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(Circulation. 2006;113:1203-1212.)
© 2006 American Heart Association, Inc.

Heart Failure

Apoptosis Repressor With Caspase Recruitment Domain Is Required for Cardioprotection in Response to Biomechanical and Ischemic Stress

Stefan Donath, MD^*; Peifeng Li, PhD^*; Christian Willenbockel, DVM; Nidal Al-Saadi, MD; Volkmar Gross, PhD; Thomas Willnow, PhD; Michael Bader, PhD; Ulrich Martin, MD; Johann Bauersachs, MD; Kai C. Wollert, MD; Rainer Dietz, MD; Rüdiger von Harsdorf, MD, on behalf of the German Heart Failure Network

From the Departments of Cardiology, Campus Virchow Clinic, Charité, Humboldt University, and Franz-Volhard Clinic, HELIOS GmbH, Berlin, Germany (S.D., P.L., N.A., R.D., R.v.H.); Max-Delbrück Center for Molecular Medicine, Berlin, Germany (S.D., V.G., T.W., M.B., R.v.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (C.W., K.C.W.); Leibniz Research Laboratories for Biotechnology and Artificial Organs, Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany (U.M.); and Department of Internal Medicine I, Julius-Maximilians University, Würzburg, Germany (J.B.).

Correspondence to Rüdiger von Harsdorf, MD, FRCPS, Associate Professor of Medicine, Division of Cardiology, University Health Network, 200 Elizabeth St, MaRS 3-908, Toronto, ON, M5G 2C4, Canada. E-mail rudiger.vonharsdorf{at}uhn.on.ca

Received July 19, 2005; revision received December 3, 2005; accepted December 21, 2005.

Background— Ischemic heart disease and heart failure are associated with an increased loss of cardiomyocytes due to apoptosis. Whether cardiomyocyte apoptosis plays a causal role in the pathogenesis of heart failure remains enigmatic. The apoptosis repressor with caspase recruitment domain (ARC) is a recently discovered antiapoptotic factor with a highly specific expression pattern in striated muscle and neurons. ARC is a master regulator of cardiac death signaling because it is the only known factor that specifically inhibits both the intrinsic and extrinsic apoptotic death pathway. In this study we attempted to elucidate the physiological role of ARC and to understand pathophysiological consequences resulting from its deletion.

Methods and Results— We generated ARC-deficient mice, which developed normally to adulthood and had no abnormality in cardiac morphology and function under resting conditions. On biomechanical stress induced by aortic banding, ARC-deficient mice developed accelerated cardiomyopathy compared with littermate controls, which was characterized by reduced contractile function, cardiac enlargement, and myocardial fibrosis. Likewise, ischemia/reperfusion injury of ARC-deficient mice resulted in markedly increased myocardial infarct sizes. Although in both instances a significant increase in apoptotic cardiomyocytes could be observed in ARC-deficient mice, neither in vitro nor in vivo studies revealed any effect of ARC on classic hypertrophic cardiomyocyte growth responses. The pathophysiological relevance of downregulated ARC levels was underscored by specimens from failing human hearts showing markedly reduced ARC protein levels.

Conclusions— Our study identifies a tissue-specific antiapoptotic factor that is downregulated in human failing myocardium and that is required for cardioprotection in pressure overload and ischemia.

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