Cardiomyocyte-Specific Deletion of Gsk3α Mitigates Post–Myocardial Infarction Remodeling, Contractile Dysfunction, and Heart Failure

Abstract

Injury due to myocardial infarction (MI) is largely irreversible. Once an infarct has occurred, the clinical goal becomes limiting remodeling, preserving left ventricular function, and preventing heart failure. Although traditional approaches (e.g., b-blockers) partially preserve left ventricular function, novel strategies are needed to limit ventricular remodeling post-MI. OBJECTIVES The aim of this study was to determine the role of glycogen synthase kinase–3a (GSK-3a) in post-MI remodeling. METHODS Mice with cardiomyocyte-specific conditional deletion of Gsk3a and littermate controls underwent sham or MI surgery. Heart function was assessed using serial M-mode echocardiography. RESULTS Gsk3a deletion in the heart markedly limits remodeling and preserves left ventricular function post-MI. This is due at least in part to dramatic thinning and expansion of the scar in the control hearts, which was less in the heart of knockout (KO) mice. In contrast, the border zone in the KO mice demonstrated a much thicker scar, and there were more viable cardiomyocytes within the scar/border zone. This was associated with less apoptosis and more proliferation of cardiomyocytes in the KO mice. Mechanistically, reduced apoptosis was due, at least in part, to a marked decrease in the Bax/Bcl-2 ratio, and increased cardiomyocyte proliferation was mediated through cyclin E1 and E2F-1 in the hearts of the KO mice. CONCLUSIONS Taken together, these findings show that reducing GSK-3a expression in cardiomyocytes limits ventricular remodeling and preserves cardiac function post-MI. Specifically targeting GSK-3a could be a novel strategy to limit adverse remodeling and heart failure. (J Am Coll Cardiol 2014;64:696–706) © 2014 by the American College of Cardiology Foundation.