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Cardiac myocyte–secreted cAMP exerts paracrine action via adenosine receptor activation
Yassine Sassi, Andrea Ahles, Dong-Jiunn Jeffery Truong, Younis Baqi, Sang-Yong Lee, Britta Husse, Jean-Sébastien Hulot, Ariana Foinquinos, Thomas Thum, Christa E. Müller, Andreas Dendorfer, Bernhard Laggerbauer, Stefan Engelhardt
Yassine Sassi, Andrea Ahles, Dong-Jiunn Jeffery Truong, Younis Baqi, Sang-Yong Lee, Britta Husse, Jean-Sébastien Hulot, Ariana Foinquinos, Thomas Thum, Christa E. Müller, Andreas Dendorfer, Bernhard Laggerbauer, Stefan Engelhardt
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Research Article Cardiology

Cardiac myocyte–secreted cAMP exerts paracrine action via adenosine receptor activation

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Abstract

Acute stimulation of cardiac β-adrenoceptors is crucial to increasing cardiac function under stress; however, sustained β-adrenergic stimulation has been implicated in pathological myocardial remodeling and heart failure. Here, we have demonstrated that export of cAMP from cardiac myocytes is an intrinsic cardioprotective mechanism in response to cardiac stress. We report that infusion of cAMP into mice averted myocardial hypertrophy and fibrosis in a disease model of cardiac pressure overload. The protective effect of exogenous cAMP required adenosine receptor signaling. This observation led to the identification of a potent paracrine mechanism that is dependent on secreted cAMP. Specifically, FRET-based imaging of cAMP formation in primary cells and in myocardial tissue from murine hearts revealed that cardiomyocytes depend on the transporter ABCC4 to export cAMP as an extracellular signal. Extracellular cAMP, through its metabolite adenosine, reduced cardiomyocyte cAMP formation and hypertrophy by activating A1 adenosine receptors while delivering an antifibrotic signal to cardiac fibroblasts by A2 adenosine receptor activation. Together, our data reveal a paracrine role for secreted cAMP in intercellular signaling in the myocardium, and we postulate that secreted cAMP may also constitute an important signal in other tissues.

Authors

Yassine Sassi, Andrea Ahles, Dong-Jiunn Jeffery Truong, Younis Baqi, Sang-Yong Lee, Britta Husse, Jean-Sébastien Hulot, Ariana Foinquinos, Thomas Thum, Christa E. Müller, Andreas Dendorfer, Bernhard Laggerbauer, Stefan Engelhardt

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Figure 5

Model of signal transmission between adrenergically stimulated CMs and CFs through secreted cAMP.

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Model of signal transmission between adrenergically stimulated CMs and C...
In CMs (left), stimulation of βARs activates adenylate cyclase (AC) via Gs, causing rapid cAMP formation. This second messenger has the potential to elicit inotropic effects and CM hypertrophy and apoptosis. Alternatively, ABC proteins, in particular ABCC4, export cAMP, which is stepwise metabolized by ENPP1 and NT5E to adenosine. Adenosine feeds back onto vicinal CMs through binding to its predominant adenosine receptor subtype, A1R, thereby engaging Gi to inhibit intracellular cAMP formation. On CFs (right), adenosine activates its predominant receptor subtypes, A2AR and A2BR. Their coupling to Gs activates adenylate cyclase, thus enhancing cAMP formation, which, in this cell type, inhibits proliferation and extracellular matrix deposition (thus preventing cardiac fibrosis).

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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