Estrogen Attenuates Chronic Stress-Induced Cardiomyopathy by Adaptively Regulating Macrophage Polarizations via β2-Adrenergic Receptor Modulation

Clinical demographics have demonstrated that postmenopausal women are predisposed to chronic stress-induced cardiomyopathy (CSC) and this has been associated with the decrease of estrogen. Meanwhile, recent studies have implicated unsolved myocardial proinflammatory responses, which are characterized by enormous CD86+ macrophage infiltrations as an underlying disease mechanism expediting the pathological remodeling of the heart during chronic stress. However, we had previously demonstrated that estrogen confers cardioprotection via the modulation of cardiomyocytes beta(2)-adrenoceptors (beta(2)AR)-Gs/Gi pathways during stress to lessen the incidence of stress-induced cardiovascular diseases in premenopausal women. Intriguingly, macrophages express beta(2)AR profoundly as well; as such, we sought to elucidate the possibilities of estrogen modulating beta(2)AR-Gs/Gi pathway to confer cardioprotection during stress via immunomodulation. To do this, ovariectomy (OVX) and sham operations (Sham) were performed on female Sprague-Dawley (SD) rats. Two weeks after OVX, the rats were injected with 40 mu g/kg/day of estradiol (E-2). Next, on day 36 after OVX, chronic stress was induced by a daily subcutaneous injection of 5 mg/kg/day of isoproterenol (ISO). The effect of E-2 on relevant clinical cardiac function indexes (LVSP, LVEDP, + dp/dt and -dp/dt), myocardial architecture (cardiomyocyte diameter and fibrosis), beta(2)AR alterations, and macrophage (CD86+ and CD206+) infiltrations were assessed. In vitro, peritoneal macrophages (PM phi) were isolated from wild-type and beta(2)AR-knockout female mice. The PM phi were treated with ISO, E-2, and beta(2)AR blocker ICI 118,551 for 24 h, and flow cytometric evaluations were done to assess their phenotypic expression. E-2 deficiency permitted the induction of CSC, which was characterized by cardiac dysfunctions, maladaptive myocardial hypertrophy, unresolved proinflammatory responses, and fibrosis. Nonetheless, E-2 presence/supplementation during stress averted all the aforementioned adverse effects of chronic stress while preventing excessive depletion of beta(2)AR. Also, we demonstrated that E-2 facilitates timely resolution of myocardial proinflammation to permit reparative functions by enhancing the polarization of CD86+ to CD206+ macrophages. However, this adaptive immunomodulation is hampered when beta(2)AR is inhibited. Taken together, the outcomes of this study show that E-2 confers cardioprotection to prevent CSC via adaptive immunomodulation of macrophage phenotypes, and beta(2)AR-mediated signaling is crucial for the polarizations of CD86+ to CD206+ macrophages.

Automated summary

Postmenopausal women are predisposed to chronic stress-induced cardiomyopathy, and estrogen plays a protective role by modulating the phenotypes of cardiomyocytes and macrophages, enhancing cardiac reparative functions.