Skip to main content
Top
Published in: BMC Endocrine Disorders 1/2021

Open Access 01-12-2021 | Obesity | Research article

Acacetin ameliorates insulin resistance in obesity mice through regulating Treg/Th17 balance via MiR-23b-3p/NEU1 Axis

Authors: Yan Wei, Jianhong Jing, Zhiping Peng, Xiaoqian Liu, Xueyang Wang

Published in: BMC Endocrine Disorders | Issue 1/2021

Login to get access

Abstract

Background

The role of miR-23b-3p in insulin resistance (IR) remained poorly understood.

Methods

After acacetin injection, obesity-induced IR model was constructed with or without miR-23b-3p upregulation and Neuraminidase 1 (NEU1) overexpression in mice. Body weight, serum metabolite and fat percent of the mice were measured. Tests on oral glucose and insulin tolerance were performed, and inflammatory cytokines C-reactive protein (CRP), Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and monocyte chemoattractant protein 1 (MCP1) levels were quantified with enzyme-linked immunosorbent assay (ELISA). The binding sites between miR-23b-3p and NEU1 were predicted by TargetScan, and verified using dual-luciferase reporter assay. Relative expressions were detected with quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. Proportion of Treg and Th17 cells in total CD4+ T cells was detected with flow cytometry.

Results

MiR-23b-3p offset the effects of acacetin on body weight, fat percent, inflammatory cytokines levels and expressions of markers of regulatory T cells (Treg cells) and T helper 17 cells (Th17 cells), NEU1 and miR-23b-3p. NEU1 was a target of miR-23b-3p, and overexpressed NEU1 reversed the effects of upregulated miR-23b-3p on reducing Treg cells but increased body weight, fat percent and inflammatory cytokines levels, percentage of Th17 cells, and upregulated NEU1 expression.

Conclusion

Upregulation of miR-23b-3p offset the effects of acacetin on obesity-induced IR through regulating Treg/Th17 cell balance via targeting NEU1.The present findings provide a possible prevention strategy for obesity-induced IR.
Appendix
Available only for authorised users
Literature
1.
go back to reference Seravalle G, Grassi G. Obesity and hypertension. Pharmacol Res. 2017;122:1–7.CrossRef Seravalle G, Grassi G. Obesity and hypertension. Pharmacol Res. 2017;122:1–7.CrossRef
2.
go back to reference Gomez-Hernandez A, Beneit N, Diaz-Castroverde S, Escribano O. Differential role of adipose tissues in obesity and related metabolic and vascular complications. Int J Endocrinol. 2016;2016:1216783.CrossRef Gomez-Hernandez A, Beneit N, Diaz-Castroverde S, Escribano O. Differential role of adipose tissues in obesity and related metabolic and vascular complications. Int J Endocrinol. 2016;2016:1216783.CrossRef
3.
go back to reference Budiyani L, Purnamasari D, Simadibrata M, Abdullah M. Insulin resistance in Gastroesophageal reflux disease. Acta Med Indones. 2018;50(4):336–42.PubMed Budiyani L, Purnamasari D, Simadibrata M, Abdullah M. Insulin resistance in Gastroesophageal reflux disease. Acta Med Indones. 2018;50(4):336–42.PubMed
4.
go back to reference Luo W, Ai L, Wang B, Wang L, Gan Y, Liu C, Jensen J, Zhou Y. Eccentric exercise and dietary restriction inhibits M1 macrophage polarization activated by high-fat diet-induced obesity. Life Sci. 2020;243:117246.CrossRef Luo W, Ai L, Wang B, Wang L, Gan Y, Liu C, Jensen J, Zhou Y. Eccentric exercise and dietary restriction inhibits M1 macrophage polarization activated by high-fat diet-induced obesity. Life Sci. 2020;243:117246.CrossRef
5.
go back to reference Yawichai A, Kalapanulak S, Thammarongtham C, Saithong T. Genome-wide identification of putative MicroRNAs in cassava (Manihot esculenta Crantz) and their functional landscape in cellular regulation. Biomed Res Int. 2019;2019:2019846.CrossRef Yawichai A, Kalapanulak S, Thammarongtham C, Saithong T. Genome-wide identification of putative MicroRNAs in cassava (Manihot esculenta Crantz) and their functional landscape in cellular regulation. Biomed Res Int. 2019;2019:2019846.CrossRef
6.
go back to reference Gallo W, Esguerra JLS, Eliasson L, Melander O. miR-483-5p associates with obesity and insulin resistance and independently associates with new onset diabetes mellitus and cardiovascular disease. PLoS One. 2018;13(11):e0206974.CrossRef Gallo W, Esguerra JLS, Eliasson L, Melander O. miR-483-5p associates with obesity and insulin resistance and independently associates with new onset diabetes mellitus and cardiovascular disease. PLoS One. 2018;13(11):e0206974.CrossRef
7.
go back to reference Price NL, Singh AK, Rotllan N, Goedeke L, Wing A, Canfran-Duque A, Diaz-Ruiz A, Araldi E, Baldan A, Camporez JP, et al. Genetic ablation of miR-33 increases food intake, enhances adipose tissue expansion, and promotes obesity and insulin resistance. Cell Rep. 2018;22(8):2133–45.CrossRef Price NL, Singh AK, Rotllan N, Goedeke L, Wing A, Canfran-Duque A, Diaz-Ruiz A, Araldi E, Baldan A, Camporez JP, et al. Genetic ablation of miR-33 increases food intake, enhances adipose tissue expansion, and promotes obesity and insulin resistance. Cell Rep. 2018;22(8):2133–45.CrossRef
8.
go back to reference Liu T, Sun YC, Cheng P, Shao HG. Adipose tissue macrophage-derived exosomal miR-29a regulates obesity-associated insulin resistance. Biochem Biophys Res Commun. 2019;515(2):352–8.CrossRef Liu T, Sun YC, Cheng P, Shao HG. Adipose tissue macrophage-derived exosomal miR-29a regulates obesity-associated insulin resistance. Biochem Biophys Res Commun. 2019;515(2):352–8.CrossRef
9.
go back to reference Fougerat A, Pan X, Smutova V, Heveker N, Cairo CW, Issad T, Larrivee B, Medin JA, Pshezhetsky AV. Neuraminidase 1 activates insulin receptor and reverses insulin resistance in obese mice. Mol Metab. 2018;12:76–88.CrossRef Fougerat A, Pan X, Smutova V, Heveker N, Cairo CW, Issad T, Larrivee B, Medin JA, Pshezhetsky AV. Neuraminidase 1 activates insulin receptor and reverses insulin resistance in obese mice. Mol Metab. 2018;12:76–88.CrossRef
10.
go back to reference Pshezhetsky AV, Hinek A. Where catabolism meets signalling: neuraminidase 1 as a modulator of cell receptors. Glycoconj J. 2011;28(7):441–52.CrossRef Pshezhetsky AV, Hinek A. Where catabolism meets signalling: neuraminidase 1 as a modulator of cell receptors. Glycoconj J. 2011;28(7):441–52.CrossRef
11.
go back to reference Pshezhetsky AV. Crosstalk between 2 organelles: Lysosomal storage of heparan sulfate causes mitochondrial defects and neuronal death in mucopolysaccharidosis III type C. Rare Dis. 2015;3(1):e1049793.CrossRef Pshezhetsky AV. Crosstalk between 2 organelles: Lysosomal storage of heparan sulfate causes mitochondrial defects and neuronal death in mucopolysaccharidosis III type C. Rare Dis. 2015;3(1):e1049793.CrossRef
12.
go back to reference Chang S, He S, Qiu G, Lu J, Wang J, Liu J, Fan L, Zhao W, Che X. MicroRNA-125b promotes invasion and metastasis of gastric cancer by targeting STARD13 and NEU1. Tumour Biol. 2016;37(9):12141–51.CrossRef Chang S, He S, Qiu G, Lu J, Wang J, Liu J, Fan L, Zhao W, Che X. MicroRNA-125b promotes invasion and metastasis of gastric cancer by targeting STARD13 and NEU1. Tumour Biol. 2016;37(9):12141–51.CrossRef
13.
go back to reference Liou CJ, Wu SJ, Chen LC, Yeh KW, Chen CY, Huang WC. Acacetin from Traditionally Used Saussurea involucrata Kar. et Kir. Suppressed Adipogenesis in 3T3-L1 Adipocytes and Attenuated Lipid Accumulation in Obese Mice. Front Pharmacol. 2017;8:589.CrossRef Liou CJ, Wu SJ, Chen LC, Yeh KW, Chen CY, Huang WC. Acacetin from Traditionally Used Saussurea involucrata Kar. et Kir. Suppressed Adipogenesis in 3T3-L1 Adipocytes and Attenuated Lipid Accumulation in Obese Mice. Front Pharmacol. 2017;8:589.CrossRef
14.
go back to reference Yao F, Yu Y, Feng L, Li J, Zhang M, Lan X, Yan X, Liu Y, Guan F, Zhang M, et al. Adipogenic miR-27a in adipose tissue upregulates macrophage activation via inhibiting PPARgamma of insulin resistance induced by high-fat diet-associated obesity. Exp Cell Res. 2017;355(2):105–12.CrossRef Yao F, Yu Y, Feng L, Li J, Zhang M, Lan X, Yan X, Liu Y, Guan F, Zhang M, et al. Adipogenic miR-27a in adipose tissue upregulates macrophage activation via inhibiting PPARgamma of insulin resistance induced by high-fat diet-associated obesity. Exp Cell Res. 2017;355(2):105–12.CrossRef
15.
go back to reference Erickson RL, Terzi MC, Jaber SM, Hankenson FC, McKinstry-Wu A, Kelz MB, Marx JO. Intraperitoneal continuous-rate infusion for the maintenance of anesthesia in laboratory mice (Mus musculus). J Am Assoc Lab Animal Sci: JAALAS. 2016;55(5):548–57. Erickson RL, Terzi MC, Jaber SM, Hankenson FC, McKinstry-Wu A, Kelz MB, Marx JO. Intraperitoneal continuous-rate infusion for the maintenance of anesthesia in laboratory mice (Mus musculus). J Am Assoc Lab Animal Sci: JAALAS. 2016;55(5):548–57.
16.
go back to reference Nagy C, Einwallner E. Study of in vivo glucose metabolism in high-fat diet-fed mice using Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT). J Vis Exp. 2018;(131):56672. Nagy C, Einwallner E. Study of in vivo glucose metabolism in high-fat diet-fed mice using Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT). J Vis Exp. 2018;(131):56672.
17.
go back to reference Fujiyama S, Nakahashi-Oda C, Abe F, Wang Y, Sato K, Shibuya A. Identification and isolation of splenic tissue-resident macrophage sub-populations by flow cytometry. Int Immunol. 2019;31(1):51–6.CrossRef Fujiyama S, Nakahashi-Oda C, Abe F, Wang Y, Sato K, Shibuya A. Identification and isolation of splenic tissue-resident macrophage sub-populations by flow cytometry. Int Immunol. 2019;31(1):51–6.CrossRef
18.
go back to reference Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2(−Delta Delta C(T)) Method. Methods (San Diego, Calif). 2001;25(4):402–8.CrossRef Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2(−Delta Delta C(T)) Method. Methods (San Diego, Calif). 2001;25(4):402–8.CrossRef
19.
go back to reference Li J, Lai X, Liao W, He Y, Liu Y, Gong J. The dynamic changes of Th17/Treg cytokines in rat liver transplant rejection and tolerance. Int Immunopharmacol. 2011;11(8):962–7.CrossRef Li J, Lai X, Liao W, He Y, Liu Y, Gong J. The dynamic changes of Th17/Treg cytokines in rat liver transplant rejection and tolerance. Int Immunopharmacol. 2011;11(8):962–7.CrossRef
20.
go back to reference Lozano-Bartolome J, Llaurado G, Portero-Otin M, Altuna-Coy A, Rojo-Martinez G, Vendrell J, Jorba R, Rodriguez-Gallego E, Chacon MR. Altered expression of miR-181a-5p and miR-23a-3p is associated with obesity and TNFalpha-induced insulin resistance. J Clin Endocrinol Metab. 2018;103(4):1447–58.CrossRef Lozano-Bartolome J, Llaurado G, Portero-Otin M, Altuna-Coy A, Rojo-Martinez G, Vendrell J, Jorba R, Rodriguez-Gallego E, Chacon MR. Altered expression of miR-181a-5p and miR-23a-3p is associated with obesity and TNFalpha-induced insulin resistance. J Clin Endocrinol Metab. 2018;103(4):1447–58.CrossRef
21.
go back to reference Garavelli S, Bruzzaniti S, Tagliabue E, Di Silvestre D, Prattichizzo F, Mozzillo E, Fattorusso V, La Sala L, Ceriello A, Puca AA, et al. Plasma circulating miR-23~27~24 clusters correlate with the immunometabolic derangement and predict C-peptide loss in children with type 1 diabetes. Diabetologia. 2020;63(12):2699–712.CrossRef Garavelli S, Bruzzaniti S, Tagliabue E, Di Silvestre D, Prattichizzo F, Mozzillo E, Fattorusso V, La Sala L, Ceriello A, Puca AA, et al. Plasma circulating miR-23~27~24 clusters correlate with the immunometabolic derangement and predict C-peptide loss in children with type 1 diabetes. Diabetologia. 2020;63(12):2699–712.CrossRef
22.
go back to reference Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Res Clin Pract. 2014;105(2):141–50.CrossRef Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Res Clin Pract. 2014;105(2):141–50.CrossRef
23.
go back to reference de Luca C, Olefsky JM. Inflammation and insulin resistance. FEBS Lett. 2008;582(1):97–105.CrossRef de Luca C, Olefsky JM. Inflammation and insulin resistance. FEBS Lett. 2008;582(1):97–105.CrossRef
24.
go back to reference Selvaraju V, Babu JR, Geetha T. Association of salivary C-reactive protein with the obesity measures and markers in children. Diabetes Metab Syndr Obes. 2019;12:1239–47.CrossRef Selvaraju V, Babu JR, Geetha T. Association of salivary C-reactive protein with the obesity measures and markers in children. Diabetes Metab Syndr Obes. 2019;12:1239–47.CrossRef
25.
go back to reference Frias FT, Rocha KCE, de Mendonça M, Murata GM, Araujo HN, de Sousa LGO, de Sousa É, Hirabara SM, Leite NC, Carneiro EM, et al. Fenofibrate reverses changes induced by high-fat diet on metabolism in mice muscle and visceral adipocytes. J Cell Physiol. 2018;233(4):3515–28.CrossRef Frias FT, Rocha KCE, de Mendonça M, Murata GM, Araujo HN, de Sousa LGO, de Sousa É, Hirabara SM, Leite NC, Carneiro EM, et al. Fenofibrate reverses changes induced by high-fat diet on metabolism in mice muscle and visceral adipocytes. J Cell Physiol. 2018;233(4):3515–28.CrossRef
26.
go back to reference Wang H, Jiang Z, Pang Z, Zhou T, Gu Y. Acacetin alleviates inflammation and matrix degradation in nucleus Pulposus cells and ameliorates intervertebral disc degeneration in vivo. Drug design, development and therapy. 2020;14:4801–13.CrossRef Wang H, Jiang Z, Pang Z, Zhou T, Gu Y. Acacetin alleviates inflammation and matrix degradation in nucleus Pulposus cells and ameliorates intervertebral disc degeneration in vivo. Drug design, development and therapy. 2020;14:4801–13.CrossRef
27.
go back to reference Liu J, Wang YG, Yu SY, Li CE, Kang SM. Protective effect of acacetin in human periodontal ligament cells via regulation of autophagy and inflammation. Die Pharmazie. 2020;75(9):436–9.PubMed Liu J, Wang YG, Yu SY, Li CE, Kang SM. Protective effect of acacetin in human periodontal ligament cells via regulation of autophagy and inflammation. Die Pharmazie. 2020;75(9):436–9.PubMed
28.
go back to reference Sun LC, Zhang HB, Gu CD, Guo SD, Li G, Lian R, Yao Y, Zhang GQ. Protective effect of acacetin on sepsis-induced acute lung injury via its anti-inflammatory and antioxidative activity. Arch Pharm Res. 2018;41(12):1199–210.CrossRef Sun LC, Zhang HB, Gu CD, Guo SD, Li G, Lian R, Yao Y, Zhang GQ. Protective effect of acacetin on sepsis-induced acute lung injury via its anti-inflammatory and antioxidative activity. Arch Pharm Res. 2018;41(12):1199–210.CrossRef
29.
go back to reference Tao L, Liu H, Gong Y. Role and mechanism of the Th17/Treg cell balance in the development and progression of insulin resistance. Mol Cell Biochem. 2019;459(1–2):183–8.CrossRef Tao L, Liu H, Gong Y. Role and mechanism of the Th17/Treg cell balance in the development and progression of insulin resistance. Mol Cell Biochem. 2019;459(1–2):183–8.CrossRef
30.
go back to reference Zhu W, Chen X, Yu J, Xiao Y, Li Y, Wan S, Su W, Liang D. Baicalin modulates the Treg/Teff balance to alleviate uveitis by activating the aryl hydrocarbon receptor. Biochem Pharmacol. 2018;154:18–27.CrossRef Zhu W, Chen X, Yu J, Xiao Y, Li Y, Wan S, Su W, Liang D. Baicalin modulates the Treg/Teff balance to alleviate uveitis by activating the aryl hydrocarbon receptor. Biochem Pharmacol. 2018;154:18–27.CrossRef
31.
go back to reference Yang WY, Shao Y, Lopez-Pastrana J, Mai J, Wang H, Yang XF. Pathological conditions re-shape physiological Tregs into pathological Tregs. Burns Trauma. 2015;3(1):1.PubMedPubMedCentral Yang WY, Shao Y, Lopez-Pastrana J, Mai J, Wang H, Yang XF. Pathological conditions re-shape physiological Tregs into pathological Tregs. Burns Trauma. 2015;3(1):1.PubMedPubMedCentral
32.
go back to reference Lee GR. The Balance of Th17 versus Treg Cells in Autoimmunity. Int J Mol Sci. 2018;19(3):730. Lee GR. The Balance of Th17 versus Treg Cells in Autoimmunity. Int J Mol Sci. 2018;19(3):730.
33.
go back to reference Saini C, Siddiqui A, Ramesh V, Nath I. Leprosy reactions show increased Th17 cell activity and reduced FOXP3+ Tregs with concomitant decrease in TGF-beta and Increase in IL-6. PLoS Negl Trop Dis. 2016;10(4):e0004592.CrossRef Saini C, Siddiqui A, Ramesh V, Nath I. Leprosy reactions show increased Th17 cell activity and reduced FOXP3+ Tregs with concomitant decrease in TGF-beta and Increase in IL-6. PLoS Negl Trop Dis. 2016;10(4):e0004592.CrossRef
34.
go back to reference Wang M, Chen F, Wang J, Zeng Z, Yang Q, Shao S. Th17 and Treg lymphocytes in obesity and type 2 diabetic patients. Clin Immunol. 2018;197:77–85.CrossRef Wang M, Chen F, Wang J, Zeng Z, Yang Q, Shao S. Th17 and Treg lymphocytes in obesity and type 2 diabetic patients. Clin Immunol. 2018;197:77–85.CrossRef
35.
go back to reference Liu C, Yang H, Shi W, Wang T, Ruan Q. MicroRNA-mediated regulation of T helper type 17/regulatory T-cell balance in autoimmune disease. Immunology. 2018;155(4):427–34.CrossRef Liu C, Yang H, Shi W, Wang T, Ruan Q. MicroRNA-mediated regulation of T helper type 17/regulatory T-cell balance in autoimmune disease. Immunology. 2018;155(4):427–34.CrossRef
36.
go back to reference Ye L, Zuo Y, Yang H, Li W, Peng Q, Lu X, Wang G, Shu X. Specific autoantibodies and clinical phenotypes correlate with the aberrant expression of immune-related MicroRNAs in Dermatomyositis. J Immunol Res. 2019;2019:2927061.PubMedPubMedCentral Ye L, Zuo Y, Yang H, Li W, Peng Q, Lu X, Wang G, Shu X. Specific autoantibodies and clinical phenotypes correlate with the aberrant expression of immune-related MicroRNAs in Dermatomyositis. J Immunol Res. 2019;2019:2927061.PubMedPubMedCentral
37.
go back to reference Dridi L, Seyrantepe V, Fougerat A, Pan X, Bonneil E, Thibault P, Moreau A, Mitchell GA, Heveker N, Cairo CW, et al. Positive regulation of insulin signaling by neuraminidase 1. Diabetes. 2013;62(7):2338–46.CrossRef Dridi L, Seyrantepe V, Fougerat A, Pan X, Bonneil E, Thibault P, Moreau A, Mitchell GA, Heveker N, Cairo CW, et al. Positive regulation of insulin signaling by neuraminidase 1. Diabetes. 2013;62(7):2338–46.CrossRef
38.
go back to reference Natori Y, Nasui M, Edo K, Sato S, Sakurai T, Kizaki T, Kihara-Negishi F. NEU1 sialidase controls gene expression and secretion of IL-6 and MCP-1 through NF-κB pathway in 3T3-L1 adipocytes. J Biochem. 2017;162(2):137–43.PubMed Natori Y, Nasui M, Edo K, Sato S, Sakurai T, Kizaki T, Kihara-Negishi F. NEU1 sialidase controls gene expression and secretion of IL-6 and MCP-1 through NF-κB pathway in 3T3-L1 adipocytes. J Biochem. 2017;162(2):137–43.PubMed
39.
go back to reference Natori Y, Nasui M, Kihara-Negishi F. Neu1 sialidase interacts with perilipin 1 on lipid droplets and inhibits lipolysis in 3T3-L1 adipocytes. Genes to cells : devoted to molecular & cellular mechanisms. 2017;22(5):485–92.CrossRef Natori Y, Nasui M, Kihara-Negishi F. Neu1 sialidase interacts with perilipin 1 on lipid droplets and inhibits lipolysis in 3T3-L1 adipocytes. Genes to cells : devoted to molecular & cellular mechanisms. 2017;22(5):485–92.CrossRef
Metadata
Title
Acacetin ameliorates insulin resistance in obesity mice through regulating Treg/Th17 balance via MiR-23b-3p/NEU1 Axis
Authors
Yan Wei
Jianhong Jing
Zhiping Peng
Xiaoqian Liu
Xueyang Wang
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2021
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/s12902-021-00688-8

Other articles of this Issue 1/2021

BMC Endocrine Disorders 1/2021 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.