H eart failure can often result from chronic neurohormonal and mechanical stress and remains a leading cause of death worldwide. The mineralocorticoid receptor (MR), a steroid receptor for corticosteroids, plays a pathophysiological role in the development of heart failure. High circulating levels of MR ligands were reportedly associated with poor prognosis in patients with heart failure, 1 whereas recent clinical trials of cardiac dysfunction showed beneficial effects of MR blockade on morbidity and mortality. [2][3][4] Although the aldosterone-MR system was conventionally associated with renal sodium absorption in the distal tubules, experimental studies have revealed a direct effect of aldosterone on the heart and a pathological role of MR in the myocardium. Aldosterone excess or MR activation in the myocardium leads to unfavorable responses, including hypertrophy, 5 fibrogenic signaling, 6 and arrhythmogenic changes.
7,8Furthermore, MR ablation in cardiomyocytes was shown to attenuate cardiac dysfunction in a mouse model of myocardial infarction 9 and chronic pressure overload.
10The mechanism for MR activation in cardiac injury remains unclear. Although ligand excess is an important stimulus, aberrant MR activation can occur with a normal or even low aldosterone status in some pathological conditions, leading to end-organ damage. Indeed, Dahl salt-sensitive rats fed a high-salt diet develop cardiac injury with enhanced MR signaling, despite low levels of circulating aldosterone, whereas eplerenone dramatically retards progression of cardiac remodeling.11 Recently, several studies have suggested that MR activity is also affected by factors other than its ligands.
12-14We previously identified Rac1, a Rho family small GTPase, as a novel modulator of MR activity and demonstrated the pathological role of Rac1-mediated MR activation in the kidney of proteinuric disease 15 and salt-sensitive hypertension.
16,17Further, overexpression of constitutively active mutant Rac1 in rat cardiomyocytes promoted nuclear accumulation of MR and increased MR-dependent transcriptional activity, regardless of the ligand, 18 implicating a potential contribution of Rac1-MR signaling in cardiac diseases.Abstract-There is increasing evidence for a crucial role of aberrant mineralocorticoid receptor (MR) activation in heart failure, with clinical studies showing beneficial effects of MR blockade. However, the mechanisms of MR activation in heart failure remain unclear. In this study, we observed that the small GTPase Rac1 contributes to myocardial MR activation, whereas Rac1-MR pathway activation leads to cardiac dysfunction. Mouse hearts subjected to chronic pressure overload induced by transverse aortic constriction showed Rac1 activation and increased nuclear accumulation of MR and expression of MR target genes, suggesting MR activation. Pharmacological inhibition of Rac1 and heterozygous deletion of Rac1 in cardiomyocytes suppressed Rac1-induced MR signaling and reduced NADPH oxidase 4 gene induction and reactive oxygen species ov...