赛妥珠单抗减弱Loxl2介导的细胞外基质重塑并保护LMNA突变诱导的扩张型心肌病中的心脏功能

Background: Dilated cardiomyopathy caused by LMNA mutations is a severe cardiac condition marked by arrhythmias, contractile dysfunction, and excessive myocardial fibrosis, which collectively impair left ventricular function and increase the risk of heart failure. Although the disease has been well characterized, a lack of insight into the pathogenesis has impeded the development of therapies. Methods: Here, we employed human induced pluripotent stem cells (hiPSCs) derived from a patient carrying a LMNA point mutation (c.665A>C, p.His222Pro), alongside a murine model carrying the same mutation, to investigate the functional and molecular abnormalities driving dilated cardiomyopathy. Results: We demonstrated that LMNA patient-derived cardiomyocytes and engineered heart tissues exhibited elevated diastolic calcium levels and reduced sensitivity to external calcium, respectively, as well as hypocontractility. These cells also displayed nuclear shape abnormalities in 2-dimensional and 3-dimensional, a hallmark of LMNA-associated dilated cardiomyopathy, associated with disrupted chromosome spatial organization and altered gene expression profiles. Transcriptomic analysis revealed dysregulation of extracellular matrix remodeling and significant upregulation of Loxl2 in mutated hiPSC-cardiomyocytes, hiPSC-engineered heart tissues, and mice. Treatment with Simtuzumab, a Loxl2 inhibitor, effectively prevented cardiac dysfunction and fibrosis in vivo. Conclusions: Taken together, our findings underscore the crucial role of Loxl2 as a therapeutic target and suggest that its inhibition could be a promising strategy to preserve cardiac function in LMNA-associated dilated cardiomyopathy.