Abstract-Soluble fms-like tyrosine kinase-1 (sFlt-1), an endogenous inhibitor of vascular endothelial growth factor and placental growth factor, is involved in the pathogenesis of cardiovascular disease. However, the significance of sFlt-1 in heart failure has not been fully elucidated. We found that sFlt-1 is decreased in renal failure and serves as a key molecule in atherosclerosis. In this study, we aimed to investigate the role of the decreased sFlt-1 production in heart failure, using sFlt-1 knockout mice. sFlt-1 knockout mice and wild-type mice were subjected to transverse aortic constriction and evaluated after 7 days. The sFlt-1 knockout mice had significantly higher mortality (52% versus 15%; P=0.0002) attributable to heart failure and showed greater cardiac hypertrophy (heart weight to body weight ratio, 8.95±0.45 mg/g in sFlt-1 knockout mice versus 6.60±0.32 mg/g in wild-type mice; P<0.0001) and cardiac dysfunction, which was accompanied by a significant increase in macrophage infiltration and cardiac fibrosis, than wild-type mice after transverse aortic constriction. An anti-placental growth factor-neutralizing antibody prevented pressure overload-induced cardiac hypertrophy, fibrosis, and cardiac dysfunction. Moreover, monocyte chemoattractant protein-1 expression was significantly increased in the hypertrophied hearts of sFlt-1 knockout mice compared with wild-type mice. Monocyte chemoattractant protein-1 inhibition with neutralizing antibody ameliorated maladaptive cardiac remodeling in sFlt-1 knockout mice after transverse aortic constriction. In conclusion, decreased sFlt-1 production plays a key role in the aggravation of cardiac hypertrophy and heart failure through upregulation of monocyte chemoattractant protein-1 expression in pressure-overloaded heart. Correspondence to Yoshihiko Saito, First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. E-mail saitonaramed@gmail.com
Suppressed Production of Soluble Fms-Like Tyrosine Kinase-1 Contributes to MyocardialRemodeling and Heart Failure Ayako Seno, Yukiji Takeda, Masaru Matsui, Aya Okuda, Tomoya Nakano, Yasuki Nakada, Takuya Kumazawa, Hitoshi Nakagawa, Taku Nishida, Kenji Onoue, Satoshi Somekawa, Makoto Watanabe, Hiroyuki Kawata, Rika Kawakami, Hiroyuki Okura, Shiro Uemura, Yoshihiko Saito © 2016 American Heart Association, Inc. function in patients with acute coronary syndrome. 6 Therefore, it seems that insufficient sFlt-1 production is associated with adverse cardiovascular outcomes.On the contrary, several previous reports have shown that upregulation of sFlt-1 contributes to the development of heart failure, with antiangiogenesis activity by binding to VEGF. 7,8 In clinical settings, plasma levels of sFlt-1 are not only directly correlated with the severity of heart failure but also strongly associated with poor outcomes in patients with heart failure.9,10 These observations provide a plausible interpretation that increased sFlt-1 production aggravates heart failure with adverse car...