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(Circulation. 2002;105:2265.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Calcineurin in Human Heart Hypertrophy

Oliver Ritter, MD; Susanne Hack, MS; Kai Schuh, PhD; Nicola Röthlein, BA; Andreas Perrot, PhD; Karl J. Osterziel, MD; Hagen D. Schulte, MD; Ludwig Neyses, MD

From the Department of Medicine (O.R., S.H., K.S., N.R.), University of Wuerzburg, Germany; Franz Volhard Clinic at the Max Delbrueck Center (A.P., K.J.O.), Charité, Humboldt University of Berlin, Germany; Department of Thoracic Surgery (H.D.S.), Heinrich Heine University Duesseldorf, Germany; and University Department of Medicine (L.N.), Manchester, UK.

Correspondence to Ludwig Neyses, MD, University Department of Medicine, Manchester Heart Center, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. E-mail ludwig.neyses{at}mhc.cmht.nwest.nhs.uk and labneyses@medizin.uni-wuerzburg.de

Background— In animal models, increased signaling through the calcineurin pathway has been shown to be sufficient for the development of cardiac hypertrophy. Calcineurin activity has been reported to be elevated in the myocardium of patients with congestive heart failure. In contrast, few data are available about calcineurin activity in patients with pressure overload or cardiomyopathic hypertrophy who are not in cardiac failure.

Methods and Results— We investigated calcineurin activity and protein expression in 2 different forms of cardiac hypertrophy: hypertrophic obstructive cardiomyopathy (HOCM) and aortic stenosis (AS). We found that the C-terminus of calcineurin A protein containing the autoinhibitory domain was less abundant in myocardial hypertrophy than in normal heart, which suggests the possibility of proteolysis. No new splice variants could be detected by reverse-transcription polymerase chain reaction. This resulted in a significant elevation of calcineurin enzymatic activity in HOCM and AS compared with 6 normal hearts. Increased calcineurin phosphatase activity caused increased migration of NF-AT2 (nuclear factor of activated T cells 2) in SDS-PAGE compatible with pronounced NF-AT dephosphorylation in hypertrophied myocardial tissue.

Conclusions— Hypertrophy in HOCM and AS without heart failure is characterized by a significant increase in calcineurin activity. This might occur by (partial) proteolysis of the calcineurin A C-terminus containing the autoinhibitory domain. Increased calcineurin activity has functional relevance, as shown by altered NF-AT phosphorylation state. Although hypertrophy in AS and HOCM may be initiated by different upstream triggers (internal versus external fiber overload), in both cases, there is activation of calcineurin, which suggests an involvement of this pathway in the pathogenesis of human cardiac hypertrophy.

Key Words: hypertrophy • cardiomyopathy • signal transduction

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