Introduction: Heart failure (HF) is caused by structural and functional abnormalities of the heart and is associated with high morbidity and mortality. Pathological myocardial hypertrophy accounts for a significant portion heart failure. The Yap protein was found to be responsive to mechanotransduction signals and can limit organ size by inducing cell cycle arrest during development. In the heart, pathological activation of Yap has been shown to drive cardiac hypertrophy, but regenerative activation of Yap can promote myocardial cell-cycle re-entry. However, how Yap is pathologically activated in the beating cardiomyocyte remains elusive. Hypothesis: ROS-Traf6 promotes the development of cardiac hypertrophy by activating Yap in a non-canonical fashion. Methods: Traf6 protein levels in heart failure patients biopsies as well as in various murine failing hearts were examined by immunofluorescence. Molecular interrogation of ROS-Traf6-Yap signaling axis was performed in primary neonatal rat cardiomyocytes (NRCM) and human induced pluripotent stem cell derived cardiomyocytes. Yap protein stability and activation by Traf6 was examined by immunoprecipitation, CHX induction, and point mutation. Myocardial specific Traf6 knockout and Yap mutant animals were used to evaluate Traf6-Yap signaling in vivo . Results: We found that Traf6 expression was significantly elevated in multiple heart failure models. Using the transverse aortic constriction (TAC)-induced cardiac hypertrophy model, pressure overload increased ROS levels which activated Traf6. Traf6 overexpression induced myocardial hypertrophy while knockdown blocked myocardial hypertrophy in Ang II treated NRCMs. Mechanistically, Traf6 binds to and ubiquitinates Yap-K234 – this promotes Yap protein stability and nuclear translocation evidenced by increase in phosphorylated Yap. Myocardial Traf6 deficiency prevents TAC-induced cardiac hypertrophy. Moreover, overexpression of Yap-K237 mutant did not restore TAC-induced cardiac hypertrophy in myocardial Yap deficient mice. Conclusions: Our results demonstrate that non-canonical Yap activation is responsible for pressure overload induced cardiac hypertrophy. Targeting of the newly identified ROS-Traf6-Yap signaling axis may provide a new approach to prevent pathogenic cardiac hypertrophy.
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