Method for treating cardiac remodeling following myocardial injury

Abstract

The invention concerns methods for treating cardiac remodeling in a subject who has undergone myocardial injury, said method comprising the administration of natriuretic peptide to said subject. Preferably the natriuretic peptide is brain natriuretic peptide. The invention also concerns methods for treating structural heart disorders arising from myocardial injury, said method comprising the administration of a natriuretic peptide to a patient in need thereof.

Description

FIELD OF THE INVENTION

The present invention concerns methods of treatment using one or more natriuretic peptides or derivatives thereof. More specifically, the invention concerns methods of treating or preventing cardiac dysfunction in a subject after said subject has undergone myocardial injury.

BACKGROUND

Myocardial infarction is a major cause of significant disability and death in the United States and in many other countries around the world, and accounts for approximately ⅔ of all heart failure. Hunt et al, AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN Heart Association. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). Journal of the American College of Cardiology 2001; 38: 2101-2113. Several disease-initiating events (e.g. myocardial infarction, untreated hypertension, congenital mutations of contractile proteins) can result in a common heart disease phenotype that consists of dilation of the cardiac chambers, resulting in reduction in contractile function (i.e., a decrease in the fraction of total blood ejected from each chamber during systole) that leads to the clinical syndrome of heart failure. This phenotype generally involves a compensatory aspect that results from myocardial infarction when the normal compensatory hypertrophy of surviving, non-infarcted myocardium is insufficient. Often this compensatory mechanism is a result of the profibrotic response associated with cardiac injury.

Available therapies for heart dysfunction are insufficient, and new methods of treatment are needed. The heart responds to infarction by hypertrophy of surviving cardiac muscle in an attempt to maintain normal contraction. However, when the hypertrophy is insufficient to compensate, cardiac remodeling and reduced cardiac function result, leading to heart failure and death. Despite important advances in medical therapies for preventing cardiac dysfunction and heart failure after myocardial infarction, these problems remain a significant unsolved public health problem.

No pharmacological therapy for post MI cardiac remodeling is curative or satisfactory, and many patients die or, in selected cases, undergo heart transplantation. Presently available pharmacological therapies for reducing cardiac dysfunction and reducing mortality in patients with heart failure fall into three main categories: angiotensin-converting enzyme (ACE) inhibitors, beta adrenergic receptor (OAR) antagonists, and aldosterone antagonists. Despite reducing mortality, patients treated with these medicines remain at significantly increased rislc for death compared to age-matched control patients without heart failure. ACE inhibitors, βAR antagonists and (at least one type of) aldosterone receptor antagonist can significantly reduce the incidence and extent of cardiac dysfunction and heart failure after myocardial infarction.

ACE inhibitors are associated with cough in 10% of patients and can result in renal failure in the setting of bilateral renal artery stenosis or other severe kidney disease. βAR antagonists are associated with impotence and depression, and are contraindicated in patients with asthma; furthermore, patients may develop worsened heart failure, hypotension, bradycardia, heart block, and fatigue with initiation of βAR antagonists. Aldosterone receptor antagonism causes significant hyperkalemia and painful gynecomastia in 10% of male patients. Agents without a demonstrated mortality benefit are also associated with problems; most notable is the consistent finding that many cardiac stimulants improve symptoms, but actually increase mortality, likely by triggering lethal cardiac arrhythmias. In summary, presently available pharmacological therapies are ineffective and are limited by significant unwanted side effects, and so development of new therapies with improved efficacy and less severe side effects is an important public health goal.

SUMMARY OF THE INVENTION

The present invention is directed to the use of natriuretic peptides for the prevention and/or treatment of cardiac remodeling in a subject that has undergone myocardial injury. In a preferred embodiment, the natriuretic peptide(s) comprise brain natriuretic peptide (BNP), also known as nesiritide. In another embodiment, the invention is directed to the treatment of cardiac dysfunction, said treatment comprising the administration of a therapeutically effective amount of natriuretic peptide to a subject that has undergone myocardial injury.

In another related embodiment, the invention is directed to a method of alleviating or reversing the effect of TGFβ mediated cell activation in cardiac tissue on the expression of one or more genes associated with fibrosis, comprising contacting one or more cells or tissues in which the expression of said genes is altered as a result of TGFβ mediated activation, with BNP. In another related embodiment, the targeted gene(s) associated with fibrosis are selected from the group consisting essentially of Collagen1, Collagent 3, Fibronectin, CTGF, PAI-1, and TIMP3.

In another embodiment, the invention is directed to a method of inhibiting the production of Collagen 1, Collagen 3 or Fibronectin proteins by the administration of a therapeutically effective amount of BNP to a subject in need thereof.

In another related embodiment, the invention is directed to a method of inhibiting TGFβ mediated myofibroblast conversion by administration of a therapeutically effective amount of BNP to a mammalian subject in need thereof.

In another related embodiment, the invention is directed to a method of alleviating or reversing the effect of TGFβ mediated cell activation in cardiac tissue on the expression of one or more genes associated with cell proliferation, comprising contacting one or more cells or tissues in which the expression of said genes is altered as a result of TGFβ mediated activation, with BNP. In another related embodiment, the targeted gene(s) associated with cell proliferation are selected from the group consisting essentially of PDGFA, IGF1, FGF18, and IGFBP10.

In another related embodiment, the invention is directed to a method of alleviating or reversing the effect of TGFβ mediated cell activation in cardiac tissue on the expression of one or more genes associated with inflammation, comprising contacting one or more cells or tissues in which the expression of said genes is altered as a result of TGFβ mediated activation, with BNP. In another related embodiment, the targeted gene(s) associated with inflammation are selected from the group comprise COX1, IL6, TNFα-inducted protein 6, TNF superfamily, member 4.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. Gene expression changes induced by TGFβ and BNP in human cardiac fibroblasts at 24 and 48 h. Histograms show the number of gene expression changes that were up-regulated and down-regulated by TGFβ and BNP treatment. Hybridizations using fluorescently-labeled cDNA probes compare untreated (control) to TGFβ-treated cells and control to BNP-treated cells. See Experimental for details related to the gene expression values. Histogram bars: 24 h (white) and 48 h (black).

FIG. 2. Effects of BNP on TGFβ-induced gene expression in human cardiac fibroblasts. Hybridizations using fluorescently-labeled cDNA probes compare TGFβ-treated to TGFβ BNP-treated cells at 24 and 48 h. Strong and weak effects represent 1.8- and 1.5-fold gene expression levels, respectively. See Experimental for details related to statistical significance. Histogram bars: no effect (white), weak effect (grey), and strong effect (black).

FIG. 3. Gene expression patterns in TGFβ-treated human cardiac fibroblasts. Data was generated using the hierarchical clustering algorithm contained in Spotfire™ software. Each row represents one of 524 genes, and each column represents the results from duplicate hybridizations: (A) control vs. TGFβ, 24 h; (B) control vs. TGFβ, 48 h; (C) TGFβ vs. TGFβ+BNP 24 h; (D) TGFβ vs. TGFβ+BNP 48 h; (E) control vs. BNP 24 h; and (F) control vs. BNP 48 h. Normalized data values depicted in shades of red and green represent elevated and repressed expression, respectively. See Table 2 in Experimental section for gene identities and expression values.

FIG. 4. Gene expression clusters in human cardiac fibroblasts: (A) fibrosis and ECM, (B) cell proliferation, and (C) inflammation. See FIG. 4 legend for descriptions of the hybridizations and gene expression color codes.

FIG. 5. Effects of BNP on TGFβ-induced Collagen 1 (A and B) and Fibronectin (C and D) mRNA and protein levels in cultured human cardiac fibroblasts. Histograms show control cells (white), cells treated with BNP (gray), cells treated with TGFβblack), and cells co-treated with BNP and TGFβ(hatched). (A and C) Real-time RT-PCR expression levels were normalized to 18S rRNA and plotted relative to the level in the 6 h control cells. Error bars reflect duplicate biological replicates; real-time RT-PCR reactions were performed in triplicate. (B and D) Western blot analyses are presented as mean±SD from three separate experiments; *p<0.01 vs. control; **p<0.01 vs. TGFβ.

FIG. 6. Effects of BNP on TGFβ-induced fibrotic and inflammatory genes. Real-time RT-PCR expression levels were normalized to 18S rRNA and plotted relative to the level in the 6 h control cells. See FIG. 5 for key to histogram bar labels and error bars.

FIG. 7. Effect of PKG and MEK inhibitors on BNP-dependent inhibition of TGFβ signaling in human cardiac fibroblasts. (A) Western analysis of ERK phosphorylation. Cells were treated with BNP (0.5 μmol/L) in the presence or absence of KT5823 (1 μmol/L) or U0126 (10 μmol/L) for 15 min. (B) Western blot and (C) real-time RT-PCR analysis to detect Collagen 1 expression. Cells were treated with 5 ng/ml TGFβ and/or BNP (100 nmol/L, three times daily) in the presence or absence of KT5823 (1 μmol/L), U0126 (0.1-10 μmol/L) or PD98059 (10 μmol/L) for 48 h. Control (C); KT5823 (KT); U0126 (U); TGFβ (TGF).

FIG. 8. Summary of BNP effects on gene expression in TGFβ-stimulated human cardiac fibroblasts.

FIG. 9. Effects of BNP on TGFβ-stimulated fibroblast proliferation. Histograms show fold induction of BrdU labeled cells treated with TGFβ alone, BNP alone or co-treated with BNP and TGFβ. Cells were co-treated with BNP and TGFβ for 24 h, then labeled with BrdU and cultured for an additional 24 h. Pooled data represent the mean±SD from three individual experiments: *p<0.01 vs. the control; **p<0.05 vs. TGFβ.

FIG. 10. Changes in plasma aldosterone level. The increased plasma aldosterone level by L-NAME/AngII was reduced by BNP (p<0.05, n=7)

FIG. 11. Changes in heart/body weight ratio. BNP abolished L-NAME/AngII-induced increase in heart/body weight ratio (p<0.01, n=12)

FIG. 12. Real time RT-PCR results. Expression of mRNA of collagen I (A), collagen III (B) and fibronectin (C) in the heart. BNP abolished the fibrotic genes that enhanced by L-NAME plus Angiotensin II (p<0.01 in all cases).

FIG. 13. Cardiac function parameters including heart rate (A), stroke volume (B), ejection fraction (C), cardiac output (D), stroke work (E), maximum dP/dt (F), minimum dP/fy (G), and arterial elastance (H). L-NAME/AngII induced deterioration of cardiac function. Administration of BNP significantly improved cardiac function as judged by increases in stroke volume, ejection fraction, cardiac output, stroke work and decrease in arterial elastance (p<0.001, n=8). BNP also increased maximum dP/dt (p<0.05) and minimum dP/dt. BNP had no effect on heart rate.

DETAILED DESCRIPTION

A. Definitions

As used herein, any reference to “reversing the effect of TGF-β-mediated cell activation on the expression of a gene associated with fibrosis” means partial or complete reversal the effect of TGF-β-mediated cell activation of that gene, relative to a normal sample of the same cell or tissue type. It is emphasized that total reversal (i.e. total return to the normal expression level) is not required, although is advantageous, under this definition.

The term “cardiac remodeling” generally refers to the compensatory or pathological response following myocardial injury. Cardiac remodeling is viewed as a key determinant of the clinical outcome in heart disorders. It is characterized by a structural rearrangement of the cardiac chamber wall that involves cardiomyocyte hypertrophy, fibroblast proliferation, and increased deposition of extracellular matrix (ECM) proteins. Cardiac fibrosis is a major aspect of the pathology typically seen in the failing heart. The proliferation of interstitial fibroblasts and increased deposition of extracellular matrix components results in myocardial stiffness and diastolic dysfunction, which ultimately leads to heart failure. A number of neurohumoral or growth factors have been implicated in the development of cardiac fibrosis. These include angiotensin II (AII), endothelin-1 (ET-1), cardiotrophin-1 (CT-1), norepinephrine (NE), aldosterone, FGF2, PDGF, and transforming growth factored (TGFβ). TGFβ expression is also stimulated by AII and ET-1 in cardiac myocytes and fibroblasts, further supporting its involvement in cardiac fibrosis.

The term “cardiac dysfunction” refers to the pathological decline in cardiac performance following myocardial injury. Cardiac dysfunction may be manifested through one or more parameters or indicia including changes to stroke volume, ejection fraction, end diastolic fraction, stroke work, arterial elastance, or an increase in heart weight to body weight ratio.

The terms “differentially expressed gene,” “differential gene expression” and their synonyms, which are used interchangeably, refer to a gene whose expression is activated to a higher or lower level in a test sample relative to its expression in a normal or control sample. For the purpose of this invention, “differential gene expression” is considered to be present when there is at least an about 2.5-fold, preferably at least about 4-fold, more preferably at least about 6-fold, most preferably at least about 10-fold difference between the expression of a given gene in normal and test samples.

“Myocardial injury” means injury to the heart. It may arise from myocardial infarction, cardiac ischemia, cardiotoxic compounds and the like. Myocardial injury may be either an acute or nonacute injury in terms of clinical pathology. In any case it involves damage to cardiac tissue and typically results in a structural or compensatory response.

As used herein, “natriuretic peptides” means a composition that includes one or more of an Atrial natriuretic peptide (ANP), a Brain natriuretic peptide (BNP), or a C-type natriuretic peptide (CNP). It is contemplated that analogues and variants of these peptides be included in the definition. Examples of such include anaritide (ANP analogue of different length) or combinations of natriuretic peptide including but not limited to ANP/BNP, ANP/CNP, an BNP/CNP variants. Preferably, natriuretic peptide means BNP (nesiritide).

The terms “treating” or “alleviating” refer to both therapeutic treatment and prophylactic or preventative measures, wherein the object is to prevent or slow down (lessen) the targeted pathologic condition or disorder. Those in need of treatment include those already with the disorder as well as those prone to have the disorder or those in whom the disorder is to be prevented. In the treatment of a fibroproliferative disease, a therapeutic agent may directly decrease the pathology of the disease, or render the disease more susceptible to treatment by other therapeutic agents.

The term “subject” for purposes of treatment refers to any animal classified as a mammal, including humans, domestic and farm animals, and zoo, sports, or pet animals, such as dogs, cats, cattle, horses, sheep, pigs, goats, rabbits, etc. Preferably, the subject is human.

Administration “in combination with” one or more further therapeutic agents includes simultaneous (concurrent) and consecutive administration in any order.

A “therapeutically effective amount”, in reference to the treatment of cardiac or renal fibrosis, e.g. when inhibitors of the present invention are used, refers to an amount capable of invoking one or more of the following effects: (1) inhibition (i.e., reduction, slowing down or complete stopping) of the development or progression of fibrosis and/or sclerosis; (2) inhibition (i.e., reduction, slowing down or complete stopping) of consequences of or complications resulting from such fibrosis and/or sclerosis; and (3) relief, to some extent, of one or more symptoms associated with the fibrosis and/or sclerosis, or symptoms of consequences of or complications resulting from such fibrosis and/or sclerosis.

B. Modes of Carrying out the Invention

Natriuretic peptides comprise a family of vasoactive hormones that play important roles in the regulation of cardiovascular and renal homeostasis. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are predominantly produced in the heart and exert vasorelaxant, natriuretic, and anti-growth activities. Binding of ANP and BNP to type-A natriuretic peptide receptor (NPRA) leads to the generation of cyclic guanosine monophosphate (cGMP), which mediates most biological effects of the peptides. Mice lacking NPRA exhibit cardiac hypertrophy, fibrosis, hypertension and increased expression of fibrotic genes including TGFβ1, TGFβ3 and Collagen 1. Furthermore, targeted disruption of the BNP gene in mice results in cardiac fibrosis and enhanced fibrotic response to ventricular pressure overload, suggesting that BNP is involved in cardiac remodeling.

TGFβ mediates fibrosis by modulating fibroblast proliferation and ECM production, particularly of collagen and fibronectin. TGFβ also promotes the phenotypic transformation of fibroblasts into myofibroblasts characterized by expression of α-smooth muscle actin. Studies have demonstrated that increased myocardial TGFβ expression is associated with cardiac hypertrophy and fibrosis. Moreover, functional blockade of TGFβ prevents myocardial fibrosis and diastolic dysfunction in pressure overloaded rats, indicating that TGFβ has a crucial role in the process of myocardial remodeling, particularly in cardiac fibrosis. However, the implication of natriuretic peptide(s) in this process has not been previously explored.

The present invention is directed to the treatment or prevention of cardiac remodeling following myocardial injury. In a preferred embodiment, the myocardial injury comprises an acute myocardial infarction. Preferably the administration of natriuretic peptide occurs as soon as possible after the injury event.

In another embodiment, the invention involves the treatment of cardiac dysfunction in a subject in need thereof comprising the administration of a natriuretic peptide to a subject in need thereof wherein said administration occurs after said subject has undergone myocardial injury.

The manner of administration and formulation of the natriuretic peptide(s) useful in the invention will depend on the nature of the condition, the severity of the condition, the particular subject to be treated, and the judgment of the practitioner; formulation will depend on mode of administration. The peptides of the invention are conveniently administered by oral administration by compounding them with suitable pharmaceutical excipients so as to provide tablets, capsules, syrups, and the like. Suitable formulations for oral administration may also include minor components such as buffers, flavoring agents and the like. Typically, the amount of active ingredient in the formulations will be in the range of about 5%-95% of the total formulation, but wide variation is permitted depending on the carrier. Suitable carriers include sucrose, pectin, magnesium stearate, lactose, peanut oil, olive oil, water, and the like.

The peptides useful in the invention may also be administered through suppositories or other transmucosal vehicles. Typically, such formulations will include excipients that facilitate the passage of the compound through the mucosa such as pharmaceutically acceptable detergents.

The peptides may also be administered by injection, including intravenous, intramuscular, subcutaneous, intrarticular or intraperitoneal injection. Preferably the natriuretic peptide(s) are administered intravenously. Typical formulations for such use are liquid formulations in isotonic vehicles such as Hank's solution or Ringer's solution.

Alternative formulations include aerosol inhalants, nasal sprays, liposomal formulations, slow-release formulations, and the like, as are known in the art.

Any suitable formulation may be used. A compendium of art-known formulations is found in Remington's Pharmaceutical Sciences, latest edition, Mack Publishing Company, Easton, Pa. Reference to this manual is routine in the art.

The dosages of the peptide(s) of the invention will depend on a number of factors which will vary from patient to patient. The dose regimen will vary, depending on the conditions being treated and the judgment of the practitioner. Further information regarding related formulations and dosages for brain natriuretic peptide can be found in the package insert or the latest version of Physicians Desk Reference (PDR) for nesiritide or the Natrecor® product.

It should be noted that the peptides useful for the invention can be administered as individual active ingredients, or as mixtures of several different compounds. In addition, the peptide(s) can be used as single therapeutic agents or in combination with other therapeutic agents. Drugs that could be usefully combined with these compounds include natural or synthetic corticosteroids, particularly prednisone and its derivatives, monoclonal antibodies targeting cells of the immune system or genes associated with the development or progression of fibrotic diseases, and small molecule inhibitors of cell division, protein synthesis, or mRNA transcription or translation, or inhibitors of immune cell differentiation or activation.

As implicated above, although the peptide(s) of the invention may be used in humans, they are also available for veterinary use in treating non-human mammalian subjects.

Further details of the invention will be apparent from the Experimental section as provided below.

EXPERIMENTAL

In vitro

Cell Culture

Two lots of primary human cardiac fibroblasts, derived from an 18-year old Caucasian male (lot 1) and a 56-year old Caucasian male (lot 2), were provided by Cambrex Bio Science (Walkersville, Md.). Cells stained positive for α-smooth muscle actin and vimenfin antibodies corroborating their identity as cardiac fibroblasts and myofibroblasts. Both lots were used for the real-time RT-PCR studies; lot 1 was used for the microarray analysis. Cells at passage 3-5 were cultured in FGM containing 15% FBS. At confluence, cells were split and cultured in 6-well plates for 24 h. Cells were changed to serum-free medium and treated with human BNP (American Peptide Company, Sunnyvale, Calif.) in the presence or absence of 5 ng/ml of TGFβ (R&D systems, Minneapolis, Minn.) for 6, 24 and 48 h. BNP and/or TGFβ-treated cells were also incubated in the presence of cGMP-dependent protein kinase (PKG) inhibitor KT5823 (1 μmol/L, Calbiochem, San Diego, Calif.), MAP kinase kinase (MEK) inhibitor U0126 (0.1-10 μmol/L, Sigma, St. Louis, Mo.) or PD98059 (10 μmol/L, Sigma) for 48 h. BNP (100 nmol/L) was added into the medium three times a day, such that the total calculated concentrations of exogenous BNP were 200 nmol/L, 600 nmol/L, and 900 nmol/L at 6, 24, and 48 h, respectively. This dosing protocol was necessary to maintain the levels of BNP in culture, since two distinct clearance pathways are responsible for the rapid degradation of natriuretic peptides. Without this treatment regime, it was found that BNP was significantly degraded in the cardiac fibroblasts; 50% of added BNP was metabolized within 24 h as measured by immunoreactive assays and cGMP stimulation cell bioassays.

Intracellular cGMP Assay

Cells were cultured in 6-well plates for 24 h, then changed to serum-free medium, and pre-incubated with 0.1 mmol/L of 3-isobutyl-1-methylxanthine (IBMX) for 1 h before treating with 10⁻⁹-10⁻⁶ mol/L of BNP for 10 min. The medium was aspirated and 0.5 ml of cold PBS was added into each well. Cells were scraped and mixed with 2 volumes of cold ethanol by vortex. After a 5 min room temperature incubation, the precipitate was removed by centrifugation at 1500×g for 10 min. The supernatant was dried by vacuum centrifugation, and levels of cGMP were measured using the cyclic GMP EIA kit (Cayman Chemical, Ann Arbor, Mich.).

BrdU incorporation

Cells were placed in 96-well plates and cultured for 24 h before changing to serum-free medium. Cells were treated with BNP (100 nmol/L, three times a day) in the presence or absence of 5 ng/ml of TGF-β for 24 h. Subsequently, 10 μmol/L of 5-bromo-2′-deoxyuridine (BrdU) was added to the cells, and they were cultured for an additional 24 h. BrdU incorporation was detected using the Cell Proliferation ELISA kit (Roche, Indianapolis, Ind.). Data was analyzed by ANOVA using the Newman-Keuls test to assess significance.

cDNA Microarray

Gene expression profiles were determined from cDNA microarrays containing 8,600 elements derived from clones isolated from normalized cDNA libraries or purchased from ResGen (Invitrogen Life Technologies, Carlsbad, Calif.). DNA for spotting was generated by PCR amplification using 5′amino-modified primers (BD Biosciences Clontech, Palo Alto, Calif.) derived from flanking vector sequences. Amplified DNA was purified in a 96-well format using Qiagen's Qiaquick columns (Valencia, Calif.) according to the manufacturer's recommendations. Samples were eluted in Milli-Q purified water, dried to completion and resuspended in 7 μl of 3×SSC. A fluorescent assay using PicoGreen (Molecular Probes, Eugene, Oreg.) was randomly performed on 12% of the PCR products to determine the average yield after purification; yields were ˜1.5 μg of DNA which corresponds to a concentration of 214 μg/ml. Purified DNA was arrayed from 384-well microtiter plates onto lysine-coated glass slides using an OmniGrid II microarrayer (GeneMachines, San Carlos, Calif.). After printing, DNA was cross-linked to the glass with 65 mjoules UV irradiation and reactive amines were blocked by treatment with succinic anhydride.

mRNA Isolation, Labeling, and Hybridizations

Total RNA was extracted from cells using Qiagen's RNeasy kit; two wells from a 6 well plate were pooled to yield a total of 4×10⁵ cells per treatment. RNA was amplified using a modified Eberwine protocol⁵ that incorporated a polyA tail into the amplified RNA. Fluorescently-labeled cDNA probes were generated by reverse transcription of 4 μg of RNA with SuperScript II (Invitrogen Life Technologies, Carlsbad, Calif.) using anchored dT primers in the presence of Cy3 or Cy5 dUTP (Amersham, Piscataway, N.J.). Labeled cDNA probe pairs were precipitated with ethanol and purified using Qiaquick columns. Twenty μg each of poly(A) DNA, yeast tRNA, and human Cot1 DNA (Applied Genetics, Melbourne, Fla.) was added to the eluant. The samples were dried to completion and resuspended in 12.5 μl 3×SSC, 0.1% SDS. Probes were heated to 95° C. for 5 minutes, applied to the arrays under a 22 mm² cover slip and allowed to hybridize for at least 16 h at 65° C. The arrays were washed at 55° C. for 10 minutes in 2×SSC, 0.1% SDS, followed by two washes at room temperature in 1×SSC (10 min) and 0.2×SSC (15 min). Hybridization of each fluorophore was quantified using an Axon GenePix 4000A scanner.

Microarray Data Analysis

Differential expression values were expressed as the ratio of the median of background-subtracted fluorescent intensity of the experimental RNA to the median of background-subtracted fluorescent intensity of the control RNA. For ratios greater than or equal to 1.0, the ratio was expressed as a positive value. For ratios less than 1.0, the ratio was expressed as the negative reciprocal (i.e., a ratio of 0.5=−2.0). Median ratios were normalized to 1.0 using two pools of 3000 randomly chosen cDNAs in each pool. Six replicates of each of the two pools were printed in 4 evenly distributed blocks of the array. Expression data was rejected if neither channel produced a signal of at least 2.0-fold over background. Differential expression ratios were determined as the mean of the two values from dye-swapped duplicates.

A statistically significant differential expression threshold value was empirically determined according to the method of Yang et al.⁵³ Seven independent self-self-hybridizations were performed in which the same RNA sample was labeled with Cy3 dUTP and Cy5 dUTP and hybridized to arrays containing 8,448 elements. Only elements that gave a signal greater than 2.0-fold over background in at least one of the dyes were considered in the analysis. Expression ratios were converted to log₍₂₎ and normalized to a mean=0. Combining data from all hybridizations, the 3 standard deviation limit was equivalent to a 1.48 fold change (+/−0.563 log₍₂₎). Of the 45,633 elements analyzed, 0.85% fell outside this threshold. Therefore, at this standard deviation limit, genes with fold changes greater than 1.48 can be considered differentially expressed at a 99% confidence level for any given hybridization. The percentage of elements that reproducibly fell outside the 3 standard deviation limit between any two duplicates of the seven self-self hybridizations was determined by comparing all 21 pair-wise combinations. An average of 18.9 elements +/−15.6 per hybridization duplicated at a fold change of 1.5, corresponding to a false positive rate of 0.29%. At a fold change of 1.8, an average of 0.71 elements +/−0.97 duplicated, corresponding to a false positive rate of 0.01%. A 1.8-fold threshold value was used to identify differentially expressed genes, except in FIG. 3, a 1.5-fold threshold value was used to designate “weak effects”.

Real-Time RT-PCR

Real-time RT-PCR¹⁸ was performed in a two-step manner. cDNA synthesis and real-time detection were carried out in a PTC-100™ Thermal Cycler (MJ Research Inc, Waltham, Mass.) and an ABI Prism™ 7700 Sequence Detection System (Applied Biosystems, Foster City, Calif.), respectively. Random hexamers (Qiagen, Valencia, Calif.) were used to generate cDNA from 200 ng RNA as described in Applied Biosystems User Bulletin #2. TaqMan™ PCR Core Reagent Kit or TaqMan™ Universal PCR Master Mix (Applied Biosystems) were used in subsequent PCR reactions according to the manufacturer's protocols. Relative quantitation of gene expression was performed using the relative standard curve method. All real-time RT-PCR reactions were performed in triplicate.

Sequence specific primers and probes were designed using Primer Express Version 2 software (Applied Biosystems). Sequences of primers and probes can be found in Table 1 below. Expression levels were normalized to 18S rRNA. The selection of 18S rRNA as an endogenous control was based on an evaluation of the ΔC_T levels (Applied Biosystems document # 4308134C) of 6 “housekeeping” genes: Cyclophilin A, 18S, GAPDH, β-actin, β-Glucuronidase, and Hypoxanthine Guanine Phosphoribosyl Transferase. The ΔC_T levels of 18S did not differ significantly between treatment conditions; thus, they were expressed at constant levels between samples.

TABLE 1
Real-time PCR primers and probes.
Western blot analysis
Gene	Forward	Probe	Reverse
18S	5′-GCCGCTAGACGTGAAATTCTTG-	5′-6FAM-AGCGGCGCAAGACGGACCAG-TAMRA-3′	5′-CATTCTTGGCAAATGCTTTCG-
	3′		3′
Collagen1	5′-GGAATTGGGCTTCGACGTT-3′	5′-6FAM-TCTGCTTGCTGTAAACTCCCTGCATCCC-	5′-TTCAGTTTGGGTTGCTTGTCTGT
		TAMRA-3′	-3′
Fibronectin	5′-AGATCTACCTGTACACCTTGAAT	5′-6FAM-TGTCGTCATGGACGCCTCCA-TAMRA-3′	5′-CATGATACCAGCAAGGAATTGG-
	GACA-3′		3′
TIMP3	5′-TGTGTCATGTGAGGCTGTAATAT	5′-6FAM-CACATCCCGCCATTTTGCTGAATCAA-	5′-GGCTAGAAGTATTTTGCTCTCCA
	GTG-3′	TAMRA-3′	TTC-3′
PAI-1	5′-GGCTGACTTCACGAGTCTTTCA-	5′-6FAM-ACCAGAGGCTCTCGACGTCCCGG-	5′-GTTCACCTCGATCTTCACTTTCT
	3′	TAMRA-3′	G-3′
CTGF	5′-TGTGTGAGGAGCGCAAGGA-3′	5′-6FAM-CTGCCCTCGCGGCTTACCGA-TAMRA-3′	5′-TAGTTGGGTCTGGGCCAAAC-3′
IL11	5′-AGAACAGCGAATTAAATGTGTCA	5′-6FAM-AGACAAATGGCCCTCAAGTGGA-	5′-CCCAGTTACGCAAGCATCCA-3′
	TACA-3′	TAMRA-3′
COX2	5′-GCTCAAACATGATGTTTGCATTC	5′-6FAM-TTGCCCAGCACTTCAGGCATCAG-	5′-GCCCTCGCTTATGATCTGTCTT-
	-3′	TAMRA-3′	3′
IL6	5′-ATGTAGCATGGCCACCTCAGAT-	5′-6FAM-TGGTCAGAAACCTGTCCACTGGGCA-	5′-TAACGCTCATACTTTTAGTTCTG
	3′	TAMRA-3′	CATAGA-3′
a-smooth	5′-CCCCAGAGACCCTGTTGCA3′	5′6FAM-GCCAGCAGACTCCATGCCGA-TAMRA-3′	5′-TGATGCTGTTGTAGGTGGTTTCA
muscle actin			-3′

Cells were cultured in 6-well plates and treated with BNP (100 nM, three times daily) in the presence or absence of 5 ng/ml TGFβ for 48 h. Lysis was induced with 0.2 ml of buffer containing 20 mM Tris-HCL, pH 7.9, 137 mM NaCl, 1% Triton X-100, 5 mM EDTA, 10 mM NaF, 1 mM β-glycerophosphate, and protease inhibitor cocktail. The protein concentration of each lysate was measured using coomassie protein reagent from PIERCE. Twenty μg of protein from each sample was loaded and electrophoresed on 4-12% gradient polyacrylamide gels and electrophoretically transferred to nitrocellulose membranes (Invitrogen, San Diego, Calif.). The membranes were incubated with rabbit anti-human Collagen 1 antibody (Cortex Biochem, San Leandro, Calif.), HRP-conjugated anti-human Fibronectin antibody, or goat anti-Actin antibody (Santa Cruz Biotehnology, Santa Cruz, Calif.) in TBST buffer containing 20 mM Tris-HCl, pH 7.5, 150 mM NaCl, 0.1% Tween-20, and 5% nonfat dried milk at 4° C. for ˜16 h. For ERK phosphorylation, cells were treated with 0.5 μmol/L BNP in the presence of 1 μmol/L KT5823 or 10 μmol/L U0126 for 15 min; the membranes were incubated with rabbit anti-human phospho-ERK ½ antibody or rabbit anti-human ERK ½ antibody (Cell Signaling, Beverly, Mass.). For secondary antibody detection, membranes were incubated with HRP-conjugated anti-rabbit antibody or anti-goat antibody at room temperature for 1 h and washed 3 times with TBST buffer. The blots were soaked in ECL Plus reagent for 5 min and exposed to KODAK x-ray film. Signals were identified and quantified using a Typhoon Scanner and Densitometer from Amersham Biosciences (Piscataway, N.J.). Data was analyzed by ANOVA using the Newman-Keuls test to assess significance. Results cGMP Production in Cardiac Fibroblasts

To determine if NPRA was expressed in the cultured fibroblast cells, cGMP accumulation assays were utilized. BNP dose-dependently induced intracellular cyclic GMP production in cardiac fibroblasts with an EC50 of 50 nmol/L. These results are consistent with the report of Cao and Gardner showing NPRA expression in cardiac fibroblasts.

Effects of BNP on TGFβ-Induced Fibroblast Proliferation

To examine the effects of TGFβ and BNP on cell proliferation, BrdU incorporation was measured in cardiac fibroblasts treated with TGFβ in the presence or absence of BNP. TGFβ modestly increased (˜50%) cardiac fibroblast proliferation, and BNP inhibited TGFβ-induced proliferation by ˜65% (FIG. 9).

Effects of BNP on TGFβ-Induced Gene Expression

In order to determine the effects of BNP on gene expression profiles induced by TGFT in cardiac fibroblasts, a microarray analysis was performed. Fluorescently-labeled cDNA probes were prepared from pooled mRNAs generated from duplicate wells of cells from four groups: unstimulated (control), TGFβ-treated, BNP-treated, and co-treated with TGFβ and BNP for 24 and 48 h (as described above). Arrays were probed in duplicate for a total of 12 hybridizations (6 at each time point): control compared to TGFβ-treated, TGFβ-treated compared to TGFβ+BNP-treated, and control compared to BNP-treated.

It was observed that BNP had no significant effects on gene expression in unstimulated human cardiac fibroblasts (FIG. 1). In contrast, TGFβ induced 394 and 501 gene expression changes at 24 and 48 h, respectively. These differentially expressed genes represent ˜7-8% of the target genes on the array. Interestingly, BNP had dramatic effects on the gene expression changes induced by TGFβ (FIG. 2). Approximately, 88% and 85% of TGFβ-regulated gene expression events were opposed by BNP at 24 and 48 h, respectively. These results demonstrate that BNP has strikingly different effects on gene expression in TGFβ stimulated fibroblasts compared to unstimulated cells.

Gene Expression Clustering

To identify different gene expression patterns following TGFβ stimulation, we performed a hierarchical cluster analysis. A visualization of this analysis is shown in FIG. 3. A complete listing of differentially expressed genes is provided in Table 2. The clustered expression patterns showed temporal effects of TGFβ responsive genes (compare A to B). In addition, the dramatic effects of BNP in opposing TGFβ induced up- and down-regulated gene changes were revealed in the clusters (compare A and B to C and D). The insignificant effects of BNP on gene expression in unstimulated cardiac fibroblast cells were evident in groups E and F.

Genes were grouped according to functional categories by using a combination of gene expression clustering and functional annotations. A cluster of genes involved in fibrosis and ECM production was up-regulated in cells stimulated with TGFβ; these genes were down-regulated when treated with BNP (FIG. 4a). This cluster includes extracellular matrix components: Collagen 1a2 (COL1A2), Collagen 15A (COL15A), Collagen 7A1 (COL7A1), Microfibril-associated glycoprotein-2 (MAGP2), Matrilin 3 (MATN3), Fibrillin 1 (FBN1), and Cartilage oligomeric matrix protein (COMP). Also included in the cluster are known markers of fibrosis such as TIMP3, CTGF, IL11, and SERPINE1 (PAI-1). Furthermore, the cluster revealed that BNP opposed TGFβ-induction of myofibroblast markers including α-smooth muscle actin 2 (ACTA2) and non-muscle myosin heavy chain (MYH9).

Many genes involved in cell proliferation were also regulated by TGFβ and were opposed by BNP (FIG. 4B). For example, TGFβ induced the expression of positive regulators of cell proliferation, including PDGFA, IGFBP10, IGF1, and Parathyroid hormone-like hormone (PTHLH). It was also found that TGFβ down-regulated both positive and negative regulators of proliferation, such as, CDC25B and Cullin 5 (CUL5), respectively. All of these TGFβ-regulated gene events were opposed by BNP.

BNP affected TGFβ-induced genes involved in inflammation (FIG. 4C). For example, BNP reversed TGFβ-induction of PTGS2 (COX2), TNF α-induced protein 6 (TNFAIP6), and TNF superfamily, member 4 (TNFSF4) (FIG. 4C and data not shown). TNFAIP6 and TNFSF4 were not included in FIG. 4C, since some of the data points at 48 h did not meet acceptable criteria (see Experimental); at 24 h both genes were elevated ˜3-fold by TGFβ and opposed by BNP. TGFβ also down-regulated many pro-inflammatory genes including IL1B, CCR2 (MCP1-R), CXCL1 (GRO1), CXCL3 (GRO3), and CCL13 (MCP4), which were reversed by BNP. The significance of these inflammatory changes is discussed below.

TABLE 2
Expression data for differentially expressed genes in TGFβ-treated human cardiac fibroblasts. Median
differential expression values are shown for each hybridization: control vs. TGFβ 24 h (column 2); control vs.
TGFβ 48 h (column 3); TGFβ vs. TGFβ + BNP 24 h (column 4); TGFβ vs.
TGFβ + BNP 48 h (column 5); control vs. BNP 24 h (column 6); and control vs. BNP 48 h (column 7).
		TGF			TGF
	TGF	BNP	BNP	TGF	BNP	BNP
Clone ID	24 h	24 h	24 h	48 h	48 h	48 h	Symbol	Name	Accession
P00777_A03	2.5	−2.8	1.1	1.5	−1.6	1.1		EST
P00777_A04	8.9	−5.7	1.2	3.3	−2.4	1		EST
P00777_A12	2.1	−2.4	−1	1.8	−1.9	−1.1		EST
P01061_E01	2.7	−3	1	2.6	−2.8	−1		EST
P01061_B10	−2.7	2.3	1.1	−4	2.4	−1.2		EST
P01077_A08	−1.8	3.1	1.3	−2.2	1.9	1.2		No Sequence
P01111_A08	−1.3	1.4	1.3	−1.8	1.7	1.1		EST
P01113_E11	−1.7	1.8	1.1	−1.8	1.6	−1		EST
P01111_F07	−4.5	5.5	1.3	−5.3	4.2	1.1		EST
P01111_A07	2	−2.7	1.3	1.4	−1.5	−1.1		EST
P01110_G03	−1.2	1.5	1.3	−3.9	2.1	1.1		No Sequence
P01108_G07	4.2	−4.4	−1.1	3.9	−4.5	−1		EST
P01099_G03	−1.9	1.9	1.1	−2.2	1.9	1.2		EST
P01113_B03	6.4	−5.1	1	4.3	−3.7	−1		EST
P01080_A11	4	−3	1	4.2	−4.1	−1		EST
P01076_E01	−1.7	1.8	1.1	−1.8	1.8	−1.1		EST
P01075_H09	−3.1	3.6	1.4	−2.9	3.2	1.4		No Sequence
P01139_D10	3	−2.6	1.1	2.1	−2.1	1		EST
P01132_B01	−2.1	2	1	−1.4	1.3	1		EST
P01123_H03	2.2	−2.2	1.2	1.9	−1.9	1.1		EST
P01117_D08	−1.7	1.5	1.1	−4.9	2.4	−1		EST
P01115_F08	−2.2	1.6	−1	−2.3	1.7	−1		EST
P01081_F02	2.4	−1.8	1.2	2.4	−2.1	1.1		No Sequence
P01087_A12	2.4	−2	1	2.6	−2.6	−1		EST
P01077_A02	2.2	−2	1	1.4	−1.3	−1		No Sequence
P01136_G11	−2	2.5	1.3	−3	2.5	1		EST
P01130_B03	−3.3	3.5	1.1	−4.2	5.3	1.1		EST
P01124_A05	−1.2	−1	1.1	−1.8	1.5	1		EST
P01124_A10	2.1	−2	−1	2.7	−2.5	−1.1		EST
P01124_B04	−1.9	2	1.3	−1.6	1.7	1.1		EST
P01120_G06	−2.3	2.2	−1.1	−2.4	2.2	−1.1		EST
P01117_B11	1.8	−2.4	1	2.4	−2	1		EST
P01116_A02	−3.1	2.7	1.1	−3.7	2.2	−1.4		EST
P01088_C10	2.1	−2	−1	1.6	−2.1	−1.1		EST
P01093_C04	2.6	−2.3	1	1.8	−1.9	−1		EST
P01095_H01	−1.8	1.8	1	−1.4	1.2	1		EST
P01099_D03	1.9	−1.8	1.1	1.1	−1.2	1.1		EST
P01100_A07	1	−1	1.1	−3	1.7	−1.1		EST
P01100_D09	−1.6	1.6	−1	−2.1	1.8	−1.1		EST
P01101_C11	−2.4	1.7	−1	−1.4	1.6	1		No Sequence
P01101_E11	−1.4	1.5	1.1	−2	1.8	−1		EST
P01103_H04	−3.2	2.9	1.1	−5.6	4.3	−1		EST
P01104_A09	−1.9	1.6	1.1	−1.8	1.5	1		No Sequence
P01104_E03	−2.5	2.3	−1	−2.8	2	−1.1		EST
P01104_G04	2.5	−2	−1	1.1	−1.3	−1.1		EST
P01104_G12	−3.7	2.7	−1.1	−4.9	3.2	−1		EST
P01105_A05	2.3	−2.3	1.3	1.3	−1.3	1		EST
P01105_D09	1.8	−1.1	1.1	1.8	−2.1	−1		EST
P01109_A01	−1.4	1.4	1.2	−2.2	1.7	1.1	A2M	alpha-2-macroglobulin	NM_000014
P01109_G11	1.4	−1	1.1	2	−1.6	1	ABCG1	ATP-binding cassette, sub-	NM_004915
								family G (WHITE), member 1
P01092_E08	2.3	−2	1.2	1.5	−1.3	1.1	ACLY	ATP citrate lyase	NM_001096
P01088_C02	−1.9	1.8	1.2	−2.1	2	1	ACO1	aconitase 1, soluble	NM_002197
P00777_G09	2.6	−2.2	−1.5	1	1	−1.3	ACTA1	actin, alpha 1, skeletal muscle	NM_001100
P01094_F04	2.6	−2.5	−1.4	−1	−1	−1.4	ACTA2	actin, alpha 2, smooth muscle,	NM_001613
								aorta
P01091_G04	1.9	−1.6	1.1	1.2	−1.3	−1	ACTR3	ARP3 actin-related protein 3	NM_005721
								homolog (yeast)
P01096_D02	−1.3	1.5	1.1	−2.3	2.2	1	ADAMTS1	a disintegrin-like and	NM_006988
								metalloprotease (reprolysin
								type) with thrombospondin
								type 1 motif, 1
P01097_D04	1.7	−1.9	−1	2.1	−1.8	−1.1	ADAMTS6	a disintegrin-like and	NM_014273
								metalloprotease (reprolysin
								type) with thrombospondin
								type 1 motif, 6
P01092_D03	−6.5	6	−1.1	−6.3	6.5	−1	ADFP	adipose differentiation-related	NM_001122
								protein
P01070_D09	−5	4.1	1.3	−9.7	3.8	1.3	ADH1B	alcohol dehydrogenase IB	NM_000668
								(class I), beta polypeptide
P01134_D11	−1.7	2	1.3	−3.6	1.6	1.2	ADH1C	alcohol dehydrogenase 1C	NM_000669
								(class I), gamma polypeptide
P01070_D05	−1.3	−1.4	1.2	−2.2	1.7	1.1	ADH5	alcohol dehydrogenase 5	NM_000671
								(class III), chi polypeptide
P01094_D10	−2.3	2.5	1.1	−2.2	1.8	−1	ADORA2B	adenosine A2b receptor	NM_000676
P01124_F09	−1.5	1.6	1.1	−1.8	1.9	1	AHR	aryl hydrocarbon receptor	NM_001621
P01101_B03	−2.4	1	1	−3	2.8	1.1	AKAP2	A kinase (PRKA) anchor	NM_007203
								protein 2
P01120_C03	−1.9	2	1.2	−1.2	1.5	1.2	AKR1B1	aldo-keto reductase family 1,	NM_001628
								member B1 (aldose reductase)
P01134_B08	−2.7	2.6	1.1	−1.4	1.9	1.2	AKR1B10	aldo-keto reductase family 1,	NM_020299
								member B10 (aldose
								reductase)
P01069_C01	−2.8	3.1	1.2	−2.2	2.6	1.1	AKR1C1	aldo-keto reductase family 1,	NM_001353
								member C1 (dihydrodiol
								dehydrogenase 1; 20-alpha (3-
								alpha)-hydroxysteroid
								dehydrogenase)
P01081_A11	−2.3	3.3	1.6	−2.2	1.9	1.3	AKR1C2	aldo-keto reductase family 1,	NM_001354
								member C2 (dihydrodiol
								dehydrogenase 2; bile acid
								binding protein; 3-alpha
								hydroxysteroid
								dehydrogenase, type III)
P01143_D10	−2.8	3.2	1.3	−2.1	2.7	1.1	AKR1C2	aldo-keto reductase family 1,	NM_001354
								member C2 (dihydrodiol
								dehydrogenase 2; bile acid
								binding protein; 3-alpha
								hydroxysteroid
								dehydrogenase, type III)
P01106_C11	−2.3	2.8	1.2	−2	2.5	1.1	AKR1C3	aldo-keto reductase family 1,	NM_003739
								member C3 (3-alpha
								hydroxysteroid
								dehydrogenase, type II)
P01094_D12	−2.8	3.6	1.2	−2.5	1.7	1.2	ALDH1A3	aldehyde dehydrogenase 1	NM_000693
								family, member A3
P01094_E01	−1.4	1.8	1.1	−2.1	1.6	1.1	ALDH3A2	aldehyde dehydrogenase 3	NM_000382
								family, member A2
P01140_G11	−1.9	2.7	1.4	−2.5	1.8	1.1	ALDH3A2	aldehyde dehydrogenase 3	NM_000382
								family, member A2
P01118_A12	−1.9	1.6	1.1	−2.6	2.2	1	ALEX1	ALEX1 protein	NM_016608
P01096_E12	−2.4	2	1	−2.1	2.2	1	ANG	angiogenin, ribonuclease,	NM_001145
								RNase A family, 5
P01145_E08	−2	2.3	1.2	−2.9	2.6	−1	ANGPT1	angiopoietin 1	NM_001146
P01091_G02	−1.2	1.5	1.2	−2.7	2	1.1	ANGPT2	angiopoietin 2	NM_001147
P01094_D06	−2.1	1.9	−1	−1.9	1.3	−1.1	ANK3	ankyrin 3, node of Ranvier	NM_001149
								(ankyrin G)
P01128_A07	−1.5	1.8	1.2	−2.2	2.3	1.2	AOX1	aldehyde oxidase 1	NM_001159
P01116_H05	−1.1	1.4	1.2	−2	1.8	1	APELIN	apelin; peptide ligand for APJ	NM_017413
								receptor
P01103_F06	2.4	−2.4	−1.1	1.4	−1.5	−1.1	APG3	autophagy Apg3p/Aut1p-like	NM_022488
P01123_A07	3.2	−3	−1	1.5	−1.8	−1	APOA1	apolipoprotein A-I	NM_000039
P01105_G06	−2.2	1.8	−1.1	−4.5	5.7	1.1	APOC1	apolipoprotein C-I	NM_001645
P01124_G03	−1.3	1.4	1	−2.4	2	1.1	APOE	apolipoprotein E	NM_000041
P01105_B02	−1.6	1.8	−1	−2.9	1.9	1.2	ARHGAP6	Rho GTPase activating protein 6	NM_001174
P01064_G03	−1.1	1.3	1.1	−2	1.6	1.2	ARHGEF16	Rho guanine exchange factor	NM_014448
								(GEF) 16
P01110_E10	−2	2.1	1.2	−2.3	1.9	1	ARHGEF3	Rho guanine nucleotide	NM_019555
								exchange factor (GEF) 3
P01142_C03	−1.6	1.8	1.5	−1.9	1.7	1.2	ARHI	ras homolog gene family,	NM_004675
								member I
P01138_A09	1.9	−2.2	−1.1	1.8	−1.9	−1.1	ARL4	ADP-ribosylation factor-like 4	NM_005738
P01064_G12	−1.7	1.8	1.1	−1.8	1.6	−1	ARNT2	aryl-hydrocarbon receptor	NM_014862
								nuclear translocator 2
P01088_H09	−1.5	1.7	1.2	−1.8	1.6	1.1	ASAH1	N-acylsphingosine	NM_004315
								amidohydrolase (acid
								ceramidase) 1
P01105_F06	2.9	−2.8	1.1	2.1	−2.4	−1.2	ASNS	asparagine synthetase	NM_001673
P01070_E06	1.8	−1.5	−1.3	1.6	−1.4	1	ATF3	activating transcription factor 3	NM_001674
P01122_G07	−1.2	1.7	1.2	−1.8	1.5	1.3	AXIN2	axin 2 (conductin, axil)	NM_004655
P01115_D06	−1.4	1.6	1	−2	1.5	−1.1	B3GALT2	UDP-Gal:betaGlcNAc beta	NM_003783
								1,3-galactosyltransferase,
								polypeptide 2
P01128_A08	−1.6	1.7	1	−2.4	1.7	−1	B3GALT3	UDP-Gal:betaGlcNAc beta	NM_003781
								1,3-galactosyltransferase,
								polypeptide 3
P01095_F06	2.4	−2.2	1.1	1.3	−1.5	−1	BAI3	brain-specific angiogenesis	NM_001704
								inhibitor 3
P01094_C02	−1.8	2	1.2	−2.4	2.7	−1	BF	B-factor, properdin	NM_001710
P01134_E02	−1.7	1.8	1	−2.2	1.6	−1	BFSP1	beaded filament structural	NM_001195
								protein 1, filensin
P01081_D08	−1.2	1.7	1.2	−3.5	1.8	1.2	BIRC1	baculoviral IAP repeat-	NM_004536
								containing 1
P01094_B06	−2.6	2.9	1.1	−4	2.5	−1	BMP4	bone morphogenetic protein 4	NM_001202
P01145_A02	−3.2	2.3	1	−3.6	3.2	−1.1	BNIP2	BCL2/adenovirus E1B 19 kDa	NM_004330
								interacting protein 2
P01075_F05	−1.5	1.5	1.2	−1.8	2	1.2	BRE	brain and reproductive organ-	NM_004899
								expressed (TNFRSF1A
								modulator)
P01124_B10	−1.3	1.5	1.3	−2.2	1.6	1.2	BST1	bone marrow stromal cell	NM_004334
								antigen 1
P01094_B08	−1.8	1.6	−1.1	−1.2	1.3	−1.1	BTD	biotinidase	NM_000060
P01093_E08	−2	1.5	−1.1	−1.9	2.7	1.1	C1R	complement component 1, r	NM_001733
								subcomponent
P01077_E12	−1.4	1.6	1.1	−1.8	1.9	−1.1	C1S	complement component 1, s	NM_001734
								subcomponent
P01097_G03	1.9	−1.7	−1	1	−1.5	−1.1	C20orf14	chromosome 20 open reading	NM_012469
								frame 14
P01140_A07	2.3	−3.2	−1	3	−2.6	−1	C20orf97	chromosome 20 open reading	NM_021158
								frame 97
P01069_E02	−1.7	1.6	1.1	−3.3	3.2	1.1	C6	complement component 6	NM_000065
P01077_E10	−3.1	2.9	1.1	−8.2	4.7	−1	C7	complement component 7	NM_000587
P01099_C10	−1.8	2.1	1.2	−2.7	3.5	1.1	CA12	carbonic anhydrase XII	NM_001218
P01117_G05	−3	2.4	−1.1	−2.2	2.3	1.1	CAMK2B	calcium/calmodulin-dependent	NM_001220
								protein kinase (CaM kinase) II
								beta
P01114_A05	−2.7	3.9	1.2	−3.5	2.7	1	CAMK2D	calcium/calmodulin-dependent	NM_001221
								protein kinase (CaM kinase) II
								delta
P01080_B05	−2.3	3	1.1	−2.3	2.1	1.1	CAMK2D	calcium/calmodulin-dependent	NM_001221
								protein kinase (CaM kinase) II
								delta
P01063_E07	−1.6	2	1.2	−1.8	1.6	1.1	CASP1	caspase 1, apoptosis-related	NM_001223
								cysteine protease (interleukin
								1, beta, convertase)
P01093_G08	−2.4	2.3	−1.2	−2.1	2.4	1	CAV1	caveolin 1, caveolae protein	NM_001753
								22 kDa
P01093_E04	1.8	−1.7	−1.1	1.6	−1.9	−1.1	CBS	cystathionine-beta-synthase	NM_000071
P01064_D02	−1.5	1.6	−1.3	−2.2	2.8	−1.1	CCL13	chemokine (C—C motif) ligand	NM_005408
								13
P01072_E08	−1.3	1.4	−1.2	−2.2	3.2	−1.1	CCL7	chemokine (C—C motif) ligand 7	NM_006273
P01127_H03	1.1	1.2	−1.3	−2	2.9	−1	CCL8	chemokine (C—C motif) ligand 8	NM_005623
P01070_A04	−1.4	1.9	1.2	−3.2	2.4	1.1	CCR2	chemokine (C—C motif)	NM_000647
								receptor 2
P01138_B02	−1.2	1.3	1.3	−3.6	1.5	1	CCRL1	chemokine (C—C motif)	NM_016557
								receptor-like 1
P01069_H09	−1.9	1.9	1.3	−3.6	1.8	1.2	CD36	CD36 antigen (collagen type I	NM_000072
								receptor, thrombospondin
								receptor)
P01072_E03	−2.8	2.7	1.2	−2.9	2.8	1.2	CDC25B	cell division cycle 25B	NM_004358
P01093_H07	2	−4.3	1.2	2.1	−2	−1	CDH2	cadherin 2, type 1, N-cadherin	NM_001792
								(neuronal)
P01129_E07	1.7	−1.4	1.1	2	−1.9	−1.1	CDH4	cadherin 4, type 1, R-cadherin	NM_001794
								(retinal)
P01130_H07	2.1	−2.4	−1.1	1.9	−1.8	−1	CDH5	cadherin 5, type 2, VE-	NM_001795
								cadherin (vascular epithelium)
P01116_H02	−3.3	2.1	1.1	−2	2.4	1.1	CDK5RAP2	CDK5 regulatory subunit	NM_018249
								associated protein 2
P01102_B02	−2.1	2.5	1	−3.4	3.2	−1.1	CDSN	comeodesmosin	NM_001264
P01140_G02	−1.4	1.3	1.1	−2.9	2.4	1	CEACAM5	carcinoembryonic antigen-	NM_004363
								related cell adhesion molecule 5
P01094_A06	−1.6	1.3	1.3	−4.2	2.9	1	CEACAM5	carcinoembryonic antigen-	NM_004363
								related cell adhesion molecule 5
P01062_G02	−1.3	1.5	1.3	−2.9	2.1	1.1	CEACAM6	carcinoembryonic antigen-	NM_002483
								related cell adhesion molecule
								6 (non-specific cross reacting
								antigen)
P01099_B05	−1.8	1.8	1.1	−2.9	3	−1.1	CEACAM7	carcinoembryonic antigen-	NM_006890
								related cell adhesion molecule 7
P01090_E04	−1.3	1.6	1.3	−1.9	1.8	−1	CEBPD	CCAAT/enhancer binding	NM_005195
								protein (C/EBP), delta
P01070_A01	−2.6	3.1	−1	−9.2	9.2	1.1	CHI3L1	chitinase 3-like 1 (cartilage	NM_001276
								glycoprotein-39)
P01125_G02	−2.9	2	1	−5	6.2	1	CHI3L2	chitinase 3-like 2	NM_004000
P01134_F10	8	−6.3	1.2	19.5	−8	1.1	CILP	cartilage intermediate layer	NM_003613
								protein, nucleotide
								pyrophosphohydrolase
P01089_A12	−1.9	2.1	1	−2.1	2.1	−1	CITED2	Cbp/p300-interacting	NM_006079
								transactivator, with Glu/Asp-
								rich carboxy-terminal domain, 2
P01076_A07	2.1	−1.8	−1	1.4	−1.2	1.1	CKAP4	cytoskeleton-associated	NM_006825
								protein 4
P01104_C09	2.2	−2.4	1.1	4.3	−2.8	1	CKLF	chemokine-like factor	NM_016326
P01103_G05	−1.4	1.6	1.3	−2.5	1.5	1.3	CLDN1	claudin 1	NM_021101
P01105_D03	−3	2.7	1.3	−2.6	2	−1	CLECSF2	C-type (calcium dependent,	NM_005127
								carbohydrate-recognition
								domain) lectin, superfamily
								member 2 (activation-induced)
P01064_F09	2.2	−1.5	1.2	1.2	−1.2	1.1	CNN1	calponin 1, basic, smooth	NM_001299
								muscle
P01090_A03	−1.1	1.3	1.2	−2.2	1.6	1.1	CNTNAP1	contactin associated protein 1	NM_003632
P01069_F02	1.2	1.2	1.2	3.2	−3	1	COL15A1	collagen, type XV, alpha 1	NM_001855
P01077_E08	1.8	−1.5	1	1.9	−1.9	−1	COL1A2	collagen, type I, alpha 2	NM_000089
P01093_F03	1.7	−2.3	1	1.9	−2.1	−1	COL4A2	collagen, type IV, alpha 2	NM_001846
P01105_C12	1.8	−1.5	1.4	3.1	−2.3	1.1	COL7A1	collagen, type VII, alpha 1	NM_000094
								(epidermolysis bullosa,
								dystrophic, dominant and
								recessive)
P01120_G04	2.7	−2.1	1.2	3.8	−3.6	1.1	COL8A2	collagen, type VIII, alpha 2	M60832
P01084_A12	−4.9	4.7	1.1	−9.9	6	1	COLEC12	collectin sub-family member	NM_030781
								12
P01082_H06	1.3	−1.3	1.2	3.3	−2.4	1.2	COMP	cartilage oligomeric matrix	NM_000095
								protein
								(pseudoachondroplasia,
								epiphyseal dysplasia 1,
								multiple)
P01129_C12	1.4	−1.5	1.3	2.6	−1.6	1.3	COMP	cartilage oligomeric matrix	NM_000095
								protein
								(pseudoachondroplasia,
								epiphyseal dysplasia 1,
								multiple)
P01076_C09	−2.2	2.7	1.2	−2.1	1.6	1.1	COPB	coatomer protein complex,	NM_016451
								subunit beta
P01085_D11	−4	4.2	1.1	−7.7	4.1	1.1	CPA4	carboxypeptidase A4	NM_016352
P01104_A07	−1.9	2	1.2	−2.5	2.2	1	CPD	carboxypeptidase D	NM_001304
P01077_G01	1.9	−1.8	1.1	1.7	−1.9	1.1	CRABP2	cellular retinoic acid binding	NM_001878
								protein 2
P01095_E03	−1.8	1.8	1.2	−2.1	2	−1.1	CREG	cellular repressor of E1A-	NM_003851
								stimulated genes
P01124_E01	−2.2	2.1	1	−2.5	2.2	−1	CREM	cAMP responsive element	NM_001881
								modulator
P01120_B01	1.8	−1.6	1.2	3.9	−3.4	1.1	CRLF1	cytokine receptor-like factor 1	NM_004750
P01120_D10	−1.5	1.9	1.3	−3.5	2.4	1.1	CROT	camitine O-	NM_021151
								octanoyltransferase
P01124_F10	−1.2	1.3	1.2	−1.8	1.7	1.1	CRYAA	crystallin, alpha A	NM_000394
P00777_A08	−2	1.6	1.1	−2.6	2.5	−1.1	CRYAB	crystallin, alpha B	NM_001885
P01077_E04	−2.1	1.8	1.1	−2.5	2.6	−1.1	CRYAB	crystallin, alpha B	NM_001885
P01125_B11	−1.8	1.2	1.1	−1.8	1.8	1	CSF1	colony stimulating factor 1	NM_000757
								(macrophage)
P01108_G05	3.8	−3	1.1	2.3	−2.4	1	CSPG2	chondroitin sulfate	NM_004385
								proteoglycan 2 (versican)
P01075_F12	−1.5	1.6	1.1	−2	2	1.1	CSRP2	cysteine and glycine-rich	NM_001321
								protein 2
P01145_A03	−2.1	2.4	1	−3.7	3.4	−1.1	CST4	cystatin S	NM_001899
P00777_D03	2.5	−2	1.1	1.1	−1.4	−1.2	CTGF	connective tissue growth factor	NM_001901
P01077_D08	2.6	−3.5	−1.2	1.8	−2.7	−1.2	CTGF	connective tissue growth factor	NM_001901
P01069_D11	2	−2.1	1.2	1.9	−1.4	1.2	CTH	cystathionase (cystathionine	NM_001902
								gamma-lyase)
P01099_B01	−1.7	2	1.1	−2	1.6	−1	CTNNAL1	catenin (cadherin-associated	NM_003798
								protein), alpha-like 1
P01093_G10	−1.4	1.4	1.1	−1.8	2	1	CTSC	cathepsin C	NM_001814
P01077_G03	−1	1.3	1.2	−1.8	1.7	1.2	CTSH	cathepsin H	NM_004390
P01069_H12	−1.5	1.5	1.1	−2.3	2.6	−1	CTSK	cathepsin K (pycnodysostosis)	NM_000396
P01093_G09	−2.5	2.1	1.1	−2	2.3	−1	CTSL	cathepsin L	NM_001912
P01112_D02	−1.6	1.8	1.2	−2.9	2.1	−1	CUGBP2	CUG triplet repeat, RNA	NM_006561
								binding protein 2
P01131_G04	−1.3	1.6	1.3	−2.2	1.7	1.3	CUGBP2	CUG triplet repeat, RNA	NM_006561
								binding protein 2
P01090_H01	−2	1.8	1.3	−1.5	1.9	1.3	CUL5	cullin 5	NM_003478
P01085_C05	−3.8	3.4	1.1	−5.5	5	−1	CXCL1	chemokine (C—X—C motif)	NM_001511
								ligand 1 (melanoma growth
								stimulating activity, alpha)
P01093_A02	−3.7	3.1	1	−5.8	5.4	−1	CXCL1	chemokine (C—X—C motif)	NM_001511
								ligand 1 (melanoma growth
								stimulating activity, alpha)
P01125_H11	−2.4	2	1.1	−2.3	2.1	1	CXCL3	chemokine (C—X—C motif)	NM_002090
								ligand 3
P01136_B01	−4.5	4.4	1.1	−8.4	10	1.1	CXCL6	chemokine (C—X—C motif)	NM_002993
								ligand 6 (granulocyte
								chemotactic protein 2)
P01069_D07	−2.4	2.3	1.3	−2	1.7	1	CYB5	cytochrome b-5	NM_001914
P00777_A11	2	−2.5	−1	1.8	−2	−1	CYR61	cysteine-rich, angiogenic	NM_001554
								inducer, 61
P00777_C11	1.8	−2.5	−1	1.8	−1.9	−1.1	CYR61	cysteine-rich, angiogenic	NM_001554
								inducer, 61
P00777_C12	2	−2.6	−1.1	1.9	−1.9	−1.1	CYR61	cysteine-rich, angiogenic	NM_001554
								inducer, 61
P01108_B04	2.3	−2.4	1.1	1.9	−1.9	−1.1	CYR61	cysteine-rich, angiogenic	NM_001554
								inducer, 61
P01130_H03	2	−2.4	−1.1	1.9	−1.8	−1.1	CYR61	cysteine-rich, angiogenic	NM_001554
								inducer, 61
P01100_C06	2.2	−2.4	−1.1	1.8	−1.9	−1	DACT1	dapper homolog 1, antagonist	NM_016651
								of beta-catenin (xenopus)
P01069_C07	1.7	−1.4	1.1	2.3	−2.1	1.1	DAF	decay accelerating factor for	NM_000574
								complement (CD55, Cromer
								blood group system)
P01129_B04	−2.8	2.5	1.2	−4.3	3.5	1	DAPK1	death-associated protein	NM_004938
								kinase 1
P01092_G02	−2.7	2.6	1.1	−3.8	2.8	1.2	DAPK1	death-associated protein	NM_004938
								kinase 1
P01065_A02	−1.8	1.9	−1	−1.8	1.7	−1.1	DDX38	DEAD/H (Asp-Glu-Ala-	NM_014003
								Asp/His) box polypeptide 38
P01105_A10	−3.7	2.9	−1	−7	5.4	−1	DKK1	dickkopf homolog 1 (Xenopus	NM_012242
								laevis)
P01113_E05	2.8	−2.4	−1.1	1.8	−2.1	−1.1	DLC1	deleted in liver cancer 1	NM_006094
P01093_C11	−1.8	1.9	−1	−4.5	3.3	−1	DPP4	dipeptidylpeptidase 4 (CD26,	NM_001935
								adenosine deaminase
								complexing protein 2)
P01073_G11	−1.8	1.7	1	−1.6	1.5	1	DPYSL2	dihydropyrimidinase-like 2	NM_001386
P01090_F08	1.4	−1.5	−1.1	2	−1.9	−1.1	DSCR1	Down syndrome critical region	NM_004414
								gene 1
P01122_D11	1.7	−1.2	1.3	1.9	−2.1	1.3	EBAF	endometrial bleeding	NM_003240
								associated factor (left-right
								determination, factor A;
								transforming growth factor
								beta superfamily)
P01123_B11	−1.8	1.7	1	−2.3	1.9	1	ECM2	extracellular matrix protein 2,	NM_001393
								female organ and adipocyte
								specific
P01124_E11	−1.6	1.9	1.2	−2.1	1.9	1.2	EDG1	endothelial differentiation,	NM_001400
								sphingolipid G-protein-coupled
								receptor, 1
P01103_G08	−1.8	1.8	1.1	−2.4	2.4	1	EDG2	endothelial differentiation,	NM_001401
								lysophosphatidic acid G-
								protein-coupled receptor, 2
P01093_C01	−2.1	1.5	−1.1	−2.9	1.9	−1.3	EDN1	endothelin 1	NM_001955
P01105_H10	−1.9	1.9	1	−2.2	2.3	−1	EFEMP1	EGF-containing fibulin-like	NM_004105
								extracellular matrix protein 1
P01064_A03	−1.4	1.9	1.2	−2	2	1.1	EFNB3	ephrin-B3	NM_001406
P01093_B07	−1.8	1.7	1.3	−1.5	1.3	1.1	EGR2	early growth response 2 (Krox-	NM_000399
								20 homolog, Drosophila)
P01121_C03	−2	2	1.2	−1.2	1.5	1.2	EHD3	EH-domain containing 3	NM_014600
P01065_E02	1.9	−1.6	1.2	3.4	−3.3	1.1	ELN	elastin (supravalvular aortic	NM_000501
								stenosis, Williams-Beuren
								syndrome)
P01096_H11	−3.4	3.7	1.1	−3.5	3.2	−1	EPAS1	endothelial PAS domain	NM_001430
								protein 1
P01102_E11	−2	2.1	1.2	−2.5	2.1	−1	EPB41L2	erythrocyte membrane protein	NM_001431
								band 4.1-like 2
P01104_A05	−2.3	3.3	1.1	−2.2	2.3	1.1	EPI64	EBP50-PDZ interactor of 64 kD	NM_031937
P01130_H01	−2	2	1.1	−2.5	3.9	−1	EPOR	erythropoietin receptor	NM_000121
P01077_A07	−1.6	2.7	1.4	−2.3	2.1	1.2	ETV5	ets variant gene 5 (ets-related	NM_004454
								molecule)
P01097_C06	−5.9	4.9	−1	−15.8	14	−1.1	EVI2B	ecotropic viral integration site	NM_006495
								2B
P01077_A01	1.8	−1.8	1.1	1.3	−1.4	1	EXT1	exostoses (multiple) 1	NM_000127
P01069_F04	−1.7	1.6	1.2	−2.1	1.7	1.1	F2R	coagulation factor II (thrombin)	NM_001992
								receptor
P01128_B02	1.8	−1.9	1.1	−1	−1.1	−1	F3	coagulation factor III	NM_001993
								(thromboplastin, tissue factor)
P01132_G03	1.9	−1.7	1.2	1.8	−1.6	1.1	FACL3	fatty-acid-Coenzyme A ligase,	NM_004457
								long-chain 3
P01096_A03	1.8	−2	1	1.8	−2	1	FACL3	fatty-acid-Coenzyme A ligase,	NM_004457
								long-chain 3
P01083_D07	2.2	−1.6	1.2	1.4	−1.3	1	FADS1	fatty acid desaturase 1	NM_013402
P01093_B02	−2	1.6	1.1	−3.4	3.4	1	FBLN1	fibulin 1	NM_001996
P01123_A08	3.4	−3	1.2	1.6	−1.9	−1	FBLN5	fibulin 5	NM_006329
P01068_H09	1.4	−1.4	1	2.2	−2	−1	FBN1	fibrillin 1 (Marfan syndrome)	NM_000138
P01084_E10	1.9	−1.7	1.3	−1.1	−1.1	1.1	FGF18	fibroblast growth factor 18	NM_003862
P01093_B03	−4.2	4.9	1.2	−5.9	5.6	1	FGF7	fibroblast growth factor 7	NM_002009
								(keratinocyte growth factor)
P01092_C04	−3.2	2.9	1.1	−3.1	2.3	−1	FGL2	fibrinogen-like 2	NM_006682
P01126_F06	−5	5.2	−1.1	−6.5	4.9	−1.1	FMO2	flavin containing	NM_001460
								monooxygenase 2
P01078_G11	−1.9	2.1	1.2	−3.1	2.2	1.1	FMO3	flavin containing	NM_006894
								monooxygenase 3
P01088_F09	2	−1.8	1.2	1.4	−1.5	1.1	FOXD1	forkhead box D1	NM_004472
P01120_B03	−1.8	1.9	1.3	−1.2	1.5	1.2	FRA	Fos-related antigen	NM_024816
P01138_B06	−1.8	1.5	1	−1.4	1.8	−1	FTHL17	ferritin, heavy polypeptide-like	NM_031894
								17
P01068_G11	2.7	−2.1	1.3	2.4	−2.5	1.1	FUT4	fucosyltransferase 4 (alpha	NM_002033
								(1,3) fucosyltransferase,
								myeloid-specific)
P01077_A05	1.8	−1.5	1	1.5	−1.2	1	FYN	FYN oncogene related to	NM_002037
								SRC, FGR, YES
P01124_G01	−1.9	1.9	1.1	−1.4	1.2	1	FZD7	frizzled homolog 7	NM_003507
								(Drosophila)
P01083_B09	3.2	−4	−1	4.2	−3.5	−1	GABARAPL2	GABA(A) receptor-associated	NM_007285
								protein-like 2
P01106_B05	−1.8	1.5	1	−1.1	2.4	1.2	GALT	galactose-1-phosphate	NM_000155
								uridylyltransferase
P01092_G07	2.5	−2.3	−1.2	1.8	−2.2	−1.1	GARS	glycyl-tRNA synthetase	NM_002047
P01085_D09	−2.9	4.1	1.4	−5.3	2.6	1.3	GAS1	growth arrest-specific 1	NM_002048
P01063_E09	−2	1.7	1.1	−2	1.8	1.2	GBP2	guanylate binding protein 2,	NM_004120
								interferon-inducible
P01123_D12	−1.9	1.4	−1.2	−2.7	2.7	−1.1	GBP2	guanylate binding protein 2,	NM_004120
								interferon-inducible
P01135_C03	−1.8	1.9	1.2	−2.7	2.4	1.1	GCNT1	glucosaminyl (N-acetyl)	NM_001490
								transferase 1, core 2 (beta-
								1,6-N-
								acetylglucosaminyltransferase)
P01127_B01	−2.8	2.2	−1.1	−2.9	3.7	−1	GDF5	growth differentiation factors 5	NM_000557
								(cartilage-derived
								morphogenetic protein-1)
P01065_A06	−1.7	1.7	1.1	−1.8	1.6	1	GGA3	golgi associated, gamma	NM_014001
								adaptin ear containing, ARF
								binding protein 3
P01076_H05	−2	2.4	1.2	−2.7	1.9	1.1	GM2A	GM2 ganglioside activator	NM_000405
								protein
P01062_E04	−2.3	1.9	−1	−2.1	1.9	−1	GNPI	glucosamine-6-phosphate	NM_005471
								isomerase
P01138_C10	−2.1	2.2	−1.1	−2	1.9	−1.1	GNPI	glucosamine-6-phosphate	NM_005471
								isomerase
P01074_D06	3.5	−4	−1	5.7	−3.6	1.1	GOLGA4	golgi autoantigen, golgin	NM_002078
								subfamily a, 4
P01083_C04	−1.1	1.2	1.2	−1.8	1.5	1.1	GOLPH2	golgi phosphoprotein 2	NM_016548
P01125_G10	1.8	−1.9	−1	1.6	−1.9	−1.1	GOLPH4	golgi phosphoprotein 4	NM_014498
P01131_F08	1.7	−2.3	−1.2	1.8	−1.6	−1.2	GOT1	glutamic-oxaloacetic	NM_002079
								transaminase 1, soluble
								(aspartate aminotransferase 1)
P01080_A01	−1.2	1.9	1.3	−3.6	1.8	1.2	GPM6B	glycoprotein M6B	NM_005278
P01082_E09	−2.2	2.3	1.2	−2.9	2.3	1	GPNMB	glycoprotein (transmembrane)	NM_002510
								nmb
P01087_G08	−3	2.3	1	−4.9	4	−1	GPNMB	glycoprotein (transmembrane)	NM_002510
								nmb
P01140_E04	−1.8	1.6	1.3	−2.5	1.8	1.1	GPRK5	G protein-coupled receptor	NM_005308
								kinase 5
P01068_E08	−3.2	1.8	−1.1	−1.9	2.9	1.1	GSTM1	glutathione S-transferase M1	NM_000561
P01068_E09	−1.8	1.5	1.1	−1.7	2.3	1.1	GSTM3	glutathione S-transferase M3	NM_000849
								(brain)
P01086_A10	−2.4	1.5	1.1	−1.9	2.7	1.1	GSTM5	glutathione S-transferase M5	NM_000851
P01080_C03	1.7	−1.8	1.1	2.1	−1.9	−1	GTPBP2	GTP binding protein 2	NM_019096
P01108_A05	−1.2	1.5	1.2	−1.9	1.7	1.1	GYPC	glycophorin C (Gerbich blood	NM_002101
								group)
P01121_B02	−1.6	1.2	−1	−1.9	1.9	1.1	HAGE	DEAD-box protein	NM_018665
P01133_H11	−1.2	1.8	1.4	−2.1	1.7	1.2	HAS2	hyaluronan synthase 2	NM_005328
P01101_C10	−1.8	1.6	−1	−1.4	1.5	−1	HEBP1	heme binding protein 1	NM_015987
P01137_B02	1.8	−1.5	1	1.6	−1.3	1	HERPUD1	homocysteine-inducible,	NM_014685
								endoplasmic reticulum stress-
								inducible, ubiquitin-like domain
								member 1
P01136_A05	2	−2.1	1.1	2	−1.8	−1	HERPUD1	homocysteine-inducible,	NM_014685
								endoplasmic reticulum stress-
								inducible, ubiquitin-like domain
								member 1
P01083_G12	1.6	−1.1	1.1	2.2	−1.5	1.2	HEYL	hairy/enhancer-of-split related	NM_014571
								with YRPW motif-like
P01126_B01	−1.3	1.4	1.1	−1.8	1.8	−1	HFL1	H factor (complement)-like 1	NM_002113
P01075_H10	−3.6	6.2	1.3	−5.3	3.8	1.3	HGF	hepatocyte growth factor	NM_000601
								(hepapoietin A; scatter factor)
P01110_C10	1.9	−1.6	1.3	1.3	−1.2	1.1	HMGCR	3-hydroxy-3-methylglutaryl-	NM_000859
								Coenzyme A reductase
P01112_G07	2	−1.7	1.3	−1	−1.1	−1	HMGCS1	3-hydroxy-3-methylglutaryl-	NM_002130
								Coenzyme A synthase 1
								(soluble)
P01064_F02	−2	2.6	1.1	−3.1	3	1	HNMT	histamine N-methyltransferase	NM_006895
P01078_F05	−2.1	2.4	1.2	−2.1	2.6	1.1	HPN	hepsin (transmembrane	NM_002151
								protease, serine 1)
P01107_H06	1.8	−1.9	−1.2	1.4	−1.7	−1.3	IARS	isoleucine-tRNA synthetase	NM_002161
P01100_C10	−1.2	1.5	1.3	−1.8	1.7	1.1	ICOS	inducible T-cell co-stimulator	NM_012092
P01124_A06	−1.7	2	1.3	−1.8	1.7	−1	ID2	inhibitor of DNA binding 2,	NM_002166
								dominant negative helix-loop-
								helix protein
P01072_H03	1.8	−1.6	1.1	1.6	−1.6	1.2	ID4	inhibitor of DNA binding 4,	NM_001546
								dominant negative helix-loop-
								helix protein
P01088_C01	−2.4	2.2	1	−2.5	2.2	−1	IDH2	isocitrate dehydrogenase 2	NM_002168
								(NADP+), mitochondrial
P01130_F01	4.5	−2.9	1.3	1.8	−1.7	1	IGF1	insulin-like growth factor 1	NM_000618
								(somatomedin C)
P01063_D10	2.1	1	1.2	3.8	−1.9	1.3	IGF1	insulin-like growth factor 1	NM_000618
								(somatomedin C)
P00777_D09	−2.6	2.2	1.1	−2.9	3.2	1.2	IGFBP4	insulin-like growth factor	NM_001552
								binding protein 4
P01130_B02	12.3	−11.1	1.2	6.1	−5.4	1.1	IL11	interleukin 11	NM_000641
P01088_D05	−2	2	1.2	−1.8	1.4	1.1	IL1B	interleukin 1, beta	NM_000576
P01063_E06	−3	3.3	1.1	−6.7	6.1	1.1	IL1R1	interleukin 1 receptor, type I	NM_000877
P01110_E12	−1.4	2.3	1.3	−2.5	1.5	1.1	IL1R1	interleukin 1 receptor, type I	NM_000877
P01145_A04	−3	2.4	−1	−4.2	2.7	−1	IL6ST	interleukin 6 signal transducer	NM_002184
								(gp130, oncostatin M receptor)
P01091_B03	−1.9	1.9	−1	−1.3	1.3	1	IMPA2	inositol(myo)-1(or 4)-	NM_014214
								monophosphatase 2
P01063_E03	1.7	−1.7	−1.2	2.4	−1.7	1.1	INDO	indoleamine-pyrrole 2,3	NM_002164
								dioxygenase
P01082_F07	2.1	−2.6	−1.1	2.2	−1.5	1.2	INHBA	inhibin, beta A (activin A,	NM_002192
								activin AB alpha polypeptide)
P01130_D09	2.1	−1.7	−1	1.7	−1.7	−1.1	INPP4B	inositol polyphosphate-4-	NM_003866
								phosphatase, type II, 105 kDa
P01067_B04	2	−1.7	1.2	1.6	−1.3	1.1	INSIG1	insulin induced gene 1	NM_005542
P01074_G10	−1.7	1.7	−1	−4.7	3.1	−1.1	IQGAP2	IQ motif containing GTPase	NM_006633
								activating protein 2
P01061_E02	2.6	−2.6	1	2.4	−2.5	−1	ISGF3G	interferon-stimulated	NM_006084
								transcription factor 3, gamma
								48 kDa
P01140_B08	1.8	−1.7	1.2	3	−1.8	1	ITGA11	integrin, alpha 11	NM_012211
P01088_C11	−1.5	1.8	1.2	−1.8	1.9	1.1	ITGAM	integrin, alpha M (complement	NM_000632
								component receptor 3, alpha;
								also known as CD11b (p170),
								macrophage antigen alpha
								polypeptide)
P01081_E02	2.3	−1.8	1.2	2.2	−2.2	1	JUNB	jun B proto-oncogene	NM_002229
P01072_G01	1.6	−1.5	1.2	1.9	−1.6	1.1	JUP	junction plakoglobin	NM_002230
P01079_A01	−1.9	2.1	−1.1	−1.5	1.5	−1	JWA	vitamin A responsive;	NM_006407
								cytoskeleton related
P01122_A09	1.1	1.3	1.2	−1.9	1.6	1.1	KCNE3	potassium voltage-gated	NM_005472
								channel, lsk-related family,
								member 3
P01113_F02	−1.8	1.9	1.2	−2.4	2.3	1.1	KHDRBS3	KH domain containing, RNA	NM_006558
								binding, signal transduction
								associated 3
P01074_B01	−1.6	1.2	1.1	−1.9	1.7	1	KIAA0102	KIAA0102 gene product	NM_014752
P01104_A04	−3.2	3.8	−1	−3	3.4	−1	KIAA1049	KIAA1049 protein	NM_014972
P01120_B02	−1.6	1.5	1.1	−1.8	1.7	1	KIF1B	kinesin family member 1B	NM_015074
P01088_C06	−1.6	1.6	1.2	−1.9	1.8	1	KRT4	keratin 4	NM_002272
P01085_D06	−1.8	1.7	1.2	−3.8	4.1	1	LAMA4	laminin, alpha 4	NM_002290
P01131_H02	−1.4	1.4	1.1	−2	1.9	−1.1	LAMC1	laminin, gamma 1 (formerly	NM_002293
								LAMB2)
P01131_H10	−2.4	1.8	−1.1	−2.1	1.5	1	LCN2	lipocalin 2 (oncogene 24p3)	NM_005564
P01100_H05	−2.8	2.7	1.2	−5	2.7	1	LEPR	leptin receptor	NM_002303
P01088_B02	−2.3	2.4	1.1	−2.6	2.1	−1	LGALS3	lectin, galactoside-binding,	NM_002306
								soluble, 3 (galectin 3)
P01081_B11	−3.5	1.3	1.1	−4.6	4.4	1	LHFP	lipoma HMGIC fusion partner	NM_005780
P01107_D06	2.2	−2	−1	1.7	−1.8	−1.1	LIMK2	LIM domain kinase 2	NM_005569
P01085_G06	1.2	−1.4	−1.1	1.9	−2.1	−1	LMO7	LIM domain only 7	NM_005358
P01085_D05	−2.1	2.2	1.2	−3.9	3.7	1.1	LOC56270	hypothetical protein 628	NM_019613
P01082_E01	2.1	−1.5	1.2	1.8	−1.6	1.2	LOX	lysyl oxidase	NM_002317
P01083_H02	−1.4	1.5	1.1	−2	2	1	LPHN2	latrophilin 2	NM_012302
P01131_D06	−1.6	1.7	1.2	−2.4	1.8	1.2	LRP4	low density lipoprotein	AB011540
								receptor-related protein 4
P01072_F03	1.8	−1.2	−1	2.2	−1.6	−1	LTBP2	latent transforming growth	NM_000428
								factor beta binding protein 2
P01088_C04	−2.3	2.3	1.1	−4.4	4.7	1.1	LTF	lactotransferrin	NM_002343
P01063_A11	−2.3	2.4	−1	−4.8	3.9	−1	LUM	lumican	NM_002345
P01135_G05	−2.4	2.4	1.2	−1.7	1.6	−1	LY96	lymphocyte antigen 96	NM_015364
P01085_C04	−2	1.8	1.2	−2	1.5	1	MADH3	MAD, mothers against	NM_005902
								decapentaplegic homolog 3
								(Drosophila)
P01091_G10	1.8	−1.4	1.2	2.2	−2.1	1.2	MADH7	MAD, mothers against	NM_005904
								decapentaplegic homolog 7
								(Drosophila)
P01089_C01	1.2	−1.2	−1	1.8	−1.6	−1.2	MAGP2	Microfibril-associated	NM_003480
								glycoprotein-2
P01084_A09	1.8	−1.6	1.2	1.4	−1.6	−1	MAP3K2	mitogen-activated protein	NM_006609
								kinase kinase kinase 2
P01073_E08	−2	2.4	−1	−2.3	1.8	−1	MAP3K5	mitogen-activated protein	NM_005923
								kinase kinase kinase 5
P01066_F10	2	−2	1.1	1.9	−1.7	1.1	MAPK7	mitogen-activated protein	NM_002749
								kinase 7
P01076_B12	1.9	−2.1	−1.1	1.7	−1.7	−1.1	MAPRE2	microtubule-associated	NM_014268
								protein, RP/EB family, member 2
P01134_C04	3.1	−2.1	1.1	2.8	−3.3	−1	MATN3	matrilin 3	NM_002381
P01145_A05	−1.7	1.9	−1	−2.6	2.1	−1	ME1	malic enzyme 1, NADP(+)-	NM_002395
								dependent, cytosolic
P01072_D11	−3.3	3.7	−1	−3.5	3.1	1	MEST	mesoderm specific transcript	NM_002402
								homolog (mouse)
P01121_F04	−1.9	2.1	1.3	−2.1	1.8	1	MGC1203	hypothetical protein MGC1203	NM_024296
P01068_F12	−2.9	2.8	1.1	−2.6	2.4	−1	MGST1	microsomal glutathione S-	NM_020300
								transferase 1
P01091_B06	−1.8	1.6	−1	−1.5	1.6	−1.1	MGST2	microsomal glutathione S-	NM_002413
								transferase 2
P01099_H09	−2.4	2.3	1.1	−2.4	2	1.2	MID1	midline 1 (Opitz/BBB	NM_000381
								syndrome)
P01062_H05	−1.4	2.2	1.3	−2.4	2.4	1.3	MME	membrane metallo-	NM_000902
								endopeptidase (neutral
								endopeptidase,
								enkephalinase, CALLA, CD10)
P01125_H08	1	1	1.1	2.6	−2.1	−1	MMP11	matrix metalloproteinase 11	NM_005940
								(stromelysin 3)
P01072_D02	2.8	−2.6	−1.3	1.7	−2	−1.2	MTHFD2	methylene tetrahydrofolate	NM_006636
								dehydrogenase (NAD+
								dependent),
								methenyltetrahydrofolate
								cyclohydrolase
P01125_A10	−1.6	1.6	1.2	−1.8	1.5	1.1	MTMR4	myotubularin related protein 4	NM_004687
P01130_C09	1.9	−1.7	1.3	1.1	−1.1	1.1	MUCDHL	mucin and cadherin-like	NM_017717
P01102_A12	1.4	−1.3	1.2	2.5	−1.6	1.1	MVK	mevalonate kinase (mevalonic	NM_000431
								aciduria)
P01133_F05	1.9	−1.8	1	1.4	−1.4	−1.1	MYH9	myosin, heavy polypeptide 9,	NM_002473
								non-muscle
P01100_B07	−2	2.4	1.1	−5.5	2.6	−1.1	MYOZ2	myozenin 2	NM_016599
P01072_C06	−1.6	1.6	1	−2.6	2.6	1.1	NCK1	NCK adaptor protein 1	NM_006153
P01086_B12	−1.2	1.4	−1	−1.8	1.6	−1.1	NCOA3	nuclear receptor coactivator 3	NM_006534
P01135_C12	3.3	−3	1.3	3.1	−2.1	1.2	NEDD9	neural precursor cell	NM_006403
								expressed, developmentally
								down-regulated 9
P01112_A08	2.5	−2.1	1.2	1.7	−1.8	1.1	NET-6	transmembrane 4 superfamily	NM_014399
								member tetraspan NET-6
P01103_E02	−1.7	2.1	1.2	−2.5	2.1	−1	NFIA	nuclear factor I/A	AL096888
P01073_E06	−1.9	1.9	1	−2.1	1.8	−1.1	NFIB	nuclear factor I/B	NM_005596
P01064_C02	−1.9	2	1.2	−3.3	2.5	1	NID2	nidogen 2 (osteonidogen)	NM_007361
P01131_E08	2.3	−1.6	1.3	5.1	−3	1.3	NINJ2	ninjurin 2	NM_016533
P01072_D01	2.2	−2.2	1.1	2.2	−2.1	−1	NK4	natural killer cell transcript 4	NM_004221
P01121_G06	−2.2	2.1	−1.1	−2.5	2.2	−1.1	NOL3	nucleolar protein 3 (apoptosis	NM_003946
								repressor with CARD domain)
P01104_C08	6.9	−6.1	1.1	5.8	−5.8	1.1	NOX4	NADPH oxidase 4	NM_016931
P01107_D11	−1.7	1.6	−1	−1.8	1.8	1	NPC2	Niemann-Pick disease, type	NM_006432
								C2
P01132_G06	2.4	−2	1.3	1.5	−1.6	1.1	NPR3	natriuretic peptide receptor	NM_000908
								C/guanylate cyclase C
								(atrionatriuretic peptide
								receptor C)
P01096_F08	−1.5	1.6	1.2	−2.1	2	1.1	NPTX2	neuronal pentraxin II	NM_002523
P01126_E07	−1.5	2	1.2	−2	1.7	1.1	NR2F2	nuclear receptor subfamily 2,	NM_021005
								group F, member 2
P01064_G11	−1.5	1.6	1	−2.1	1.5	−1	NRCAM	neuronal cell adhesion	NM_005010
								molecule
P01097_E11	1.9	−1.8	1.1	1.6	−1.8	−1	NS1-BP	NS1-binding protein	NM_006469
P01103_C04	2.4	−2.2	−1	1.3	−1.5	−1	NUDT3	nudix (nucleoside diphosphate	NM_006703
								linked moiety X)-type motif 3
P01072_B11	2.6	−2.6	−1.1	2.3	−2.3	−1.2	ODC1	omithine decarboxylase 1	NM_002539
P01082_E10	−1.4	2	1.3	−5.7	1.9	1.2	OGN	osteoglycin (osteoinductive	NM_014057
								factor, mimecan)
P01119_G07	−2.1	2.2	1.1	−2.2	1.6	−1	OSBPL1A	oxysterol binding protein-like	NM_018030
								1A
P01075_F01	2.3	−1.6	−1	3.9	−3.7	−1	OSF-2	osteoblast specific factor 2	NM_006475
								(fasciclin I-like)
P01129_A10	2.2	−1.6	−1	4.1	−3.6	−1	OSF-2	osteoblast specific factor 2	NM_006475
								(fasciclin I-like)
P01126_B11	−2	1.5	−1.2	1.1	1.7	1.2	OXA1L	oxidase (cytochrome c)	NM_005015
								assembly 1-like
P01071_D09	−1.9	1.6	−1.1	1.1	1.7	1.3	OXA1L	oxidase (cytochrome c)	NM_005015
								assembly 1-like
P01085_C08	−1.3	1.3	1.1	−2.2	1.6	−1	OXTR	oxytocin receptor	NM_000916
P01125_D04	2.1	−1.7	1.2	4.2	−2.3	1.3	PACE4	paired basic amino acid	NM_002570
								cleaving system 4
P01090_D03	−1.4	1.2	−1	−2.4	1.8	−1.2	PARG1	PTPL1-associated RhoGAP 1	NM_004815
P01122_G06	2.6	−2.4	1.1	1.9	−2	−1	PAWR	PRKC, apoptosis, WT1,	NM_002583
								regulator
P01120_F04	−1.8	2.3	1.3	−2	1.7	1.1	PBF	papillomavirus regulatory	NM_018660
								factor PRF-1
P01071_G08	−2	1.5	−1	−1.4	1.7	1	PBP	prostatic binding protein	NM_002567
P01064_A09	1.1	−1.2	1.2	1.9	−1.5	1.2	PCDH1	protocadherin 1 (cadherin-like	NM_002587
								1)
P01066_G05	−1.4	1.6	1.3	−3.2	2.4	1.2	PDE1A	phosphodiesterase 1A,	NM_005019
								calmodulin-dependent
P01128_B03	1.8	−1.7	1.1	−1.1	−1	−1	PDE5A	phosphodiesterase 5A, cGMP-	NM_001083
								specific
P01087_E02	3.4	−2.4	1.1	3	−3.7	−1	PDGFA	platelet-derived growth factor	NM_002607
								alpha polypeptide
P01081_F07	−2.3	2.1	1.1	−2.2	2.1	1.1	PDGFRA	platelet-derived growth factor	NM_006206
								receptor, alpha polypeptide
P01142_D01	−1.1	−1.8	1.2	−2.2	1.9	1.2	PDGFRL	platelet-derived growth factor	NM_006207
								receptor-like
P01064_G02	1.3	−1.1	1.3	2.3	−2	1.2	PDGFRL	platelet-derived growth factor	NM_006207
								receptor-like
P01137_F04	−1.8	2	1.1	−2	1.4	1.1	PDP	pyruvate dehydrogenase	NM_018444
								phosphatase
P01071_H07	1.8	−1.9	1	1.3	−1	1.1	PFKP	phosphofructokinase, platelet	NM_002627
P01064_H07	−1.8	1.7	1	−1.6	1.5	1	PHF3	PHD finger protein 3	NM_015153
P01131_G12	1.2	−1	1.2	1.8	−1.7	1.2	PIGB	phosphatidylinositol glycan,	NM_004855
								class B
P01074_H07	−1.8	1.9	1.2	−1.9	1.6	1	PIK3R1	phosphoinositide-3-kinase,	AF279367
								regulatory subunit, polypeptide
								1 (p85 alpha)
P01068_A02	−2.4	1.7	−1.1	−1.4	2.1	1	PIR	Pirin	NM_003662
P01112_H01	1.8	−1.6	1.4	1.3	−1.4	−1	PIST	PDZ/coiled-coil domain	NM_020399
								binding partner for the rho-
								family GTPase TC10
P01118_H09	−2.4	2.1	−1	−1.8	1.9	1	PITPNM	phosphatidylinositol transfer	NM_004910
								protein, membrane-associated
P01110_G02	−1.3	1.6	1.3	−4	2	1	PKIB	protein kinase (cAMP-	NM_032471
								dependent, catalytic) inhibitor
								beta
P01146_A11	1.4	−1.5	−1	1.8	−1.9	−1	PLA2G4C	phospholipase A2, group IVC	NM_003706
								(cytosolic, calcium-
								independent)
P01124_G10	3	−2.5	1	2.5	−3.2	−1.2	PLA2R1	phospholipase A2 receptor 1,	NM_007366
								180 kDa
P01070_G08	1.8	−1.7	−1	1.9	−2.3	−1.1	PLAU	plasminogen activator,	NM_002658
								urokinase
P01064_F01	−1.8	2.3	1.2	−1.7	1.9	1.2	PLCL1	phospholipase C-like 1	NM_006226
P01118_E04	2.4	−1.8	1.3	2.3	−1.9	1.1	PLEK2	pleckstrin 2	NM_016445
P01072_A03	5.2	−5.1	1.3	2.1	−1.6	1.2	PLN	phospholamban	NM_002667
P01084_A08	2.8	−2.2	1.1	1.9	−1.8	1.1	PLOD2	procollagen-lysine, 2-	NM_000935
								oxoglutarate 5-dioxygenase
								(lysine hydroxylase) 2
P01063_E04	1.6	−1.7	−1.2	2.4	−1.6	1.1	PLP2	proteolipid protein 2 (colonic	NM_002668
								epithelium-enriched)
P01130_B04	−3.6	4.3	1	−5.6	5.1	1.1	PMP2	peripheral myelin protein 2	NM_002677
P01131_C08	−2.2	1.6	1.1	−3.4	2.3	1.1	PNUTL2	peanut-like 2 (Drosophila)	NM_004574
P01106_F02	1.5	−1.3	1.2	1.8	−1.7	1.1	PODXL	podocalyxin-like	NM_005397
P01074_B08	2.8	−1.8	1.2	2.2	−2.8	1.1	POLD3	polymerase (DNA directed),	BC020587
								delta 3
P01080_A04	−1.3	1.4	1	−1.8	1.5	1.1	PP	pyrophosphatase (inorganic)	NM_021129
P01123_E01	−2.9	3.2	1.3	−3.1	2.8	1.3	PPAP2B	phosphatidic acid phosphatase	NM_003713
								type 2B
P01064_B12	−1.5	1.7	1.2	−2.2	1.5	−1	PPARG	peroxisome proliferative	NM_005037
								activated receptor, gamma
P01136_D03	−5.4	3.3	1.1	−5.3	4.2	−1	PPL	periplakin	NM_002705
P01131_H04	1.2	−1.4	−1.2	2	−1.6	−1.2	PPP2R4	protein phosphatase 2A,	NM_021131
								regulatory subunit B′ (PR 53)
P01087_D04	−1.2	1.3	−1.1	−1.9	1.5	−1.1	PRKCM	protein kinase C, mu	NM_002742
P01128_H07	2.3	−2.2	1.3	1.4	−1.4	1.1	PRPS1	phosphoribosyl pyrophosphate	NM_002764
								synthetase 1
P01062_F06	−1.6	1.5	1.1	−4.4	3.6	1	PSG1	pregnancy specific beta-1-	NM_006905
								glycoprotein 1
P01133_G04	−2	1.9	1.2	−5.5	4.8	−1	PSG1	pregnancy specific beta-1-	NM_006905
								glycoprotein 1
P01131_G08	−1.4	1.4	1.2	−2.6	2.6	1.1	PSG11	pregnancy specific beta-1-	NM_002785
								glycoprotein 11
P01141_B07	−1.4	1.8	1.3	−4.1	4	1.1	PSG4	pregnancy specific beta-1-	NM_002780
								glycoprotein 4
P01079_F07	−1.5	1.5	1.1	−2	1.5	−1	PTGER4	prostaglandin E receptor 4	NM_000958
								(subtype EP4)
P01131_C07	−2.8	1.7	−1.1	−2.2	1.8	−1.1	PTGIS	prostaglandin I2 (prostacyclin)	NM_000961
								synthase
P01102_D10	2.3	−2.8	−1.1	1.1	−1.2	−1.1	PTGS1	prostaglandin-endoperoxide	NM_000962
								synthase 1 (prostaglandin G/H
								synthase and cyclooxygenase)
P01087_D05	3	−2.6	1.1	1.3	−1.2	−1.1	PTGS2	prostaglandin-endoperoxide	NM_000963
								synthase 2 (prostaglandin G/H
								synthase and cyclooxygenase)
P01106_G06	1.8	−1.5	1.2	3.1	−1.5	1.1	PTHLH	parathyroid hormone-like	NM_002820
								hormone
P01071_G12	−1.9	1.4	−1	−3.7	3.6	−1.1	PTN	pleiotrophin (heparin binding	NM_002825
								growth factor 8, neurite
								growth-promoting factor 1)
P01128_H08	−2.3	2.4	1.1	−1.5	1.3	−1	PTTG1	pituitary tumor-transforming 1	NM_004219
P01095_A03	−2.4	2.4	1.2	−1.4	1.2	1	PTTG1	pituitary tumor-transforming 1	NM_004219
P01097_G06	−1.7	1.7	−1	−2.2	1.6	−1	PUS1	pseudouridylate synthase 1	NM_025215
P01076_C04	2.5	−1.7	1.2	3.1	−2.6	1.2	QPCT	glutaminyl-peptide	NM_012413
								cyclotransferase (glutaminyl
								cyclase)
P01129_C05	−2.1	1.8	−1	−1.5	2.1	1.2	RAB13	RAB13, member RAS	NM_002870
								oncogene family
P01115_G01	−1.8	1.5	1.1	−1.6	2.2	1.2	RAB13	RAB13, member RAS	NM_002870
								oncogene family
P01110_E09	1.4	−1.2	1.2	1.8	−1.6	1	RAI	RelA-associated inhibitor	NM_006663
P01100_E02	−1.5	1.5	1.1	−3.3	2.7	1	RAI3	retinoic acid induced 3	NM_003979
P01082_A01	−2.4	1.8	1.1	−2.6	2.3	1.1	RARRES3	retinoic acid receptor	NM_004585
								responder (tazarotene
								induced) 3
P01117_H10	−1.8	1.6	1.1	−2.5	2	1	RASSF5	Ras association (RalGDS/AF-	NM_031437
								6) domain family 5
P01108_C07	1.4	−1.4	1.1	2.5	−1.9	1.2	RBP1	retinol binding protein 1,	NM_002899
								cellular
P01136_C04	2.6	−1.8	1.1	2.3	−1.6	1.2	RGS2	regulator of G-protein	NM_002923
								signalling 2, 24 kDa
P01145_A10	−1.2	1.2	−1.1	−2	1.6	−1.1	RGS4	regulator of G-protein	NM_005613
								signalling 4
P01090_D02	−1.3	1.2	−1.1	−3	1.9	−1.3	RGS4	regulator of G-protein	NM_005613
								signalling 4
P01081_H10	−2.2	1.6	1	−6.7	4.7	−1	RGS5	regulator of G-protein	NM_003617
								signalling 5
P01071_E04	−1.9	1.4	−1.1	−3.8	3.2	−1.1	RNASE1	ribonuclease, RNase A family,	NM_002933
								1 (pancreatic)
P01088_G09	−1	1	1	−1.8	1.8	−1.1	RPL5	ribosomal protein L5	NM_000969
P01127_E10	1.8	−1.6	1.1	1.7	−1.5	−1	RRAS	related RAS viral (r-ras)	NM_006270
								oncogene homolog
P01122_B03	−2	2	1.1	−2.4	3.1	1.2	RRP4	homolog of Yeast RRP4	NM_014285
								(ribosomal RNA processing 4),
								3′-5′-exoribonuclease
P01104_D09	2.1	−1.7	1.1	2	−1.8	1	RTP801	HIF-1 responsive RTP801	NM_019058
P01121_G04	2.1	−1.8	1.1	4.1	−3.2	1.1	RUVBL2	RuvB-like 2 (E. coli)	NM_006666
P01087_B06	−1.4	1	−1.2	−1.9	2.4	−1.2	S100A10	S100 calcium binding protein	NM_002966
								A10 (annexin II ligand,
								calpactin I, light polypeptide
								(p11))
P01064_F10	1.5	−1.5	−1.3	1.8	−1.5	−1.2	S100A11	S100 calcium binding protein	NM_005620
								A11 (calgizzarin)
P00777_A05	−1.9	1.7	1.1	−2.3	2.4	1.1	S100A4	S100 calcium binding protein	NM_002961
								A4 (calcium protein,
								calvasculin, metastasin,
								murine placental homolog)
P00777_A06	−1.9	1.8	1.1	−2.6	2.7	1.1	S100A4	S100 calcium binding protein	NM_002961
								A4 (calcium protein,
								calvasculin, metastasin,
								murine placental homolog)
P01143_A11	−1.7	1.7	1.1	−2.4	2.4	1.1	S100A4	S100 calcium binding protein	NM_002961
								A4 (calcium protein,
								calvasculin, metastasin,
								murine placental homolog)
P01141_F03	1.5	−1.2	1.3	3.9	−1.7	1.3	SAA2	serum amyloid A2	NM_030754
P01061_F04	−3.1	4	1.3	−2.2	2.8	1.3	SAT	spermidine/spermine N1-	NM_002970
								acetyltransferase
P01124_B03	−2.9	3.7	1.4	−2.1	2.5	1.4	SAT	spermidine/spermine N1-	NM_002970
								acetyltransferase
P01140_G05	2	−2.1	1.1	1.3	−1.3	−1	SC5DL	sterol-C5-desaturase (ERG3	NM_006918
								delta-5-desaturase homolog,
								fungal)-like
P01066_H04	4.1	−2.7	1.2	3	−2	1.2	SCD	stearoyl-CoA desaturase	NM_005063
								(delta-9-desaturase)
P01140_D11	4.7	−3.8	1.2	3.5	−2.4	1	SCD	stearoyl-CoA desaturase	NM_005063
								(delta-9-desaturase)
P01119_B12	−1.6	1.9	1.2	−3.9	2.3	1.1	SCDGF-B	spinal cord-derived growth	NM_025208
								factor-B
P01087_A04	−1.1	1.3	1.2	−4	2	1.2	SCG2	secretogranin II (chromogranin	NM_003469
								C)
P01096_B12	2.6	−1.9	1.2	2.8	−2.5	−1	SCRG1	scrapie responsive protein 1	NM_007281
P01071_B04	−1.7	1.7	−1.1	−2.6	2.3	1	SDC4	syndecan 4 (amphiglycan,	NM_002999
								ryudocan)
P01063_H09	−1.8	1.7	1	−1.8	1.6	−1	SDCBP	syndecan binding protein	NM_005625
								(syntenin)
P01076_C05	1.8	−1.5	1.2	1	−1.2	−1	SEC23A	Sec23 homolog A (S. cerevisiae)	NM_006364
P01096_G04	−3.6	2.5	−1	−3	6	1.3	SELENBP1	selenium binding protein 1	NM_003944
P01119_G09	−3.2	2.4	1.1	−2.5	5.8	1.4	SELENBP1	selenium binding protein 1	NM_003944
P01076_B03	−1.6	1.4	−1	−2	1.5	−1.1	SEPP1	selenoprotein P, plasma, 1	NM_005410
P01062_D11	3	−2.9	−1	4.3	−3.3	−1	SERPINE1	serine (or cysteine) proteinase	NM_000602
								inhibitor, clade E (nexin,
								plasminogen activator inhibitor
								type 1), member 1
P01090_H11	−1.3	1.2	1.2	−1.9	2.1	1.3	SFRP1	secreted frizzled-related	NM_003012
								protein 1
P01078_F01	−1.8	2.4	−1.1	−1.6	1.6	1.1	SFRP4	secreted frizzled-related	NM_003014
								protein 4
P01087_A06	−2.9	1.9	−1.2	−3	2.2	−1.3	SGNE1	secretory granule,	NM_003020
								neuroendocrine protein 1 (7B2
								protein)
P01106_G05	1.8	−1.7	1.3	2.9	−2.2	1.2	SKIL	SKI-like	NM_005414
P01102_A06	−1.8	2	1.3	−3.2	2.8	1.3	SLC11A3	solute carrier family 11	NM_014585
								(proton-coupled divalent metalion
								transporters), member 3
P01105_A03	1.9	−1.7	1.1	1.5	−1.4	−1	SLC1A4	solute carrier family 1	NM_003038
								(glutamate/neutral amino acid
								transporter), member 4
P01143_D11	−2.7	2.5	1.3	−2.1	2.8	1.1	SLC25A11	solute carrier family 25	NM_003562
								(mitochondrial carrier;
								oxoglutarate carrier), member
								11
P01111_H03	1.8	−1.7	1	1.9	−2	−1	SLC7A11	solute carrier family 7,	NM_014331
								(cationic amino acid
								transporter, y+ system)
								member 11
P01138_A08	3	−2.9	−1	2.3	−2.4	−1.1	SLC7A5	solute carrier family 7 (cationic	NM_003486
								amino acid transporter, y+
								system), member 5
P01088_E10	3.1	−2.7	1.1	2.6	−2.3	1	SLC7A5	solute carrier family 7 (cationic	NM_003486
								amino acid transporter, y+
								system), member 5
P01112_E05	−1.6	1.3	1	−3	2.2	−1	SLIT3	slit homolog 3 (Drosophila)	NM_003062
P01136_F07	−1.1	1.4	1.2	−2.1	1.9	1.1	SLIT3	slit homolog 3 (Drosophila)	NM_003062
P01079_G03	−3.1	3.4	−1	−3.9	3.5	−1	SNAI2	snail homolog 2 (Drosophila)	NM_003068
P01140_F07	2.9	−2.6	1.1	2.2	−2.5	1.1	SNF1LK	SNF1-like kinase
P01083_A04	−3.2	3.2	1	−9.3	7	−1.1	SNK	serum-inducible kinase	NM_006622
P01085_F06	−1.2	1.2	1.1	−2.6	1.7	1.1	SOD3	superoxide dismutase 3,	NM_003102
								extracellular
P01074_H12	1	1.1	1.1	−2.6	1.5	1.1	SPINT2	serine protease inhibitor,	NM_021102
								Kunitz type, 2
P01108_B02	−2.5	2.6	1.2	−4.2	2.2	−1	SPRY1	sprouty homolog 1, antagonist	AF041037
								of FGF signaling (Drosophila)
P01095_F04	−2.6	2	−1.1	−1.8	1.8	−1.1	SQRDL	sulfide quinone reductase-like	NM_021199
								(yeast)
P01128_E07	1.9	−2	1	2.6	−2.7	−1	SRPUL	sushi-repeat protein	NM_014467
P01073_B02	−1.7	1.7	1.2	−2.5	1.9	−1	SRPX	sushi-repeat-containing	NM_006307
								protein, X chromosome
P01104_F12	−2.1	2.5	1.2	−2.2	2.3	−1.1	SSBP2	single-stranded DNA binding	NM_012446
								protein 2
P01069_C06	1.9	−1.3	−1	2.7	−2.6	−1	SSR1	signal sequence receptor,	NM_003144
								alpha (translocon-associated
								protein alpha)
P01130_F10	−1.3	1.6	1.1	−2.3	2.3	−1.1	STC1	stanniocalcin 1	NM_003155
P01130_B11	2.1	−2	−1	1.7	−1.8	−1.1	STCH	stress 70 protein chaperone,	NM_006948
								microsome-associated, 60 kDa
P01074_E03	1.7	−1.3	−1	−1.9	1.5	−1.1	STE	sulfotransferase, estrogen-	NM_005420
								preferring
P01127_G01	−1.4	1.5	1.2	−1.9	1.5	1.2	STK17B	serine/threonine kinase 17b	NM_004226
								(apoptosis-inducing)
P01125_C11	−2	1.6	−1	−2.2	2.1	−1	STK25	serine/threonine kinase 25	NM_006374
								(STE20 homolog, yeast)
P01076_D03	−2.7	2.9	1.1	−2.1	1.8	1	STK38	serine/threonine kinase 38	NM_007271
P01105_E03	−2.8	2.7	−1.1	−2.7	2.5	−1.1	STMN1	stathmin 1/oncoprotein 18	NM_005563
P01069_A08	−1.5	1.5	1.1	−1.8	1.5	1	STOM	stomatin	NM_004099
P01102_E10	−1.5	1.6	1.1	−2.3	1.5	1	SVIL	supervillin	NM_003174
P01062_H06	−1.5	2.1	1.2	−2.9	2.7	1.2	TACSTD2	tumor-associated calcium	NM_002353
								signal transducer 2
P01098_E05	1.9	−1.8	1.2	1.2	−1.3	1.1	TAF13	TAF13 RNA polymerase II,	NM_005645
								TATA box binding protein
								(TBP)-associated factor,
								18 kDa
P01101_B02	−1.9	1.4	1.1	−2	1.8	1	TCF7L1	transcription factor 7-like 1 (T-	NM_031283
								cell specific, HMG-box)
P01061_C01	−1.7	1.6	1.3	−2	2.4	1.1	TF	transferrin	NM_001063
P01144_C03	−3.4	3.6	1.2	−4	2.9	1.1	TFPI	tissue factor pathway inhibitor	NM_006287
								(lipoprotein-associated
								coagulation inhibitor)
P01071_A04	−1.4	1.6	1.4	−2.3	2.3	1.1	TFPI2	tissue factor pathway inhibitor 2	NM_006528
P01085_B12	−1.4	1.4	1.2	−2.1	1.7	1.1	TGFB2	transforming growth factor,	NM_003238
								beta 2
P01061_C08	−3.5	3.8	1.2	−4.7	4	1.2	TGFBR3	transforming growth factor,	NM_003243
								beta receptor III (betaglycan,
								300 kDa)
P01078_B04	1.8	−1.7	−1	1.8	−1.9	−1.2	THBS2	thrombospondin 2	NM_003247
P01124_G04	2.8	−2.5	−1	2.4	−3.1	−1.3	TIMP3	tissue inhibitor of	NM_000362
								metalloproteinase 3 (Sorsby
								fundus dystrophy,
								pseudoinflammatory)
P01086_F06	2.1	−2.4	−1	2.6	−3.1	−1.2	TIMP3	tissue inhibitor of	NM_000362
								metalloproteinase 3 (Sorsby
								fundus dystrophy,
								pseudoinflammatory)
P01071_A06	−3	3	−1	−2.5	2.6	−1	TM4SF1	transmembrane 4 superfamily	NM_014220
								member 1
P01099_E08	−1.6	1.8	1	−1.8	1.5	−1.1	TncRNA	trophoblast-derived noncoding
								RNA
P01126_E09	−1.7	2	1	−3.7	4.2	1.1	TNFAIP2	tumor necrosis factor, alpha-	NM_006291
								induced protein 2
P01085_A06	−1.5	1.6	−1	−2.4	1.9	1.1	TNFAIP3	tumor necrosis factor, alpha-	NM_006290
								induced protein 3
P01138_G10	1.8	−1.7	1.2	2.1	−2	1	TNFRSF12A	tumor necrosis factor receptor	NM_016639
								superfamily, member 12A
P01078_E05	−2.1	3	1.4	−2.6	2.5	1.2	TNFSF10	tumor necrosis factor (ligand)	NM_003810
								superfamily, member 10
P01144_C11	−2	2	1	−1.9	1.4	1.2	TOP2A	topoisomerase (DNA) II alpha	NM_001067
								170 kDa
P01140_D03	2.1	−1.7	−1	1.2	−1.6	−1	TTID	titin immunoglobulin domain	NM_006790
								protein (myotilin)
P01070_H07	−2.9	2.3	1.1	−3	2.6	−1.1	TXNRD1	thioredoxin reductase 1	NM_003330
P01089_D01	1.7	−3	1.1	2.5	−2.3	−1	UCHL1	ubiquitin carboxyl-terminal	NM_004181
								esterase L1 (ubiquitin
								thiolesterase)
P01123_D07	−1.9	2.4	1.1	−2	1.8	1.1	UGCG	UDP-glucose ceramide	NM_003358
								glucosyltransferase
P01089_F07	1.5	−2.6	1.2	2.4	−1.7	1.2	UMPK	undine monophosphate kinase	NM_012474
P01070_F11	2.1	−3.1	1.1	2.4	−1.9	1	UMPS	uridine monophosphate	NM_000373
								synthetase (orotate
								phosphoribosyl transferase
								and orotidine-5′-
								decarboxylase)
P01061_B02	−2.7	2.4	1	−4.2	2.3	−1.3	VCAM1	vascular cell adhesion	NM_001078
								molecule 1
P01141_C06	2.7	−1.8	1.3	1.4	−1.2	1.2	WISP1	WNT1 inducible signaling	NM_003882
								pathway protein 1
P00777_C09	−1.6	1.8	1.1	−5	4	−1	WISP2	WNT1 inducible signaling	NM_003881
								pathway protein 2
P00777_C10	−2.2	2.1	1.1	−5.6	4.4	−1	WISP2	WNT1 inducible signaling	NM_003881
								pathway protein 2
P01126_H07	−1.8	1.6	1.1	−3	3.9	−1	WISP2	WNT1 inducible signaling	NM_003881
								pathway protein 2
P01142_D08	3.7	−3	1.3	3.6	−2.8	1.1	XRCC4	X-ray repair complementing	NM_003401
								defective repair in Chinese
								hamster cells 4
P01104_H07	−1.7	1.7	1.2	−1.9	1.5	1.1	ZFPM2	zinc finger protein, multitype 2	NM_012082
P01064_H12	−1.4	1.5	1.1	−1.8	1.5	−1	ZNF142	zinc finger protein 142 (clone	NM_005081
								pHZ-49)
P01075_E02	1.5	−1.2	1.1	1.9	−1.9	1	ZNF193	zinc finger protein 193	NM_006299

Validation of Microarray by Real-Time RT-PCR and Western Blot Analyses

Representative microarray data was validated using real-time RT-PCR and Western analyses. TGFβ induced Collagen 1 mRNA levels in human cardiac fibroblasts at 6, 24, and 48 h; this induction was blocked by BNP at all 3 time points (FIG. 5A). Collagen 1 protein synthesis was also induced (˜3-fold) at 48 h, and BNP inhibited this stimulation by ˜75% (FIG. 5B). BNP also inhibited TGFβ-induced Fibronectin mRNA and protein expression at 48 h (FIG. 5C,D). These data corroborate the microarray results, with the exception of Fibronectin, which did not exceed the array differential expression threshold value, most likely due to the lower sensitivity of the microarray compared to real-time RT-PCR. The effects of BNP on TGFβ stimulation of pro-fibrotic genes CTGF, PAI-1, TIMP3, IL11, and ACTA2 were also confirmed by real-time RT-PCR (FIG. 6). Additional verification was obtained for the pro-inflammatory genes COX2 and IL6 at 6, 24, and 48 h (FIG. 6). Again, most likely due to sensitivity issues, IL6 was not included in FIG. 4C, since it did not exceed the array differential expression threshold value.

In addition, real-time RT-PCR assays were performed for 9 genes on primary cultures of human cardiac fibroblasts from a second independent donor lot of fibroblasts (see Table 3). The effects of BNP on TGFβ-induced gene expression in both donors were similar, although donor lot 2 was slightly less responsive to TGFβ. Taken together, these results confirm the microarray data using independent assay methods, as well as, multiple human cardiac fibroblast donors.

TABLE 3
Real-time RT-PCR validation of microarray data using human cardiac fibroblasts from
two separate donors (lot 1 and lot 2). Expression levels are normalized to 18s RNA and
are shown relative to the control samples. Standard deviations reflect duplicate
biological replicates; real-time RT-PCR reactions were performed in triplicate.
Gene	Control	BNP	TGFβ	TGFβ + BNP	Time (h)	Lot
Collagen 1	1.0 ± 0.05	1.0 ± 0.05	1.9 ± 0.04	1.2 ± 0.01	6	1
	1.0 ± 0.06	1.1 ± 0.13	3.3 ± 0.05	1.3 ± 0.26	24	1
	1.0 ± 0.11	1.0 ± 0.26	1.5 ± 0.09	1.2 ± 0.01	24	2
	1.0 ± 0.13	1.2 ± 0.03	3.8 ± 0.38	1.3 ± 0.03	48	1
	1.0 ± 0.20	1.0 ± 0.01	2.5 ± 0.32	1.3 ± 0.18	48	2
Fibronectin	1.0 ± 0.04	0.9 ± 0.19	1.1 ± 0.17	1.0 ± 0.29	6	1
	1.0 ± 0.21	1.0 ± 0.10	1.0 ± 0.05	1.0 ± 0.18	24	1
	1.0 ± 0.19	0.9 ± 0.24	1.0 ± 0.02	1.0 ± 0.12	24	2
	1.0 ± 0.04	1.1 ± 0.04	2.2 ± 0.38	1.3 ± 0.35	48	1
	1.0 ± 0.01	1.0 ± 0.11	2.0 ± 0.39	1.5 ± 0.02	48	2
SERPINE1/PAI-1	1.0 ± 0.07	0.7 ± 0.08	7.3 ± 0.44	1.7 ± 0.37	6	1
	1.0 ± 0.01	0.7 ± 0.01	8.5 ± 0.08	0.7 ± 0.10	24	1
	1.0 ± 0.10	0.7 ± 0.11	2.4 ± 0.06	1.1 ± 0.10	24	2
	1.0 ± 0.22	0.9 ± 0.00	8.4 ± 1.33	0.9 ± 0.13	48	1
	1.0 ± 0.17	0.8 ± 0.03	2.6 ± 0.03	0.9 ± 0.06	48	2
CTGF	1.0 ± 0.15	0.9 ± 0.24	3.5 ± 0.08	0.9 ± 0.03	6	1
	1.0 ± 0.28	1.0 ± 0.29	3.3 ± 0.25	0.7 ± 0.25	24	1
	1.0 ± 0.09	1.5 ± 0.44	2.2 ± 0.16	1.5 ± 0.04	24	2
	1.0 ± 0.45	1.4 ± 0.13	3.1 ± 0.01	1.1 ± 0.01	48	1
	1.0 ± 0.32	1.3 ± 0.12	2.1 ± 0.14	1.0 ± 0.24	48	2
IL11	1.0 ± 0.20	1.1 ± 0.04	13.3 ± 0.89	2.1 ± 0.06	6	1
	1.0 ± 0.13	1.2 ± 0.07	32.3 ± 0.82	1.1 ± 0.14	24	1
	1.0 ± 0.06	1.0 ± 0.05	7.7 ± 0.81	2.1 ± 0.18	24	2
	1.0 ± 0.23	0.7 ± 0.10	17.6 ± 0.22	1.0 ± 0.08	48	1
	1.0 ± 0.09	0.8 ± 0.09	5.9 ± 0.18	1.2 ± 0.10	48	2
TIMP3	1.0 ± 0.01	0.9 ± 0.11	1.4 ± 0.03	1.0 ± 0.12	6	1
	1.0 ± 0.31	1.0 ± 0.12	2.6 ± 0.26	1.0 ± 0.23	24	1
	1.0 ± 0.13	0.7 ± 0.09	1.5 ± 0.12	1.3 ± 0.14	24	2
	1.0 ± 0.26	0.9 ± 0.00	3.0 ± 0.34	1.0 ± 0.09	48	1
	1.0 ± 0.08	0.6 ± 0.00	1.7 ± 0.13	0.8 ± 0.01	48	2
IL6	1.0 ± 0.06	0.9 ± 0.02	3.6 ± 0.27	1.3 ± 0.14	6	1
	1.0 ± 0.13	0.9 ± 0.21	1.7 ± 0.14	0.8 ± 0.03	24	1
	1.0 ± 0.09	0.9 ± 0.07	1.4 ± 0.05	1.0 ± 0.11	24	2
	1.0 ± 0.13	0.9 ± 0.03	1.6 ± 0.12	0.9 ± 0.05	48	1
	1.0 ± 0.17	0.9 ± 0.06	1.4 ± 0.17	0.9 ± 0.17	48	2
PTGS2/COX-2	1.0 ± 0.01	1.2 ± 0.22	9.0 ± 1.49	1.8 ± 0.05	6	1
	1.0 ± 0.08	1.2 ± 0.38	3.5 ± 0.67	1.2 ± 0.19	24	1
	1.0 ± 0.07	1.1 ± 0.05	4.9 ± 0.36	1.4 ± 0.18	24	2
	1.0 ± 0.10	1.0 ± 0.12	2.2 ± 0.12	1.3 ± 0.03	48	1
	1.0 ± 0.19	1.0 ± 0.06	5.4 ± 0.92	1.2 ± 0.01	48	2
ACTA2	1.0 ± 0.03	0.8 ± 0.12	1.1 ± 0.11	0.9 ± 0.20	6	1
	1.0 ± 0.14	0.9 ± 0.11	2.2 ± 0.00	0.9 ± 0.07	24	1
	1.0 ± 0.04	0.9 ± 0.25	2.3 ± 0.12	1.6 ± 0.41	24	2
	1.0 ± 0.17	1.0 ± 0.03	1.0 ± 0.19	1.0 ± 0.21	48	1
	1.0 ± 0.05	0.7 ± 0.11	2.5 ± 0.13	1.0 ± 0.12	48	2

In a related study, a gene microassay profile of rat heart tissue was conducted. The results of this study are shown in FIG. 12. Fibrotic and extracellular matrix associated genes were stimulated in vivo by L-NAME plus angiotensin II. MRNA expression for collagen I, collagen III, and fibronectin was markedly reduced by the administration of BNP.

MEK/ERK Pathway Involved in BNP's Anti-Fibrotic Role

Natriuretic peptides were previously shown to stimulate ERK activity in cardiac myocytes and vascular endothelial cells. The MEK/ERK pathway has been linked to the repression of TGFβ/Smad signaling. To determine whether PKG or ERK signaling is involved in BNP-dependent attenuation of TGFβ signaling, cultured cells were treated with BNP and/or TGFβ in the presence of a PKG inhibitor (KT5823) or two different MEK inhibitors (U0126, PD98059). BNP induced ERK phosphorylation was completely blocked by KT5823 and U0126, indicating that BNP activates ERK via PKG and MEK signaling cascades (FIG. 7a). Both MEK inhibitors (U0126, PD98059) reversed BNP inhibition of TGFβ-induced Collagen-1 expression analyzed by Western blot (FIG. 7b) and real-time RT-PCR (FIG. 7c). A similar result was demonstrated for PAI-1 using real-time RT-PCR. These findings suggest that the ERK pathway plays an important role in BNP-dependent inhibition of the fibrotic response induced by TGFβ in human cardiac fibroblasts.

Fibrosis and ECM

One of the key features of cardiac fibrosis is the increased deposition of the ECM. The dynamic turnover of ECM proteins is controlled by several regulatory mechanisms: de novo biosynthesis of ECM components, proteolytic degradation of ECMs by matrix metalloproteinases (MMPs), and inhibition of MMP activities by endogenous inhibitors, TIMPs. All of these processes have been shown to be profoundly affected by TGFβ. The results provided herein suggest that TGFβ-induced ECM deposition in human cardiac fibroblasts occurs largely by increasing ECM gene expression, including Fibronectin, COL1A2, COL15A, COL7A1, MAGP2, MATN3, FBN1, and COMP. Fibronectin and collagen expression in cardiac fibroblasts has been well-established in the fibrotic response, however, this is the first report of TGFβ induction of other ECM genes including MAGP2, MATN3, FBN1 and COMP, further corroborating TGFβ's role in ECM induction. Interestingly, COMP, which is a member of the thrombospondin family, has been shown to have a direct interaction with Fibronectin,²⁵ supporting its role in fibrotic processes. We also found Thombospondin 2, which is involved in the activation of latent TGFβ²⁶ regulated by TGFβ in our studies and opposed by BNP (Table 2). Also sharing close identity with the latent TGFβ family of binding proteins is FBN1, a component of extracellular microfibrils. The opposing effects of BNP on these gene regulatory events, suggests that BNP modulates cardiac fibrosis.

In addition to the suppression of TGFβ-induced ECM biosynthesis, BNP may also modulate the degradation of ECM proteins by opposing elevated TIMP3 levels in TGFβ-stimulated cells. The TIMP family of proteins is believed to play significant roles in controlling extracellular matrix remodeling. Elevation of TIMP3 expression has been observed in animal models of myocardial infarction, suggesting that it may be a contributor to matrix remodeling in the failing heart.

Another hallmark of the fibrotic process is the transformation of cardiac fibroblasts to myofibroblasts and the induction of pro-fibrotic mediators. Myofibroblasts acquire contractile properties similar to smooth muscle cells. The results provided above demonstrate that BNP inhibited TGFβ-induction of several myofibroblast markers including ACTA2 and MYH9. BNP also inhibited TGFβ pro-fibrotic mediators, such as, CTGF, PAI-1, and IL11. CTGF and PAI-1 are well-established downstream signaling genes of the TGFβ pathway, and IL11 has been associated with tissue remodeling and fibrosis. IL11 expression in cardiac fibroblasts also seems to contribute to TGFβ-mediated fibrosis. The use of BNP to suppress this response should result in a protective effect.

Collectively, these effects of BNP on gene expression in TGFβ-stimulated cells demonstrate a role for BNP in anti-fibrotic processes in cardiac fibroblasts. In striking contrast to TGFβ-treated cells, BNP had no significant effects in unstimulated fibroblasts. This is consistent with the physiological actions of BNP, working only in opposition to other hormonal systems such as the renin-angiotensin-aldosterone system.

Changes in Cell Proliferation

The effects of TGFβ on cell growth is cell-type dependent. As provided above, TGFβ stimulated cardiac fibroblast proliferation. Whether TGFβ has a direct effect on cell cycle or an indirect effect through other mechanisms is unclear. However, cDNA microarray analysis revealed that BNP markedly inhibits the expression of a number of TGFβ-induced growth factors or growth factor-like genes including PDGFA, IGF1, FGF18, and IGFBP10 (CYR61). The up-regulation of these genes by TGFβ could partially explain the induction of cell proliferation, suggesting that it may be mediated indirectly through the stimulation of growth factor productions. TGFβ also induced the expression of PTHLH (PTHrP), which has known chronotropic and vasodilatory effects. In osteoblast-like cells PTHrP can induce cell proliferation. Interestingly, in the myocardium, PTHrP levels are increased in congestive heart failure (CHF).

The growth inhibitory effects of natriuretic peptides have previously been reported. Cao and Gardner first demonstrated that natriuretic peptides inhibit PDGF, FGF2, and mechanical stretch-induced DNA synthesis in neonatal rat cardiac fibroblasts. Consistent with these findings, natriuretic peptides and cyclic GMP have been reported to inhibit cell proliferation induced by angiontensin II, endothelin-1, and norepinephrine in many cell types including cardiac fibroblasts, vascular smooth muscle cells, endothelial cells, and mesangial cells. The results provided herein suggest an important role for BNP in regulating fibroblast growth during cardiac remodeling.

Changes in Inflammatory Genes

Cardiac expression of cytokines is thought to contribute to a decrease in left ventricle contractile performance and deleterious remodeling. Although similar effects have been observed with ANP, reported herein for the first time is that brain natriuretic peptide blocks TGFβ stimulation of several pro-inflammatory genes including COX2, IL6, TNFAIP6, and TNFSF4.

TGFβ has a dual effect in the regulation of inflammatory processes. For example, it increases COX2 expression and prostaglandin E2 release in pulmonary artery smooth muscle cells, airway smooth muscle cells, and intestinal epithelial cells. On the other hand, TGFβ down-regulates the production of MCP-1 and complement components (C3 and C4) in human proximal tubular epithelial cells and macrophages. The results provided herein corroborates the dual effect of TGFβ in the modulation of inflammatory gene expression in cardiac fibroblasts. From these results, it was found that while TGFβ induced some inflammatory genes, it down-regulated others, such as, IL1b, MCP1-R, GRO1, GRO3, and MCP4. Both effects are reversed by BNP. However, in the absence of TGFβ stimulation, BNP had no significant effect on the expression of inflammatory genes. It is likely that a balance of pro- and anti-inflammatory stimuli is important in the process of cardiac remodeling.

Signaling Mechanism Underlying BNP's Anti-Fibrotic Role

Studies aimed at elucidating the mechanism of BNP's inhibition of a fibrotic response indicate that the ERK signaling pathway plays an important role. The results provided herein demonstrate that BNP phosphorylates ERK via PKG-dependent signaling in primary human cardiac fibroblasts. Moreover, this activation attenuates the TGFβ-induced fibrotic response as measured by Collagen 1 expression. This is consistent with previous studies showing that ERK activation is required for both the anti-hypertrophic effect of ANP in cardiac myocytes, and the inhibition of TGFβ signaling in mammary and lung epithelial cells.

In Vivo Studies

In a related study, an in vivo model for acute myocardial injury was used to explore the effects of BNP. Male Sprague Dawley rats ranging in weight from 225 to 250 gm were utilized. Acute myocardial injury was induced by administration of Nω-nitro-L-arginine methyl ester (L-NAME, 40 mg/kg/day)salt (1% NaCl) plus angiotensin II (AngII, 0.5 mg/kg/day) in the rats. The L-NAME was administered in drinking water from day 1 to day 14. Angiotensin II was continuously infused subcutaneously with an osmotic pump from day 11 to day 14. Rat BNP (400 mg/kg/min) was intravenously infused through an external infusion pump from day 10 to day 14.

Systolic blood pressure, plasma level of aldosterone, cardiac function heart/body weight ration and gene expression in the heart were analyzed. Systolic blood pressure was monitored via tail cuff technique with an IITC blood pressure recording system. Cardiac function was monitored via a Millar ARIA Pressure Volume Conductance System with an 1.4 F catheter. Gene expression as referenced above with results provided in FIG. 12 were monitored by RT-PCR with an ABI Prism™ 7700 sequence detection system.

It was observed that BNP had no effect on systolic blood pressure raised by L-NAME+AngII but significantly attenuated aldosterone1.25.2±0.2 vs. 6.6±0.16 ng/ml, p<0.05). See FIG. 10. As shown in FIG. 13, BNP improved cardiac function by significantly increase in stroke volume (2.68±0.23 vs. 4.74±0.73 ul, p<0.05), ejection fraction (13.6±1.1 vs. 20.4±2.4% p<0.05), and diastolic volume (19.0±0.9 vs 22.4±1.1 ul, p<0.05) and stroke work (223.0±29.4 vs 531.5±99.1 mmH*ul, p<0.05), and decrease in arterial elastance (6.50±5.7 vs 42.6±5.1 mmHg/ul, p<0.01). As shown in FIG. 11, BNP significantly reduced the heart/body weigh ratio (0.0039±0.002 vs. 0.0029±0.001, p<0.05) and as referenced above, abolished the profibrotic phenotype indicated by decreasing expression of collagen I (p<0.01), collagen III (p<0.05) and fibronectin (p<0.05).

SUMMARY

Along with the endothelin pathway, the renin-angiotensin and aldosterone system, the fibrosis-promoting TGFβ pathway is important in the pathophysiology of heart failure. BNP appears to oppose TGFβ-regulated gene expression related to fibrosis and myofibroblast conversion. Furthermore, BNP's opposition to the TGFβ-stimulated fibrotic response is dependent on the PKG and the MEK/ERK pathways. This finding is consistent with the observation that BNP deficient mice show increased fibrosis and Collagen 1 expression. In addition to BNP's global effects on fibrosis, it may also have effects on other processes, such as inflammation and proliferation (FIG. 8). These findings support a beneficial role for BNP in the prevention of cardiac fibrosis and the treatment of cardiac diseases. They also provide the first demonstration that BNP has a direct effect on cardiac fibroblasts to oppose a TGFβ-induced fibrotic response, suggesting that BNP functions as an anti-fibrotic factor in the heart to prevent cardiac remodeling in pathological conditions.

Independent from the antifibrotic effect, the in vivo studies as provided herein indicate that BNP may be used to reduce cardiac remodeling and prevent subsequent heart failure. BNP may also be useful as a cardioprotective agent to improve cardiac function post acute myocardial injury such as myocardial infarction.

All references cited throughout the specification are expressly incorporated herein by reference. While the present invention has been described with reference to the specific embodiments thereof, it should be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the true spirit and scope of the invention. In addition, many modifications may be made to adapt a particular situation, material, composition of matter, process, and the like. All such modifications are within the scope of the claims appended hereto.

Claims

1. A method for treating cardiac remodeling in a subject that has undergone myocardial injury, said method comprising administering a therapeutically effective amount of natriuretic peptide to said subject.

2. A method for treating cardiac dysfunction in a subject that has undergone myocardial injury, said method comprising administering a therapeutically effective amount of natriuretic peptide to said subject.

3. A method for treating cardiac fibrosis in a subject who has undergone myocardial injury, said method comprising administering a therapeutically effective amount of natriuretic peptide to said subject.

4. The method of claims 1 or 2 wherein said natriuretic peptide is brain natriuretic peptide.

5. A method of inhibiting the production of Collagen 1, Collagen 3 or Fibronectin protein in a subject who has undergone myocardial injury, said method comprising administering a therapeutically effective amount of brain natriuretic peptide to said subject.

6. A method of alleviating or reversing the effect of TGFβ mediated cell activation in cardiac tissue on the expression of one or more genes associated with fibrosis, comprising contacting one or more cells or tissues in which the expression of said genes is altered as a result of TGFβ mediated activation, with brain natriuretic peptide.

7. The method of claim 5 wherein said genes are selected from the group consisting essentially of Collagen1, Collagen 3, Fibronectin, CTGF, PAI-1, and TIMP3.

8. A method of inhibiting the transformation of cardiac fibroblast cells into myofibroblast cells in a subject that has undergone myocardial injury, said method comprising administering a therapeutically effective amount of brain natriuretic peptide to said subject.