Oral administration of Angiotensin-(1-7) included in hydroxypropyl β-cyclodextrin attenuates cardiac hypertrophy and inflammation in a mouse model of Takotsubo cardiomyopathy

Background Takotsubo cardiomyopathy (TTC) is a stress-induced cardiomyopathy characterized by acute cardiac dysfunction, inflammation, and hypertrophy, yet no therapy directly targets the underlying myocardial injury. Clinical studies have reported elevated circulating Angiotensin II (Ang II) levels in TTC patients, suggesting dysregulation of the renin-angiotensin system (RAS). Given the established cardioprotective effects of Angiotensin-(1-7) [Ang-(1-7)] in other cardiovascular diseases, we hypothesized that oral administration of Ang-(1-7) could attenuate acute cardiac remodeling during TTC. Methods Female C57BL/6J mice were subjected to a single high-dose isoproterenol (ISO) injection (300 mg/Kg, intraperitoneal) to induce TTC and received daily oral treatment with Ang-(1-7) complexed with hydroxypropyl {beta}-cyclodextrin [Ang-(1-7)-CD] or vehicle (CD), for 4 days, beginning one day before ISO administration. Cardiac proteome alterations were characterized by tandem mass tag (TMT)-based quantitative proteomics. Cardiac hypertrophy was assessed by heart weight normalized to tibial length and cardiomyocyte cross-sectional area. Myocardial inflammation was evaluated by histopathology, CD68 immunostaining, and flow cytometric analysis of infiltrating leukocyte populations. Results We observed a distinct cardiac proteome signature in Ang-(1-7)-treated ISO mice, predicting inhibition of pathways associated with cardiac hypertrophy and adverse remodeling. These molecular changes were accompanied by reduced heart weight normalized to tibial length and smaller cardiomyocyte cross-sectional area compared with vehicle-treated ISO mice. Oral Ang-(1-7) also attenuated myocardial inflammation, as evidenced by lower inflammatory scores, reduced CD68+ macrophage infiltration, decreased numbers of CD45+ leukocytes, and marked suppression of Ly6G+ neutrophil and CCR2+ monocyte recruitment to the heart. These protective effects were associated with improved survival following ISO challenge. MS data are available via ProteomeXchange (PXD082872). Conclusions Oral administration of Ang-(1-7) attenuated acute cardiac hypertrophy and inflammation in experimental TTC while inducing cardiac proteome changes consistent with reduced adverse remodeling. These findings identify activation of the protective RAS axis as a promising therapeutic strategy for limiting myocardial injury during TTC.