Analysing the Regulation of a Catecholamine-Dependent Altered cAMP Signalling in a Patient-Specific Induced Pluripotent Stem Cell Takotsubo-Model - European Medical Journal

Analysing the Regulation of a Catecholamine-Dependent Altered cAMP Signalling in a Patient-Specific Induced Pluripotent Stem Cell Takotsubo-Model

2 Mins
Daniela Hübscher,1 Thomas Borchert,1 Gerd Hasenfuss,1 Viacheslav O. Nikolaev,2 *Katrin Streckfuss-Bömeke3

Dr Hasenfuss reports personal fees from AstraZeneca, Berlin Chemie, Corvia, Impulse Dynamics, Novartis, Servier, Springer, and Vifor outside the submitted work. All other authors have declared no conflicts of interest.


his work was supported by the German Center for Cardiovascular Research (DZHK) [FKZ 81X2300170 (to VON and KSB), and 81X2300165 (to KSB)], the BMBF grant e: Bio-Modul II-Verbundprojekt: CaRNAtion (031l0075C to GH and KSB), and the German Heart Foundation/German Foundation of Heart Research (to KSB).

EMJ Cardio. ;7[1]:79-80. Abstract Reviews No. AR5.
Beta-adrenergic signalling, 3’, 5’-cyclic adenosine monophosphate (cAMP), catecholamines, förster resonance energy transfer (FRET), induced pluripotent stem (iPSC)-cardiomyocytes, phosphodiesterase (PDE), Takotsubo

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


Takotsubo syndrome (TTS) is characterised by acute left ventricular dysfunction in the absence of obstructive coronary lesions.1 TTS is a life-threatening disease with a mortality rate of up to 8% in the acute phase. Furthermore, 21.8% of patients show in-house complications, such as cardiogenic shock or ventricular tachycardia.2 Although enhanced β-adrenergic signalling and higher sensitivity to catecholamine-induced stress toxicity were identified as mechanisms associated with the TTS phenotype in the authors’ former study, the pathogenesis of TTS is still not completely understood.3 The aim of the study was to prove the hypothesis of a phosphodiesterase (PDE)-dependent regulation of 3’,5’-cyclic adenosine monophosphate (cAMP) signalling in TTS under catecholamine stress.


Functional TTS-induced pluripotent stem cell-derived cardiomyocytes (TTS-iPSC-CM) were generated from six patients and the cells were treated with catecholamines to mimic a TTS-phenotype. Using a cytosolic Förster resonance energy transfer (FRET) based cAMP sensor, it was observed that β-adrenergic receptor (β-AR) stimulations led to stronger FRET responses in the cytosol of TTS-CM compared to controls. In addition to β-AR, PDE are key molecules involved in cAMP signalling in CM. At basal level, TTS-CM show a significantly higher PDE3A and a reduced PDE4D protein expression in the TTS-CM compared to control. In addition, FRET experiments show that after β-AR stimulation, the strong effects of the PDE4 family in the cytosol of control cells were significantly decreased in TTS-CM. This is in line with previously described reduction of the overall cytosolic PDE4 activity in severely hypertrophied and failing rat and mouse.4 By analysing PDE-dependent cAMP downstream effects as PKA-dependent phosphorylation, an additional increase of phospholamban (PLN) phosphorylation (PLN-S16) was observed, especially in the control group, when treating iPSC-CM with a combination of isoprenaline and PDE4 inhibitor. In contrast, in TTS-iPSC-CM the contribution of the PDE-families PDE2, 3, or 4 to phosphorylation of PLN-S16 was increased in comparison to isoprenaline alone. This suggests that different PDE in TTS and control are involved in functional segregation of the sarcoplasmic/endoplasmic reticulum calcium ATPase 2a (SERCA2a) microdomain from the cytosol in terms of cAMP downstream effects. To directly address the hypothesis that local cAMP dynamics might be altered in TTS, a SERCA microdomain targeted FRET based cAMP sensor was used. In contrast to the cytosolic cAMP regulation, the contribution of PDE2 and PDE3 to local cAMP degradation was increased in both TTS and control. Nevertheless, the strong PDE4 inhibitor effects in control cells are still reduced in TTS in the SERCA domain.


The data, for the first time, shows alterations of local cAMP signalling in healthy and diseased TTS-iPSC-CM. The PDE-specific contribution to cAMP degradation in the cytosol of TTS iPSC-CM is lost in the SERCA domain. Additionally, the results uncover a PDE-dependent altered β-adrenergic signalling as a potential disease cause. Furthermore, the data highlight that TTS-iPSC-CM can be used to provide a versatile tool for evaluating new treatment options for TTS as therapeutic targets.

Ghadri JR et al. Takotsubo cardiomyopathy: Still much more to learn. Heart. 2014;100(22):1804-12. Tsuchihashi K et al. Transient left ventricular apical ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction. Angina pectoris-myocardial infarction investigations in Japan. J Am Coll of Cardiol. 2001;38(1):11-8. Borchert T et al. Catecholamine-dependent β-adrenergic signaling in a pluripotent stem cell model of takotsubo cardiomyopathy. J Am Coll Cardiol. 2017;70(8):975-91. Sprenger JU et al. In vivo model with targeted cAMP biosensor reveals changes in receptor-microdomain communication in cardiac disease. Nat Commun. 2015;6:6965.

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