presence or knockdown of a top-ranking activator of M1 type macrophages such as nuclear receptor corepressor 1 (NCOR1), were used to elucidate better the involvement of this gene in transcriptional regulation in vitro. The cardiac function of myeloid cell-specific NCOR1 knockout HFpEF mice undergoing a high-fat diet and L-NAME was investigated. LV myocardial samples were used to evaluate the pro-inflammatory activity of macrophages in human HFpEF tissues. Results Human and murine LV specimens showed upregulation of vascular adhesion molecules (ICAM1, ICAM2, E-selectin), recruitment of M1 macrophages to the myocardium, and decreased M2 macrophages. Notably, NCOR1 deletion in macrophages protected against diastolic dysfunction, exercise intolerance, and myocardial inflammation (TNF-a, IL6, IL-1b). Mechanistically, induction of metabolic stress by palmitic acid induced macrophage polarization, upregulation of NCOR1 and inflammatory genes in RAW cells. By contrast, Finally, NCOR1 depletion prevented pro-inflammatory transcriptional programs and secretion of TNF-a, IL6 and IL-1b in the macrophage secretome. Conclusion Targeting macrophage NCOR1 could represent a promising approach to blunt myocardial inflammation in HFpEF.