Mitochondrial Integrity and Function in the Progression of Early Pressure Overload–Induced Left Ventricular Remodeling by Antoine H. Chaanine, K Sreekumaran.

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Mitochondrial Integrity and Function in the Progression of Early Pressure Overload–Induced Left Ventricular Remodeling by Antoine H. Chaanine, K Sreekumaran Nair, Robert H. Bergen, Katherine Klaus, Adam J. Guenzel, Roger J. Hajjar, and Margaret M. Redfield J Am Heart Assoc Volume 6(6):e005869 June 15, 2017 © 2017 Antoine H. Chaanine et al.

Serial assessment of LV volumes at 3 and 8 weeks post‐ascending aortic banding (AAB) in the different phenotypes. Serial assessment of LV volumes at 3 and 8 weeks post‐ascending aortic banding (AAB) in the different phenotypes. LV end‐diastolic (LVEDV) and LV end‐systolic (LVESV) volume at 3 (A and B) and 8 (C and D) weeks post‐AAB. Individual data points, box and whisker plots showing the median, interquartile range, and maximum and minimum values. *P<0.05 vs sham; +P<0.05 vs CR and ‡P<0.05 vs MILD. CR indicates concentric remodeling; MILD, mild eccentric remodeling; MOD, moderate eccentric remodeling. Antoine H. Chaanine et al. J Am Heart Assoc 2017;6:e005869 © 2017 Antoine H. Chaanine et al.

Echocardiographic assessment of the different phenotypes. Echocardiographic assessment of the different phenotypes. A, Representative M‐mode images at the level of the midpapillary muscle in the different phenotypes. B and C, LV septal (IVSd) and posterior wall (LVPWd) thickness across the different phenotypes. D, LV ejection fraction (LVEF) across the different phenotypes. Individual data points, box and whisker plots showing the median, interquartile range, and maximum and minimum values. *P<0.05 vs sham; +P<0.05 vs CR and ‡P<0.05 vs MILD. CR indicates concentric remodeling; IVSd, interventricular septal thickness in end‐diastole; LVEF, left ventricular ejection fraction; LVPWd, left ventricular wall thickness in end‐diastole; MILD, mild eccentric remodeling; MOD, moderate eccentric remodeling. Antoine H. Chaanine et al. J Am Heart Assoc 2017;6:e005869 © 2017 Antoine H. Chaanine et al.

Hemodynamic assessment of the different phenotypes. Hemodynamic assessment of the different phenotypes. A, Top panel: Representative P–V loop tracings at steady state (left) and with inferior vena cava constriction (right) in the different phenotypes. Bottom panel: Representative P–V loop tracings scaled for diastolic pressures at steady state (left) and with inferior vena cava constriction (right) in the different phenotypes. LV maximum pressure (LVPmax) (B), LV end‐diastolic pressure (LVEDP) (C), the dimensionless chamber stiffness index (DCSI) (D) and end‐systolic elastance (Ees) (E) across the different phenotypes. Individual data points, box and whisker plots showing the median, interquartile range, and maximum and minimum values. *P<0.05 vs sham; +P<0.05 vs CR and ‡P<0.05 vs MILD. CR indicates concentric remodeling; LV, left ventricular; MILD, mild eccentric remodeling; MOD, moderate eccentric remodeling; P–V, pressure–volume. Antoine H. Chaanine et al. J Am Heart Assoc 2017;6:e005869 © 2017 Antoine H. Chaanine et al.

LV interstitial fibrosis, markers of pathological hypertrophy and fetal gene expression in the different phenotypes. LV interstitial fibrosis, markers of pathological hypertrophy and fetal gene expression in the different phenotypes. A, Representative photomicrographs of LV tissue stained with Picrosirius red taken by light (upper and bottom row) and polarized microscopy (middle row). Upper and middle row scale bar 200 μm. Bottom row scale bar 100 μm. B, Interstitial fibrosis assessed by collagen area fraction (CAF). C and D, Collagen I and III mRNA expression relative to sham. E, F, and G, Alpha‐skeletal muscle actin (ACTA1), Beta‐myosin heavy chain (β‐MyHC) and brain natriuretic peptide (BNP) mRNA expression relative to sham. Individual data points, box and whisker plots showing the median, interquartile range, and maximum and minimum values. *P<0.05 vs sham; +P<0.05 vs CR and ‡P<0.05 vs MILD. CR indicates concentric remodeling; MILD, mild eccentric remodeling; MOD, moderate eccentric remodeling. Antoine H. Chaanine et al. J Am Heart Assoc 2017;6:e005869 © 2017 Antoine H. Chaanine et al.

Assessment of the matrix metalloproteinases (MMP) and their tissue inhibitors (TIMP) in the different phenotypes. Assessment of the matrix metalloproteinases (MMP) and their tissue inhibitors (TIMP) in the different phenotypes. A, MMP‐2, MMP‐9, TIMP‐1, and TIMP‐2 expression in the different phenotypes compared to sham. Blue arrows showing MMP‐2 monomer and dimer at 75 and 150 kDa, respectively. B, Ratios of MMP‐2 and MMP‐9 over TIMP‐1 and TIMP‐2, respectively. The n number of animals studied for immunoblotting in the sham, CR, MILD, and MOD groups is 5, 8, 8, and 6, respectively. Bar graphs show mean and SD. *P<0.05 vs sham; +P<0.05 vs CR and ‡P<0.05 vs MILD. CR indicates concentric remodeling; MILD, mild eccentric remodeling; MOD, moderate eccentric remodeling. Antoine H. Chaanine et al. J Am Heart Assoc 2017;6:e005869 © 2017 Antoine H. Chaanine et al.

Assessment of calcium cycling proteins, endoplasmic reticulum stress apoptotic and mitochondrial pro‐apoptotic markers, biogenesis, and content in the different phenotypes. Assessment of calcium cycling proteins, endoplasmic reticulum stress apoptotic and mitochondrial pro‐apoptotic markers, biogenesis, and content in the different phenotypes. A, SERCA2a and NCX‐1 expression and ratio of S16 phosphorylated to total phospholamban. B, CHOP expression. C, BNIP3 expression and Bax/Bcl‐2 ratio in the different phenotypes compared to sham. The n number of animals studied for immunoblotting in the sham, CR, MILD, and MOD groups is 5, 8, 8, and 6, respectively. Bar graphs show mean and SD. *P<0.05 vs sham; +P<0.05 vs CR and ‡P<0.05 vs MILD. CR indicates concentric remodeling; MILD, mild eccentric remodeling; MOD, moderate eccentric remodeling. Antoine H. Chaanine et al. J Am Heart Assoc 2017;6:e005869 © 2017 Antoine H. Chaanine et al.

Assessment of apoptosis in the different phenotypes. Assessment of apoptosis in the different phenotypes. A, TUNEL assay in the different phenotypes compared to sham. Images are 20× magnified, scale bar = 50 μm. The n number of studied animals for sham, CR, MILD, and MOD is 5, 8, 8, and 7, respectively. B, Cleaved caspase 3 relative to caspase 3 expression in the different phenotypes compared with sham. The n number of studied animals in the sham, CR, MILD, and MOD is 5, 8, 8, and 6, respectively. Bar graphs show mean and standard deviation. *P<0.05 vs sham; +P<0.05 vs CR and ‡P<0.05 vs MILD. CR indicates concentric remodeling; MILD, mild eccentric remodeling; MOD, moderate eccentric remodeling; TUNEL, terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick‐end labeling. Antoine H. Chaanine et al. J Am Heart Assoc 2017;6:e005869 © 2017 Antoine H. Chaanine et al.

Assessment of mitochondrial oxidative phosphorylation in the different phenotypes. Assessment of mitochondrial oxidative phosphorylation in the different phenotypes. A, Electron transport chain complexes I–V. B, Citrate synthase (CS) activity. C, COX IV activity. D, PGC‐1α expression. E, Mitochondrial to nuclear DNA ratio across the different phenotypes relative to sham. The n number of studied animals for sham, CR, MILD, and MOD is 5, 8, 8, and 6 for immunoblotting and 5, 8, 8, and 7 for CS and COX IV activity, respectively. Bar graphs show mean and SD. *P<0.05 vs sham; +P<0.05 vs CR and ‡P<0.05 vs MILD. CR indicates concentric remodeling; MILD, mild eccentric remodeling; MOD, moderate eccentric remodeling. Antoine H. Chaanine et al. J Am Heart Assoc 2017;6:e005869 © 2017 Antoine H. Chaanine et al.