Small molecule disruption of G protein βγ subunit signaling reprograms human macrophage phenotype and prevents autoimmune myocarditis in rats

The purpose of this study was to determine whether blocking of G protein beta gamma (G beta gamma) signaling halts heart failure (HF) progression by macrophage phenotype manipulation. Cardiac G beta gamma signaling plays a crucial role in HF pathogenesis. Previous data suggested that inhibiting G beta gamma signaling reprograms T helper cell 1 (Th1) and Th2 cytokines, suggesting that G beta gamma might be a useful drug target for treating HF. We investigated the efficacy of a small molecule G beta gamma inhibitor, gallein, in a clinically relevant, experimental autoimmune myocarditis (EAM) model of HF as well as in human macrophage phenotypes in vitro. In the myocardium of HF patients, we observed that G protein coupled receptor kinase (GRK)2 levels were down-regulated compared with healthy controls. In rat EAM, treatment with gallein effectively improved survival and cardiac function, suppressed cardiac remodeling, and further attenuated myocardial protein expression of GRK2 as well as high mobility group box (HMGB)1 and its cascade signaling proteins. Furthermore, gallein effectively inhibited M1 polarization and promoted M2 polarization in vivo in the EAM heart and in vitro in human monocyte-derived macrophages. Taken together, these data suggest that the small molecule G beta gamma inhibitor, gallein, could be an important pharmacologic therapy for HF as it can switch the phenotypic reprogramming from M1 to M2 phenotype in a rat model of EAM heart and in human macrophages.