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Circulation. 2019 Jun 11;139(24):2778-2792. doi: 10.1161/CIRCULATIONAHA.118.036769. Epub 2019 Mar 29.

Inhibition of the Hypoxia-Inducible Factor 1α-Induced Cardiospecific HERNA1 Enhance-Templated RNA Protects From Heart Disease.

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Institute of Molecular Health Sciences, ETH Zurich, Switzerland (P.M., G.R., N.F., S.T., W.K.).
Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Dresden, Germany (P.M., E.H.).
MRC Clinical Sciences Centre, Imperial College London, United Kingdom (C.B., S.K., J.K.).
Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe-University Frankfurt, Germany (C.B., M.-D.P., R.S., P.G., S.D., J.K.).
Department of Internal Medicine III: Cardiology and Angiology, University of Kiel, Germany (S.S.).
Klinik für Kardiologie und Pneumologie, Georg-August-Universität Goettingen and DZHK (German Centre for Cardiovascular Research) (S.S.).
Cardiovascular Assessment Facility, University of Lausanne and CHUV, Switzerland (C.B., A.S.).
Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, and Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Germany (S.N.S.).
Department of Medicine, University of Lausanne Medical School, Switzerland (T.P.).



Enhancers are genomic regulatory elements conferring spatiotemporal and signal-dependent control of gene expression. Recent evidence suggests that enhancers can generate noncoding enhancer RNAs, but their (patho)biological functions remain largely elusive.


We performed chromatin immunoprecipitation-coupled sequencing of histone marks combined with RNA sequencing of left ventricular biopsies from experimental and genetic mouse models of human cardiac hypertrophy to identify transcripts revealing enhancer localization, conservation with the human genome, and hypoxia-inducible factor 1α dependence. The most promising candidate, hypoxia-inducible enhancer RNA ( HERNA)1, was further examined by investigating its capacity to modulate neighboring coding gene expression by binding to their gene promoters by using chromatin isolation by RNA purification and λN-BoxB tethering-based reporter assays. The role of HERNA1 and its neighboring genes for pathological stress-induced growth and contractile dysfunction, and the therapeutic potential of HERNA1 inhibition was studied in gapmer-mediated loss-of-function studies in vitro using human induced pluripotent stem cell-derived cardiomyocytes and various in vivo models of human pathological cardiac hypertrophy.


HERNA1 is robustly induced on pathological stress. Production of HERNA1 is initiated by direct hypoxia-inducible factor 1α binding to a hypoxia-response element in the histoneH3-lysine27acetylation marks-enriched promoter of the enhancer and confers hypoxia responsiveness to nearby genes including synaptotagmin XVII, a member of the family of membrane-trafficking and Ca2+-sensing proteins and SMG1, encoding a phosphatidylinositol 3-kinase-related kinase. Consequently, a substrate of SMG1, ATP-dependent RNA helicase upframeshift 1, is hyperphoshorylated in a HERNA1- and SMG1-dependent manner. In vitro and in vivo inactivation of SMG1 and SYT17 revealed overlapping and distinct roles in modulating cardiac hypertrophy. Finally, in vivo administration of antisense oligonucleotides targeting HERNA1 protected mice from stress-induced pathological hypertrophy. The inhibition of HERNA1 postdisease development reversed left ventricular growth and dysfunction, resulting in increased overall survival.


HERNA1 is a novel heart-specific noncoding RNA with key regulatory functions in modulating the growth, metabolic, and contractile gene program in disease, and reveals a molecular target amenable to therapeutic exploitation.


RNA; heart failure; hypoxia

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