Abstract
Aortic valve stenosis (AVS) is the most common valvular heart disease in the Western world. Therapy based on apolipoprotein A-I (apoA-I), the major protein component of high-density lipoproteins, results in AVS regression in experimental models. Nevertheless, apoA-I degradation by proteases might lead to suboptimal efficacy of such therapy. An activatable probe using a quenched fluorescently labeled full-length apoA-I protein was generated to assess apoA-I-degrading protease activity in plasma derived from 44 men and 20 women with severe AVS (age 65.0 ± 10.4 years) as well as from a rabbit model of AVS. In human and rabbit AVS plasma, apoA-I-degrading protease activity was significantly higher than in controls (humans: 0.038 ± 0.009 vs 0.022 ± 0.005 RFU/s, p < 0.0001; rabbits: 0.033 ± 0.016 vs 0.017 ± 0.005 RFU/s, p = 0.041). Through the use of protease inhibitors, we identified metalloproteinases (MMP) as exerting the most potent proteolytic effect on apoA-I in AVS rabbits (67%, p < 0.05 vs control), while the cysteine protease cathepsin S accounted for 54.2% of apoA-I degradation in human plasma (p < 0.05 vs control) with the maximum effect seen in women (68.8%, p < 0.05 vs men). Accordingly, cathepsin S activity correlated significantly with mean transaortic pressure gradient in women (r = 0.5, p = 0.04) but not in men (r = − 0.09, p = 0.60), and was a significant independent predictor of disease severity in women (standardized beta coefficient 0.832, p < 0.001) when tested in a linear regression analysis. ApoA-I proteolysis is increased in AVS. Targeting circulating cathepsin S may lead to new therapies for human aortic valve disease.
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Funding
This work was supported by the Swiss National Science Foundation (SNSF, grants P3SMP3_151740/1142741 to BES and CG), the Novartis Foundation for Medical-Biological Research, Switzerland (to BES and CG), and the Gottfried und Julia Bangerter-Rhyner-Foundation, Switzerland (to BES). Dr. Tardif holds the Canada Research Chair in translational and personalized medicine and the Pfizer-endowed research chair in atherosclerosis at the Université de Montréal.
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Dr. Tardif has received research grants from Amarin, AstraZeneca, DalCor, Esperion, Ionis, Merck, Pfizer, Sanofi, and Servier; received honoraria from DalCor, Pfizer, Sanofi, and Servier; and holds minor equity interest in DalCor. The other authors report no conflict of interest. Dr Gebhard and Dr Stähli have received research grants from the Novartis Foundation, Switzerland.
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Gebhard, C., Maafi, F., Stähli, B.E. et al. Apolipoprotein A-I proteolysis in aortic valve stenosis: role of cathepsin S. Basic Res Cardiol 113, 30 (2018). https://doi.org/10.1007/s00395-018-0689-7
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DOI: https://doi.org/10.1007/s00395-018-0689-7