Insulin signaling regulates cardiac titin properties in heart development and diabetic cardiomyopathy

Isoform-switching of the giant elastic protein titin is a main mechanism for adjusting passive myocardial stiffness in perinatal heart development and chronic heart disease. Previous evidence suggested that thyroid-hormone signaling converging onto the phosphoinositol-3-kinase (PI3K)/AKT pathway regulates titin-isoform composition in developing cardiomyocytes. Here we hypothesized that insulin, another activator of PI3K/AKT, alters titin-isoform composition and titin-based stiffness. We also checked for insulin-induced changes in titin phosphorylation. In embryonic rat cardiomyocytes cultured in the presence of insulin for 7 days, the mean proportion of the stiff N2B-titin isoform (M(w), 3000 kDa) significantly increased from 53% in controls to 65% in insulin-treated cells, the remainder being the more compliant N2BA-isoforms (M(w), 3200-3700 kDa). This insulin-dependent titin-isoform shift was blocked by PI3K-inhibitor, LY294002, suggesting that insulin controls the cardiac titin-isoform pattern by activating PI3K/AKT. Titin phosphorylation was substantially increased in insulin-treated compared to control cardiomyocytes. The impact of insulin-deficiency in vivo on titin-isoform expression, titin phosphorylation, and passive myocardial stiffness was studied in streptozotocin-treated (STZ) rats as a model of diabetes mellitus type-1. Within 5 months, STZ rats developed cardiac hypertrophy and mild left ventricular fibrosis, concomitant with elevated glucose levels. The mean proportion of N2B-titin was slightly but significantly decreased from 86% in controls to 79% in STZ hearts. Titin phosphorylation levels remained unchanged. Mechanical measurements on skinned cardiac fibers showed only minor passive stiffness modifications in STZ myocardium. We conclude that insulin signaling regulates titin-isoform composition and titin phosphorylation in embryonic cardiomyocytes and could also contribute to altered diastolic function in diabetic cardiomyopathy.