Abstract Body: Cardiac hypertrophy, a precursor to heart failure, represents a leading cause of global mortality and morbidity. Current therapeutic strategies focused on reducing the heart's workload, demonstrate limited efficacy. Nuclear-localized cAMP emerges as a promising therapeutic target, intervening in hypertrophic gene transcription and exhibiting overactivation in hypertrophic cardiomyocytes. Despite its potential, the spatiotemporal regulation and molecular targets of nuclear-localized cAMP (NLS-cAMP) remain elusive.

Employing super-resolution imaging, we identified a pool of β1 adrenergic receptors (β1AR) at the nuclear envelope that transduces NLS-cAMP-PKA signaling in cardiomyocytes. Utilizing a nuclear-localized FRET biosensor, our investigations revealed that the deletion or inhibition of monoamine oxidase A (MAOA) amplifies the norepinephrine-induced NLS-β1AR activation signal. Conversely, overexpressing MAOA prevents NLS-B1AR activation, underscoring the critical role of MAOA in regulating the NLS-cAMP nanodomain.

Single-cell transcriptome analysis unveiled a decline in MAOA expression in a mouse cardiac hypertrophy model. Cardiac-specific deletion of MAOA in mice led to simultaneous hypertrophy and eventual heart failure. Mechanistically, MAOA deletion increased PKA-dependent phosphorylation of HDAC1, H3K27 acetylation, and chromatin accessibility of hypertrophic genes, including Nppa and Nppb. To validate therapeutic potential, we intraventricularly injected adeno-associated virus (AAV) 9 vectors expressing mcherry or mcherry-MAOA under the control of the cTNT promoter into mice. Inducing cardiac hypertrophy through Angiotensin II infusion five weeks later, mice preinjected with AAV-MAOA exhibited attenuated cardiac hypertrophy and improved cardiac function.

Our findings suggest that MAOA gene therapy holds promise for treating hypertrophy by specifically targeting the NLS-cAMP nanodomain, opening new avenues for targeted interventions in cardiac hypertrophy and heart failure.