Po-02-246 pparγ activation mediates cardiac pathologies in two mouse models of arrhythmogenic cardiomyopathy (acm) and its therapeutic implications

Using ACM patient-specific induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs), we showed that abnormal peroxisome proliferator-activated receptor-gamma (PPARγ) activation on normal adult PPARα-mediated metabolic backgrounds in CMs resulted in pathological hallmarks of ACM. PPARγ inhibitors rescue all ACM pathologies effects (Nature 2013) but may carry systemic side effects. Here, we study the pathogenic role of PPARγ activation in 2 ACM mouse models and test therapeutic potentials of 2 angiotensin II-receptor blockers (ARBs) commonly used to treat cardiomyopathies: Valsartan and Losartan. Valsartan has minimal activity yet Losartan has strong activity for PPARγ gene activation, respectively. We used 2 established ACM mouse models in this study: 1) mice with tamoxifen (TAM)-inducible and CM-specific (by αγMHC-Cre) double knockout (DKO) of plakoglobin (JUP) and βcatenin (MCB 2012) that developed ACM pathologies at 2-3 months only after TAM injection; and 2) mice with CM-specific and homozygous knockout of JUP (JUP KO, Hum Mol Genet 2011) that develop ACM pathologies rapidly in 1-2 months after birth. Feeding DKO mice with 0.1 mg/ml rosiglitazone (Rosi, a PPARγ activator) for 2 weeks (wks) after TAM injection accelerated the decrease in left ventricular ejection fraction (LV EF) (from 67.4% to 27.1%) within 2-3 weeks after feeding Rosi. For JUP KO mice at 8-9 wks after birth, the pathological hearts showed hyperactivated PPARγ (at both mRNA and protein levels) and elevated apoptotic gene expressions (3-fold increases in caspase 3 and BAX/BCL2 ratios). Feeding both ACM mouse models with 0.2 mg/ml Valsartan for 6 wks reduced PPARγ proteins and apoptotic genes (BAX/BCL2 ratios) by 2-3 folds. In JUP KO mice, Valsartan prevented LV EF deterioration yet losartan at equivalent doses led to early death and reduced LV EF. Our study results support strongly that abnormal PPARγ activation in ACM CMs plays a key pathogenic role in both human iPSC-CM-based and 2 mouse models of ACM. An ARB with PPARγ agnostic activities can worsen ACM pathologies and only ARB with minimal PPARγ agonistic activity can prevent ACM disease progression. These results have significant implications in avoiding using any drug with PPARγ agnostic activities to treat human ACM.