Novel receptor-derived cyclopeptides to treat heart failure caused by anti-β1-adrenoceptor antibodies in a human-analogous rat model

PLoS One. 2015 Feb 20;10(2):e0117589. doi: 10.1371/journal.pone.0117589. eCollection 2015.

Abstract

Despite recent therapeutic advances the prognosis of heart failure remains poor. Recent research suggests that heart failure is a heterogeneous syndrome and that many patients have stimulating auto-antibodies directed against the second extracellular loop of the β1 adrenergic receptor (β1EC2). In a human-analogous rat model such antibodies cause myocyte damage and heart failure. Here we used this model to test a novel antibody-directed strategy aiming to prevent and/or treat antibody-induced cardiomyopathy. To generate heart failure, we immunised n = 76/114 rats with a fusion protein containing the human β1EC2 (amino-acids 195-225) every 4 weeks; n = 38/114 rats were control-injected with 0.9% NaCl. Intravenous application of a novel cyclic peptide mimicking β1EC2 (β1EC2-CP, 1.0 mg/kg every 4 weeks) or administration of the β1-blocker bisoprolol (15 mg/kg/day orally) was initiated either 6 weeks (cardiac function still normal, prevention-study, n = 24 (16 treated vs. 8 untreated)) or 8.5 months after the 1st immunisation (onset of cardiomyopathy, therapy-study, n = 52 (40 treated vs. 12 untreated)); n = 8/52 rats from the therapy-study received β1EC2-CP/bisoprolol co-treatment. We found that β1EC2-CP prevented and (alone or as add-on drug) treated antibody-induced cardiac damage in the rat, and that its efficacy was superior to mono-treatment with bisoprolol, a standard drug in heart failure. While bisoprolol mono-therapy was able to stop disease-progression, β1EC2-CP mono-therapy -or as an add-on to bisoprolol- almost fully reversed antibody-induced cardiac damage. The cyclo¬peptide acted both by scavenging free anti-β1EC2-antibodies and by targeting β1EC2-specific memory B-cells involved in antibody-production. Our model provides the basis for the clinical translation of a novel double-acting therapeutic strategy that scavenges harmful anti-β1EC2-antibodies and also selectively depletes memory B-cells involved in the production of such antibodies. Treatment with immuno-modulating cyclopeptides alone or as an add-on to β1-blockade represents a promising new therapeutic option in immune-mediated heart failure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antibodies / immunology*
  • B-Lymphocytes / drug effects
  • B-Lymphocytes / immunology
  • B-Lymphocytes / metabolism
  • Bisoprolol / pharmacology
  • Bisoprolol / therapeutic use
  • CD4-Positive T-Lymphocytes / cytology
  • CD4-Positive T-Lymphocytes / immunology
  • CD4-Positive T-Lymphocytes / metabolism
  • Disease Models, Animal
  • Disease Progression
  • Echocardiography
  • Heart Failure / pathology
  • Heart Failure / prevention & control*
  • Humans
  • Male
  • Myocardium / metabolism
  • Myocardium / pathology
  • Peptides, Cyclic / chemical synthesis
  • Peptides, Cyclic / pharmacology
  • Peptides, Cyclic / therapeutic use*
  • Rats
  • Rats, Inbred Lew
  • Receptors, Adrenergic, beta-1 / immunology*

Substances

  • Antibodies
  • Peptides, Cyclic
  • Receptors, Adrenergic, beta-1
  • Bisoprolol

Grants and funding

The present work was publicly funded by grants of the German Research Foundation ("Deutsche Forschungs-gemeinschaft" [Grant Ja 706/2-4]), by the Interdisciplinary Center for Clinical Research (IZKF) Würzburg, [Project A-52], and by the German Ministry of Research and Education ("Bundesministerium für Bildung und Forschung" (BMBF) [Grants GoBio-1, FKZ 0315031, FKZ 0315363, and MolDiag FKZ 01ES0901]). All authors have read and approved submission of the final manuscript.