Introduction
Sepsis is defined as a potentially life-threatening condition, which is characterized as an uncontrolled host response to infection [
1,
2]. Notably, the condition called “septic shock” refers to circulatory and cellular abnormalities during sepsis, which are profound enough to greatly increase mortality [
1]. The previous study has recognized that sepsis-induced myocardial depression, also called sepsis-induced heart dysfunction, is a potential and serious complication of sepsis [
3]. It is characterized by impaired myocardial contractility and reduced ejection fraction, which could lead to higher mortality, especially in pediatric patients [
3‐
5]. Since a thorough pathophysiologic understanding of sepsis-induced myocardial depression has not been defined, an imperative for more studies on this issue are required.
Recent studies have indicated that non-coding RNAs including microRNAs and long non-coding RNAs (lncRNAs) are involved in the process of sepsis-induced myocardial depression [
6,
7]. However, little is known regarding transcripts of uncertain coding potential (TUCPs), which are an important component of RNA in cells. TUCPs are recognized as part of the lncRNAs, but are excluded by Pfam scan criteria during the steps for filtering lncRNAs [
8]. Functional studies have suggested that many TUCP transcripts could encode small peptides [
9]. TUCPs were previously annotated as pseudogenes, but could be involved in different functions as non-coding regulatory agents [
10]. However, to the best of our knowledge, no studies have explored the expression patterns and potential functions of TUCPs in sepsis-induced myocardial depression.
We hypothesized that TUCPs might be involved in the pathological process of sepsis-induced myocardial depression. We performed this preliminary work in a preclinical model to identify the potential role of TUCPs in sepsis-induced myocardial depression. Our study aimed to describe the features of TUCPs and determine their potential functions in this condition. This first study on TUCPs in sepsis provides a useful resource for studying TUCPs’ functional roles and obtaining a new perspective toward understanding the pathophysiological process of sepsis-induced myocardial depression.
Discussion
According to clinical epidemiological studies, the estimated incidence of sepsis and the associated in-hospital mortality rate in the US are approximately 5.9% and 15.6%, respectively, making it a major public health problem [
19]. Notably, septic shock, which is a subtype of sepsis with circulatory and cellular/metabolic dysfunction, is still associated with an even higher risk of mortality. Sepsis-induced myocardial depression, as a main complication of septic shock, is one of the most important factors contributing to the high mortality of septic shock. However, the basic pathophysiological mechanisms underlying sepsis-induced myocardial depression remain unclear and should be investigated in further studies.
Studies on gene regulatory networks have focused on protein-coding genes. However, recently, with the development of next-generation high-throughput sequencing, genomic analyses have determined that approximately 90% of non-coding sequences in the human genome are transcribed into non-coding RNAs (ncRNAs), which play key regulatory roles in multiple biological processes [
20]. Previous studies showed that lncRNAs, microRNAs, and even circRNAs play important roles in the regulation of sepsis-induced myocardial depression [
6,
7]. Notably, TUCPs, as part of the lncRNAs, despite previously being annotated as pseudogenes, could be involved in different functions as non-coding regulatory agents. However, it had remained unknown whether the expression pattern of TCUPs in sepsis-induced myocardial depression differs from that in healthy controls. Therefore, to clarify the potential function of TUCPs, we performed this study to identify the basic characteristics and DE TUCPs in sepsis-induced myocardial depression. The results revealed 4,851 TUCPs from both the sepsis group and the control group, based on a total of 12 samples of left ventricular tissue. Through further analyses, we reported 85 TUCPs that were differentially expressed between the sepsis group and the control group, including 38 that were upregulated and 47 that were downregulated in the sepsis group. The differential expression of these TUCPs suggested that they could play critical roles in the pathology of sepsis-induced myocardial depression.
Although we identified 85 TUCPs that were differentially expressed between the sepsis group and the control group, the potential functions of these TUCPs were unclear. Therefore, to clarify these functions, we performed GO term and KEGG pathway enrichment analyses of the TUCPs with their target mRNAs. The aim was to evaluate their potential regulatory roles and provide compelling evidence that TUCPs participate in the pathogenesis of sepsis-induced myocardial depression. Notably, we found that TUCPs could participate in energy production and myocardial contraction in this disease, which are associated with the basic pathophysiological changes of sepsis-induced myocardial depression, highlighting the key roles of TUCPs in this disease. For example, the GO terms “Regulation of the force of heart contraction,” “Regulation of ATPase activity,” and “Cardiac muscle contraction” as well as some specific pathways including “cGMP–PKG signaling pathway,” “Cardiac muscle contraction,” “Calcium signaling pathway,” and “Adrenergic signaling in cardiomyocytes” were enriched based on co-location analyses. Thus, TUCPs can serve as important therapeutic targets for sepsis-induced myocardial depression. Further research is needed to confirm the roles of TUCPs in energy production and myocardial contraction, and to evaluate their value as therapeutic targets.
As for the GO and KEGG analyses based on co-expression, TUCPs were also proved to participate in sepsis-induced myocardial depression. Considering that the metabolism in sepsis differs from that under physiological conditions, clarifying how metabolism is regulated in this disease could provide new insight into its pathogenesis. The GO terms “Regulation of metabolic process,” “Regulation of primary metabolic process,” “Positive regulation of metabolic process,” and “Regulation of cellular metabolic process” were enriched, suggesting that TUCPs could affect the metabolic process in sepsis and play a regulatory role in this disease. Besides, some specific pathways including “TNF signaling pathway,” “NF-kappa B signaling pathway,” “Jak–STAT signaling pathway,” and “Apoptosis” were enriched based on KEGG analyses. Although reported studies [
21‐
24] have stated that these four common pathways play potential roles in sepsis, the regulatory relationship between TUCPs and these pathways is still unclear, and should be analyzed in more depth in future basic studies.
Although our study is the first to illustrate the potential role of TUCPs in sepsis-induced myocardial depression, several limitations should be noticed and need future studies to solve these questions. We only identify potential impact of TUCPs through analysis at RNA expression level and there is no proteomic analysis of protein expression levels to confirm these associated proteins are actually affected. Therefore, in the futhur study, we will choose several specific TUCPs and demonstrate the causal relationship between the TUCPs and their expression of these potential target genes, aiming to confirm the regulatory role of TUCPs in sepsis-induced myocardial depression. Additionally, preclinical findings from rodents have not always borne out in human studies, and we will perform relative studies to confirm the validity of our results in human patients. What’s more, we didn’t explore the possibility of TUCPs to encode peptides. This could be a potential mechanism of action of the TUCPs, and in this case both TUCP and peptide could have their own biological activity in sepsis-induced myocardial depression. The furture research will evaluate the possibility of several specific TUCPs to encode peptides and thus validate their functions in the disease.
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