Rationale: Studies in transgenic mice showed the key role of (Pim-1) (proviral integration site for Moloney murine leukemia virus-1) in the control of cardiomyocyte function and viability.Objective: We investigated whether Pim-1 represents a novel mechanistic target for the cure of diabetic cardiomyopathy, a steadily increasing cause of nonischemic heart failure.
Methods and Results:In streptozotocin-induced type 1 diabetic mice, Pim-1 protein levels declined during progression of cardiomyopathy, along with upregulation of Pim-1 inhibitors, protein phosphatase 2A, and microRNA-1. Moreover, diabetic hearts showed low levels of antiapoptotic B-cell lymphoma-2 (Bcl-2) protein and increased proapoptotic caspase-3 activity. Studies on adult rat cardiomyocytes and murine cardiac progenitor cells challenged with high glucose confirmed the in vivo expressional changes. In rescue studies, anti-microRNA-1 boosted Pim-1 and Bcl-2 expression and promoted cardiomyocyte and cardiac progenitor cell survival under high glucose conditions. Similarly, transfection with Pim-1 plasmid prevented high glucoseinduced cardiomyocyte and cardiac progenitor cell apoptosis. Finally, a single intravenous injection of human PIM-1 via cardiotropic serotype-9 adeno-associated virus (1؋10 10 or 5؋10 10 genome copies per animal) at 4 weeks after diabetes induction led to sustained cardiac overexpression of Pim-1 and improved diastolic function and prevented left ventricular dilation and failure. Histological examination showed reduced cardiomyocyte apoptosis and fibrosis in association with increased c-kit ؉ cells and cardiomyocyte proliferation, whereas molecular analysis confirmed activation of the prosurvival pathway and conservation of sarcoendoplasmic reticulum Ca
2؉-ATPase and ␣-myosin heavy chain in Pim-1-treated hearts. Key Words: diabetic cardiomyopathies Ⅲ diastolic dysfunction Ⅲ Pim-1 kinase Ⅲ gene therapy Ⅲ cardiac stem cells A common form of cardiomyopathy directly related to diabetes mellitus (DM), ie, diabetic cardiomyopathy, typically progresses from diastolic dysfunction to heart failure in the absence of coronary artery disease or hypertension. [1][2][3] Studies in animal models illustrate the complexity of the underpinning pathogenic mechanisms (reviewed in Bugger and Abel 4 ). Hence, a deeper understanding of targets for early therapeutic interventions is critically needed.
Conclusions:Recent work from Muraski and colleagues 5 uncovered the pivotal role of (Pim-1) (proviral integration site for Moloney murine leukemia virus-1), a member of the serine/threonine protein kinase family, in the cardiac cell response to stressors. Promotion of cardiomyocyte survival by Pim-1 is mediated by activation of B-cell lymphoma-2 (Bcl-2), phosphorylation/ inhibition of Bcl-2-associated death promoter (Bad), and maintenance of mitochondrial integrity. 6,7 By inducing c-Myc, nucleostemin, and cyclin E expression and p21 phosphorylation, Pim-1 increases the proliferative activity of cardiac progenitor cells (CPCs). 8,9 Furthermore, Pim-1 acts...