A Cardiac-enriched MicroRNA, miR-378, Blocks Cardiac Hypertrophy by Targeting Ras Signaling*

Background: miR-378 is a newly discovered cardiomyocyte-enriched miRNA. Results: By targeting Grb-2, miR-378 blocks activation of the hypertrophic signaling cascade and gene expression. Its deficiency contributes to the development of hypertrophy in a Ras activity-dependent manner. Conclusion: miR-378 is a negative regulator of cardiac hypertrophy. Significance: Cellular restoration of miR-378 will be beneficial in preventing adverse cardiac remodeling. Understanding the regulation of cardiomyocyte growth is crucial for the management of adverse ventricular remodeling and heart failure. MicroRNA-378 (miR-378) is a newly described member of the cardiac-enriched miRNAs, which is expressed only in cardiac myocytes and not in cardiac fibroblasts. We have previously shown that miR-378 regulates cardiac growth during the postnatal period by direct targeting of IGF1R (Knezevic, I., Patel, A., Sundaresan, N. R., Gupta, M. P., Solaro, R. J., Nagalingam, R. S., and Gupta, M. (2012) J. Biol. Chem. 287, 12913–12926). Here, we report that miR-378 is an endogenous negative regulator of cardiac hypertrophy, and its levels are down-regulated during hypertrophic growth of the heart and during heart failure. In primary cultures of cardiomyocytes, overexpression of miR-378 blocked phenylephrine (PE)-stimulated Ras activity and also prevented activation of two major growth-promoting signaling pathways, PI3K-AKT and Raf1-MEK1-ERK1/2, acting downstream of Ras signaling. Overexpression of miR-378 suppressed PE-induced phosphorylation of S6 ribosomal kinase, pERK1/2, pAKT, pGSK-3β, and nuclear accumulation of NFAT. There was also suppression of the fetal gene program that was induced by PE. Experiments carried out to delineate the mechanism behind the suppression of Ras, led us to identify Grb2, an upstream component of Ras signaling, as a bona fide direct target of miR-378-mediated regulation. Deficiency of miR-378 alone was sufficient to induce fetal gene expression, which was prevented by knocking down Grb2 expression and blocking Ras activation, thus suggesting that miR-378 interferes with Ras activation by targeting Grb2. Our study demonstrates that miR-378 is an endogenous negative regulator of Ras signaling and cardiac hypertrophy and its deficiency contributes to the development of cardiac hypertrophy.

protein-coupled receptor and agonists (Ang II, ␣ and ␤ adrenergic receptor agonists), and integrin-focal adhesion kinase, which is stimulated by mechanical stretch. Ras activation transmits growth signals via activating two major growth promoting signaling cascades: IGF-PI3K-AKT-mTOR and Raf1-MEK1-ERK1/2 pathways (4,5). One of the major downstream targets of the AKT pathway is inactivation of glycogen synthase kinase (GSK)-3␤, which allows nuclear import of NFAT and activation of the cardiac gene program. Similarly, Raf1-MEK1 activation enhances transcriptional activity of ERK1 and ERK2 and leads to activation of gene expression. Cumulative effects of these pathways cause activation of the hypertrophy inducing program (6,7). There are several studies that have shown that overactivation of Ras signaling induces pathological cardiac remodeling (8 -11).
miRNAs are small noncoding RNAs that have emerged as powerful endogenous negative regulators of gene expression. Among more than 1000 miRNAs described so far in humans, relatively few (example, miR-1, miR-208, miR-499, and miR-133) show high levels of expression in the heart. The gain-and loss-of-function studies have shown important regulatory roles of cardiac-enriched miRNAs in the process of cardiac development (miR-1 and miR-133) and in the settings of cardiac diseases such as arrhythmias (miR-1, miR-133, and miR-208a), myocardial infarction (miR-499), and pressure overload-induced cardiac hypertrophy (miR-208a, miR-1, and miR-133) (reviewed in Ref. 12). Recently, some of these cardio-abundant miRNAs have also emerged as biomarkers of myocardial infarction and heart failure, thus further underscoring their importance in the diagnosis and treatment of cardiac diseases (reviewed in Ref. 13). We have recently identified a new member of cardiac-enriched miRNAs, miR-378, which is induced after birth. Interestingly, this miRNA (miR-378) is expressed only in cardiomyocytes and not in cardiac fibroblasts. We have demonstrated that miR-378 directly targets IGF-1R and regulates postnatal cardiac remodeling. We have also demonstrated that IGF-1 acts as a negative regulator of miR-378 (14).
We demonstrate here a new role for miR-378 acting as an endogenous negative regulator of Ras signaling and development of cardiac hypertrophy. We identified Grb-2, a known cardiac hypertrophy modulator and an essential component of the Ras signaling pathway, as a direct target of miR-378. Through gain-and loss-of-function experiments, we show that miR-378 blocks hypertrophy agonist-stimulated Ras activation and downstream effectors of the PI3K/AKT and Raf-MEK1 signaling pathways thereby promoting anti-growth activity of GSK-3␤ and inhibiting transcriptional activity of NFAT and ERK. The cumulative effect leads to suppression of fetal gene expression and inhibition of hypertrophy of cardiomyocytes. We also show that the stimuli, which promote development of cardiac hypertrophy, cause down-regulation of miR-378. These data thus suggest that inhibition of miR-378 by hypertrophy agonists contributes to the development of cardiac hypertrophy. Therefore, replenishing miR-378 levels may be beneficial to protect the heart developing pathological remodeling and descending to heart failure.

Reagents and Antibodies
Reagents used in the study were purchased as follows: Dulbecco's modified Eagle's medium (DMEM), Lipofectamine 2000, TRIzol, T4 DNA ligase, restriction enzymes, SuperScript III reverse transcriptase kit, DH5␣ cells, RNA oligos (378mimic, anti-miR-378, scramble, and mimic control), and Opti-MEM transfection media were purchased from Invitrogen; fetal bovine serum (FBS) from Gemini Inc.; collagenase type 3, trypsin, and soybean inhibitor from Worthington Biochemical; DNA probes for miR-378 and U6 were synthesized from IDT; the gel extraction kit and DNA Maxi prep kit were purchased from Qiagen; Fast SYBR Green Master Mix was purchased from Applied Biosystems; ECL Western blot detection kit, chemiluminescence films, and HyBond N ϩ nylon membrane was purchased from Amersham Biosciences; nitrocellulose transfer membrane, RC/DC assay, and Precision Plus Dual protein ladder from Bio-Rad; Restore Western blot stripping buffer was from Thermo Science; laminin, and other general chemicals were purchased from Sigma; hybridization buffer and Nuc Away columns from Ambion; pmiRGLO vector and the Dual Luciferase assay kit were purchased from Promega; and [␥-32 P]ATP from PerkinElmer Life Sciences. Specific antibodies were obtained from the following sources: AKT, p-AKT (Ser 473 ), p-ERK1/2, p-GSK3-␤ (Ser 21/9 ), p-S6K, and p-glycogen synthase (Ser 641 ) were purchased from Cell Signaling; antibodies against GAPDH, NFAT, ERK-2, GRB-2, ␤-actin, and HRPconjugated anti-mouse or anti-goat antibodies were purchased from Santa Cruz; anti-Ras antibodies were from Upstate; ␣-actinin and anti-rabbit HRP antibody were from Sigma; rabbit anti-atrial natriuretic factor (anti-ANF; T-4014) was from Peninsula Laboratories; fluorescent labeled Alexa Fluor 488 (green) and 594 (red) antibodies, To-Pro nuclei labeling reagent, and ProLong Gold antifade reagent were purchased from Molecular Probes. Ad-CMV-Ras (N17) was purchased from Vector Biolabs.

Cell Culture, DNA Constructs, Transfection, and Adenovirus Infection
Primary cultures of cardiomyocyte were isolated from 1-dayold neonatal rats (Harlan Sprague-Dawley) as per our published procedures (15). All animal protocols were reviewed and approved by the University of Illinois Institutional Animal Care and Use Committee. Cardiomyocytes were grown in Dulbecco's modified Eagle's medium supplemented with penicillin/ streptomycin and 10% fetal bovine serum (complete growth medium). H9C2 cells were grown in DMEM supplemented with 10% FBS. Seventy-two h prior to transfection, H9 cells were switched to differentiation medium (DMEM ϩ 2% FBS) and maintained in this medium throughout the experimental period. A three-repeat sequence of the miR-378 predicted target region was synthesized from the 3Ј UTR of human Grb-2 and cloned into an Xho-Xba site in the dual luciferase reporter vector pmiRGLO. The control construct with mutations incorporated in the miR-378 seed region was generated similarly. These constructs were sequence verified. Cells were transfected with appropriate DNA using Lipofectamine transfection rea-gent according to the manufacturer's protocol. For adenovirus infection, after 24 to 30 h of seeding of cardiomyocytes, cells were infected at a multiplicity of infection of 10 in serum containing media.

RNA Interference
For endogenous inhibition of Grb2 expression, we used a duplex siRNA corresponding to human Grb2 coding nucleotides 607-627 (Thermo Scientific). This siRNA was previously shown to effectively inhibit Grb2 expression in HeLa cells by more than 80% using sense strand as a negative control (16).

Induction of Hypertrophy
Cell Culture-Cardiomyocytes were exposed to 20 M phenylephrine (PE) or 100 nM angiotensin II (Ang II) or 10 M isoproterenol for 48 h in serum-free defined medium (Opti-MEM; Invitrogen).
Animals-All animal protocols were reviewed and approved by the University of Illinois Institutional Animal Care and Use Committee. Isoproterenol (ISP, 8.7 mg/kg/d) was delivered chronically for 7 days by implanting osmotic mini pumps (ALZET model 2001, flow rate 1 l/h/day) in the peritoneal cavity of mice. Control mice underwent the same procedure except that their pumps were filled with vehicle. Pressure overload hypertrophy was induced by transverse aortic constriction of ascending aorta of mice, as described elsewhere (17). Volume overload was induced in adult Sprague-Dawley rats surgically by aorto-caval shunt as per our published protocol (18). The measurement of hypertrophy of cardiomyocytes and the expression of hypertrophic marker genes were carried out essentially as described earlier (19).
Patient Samples-Cardiac tissue samples were obtained from the Tissue Repository Bank maintained at the Loyola University Medical Center. The study was approved by Institutional Review Board of Loyola University Medical Center and the University of Illinois, Chicago, and performed in accordance with NIH guidelines.

Northern Analysis
Total RNA was isolated resolved in 12% urea-PAGE, transferred, and processed for hybridization with radiolabeled probes as per our published protocols (14). After washing, the signal was captured by exposing the membranes to the phosphorimaging screen followed by scanning on a Storm 860 scanner. Signal intensity was quantified using the ImageJ program. The U6-labeled radioactive probe was used as loading control for all samples after stripping the membranes.

Immunoprecipitation and Western Analyses
Western blotting and immunoprecipitation experiments were done using a standard protocol as described elsewhere (20).

[ 3 H]Leucine Incorporation Assay
Immediately after treatment of cardiomyocytes with PE, cells were incubated with [ 3 H]leucine (1.0 mCi/ml, 163 Ci/mmol specific activity, Amersham Biosciences) in leucine-free minimal essential medium for 48 h. Cells were washed and processed for leucine incorporation as described previously (21). Values were normalized with DNA content, measured by the Quant-iT picogreen double-stranded DNA assay kit (Invitrogen).

Immunostaining of Cells
Cardiomyocytes (10,000 to 20,000) were plated on 1% fibronectin-coated coverslips and processed for immunostaining as per the protocols described previously (14). Sarcomere reorganization and ANF release were measured by staining the cardiomyocytes with antibodies specific for ␣-actinin and ANF, respectively. For analysis of cellular distribution of NFAT, cells were immunostained with protein-specific antibodies, and the protein was localized by use of a confocal microscopy. Cell imaging was performed on a Bio-Rad Laser Sharp 2000 system (Bio-Rad) using a ϫ40 objective (Zeiss). For each experimental group, there was a minimum of three experiments with at least three replicates of each sample.

Dual Luciferase Reporter Assay
Firefly and Renilla luciferase activities were measured sequentially using a Dual Luciferase Reporter Assay System as per the manufacturer's instructions. The firefly luciferase signal was measured first at 480 nm and followed by Renilla luciferase at 560 nm in the same sample using a EG&G Berthold LUMAT LB9507 reader. Firefly luciferase activity was normalized using the Renilla luciferase signal and values were expressed as arbitrary relative light units.

Real-time Polymerase Chain Reaction
Real-time PCR primers for mouse ANF, Grb-2, and ␤-MHC were designed using Primer Design software, the sequence is available upon request. Total RNA was isolated, treated with DNase, and reverse transcribed using the SuperScript III kit and random hexamers. In a 20-l PCR, 5 ng of cDNA template was mixed with primers to a final concentration of 200 nM and 10 l of Fast SYBR Green master mix. Amplification was carried out in a 7500 Fast Real-time PCR system by first incubating the reaction mixture at 95°C for 20 s, followed by 40 cycles of 95°C for 3 s, and 60°C for 30 s. For quality control purposes, at the end of each run, dissociation curves were generated by incubating the reactions at 95°C for 15 s, 60°C for 1 min, 95°C for 15 s, and 60°C for 15 s. Primer pairs used in the study were free of primer dimer artifacts. Expression ratios were calculated by the ⌬⌬C T method, where C T is the cycle threshold, using GAPDH as a reference gene.

Statistical Analysis
Data are expressed as the mean Ϯ S.D. of at least 3 independent experiments. Control and treatment groups were matched in sets containing cells isolated and cultured on the same day to eliminate variability due to a cell batch. The two-tailed Student's t test was used for performing analysis of variance in Excel. A p value of 0.05 or less was considered statistically significant. . We next examined miR-378 expression levels in three different in vivo models of cardiac hypertrophy: pressure overload by creating transverse aortic constriction in adult mice for 4 weeks, volume overload by inducing aorto-caval shunt in adult rats for 6 weeks, and isoproterenol infusion by implanting mini osmotic pumps in adult mice for 2 weeks. As reported in our previous publications, all three interventions produced a significant amount of cardiac hypertrophy (21)(22)(23). In these in vivo models, expression levels of miR-378 was reduced by 40 to 60% compared with sham controls (Fig. 1, C-E). We also measured miR-378 levels in patients with end-stage heart failure diagnosed with nonischemic dilated cardiomyopathy and com-pared it with nonfailing hearts. We found that out of three patients that were analyzed, two showed a significant reduction in miR-378 expression. These findings thus indicate that reduced expression of miR-378 is associated with the development of cardiac hypertrophy in animal models as well as in select cases of human heart failure.

Cardiac Expression of miR-378 Is
Overexpression of miR-378 Blocks Cardiac Hypertrophy-To test whether replenishing miR-378 levels during hypertrophy could block hypertrophy of cardiomyocytes, we overexpressed miR-378 by using a double-stranded synthetic miR-378-mimic (miR-378), a control oligo (mimic-C) designed with no homology to any known miRNA sequences in the database served as negative control. Primary cultures of cardiomyocytes were transfected with increasing amounts (10 -50 nM) of miR-378, which led to a dose-dependent increase in the expression levels of miR-378. Subsequent experiments were performed with a 25 nM dose of miR-378, which produced nearly 5-10-fold higher expression of mature miR-378 relative to the endogenous levels ( Fig. 2A). Cardiomyocytes overexpressed with miRNA were then treated with PE (20uM) or Ang II (100 nM, twice 24 h apart) for 48 h, and their hypertrophic response was measured by monitoring induction of protein synthesis. We found that miR-378 overexpression significantly reduced PE-and Ang II-induced protein accumulation, as measured by [ 3 H]leucine incor- U6 was used as a loading control. B, quantification of miR-378 signal normalized with U6 from A, each bar represent mean Ϯ S.D. of n ϭ 3. C, real-time PCR analysis by TaqMan assay showing fold-change in miR-378 expression in heart samples of mice subjected to transverse aortic constriction for 4 weeks or chronic infusion of isoproterenol for 2 weeks. n ϭ 6 mice per group. D, Northern blot showing miR-378 expression in representative rat heart samples subjected to volume overload for 6 weeks (V1, V2, V3, V4, V5; n ϭ 8) and representative sham controls (S1, S2, and S3; n ϭ 6), U6 was used as a loading control. E, quantification (mean Ϯ S.D.) of miR-378 signal normalized with U6 in sham and volume overloaded hearts. F, miR-378 expression by real-time PCR using TaqMan assays in human heart samples obtained from nonfailing hearts (NF, n ϭ 3), and from patients with heart failure diagnosed with nonischemic cardiomyopathy (DCM1, DCM2, and DCM3). Data are presented as mean Ϯ S.D. of repeat measurements in triplicates. Stars indicate statistical significant difference as compared with nonfailing control hearts. poration into total cellular proteins ( Fig. 2B). We also monitored the influence of miR-378 gain-in-function on PEstimulated changes in cell morphology and size. By confocal imaging we found that PE treatment for 48 h caused more regular cell shape of cardiomyocytes with myofibrils organized into sarcomeres. These cells showed a significant increase in cell surface area. Increased expression of miR-378 by itself had no significant effect on cell morphology or cell size, it significantly interfered with PE-stimulated myofibrillar organization to the extent that miR-378 overexpressing cells had a more regular shape, their myofibrillar organization appeared similar to untreated rather than PE-stimulated control cells (Fig. 2C). Overexpression of miR-378 significantly reduced the PE-stimulated increase in cell size (Fig. 2D). Induction of fetal gene expression is considered a hallmark of cardiac hypertrophy. We therefore measured the effect of miR-378 on the PE-stimulated induction of ANF, skeletal actin, and brain natriuretic pepetide (BNP) expression in cardiomyocytes. Overexpression of miR-378 by itself had no significant effect on ANF release or expression as evaluated by confocal imaging, by Western blotting or real-time PCR (Fig. 3, A-C). Upon PE stimulation, high perinuclear ANF staining, which was noted in cardiomyocytes trans-fected with control mimic-C, was found significantly reduced in cells overexpressed with miR-378 (Fig. 3A). This was confirmed quantitatively by Western blot and real-time PCR analyses, which showed a significant reduction in ANF protein levels and mRNA levels (Fig. 3, B and C). There was also a significant reduction in the mRNA levels of skeletal actin and BNP by miR-378 upon PE treatment (Fig. 4A). We also examined the promoter activity of ␤-MHC, which is a well known marker of the fetal gene program and pathologic cardiac remodeling (3). By transient transfection assays we found that overexpression of miR-378 significantly reduced the PE-stimulated induction of ␤-MHC-luciferase activity in cardiomyocytes (Fig. 4B).
We next analyzed nuclear accumulation of NFAT, another marker for induction of the hypertrophic gene program. Under basal conditions the NFAT proteins are phosphorylated and reside in the cytoplasm. But upon stimulation of cells by hypertrophic agonists they are dephosphorylated by calcineurin, resulting in translocation to the nucleus, where they cooperate with other muscle transcription factors and activate the hypertrophic gene program (24). We used confocal microscopy to examine subcellular distribution of NFAT in cardiomyocytes transfected with miR-378 or mimic-C. As shown in Fig. 4C, under basal nonstimulated conditions miR-378 overexpression had no noticeable effect on NFAT subcellular distribution. Following PE treatment for 48 h, cells transfected with mimic-C had a considerable amount of NFAT localized in the nucleus, whereas NFAT staining was minimal in the nuclei of cells overexpressing miR-378. We next examined whether miR-378 has the ability to regulate protein synthesis. For this purpose we measured p70S6 kinase activity, a key signaling kinase regulating translation of protein synthesis (25,26). The results showed that PE stimulation of cardiomyocytes enhanced the phosphorylation of p70S6 kinase in mimic-C-transfected cells, which was found considerably reduced by overexpression of miR-378 ( Fig.  5A, top panel). Together, these results demonstrated that miR-378 has the ability to inhibit agonist-stimulated hypertrophy of cardiomyocytes.
miR-378 Inhibits Activation of MAPK/ERK and PI3K/AKT Signaling Pathways-Having known that both transcription and translation events inducing cardiomyocyte hypertrophy were significantly inhibited by miR-378; we next searched for signaling mechanisms that contributed to this effect. In the case of activation of G protein-coupled receptors by agonists such as PE, isoproterenol, or Ang II, sequential activation of MAPK, PI3K, and AKT has been documented (4). Among the MAPKs, ERK1/2 is considered to be a central regulator of agonist-medi-ated cardiac hypertrophy (4). We therefore examined the effect of miR-378 on the activation of ERK1/2 at different time points (5 and 15 min) after stimulation of cells with PE. The results showed that PE induced the phosphorylation of ERK1/2 in cells overexpressing mimic-C, which was found significantly reduced in cells overexpressed with miR-378 (supplemental Fig. S1). Some previous reports have shown that prolonged exposure of cells to PE is required to detect alterations in gene expression and protein synthesis, and that the initial peak of ERK1/2 activity is not sufficient to trigger the hypertrophic response (27). To address this issue, we studied phosphorylation of ERK1/2 in miR-378 overexpressing cells after 48 h of PE treatment. We again found that miR-378 significantly inhibited PE-mediated activation of ERK1/2 as compared with the mimic-C control (Fig. 5, A and B), suggesting that miR-378 is capable of suppressing the MAPK/ERK1/2 signaling pathway activity. We then examined the role of miR-378 in regulating activity of the PI3K/AKT pathway. AKT is activated by various extracellular stimuli in a PI3K-dependent manner by an upstream kinase PDK1 (4). The downstream targets of AKT include GSK-3␤, FOXOs, and mTOR. During cardiac hypertrophy GSK-3␤ (Ser 9 ) has been shown to be phosphorylated by AKT, leading to suppression of its kinase activity (28). By analyzing the phosphorylation status of proteins, we found that PE treatment induced phosphorylation of AKT and GSK-3␤, which was inhibited by overexpression of miR-378, but not by mimic-C (Fig. 5, C and D). Additionally, we observed increased activity of GSK-3␤ by miR-378 upon PE treatment as measured by phosphorylation of its substrate, glycogen synthase (Ser 641 ), which was found significantly reduced by PE in control cells expressed with mimic-C. This suggests that in hypertrophic conditions GSK-3␤ activity is maintained upon miR-378 overexpression (Fig. 5, C and D). These results thus demonstrated that overexpression of miR-378 reduces the activity of pro-hypertrophic MEK/ERK1/2 and PI3K-AKT signaling, and enhances the activity of anti-hypertrophic GSK-3␤ signaling pathways.
Inhibition of Endogenous of miR-378 Increases Cardiomyocyte Cell Size, and Potentiates PE-mediated Hypertrophic Signaling and Activation of Fetal Gene Program-We next took a complementary approach to address whether inhibition of endogenous miR-378 would induce the hypertrophy response. For inhibition of miR-378, we used a commercially available miR-378 anti-miR, and a single-stranded scramble control (scramble-C), designed not to target any known miR sequences, served as a negative control. Transfection of cardiomyocytes with anti-miR resulted in complete elimination of endogenous miR-378 expression (Fig. 6A). Inhibition of miR-378 alone was found sufficient to induce an almost 30% increase in cardiomyocyte size (Fig. 6, B and C) and it induced the mRNA levels of fetal genes, BNP by 5-fold and skeletal actin by 2.5-fold (Fig. 6D). There was also an increase in ANF release around nuclei as examined by confocal imaging and almost 5-fold induction in ANF protein expression (Fig. 7, A and B). These results indicated that basal activity of miR-378 must be essential for restraining fetal gene expression in nonstimulated conditions. We next examined the effect of miR-378 inhibition on PEstimulated changes in cell morphology, cell size, and on fetal gene expression. The majority of PE-treated control cells showed a well defined shape with organized myofibrils, anti-miR transfected cells, although showed similarly organized myofibrils that appeared more irregular in shape, were about 40% larger than PE-stimulated control cells (Fig. 6, B and C). There was also a higher induction in mRNA levels of skeletal actin (50%) and BNP (30%) in anti-miR-transfected cells as compared with control cells (Fig. 6D). This was associated with intense perinuclear release of ANF compared with PE-treated controls (Fig. 7A). The results obtained from Western blotting also confirmed nearly 2.5-fold higher induction of ANF by PE treatment in the anti-miR group, compared with control cells (Fig. 7B, supplemental Fig. S2). We next analyzed activation of p-p70S6K and pERK1/2 and found no changes in nonstimu-lated cells with anti-miR. Upon PE stimulation, a significantly higher phosphorylation of both signaling kinases was observed in the anti-miR group, as compared with control cells (Fig. 7, C  and D), suggesting higher activation of the hypertrophy inducing signaling cascade by miR-378 inhibition.
miR-378 Is a Negative Regulator of Ras Signaling-Because the activity of both the ERK1/2 and AKT signaling pathways was suppressed by miR-378, we hypothesized that there might be a common upstream target that regulates the activity of both of these pathways. We focused on Ras, a small (21 kDa) GTPbinding protein, which plays a pivotal role in the development of cardiac hypertrophy, and which is capable of regulating the activity of both ERK1/2 and AKT pathways (29,30). Ras is biologically active when bound to GTP and becomes inactive as a result of its innate GTPase activity, which hydrolyzes the bound GTP to GDP (5). To test whether Ras signaling is affected by miR-378, we performed a Ras activity assay. In this assay, active Ras is co-precipitated with the Ras-binding domain of Raf (Raf-RBD), which specifically binds to Ras-GTP (active Ras). As shown in Fig. 8, A and B, higher levels of active Ras was observed in PE-treated cardiomyocytes transfected with control mimic-C, compared with cells overexpressed with miR-378. This data suggest that miR-378 has the potential to block the agonist-mediated activation of Ras. To biochemically titrate the effect of miR-378 on Ras signaling, we used a recombinant adenovirus Ad-rasN17 encoding the dominant-negative Ras protein. Ras-N17 is a Ras mutant protein with substitution of asparagine (Asn) in place of serine (Ser) at position 17. This mutant inhibits the function of all endogenous cellular Ras proteins and prevents phosphorylation of mitogen-activated protein kinases and cell proliferation of myoblasts upon serum stimulation (31). We validated the efficacy of the Ad-rasN17 mutant in cardiomyocytes by finding the reduced AKT phosphorylation after serum stimulation (supplemental Fig. S3). We next tested whether induction of ANF by miR-378 inhibition (as shown in Fig. 7B) is dependent on the activity of Ras. Car-diomyocytes were infected with Ad-rasN17 or with a blank adenovirus vector. The next day the same cells were overexpressed with anti-miR-378 or scramble-C under serum-free conditions and 24 h later they were switched to serum containing medium for an additional 24 h. As expected we found induced expression of ANF in anti-miR-378 expressing cells, which was significantly reduced in cells overexpressed with Ad-Ras-N17. In these experiments we found no alteration in ANF expression between cells expressing Ad-Ras-N17 and Ad-blank virus in combination with scramble-C (Fig. 8, C and D). From these data we deduced that Ras signaling is effectively targeted by miR-378, and that ANF induction by miR-378 inhibition could be a result from activation of Ras signaling.
Grb2, an Essential Component of Ras Signaling, Is a Direct Target of miR-378-Because overexpression of miR-378 effectively inhibited Ras signaling, we next sought to identify direct targets of miR-378 involved in Ras signaling activation. We used the most commonly used bioinformatics prediction tools (Target scan (32), Pic tar (33), Diana-microT (34), miRanda (35) and miR database (36)) to identify the target. We limited our The antibody used for detecting pERK recognizes pERK1 and pERK2 and that used for total ERK recognizes only ERK2. The expression of total ERK2 was not changed in these cells and was used to normalize the expression of pERK1/2. B, quantification of phosphorylated S6 kinase (normalized to ␤-actin) and pERK1/2 (normalized to ERK2) from A, each bar represents mean Ϯ S.D. of 3 independent experiments. C, representative Western blot showing expression of pAKT, pGSK3␤, and p-glycogen synthase. Cells were transfected as in A, after 48 h media was changed to serum-free medium for 18 h, cells were then treated with PE for 10 min. The GSK-3␤ activity was assayed by examining phosphorylation of its substrate, glycogen synthase. Antibodies against total AKT and ␤-actin were used as loading controls. The same membrane was sequentially used to probe with various antibodies after stripping the membrane. The "p" prefix denotes the phosphorylated form. Numbers in parentheses indicate the position of the phosphoamino acid recognized by the antibody. D, quantification of pAKT (normalized to total AKT) and pGSK-3␤ and p-glycogen synthase (normalized to ␤-actin) from C, each bar represents mean Ϯ S.D. of 3 independent experiments. Dagger, significant (p Ͻ 0.05) when compared with nontreated control; asterisk, significant when compared with PE-stimulated control.
search to those targets that are commonly predicted at least by two programs, and also to those that showed species conservation among vertebrates. Our search revealed multiple members that are activators of Ras signaling as potential targets of miR-378. These include Grb2, ERK2, RIT1, KSR1, and RAS.GRP4 (37)(38)(39)(40)(41)(42)(43). Interestingly, our search did not identify even a single member that is known to inactivate the Ras signaling pathway. A list of candidate targets showing location of the miR-378 "seed" sequence and their role in the Ras signaling pathway is summarized in Table 1. Among the list of potential targets of miR-378, we focused on Grb2 for experimental validation. The species conservation miR-378 seed sequence in the 3Ј UTR of Grb2 is shown in Fig. 8E. We next performed functional assays where the seed sequence of miR-378 from the 3Ј UTR of Grb2 was cloned downstream of a luciferase reporter in a dual reporter construct. The wild type and mutant constructs were transfected into H9C2 cells, which we showed previously to express very low levels of miR-378, compared with cardiomyo-cytes isolated from neonatal hearts (14). In this assay we found that overexpression of miR-378 significantly inhibited the luciferase activity of WT, but not of the mutant 3Ј UTR of Grb2 (Fig.  9A), thus suggesting that the 3Ј UTR of Grb2 is responsive to miR-378-mediated regulation. We then examined the effect of miR-378 on the endogenous level of the Grb2 protein by expressing increasing amounts of miR-378. A dose-dependent reduction in the expression levels of Grb2 was observed in miR-378 overexpressing cells. The reduction in Grb2 levels ranged from 20% to 5-fold with increasing concentrations of miR-378 (Fig. 9B, supplemental Fig. S4A), thus suggesting that Grb2 is a valid target of miR-378. In our computational analysis, ERK2 also emerged as a potential target and activated ERK2 is a widely accepted growth promoting effector of Ras signaling. We therefore also analyzed ERK2 expression in the same lysate preparation, and found that ERK2 levels remain unchanged even in cells expressing very high levels of this micro-RNA (Fig.  9B), consistent with results presented in Fig. 5A. These data To-Pro stain was used to mark the position of nuclei (blue), note the sarcomeric organization and increased cell size by PE, which was further increased by inhibition of miR-378 by anti-miR. C, quantification of cell size of cardiomyocytes in scr-C and anti-miR-transfected cells under basal nonstimulated conditions (Ϫ) and upon PE stimulation (ϩ). Cell size was quantified and analyzed as described in the legend to Fig. 2C. D, real-time PCR analysis for mRNA expression of fetal genes, skeletal actin, and BNP, normalized to GAPDH. Each bar is a mean Ϯ S.D. of replicates with a minimum of n ϭ 4 in each group. Dagger, significant when compared with nontreated control; asterisk, significant when compared with PE-stimulated control.
suggested that Grb2 and not ERK2 is a valid target of miR-378. Because miRNAs are known to repress expression of the target proteins by repressing protein translation and/or by promoting mRNA degradation, we next examined the effect of miR-378 overexpression on Grb2 mRNA levels. For this experiment, we tested miR-378 at 25 nM dose because it significantly downregulated (5-fold compared with mimic C) the Grb2 protein levels. After 72 h of transfection of cardiomyocytes with miR-378, or mimic-C, the Grb2 mRNA levels were analyzed by realtime PCR. The results showed nearly 2-fold reduction in the mRNA levels of Grb-2 by miR-378 overexpression (supplemental Fig. S4B). These results demonstrated that miR-378 targets Grb2 by causing translation inhibition as well as promoting its mRNA degradation.
Several previous studies have shown that Grb2 is an upstream component of Ras signaling adapter proteins essential for stimulation of Ras upon the mechanical stretch of cells (37, 44 -46). However, the role of Grb2 in PE-stimulated hypertrophy and in human heart failure has not been documented. We therefore examined the Grb2 protein levels in PE-stimu-lated cells and found almost 2-2.5-fold increased expression by PE treatment as compared with controls. The increase in Grb2 expression was not observed in PE-treated miR-378 overexpressing cells (Fig. 9C, supplemental Fig. S5A). We next probed human failing hearts for the expression levels of Grb2 and found that out of 3 heart failure patients examined, 2 showed induction in Grb2 ranging from 3-to 6-fold (Fig. 9D, supplemental Fig. S5B). To our excitement these 2 patients also showed reduced miR-378 levels (as shown in Fig. 1F). The patient that had unchanged miR-378 expression showed no induction of Grb2. These results thus demonstrate a strong reciprocal relationship between Grb2 and miR-378 expression levels during induction of hypertrophy by PE and in patients with heart failure.
To further establish a role of miR-378 in Grb2 suppression, we used a siRNA duplex oligo, which was previously designed against human Grb2 coding nucleotides 607-627 and was shown to inhibit Grb2 expression by 90% in HeLa cells (16). Upon sequence alignment, this region of Grb2 was found to be fully conserved in rat and also in mice. This siRNA duplex pro- duced about 70% inhibition of Grb2 protein levels in rat cardiomyocytes (Fig. 9E). Functional connection between miR-378 and Grb2 was then examined by using ANF induction as readout of miR-378 inhibition. We found that ANF induction by anti-miR-378 could be prevented by inhibition of endogenous Grb2 (Fig. 9F, and supplemental Fig. S6A). There was also a significant reduction (20%) in cell size that was induced by miR-378 inhibition (not shown). We also examined the effect of Grb2 siRNA on PE-stimulated induction of fetal gene expression and found that Grb2 inhibition significantly reduced mRNA levels of ANF, BNP, and skeletal actin (supplemental Fig. S6B). These results collectively suggested that Grb2 partic-ipates in PE-stimulated cardiac hypertrophy and that it is a bona fide target of miR-378.

DISCUSSION
This study was designed to investigate the role of miR-378 in the development of cardiac hypertrophy. By different experimental approaches, we show that miR-378 is an endogenous negative regulator of cardiac hypertrophy. The expression level of miR-378 is down-regulated during development of hypertrophy and in heart failure and overexpression of miR-378 inhibits hypertrophic growth of cardiomyocytes by interfering with the nuclear accumulation of NFAT and induction of the fetal gene program. Conversely, inhibition of miR-378 by anti-miR in cardiomyocytes enhanced PE-induced fetal gene expression and hypertrophic signaling. Experiments carried out to identify the direct target of miR-378 led us to determine that miR-378 blocks cardiac hypertrophic response by repressing Grb2 and Ras signaling, and thereby suppressing the activity of two major downstream pro-hypertrophic signaling effectors, pAKT and pERK. A model illustrating anti-hypertrophic effects of miR-378 is given in Fig. 10.
The findings showing miR-378 can block activation of Ras signaling are highly significant. The only other miRNA regulating Ras signaling in the heart is miR-21, but this miRNA is reported to enhance Ras-ERK signaling in cardiac fibroblasts. The expression levels of miR-21 are induced in pressure overload hypertrophy and inhibition of miR-21 prevents cardiac fibrosis and development of adverse remodeling (47). The mechanism behind the anti-fibrotic effect of miR-21 deficiency is linked to the de-repression of "sprouty" proteins (48), which are so far the only known endogenous repressors of Ras signaling (49). Our data presented in this study have identified miR-378 as a novel endogenous repressor of Ras-ERK signaling operative in cardiac myocytes because this miRNA, as we reported previously (14), is not expressed in cardiac fibroblasts.
The most recent microRNA database (www.mirbase.org) describes the existence of 10 isoforms of miR-378 in humans. These isoforms show high sequence homology sharing the exact same seed sequence, and differing at most by only 2 nucleotides outside the seed region. The hairpin stem-loop structure of the pre-miR region of six isoforms (miR-378a, miR-378b, miR-378d-2, miR-378e, miR-378f, and miR-378g) is embedded within the introns of the protein coding genes, whereas that of the remaining four isoforms (miR-378c, miR-378d-1, miR-378h, and miR-378i) are located as stand alone at various genomic locations (summarized in supplemental Table S1). The isoform miR-378a (also known as miR-378a-3p and miR-422b) originates from the 1st intron of the Pgc1␤ gene, which also co-transcribes miR-378* (also known as miR-378 -5p). Despite the description of multiple isoforms of miR-378 origi-nating from multiple genomic loci in the microRNA database, Olson's group (50) recently reported that deletion of one single locus of the Pgc1␤ intronic region resulted in complete loss of cardiac expression of miR-378. This observation indicates that in the heart, either other pre-miR sequences are not expressed or that they are not processed into the mature form of miR-378. Future analysis of miR-378 expression by use of pre-miR-specific probes should be able to identify whether additional isoforms of this miRNA are expressed in the heart or not. In this recent report whole body knock-out of miR-378a/miR-378* was found to produce resistance to high fat diet-induced obesity and to enhance the mitochondrial fatty acid metabolism utilizing noncardiac mechanisms (50). The cardiac phenotype of miR-378 deficiency was, however, not described in this study. In our study, when we used anti-miR-378 that was designed to inhibit all isoforms of miR-378 in cardiomyocytes, we observed an increased cell size of cardiomyocytes and dramatic up-regulation of fetal gene expression including ANF, BNP, and skeletal actin. This was consistent with one of our earlier studies where we observed reduced expression of miR-378 in the fetal heart (where fetal genes are highly expressed) and robust expression of miR-378 in the adult heart (where fetal gene expression is minimal) (14). From these findings we deduce that cardiac abundance of miR-378 in adults plays an important role in maintaining cardiac cell homeostasis by keeping cardiac cell growth and the fetal gene program in check.

Members of RAS pathway
Gene function

RIT1
A RAS-related GTPase, expressed ubiquitously. It is stress inducible and activates MEKs (40). Its specific role in the heart is not known.

MAPK1
Also known as p42/ERK2 is a well known effector for Rasmediated signaling cascade. It is a key regulator of hypertrophy agonist-stimulated growth of cardiac myocytes.
NM_002745 (181-188) DianaT, Targetscan, Miranda RAS GRP4 RAS.GRP4, a RAS guanine nucleotide releasing protein, is activated by phorbol esters, calcium, and DAG (41)(42)(43). It is expressed in fetal heart, in adults it is restricted to mast cells (42). In the heart, could this protein be a part of fetal gene program that gets activated by hypertrophy agonists and regulates Ras signaling? This possibility remains to be investigated. APRIL 19, 2013 • VOLUME 288 • NUMBER 16

MicroRNA-378 Targets Ras Signaling in Cardiac Myocytes
recently the miR-212/132 family. All of these miRNAs, except miR-208a, show increased expression in response to hypertrophic agonists. Overexpression of these miRNAs enhances hypertrophic growth and their inhibition confers resistance to cardiac stress (51, 54 -61). Among the anti-hypertrophic miR-NAs, miR-98/let-7 regulates cardiac hypertrophy indirectly via thioredoxin (62), the other three miRNAs (miR-9, miR-1, and miR-133) could directly inhibit response of cardiomyocytes to hypertrophic stimuli (53,(63)(64)(65)(66)(67)(68)(69). Expression of these three miRNAs is down-regulated by hypertrophy agonists and their overexpression diminished the hypertrophic response. Our data presented here show that miR-378 is a new member of anti-hypertrophic miRNAs. Similar to previously described anti-hypertrophic miRNAs, the expression level of miR-378 is down-regulated by hypertrophic stimuli, both in vitro and in vivo in three different models of cardiac hypertrophy as well as in patients with heart failure, and its overexpression blocks the hypertrophic response of cardiomyocytes. The effect of anti-hypertrophic miRNAs is known to be mediated by targeting distinct sets of molecular pathways. miR-9 directly targets myocardin and interferes with the nuclear activity of NFAT (69). miR-133a inhibits hypertrophy by direct targeting of calcineurin (68), NFAT (66), and Cdc42 and RhoA (63), miR-1 targets twinfilin-1 (70), and calmodulinmediated hypertrophic signaling (64,71). Genetic deficiency of miR-133a results in extensive fibrosis, impaired cardiac function, and pathological remodeling (72). Even though miR-133a is a cardiomyocyte-specific miRNA, it should be noted that it could also influence cardiac fibroblast function and reduce fibrosis by targeting connective tissue growth factor (53). miR-1 and miR-133a are cardiomyocyte-enriched miRNAs, both inhibit cardiac hypertrophy and both target IGF1 signaling (63, Cardiomyocytes were transfected with increasing amounts of miR-378. After 72 h cell lysates were analyzed for endogenous expression levels of ERK2 and Grb2. ␤-Actin was used as loading control. The same membrane was sequentially probed with different antibodies after stripping. Significant inhibition of Grb2 but not of ERK2 expression was noted with increasing doses of miR-378. C, Western blot showing increased expression of Grb2 in PE-stimulated cardiomyocytes. Cells were transfected with control (mimic-C) or miR-378 and then treated with PE for 10 min or 48 h. A significant induction in Grb2 was noted at both time points of PE treatment in controls but not in miR-378 overexpressing cells. GAPDH used as loading control. D, Western blot demonstrating Grb2 expression in human nonfailing hearts (NF1, NF2, and NF3) and in patients with nonischemic cardiomyopathy (DCM1, DCM2, and DCM3). A significant induction of Grb2 was noted in 2 (DCM2 and DCM3) heart failure patients. E, Western blot showing that siRNA duplexes of Grb2 (40 nM) when transfected twice in cardiomyocytes at 24-h intervals produces about 70 -80% inhibition in the expression levels of endogenous Grb2. F, knockdown of Grb2 prevents ANF induction triggered from miR-378 inhibition. Cardiomyocytes were transfected with Grb2 siRNA duplex or negative control siRNA as described in E in association with anti-miR-378 or scramble control in serum-free medium, 24 h prior to harvesting, cells were switched to serum containing medium. 73). Similar to miR-1 and miR-133, we recently described miR-378 as a cardiomyocyte-specific miRNA in the heart, which inhibits IGF1 signaling by direct targeting of IGF1R during postnatal cardiac remodeling (14).
In this study, we provide evidence that similar to miR-1 and miR-133, miR-378 is also an anti-hypertrophic miRNA, but its anti-hypertrophic effects are mediated by repressing Ras activity. Although several components of the Ras-signaling pathway emerged as potential targets of miR-378 from our in silico analysis, we could identify one component, Grb2, as a direct target of miR-378. Grb2 is an adapter protein essential for Ras activation. A direct role of Grb2 in cardiac hypertrophy was demonstrated in a study of genetic deletion of Grb2, whereas germ line deletion of Grb2 was found to be embryonic lethal, Grb2 ϩ/Ϫ mice were found protected from pressure overload-induced cardiac hypertrophy (38), demonstrating a direct pathological role of Grb2 in the regulation of cardiac hypertrophy. Our study demonstrates that Grb2 expression is induced in patients with heart failure and also upon PE stimulation in cardiomyocytes, and that inhibition of Grb2 by siRNA interferes with PE-stimulated induction of fetal gene expression. We have demonstrated here that miR-378 is a strong repressor of Grb2. It directly binds to the 3Ј UTR of Grb2 mRNA and causes both translation inhibition as well as degradation of its mRNA thus profoundly inhibiting Grb2 expression. Although from our target prediction analysis, ERK2 also emerged as a potential target of miR-378, the expression levels of ERK2 were not affected with miR-378 overexpression, thereby excluding ERK2 as a direct target of miR-378. It remains to be seen whether other components of Ras signaling that emerged by in silico analysis could indeed turn out to be authentic targets of miR-378.
Ras signaling is known to play a significant role in the induction of pathological remodeling. Multiple hypertrophy agonists activate the Ras-signaling pathway (4, 6, 7) and ectopic activation of Ras signaling induces pathological cardiac remodeling (8 -11). Ras signaling is activated by growth factor receptors (insulin-like growth factor receptor, epidermal growth factor receptor, and platelet-derived growth factor receptor), by G protein-coupled receptors (Ang II receptors, and ␣ and ␤ adrenergic receptors), and by integrin-focal adhesion kinase (induced by mechanical stretch). The two major downstream effectors for the Ras-signaling pathway include activation of PI3K-AKT and Raf-MEK-ERK signaling pathways. Although both of these downstream effector pathways have also been implicated in the regulation of physiological growth of the heart, their sustained hyperactivation leads to the development of pathological hypertrophy and heart failure (8, 74 -76). We have recently shown that heart failure resulting from SIRT6 knock-out is associated with a massive induction of IGF-AKT signaling (19). Because miR-378 directly targets IGF1R and represses IGF-induced activation of AKT (14), a possible contribution of this pathway in the anti-hypertrophic effects of miR-378 cannot be excluded. Therefore it appears that miR-378 uses multiple targets to repress Ras activation in cardiomyocytes; two of these, which we have demonstrated in this study, include IGF1R (as reported by us previously) and Grb2.
Considering the wide implications of Ras-ERK activation in cardiac pathophysiology, it should be noted that this signaling pathway has significant application in the development of a specific hypertrophic cardiomyopathy (HCM) associated with a syndrome named "RASopathy," which comprises a set of phenotypically related, yet distinct, human developmental defects (e.g. Noonan, Costello, Cardio-Facial-Cutaneous, and LEOPARD syndromes) (77,78). Some, but not all, of these syndromes develop HCM (79). The underlying cause of HCM in this syndrome is a high occurrence rate of dominant gain-offunction germ-line mutations in genes encoding members of Ras-ERK pathway (KRAS, NRAS, Raf1, SOS1, and PTPN11) (80 -82). Mutant mouse models with specific mutations in these genes also recapitulate many features of the RASopathy syndrome including cardiac hypertrophy, ventricular dysfunction, and aberrant expression of fetal genes (83,84). Although the occurrence rate of HCM is variable with mutations of different genes, in almost all cases, HCM is preventable by either genetic ablation of ERK1/2 or by pharmacological inhibition of MEK (85)(86)(87).
In summary, our study has defined a new role for miR-378 demonstrating its ability to block cardiac hypertrophy by preventing Ras activation. These findings have profound implications not only for the management of heart failure, but also for During development of cardiac hypertrophy miR-378 levels are down-regulated, leading to activation of Ras. Activated Ras transmits its signals by activating two growth promoting signaling pathways: AKT and ERK1/2. AKT phosphorylates GSK-3␤ and inactivates it, thereby causing de-phosphorylation and nuclear accumulation of NFAT. Phosphorylated ERK1/2 activates transcription activity of GATA4 and MEF2. Increased activity of these transcription factors leads to induction of fetal gene expression and hypertrophic gene program. Because anti-miR-378 activated fetal gene expression in the absence of hypertrophic agonists (see Figs. 6D and 7, A and B), we believe that miR-378 deficiency might have a direct role in regulating the expression of fetal genes.
HCM accompanying hyperactivation of Ras signaling in human congenital defects associated with RASopathy. Figure S1: MiR-378 inhibits PE-stimulated early activation of ERK1/2 in cardiomyocytes. Cells were transfected with mimic-C or miR-378, after 48 h cell media was changed to serum free. After 18 h cells were stimulated with PE (20 uM) for 5 or 15 min (n=3). * significant as compared to PE treated mimic-C. A 3-fold induction was noted with 378-antimiR under basal conditions. Almost 3-fold higher expression of ANF was also noted following PE-treatment for 48 h in 378-antimiR transfected cells as compared to scramble-C (n=3). Ϯ significant as compared to vehicle treated scramble control, * significant when compared to PE treated control. For a representative radiogram please refer to Figure 7B. Figure S3: Adenovirus, Ad-rasN17, expressing dominant negative mutant form of Ras, inhibits serum-stimulated AKT activation in cardiomyocytes. One of the known downstream effectors of Ras-signaling is phosphorylation of AKT. To test the effectiveness of Ad-rasN17 adenovirus (used in this study) in inhibiting Ras signaling in cardiomyocytes serum-stimulated AKT activation was measured in cardiomyocytes after infection with Ad-rasN17 or control adenovirus (Ad-blank). Ad-rasN17 but not Ad-blank significantly inhibited serum-stimulated activation of pAKT (n=3). Ϯ significant as compared to serum free (SF) Ad-blank control, * significant when compared to serum stimulated Ad-blank control.  Figure 9B. B. Over-expression of miR-378 resulted in almost 50% reduction in the mRNA levels of Grb-2 as measured by real-time PCR (n=3). * Significant as compared to mimic-C control. Over-expression of miR-378 caused a significant reduction in Grb2 in untreated cells and it prevented PEstimulated induction of Grb2. Ϯ significant in relation to non-treated cells, * significant in relation to corresponding controls transfected with mimic-C (n=2). For a representative radiogram refer to Figure  9C. B. Quantification of Grb2 expression in human samples of non-failing heart (NF1, NF2, NF3) and heart patients with non-ischemic cardiomyopathy (DCM1, DCM2, DCM3). Each bar is a mean ± SD of three replicate assays. * Significant in relation to non-failing hearts. Representative radiogram is shown in Figure 9D. Transfection of cardiomyocytes with 378-antimiR caused almost 12-fold induction in ANF protein levels when it was co transfected with a negative control SiRNA whereas co-transfection with Grb2 SiRNA produced only 4.5-fold induction in ANF. There was no difference when Grb2 SiRNA or control SiRNA were co-transfected with scramble control. For a representative radiogram please refer to Figure 9F. Ϯ significant when compared to scramble control, * significant in relation to control siRNA. B. Real-time PCR analysis of hypertrophy markers in PE-stimulated cardiomyocytes following Grb2 inhibition. Cardiomyocytes were transfected with control SiRNA or Grb2 SiRNA and then treated with PE for 48 h. Cells transfected with control SiRNA treated with vehicle served as control. Data presented as mean ± SD. Each assay performed in triplicates (n=2). * significant in relation to vehicle treated control SiRNA and also with PE-stimulated control SiRNA .