C oronary heart disease resulting in myocardial infarction (MI) is the major cause of death in men and women. 1 Each year about 735 000 people in the United States have an MI and most suffer irreversible tissue damage, leading to...
moreC oronary heart disease resulting in myocardial infarction (MI) is the major cause of death in men and women. 1 Each year about 735 000 people in the United States have an MI and most suffer irreversible tissue damage, leading to ventricular remodeling, hypertrophy, dilatation, and eventually heart failure. 2 After MI, the adult heart undergoes a sequence of molecular and cellular events that delineate the different stages of tissue repair. Initially, cardiomyocytes within infarcted myocardium begin to die within minutes after coronary artery occlusion. 3 Toxic products and signals released from dying cells induce endothelial cell adhesion proteins, as well as cytokines and chemokines, to recruit inflammatory cells that remove tissue debris, and activate proteases to degrade extra-cellular matrix. 4 After debris is cleared, usually within 2 to 3 days after MI, the gap is filled with granulation tissue that is composed of proliferating cells, mainly endothelial cells that form new capillaries, and myofibroblasts that secrete collagen and other matrix proteins. 5 Two to 3 weeks after the original Rationale: We have recently shown that the bone morphogenetic protein (BMP) antagonist Gremlin 2 (Grem2) is required for early cardiac development and cardiomyocyte differentiation. Our initial studies discovered that Grem2 is strongly induced in the adult heart after experimental myocardial infarction (MI). However, the function of Grem2 and BMP-signaling inhibitors after cardiac injury is currently unknown. Objective: To investigate the role of Grem2 during cardiac repair and assess its potential to improve ventricular function after injury. Methods and Results: Our data show that Grem2 is transiently induced after MI in peri-infarct area cardiomyocytes during the inflammatory phase of cardiac tissue repair. By engineering loss-(Grem2 −/−) and gain-(TG Grem2) of-Grem2-function mice, we discovered that Grem2 controls the magnitude of the inflammatory response and limits infiltration of inflammatory cells in peri-infarct ventricular tissue, improving cardiac function. Excessive inflammation in Grem2 −/− mice after MI was because of overactivation of canonical BMP signaling, as proven by the rescue of the inflammatory phenotype through administration of the canonical BMP inhibitor, DMH1. Furthermore, intraperitoneal administration of Grem2 protein in wild-type mice was sufficient to reduce inflammation after MI. Cellular analyses showed that BMP2 acts with TNFα to induce expression of proinflammatory proteins in endothelial cells and promote adhesion of leukocytes, whereas Grem2 specifically inhibits the BMP2 effect. Conclusions: Our results indicate that Grem2 provides a molecular barrier that controls the magnitude and extent of inflammatory cell infiltration by suppressing canonical BMP signaling, thereby providing a novel mechanism for limiting the adverse effects of excessive inflammation after MI. (Circ Res. 2016;119:434-449.