Abstract
Exercise limitation comes from a close interaction between cardiovascular and skeletal muscle impairments. To better understand the implication of possible peripheral oxidative metabolism dysfunction, we studied the proteomic signature of skeletal muscle in pulmonary arterial hypertension (PAH). Eight idiopathic PAH patients and eight matched healthy sedentary subjects were evaluated for exercise capacity, skeletal muscle proteomic profile, metabolism, and mitochondrial function. Skeletal muscle proteins were extracted, and fractioned peptides were tagged using an iTRAQ protocol. Proteomic analyses have documented a total of 9 downregulated proteins in PAH skeletal muscles and 10 upregulated proteins compared to healthy subjects. Most of the downregulated proteins were related to mitochondrial structure and function. Focusing on skeletal muscle metabolism and mitochondrial health, PAH patients presented a decreased expression of oxidative enzymes (pyruvate dehydrogenase, p < 0.01) and an increased expression of glycolytic enzymes (lactate dehydrogenase activity, p < 0.05). These findings were supported by abnormal mitochondrial morphology on electronic microscopy, lower citrate synthase activity (p < 0.01) and lower expression of the transcription factor A of the mitochondria (p < 0.05), confirming a more glycolytic metabolism in PAH skeletal muscles. We provide evidences that impaired mitochondrial and metabolic functions found in the lungs and the right ventricle are also present in skeletal muscles of patients.
Key message
• Proteomic and metabolic analysis show abnormal oxidative metabolism in PAH skeletal muscle.
• EM of PAH patients reveals abnormal mitochondrial structure and distribution.
• Abnormal mitochondrial health and function contribute to exercise impairments of PAH.
• PAH may be considered a vascular affliction of heart and lungs with major impact on peripheral muscles.
Similar content being viewed by others
References
Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F et al (2013) Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62:D42–D50
Mainguy V, Provencher S, Maltais F, Malenfant S, Saey D (2011) Assessment of daily life physical activities in pulmonary arterial hypertension. PLoS One 6:e27993
Rival G, Lacasse Y, Martin S, Bonnet S, Provencher S (2014) Effect of pulmonary arterial hypertension specific therapies on health-related quality of life: a systematic review. Chest 146:686–708
Pugh ME, Buchowski MS, Robbins IM, Newman JH, Hemnes AR (2012) Physical activity limitation as measured by accelerometry in pulmonary arterial hypertension. Chest 142:1391–1398
Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, Provencher S (2010) Peripheral muscle dysfunction in idiopathic pulmonary arterial hypertension. Thorax 65:113–117
Potus F, Malenfant S, Graydon C, Mainguy V, Tremblay E, Breuils-Bonnet S, Ribeiro F, Porlier A, Maltais F, Bonnet S et al (2014) Impaired angiogenesis and peripheral muscle microcirculation loss contribute to exercise intolerance in pulmonary arterial hypertension. Am J Respir Crit Care Med 190:318–328
Sutendra G, Michelakis ED (2014) The metabolic basis of pulmonary arterial hypertension. Cell Metab 19:558–573
Courboulin A, Paulin R, Giguère NJ, Saksouk N, Perreault T, Meloche J, Paquet ER, Biardel S, Provencher S, Côté J et al (2011) Role for miR-204 in human pulmonary arterial hypertension. J Exp Med 208:535–548
Dromparis P, Paulin R, Stenson TH, Haromy A, Sutendra G, Michelakis ED (2013) Attenuating endoplasmic reticulum stress as a novel therapeutic strategy in pulmonary hypertension. Circulation 127:115–125
Paulin R, Dromparis P, Sutendra G, Gurtu V, Zervopoulos S, Bowers L, Haromy A, Webster L, Provencher S, Bonnet S et al (2014) Sirtuin 3 deficiency is associated with inhibited mitochondrial function and pulmonary arterial hypertension in rodents and humans. Cell Metab 20:827–839
Piao L, Fang Y-H, Cadete VJJ, Wietholt C, Urboniene D, Toth PT, Marsboom G, Zhang HJ, Haber I, Rehman J et al (2010) The inhibition of pyruvate dehydrogenase kinase improves impaired cardiac function and electrical remodeling in two models of right ventricular hypertrophy: resuscitating the hibernating right ventricle. J Mol Med 88:47–60
Sutendra G, Dromparis P, Paulin R, Zervopoulos S, Haromy A, Nagendran J, Michelakis ED (2013) A metabolic remodeling in right ventricular hypertrophy is associated with decreased angiogenesis and a transition from a compensated to a decompensated state in pulmonary hypertension. J Mol Med 91:1315–1327
Enache I, Charles AL, Bouitbir J, Favret F, Zoll J, Metzger D, Oswald-Mammosser M, Geny B, Charloux A (2013) Skeletal muscle mitochondrial dysfunction precedes right ventricular impairment in experimental pulmonary hypertension. Mol Cell Biochem 373:161–170
Mabuchi K, Sréter FA (1980) Actomyosin ATPase. II. Fiber typing by histochemical ATPase reaction. Muscle Nerve 3:233–239
Larsen S, Nielsen J, Hansen CN, Nielsen LB, Wibrand F, Stride N, Schroder HD, Boushel R, Helge JW, Dela F et al (2012) Biomarkers of mitochondrial content in skeletal muscle of healthy young human subjects. J Physiol (Lond) 590:3349–3360
Zeeberg BR, Feng W, Wang G, Wang MD, Fojo AT, Sunshine M, Narasimhan S, Kane DW, Reinhold WC, Lababidi S et al (2003) GoMiner: a resource for biological interpretation of genomic and proteomic data. Genome Biol 4:R28
Maere S, Heymans K, Kuiper M (2005) BiNGO: a Cytoscape plugin to assess overrepresentation of gene ontology categories in biological networks. Bioinformatics 21:3448–3449
Shannon P, Markiel A, Ozier O, Baliga NS, Wang JT, Ramage D, Amin N, Schwikowski B, Ideker T (2003) Cytoscape: a software environment for integrated models of biomolecular interaction networks. Genome Res 13:2498–2504
Bonnet S, Michelakis ED, Porter C, Andrade-Navarro M, Thebaud B, Breuils-Bonnet S, Haromy A, Harry G, Moudgil R, McMurtry S et al (2006) An abnormal mitochondrial-hypoxia inducible factor-1 alpha-Kv channel pathway disrupts oxygen sensing and triggers pulmonary arterial hypertension in fawn hooded rats—similarities to human pulmonary arterial hypertension. Circulation 113:2630–2641
Archer SL (2013) Mitochondrial dynamics—mitochondrial fission and fusion in human diseases. N Engl J Med 369:2236–2251
Ryan JJ, Marsboom G, Fang Y-H, Toth PT, Morrow E, Luo N, Piao L, Hong Z, Ericson K, Zhang HJ et al (2013) PGC1α-mediated mitofusin-2 deficiency in female rats and humans with pulmonary arterial hypertension. Am J Respir Crit Care Med 187:865–878
Ullrich M, Liang V, Chew YL, Banister S, Song X, Zaw T, Lam H, Berber S, Kassiou M, Nicholas HR et al (2014) Bio-orthogonal labeling as a tool to visualize and identify newly synthesized proteins in Caenorhabditis elegans. Nat Protoc 9:2237–2255
Marsboom G, Wietholt C, Haney CR, Toth PT, Ryan JJ, Morrow E, Thenappan T, Bache-Wiig P, Piao L, Paul J et al (2012) Lung 18 F-fluorodeoxyglucose positron emission tomography for diagnosis and monitoring of pulmonary arterial hypertension. Am J Respir Crit Care Med 185:670–679
Piao L, Fang Y-H, Parikh K, Ryan JJ, Toth PT, Archer SL (2013) Cardiac glutaminolysis: a maladaptive cancer metabolism pathway in the right ventricle in pulmonary hypertension. J Mol Med 91:1185–1197
Rogers MA, Hagberg JM, Martin WH, Ehsani AA, Holloszy JO (1990) Decline in VO2max with aging in master athletes and sedentary men. J Appl Physiol 68:2195–2199
Chance B, Leigh JS, Clark BJ, Maris J, Kent J, Nioka S, Smith D (1985) Control of oxidative metabolism and oxygen delivery in human skeletal muscle: a steady-state analysis of the work/energy cost transfer function. Proc Natl Acad Sci U S A 82:8384–8388
Provencher S, Chemla D, Hervé P, Sitbon O, Humbert M, Simonneau G (2006) Heart rate responses during the 6-minute walk test in pulmonary arterial hypertension. Eur Respir J 27:114–120
Groepenhoff H, Holverda S, Marcus JT, Postmus PE, Boonstra A, Vonk-Noordegraaf A (2007) Stroke volume response during exercise measured by acetylene uptake and MRI. Physiol Meas 28:1–11
Tolle J, Waxman A, Systrom D (2008) Impaired systemic oxygen extraction at maximum exercise in pulmonary hypertension. Med Sci Sports Exerc 40:3–8
De Bock K, Georgiadou M, Carmeliet P (2013) Role of endothelial cell metabolism in vessel sprouting. Cell Metab 18:634–647
Tomasetti M, Nocchi L, Staffolani S, Manzella N, Amati M, Goodwin J, Kluckova K, Nguyen M, Strafella E, Bajzikova M et al (2014) MicroRNA-126 suppresses mesothelioma malignancy by targeting IRS1 and interfering with the mitochondrial function. Antioxid Redox Signal 21:2109–2125
Abdul-Salam VB, Paul GA, Ali JO, Gibbs SR, Rahman D, Taylor GW, Wilkins MR, Edwards RJ (2006) Identification of plasma protein biomarkers associated with idiopathic pulmonary arterial hypertension. Proteomics 6:2286–2294
Abdul-Salam VB, Wharton J, Cupitt J, Berryman M, Edwards RJ, Wilkins MR (2010) Proteomic analysis of lung tissues from patients with pulmonary arterial hypertension. Circulation 122:2058–2067
Paulin R, Michelakis ED (2014) The metabolic theory of pulmonary arterial hypertension. Circ Res 115:148–164
Ryan JJ, Archer SL (2014) The right ventricle in pulmonary arterial hypertension: disorders of metabolism, angiogenesis and adrenergic signaling in right ventricular failure. Circ Res 115:176–188
Humbert M, Monti G, Brenot F, Sitbon O, Portier A, Grangeot-Keros L, Duroux P, Galanaud P, Simonneau G, Emilie D (1995) Increased interleukin-1 and interleukin-6 serum concentrations in severe primary pulmonary hypertension. Am J Respir Crit Care Med 151:1628–1631
Bertero T, Lu Y, Annis S, Hale A, Bhat B, Saggar R, Saggar R, Wallace WD, Ross DJ, Vargas SO et al (2014) Systems-level regulation of microRNA networks by miR-130/301 promotes pulmonary hypertension. J Clin Invest 124:3514–3528
Rabinovitch M (2010) PPARgamma and the pathobiology of pulmonary arterial hypertension. Adv Exp Med Biol 661:447–458
Kintscher U, Law RE (2005) PPARgamma-mediated insulin sensitization: the importance of fat versus muscle. Am J Physiol Endocrinol Metab 288:E287–E291
Hansmann G, Wagner RA, Schellong S, Perez VAJ, Urashima T, Wang L, Sheikh AY, Suen RS, Stewart DJ, Rabinovitch M (2007) Pulmonary arterial hypertension is linked to insulin resistance and reversed by peroxisome proliferator-activated receptor-gamma activation. Circulation 115:1275–1284
Zamanian RT, Hansmann G, Snook S, Lilienfeld D, Rappaport KM, Reaven GM, Rabinovitch M, Doyle RL (2009) Insulin resistance in pulmonary arterial hypertension. Eur Respir J 33:318–324
West J, Niswender KD, Johnson JA, Pugh ME, Gleaves L, Fessel JP, Hemnes AR (2013) A potential role for insulin resistance in experimental pulmonary hypertension. Eur Respir J 41:861–871
Aguer C, Mercier J, Man CYW, Metz L, Bordenave S, Lambert K, Jean E, Lantier L, Bounoua L, Brun JF et al (2010) Intramyocellular lipid accumulation is associated with permanent relocation ex vivo and in vitro of fatty acid translocase (FAT)/CD36 in obese patients. Diabetologia 53:1151–1163
Karakelides H, Asmann YW, Bigelow ML, Short KR, Dhatariya K, Coenen-Schimke J, Kahl J, Mukhopadhyay D, Nair KS (2007) Effect of insulin deprivation on muscle mitochondrial ATP production and gene transcript levels in type 1 diabetic subjects. Diabetes 56:2683–2689
Cheng Z, Almeida FA (2014) Mitochondrial alteration in type 2 diabetes and obesity: an epigenetic link. Cell Cycle 13:890–897
Sousa Silva M, Gomes RA, Ferreira AEN, Ponces Freire A, Cordeiro C (2013) The glyoxalase pathway: the first hundred years… and beyond. Biochem J 453:1–15
Khajali F, Liyanage R, Wideman RF (2011) Methylglyoxal and pulmonary hypertension in broiler chickens. Poult Sci 90:1287–1294
Meloche J, Pflieger A, Vaillancourt M, Paulin R, Potus F, Zervopoulos S, Graydon C, Courboulin A, Breuils-Bonnet S, Tremblay E et al (2014) Role for DNA damage signaling in pulmonary arterial hypertension. Circulation 129:786–797
Malenfant S, Neyron A-S, Paulin R, Potus F, Meloche J, Provencher S, Bonnet S (2013) Signal transduction in the development of pulmonary arterial hypertension. Pulm Circ 3:278–293
Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, Dekhuijzen PNR, Franssen F, Gayan-Ramirez G, Gea J et al (2014) An official american thoracic society/european respiratory society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 189:e15–e62
Allaire J, Maltais F, Doyon J-F, Noël M, Leblanc P, Carrier G, Simard C, Jobin J (2004) Peripheral muscle endurance and the oxidative profile of the quadriceps in patients with COPD. Thorax 59:673–678
Maltais F, Simard AA, Simard C, Jobin J, Desgagnés P, LeBlanc P (1996) Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise in normal subjects and in patients with COPD. Am J Respir Crit Care Med 153:288–293
Maltais F, Leblanc P, Whittom F, Simard C, Marquis K, Bélanger M, Breton MJ, Jobin J (2000) Oxidative enzyme activities of the vastus lateralis muscle and the functional status in patients with COPD. Thorax 55:848–853
Meyer A, Zoll J, Charles A-L, Charloux A, de Blay F, Diemunsch P, Sibilia J, Piquard F, Geny B (2013) Skeletal muscle mitochondrial dysfunction during chronic obstructive pulmonary disease: central actor and therapeutic target. Exp Physiol 98:1063–1078
Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, Provencher S (2010) Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension. J Cardiopulm Rehabil Prev 30:319–323
de Man FS, Handoko ML, Groepenhoff H, van t Hul AJ, Abbink J, Koppers RJH, Grotjohan HP, Twisk JWR, Bogaard H-J, Boonstra A et al (2009) Effects of exercise training in patients with idiopathic pulmonary arterial hypertension. Eur Respir J 34:669–675
Batt J, Shadly Ahmed S, Correa J, Bain A, Granton J (2014) Skeletal muscle dysfunction in idiopathic pulmonary arterial hypertension. Am J Respir Cell Mol Biol 50:74–86
Acknowledgments
The authors wish to thank the contribution of members of the Pulmonary Research Group team (www.pulmonaryarterialhypertension.ca) as well as the work and contribution of the Respiratory Health Network tissue bank (IUCPQ site) for storing human quadriceps biopsies. The authors also acknowledged the help of Luce Bouffard, BSc, for her technical assistance with biopsies and Ryan Wong for technical assistance with the manuscript.
Conflict of interest
Dr. Bonnet is a consultant for Merck & Co, Inc. Dr. Provencher has received research grants from Actelion Pharmaceuticals Ltd, Bayer AG, and GlaxoSmithKline and has received speaker fees from Actelion Pharmaceuticals Ltd. The Pulmonary Hypertension Research Group is also supported by the Fond de Recherche du Québec en Santé (FRQ-S). The remaining authors reported no potential conflicts of interest.
Funding
S.M. is a recipient of a doctoral training award from the Fond de Recherche du Québec en Santé (FRQ-S), F.P. is a recipient of a doctoral training award from the Centre de Recherche de l’IUCPQ. S.B. holds grants from the Canadian Institute of Health Research (CIHR) and from the Heart and Stroke Foundation of Canada. He also holds a CIHR Research Chair on vascular biology. S.P. holds a CIHR grant and is a FRQ-S clinical scientist.
Author information
Authors and Affiliations
Corresponding authors
Additional information
Simon Malenfant and François Potus contributed equally to this work.
Sébastien Bonnet and Steeve Provencher are co-senior authors.
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(PDF 556 kb)
Rights and permissions
About this article
Cite this article
Malenfant, S., Potus, F., Fournier, F. et al. Skeletal muscle proteomic signature and metabolic impairment in pulmonary hypertension. J Mol Med 93, 573–584 (2015). https://doi.org/10.1007/s00109-014-1244-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00109-014-1244-0