# The Application of Dynamic Models to the Exploration ofβ1-AR Overactivation as a Cause of Heart Failure

Authors: Xiaoyun Wang; Min Zhao; Xiaoqiang Wang; Shuping Li; Ning Cao; Huirong Liu
Journal: Computational and Mathematical Methods in Medicine
 (2018)

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## Abstract

High titer ofβ1-adrenoreceptor autoantibodies (β1-AA) has been reported to appear in heart failure patients. It induces sustained β1-adrenergic receptor (β1-AR) activation which leads to heart failure (HF), but the mechanism is as yet unclear. In order to investigate the mechanisms causing β1-AR non-desensitization, we studied the beating frequency of the neonatal rat cardiomyocytes (NRCMs) under different conditions (an injection of isoprenaline (ISO) for one group and β1-AA for the other) and established three dynamic models in order to best describe the true relationships shown in medical experiments; one model used a control group of healthy rats; then in HF rats one focused on conformation changes in β1-AR; the other examined interaction between β1-AR and β2-adrenergic receptors (β2-AR). Comparing the experimental data and corresponding Akaike information criterion (AIC) values, we concluded that the interaction model was the most likely mechanism. We used mathematical methods to explore the mechanism for the development of heart failure and to find potential targets for prevention and treatment. The aim of the paper was to provide a strong theoretical basis for the clinical development of personalized treatment programs. We also carried out sensitivity analysis of the initial concentration β1-AA and found that they had a noticeable effect on the fitting results.


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## Body

## 1. Introduction

The incidence of heart failure (HF) is increasing year by year throughout the world, as is the cost of treating it [1]. Accurately recognising the cardiac signals associated with HF not only would prevent the progress of chronic HF, but also can guide individual treatment and positively influence the normal progression of the disease [2]. A variety of mechanisms are involved in HF progression, including nervous system inhibition. Heart failure itself causes cardiovascular irregularity due to material imbalance and cell damage [3]. Studies have shown that sustained activation of the sympathetic nervous system (SNS) is the core mechanism trigger of heart failure [4]. The main way in which the overactivation of the SNS occurs is the overactivation of the cardiomyocytes at the β1-adrenergic receptor (β1-AR) [5]. β1-adrenergic receptor autoantibodies (β1-AA) were found in the serum of patients with dilated cardiomyopathy in a study [6]. As β1-AA can bind with and activate β1-AR, it has a β1-AR agonist-like effect [7]. Excessive activation of β1-AR leads to impaired cardiac function [8]. A study found that, in addition to catecholamine β1-AR agonist ISO, β1-adrenoceptor (β1-AA) autoantibodies that could cause continuous activation of β1-AR [9] were detected in 40%–60% of HF patients [8]. β1-AR and β2-AR (β1-adrenergic receptors) link through the C-terminal, which are within cardiac cells, and belong to the G protein-coupled receptor family [10]. β1-AR and β2-AR can form heterodimers [11], where β2-AR downstream couples with stimulatory G protein (Gs) and inhibitory G protein (Gi) [12]. Another study [13] found that, in the early stages of heart failure, when β1-AR is activated, it can cause the β2-AR downstream signal to be converted from Gs to Gi, and Gi is activated by the activity of G protein-coupled receptor kinase 2 (GRK2), which then causes β1-AR phosphorylation, as well as β-arrestin binding to form endocytosis, after which β1-AR endocytosis [13] inhibits the overactivation of β1-AA. There are two main mechanisms involved in the continuous activation of β1-AR: β1-AR conformation changes and interaction between β1-AR and β2-AR. However, the mechanisms for how β1-AA induces continuous activation of β1-AR are not entirely clear.To identify the core molecular mechanism ofβ1-AR non-desensitization, we adopted a novel approach by establishing differential dynamic models. We used C++ to estimate the parameters, obtained modified 60-minute snapshots highlighting the experimental data, and made predictions on how the images would progress over the next 60 minutes. Then we took advantage of AIC to select the optimal model of β1-AR non-desensitization induced by β1-AA, and the corresponding mechanism. β2-AR plays an important role in the activation of β1-AR, which can be used to estimate cardiac function, prevent deterioration of cardiac function, and improve the quality of life of the patients with HF.This paper is organized as follows. In Section2, we established the models and listed the differential equations separately. Section 3 focused on the analysis of the models and determination of the parameters. We select the optimal model to identify the key molecular mechanism, by applying the Akaike information criterion (AIC). Results on the sensitivity analysis of parameters are given in Section 4. Section 5 is the conclusion.Figure1 shows the interrelationships between the various substances. It reflects the receptor desensitization when the β1-AR is combined with ISO and non-desensitization when the β1-AR is combined with β1-AA, causing conformational changes and interaction between the β1-AR and the β2-AR, eventually leading to HF.Figure 1
Relation diagram among the ISO,β1-AA, β1-AR, and β2-AR.


## 2. Methods

### 2.1. Extraction and Detection of Neonatal Rat Cardiomyocytes

Laboratory animal medicine of Capital Medical University provided 20 male newborn rats born 0–3 days as raw materials for extracting neonatal rat cardiomyocytes. According to previous method [14], the details of myocardial cell isolation and culture of neonatal rats are as follows: (1) open the sternum, expose the heart, clip it with tweezers, and wash in cold phosphate-buffered saline (PBS); (2) remove excess connective tissue from the washed heart and cut with ophthalmic scissors; (3) the heart fragments were aspirated into a centrifuge tube, and cold PBS was added and then centrifuged at 1000 rpm for 5 mins; (4) remove the centrifuge tube and vacuum suction PBS; (5) add 1 ml of 0.25 % trypsin and 1 ml of 0.25 % collagenase, blow vigorously, set in a 37°C water bath, and shake for 20 mins; (6) add 1 ml fetal bovine serum to stop digestion; (7) digestion was collected by adding 2 ml of DMEM containing 10% fetal bovine serum (FBS), 1000 rpm, and after centrifugation for 10 mins, the supernatant was discarded and fresh medium was added for differential adherence; (8) after adherence for 1 h, the culture medium was transferred to a new centrifuge tube and centrifuged at 1000 rpm for 5 mins. Cells were collected and the supernatant was discarded. Fresh medium was added and transferred to a 6-well plate for cell culture and 2 ml of DMEM low-glucose medium was added to each well. Detection of the beating frequency of NRCMs [15] was as follows: the culture medium was replaced on the day of the experiment and stably incubating in a 37°C cell culture incubator for 30 minutes, the 6-well plate was placed on a constant-temperature table of inverted microscopy, and a total of 10 fields of view of 3 six-well plates were randomly observed. Each field was measured for 30 seconds at a time, and the number of synchronized contractions of an isolated single cell or a group of cardiomyocytes in the untreated group was measured.Then, we used 0.1μM of ISO, β1-AA, and IgG (immunoglobulin G) (eliminating the effects of β1-AA itself) to stimulate, respectively. After that, the beating frequency of NRCMs was measured by Live Cell Imaging System offered by Medical Sciences Center Lab of Capital Medical University. Specifically, we measured the frequency in beat per minute of the cardiomyocytes after stimulation by live cell workstation and visualization at 63-fold magnification. Before being exposed to drugs, the cells had been stabilized for 10 mins in the system. The present study complies with the recommendations in the Guide for the Care and Use of Laboratory Animals protocol, NIH guidelines (Guide for the Care and Use of Laboratory Animals), and conformed to AVMA Guidelines on Euthanasia.Tables1 and 2 showed the measured data of beating frequency of NRCMs added to ISO and β1-AA. We used the beat frequency of NRCMs at time 0 as the base value, which was recorded as 0. When the standard deviation was greater than or equal to 4, the data was appropriately adjusted within the scope of standard deviation.Table 1
Data on frequency of beats of measured NRCMs added to ISO.
Time (min) Mean values (bmp) Standard Deviation (bmp) n=3 0.0 0 3.055 1.0 24.667 5.292 3.0 36.667 3.464 5.0 33.46 7.211 7.0 37.837 4.163 9.0 22.0 4.163 10.0 15.333 5.774 20.0 10.0 1.155 30.0 9.333 3.055 60.0 2.667 4.0Table 2
Data on frequency of beats of measured NRCMs added toβ1-AA.
Time (min) Mean values (bmp) Standard Deviation (bmp) n=3 0.0 0.0 2.0 1.0 22.0 2.0 3.0 26.0 2.0 5.0 30.0 3.464 7.0 31.5 7.024 9.0 32.2 5.774 10.0 32.33 4.619 20.0 32.5 7.211 30.0 33.0 5.292 60.0 33.0 6.0Figure2 reflects the positive correlation between concentration and beating frequency of NRCMs. Also, Martinsson et al. [16] studied the relationship between ISO and heart rate in their experiment results.Figure 2
Relationship between different reactant concentrations and beating frequency of NRCMs.(a) Control model in three minutes.(b) Experiment model in three minutes. Multiple sets of experiments were performed using the previously mentioned method for detecting NRCMs, and the beating frequency of NRCMs at a concentration of 0.1 nM to 1 μM was measured.
(a) (b)


### 2.2. The Models

There are many molecular mechanisms causingβ1-AR non-desensitization, among which conformation changes and interaction are the most likely ones. In order to clarify the most likely molecular mechanism, we established dynamical models including control model and experiment models to study the specific molecular mechanisms.


#### 2.2.1. Explanation of Interaction

Definition 1 (a protein-to-protein interaction (PPI) [17]).
Proteins rarely act alone as their functions tend to be regulated. Many molecular processes within a cell are carried out by molecular machines that are built from a large number of protein components organized by theirPPIs (protein-protein interactions). In the experimental groups, β1-AR and β2-AR belong to the G protein-coupled receptor family that are connected through the C-terminus [10] which belongs to PPI. Although β1-AA does not directly bind to β2-AR, β1-AA will indirectly affect the conformation of β2-AR by activating β1-AR based on the studies of laboratory animal medicine of Capital Medical University. Therefore, β1-AA can interfere with their dimerization which reflects the fact that β2-AR can affect the persistence of β1-AR activation.


#### 2.2.2. The Establishment of the Model Block Diagrams

The possible molecular mechanisms aboutβ1-AR overactivation are conformation changes and interaction. To determine a more specific molecular mechanism, we propose the dynamical models including control model and experiment models, where experiment models are composed of conformation changes model and interaction model. In order to facilitate the study and simplify the reaction diagram, we use corresponding letters instead of reactants and the definition of the corresponding parameters in dynamical models; see Table 3.Table 3
Nonstandard abbreviations.
L ISO P product B 1 β 1 - AR L B 1 intermediate complexes B 1 ′ β 1 - AR with structure changes B 1 ′ I intermediate complexes B 2 β 2 - AR B 1 B 2 conjugation of β 1 - AR and β 2 - AR B 2 ′ β 2 - AR with structure changes B 1 I ′ the product with structure change I β 1 - AA B 1 I B 2 intermediate complexes(  1) The Block Diagram of Control Model (See Figure3). In Figure 3, k1 represents the combined velocity of L and B1, k-1 represents the reverse reaction velocity, k2 represents the velocity of LB1 decomposition, k-2 is the reverse reaction velocity, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again.Figure 3
The block diagram of control model. ISO (L) activatesβ1-AR (B1) receptor generating intermediate complexes LB1 causing endocytosis of β1-AR, so that it can no longer come into contact with the protected ligand; then the complexes LB produce a new substance P and structurally changed receptor β1-AR (B1′) that returns to the cell surface to terminate the signal.(  2) The Block Diagram of Conformation Changes Model (See Figure4). In Figure 4, k1 represents the combined velocity of I and B1, k-1 represents the reverse reaction velocity, k2 represents the velocity of B1′I decomposition, k-2 is the reverse reaction velocity, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again.Figure 4
The block diagram of conformation changes model.β1-AA (I) activates β1-AR (B1) receptor generating intermediate complexes B1′I with conformation changes. The production of B1′I continues to activate the signal, and then it produces a new substance P and structurally changed receptor β1-AR (B1′).(  3) The Block Diagram of Interaction Model (See Figure5). In Figure 5, k1 represents the combined velocity of I and B1B2, k-1 represents the reverse reaction velocity, k2 represents the velocity of B1IB2 decomposition, k3 represents the velocity of B1I′ decomposition, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again. Also, β1-AR and β2-AR belong to the G protein-coupled receptor family [10], and thus we assume that they have the same degradation velocity u1.Figure 5
The block diagram of interaction model. We also takeβ2-AR (B2) into consideration in the reaction based on medical experiments. According to the studies of laboratory animal medicine of Capital Medical University, they found that β1-AA had a unique characteristic that can inhibit heterodimerization of β1/β2-AR and thus lead to decompose of β1-AR and β2-AR that are originally connected, resulting in endocytosis inhibition and sustained activation of the signal. Therefore, there is no conjugation of β1-AR and β2-AR (B1B2) in the products. Besides, β1-AA (I) cannot directly bind to β2-AR (B2), so there is no IB2 in the products. Thus, we consider that B1IB2 (I and B2 are combined to B1) are intermediate complexes and B1′I, B2′ are the products with structure change.Next, we established three mathematical models as shown in Figures3, 4, and 5 and established the corresponding ordinary differential equations based on the relevant theoretical knowledge of biochemical reaction models in cell and molecular biology [18, 19].


#### 2.2.3. Corresponding Differential Equations

(  1) The Control Model. we propose a control model for healthy rats based on Figure 3. The time evolution of control model is described by five coupled differential equations.(1)dLdt=-k1LB1+k-1LB1,dB1dt=-k1LB1+k-1LB1+u3B1′,dLB1dt=k1LB1-k-1LB1-k2LB1+k-2B1′P,dB1′dt=k2LB1-u1B1′-u3B1′-k-2B1′P,dPdt=k2LB1-k-2B1′P-u2P,where the initial conditions of the control model are [L](0)=[L0]=1×10-7mol/L, [B1](0)=[B10]=3×10-8mol/L, [LB1](0)=0, [B1′](0)=0, and [P](0)=0.(  2) The Conformation Changes Model. We have known that β1-AA and ISO compete for different binding sites of β1-AR, which belongs to the competitive inhibition in different positions of β1-AR [10]. Assuming that there is no reaction between β1-AA and β2-AR, the time evolution of conformation changes model based on Figure 4 is described by five coupled differential equations.(2)dIdt=-k1IB1+k-1B1′I,dB1dt=-k1IB1+k-1B1′I+u3B1′,dB1′Idt=k1IB1-k-1B1′I-k2B1′I+k-2B1′P,dB1′dt=k2B1′I-k-2B1′P-u1B1′-u3B1′,dPdt=k2B1′I-k-2B1′P-u2P,where the initial conditions of the conformation changes model are [I](0)=[I0]=1×10-7mol/L, [B1](0)=[B10]=2.3×10-9mol/L, [B1′I](0)=0, [B1′](0)=0, and [P](0)=0.(  3) The Interaction Model. In the preliminary study, β1-AR and β2-AR form heterodimer through the C-terminal [10], while β1-AA can be combined with β1-AR but not directly with β2-AR [15]. Thus, we consider the effect of β2-AR on the experimental group to establish interaction model, while the other conditions of the experiment group remain unchanged.(3)dIdt=-k1IB1B2+k-1B1IB2,dB1B2dt=-k1IB1B2+k-1B1IB2+u3B1′+u3B2′,dB1IB2dt=k1IB1B2-k-1B1IB2-k2B1IB2,dB1I′dt=k2B1IB2-k3B1I′,dB1′dt=k3B1I′-u1B2′-u3B1′,dB2′dt=k2B1IB2-u1B2′-u3B2′,dPdt=k3B1I′-u2P,where the initial conditions of the interaction model are [I](0)=[I0]=1×10-7mol/L, [B1B2](0)=1.8×10-9mol/L, [B1IB2](0)=0, [B1I′](0)=0, [B1′](0)=0, [B2′](0)=0, and [P](0)=0.Next, we will use second order Runge-Kutta method to estimate the parameters of systems (1), (2), and (3) and then select the optimal model of β1-AR non-desensitization.


## 2.1. Extraction and Detection of Neonatal Rat Cardiomyocytes

Laboratory animal medicine of Capital Medical University provided 20 male newborn rats born 0–3 days as raw materials for extracting neonatal rat cardiomyocytes. According to previous method [14], the details of myocardial cell isolation and culture of neonatal rats are as follows: (1) open the sternum, expose the heart, clip it with tweezers, and wash in cold phosphate-buffered saline (PBS); (2) remove excess connective tissue from the washed heart and cut with ophthalmic scissors; (3) the heart fragments were aspirated into a centrifuge tube, and cold PBS was added and then centrifuged at 1000 rpm for 5 mins; (4) remove the centrifuge tube and vacuum suction PBS; (5) add 1 ml of 0.25 % trypsin and 1 ml of 0.25 % collagenase, blow vigorously, set in a 37°C water bath, and shake for 20 mins; (6) add 1 ml fetal bovine serum to stop digestion; (7) digestion was collected by adding 2 ml of DMEM containing 10% fetal bovine serum (FBS), 1000 rpm, and after centrifugation for 10 mins, the supernatant was discarded and fresh medium was added for differential adherence; (8) after adherence for 1 h, the culture medium was transferred to a new centrifuge tube and centrifuged at 1000 rpm for 5 mins. Cells were collected and the supernatant was discarded. Fresh medium was added and transferred to a 6-well plate for cell culture and 2 ml of DMEM low-glucose medium was added to each well. Detection of the beating frequency of NRCMs [15] was as follows: the culture medium was replaced on the day of the experiment and stably incubating in a 37°C cell culture incubator for 30 minutes, the 6-well plate was placed on a constant-temperature table of inverted microscopy, and a total of 10 fields of view of 3 six-well plates were randomly observed. Each field was measured for 30 seconds at a time, and the number of synchronized contractions of an isolated single cell or a group of cardiomyocytes in the untreated group was measured.Then, we used 0.1μM of ISO, β1-AA, and IgG (immunoglobulin G) (eliminating the effects of β1-AA itself) to stimulate, respectively. After that, the beating frequency of NRCMs was measured by Live Cell Imaging System offered by Medical Sciences Center Lab of Capital Medical University. Specifically, we measured the frequency in beat per minute of the cardiomyocytes after stimulation by live cell workstation and visualization at 63-fold magnification. Before being exposed to drugs, the cells had been stabilized for 10 mins in the system. The present study complies with the recommendations in the Guide for the Care and Use of Laboratory Animals protocol, NIH guidelines (Guide for the Care and Use of Laboratory Animals), and conformed to AVMA Guidelines on Euthanasia.Tables1 and 2 showed the measured data of beating frequency of NRCMs added to ISO and β1-AA. We used the beat frequency of NRCMs at time 0 as the base value, which was recorded as 0. When the standard deviation was greater than or equal to 4, the data was appropriately adjusted within the scope of standard deviation.Table 1
Data on frequency of beats of measured NRCMs added to ISO.
Time (min) Mean values (bmp) Standard Deviation (bmp) n=3 0.0 0 3.055 1.0 24.667 5.292 3.0 36.667 3.464 5.0 33.46 7.211 7.0 37.837 4.163 9.0 22.0 4.163 10.0 15.333 5.774 20.0 10.0 1.155 30.0 9.333 3.055 60.0 2.667 4.0Table 2
Data on frequency of beats of measured NRCMs added toβ1-AA.
Time (min) Mean values (bmp) Standard Deviation (bmp) n=3 0.0 0.0 2.0 1.0 22.0 2.0 3.0 26.0 2.0 5.0 30.0 3.464 7.0 31.5 7.024 9.0 32.2 5.774 10.0 32.33 4.619 20.0 32.5 7.211 30.0 33.0 5.292 60.0 33.0 6.0Figure2 reflects the positive correlation between concentration and beating frequency of NRCMs. Also, Martinsson et al. [16] studied the relationship between ISO and heart rate in their experiment results.Figure 2
Relationship between different reactant concentrations and beating frequency of NRCMs.(a) Control model in three minutes.(b) Experiment model in three minutes. Multiple sets of experiments were performed using the previously mentioned method for detecting NRCMs, and the beating frequency of NRCMs at a concentration of 0.1 nM to 1 μM was measured.
(a) (b)


## 2.2. The Models

There are many molecular mechanisms causingβ1-AR non-desensitization, among which conformation changes and interaction are the most likely ones. In order to clarify the most likely molecular mechanism, we established dynamical models including control model and experiment models to study the specific molecular mechanisms.


### 2.2.1. Explanation of Interaction

Definition 1 (a protein-to-protein interaction (PPI) [17]).
Proteins rarely act alone as their functions tend to be regulated. Many molecular processes within a cell are carried out by molecular machines that are built from a large number of protein components organized by theirPPIs (protein-protein interactions). In the experimental groups, β1-AR and β2-AR belong to the G protein-coupled receptor family that are connected through the C-terminus [10] which belongs to PPI. Although β1-AA does not directly bind to β2-AR, β1-AA will indirectly affect the conformation of β2-AR by activating β1-AR based on the studies of laboratory animal medicine of Capital Medical University. Therefore, β1-AA can interfere with their dimerization which reflects the fact that β2-AR can affect the persistence of β1-AR activation.


### 2.2.2. The Establishment of the Model Block Diagrams

The possible molecular mechanisms aboutβ1-AR overactivation are conformation changes and interaction. To determine a more specific molecular mechanism, we propose the dynamical models including control model and experiment models, where experiment models are composed of conformation changes model and interaction model. In order to facilitate the study and simplify the reaction diagram, we use corresponding letters instead of reactants and the definition of the corresponding parameters in dynamical models; see Table 3.Table 3
Nonstandard abbreviations.
L ISO P product B 1 β 1 - AR L B 1 intermediate complexes B 1 ′ β 1 - AR with structure changes B 1 ′ I intermediate complexes B 2 β 2 - AR B 1 B 2 conjugation of β 1 - AR and β 2 - AR B 2 ′ β 2 - AR with structure changes B 1 I ′ the product with structure change I β 1 - AA B 1 I B 2 intermediate complexes(  1) The Block Diagram of Control Model (See Figure3). In Figure 3, k1 represents the combined velocity of L and B1, k-1 represents the reverse reaction velocity, k2 represents the velocity of LB1 decomposition, k-2 is the reverse reaction velocity, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again.Figure 3
The block diagram of control model. ISO (L) activatesβ1-AR (B1) receptor generating intermediate complexes LB1 causing endocytosis of β1-AR, so that it can no longer come into contact with the protected ligand; then the complexes LB produce a new substance P and structurally changed receptor β1-AR (B1′) that returns to the cell surface to terminate the signal.(  2) The Block Diagram of Conformation Changes Model (See Figure4). In Figure 4, k1 represents the combined velocity of I and B1, k-1 represents the reverse reaction velocity, k2 represents the velocity of B1′I decomposition, k-2 is the reverse reaction velocity, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again.Figure 4
The block diagram of conformation changes model.β1-AA (I) activates β1-AR (B1) receptor generating intermediate complexes B1′I with conformation changes. The production of B1′I continues to activate the signal, and then it produces a new substance P and structurally changed receptor β1-AR (B1′).(  3) The Block Diagram of Interaction Model (See Figure5). In Figure 5, k1 represents the combined velocity of I and B1B2, k-1 represents the reverse reaction velocity, k2 represents the velocity of B1IB2 decomposition, k3 represents the velocity of B1I′ decomposition, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again. Also, β1-AR and β2-AR belong to the G protein-coupled receptor family [10], and thus we assume that they have the same degradation velocity u1.Figure 5
The block diagram of interaction model. We also takeβ2-AR (B2) into consideration in the reaction based on medical experiments. According to the studies of laboratory animal medicine of Capital Medical University, they found that β1-AA had a unique characteristic that can inhibit heterodimerization of β1/β2-AR and thus lead to decompose of β1-AR and β2-AR that are originally connected, resulting in endocytosis inhibition and sustained activation of the signal. Therefore, there is no conjugation of β1-AR and β2-AR (B1B2) in the products. Besides, β1-AA (I) cannot directly bind to β2-AR (B2), so there is no IB2 in the products. Thus, we consider that B1IB2 (I and B2 are combined to B1) are intermediate complexes and B1′I, B2′ are the products with structure change.Next, we established three mathematical models as shown in Figures3, 4, and 5 and established the corresponding ordinary differential equations based on the relevant theoretical knowledge of biochemical reaction models in cell and molecular biology [18, 19].


### 2.2.3. Corresponding Differential Equations

(  1) The Control Model. we propose a control model for healthy rats based on Figure 3. The time evolution of control model is described by five coupled differential equations.(1)dLdt=-k1LB1+k-1LB1,dB1dt=-k1LB1+k-1LB1+u3B1′,dLB1dt=k1LB1-k-1LB1-k2LB1+k-2B1′P,dB1′dt=k2LB1-u1B1′-u3B1′-k-2B1′P,dPdt=k2LB1-k-2B1′P-u2P,where the initial conditions of the control model are [L](0)=[L0]=1×10-7mol/L, [B1](0)=[B10]=3×10-8mol/L, [LB1](0)=0, [B1′](0)=0, and [P](0)=0.(  2) The Conformation Changes Model. We have known that β1-AA and ISO compete for different binding sites of β1-AR, which belongs to the competitive inhibition in different positions of β1-AR [10]. Assuming that there is no reaction between β1-AA and β2-AR, the time evolution of conformation changes model based on Figure 4 is described by five coupled differential equations.(2)dIdt=-k1IB1+k-1B1′I,dB1dt=-k1IB1+k-1B1′I+u3B1′,dB1′Idt=k1IB1-k-1B1′I-k2B1′I+k-2B1′P,dB1′dt=k2B1′I-k-2B1′P-u1B1′-u3B1′,dPdt=k2B1′I-k-2B1′P-u2P,where the initial conditions of the conformation changes model are [I](0)=[I0]=1×10-7mol/L, [B1](0)=[B10]=2.3×10-9mol/L, [B1′I](0)=0, [B1′](0)=0, and [P](0)=0.(  3) The Interaction Model. In the preliminary study, β1-AR and β2-AR form heterodimer through the C-terminal [10], while β1-AA can be combined with β1-AR but not directly with β2-AR [15]. Thus, we consider the effect of β2-AR on the experimental group to establish interaction model, while the other conditions of the experiment group remain unchanged.(3)dIdt=-k1IB1B2+k-1B1IB2,dB1B2dt=-k1IB1B2+k-1B1IB2+u3B1′+u3B2′,dB1IB2dt=k1IB1B2-k-1B1IB2-k2B1IB2,dB1I′dt=k2B1IB2-k3B1I′,dB1′dt=k3B1I′-u1B2′-u3B1′,dB2′dt=k2B1IB2-u1B2′-u3B2′,dPdt=k3B1I′-u2P,where the initial conditions of the interaction model are [I](0)=[I0]=1×10-7mol/L, [B1B2](0)=1.8×10-9mol/L, [B1IB2](0)=0, [B1I′](0)=0, [B1′](0)=0, [B2′](0)=0, and [P](0)=0.Next, we will use second order Runge-Kutta method to estimate the parameters of systems (1), (2), and (3) and then select the optimal model of β1-AR non-desensitization.


## 2.2.1. Explanation of Interaction

Definition 1 (a protein-to-protein interaction (PPI) [17]).
Proteins rarely act alone as their functions tend to be regulated. Many molecular processes within a cell are carried out by molecular machines that are built from a large number of protein components organized by theirPPIs (protein-protein interactions). In the experimental groups, β1-AR and β2-AR belong to the G protein-coupled receptor family that are connected through the C-terminus [10] which belongs to PPI. Although β1-AA does not directly bind to β2-AR, β1-AA will indirectly affect the conformation of β2-AR by activating β1-AR based on the studies of laboratory animal medicine of Capital Medical University. Therefore, β1-AA can interfere with their dimerization which reflects the fact that β2-AR can affect the persistence of β1-AR activation.


## 2.2.2. The Establishment of the Model Block Diagrams

The possible molecular mechanisms aboutβ1-AR overactivation are conformation changes and interaction. To determine a more specific molecular mechanism, we propose the dynamical models including control model and experiment models, where experiment models are composed of conformation changes model and interaction model. In order to facilitate the study and simplify the reaction diagram, we use corresponding letters instead of reactants and the definition of the corresponding parameters in dynamical models; see Table 3.Table 3
Nonstandard abbreviations.
L ISO P product B 1 β 1 - AR L B 1 intermediate complexes B 1 ′ β 1 - AR with structure changes B 1 ′ I intermediate complexes B 2 β 2 - AR B 1 B 2 conjugation of β 1 - AR and β 2 - AR B 2 ′ β 2 - AR with structure changes B 1 I ′ the product with structure change I β 1 - AA B 1 I B 2 intermediate complexes(  1) The Block Diagram of Control Model (See Figure3). In Figure 3, k1 represents the combined velocity of L and B1, k-1 represents the reverse reaction velocity, k2 represents the velocity of LB1 decomposition, k-2 is the reverse reaction velocity, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again.Figure 3
The block diagram of control model. ISO (L) activatesβ1-AR (B1) receptor generating intermediate complexes LB1 causing endocytosis of β1-AR, so that it can no longer come into contact with the protected ligand; then the complexes LB produce a new substance P and structurally changed receptor β1-AR (B1′) that returns to the cell surface to terminate the signal.(  2) The Block Diagram of Conformation Changes Model (See Figure4). In Figure 4, k1 represents the combined velocity of I and B1, k-1 represents the reverse reaction velocity, k2 represents the velocity of B1′I decomposition, k-2 is the reverse reaction velocity, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again.Figure 4
The block diagram of conformation changes model.β1-AA (I) activates β1-AR (B1) receptor generating intermediate complexes B1′I with conformation changes. The production of B1′I continues to activate the signal, and then it produces a new substance P and structurally changed receptor β1-AR (B1′).(  3) The Block Diagram of Interaction Model (See Figure5). In Figure 5, k1 represents the combined velocity of I and B1B2, k-1 represents the reverse reaction velocity, k2 represents the velocity of B1IB2 decomposition, k3 represents the velocity of B1I′ decomposition, and u1 and u2 represent the degradation velocity of B1′ and P, respectively. u3 represents the velocity at which undegraded B1′ returns to the cell surface and participates in the reaction again. Also, β1-AR and β2-AR belong to the G protein-coupled receptor family [10], and thus we assume that they have the same degradation velocity u1.Figure 5
The block diagram of interaction model. We also takeβ2-AR (B2) into consideration in the reaction based on medical experiments. According to the studies of laboratory animal medicine of Capital Medical University, they found that β1-AA had a unique characteristic that can inhibit heterodimerization of β1/β2-AR and thus lead to decompose of β1-AR and β2-AR that are originally connected, resulting in endocytosis inhibition and sustained activation of the signal. Therefore, there is no conjugation of β1-AR and β2-AR (B1B2) in the products. Besides, β1-AA (I) cannot directly bind to β2-AR (B2), so there is no IB2 in the products. Thus, we consider that B1IB2 (I and B2 are combined to B1) are intermediate complexes and B1′I, B2′ are the products with structure change.Next, we established three mathematical models as shown in Figures3, 4, and 5 and established the corresponding ordinary differential equations based on the relevant theoretical knowledge of biochemical reaction models in cell and molecular biology [18, 19].


## 2.2.3. Corresponding Differential Equations

(  1) The Control Model. we propose a control model for healthy rats based on Figure 3. The time evolution of control model is described by five coupled differential equations.(1)dLdt=-k1LB1+k-1LB1,dB1dt=-k1LB1+k-1LB1+u3B1′,dLB1dt=k1LB1-k-1LB1-k2LB1+k-2B1′P,dB1′dt=k2LB1-u1B1′-u3B1′-k-2B1′P,dPdt=k2LB1-k-2B1′P-u2P,where the initial conditions of the control model are [L](0)=[L0]=1×10-7mol/L, [B1](0)=[B10]=3×10-8mol/L, [LB1](0)=0, [B1′](0)=0, and [P](0)=0.(  2) The Conformation Changes Model. We have known that β1-AA and ISO compete for different binding sites of β1-AR, which belongs to the competitive inhibition in different positions of β1-AR [10]. Assuming that there is no reaction between β1-AA and β2-AR, the time evolution of conformation changes model based on Figure 4 is described by five coupled differential equations.(2)dIdt=-k1IB1+k-1B1′I,dB1dt=-k1IB1+k-1B1′I+u3B1′,dB1′Idt=k1IB1-k-1B1′I-k2B1′I+k-2B1′P,dB1′dt=k2B1′I-k-2B1′P-u1B1′-u3B1′,dPdt=k2B1′I-k-2B1′P-u2P,where the initial conditions of the conformation changes model are [I](0)=[I0]=1×10-7mol/L, [B1](0)=[B10]=2.3×10-9mol/L, [B1′I](0)=0, [B1′](0)=0, and [P](0)=0.(  3) The Interaction Model. In the preliminary study, β1-AR and β2-AR form heterodimer through the C-terminal [10], while β1-AA can be combined with β1-AR but not directly with β2-AR [15]. Thus, we consider the effect of β2-AR on the experimental group to establish interaction model, while the other conditions of the experiment group remain unchanged.(3)dIdt=-k1IB1B2+k-1B1IB2,dB1B2dt=-k1IB1B2+k-1B1IB2+u3B1′+u3B2′,dB1IB2dt=k1IB1B2-k-1B1IB2-k2B1IB2,dB1I′dt=k2B1IB2-k3B1I′,dB1′dt=k3B1I′-u1B2′-u3B1′,dB2′dt=k2B1IB2-u1B2′-u3B2′,dPdt=k3B1I′-u2P,where the initial conditions of the interaction model are [I](0)=[I0]=1×10-7mol/L, [B1B2](0)=1.8×10-9mol/L, [B1IB2](0)=0, [B1I′](0)=0, [B1′](0)=0, [B2′](0)=0, and [P](0)=0.Next, we will use second order Runge-Kutta method to estimate the parameters of systems (1), (2), and (3) and then select the optimal model of β1-AR non-desensitization.


## 3. Model Analysis and Results

### 3.1. Parameter Fitting and Graphs Analysis

Second order Runge-Kutta method is used to solve the ODE systems obtained in our models. Our parameter fitting is an optimization process, which minimizes the squared summation of[AB]pred-[AB]data at all time [AB]data got measured, where for simplicity we use [AB] to denote the concentrations of the intermediate products LB1, B1′I, and B1IB2 in the three models, respectively (i.e., [LB1], [B1′I], and [B1IB2]). We also denote the total squared summation by S. Obviously S is a function of all the parameters that require fitting. Given a set of parameters, second order Runge-Kutta method gives the value of [AB]pred and thus S. We use steepest descent method to find the minimum of S. In this process, the gradient of S over all parameters is calculated numerically. For example, for positive parameter ki, (4)∂S∂ki=Ski1+Δ-SkikiΔ.In our program Δ=1.0e-6, and the time step in the Runge-Kutta method is chosen to be 0.01 min.We use the measured values in Table1 to do the parameter fitting for the control model and the values in Table 2 for the experiment models. Note that the measured data in the tables is not the exact concentration of [AB]. Instead, we assumed that the measured data is proportional to the concentration of [AB]. In other words, we introduce an extra parameter λ, and [AB]data=λTdata, where Tdata is the measured data in the tables. In the optimization process, we trait λ in the same way we trait other parameters. And λ is also get fitted. Combining Figure 2 and parameter fitting method, we determined that the concentration is directly proportional to the heart rate of NRCMs and the proportionality factor is 0.0025.Next, we analyze the fitting of the graphs and the prediction of the different time points, as shown in Figures6–8.Figure 6
The fitting and prediction graphs of control model.(a) Fitting graph.(b) Prediction graph at 120 mins.
(a) (b)Figure 7
The fitting and prediction graphs of conformation changes model.(a) Fitting graph.(b) Prediction graph at 120 mins.
(a) (b)Figure 8
The fitting and prediction graphs of interaction model.(a) Fitting graph.(b) Prediction graph at 120 mins.
(a) (b)Figure6(a) shows the fitting results of control group model from 0 min to 60 mins, in which the points are experimentally measured and the curve is the solution of dynamical control group model of [LB1]. And the fitting curve finally declined which reflects the fact that β1-AR desensitizes when reacting with ISO in healthy rats. However, the situation was quite different with HF rats.Figure6(b) displays the prediction result from 60 mins to 120 mins. It predicts that [LB1] continues to decrease, eventually tends to zero, and becomes stable, which clearly showed the mechanism of β1-AR desensitization.Figure7(a) presents the fitting results of the conformation changes model from 0 min to 60 mins, in which the points are experimentally measured and the curve is the solution of dynamical conformation changes model of [B1′I].Figure7(b) is the prediction results from 60 mins to 120 mins. The [B1′I] curve eventually stabilized in (b), which clearly showed the mechanism of β1-AR non-desensitization.Figure8(a) presents the fitting results of the interaction model from 0 min to 60 mins, in which the points are experimentally measured, the curve is the solution of dynamical interaction model of [B1IB2], and the fitting curve finally stabilized.Figure8(b) is the prediction results from 60 mins to 120 mins. The upward trend of the [B1IB2] curve reflects the effects of β1-AA and β2-AR on the non-desensitization of the β1-AR.Then, we analyze the reaction speeds and Table4 lists the reaction velocities of three models. Since the units of positive reaction velocities and reverse reaction velocities are different, they cannot be directly compared. Therefore, we simulated the reaction speeds figures of the control group and the experimental groups, and the reaction speed is the product of the reaction velocity and concentration. See Figure 9.Table 4
Velocities in three models.
models k 1 k - 1 k 2 k - 2 k 3 u 1 u 2 u 3 M - 1 m i n - 1 m i n - 1 m i n - 1 M - 1 m i n - 1 m i n - 1 m i n - 1 m i n - 1 m i n - 1 control model 0.279 0.107 0.273 1∗10-6 – 0.039 0.011 0.028 conformation changes model 0.275 0.474 0.018 0.021 – 1∗10−6 0.100 0.271 interaction model 0.361 0.422 0.014 – 0.153 0.122 0.100 0.191Figure 9
Comparison of speeds of positive and negative reactions between experimental models and control model.(a) Control model.(b) Conformation changes model.(c) Interaction model.
(a) (b) (c)As can be seen from Figure9, the positive and negative reaction speeds of the control model and experimental models are greater than those of the reverse reaction, and the positive reaction speeds decrease rapidly. In the course of the decrease of the positive reaction speeds, the speed of reversed reaction continues to rise. Finally, their tendency gradually slows down.


### 3.2. Model Selection

Akaike’s information criterion [20–22] (AIC) is a measure of the goodness of fit of an estimated statistical model and a tool for model selection. Given a data set, several competing models can be ranked according to their AIC, with the one with the lowest AIC being the best. The AIC is defined as follows: (5)AIC=nInRe+2k,Re=RSSn,where RSS is the residual sum of squares, n is the amount of the real data, and k is the total amount of estimated parameters in the model. AICc is AIC with a second order correction for small sample sizes (n/k<40), to start with(6)AICc=AIC+2kk+1n-k-1.Moreover, AIC difference is defined asΔi=AICi-AICmin, where AICi is the AIC or AICc of the ith model, and AICmin is the AIC or AICc of the model with minimal AIC. If 0≤Δi≤2, the ith model has substantial data support. If 4≤Δi≤7, the ith model has considerable less data support. If Δi≥10, the ith model has essentially no data support.Since then/k=10/4<40, we use AICc to select the model, which determines the mechanism of the β1-AR non-desensitization. In order to verify the validity of the models, we apply AIC to view the residuals between theoretic and real data under three models. We calculated the AICc values of the conformation model and interaction model which are, respectively, AICc1≈-7.287, AICc2≈-8.494. By comparing the AICc values calculated in the two models above, we conclude easily that AICc1>AICc2, AICcmin≈-8.494. It is obvious that the possibility of interaction is the largest, which conforms to the analysis of graphs and parameter.


## 3.1. Parameter Fitting and Graphs Analysis

Second order Runge-Kutta method is used to solve the ODE systems obtained in our models. Our parameter fitting is an optimization process, which minimizes the squared summation of[AB]pred-[AB]data at all time [AB]data got measured, where for simplicity we use [AB] to denote the concentrations of the intermediate products LB1, B1′I, and B1IB2 in the three models, respectively (i.e., [LB1], [B1′I], and [B1IB2]). We also denote the total squared summation by S. Obviously S is a function of all the parameters that require fitting. Given a set of parameters, second order Runge-Kutta method gives the value of [AB]pred and thus S. We use steepest descent method to find the minimum of S. In this process, the gradient of S over all parameters is calculated numerically. For example, for positive parameter ki, (4)∂S∂ki=Ski1+Δ-SkikiΔ.In our program Δ=1.0e-6, and the time step in the Runge-Kutta method is chosen to be 0.01 min.We use the measured values in Table1 to do the parameter fitting for the control model and the values in Table 2 for the experiment models. Note that the measured data in the tables is not the exact concentration of [AB]. Instead, we assumed that the measured data is proportional to the concentration of [AB]. In other words, we introduce an extra parameter λ, and [AB]data=λTdata, where Tdata is the measured data in the tables. In the optimization process, we trait λ in the same way we trait other parameters. And λ is also get fitted. Combining Figure 2 and parameter fitting method, we determined that the concentration is directly proportional to the heart rate of NRCMs and the proportionality factor is 0.0025.Next, we analyze the fitting of the graphs and the prediction of the different time points, as shown in Figures6–8.Figure 6
The fitting and prediction graphs of control model.(a) Fitting graph.(b) Prediction graph at 120 mins.
(a) (b)Figure 7
The fitting and prediction graphs of conformation changes model.(a) Fitting graph.(b) Prediction graph at 120 mins.
(a) (b)Figure 8
The fitting and prediction graphs of interaction model.(a) Fitting graph.(b) Prediction graph at 120 mins.
(a) (b)Figure6(a) shows the fitting results of control group model from 0 min to 60 mins, in which the points are experimentally measured and the curve is the solution of dynamical control group model of [LB1]. And the fitting curve finally declined which reflects the fact that β1-AR desensitizes when reacting with ISO in healthy rats. However, the situation was quite different with HF rats.Figure6(b) displays the prediction result from 60 mins to 120 mins. It predicts that [LB1] continues to decrease, eventually tends to zero, and becomes stable, which clearly showed the mechanism of β1-AR desensitization.Figure7(a) presents the fitting results of the conformation changes model from 0 min to 60 mins, in which the points are experimentally measured and the curve is the solution of dynamical conformation changes model of [B1′I].Figure7(b) is the prediction results from 60 mins to 120 mins. The [B1′I] curve eventually stabilized in (b), which clearly showed the mechanism of β1-AR non-desensitization.Figure8(a) presents the fitting results of the interaction model from 0 min to 60 mins, in which the points are experimentally measured, the curve is the solution of dynamical interaction model of [B1IB2], and the fitting curve finally stabilized.Figure8(b) is the prediction results from 60 mins to 120 mins. The upward trend of the [B1IB2] curve reflects the effects of β1-AA and β2-AR on the non-desensitization of the β1-AR.Then, we analyze the reaction speeds and Table4 lists the reaction velocities of three models. Since the units of positive reaction velocities and reverse reaction velocities are different, they cannot be directly compared. Therefore, we simulated the reaction speeds figures of the control group and the experimental groups, and the reaction speed is the product of the reaction velocity and concentration. See Figure 9.Table 4
Velocities in three models.
models k 1 k - 1 k 2 k - 2 k 3 u 1 u 2 u 3 M - 1 m i n - 1 m i n - 1 m i n - 1 M - 1 m i n - 1 m i n - 1 m i n - 1 m i n - 1 m i n - 1 control model 0.279 0.107 0.273 1∗10-6 – 0.039 0.011 0.028 conformation changes model 0.275 0.474 0.018 0.021 – 1∗10−6 0.100 0.271 interaction model 0.361 0.422 0.014 – 0.153 0.122 0.100 0.191Figure 9
Comparison of speeds of positive and negative reactions between experimental models and control model.(a) Control model.(b) Conformation changes model.(c) Interaction model.
(a) (b) (c)As can be seen from Figure9, the positive and negative reaction speeds of the control model and experimental models are greater than those of the reverse reaction, and the positive reaction speeds decrease rapidly. In the course of the decrease of the positive reaction speeds, the speed of reversed reaction continues to rise. Finally, their tendency gradually slows down.


## 3.2. Model Selection

Akaike’s information criterion [20–22] (AIC) is a measure of the goodness of fit of an estimated statistical model and a tool for model selection. Given a data set, several competing models can be ranked according to their AIC, with the one with the lowest AIC being the best. The AIC is defined as follows: (5)AIC=nInRe+2k,Re=RSSn,where RSS is the residual sum of squares, n is the amount of the real data, and k is the total amount of estimated parameters in the model. AICc is AIC with a second order correction for small sample sizes (n/k<40), to start with(6)AICc=AIC+2kk+1n-k-1.Moreover, AIC difference is defined asΔi=AICi-AICmin, where AICi is the AIC or AICc of the ith model, and AICmin is the AIC or AICc of the model with minimal AIC. If 0≤Δi≤2, the ith model has substantial data support. If 4≤Δi≤7, the ith model has considerable less data support. If Δi≥10, the ith model has essentially no data support.Since then/k=10/4<40, we use AICc to select the model, which determines the mechanism of the β1-AR non-desensitization. In order to verify the validity of the models, we apply AIC to view the residuals between theoretic and real data under three models. We calculated the AICc values of the conformation model and interaction model which are, respectively, AICc1≈-7.287, AICc2≈-8.494. By comparing the AICc values calculated in the two models above, we conclude easily that AICc1>AICc2, AICcmin≈-8.494. It is obvious that the possibility of interaction is the largest, which conforms to the analysis of graphs and parameter.


## 4. Sensitivity Analysis

We determined that the interaction model betweenβ1-AR and β2-AR is the optimal model for heart failure through the AIC criterion. Next, when the initial concentration of β1-AA is different, we analyzed the figures and data (measured by Capital Medical University) fitting of the interaction model between β1-AR and β2-AR. From Figure 10, we can see that the initial concentration of β1-AA has a certain effect on the fitting result. Table 5 shows the reaction velocity for the interaction model at different concentrations.Table 5
Velocity values in interaction model.
Concentration ofβ1-AA k 1 k - 1 k 2 k 3 (mol/L) ( M - 1 m i n - 1 ) ( m i n - 1 ) ( m i n - 1 ) ( m i n - 1 ) 1×10-9 11.173 0.000001 0.067 0.000001 1×10-8 3.201 0.753 0.059 0.408 1×10-6 0.035 0.362 0.343 0.238Figure 10
The fitting graphs of[B1IB2] with the change of initial concentrations of β1-AA (I) in interaction model.(a)1×10-9mol/L.(b)1×10-8mol/L.(c)1×10-6mol/L.
(a) (b) (c)Figure10, respectively, showed the graphs of [B1IB2] when the initial concentrations of β1-AA are 1×10-9mol/L, 1×10-8mol/L, and 1×10-6mol/L in 10 minutes, while the concentration of B1B2 remains unchanged at 1.8×10-9mol/L. And we can see that when the concentration of β1-AA is 1×10-9mol/L, the fitting result is the worst, followed by 1×10-6mol/L and 1×10-8mol/L. As can be seen from Figure 8, when concentration of β1-AA is 1×10-7mol/L, the fitting result is the best. Therefore, the optimum concentration of mice monoclonal β1-AA leading to the NRCMs beating frequency was 0.1 μM (detected from 1 nM to 1 μM).


## 5. Conclusion

We analyzed the two types of mechanisms that cause HF; it can be concluded that conformation changes and interactions betweenβ1-AR and β2-AR both contribute to the HF progression in rats and the interaction has the greater impact on it. In our study, for the first time, the model block diagrams described the causation of HF. By comparing the experimental group models with the control group model and then calculating the AICc, we concluded that the interaction model between β1-AR and β2-AR was the optimal model, which leads to the important role of β2-AR in the progression of HF. β2-AR and β1-AR connect together and participate in a reaction, which then causes conformation changes in receptor β1-AR. This results in endocytosis inhibition, which ultimately leads to β1-AR non-desensitization and HF. Thus, β2-AR is an important consideration in guiding the treatment of HF.Previous studies have found thatβ1-AR and β2-AR could form heterodimers, although they also found that the autoantibody β1-AA did not bind to β2-AR [15]. We found that β1-AA could inhibit heterodimerization of β1/β2-AR, observing laboratory experiments on animals at Capital Medical University. Therefore, we speculated that β1-AA might indirectly affect the β2-AR- C-terminal conformation and interfere with heterodimerization of β1/β2-AR. This would lead to β1-AR endocytosis inhibition, to continuous signal activation, and ultimately to heart failure.Because the interaction betweenβ1-AR and β2-AR was found to be the trigger mechanism of heart failure progression, receptor β2-AR should be further studied to determine if it could play a role in heart failure treatment. In the presence of β1-AA-positive heart failure, β2-AR can be used as a drug and therapeutic target to improve the interaction between β1-AR and β2-AR, thereby decreasing the risk of further heart failure.



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*Source: 1613290-2018-07-30.xml*