Yonago Acta medica 2014;57:109–116

Original Article

Glucocorticoids Induce Cardiac Fibrosis via Mineralocorticoid Receptor in
Oxidative Stress: Contribution of Elongation Factor Eleven-Nineteen Lysine-Rich
Leukemia (ELL)
Yosuke Omori,* Toshiaki Mano,† Tomohito Ohtani,* Yasushi Sakata,* Yasuharu Takeda,* Shunsuke Tamaki,*Yasumasa Tsukamoto,* Takeshi Miwa,‡ Kazuhiro Yamamoto§ and Issei Komuro¶*Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan, †Cardiovascular
Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya 663-8501, Japan, ‡Genome Information ResearchCenter, Osaka University, Suita 565-0871, Japan, §Division of Molecular Medicine and Therapeutics, Department of Multidisciplinary
Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan and ¶Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku 113-0033, Japansterone levels.3, 4 However, the mechanism underlying
the benefits of MR-blockade in those HF patients is still
unclear.
In typical aldosterone targets such as renal, tubular
or vascular smooth muscle cells, 11beta-hydroxysteroid
dehydrogenase type II (11betaHSD2) converts glucocorticoid to inactive form, and thus aldosterone can exert
specific actions on MR.5 In contrast, in several non-epithelial tissues such as heart, expression of 11betaHSD2
is negligibly low.5, 6 The physiological glucocorticoids
are corisol in humans and corticosterone in rodents andthey have similar affinity for MR as aldosterone.7 Cardiac MRs are overwhelmingly occupied by glucocorticoids rather than by aldosterone.8 High serum levels ofcortisol, the major glucocorticoid in humans are an independent predictor of increased mortality risk in patientswith HF.9 We have shown that administration of eplerenone, an MR antagonist, attenuates cardiac fibrosis andprevents HF in hypertensive HF Dahl salt-sensitive rats,
with corticosterone levels in the left ventricule (LV)
approximately 800 times those of aldosterone.6 Thissuggests that corticosterone acts as an MR agonist andpromotes cardiac fibrosis which plays an important rolein the development of HF.10, 11 It has been postulated that
if intracellular redox state changes with tissue damage
and the generation of reactive oxygen species (ROS), thephysiological glucocorticoids act as MR agonists.12–14
Serum cortisol has also been reported as a useful predic-

ABSTRACT
Background

Cardiac fibrosis is considered to be a
crucial factor in the development of heart failure. Blockade of the mineralocorticoid receptor (MR) attenuatedcardiac fibrosis and improved the prognosis of patientswith chronic heart failure but the ligand for MR and theregulatory mechanism of MR pathway in the diseased
heart are unclear. Here, we investigated whether glucocorticoids can promote cardiac fibrosis through MR inoxidative stress and the involvement of elongation factor
eleven-nineteen lysine-rich leukemia (ELL), a co-activator of MR, in this pathway.
Methods and Results The MR antagonist eplerenone
attenuated corticosterone-induced collagen synthesis assessed by [3H]proline incorporation in rat neonatal cultured cardiac fibroblasts in the presence of H2O2, as anoxidative stress but not in the absence of H2O2. H2O2 increased the ELL expression levels and MR-bound ELL.
ELL expression levels and MR-bound ELL were also
increased in the left ventricle of heart failure model rats
with significant fibrosis and enhanced oxidative stress.
Eplerenone did not attenuate corticosterone-induced
increase of [3H]proline incorporation in the presence of
H2O2 after knockdown of ELL expression using smallinterfering RNA in cardiac fibroblasts.
Conclusion Glucocorticoids can promote cardiac fibrosis via MR in oxidative stress, and oxidative stressmodulates MR response to glucocorticoids through theinteraction with ELL. Preventing cardiac fibrosis bymodulating glucocorticoid-MR-ELL pathway may become a new therapeutic strategy for heart failure.
Key words

Corresponding author: Toshiaki Mano, MD, PhD
mano@hyo-med.ac.jp
Received 2014 July 14
Accepted 2014 August 22
Abbreviations: ELL, elongation factor eleven-nineteen lysinerich leukemia; DMEM, Dulbecco’s modified Eagle’s medium;
FCS, fetal calf serum; GAPDH, glyceraldehyde-3-phosphate
dehydrogenase; IP, immunoprecipitation; HF, heart failure; HNE,
4-hydroxy-2-nonenal; LV, left ventricle; MR, mineralocorticoid
receptor; 11betaHSD2, 11beta-hydroxysteroid dehydrogenase type
II; ROS, reactive oxygen species; RT-qPCR, real-time quantitative
revere transcriptase-PCR; siRNA, small interfering RNA

co-activator; corticosterone; eplerenone;

heart failure
Blockade of the mineralocorticoid receptor (MR) improved mortality of patients with chronic heart failure(HF)1, 2 and was effective in the reduction of myocardialdamage even in HF patients with low to normal aldo109

Y. Omori et al.

tor of cardiac events in patients with HF in the presenceof oxidative stress.15 However, it is still unclear whether
glucocorticoids promote cardiac fibrosis via MR in oxidative stress and the mechanisms.
Elongation factor eleven-nineteen lysine-rich leukemia (ELL) was reported to bind to MR and increase
MR activity in response to glucocorticoids as well as tomineralocorticoids as a co-activator of MR.16 Therefore,
ELL may be involved in glucocorticoid promotion ofcardiac fibrosis via MR but the function in the diseased
heart has not to be determined.
Here, we investigated whether glucocorticoid could
promote cardiac fibrosis via MR in oxidative stress. In
addition, the role of ELL in glucocorticoid-induced cardiac fibrosis via MR was investigated.

anti-4-hydroxy-2-nonenal (HNE) antibody (1:50 dilution; NOF Medical Department, Tokyo) as previously
described.18
Cultured cardiac fibroblasts

Neonatal rat cardiac fibroblasts were isolated from
Wistar rats by standard techniques with some modification of the previously described method.21 Briefly,
neonatal rats were deeply anesthetized by inhalation of
5% sevoflurane until loss of paw withdrawal reflex was
obtained. After cervical dislocation was performed, they
were opened by sternotomy and their hearts removed.
LV samples from neonatal rats were cut into pieces ofapproximately 1 mm3 with scissors and subjected tocollagenase (Wako Pure Chemical Industries, Osaka,
Japan) digestion in phosphate-buffered saline. Dispersed
cells were incubated on 100 mm culture dishes for 40
min in a 5% CO2 incubator. Non-myocytes attached tothe bottom of the dishes were subsequently incubatedwith Dulbecco’s modified Eagle’s medium (DMEM)(Invitrogen, Carlsbad, CA) supplemented with 10% fetal
calf serum (FCS) (26140, Invitrogen) for an additional
48 h. Confluent cardiac fibroblasts were treated with
0.05% trypsin-EDTA (Invitrogen) and subcultured.
Virtually pure fibroblast cultures were confirmed byimmunostaining with a monoclonal anti-vimentin (V9)antibody (1:250 dilution; sc-6260, Santa Cruz Biotechnology, Dallas, TX).22 Cells were passaged twice andincubated in DMEM supplemented with 10% charcoal
stripped FCS (12676, Invitrogen). The medium of subconfluent cells of the second passage was changed to
DMEM without FCS 24 h before H2O2 administration (1μmol/L; Wako Pure Chemical Industries), corticosterone(300 nmol/L; Sigma-Aldrich, St. Louis) or eplerenone (1μmol/L; Tocris Bioscience, Ellisville, MO).

MATERIALS AND METHODSThis study was approved by the institutional ethics
committee of Osaka University Graduate School of
Medicine (Approval Number: 23-014-0, 23-030-1, 23062-0), and conforms to the Guide for the Care and Useof Laboratory Animals published by the United States
National Institutes of Health.
HF model rats

Male Dahl salt-sensitive rats (Japan SLC, Shizuoka,
Japan) fed on 8% NaCl diet from 6 weeks old as HF
group (n = 8) and male Dahl salt-sensitive rats fed on
0.3% NaCl diet throughout the study protocol as an agematched control group (n = 8) were used for this study.17
This model presents HF around 19 to 20 weeks of age
with significant cardiac fibrosis.18, 19 Rats were sacrificed
in 22 weeks of age with established HF. Anesthesia
included ketamine HCl (80 mg/kg, intraperitoneally)and xylazine HCl (10 mg/kg, intraperitoneally) and its
adequacy monitored by the stability of blood pressure,heart rate, and lack of flexor responses to paw-pinch.20
The heart and lungs were rapidly harvested, and LV andlung weight corrected for tibial length. The LV was immediately placed in liquid nitrogen and stored at −80
˚C for real-time quantitative reverse transcriptase-PCR(RT-qPCR) and Western blot analysis. LV samples were
fixed with a phosphate-buffered 10% formalin solution
for Azan-Mallory staining, and embedded in Tissue-Tek
O.C.T. compound (Sakura Finetechnical, Tokyo, Japan)
on dry ice for immunohistochemistry.

Western blot analysis

The protocol of Western blot analysis was the same aspreviously described.18, 19 LV tissue was homogenizedin buffer (50 mM Tris-HCl, 0.1 mM sodium orthovanadate, 50 mM sodium fluoride, 150 mM sucrose, 1 mM
benzamide, 5 mM EDTA and 2 mM EGTA) supplemented with protease inhibitor cocktail (Thermo Scientific, Waltham, MA). Cells were lysed with buffer (50mM Tris-HCl, 0.1 mM sodium orthovanadate, 50 mM
sodium fluoride, 150 mM sucrose, 1 mM benzamide,
5 mM EDTA, 2 mM EGTA and 1% Triton X-100)
supplemented with the protease inhibitor cocktail. Aftercentrifugation, the supernatant protein concentration
was determined by the Lowry’s method. Aliquots weremixed with equal volumes of Laemmli buffer (250 mM
Tris-HCl, 20% glycerol, 4% sodium dodecyl sulfate,

Histological analysis

Azan Mallory staining was performed on LV transverse
sections to evaluate LV fibrosis as previously described.18
To evaluate oxidative stress in the LV of the HF rats,
tissue sections were incubated with mouse monoclonal
110Cardiac fibrosis through MR

10% 2-mercaptoethanol and 0.01% bromophenol blue),heated for 5 min at 95 ˚C, subjected to electrophoresison 7.5% SDS-PAGE and then transferred to ImmobilonP Transfer membranes (Millipore, Billerica, MA). The
membrane was then incubated with rabbit polyclonal
primary antibodies for ELL (1:200 dilution; sc-28702;
Santa Cruz Biotechnology), MR (sc-11412; Santa Cruz
Biotechnology) or glyceraldehyde-3-phosphate dehydrogenase (GAPDH) (1:2000 dilution; sc-25778; Santa
Cruz Biotechnology) at 4 ˚C overnight, followed by secondary antibody [111-035-144; peroxidase-conjugatedAffiniPure goat anti-rabbit immunoglobulin G (H + L),
Jackson ImmunoResearch Laboratories, West Grove,
PA] at room temperature for 1 h. Blots were developedby enhanced chemiluminescence and expression levels
quantified with LAS-4000 and MultiGauge software(Fujifilm, Tokyo). The band density of the protein of interest was normalized to GAPDH expression.20

assays-on-demand gene expression products (assay ID
Rn01420173_g1 and Rn00492539_m1, respectively;
Applied Biosystems). The amount of each mRNA wasdivided by that of GAPDH mRNA to correct for the efficiency of cDNA synthesis and normalized to the meanof the control.
MR IP

Samples were homogenized with immunoprecipitation (IP) buffer (50 mM Tris-HCl, 0.1 mM sodium orthovanadate, 50 mM sodium fluoride, 150 mM sucrose,
1 mM benzamide, 5 mM EDTA, 2mM EGTA and 1%
Triton X100) supplemented with the protease inhibitor
cocktail. The same amount of samples was pre-clearedwith protein A-agarose IP reagent (sc-2001; Santa Cruz
Biotechnology), and incubated with 2 µg of rabbit polyclonal primary antibodies for MR (sc-11412; Santa Cruz
Biotechnology) for 1 h at 4 ˚C. MR-associated proteins
were pulled-down with protein A-agarose IP reagent
overnight at 4 ˚C, and washed 4 times in IP buffer. Immunoprecipitated proteins were eluted in Laemmli buffer and Western blot analysis performed to detect ELL
bound to MR by using the antibody for ELL.

RT-qPCR

Total RNA was extracted from the LV samples and cardiac fibroblasts stored at –80 ˚C and reverse-transcribedwith oligo d(T)16 as a reverse primer as previously
described.23 RT-qPCR with the ABI PRISM 7900 HT
Sequence Detection System and Software Version 2.3(Applied Biosystems, Foster City, CA) was conducted tomeasure mRNA levels. The sequence of the primers andTaqMan probe for GAPDH were previously described.24
The primers and TaqMan probes for ELL, and MR were

[3H]proline incorporation into cardiac fibroblasts

To evaluate collagen synthesis, cardiac fibroblasts wereincubated in medium supplemented with [3H]proline (1μCi/mL; Perkin Elmer, Waltham, MA) in the absence orpresence of corticosterone (300 nmol/L).20 The effectsof MR antagonist (eplerenone, 1 μmol/L) on corticosterone-stimulated [3H]
proline incorporation were assessed in
the absence or the presence of H2O2 (1μmol/L). After 48 h treatment, extracellular proline was removed by aspirationof media, plates were washed twicewith phosphate-buffered saline, and 5%
cold trichloroacetic acid was added tosolubilize intracellular free [3H]proline
and precipitate [3H]proline incorporated
into collagen. After 30 min, trichloroacetic acid was aspirated, plates were
washed twice with 95% ethanol, and 0.5
N NaOH was added to solubilize theFig. 1. [3H]proline incorporation into cardiac fibroblasts under oxidative stress.
A: Cardiac fibroblasts were treated with Cor (300 nmol/L) and/or Epl (1 μmol/L) in
precipitated proteins. After an additional
the absence of H2O2. Untreated cardiac fibroblasts were served as control. n = 8
30 min, scintillation cocktail (Insta-Gel
for each group.
Plus; Perkin Elmer) was added, and the
B: Cardiac fibroblasts were treated with Cor (300 nmol/L) and/or Epl (1 μmol/L)
radioactivity was measured in a liquidin the presence of H2O2 (1 μmol/L). Cardiac fibroblasts treated with H2O2 alone
scintillation counter (LS 6500; Beckman
were served as control. n = 8 for each group.
Control was arbitrarily set to 1. Data are expressed as mean values ± SD.
Coulter, Brea, CA). The amount of [3H]
*P < 0.05 versus control.
proline incorporation was normalized to†P < 0.05 versus Cor (+) Epl (–).
the mean of the control.
#P < 0.05 versus Cor (–) Epl (+).
Cor, corticosterone; Epl, eplerenone.

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Y. Omori et al.

Fig. 2. The effect of H2O2 on the expression of ELL, MR and 11betaHSD2, and ELL-MR interaction in cultured cardiac fibroblasts. Cardiac fibroblasts were treated with H2O2 (1 μmol/L) for 48 h. Cardiac fibroblasts without H2O2 were served as Ctl.
A: RT-qPCR was performed to evaluate the mRNA levels of ELL, MR and 11betaHSD2 in the cardiac fibroblasts (n = 5 for each group).
B: WB analysis was performed to evaluate the protein levels of ELL and MR in the cardiac fibroblasts. The images (upper) and the results of densitometry (lower) of WB analysis (n = 4 for each group).
Ctl was arbitrarily set to 1. Data are expressed as mean values ± SD.
*P < 0.05 versus Ctl.
C: Cell lysate of cardiac fibroblasts was subjected to IP with anti-MR antibody. Immunoprecipitates were subsequently analyzed byWestern blotting with anti-ELL antibody.
Ctl, control; ELL, elongation factor eleven-nineteen lysine-rich leukemia; IP, immunoprecipitation; RT-qPCR, real-time quantitative reverse transcriptase-PCR; MR, mineralocorticoid receptor; WB, Western blot.

RESULTS

Small interfering RNA-mediated knockdown of
ELL

Corticosterone promotes collagen production via
MR in oxidative stress in cardiac fibroblasts

Cardiac fibroblasts from the second passage were transfected with ELL small interfering RNA (siRNA) or with
non-targeting control siRNA (B-Bridge International,
Cupertino, CA) at a final concentration of 50 nmol/Lwith Lipofectamine RNAiMAX (Invitrogen) in DMEM
supplemented with 10% charcoal stripped FCS without
antibiotics according to the manufacturer’s instructions.
The media were changed to DMEM supplemented with
10 % charcoal stripped FCS and antibiotics 24 h afterof siRNA transfection. The inhibitory efficiency of eachsiRNA was examined by measuring ELL mRNA levels
by RT-qPCR 108 h after of siRNA transfection. Measurement of [3H]proline incorporation into siRNA transfected cardiac fibroblasts was performed.

To investigate whether glucocorticoid promotes collagenproduction through MR, [3H]proline incorporation into
cardiac fibroblasts was measured.
Corticosterone increased [3H]proline incorporation
into cardiac fibroblasts (Figs. 1A and B). The corticosterone-induced increase of [3H]proline incorporation
was not changed by eplerenone in the absence of H2O2
(Fig. 1A), but attenuated by eplerenone in the presenceof H2O2 (Fig. 1B). Eplerenone alone did not affect the[3H]proline incorporation in either the absence or thepresence of H2O2 (Figs. 1A and B). H2O2 alone did notaffect the [3H]proline incorporation in the cardiac fibroblasts (data not shown). These results indicate that corticosterone increases collagen production through MR in
cardiac fibroblasts under oxidative stress.

Statistics

Results are expressed as mean ± SD. Differences amonggroups were analyzed by one-way analysis of variance,
followed by the Fisher protected least significant difference post hoc test. A P value < 0.05 was regarded asstatistically significant.

ELL expression and binding to MR are increasedby oxidative stress in cardiac fibroblasts

To investigate the effect of oxidative stress on the ELL
expression levels and the ELL-MR interaction, cardiac
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Cardiac fibrosis through MR

Fig. 3. LV fibrosis, ROS generation, ELL expression and ELL-MR interaction in the LVs of 22 weeks old Dahl salt-sensitive rats.
Representative photomicrographs of Azan Mallory staining to evaluate LV fibrosis (A) and representative immunohistochemical staining
for 4-hydroxy-2-nonenal to evaluate ROS generation (B) in the LV of a Dahl-salt sensitive rat in the Ctl group and the HF group.
C: RT-qPCR analysis of the mRNA levels of ELL in the LVs of Dahl salt-sensitive rats (n = 8 for each group).
D: WB analysis of the protein levels of ELL in the LVs of Dahl salt-sensitive rats. The images (left) and the results of densitometry (right)
of WB analysis (n = 5 for each group).
Data are expressed as mean values ± SD. The Ctl group was arbitrarily set to 1.
*P < 0.05 versus the Ctl group.
E: LV lysate of Dahl salt-sensitive rats was subjected to IP with anti-MR antibody. Immunoprecipitates were subsequently analyzed byWestern blotting with anti-ELL antibody.
Ctl, control; ELL, elongation factor eleven-nineteen lysine-rich leukemia; HF, heart failure; IP, immunoprecipitation; LV, left ventricle;
MR, mineralocorticoid receptor; ROS, reactive oxygen species; WB, Western blot.

fibroblasts were incubated in the presence or absence of
H2O2 (1 μmol/L) for 48 h.
The mRNA and the protein levels of ELL were increased in the cultured cardiac fibroblasts under oxidative stress with H2O2 (Figs. 2A and B). IP assay revealed
the presence of ELL-MR binding and that the amountof ELL bound to MR was increased in the cardiac fibroblasts incubated in the presence of H2O2 (Fig. 2C).
The mRNA and protein levels of MR were unchanged by H2O2 (Figs. 2A and B).

Systolic blood pressure was elevated in the HF
group than in the control group (224 ± 15 mmHg in the
HF group versus 128 ± 7 mmHg in the control group,P < 0.05). The increased ratio of lung weight to tibial
length indicated that the HF group developed overt
congestive HF (83.3 ± 15.3 mg/mm in the HF groupversus 36.8 ± 1.5 mg/mm in the control group, P < 0.05).
Significant interstitial fibrosis was observed in the HF
group (Fig. 3A) and the percent area of LV fibrosis wasincreased in the HF group compared with the control
group (4.9 ± 0.4% in the HF group versus 2.2 ± 0.4% in
the control group, P < 0.05). HNE staining revealed theincreased ROS generation in the LV of the HF group (Fig.
3B).
Both mRNA and the protein levels of ELL were increased in the LV of the HF group compared with con-

ELL expression and binding to MR are increased in
LV of HF rats with enhanced oxidative stressTo evaluate the ELL expression levels and the interaction between ELL and MR in in vivo heart, the LV of
the HF rats were compared with those of control rats.
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Fig. 4. [3H]proline incorporation into cardiac fibroblasts after knockdown of ELL under oxidative stress.
A: Cardiac fibroblasts were transfected with siELL (50 nmol/L, n = 3). Cardiac fibroblasts transfected with siNT (50 nmol/L, n = 3)
were served as control.
B: Cardiac fibroblasts were transfected with siNT (50 nmol/L) with Cor (300 nmol/L) and/or Epl (1 μmol/L) in the presence of H2O2
(1 μmol/L). Cardiac fibroblasts transfected with siNT in the presence of H2O2 were served as control. n = 8 for each group.
C: siELL transfected cardiac fibroblasts were treated with Cor (300 nmol/L) and/or Epl (1 μmol/L) in the presence of H2O2 (1 μmol/L).
siELL transfected cardiac fibroblasts with H2O2 alone were served as control. n = 8 for each group.
Control was arbitrarily set to 1. Data are expressed as mean values ± SD.
*P < 0.05 versus control.
†P < 0.05 versus Cor (+) Epl (–) H2O2 (+).
#P < 0.05 versus Cor (–) Epl (+) H2O2 (+).
Cor, corticosterone; ELL, elongation factor eleven-nineteen lysine-rich leukemia; Epl, eplerenone; siELL, ELL siRNA; siNT, non-targeting control siRNA.

trol (Figs. 3C and D). IP assays revealed that the amountof ELL bound to MR was increased in the LVs of the
HF group (Fig. 3E).

DISCUSSION
In this study, we showed that i) corticosterone promoted
collagen production via MR in the presence of oxidative stress in cardiac fibroblasts, ii) ELL expression
levels and MR-bound ELL were increased in cardiac
fibroblasts in oxidative stress, iii) ELL expression levels
and MR-bound ELL were increased in LV of HF rats byoxidative stress and iv) knockdown of ELL expression
blunted the corticosterone-induced collagen production
via MR in oxidative stress in cardiac fibroblasts.
Although it has been suggested that glucocorticoids
can function to work as an MR ligand in the heart, it isstill uncertain how glucocorticoids act via MR in the
diseased heart and contribute to the development of HF.
Glucocorticoids occupy cardiac MR without obvious
mineralocorticoid-like effects in normal conditions,8but may activate MR under particular condition such asoxidative stress.5, 12–14 Our previous study demonstrated
that blockade of MR attenuated cardiac fibrosis andprevented HF in the HF model rats with low cardiac aldosterone levels.6 In the present study, we expanded theprevious studies by demonstrating that corticosterone
can increase collagen production via MR in oxidative
stress. Therefore, blockade of MR may protect cardiac
MR from corticosterone, reduce cardiac fibrosis, andprevent the development of HF with enhanced oxidative

MR blockade did not inhibit corticosterone-induced
collagen production after knockdown of ELL in
cardiac fibroblasts[3H]proline incorporation into cardiac fibroblasts induced by corticosterone was evaluated after knockdownof ELL expression using siRNA for ELL, to investigate
the role of ELL in glucocorticoid-induced collagen production.
The ELL mRNA levels in cardiac fibroblasts weresignificantly decreased after the transfection of ELL
siRNA compared with non-targeting control siRNA (Fig.
4A). Corticosterone increased [3H]proline incorporation,and this increase was attenuated by eplerenone in thepresence of H2O2 with non-targeting control siRNA (Fig.
4B). However, the corticosterone-induced increase of[3H]proline incorporation was not attenuated by eplerenone in the presence of H2O2 after knockdown of ELL
by siRNA (Fig. 4C). These results suggest that ELL
enables corticosterone to promote collagen production
through MR under oxidative stress.

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Cardiac fibrosis through MR

stress. In the absence of H2O2, corticosterone induced
collagen production without the inhibition by eplerenon
in this in vitro study. Corticosterone can also bind to glucocorticoid receptor. Our previous study showed that theexpression of glucocorticoid receptor was upregulated
in the hypertrophied heart but the role of the glucocorticoid receptor on cardiac fibrosis was not clear.19 Further
studies are required to clarify the role of glucocorticoid
receptor and MR on in vivo cardiac fibrosis.
In non-epithelial tissues such as heart, the expression of 11betaHSD2 which inactivates glucocorticoid toinactive form is negligibly low.5, 6 In the present study,
11betaHSD2 protein levels were undetermined becauseof its very low expression level in cultured cardiac fibroblasts (data not shown). The MR expression levels werealso unchanged by oxidative stress in cultured cardiac
fibroblasts. Therefore, it suggests that corticosterone
can promote collagen synthesis via MR under oxidative
stress independently of 11betaHSD2 or MR expression
levels. At the post-receptor level several co-activators of
MR other than ELL have been reported;25–29 we havenot investigated the involvement of these factors andtheir interaction with ELL in the present study.
In cardiac myocytes, glucocorticoids have beenreported to increase beating frequency via MR in oxidative stress,30, 31 but has not been elucidated how oxidative stress modulates MR response to glucocorticoid. In
the present study, knockdown of ELL can at least partially decrease the MR response to corticosterone underoxidative stress. ELL, a co-activator of MR, enhances
MR transcriptional activity by both glucocorticoids andmineralocorticoids.16 In the present study, ELL expression levels and the amount of ELL bound to MR wereincreased in cultured cardiac fibroblasts in oxidative
stress; corticosterone did not promote collagen synthesis through MR after knockdown of ELL expression.
These results indicate that ELL may contribute to thedevelopment of cardiac fibrosis by co-activating MR
with corticosterone under oxidative stress. In this study,
we did not show how ELL expression levels and ELLMR binding were changed under oxidative stress andfurther investigation should clarify those mechanisms.
The ELL expression and the amount of ELL bound to
MR were increased in the LV of the HF model rats, andassociated with increased cardiac fibrosis and enhanced
oxidative stress. Given that glucocorticoid activity via
MR and ELL expression were increased together inoxidative stress, it suggests that ELL may contribute to
the MR activation in the development of cardiac fibrosisand HF in vivo. Although the mechanism of the regulation of ELL expression was unknown, it is possible thatsome therapeutic approaches reduce ELL expression andaffect the MR dependent cardiac fibrosis. Cardiac conditional KO of ELL gene might also elucidate the functionof ELL and coticosterone in cardiac fibrosis of in vivo
heart.
Serum cortisol has also been reported as a usefulpredictor of cardiac events in patients with HF, but there
is not enough evidence showing cardiac fibrosis in patients with high serum glucocorticoid such as Cushing
syndrome or connective tissue diseases with steroid
therapy. It is possible that high serum concentration of
glucocorticoid has a different effect on the heart from a
local increase of corticosterone in cardiac tissue whilea local increase of corticosterone in cardiac tissue has arole in cardiac fibrosis in the presence of oxidative stressin the in vivo heart.
In summary, our present study indicates that corticosterone promotes cardiac fibrosis via MR in oxidative
stress, and this corticosterone-induced cardiac fibrosis is
at least partially modulated by ELL. Preventing cardiac
fibrosis by modulating glucocorticoid-MR-ELL pathways may thus become a new therapeutic strategy for
HF.
Acknowledgments: The authors are grateful to Ms. Saori Nanbu
for the excellent technical assistance of the experiments.
This study was supported in part by grants from the JapaneseSociety for the Promotion of Science (No. 23591042 and No.
21590893).
The authors declare no conflict of interest.
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