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2015 ; 2
(ä): 25
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Functional Amyloid Signaling via the Inflammasome, Necrosome, and Signalosome:
New Therapeutic Targets in Heart Failure
#MMPMID26664897
Parry TL
; Melehani JH
; Ranek MJ
; Willis MS
Front Cardiovasc Med
2015[]; 2
(ä): 25
PMID26664897
show ga
As the most common cause of death and disability, globally, heart disease remains
an incompletely understood enigma. A growing number of cardiac diseases are being
characterized by the presence of misfolded proteins underlying their
pathophysiology, including cardiac amyloidosis and dilated cardiomyopathy (DCM).
At least nine precursor proteins have been implicated in the development of
cardiac amyloidosis, most commonly caused by multiple myeloma light chain disease
and disease-causing mutant or wildtype transthyretin (TTR). Similarly, aggregates
with PSEN1 and COFILIN-2 have been identified in up to one-third of idiopathic
DCM cases studied, indicating the potential predominance of misfolded proteins in
heart failure. In this review, we present recent evidence linking misfolded
proteins mechanistically with heart failure and present multiple lines of new
therapeutic approaches that target the prevention of misfolded proteins in
cardiac TTR amyloid disease. These include multiple small molecule
pharmacological chaperones now in clinical trials designed specifically to
support TTR folding by rational design, such as tafamidis, and chaperones
previously developed for other purposes, such as doxycycline and
tauroursodeoxycholic acid. Last, we present newly discovered non-pathological
"functional" amyloid structures, such as the inflammasome and necrosome signaling
complexes, which can be activated directly by amyloid. These may represent future
targets to successfully attenuate amyloid-induced proteotoxicity in heart
failure, as the inflammasome, for example, is being therapeutically inhibited
experimentally in autoimmune disease. Together, these studies demonstrate
multiple novel points in which new therapies may be used to primarily prevent
misfolded proteins or to inhibit their downstream amyloid-mediated effectors,
such as the inflammasome, to prevent proteotoxicity in heart failure.