Association of cardiotrophin-1 with myocardial fibrosis in hypertensive patients with heart failure

Hypertension. 2014 Mar;63(3):483-9. doi: 10.1161/HYPERTENSIONAHA.113.02654. Epub 2013 Dec 23.


Cardiotrophin-1 has been shown to be profibrogenic in experimental models. The aim of this study was to analyze whether cardiotrophin-1 is associated with left ventricular end-diastolic stress and myocardial fibrosis in hypertensive patients with heart failure. Endomyocardial biopsies from patients (n=31) and necropsies from 7 control subjects were studied. Myocardial cardiotrophin-1 protein and mRNA and the fraction of myocardial volume occupied by collagen were increased in patients compared with controls (P<0.001). Cardiotrophin-1 overexpression in patients was localized in cardiomyocytes. Cardiotrophin-1 protein was correlated with collagen type I and III mRNAs (r=0.653, P<0.001; r=0.541, P<0.01) and proteins (r=0.588, P<0.001; r=0.556, P<0.005) in all subjects and with left ventricular end-diastolic wall stress (r=0.450; P<0.05) in patients. Plasma cardiotrophin-1 and N-terminal pro-brain natriuretic peptide and serum biomarkers of myocardial fibrosis (carboxy-terminal propeptide of procollagen type I and amino-terminal propeptide of procollagen type III) were increased (P<0.001) in patients compared with controls. Plasma cardiotrophin-1 was correlated with N-terminal pro-brain natriuretic peptide (r=0.386; P<0.005), carboxy-terminal propeptide of procollagen type I (r=0.550; P<0.001), and amino-terminal propeptide of procollagen type III (r=0.267; P<0.05) in all subjects. In vitro, cardiotrophin-1 stimulated the differentiation of human cardiac fibroblast to myofibroblasts (P<0.05) and the expression of procollagen type I (P<0.05) and III (P<0.01) mRNAs. These findings show that an excess of cardiotrophin-1 is associated with increased collagen in the myocardium of hypertensive patients with heart failure. It is proposed that exaggerated cardiomyocyte production of cardiotrophin-1 in response to increased left ventricular end-diastolic stress may contribute to fibrosis through stimulation of fibroblasts in heart failure of hypertensive origin.

Keywords: cardiotrophin 1; collagen; fibrosis; heart failure.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiomyopathies / etiology
  • Cardiomyopathies / genetics
  • Cardiomyopathies / metabolism*
  • Cytokines / biosynthesis
  • Cytokines / genetics*
  • Disease Progression
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Fibroblasts / metabolism
  • Fibroblasts / pathology
  • Fibrosis / etiology
  • Fibrosis / metabolism
  • Fibrosis / pathology
  • Gene Expression Regulation*
  • Heart Failure / complications
  • Heart Failure / genetics
  • Heart Failure / metabolism*
  • Humans
  • Hypertension / complications
  • Hypertension / genetics
  • Hypertension / metabolism*
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Myocardium / metabolism*
  • Myocardium / pathology
  • Myocytes, Cardiac / metabolism
  • Myocytes, Cardiac / pathology
  • RNA, Messenger / genetics*
  • Real-Time Polymerase Chain Reaction


  • Cytokines
  • RNA, Messenger
  • cardiotrophin 1