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BET Bromodomains Mediate Transcriptional Pause Release in Heart Failure
Open accessAbstract
Heart failure (HF) is driven by the interplay between regulatory transcription factors and dynamic alterations in chromatin structure. Pathologic gene transactivation in HF is associated with recruitment of histone acetyl-transferases and local chromatin hyperacetylation. We therefore assessed the role of acetyl-lysine reader proteins, or bromodomains, in HF. Using a chemical genetic approach, we establish a central role for BET family bromodomain proteins in gene control during HF pathogenesis. BET inhibition potently suppresses cardiomyocyte hypertrophy in vitro and pathologic cardiac remodeling in vivo. Integrative transcriptional and epigenomic analyses reveal that BET proteins function mechanistically as pause-release factors critical to expression of genes that are central to HF pathogenesis and relevant to the pathobiology of failing human hearts. This study implicates epigenetic readers as essential effectors of transcriptional pause release during HF pathogenesis and identifies BET coactivator proteins as therapeutic targets in the heart.
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“BET inhibition exerted a strong protective effect on left ventricular ejection fraction (Fig. 1B)4,6-10.”
From Chromatin remodelling drives immune cell–fibroblast communication in heart failure (2024) · cites this paper as [6]
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“As BET proteins are transcriptional co-activators and their inhibition is associated with protection in heart failure models6-8”
From Chromatin remodelling drives immune cell–fibroblast communication in heart failure (2024) · cites this paper as [6]
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1 retracted
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“model of cardiac pressure overload, which provides focal hemodynamic stress to the heart and recapitulates several cardinal aspects of pathologic hypertrophy and HF in humans (Rockman et al., 1991).”
RetractedSubramanian, A., Tamayo, P., Mootha, V. K., Mukherjee, S., Ebert, B. L., Gillette, M. A., Paulovich, A., Pomeroy, S. L., Golub, T. R., Lander, E. S., et al. (2005) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0506580102 · Cited by 53,625 · cited 1×
“Using gene set enrichment analysis (GSEA) (Subramanian et al., 2005), we compared our set of TAC-induc-”
Ultrafast and memory-efficient alignment of short DNA sequences to the human genome.
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Model-based Analysis of ChIP-Seq (MACS)
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“The pathologic nature of this process has been validated in large epidemiologic studies, which demonstrate that the presence of chronic cardiac hypertrophy is a robust predictor of subsequent HF and death (Hill and Olson, 2008; Levy et al., 1990).”
Selective inhibition of BET bromodomains
Filippakopoulos, P., Qi, J., Picaud, S., Shen, Y., Smith, W. B., Fedorov, O., Morse, E. M., Keates, T., Hickman, T. T., Felletar, I., et al. (2010) · Nature · doi:10.1038/nature09504 · Cited by 4,262 · cited 4×
“We and others have utilized this chemical genetic tool to probe BET function in a number of developmental and disease contexts, such as cancer (Delmore et al., 2011; Filippakopoulos et al., 2010), HIV infection (Banerjee et al.”
InfluentialSelf-citationSelective Inhibition of Tumor Oncogenes by Disruption of Super-Enhancers
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“Furthermore, the very recent discovery of asymmetrically loaded BRD4 on a critical subset of state-specific enhancers termed superenhancers (Lovén et al., 2013) raises the possibility that such superenhancers might also be active in the stressed myocardium and contribute to BET target specificity.”
Self-citationBET Bromodomain Inhibition as a Therapeutic Strategy to Target c-Myc
Delmore, J. E., Issa, G. C., Lemieux, M. E., Rahl, P. B., Shi, J., Jacobs, H. M., Kastritis, E., Gilpatrick, T., Paranal, R. M., Qi, J., et al. (2011) · Cell · doi:10.1016/j.cell.2011.08.017 · Cited by 2,888 · cited 4×
“Prior studies from our laboratory and others have implicated BET bromodomains in neoplastic MYC transcription in hematopoietic tumors (Delmore et al., 2011; Zuber et al., 2011).”
InfluentialSelf-citationXie, X., Lu, J., Kulbokas, E. J., Golub, T. R., Mootha, V., Lindblad-Toh, K., Lander, E. S., & Kellis, M. (2005) · Nature · doi:10.1038/nature03441 · Cited by 1,872 · cited 1×
“Specifically, we studied the Broad Institute Molecular Signatures Database C3 motif gene sets (Xie et al., 2005), as well as three functional, in vivo signatures of CMspecific transcriptional effectors: Calcineurin-NFAT (Bousette et al.”
RNAi screen identifies Brd4 as a therapeutic target in acute myeloid leukaemia
Zuber, J., Shi, J., Wang, E., Rappaport, A. R., Herrmann, H., Sison, E. A., Magoon, D., Qi, J., Blatt, K., Wunderlich, M., et al. (2011) · Nature · doi:10.1038/nature10334 · Cited by 1,870 · cited 2×
“Prior studies from our laboratory and others have implicated BET bromodomains in neoplastic MYC transcription in hematopoietic tumors (Delmore et al., 2011; Zuber et al., 2011).”
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“Pharmacologic inhibition of BET protein function has been a promising therapeutic strategy for several diseases including cancers (4, 12–16), inflammation (17), and heart failure (18).”
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BackgroundErythropoiesis provides a BRD's eye view of BET protein function
Stonestrom, A. J., Hsu, S. C., Werner, M. T., & Blobel, G. A. (2016) · Drug Discovery Today Technologies · doi:10.1016/j.ddtec.2016.05.004 · Cited by 21
“Preclinical studies have also demonstrated the potential efficacy of BET inhibition in applications that would require chronic administration such as heart failure, and type I diabetes mellitus [67,68].”
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SPOP-mediated degradation of BRD4 dictates cellular sensitivity to BET inhibitors
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“Mechanistically, histone acetyltransferases (HATs) can add acetyl groups to histone Lys residues as writers, while histone deacetylases (HDACs) and Sirtuins (SIRTs) can remove acetyl groups as erasers.(2) On the other hand, Bromodomain (BRD) proteins bind to acetylated lysine (Kac) and function as readers of lysine ac…”
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Self-citationBET Proteins: An Approach to Future Therapies in Transplantation
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Self-citationBET bromodomain is a novel regulator of TAZ and its activity
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Self-citationBromodomain and Extra Terminal Protein Inhibitors Promote Pancreatic Endocrine Cell Fate
Huijbregts, L., Petersen, M. B. K., Berthault, C., Hansson, M. D., Aïello, V., Rachdi, L., Grapin‐Botton, A., Honoré, C., & Scharfmann, R. (2019) · Diabetes · doi:10.2337/db18-0224 · Cited by 17
“Brd4 has been the most studied BET member because it was shown to modulate RNA polymerase II activity either by interacting with members of the transcription initiation complex, such as pTEFb and mediator (44–46), or by directly releasing proximally paused RNA polymerase II (47).”
BackgroundBromodomain‐containing protein 4 and its role in cardiovascular diseases
Li, L., Xie, W., Gui, Y., & Zheng, X. (2020) · Journal of Cellular Physiology · doi:10.1002/jcp.30225 · Cited by 17
“A study by Anand et al. (2013) revealed that BRD4 has the highest expression of the BET genes in isolated adult hypertrophic cardio- myocytes and hypertrophic cardiac tissue.”
BackgroundUsing Omics to Identify Novel Therapeutic Targets in Heart Failure
Lteif, C., Huang, Y., Guerra, L. A., Gawronski, B. E., & Duarte, J. D. (2024) · Circulation Genomic and Precision Medicine · doi:10.1161/circgen.123.004398 · Cited by 20
“…acetyl-lysine reader proteins appears to reduce cardiomyocyte hypertrophy in vitro and both LV hypertrophy and fibrosis in mouse models of HF. 41,42 In addition, the BET inhibitor apabetalone decreased first-hospitalizations for HF, total HF hospitalizations, and the composite of cardiovascular…”
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Toward a New Paradigm for Targeted Natriuretic Peptide Enhancement in Heart Failure
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Bromodomain Inhibitor JQ1 Provides Novel Insights and Perspectives in Rhabdomyosarcoma Treatment
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“BRD4, one of the most studied member of the BET-containing protein family, is an epigenetic factor that is associated with active promoters and enhancers of transcriptionally active genes [18,34].”
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“In heart failure models, BRD4 occupies the majority of activated enhancers and BET inhibition disturbs associated transcription, suppressing cardiomyocyte hypertrophy [234].”
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“…‘erase’ acetylation and methylation marks on histones and indirectly affect DNA structure, BET bromodomain proteins represent an important family of histone mark ‘readers’ that directly interact with acetylated lysines and activate pathological gene transcription in the heart (Anand et al. 2013).”
BackgroundBET Protein-Mediated Transcriptional Regulation in Heart Failure
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Cytoprotective, Cytotoxic and Cytostatic Roles of Autophagy in Response to BET Inhibitors
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“[30,31], inflammatory disease [32] and cancer [33,34].”
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Chromatin Remodeling Drives Immune-Fibroblast Crosstalk in Heart Failure PathogenesisPreprint
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“Bromodomain-containing protein 4 has been found in many other types of cells (31, 32) but has never been reported in the nasal tissues.”
BackgroundThe roles and mechanisms of epigenetic regulation in pathological myocardial remodeling
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BackgroundEnvironmental factors influence somatic cell reprogramming to cardiomyocyte-like cells
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Hilton-Proctor, J. P., Ilyichova, O. V., Zheng, Z., Jennings, I. G., Johnstone, R. W., Shortt, J., Mountford, S. J., Scanlon, M. J., & Thompson, P. E. (2019) · Bioorganic & Medicinal Chemistry · doi:10.1016/j.bmc.2019.115157 · Cited by 10
Katanasaka, Y., Sunagawa, Y., Sakurai, R., Tojima, M., Naruta, R., Hojo, Y., Kawase, Y., Hamabe‐Horiike, T., Mori, K., Hasegawa, K., et al. (2025) · Journal of Biomedical Science · doi:10.1186/s12929-025-01162-6 · Cited by 9
Measuring hypertrophy in neonatal rat primary cardiomyocytes and human iPSC-derived cardiomyocytes
Bourque, K., Hawey, C., Jones-Tabah, J., Pétrin, D., Martin, R., Sun, Y., & Hébert, T. E. (2021) · Methods · doi:10.1016/j.ymeth.2021.12.006 · Cited by 12
Lin, Z., Li, Z., Guo, Z., Cao, Y., Li, J., Liu, P., & Li, Z. (2022) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.887991 · Cited by 9
State of change: epigenetic and mitochondrial regulation of cardiac fibroblast activation
Garvin, A. M., & Hale, T. M. (2022) · Current Opinion in Physiology · doi:10.1016/j.cophys.2022.100557 · Cited by 9
Xie, Y., Pan, Y., Chen, Q., Chen, Y., Chen, G., Wang, M., Zeng, P. C., Li, Z., Li, Z., Wang, S., et al. (2023) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.64.7.9 · Cited by 9
Potential Applications of Induced Pluripotent Stem Cells for Cardiovascular Diseases
Wang, X., Han, Z., Yu, Y., Xu, Z., Cai, B., & Yuan, Y. (2018) · Current Drug Targets · doi:10.2174/1389450120666181211164147 · Cited by 9
Xing, J., Zhang, R., Zheng, M. Y., Luo, C., & Jiang, X. R. (2018) · Worldwide Protein Data Bank · doi:10.2210/pdb6afr/pdb · Cited by 9
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Roles of Brd4 in Vascular Smooth Muscle Cells: Implications for Aging and Vascular Dysfunction
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Inflammation-resolution signalling in cardiac repair, remodelling, and heart failure
Halade, G. V., Bäck, M., & Kain, V. (2025) · European Heart Journal Open · doi:10.1093/ehjopen/oeaf157 · Cited by 9
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Gβγ subunits colocalize with RNA polymerase II and regulate transcription in cardiac fibroblasts
Khan, S. M., Martin, R., Bayne, A. N., Pétrin, D., Bourque, K., Jones-Tabah, J., Bouazza, C. A., Blaney, J., Lau, J., Martins-Cannavino, K., et al. (2023) · Journal of Biological Chemistry · doi:10.1016/j.jbc.2023.103064 · Cited by 8
Nimura, K., & Kaneda, Y. (2015) · Journal of Human Genetics · doi:10.1038/jhg.2015.84 · Cited by 7
Drugging transcription in heart failure
Padmanabhan, A., & Haldar, S. M. (2019) · The Journal of Physiology · doi:10.1113/jp276745 · Cited by 8
“…cardiac tissue from this study revealed that BET inhibition suppressed the activation of specific cardiac gene expression programmes that enrich for targets of nuclear factor of activated T cells (NFAT), nuclear factor-κB (NFκB) and GATA binding protein 4 (GATA4) signalling (Anand et al. 2013).”
BackgroundMethodResultInfluentialSelf-citationRubin, S. J. S., & Qvit, N. (2020) · Current Topics in Medicinal Chemistry · doi:10.2174/1568026620666201021141401 · Cited by 8
Ferro, A., Segreti, A., Crispino, S. P., Cricco, R., Cristo, A. D., Ciancio, M., Gurrieri, F., Ussia, G. P., & Grigioni, F. (2025) · Genes · doi:10.3390/genes16070801 · Cited by 8
“Additionally, BET inhibitors such as JQ1 are being explored as promising treatments for HF [46].”
Effect of BRD4 Inhibitor on Cognitive Deficit and c-Fos /BDNF level in rats with Alzheimer's disease
Faraji, N., Badrikoohi, M., & Babaei, P. (2023) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-023-01342-7 · Cited by 7
“Furthermore, distinct alteration in the proteins level of c-Fos/BDNF after BRD4 inhibition in the various physiological and pathophysiological situations indicate that transcriptional effects of BET inhibitors are not only highly specific to the organism status being examined [8], and characteristic of treatment (acut…”
BackgroundResearch Progress of Selective Small Molecule Bromodomain-Containing Protein 9 Inhibitors
Ma, H., Zhang, J., Zheng, P., Zhenwei, W., & Huibin, Z. (2018) · Future Medicinal Chemistry · doi:10.4155/fmc-2017-0243 · Cited by 7
Zhang, Y., & Erb, M. A. (2021) · Current Research in Chemical Biology · doi:10.1016/j.crchbi.2021.100011 · Cited by 7
Histone Modifications in Cardiovascular Disease: Mechanisms and Therapeutic Opportunities
Zheng, Y., Gao, Y., Guo, M., Wang, L., Zheng, X., Liao, Y., Li, Y., Zhu, J.-P., & Wei, J. (2026) · MedComm · doi:10.1002/mco2.70765 · Cited by 7
Soifer, M., Mousa, H. M., Levy, R. B., & Perez, V. L. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.656998 · Cited by 6
Transcriptional plasticity of fibroblasts in heart disease
Micheletti, R., & Alexanian, M. (2022) · Biochemical Society Transactions · doi:10.1042/bst20210864 · Cited by 7
Gargano, D., Segatto, M., & Bartolomeo, S. D. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24065665 · Cited by 9
Wang, H., Wang, X., Xu, L., & Cao, H. (2020) · BMC Cardiovascular Disorders · doi:10.1186/s12872-020-01527-9 · Cited by 7
Furlan, A., Agbazahou, F., Henry, M., Pisfil, M. G., Nézet, C. L., Champelovier, D., Fournier, M., Vandenbunder, B., Bidaux, G., & Héliot, L. (2018) · médecine/sciences · doi:10.1051/medsci/20183408015 · Cited by 6
Unraveling the Role of Bromodomain and Extra-Terminal Proteins in Human Uterine Leiomyosarcoma
Yang, Q., Falahati, A., Khosh, A., Lastra, R. R., Boyer, T., & Al-Hendy, A. A. (2024) · Cells · doi:10.3390/cells13171443 · Cited by 6
“In addition, BET inhibitors also provide multiple beneficial effects on anti-inflammation [47], heart failure [62], spermatogenesis [63], and chemoresistance [64,65].”
BackgroundTargeting Viperin prevents coxsackievirus B3-induced acute heart failure
Yuan, Y., Qian, L., Miao, Y., Cui, Q., Cao, T., Yu, Y., Zhang, T., Zhao, Q., Zhang, R., Ren, T., et al. (2025) · Cell Discovery · doi:10.1038/s41421-025-00778-0 · Cited by 5
“SERCA2a, BET bromodomain protein, and mitochondrial DNA regulate transverse aortic constriction (TAC)-induced HF 11 – 13 .”
Self-citationRoth, R., Häckh, M., Schnick, T., Rommel, C., Koentges, C., Bugger, H., Domisch, C., Bristow, M. R., Ambardekar, A. V., McKinsey, T. A., et al. (2025) · Epigenetics · doi:10.1080/15592294.2025.2506625 · Cited by 5
“For the heart, in particular the role of the bromodomain protein BRD4 has been well studied [29–32].”
Roles of Bromodomain Extra Terminal Proteins in Metabolic Signaling and Diseases
Wu, D., & Duan, Q. (2022) · Pharmaceuticals · doi:10.3390/ph15081032 · Cited by 5
“found that BETs function as pause-release factors critical to the expression of pathological hypertrophic genes, and that inhibition of these BETs suppresses cardiomyocyte hypertrophy in vitro and pathological cardiac remodeling in vivo [30].”
BackgroundThe Bromodomain as the Acetyl-Lysine Binding Domain in Gene Transcription
Smith, S. G., & Zhou, M. (2015) · Springer eBooks · doi:10.1007/978-3-319-18102-8_1 · Cited by 4
“2013), and the BET family has recently been shown to play a role in the pathogenesis of heart failure (Anand et al. 2013).”
Background
Metadata
- Authors
- Anand, P., Brown, J. D., Lin, C. Y., Qi, J., Zhang, R., Artero, P. C., Alaiti, M. A., Bullard, J., Alazem, K., Margulies, K. B., Cappola, T. P., Lemieux, M., Plutzky, J., Bradner, J. E., & Haldar, S. M.
- Affiliations
- University Hospitals of Cleveland (US)
- Brigham and Women's Hospital (US)
- Dana-Farber Cancer Institute (US)
- University of Pennsylvania (US)
- Harvard University (US)
- Corresponding author
- Bradner, James E.
- Haldar, Saptarsi M.
- ORCID
- Venue
- Cell
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 154
- Issue
- 3
- Pages
- 569-582
- ISSN
- 0092-8674 (ISSN-L)
- PMC
- PMC4090947
- OpenAlex
- W2154924534
- Cited by
- 406
- References
- 63
- Citations by year
- 2026: 21 · 2025: 26 · 2024: 18 · 2023: 25 · 2022: 25 · 2021: 36 · 2020: 49 · 2019: 33 · 2018: 28 · 2017: 29 · 2016: 36 · 2015: 42 · 2014: 30 · 2013: 6
- FWCI
- 17.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Cell (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Wellcome Trust
- National Heart, Lung, and Blood Institute (T32HL105338, K08HL105678, K08HL086614, R01HL105993, P01HL048743)
- National Cancer Institute (K08CA128972)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK093821)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Degradation and Inhibitors
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Genomics and Chromatin Dynamics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Keywords
- heart failure, BET proteins, chromatin acetylation, histone acetyltransferase, cardiac remodeling, cardiomyocyte hypertrophy, epigenetic reader protein, BET inhibition, gene expression regulation, chemical genetics
- MeSH terms
- Animals, Chromatin, Disease Models, Animal, Heart, Cardiomegaly, Heart Failure, Humans, Mice, Inbred C57BL, Transcription Factors, Transcription, Genetic, Protein Structure, Tertiary, Myocytes, Cardiac, Epigenesis, Genetic, Mice, Rats, Transcriptome
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