Renal denervation attenuates cardiac dysfunction in HFpEF by inhibiting the ATP-P2X7-NLRP3 inflammasome axis.

Abstract

Heart failure with preserved ejection fraction (HFpEF) arises from intersecting comorbidities involving inflammation, metabolic stress, and sympathetic nervous system (SNS) activation. To mirror this complexity, we established a clinically oriented 3-hit mouse model combining advanced age, a high-fat diet, and chronic NOS inhibition with NG-Nitro-L-arginine methyl ester (L-NAME). We tested whether renal denervation (RDN) mitigates HFpEF by blunting SNS outflow and the ATP-P2X7-NLRP3 inflammasome axis, and in parallel probed the contribution of this pathway using pharmacologic and cellular approaches. 3-hit mice developed preserved ejection fraction with diastolic dysfunction, cardiomyocyte hypertrophy, interstitial fibrosis, impaired exercise capacity, and elevated inflammatory cytokines, accompanied by increased myocardial ATP, activation of P2X7/NLRP3 signaling, oxidative stress, and pyroptosis.RDN lowered systemic and myocardial norepinephrine, suppressed P2X7-NLRP3 inflammasome activation, reduced fibrosis and cardiomyocyte cross-sectional area, improved E/e' and exercise capacity, and reduced oxidative stress and myocardial injury. In pharmacological intervention experiments, selective blockade with the P2X7 antagonist A438079 or the NLRP3 inhibitor MCC950 improved diastolic function and exercise capacity and attenuated myocardial fibrosis and cardiomyocyte hypertrophy. Complementary mechanistic studies in cardiomyocytes (H9c2 and primary neonatal rat cardiomyocytes) showed that ATP induced mitochondrial ROS accumulation, inflammasome activation, cytokine release, and cell injury, which were partially reversed by P2X7 knockdown or pharmacological antagonism. Together, these data validate a multi-hit HFpEF model and implicate an SNS-driven ATP-P2X7-NLRP3 axis as a potential therapeutic target. Both RDN and selective pathway inhibition improved diastolic function and attenuated ventricular remodeling, and inform future therapeutic strategies for HFpEF characterized by heightened sympathetic tone.