Na+/Ca2+ Exchanger-1 Protects Against Systolic Failure In The Akita(Ins2) Model Of Diabetic Cardiomyopathy Via A Cxcr4/Nf-Kappa B Pathway

LaRocca TJ, Fabris F, Chen J, Benhayon D, Zhang S, McCollum L, Schecter AD, Cheung JY, Sobie EA, Hajjar RJ, Lebeche D. Na+/Ca2+ exchanger-1 protects against systolic failure in the Akita(ins2) model of diabetic cardiomyopathy via a CXCR4/NF-kappa B pathway. Am J Physiol Heart Circ Physiol 303: H353-H367, 2012. First published May 18, 2012; doi: 10.1152/ajpheart.01198.2011.-Diabetic cardiomyopathy is characterized, in part, by calcium handling imbalances associated with ventricular dysfunction. The cardiac Na+/Ca2+ exchanger 1 (NCX1) has been implicated as a compensatory mechanism in response to reduced contractility in the heart; however, its role in diabetic cardiomyopathy remains unknown. We aimed to fully characterize the Akita(ins2) murine model of type 1 diabetes through assessing cardiac function and NCX1 regulation. The CXCL12/CXCR4 chemokine axis is well described in its cardioprotective effects via progenitor cell recruitment postacute myocardial infarction; however, it also functions in regulating calcium dependent processes in the cardiac myocyte. We therefore investigated the potential impact of CXCR4 in diabetic cardiomyopathy. Cardiac performance in the Akita(ins2) mouse was monitored using echocardiography and in vivo pressure-volume analysis. The Akita(ins2) mouse is protected against ventricular systolic failure evident at both 5 and 12 mo of age. However, the preserved contractility was associated with a decreased sarco(endo)plasmic reticulum Ca2+-ATPase (SERCA2a)/phospholamban ratio and increased NCX1 content. Direct myocardial injection of adenovirus encoding anti-sense NCX1 significantly decreased NCX1 expression and induced systolic failure in the Akita(ins2) mouse. CXCL12 and CXCR4 were both upregulated in the Akita(ins2) heart, along with an increase in I kappa B-alpha and NF-kappa B p65 phosphorylation. We demonstrated that CXCR4 activation upregulates NCX1 expression through a NF-kappa B-dependent signaling pathway in the cardiac myocyte. In conclusion, the Akita(ins2) type 1 diabetic model is protected against systolic failure due to increased NCX1 expression. In addition, our studies reveal a novel role of CXCR4 in the diabetic heart by regulating NCX1 expression via a NF-kappa B-dependent mechanism.