Article(id=1211269164648493662, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269157790806494, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.04.12, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1604332800000, receivedDateStr=2020-11-03, revisedDate=1609171200000, revisedDateStr=2020-12-29, acceptedDate=null, acceptedDateStr=null, onlineDate=1766718673144, onlineDateStr=2025-12-26, pubDate=1619539200000, pubDateStr=2021-04-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766718673144, onlineIssueDateStr=2025-12-26, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766718673144, creator=13701087609, updateTime=1766718673144, updator=13701087609, issue=Issue{id=1211269157790806494, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='4', pageStart='319', pageEnd='424', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766718671510, creator=13701087609, updateTime=1766718756000, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1211269512217882745, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269157790806494, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1211269512217882746, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1211269157790806494, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=393, endPage=397, ext={EN=ArticleExt(id=1211269165030175348, articleId=1211269164648493662, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Research progress on the relation of ATF6 to cardiovascular diseases, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Activated transcription factor 6 (ATF6) is a transmembrane glycoprotein located in the endoplasmic reticulum.It exists widely in various tissues including myocardium and participates in endoplasmic reticulum stress (ERS) by regulating the unfolded protein response (UPR) signal pathway, which has become one of the major regulators of organs/tissues homeostasis and is of great significance in signal transduction, gene expression and protein synthesis. A number of studies have shown that ATF6 plays an important regulatory role in the occurrence and development of atherosclerosis, myocardial infarction, cardiac hypertrophy, diabetic cardiomyopathy, arrhythmia and other common cardiovascular diseases (CVD). At present, some studies have proved that ATF6 can regulate its activity and function to intervene the occurrence and development of some CVD. As a result, whether a small molecule regulator can be designed to treat some CVD by regulating ATF6 has become a research hot-spot. ATF6-based therapies have made great progress and have shown promising efficacy in small animal models of CVD and other systemic protein-based diseases. The small molecule regulator to ATF6 has a broad application prospect in cardiovascular disease, but further basic and clinical studies are still needed to lay the theoretical and practical foundation for its application. In present paper, the structure, classification and correlation of ATF6 with CVD are reviewed in order to provide references for experimental researches, clinical diagnoses and treatments of CVD.

, correspAuthors=Zheng Zhang, authorNote=null, correspAuthorsNote=
*E-mail:
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激活转录因子6(ATF6)是一种位于内质网的跨膜糖蛋白,广泛分布于包括心肌在内的多种组织,主要通过调节未折叠蛋白反应信号通路来参与内质网应激,是器官及组织稳态的主要调节因子之一。多项研究表明,ATF6在动脉粥样硬化、心肌梗死、心肌肥厚、糖尿病心肌病及心律失常等常见心血管疾病的发生发展中均起着重要的调控作用。该文就ATF6的结构、分型及其与心血管疾病的关系进行综述,以期为心血管疾病的实验研究及临床诊疗提供参考。

, correspAuthors=张钲, authorNote=null, correspAuthorsNote=
张钲,E-mail:
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王沛,硕士研究生,主要从事心血管疾病方面的研究

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激活转录因子6与心血管疾病关系的研究进展
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王沛 1 , 彭瑜 2, 3 , 张钲 1, 2, 3, *
解放军医学杂志 | 综述 2021,46(4): 393-397
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解放军医学杂志 | 综述 2021, 46(4): 393-397
激活转录因子6与心血管疾病关系的研究进展
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王沛1, 彭瑜2, 3, 张钲1, 2, 3, *
作者信息
  • 1兰州大学第一临床医学院,兰州 730000
  • 2兰州大学第一医院心脏中心,兰州 730000
  • 3甘肃省心血管病重点实验室,兰州 730000
  • 王沛,硕士研究生,主要从事心血管疾病方面的研究

通讯作者:

张钲,E-mail:
Research progress on the relation of ATF6 to cardiovascular diseases
Pei Wang1, Yu Peng2, 3, Zheng Zhang1, 2, 3, *
Affiliations
  • 1The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
  • 2Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou 730000, China
  • 3Gansu Key Laboratory of Cardiovascular Disease, Lanzhou 730000, China
出版时间: 2021-04-28 doi: 10.11855/j.issn.0577-7402.2021.04.12
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激活转录因子6(ATF6)是一种位于内质网的跨膜糖蛋白,广泛分布于包括心肌在内的多种组织,主要通过调节未折叠蛋白反应信号通路来参与内质网应激,是器官及组织稳态的主要调节因子之一。多项研究表明,ATF6在动脉粥样硬化、心肌梗死、心肌肥厚、糖尿病心肌病及心律失常等常见心血管疾病的发生发展中均起着重要的调控作用。该文就ATF6的结构、分型及其与心血管疾病的关系进行综述,以期为心血管疾病的实验研究及临床诊疗提供参考。

激活转录因子6  /  心血管疾病  /  内质网应激  /  未折叠蛋白反应

Activated transcription factor 6 (ATF6) is a transmembrane glycoprotein located in the endoplasmic reticulum.It exists widely in various tissues including myocardium and participates in endoplasmic reticulum stress (ERS) by regulating the unfolded protein response (UPR) signal pathway, which has become one of the major regulators of organs/tissues homeostasis and is of great significance in signal transduction, gene expression and protein synthesis. A number of studies have shown that ATF6 plays an important regulatory role in the occurrence and development of atherosclerosis, myocardial infarction, cardiac hypertrophy, diabetic cardiomyopathy, arrhythmia and other common cardiovascular diseases (CVD). At present, some studies have proved that ATF6 can regulate its activity and function to intervene the occurrence and development of some CVD. As a result, whether a small molecule regulator can be designed to treat some CVD by regulating ATF6 has become a research hot-spot. ATF6-based therapies have made great progress and have shown promising efficacy in small animal models of CVD and other systemic protein-based diseases. The small molecule regulator to ATF6 has a broad application prospect in cardiovascular disease, but further basic and clinical studies are still needed to lay the theoretical and practical foundation for its application. In present paper, the structure, classification and correlation of ATF6 with CVD are reviewed in order to provide references for experimental researches, clinical diagnoses and treatments of CVD.

activated transcription factor 6  /  cardiovascular diseases  /  endoplasmic reticulum stress  /  unfolded protein response
王沛, 彭瑜, 张钲. 激活转录因子6与心血管疾病关系的研究进展. 解放军医学杂志, 2021 , 46 (4) : 393 -397 . DOI: 10.11855/j.issn.0577-7402.2021.04.12
Pei Wang, Yu Peng, Zheng Zhang. Research progress on the relation of ATF6 to cardiovascular diseases[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (4) : 393 -397 . DOI: 10.11855/j.issn.0577-7402.2021.04.12
心血管疾病(cardiovascular disease,CVD)是全球范围内死亡率最高的疾病,且发病率呈逐年上升趋势[1]。CVD的发生发展涉及众多系统、器官及组织。内质网是真核细胞胞质的膜系统,内通核膜的外膜,外连细胞膜,具有蛋白质合成、分泌性/跨膜蛋白质转位、Ca2+调节及脂质生物合成等多种基本生物学功能,尤其在蛋白质的合成、加工、包装及运输中具有极其重要的作用[2]。内质网蛋白质稳态受未折叠蛋白反应(unfolded protein response,UPR)调控,这是一种应激反应信号通路。代谢紊乱、缺氧及炎症等刺激因素作为CVD病理生理的主要组成部分,可导致内质网腔内蛋白质的错误折叠及积累,引起内质网稳态失衡,称为内质网应激(endoplasmic reticulum stress,ERS)[3]。ERS会触发UPR,通过激活转录及翻译途径来恢复内质网的稳态。UPR的急性激活可能是适应性的,有利于维持细胞内稳态,但长期、持续的激活会导致细胞功能障碍及细胞死亡。事实上,许多疾病的发病机制涉及UPR的异常调节。最近的研究表明,UPR参与了CVD的发生发展,如结构性心脏病、缺血性心脏病及终末期心脏病[4]。在CVD的治疗中,维持心肌细胞内蛋白稳定对保证心肌细胞活力及功能至关重要。作为调节UPR的重要信号分子,激活转录因子6(activated transcription factor 6,ATF6)已被证实是基于上述机制的CVD治疗靶点[5-6]。因此,本文就ATF6在CVD发生发展中的作用及机制进行综述,以期为相关疾病的实验研究及临床诊疗提供思路。
ATF6是一种位于内质网的分子质量为90 ku的Ⅱ型跨膜糖蛋白,其C端突入内质网腔内,N端则位于细胞质,是碱性域亮氨酸拉链(basic leucine zippe,bZIP)转录因子家族的成员。哺乳动物表达两种同源ATF6蛋白:ATF6α(670个氨基酸)及ATF6β(703个氨基酸),尽管二者具有明显的序列同源性,但却表现出不同的转录激活域,ATF6α是一种有效的转录激活剂,而ATF6β的转录激活作用甚微,且有可能被ATF6α抑制。在ERS的诱导作用下,来自ATF6α蛋白的免疫球蛋白结合蛋白(binding immunoglobulin protein,Bip)解离,暴露了ATF6α蛋白的2个高尔基体定位序列GLS1及GLS2,使ATF6α转位至高尔基体,并被其中的2种蛋白酶S1P及S2P裂解,产生1个含50 ku氨基末端的细胞质片段ATF6f。在这种受控膜内蛋白水解(regulated intramembrane proteolysis,RIP)后,被释放的ATF6f转录因子进入细胞核并与ERS反应元件结合,诱导X-盒结合蛋白1(X-box binding protein 1,XBP1)及Bip、内质网分子伴侣的表达,增强内质网蛋白的折叠能力,进而维持内质网中蛋白质的合成稳态,帮助细胞抵御应激,维持生存状态[7]
动脉粥样硬化(atherosclerosis,AS)是一种慢性炎症性动脉疾病,也是心血管系统中最常见的疾病。在AS过程中,血脂过多、高半胱氨酸血症、单核/巨噬细胞激活等因素均可刺激ERS,诱导ATF6对细胞内的UPR进行调控[8]。Gao等[9]发现,在给予小鼠致动脉粥样硬化饮食后,ATF6及其调控基因的表达均明显下调,进而使UPR减弱,导致血脂升高,并加剧了血管内皮细胞的炎症反应。Zhang等[10]发现,高水平同型半胱氨酸可诱导ERS激活ATF6,促进ATF6与可溶性环氧化物水解酶(soluble epoxide hydrolase,sEH)启动子结合,增强sEH表达,而sEH表达增高则会水解环氧二十碳三烯酸(epoxyeicosatrienoic acids,EETs),降低EETs的内皮保护作用。Doran等[11]发现,在人类及小鼠的动脉粥样硬化病程中,坏死斑块巨噬细胞内钙调蛋白依赖性蛋白激酶(CaMKⅡ)激活,Ca2+/CaMKⅡ在坏死薄帽斑块的形成中具有重要作用,而ATF6正是这一途径中的关键信号分子。基于上述发现,有研究者考虑针对ATF6进行靶向调控以抑制AS的发生发展。Xu等[12]发现,柚皮苷可通过抑制小鼠巨噬细胞ERS信号分子ATF6的活性而促进细胞内胆固醇外流增强,进而抑制小鼠主动脉粥样硬化病变。
心肌梗死(myocardial infarction,MI)是由于冠脉血供减少或中断使相应的心肌发生严重而持久的缺血所致,近年来其发病呈年轻化趋势,已成为威胁人类健康的主要疾病之一[13]
MI的发病率及病死率均较高,是导致CVD患者死亡的主要原因。Toko等[14]通过构建MI小鼠模型,发现MI后小鼠心脏ATF6活性升高,此时若使用ATF6抑制剂4-(2-氨基乙基)苯磺酰氟治疗,则可降低MI后小鼠的心功能,使病死率增高;该研究还发现,使用药物抑制ATF6可导致假手术小鼠左心室扩张及心功能下降;与野生型同卵鼠比较,表达ATF6显性负性突变体的转基因小鼠左心室更大,射血分数更低,提示ATF6激活后不仅可在病理状态下保护心脏,在生理状态下也具有维持心脏功能的重要作用。缺血性心肌病(ischemic cardiomyopathy,ICM)属于MI的晚期阶段,Ortega等[15]发现,ICM患者左心室高表达的ATF6可通过调控内质网结构蛋白的水平来改变内质网结构,从而影响左心室功能,结构蛋白核糖体结合蛋白1(ribosomal receptor-binding protein 1,RRBP1)水平越高,左心室功能越差。
尽快恢复血供被认为是治疗MI的关键步骤[16]。心脏血管阻塞后通过溶栓、介入等治疗措施恢复血供时可发生心肌缺血再灌注损伤(myocardial ischemia reperfusion injury,MIRI)。目前MIRI的具体发生发展机制尚不清楚,大量国内外研究均致力于阐明其病因及发病机制[17]。研究表明,ERS诱导的细胞凋亡在MIRI中起关键作用,而ATF6作为ERS的核心信号分子,在MIRI过程中对心肌细胞具有保护作用[18]。Blackwood等[6]研究发现,在MIRI过程中使用选择性药物激活UPR信号通路中的ATF6,可稳定转录蛋白,改善心肌损伤并保护心脏功能,而这些作用在心肌细胞ATF6缺失时消失,表明ATF6在缺血再灌注过程中通过维持心肌细胞蛋白质平衡而发挥心脏保护作用。Jin等[19]发现,在缺血再灌注诱导下,小鼠心肌细胞ATF6表达下调可增加心肌中活性氧自由基(reactive oxygen species,ROS)的生成及心肌细胞凋亡,而腺相关病毒9(adeno-associated virus 9,AAV9)诱导的ATF6过表达可减轻这一反应;通过构建ATF6基因敲除小鼠模型来验证这一结论,发现ATF6基因敲除小鼠在缺血再灌注过程中表现出更严重的心肌受损及功能下降。Jia等[20]采用大鼠体内MIRI模型及Langendorff离体灌注大鼠心脏体外实验发现,ATF6表达上调在慢性缺氧减轻MIRI的病理生理过程中发挥着重要作用。
在MIRI过程中,ATF6可诱导活化氧化应激反应基因,这些基因编码位于内质网外的多种抗氧化蛋白来抵御应激,表明ATF6为氧化应激反应基因的关键转录诱导剂,该基因编码的抗氧化蛋白在MIRI过程中可减少ROS的生成,减轻心肌细胞凋亡[19]。因此,以ATF6为靶点可能会成为临床诊治MIRI的一条新思路。
心肌肥厚是由心肌细胞蛋白合成异常引起的[21],细胞内蛋白合成量与细胞维持蛋白量的能力失衡,最终导致了错误折叠蛋白的积累。Glembotski等[18]发现,ATF6调控的内质网蛋白质量控制系统对于细胞在生长过程中维持蛋白质量十分重要,可能是治疗心肌肥厚的潜在靶点。Li等[22]发现,在内脂素诱导的H9C2心肌细胞肥大过程中,ATF6表达水平明显上调,但如果先用ERS阻断剂普伐他汀预处理H9C2细胞,则在ATF6明显降低的基础上,心肌细胞肥大标志物心房钠尿肽(ANP)及脑尿钠肽(BNP)表达水平均明显降低。此外,Li等[23]又构建了大鼠主动脉弓缩窄(TAC)模型以研究轴突生长抑制因子(Nogo)-B在对心肌肥厚的调节作用,发现抑制Nogo-B可激活ERS通路的ATF6分支信号通路,从而促进心肌细胞肥大及心肌成纤维细胞活化。Blackwood等[5]也发现,TAC小鼠ATF6信号通路激活后可诱导其靶基因转录,最终导致心肌细胞肥大,而敲除ATF6基因可减弱TAC以及运动诱导的心肌细胞肥大及心功能受损。Correll等[24]研究了ATF6α及ATF6β对心脏压力过载反应的影响,对ATF6基因敲除小鼠进行2周的TAC处理,结果显示,与对照组比较,实验组小鼠心肌肥厚程度明显下降,ERS相关蛋白表达水平也明显降低。然而,在长期压力超负荷的情况下,实验组小鼠较对照组小鼠的心脏代偿能力减弱,表现为心脏重量增加、肺水肿及心功能下降,揭示了ATF6在调节心脏压力过载引起的心肌肥厚反应及内质网基因表达方面的作用。在心肌细胞中,内质网是蛋白质合成最多的部位。因此,负责调控应激状态下内质网蛋白质质量平衡的ATF6可能是心脏对肥厚性生长刺激做出适应性反应的重要决定因素。
糖尿病心肌病(diabetic cardiomyopathy,DCM)是糖尿病患者死亡的主要原因。研究表明,高血糖诱导的基于ATF6调控的ERS在DCM发生发展中起重要作用[25]
对于DCM,心肌细胞凋亡及心肌纤维化是公认的病因。Xu等[26]通过构建金属硫蛋白-转基因(MT-TG)及野生型糖尿病小鼠模型,发现野生型糖尿病小鼠的心肌细胞凋亡增多,同时伴有ATF6裂解明显增加,而MT-TG糖尿病小鼠则未见此反应。Liu等[27]发现,在糖尿病大鼠模型中,由ATF6介导的ERS在高糖诱导的心肌细胞凋亡过程中被激活,而ATF6缺失可减轻高糖诱导的心肌细胞凋亡;他们还通过构建DCM大鼠模型发现ATF6信号通路在心脏组织中被激活,导致细胞内钙累积及活化T细胞核因子(NFAT)激活,进而启动细胞外基质(ECM)基因表达,导致心肌间质胶原沉积。此外,Liu等[28]还发现,苦参碱在非细胞毒性浓度下可阻断心脏成纤维细胞(CFs)中的ATF6信号通路,从而抑制ECM的合成,抑制心肌纤维化,进而恢复心功能,提高心脏顺应性。Galan等[29]发现,在1型糖尿病小鼠模型中,抑制表皮生长因子受体酪氨酸激酶(EGFRtk)磷酸化及ERS可下调ATF6的表达,减轻细胞凋亡,改善微血管功能。ATF6信号通路诱导的心肌纤维化是DCM的发生机制之一,其特征是心脏顺应性及功能丧失[28]。Ji等[30]发现,ERS最主要的致细胞凋亡途径是通过ERS相关蛋白CCAAT/增强子结合蛋白同源蛋白(CHOP)介导的,而ATF6是此途径中的重要诱导因子。利拉鲁肽可下调ATF6的表达,通过抑制UPR通路阻断CHOP介导的ERS,从而减轻细胞凋亡。Sun等[31]发现,黄芪多糖可通过下调ERS通路相关因子ATF6的表达,在DCM大鼠及高糖诱导的H9C2细胞中减轻心肌细胞凋亡。上述研究均表明,通过调控ATF6信号通路来减轻心肌细胞凋亡及心肌纤维化是切实可行的,可以此为靶点进一步研究DCM的防治措施。
心律失常作为常见的CVD之一,其发病机制较复杂,涉及多种心脏电生理及结构的改变,因此,心律失常的治疗目前仍然是临床的难题,且一直是临床研究的热点[32]
心房颤动(atrial fibrillation,AF)是最常见的心律失常之一,有研究表明其发生发展与心肌离子通道功能失调有关[33]。Deshmukh等[34]对239例AF患者选择左心耳进行全基因组mRNA芯片分析,发现心肌离子通道转录水平的明显变化仅限于持续性AF患者,心肌离子通道功能的改变在AF后期起作用,而AF的易感性与应激反应通路有关;ATF6作为应激反应通路转录因子的靶蛋白,其表达降低与AF易感性明显相关,然而是否由于过度的应激反应导致心肌离子通道功能失调,使得房颤持续发展,仍需进一步研究证实。众所周知,hERG基因突变造成的hERG通道蛋白功能不足是长QT间期综合征(long Q-T syndrome 2,LQTS)的主要病因[35]。ATF6靶向调控应激反应通路的作用也在LQTS中被证实。Shi等[36]发现,高糖可通过上调ATF6的表达水平来激活UPR,造成hERG通道蛋白的表达明显下调,抑制hERG通道的运输,这正是复极减缓及QT间期延长的关键因素。
基于上述ATF6与多种CVD的关系,能否设计一种小分子诱导剂,通过调控ATF6表达来诊治CVD是当前研究的重点。随着对ATF6激活机制的深入研究及小分子库的严格筛选检测,基于ATF6的治疗方法取得了较大进展,并在CVD及其他基于蛋白质疾病的小动物模型上显示出了良好的疗效[37]。但目前仍存在较大的研究空间,如在人体细胞中,ATF6及适应性UPR其他必要成分的表达水平随年龄的增长而降低,而CVD发病率随年龄的增长而增高,这就突显了进一步研究ATF6在各种CVD中的激活情况及作用机制的必要性。
ATF6作为CVD发生发展中的一个重要调控因子,可调控病理生理过程中的多种信号通路,与动脉粥样硬化、MI、心肌肥厚、DCM、心律失常等常见CVD的发生发展密切相关,且在不同的CVD中,正向/负向调控作用存在不一致的情况。目前,ATF6在多种CVD病因中的激活及作用机制尚未完全阐明,许多以ATF6为靶点的治疗方式仍有待开发。随着更多高质量研究的开展,靶向ATF6治疗将会成为CVD防治领域的又一亮点。
  • 国家自然科学基金(82060807)
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2021年第46卷第4期
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doi: 10.11855/j.issn.0577-7402.2021.04.12
  • 接收时间:2020-11-03
  • 首发时间:2025-12-26
  • 出版时间:2021-04-28
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  • 收稿日期:2020-11-03
  • 修回日期:2020-12-29
基金
National Natural Science Foundation of China(82060807)
国家自然科学基金(82060807)
作者信息
    1兰州大学第一临床医学院,兰州 730000
    2兰州大学第一医院心脏中心,兰州 730000
    3甘肃省心血管病重点实验室,兰州 730000

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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