- Mechanisms of the 3- hydroxyl-3-methylglutaryl-coenzyme a reductase inhibitor- induced myotoxicity in human skeletal muscle cell cultures (2005)
- The HMG-CoA reductase inhibitors SIM, LOV, ATV, PRA, FV and NKS were investigated for their effects on human SkMCs. We were able to demonstrate that statins can induce oxidative stress (ROS formation, GSH-depletion, TBARS), apoptosis (, caspase-3 activity, nuclear morphology) and necrosis (LDH-leakage) in hSkMCs. After incubation with statins, the sequence of cellular events starts by the increased formation of ROS (30 min) followed by caspase-3 activation (2-4 hours) and necrosis (LDH-leakage) and formation of condensed and fragmented nuclei after 24-72 hours. It was shown that, antioxidants (NAC, DTT, TPGS, M-2 and M-3) and the HMG-CoA reductase downstream metabolites (MVA, F, FPP, GG and GGPP) protected against statin-induced ROS formation, caspase-3 activation and partially from necrosis. The caspase-3 inhibitor Ac-DEVD-CHO rescues cells partially from necrosis. These results suggest that the statin-induced necrosis is HMG-CoA dependent and occurs secondary to apoptosis, which by decrease of ATP is driven into necrosis. The increase of ATP observed at low concentrations and early time points suggest an increased glycolytic activity. This was confirmed by increased PDK-4 gene expression and increased PFK2/F-2,6-BPase expression both activator of glycolysis. Glycolysis was also confirmed for some statins by increased cellular lactate concentations. The consequence of PDK-4 mediated pyruvate dehydrogenase inactivation is the metabolic switching from fatty acid to amino acid from proteins as energy source. The oxidative stress hypothesis was further supported by the induction of the FOXO3A transcription factor, which is involved in regulating MnSOD-2 expression in the mitochondrium. The mechanism by which statins produce ROS is still not resolved. There is an indirect evidence from our experiments as well as from the literature, that immediately after the statin treatment, intracellular Ca2+ is mobilized due to HMG-CoA reductase inhibition, which after mitochondrial uptake could lead to increased ROS formation.