Desmin is the major protein component of the intermediate filaments (IFs) cytoskeleton in muscle cells, including cardiac. The accumulation of cleaved and misfolded desmin is a cellular hallmark of heart failure (HF). These desmin alterations are reversed by therapy, suggesting a causal role for the IFs in the development of HF. Though IFs are known to play a role in the protection from stress, a mechanistic model of how that occurs is currently lacking. On the other hand, the heart is uniquely suited to study the function of the IFs, due to its inherent, cyclic contraction. That is, HF can be used as a model to address how IFs afford protection from mechanical, and possibly redox, stress. In this review we provide a brief summary of the current views on the function of the IFs, focusing on desmin. We also propose a new model according to which the propensity of desmin to aggregate may have been selected during evolution as a way to dissipate excessive mechanical and possibly redox stress. According to this model, though desmin misfolding may afford protection from acute injury, the sustained or excessive accumulation of desmin aggregates could impair proteostasis and contribute to disease.

Background Pulseless electrical activity (PEA) is a common initial rhythm in cardiac arrest. A substantial number of PEA arrests are caused by coronary ischemia in the setting of acute coronary occlusion, but the underlying mechanism is not well understood. We hypothesized that the initial rhythm in patients with acute coronary occlusion is more likely to be PEA than ventricular fibrillation in those with prearrest severe left ventricular dysfunction. Methods and Results We studied the initial cardiac arrest rhythm induced by acute left anterior descending coronary occlusion in swine without and with preexisting severe left ventricular dysfunction induced by prior infarcts in non–left anterior descending coronary territories. Balloon occlusion resulted in ventricular fibrillation in 18 of 34 naïve animals, occurring 23.5±9.0 minutes following occlusion, and PEA in 1 animal. However, all 18 animals with severe prearrest left ventricular dysfunction (ejection fraction 15±5%) developed PEA 1.7±1.1 minutes after occlusion. Conclusions Acute coronary ischemia in the setting of severe left ventricular dysfunction produces PEA because of acute pump failure, which occurs almost immediately after coronary occlusion. After the onset of coronary ischemia, PEA occurred significantly earlier than ventricular fibrillation (<2 minutes versus 20 minutes). These findings support the notion that patients with baseline left ventricular dysfunction and suspected coronary disease who develop PEA should be evaluated for acute coronary occlusion.

Background: Though acute mortality by myocardial infarction (MI) has declined in past decades, MI still represents one of the leading causes of heart failure (HF) development. We recently demonstrated the accumulation of toxic desmin aggregates in patients with HF of ischemic origin. Since desmin aggregates are toxic for the heart we aimed to test whether their formation can be induced by oxidative stress as a proxy for reperfusion injury, as well as addressing the effects of therapeutic strategies aimed at reducing desmin aggregation with cardiac oxidative stress. Methods and Results: We demonstrate here that oxidative stress is able to induce desmin aggregation, acutely, in a cell-specific and dose-dependent fashion. We also show that elevation of O-linked β-N-acetylglucosamine (O-GlcNAc) prior to or after oxidative stress reduces the formation of toxic desmin aggregates and its pro-aggregating desmin post-translational modifications (PTM). In addition, we show for the first time a role for the transmembrane protease serine 13 (TMPRSS13) with desmin cleavage in response to oxidative stress while desmin single cysteine plays a protective role from I/R injury, which is independent of gain or loss of desmin function. Conclusions: The proliferation of desmin PTM-forms (i.e., proteoforms) and its aggregation hallmark acute and chronic cardiac stress and result in both loss of and gain of desmin function. We report here two novel mechanisms that could be targeted for therapy to preserve desmin homeostasis and cardiac function in the acute settings of oxidative stress and reperfusion injury.

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