Молекулярные маркеры фиброза при постинфарктном ремоделировании миокарда

Несмотря на высокую распространенность и клиническую значимость фиброза миокарда, молекулярно-генетические факторы его реализации в постинфарктном периоде остаются предметом дискуссий.

Цель. Выявление молекулярных маркеров фиброза миокарда при его постинфарктном ремоделировании.

Материалы и методы. При проведении плановой коронаровентрикулографии выполнялась эндомиокардиальная биопсия миокарда пораженных и интактных областей межжелудочковой перегородки со стороны правого желудочка 7 пациентов с перенесенным передним распространенным инфарктом миокарда. Получены биоптаты фиброзированного и прилежащего здорового миокарда, которые были механически разделены на два равных сегмента и подвергнуты: 1) гомогенизации с последующим выделением РНК, синтезом кД-НК и анализом генной экспрессии при помощи количественной полимеразной цепной реакции; 2) фиксации в формалине и заключению в парафин с дальнейшим окрашиванием по ван Гизону для гистологической верификации фиброза.

Результаты. Обнаружено, что экспрессия генов ACTA2, VIM, CTGF, COL1A1, TGFB1, TGFBR1, AGTR1, CCL2 и TNF в фиброзированном миокарде более чем в три раза выше, чем в прилежащем здоровом миокарде, что может отражать активный синтез белков экстрацеллюлярного матрикса миофибробластами, дифференцирующимися из синтетически неактивных фибробластов в процессе развития фиброза миокарда, который сопровождается асептическим воспалением.

Заключение. Впервые показано, что гены AGTR1, CCL2 и TNF могут быть вовлечены в развитие фиброза у пациентов после перенесенного инфаркта миокарда; подтверждена значимость генов ACTA2, VIM, CTGF, COL1A1, TGFB1 и TGFBR1 для этого патологического процесса.

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