Abstract Body: Introduction:
The p38 mitogen-activated protein kinase (p38 MAPK), activated by stress, plays a role in cardiac hypertrophy and heart failure (HF). The precise mechanism of action of p38 MAPK remains unclear, which could explain the mixed outcomes in P38 inhibitor trials. Here, we examine the impact of p38 MAPK inhibition on cardiac function and the proteome/phosphoproteome of the failing heart.

Objective:
To ascertain p38 MAPK’s impact on the progression of HF by inhibiting it with SB203580 (SB) in a guinea pig model of HF and sudden cardiac death.

Methods:
We assessed the proteomic changes in a previously described guinea pig HF model of ascending aortic constriction and once-daily isoproterenol administration (ACi). Three groups were included: sham-operated controls (Control), ACi, and ACi plus SB treatment (ACiSB). Cardiac function was evaluated by M-Mode echocardiography and proteome/phosphoproteome analysis was performed by multiplexed TMT-labeling and LC-MS/MS.

Results:
Inhibition of p38 MAPK with SB attenuated but did not fully block HF progression. At 5 weeks, fractional shortening was significantly improved in the ACiSB group compared to ACi (p=0.0037). Furthermore, it significantly decreased cardiac hypertrophy and lung edema (p-values <0.0001 and 0.0003 respectively). Compared to our previous study on the impact of a mitochondrially-targeted antioxidant (MitoTEMPO), SB protected a smaller subset of protein expression changes in HF; However, its impact on the phosphoproteome was substantial, extending beyond known p38 substrates. SB suppressed HF-induced inflammatory pathway proteins, modestly protected against downregulation of some mitochondrial respiratory chain proteins, and prevented maladaptive phosphorylation of several proteins involved in excitation-contraction coupling, including the ryanodine receptor, phospholamban, and cytoskeletal protein phosphorylation.

Conclusion:
p38 MAPK inhibition offered significant protection against HF, primarily affecting the phosphoproteome with modest effects on protein expression. The data suggests that narrowly targeted p38 MAPK-driven phosphoproteome modifications contribute to cardiac decompensation, despite broad protein expression changes in HF. Differences between MitoTEMPO and SB effects on the HF proteome highlight the plethora of remodeling pathways triggered by mitochondrial ROS including p38 MAPK activation. Our findings emphasize the importance of preventing p38 MAPK to preserve cardiac function.