LncRNA Bigheart trans-activates gene expression in a feed forward mechanism that facilitates calcineurin-NFAT signaling in myocardial hypertrophy

Terminally differentiated cardiomyocytes exhibit hypertrophy as a default response to injury by translating biomechanical stress into a complex network of intracellular signaling events. The molecular intricacies how calcium-dependent signaling engage molecular circuits and epigenetic modifications to activate deleterious gene programs remain enigmatic. Here we report on the re-activation of the evolutionarily conserved lncRNA "Bigheart", which is repressed in the postnatal myocardium and quickly re-activated in a calcineurin-NFAT-dependent fashion in the diseased myocardium in man and mouse. In line, AAV9-mediated overexpression of lncRNA Bigheart in otherwise healthy primary cardiomyocytes or mouse hearts suffices to drive maladapative hypertrophy. Conversely, mice receiving a "Gapmer" antisense oligonucleotide designed to specifically silence endogenous lncRNA Bigheart display resistance to biomechanical stress-induced myocardial remodeling, indicating its requirement in left ventricular hypertrophy. Mechanistically, lncRNA Bigheart recruits the RNA binding proteins hnRNP-F1 and HMGB1 to modulate the local chromatin environment and trans-activate Bigheart target genes including Rcan1 to stimulate calcineurin-NFAT coupling. Our observations confirm that human heart failure arises from specific susceptibilities in gene regulatory circuits that are amenable for therapeutic intervention using RNA-based therapeutics.