L-type Ca2+ channel blockers promote vascular remodeling through activation of STIM proteins

Martin T. Johnson, Aparna Gudlur, Xuexin Zhang, Ping Xin, Scott M. Emrich, Ryan E. Yoast, Raphael Courjaret, Robert M. Nwokonko, Wei Li, Nadine Hempel, Khaled Machaca, Donald L. Gill, Patrick G. Hogan, Mohamed Trebak

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Voltage-gated L-type Ca2+ channel (Cav1.2) blockers (LCCBs) are major drugs for treating hypertension, the preeminent risk factor for heart failure. Vascular smooth muscle cell (VSMC) remodeling is a pathological hallmark of chronic hypertension. VSMC remodeling is characterized by molecular rewiring of the cellular Ca2+ signaling machinery, including down-regulation of Cav1.2 channels and up-regulation of the endoplasmic reticulum (ER) stromal-interacting molecule (STIM) Ca2+ sensor proteins and the plasma membrane ORAI Ca2+ channels. STIM/ORAI proteins mediate store-operated Ca2+ entry (SOCE) and drive fibro-proliferative gene programs during cardiovascular remodeling. SOCE is activated by agonists that induce depletion of ER Ca2+, causing STIM to activate ORAI. Here, we show that the three major classes of LCCBs activate STIM/ORAI-mediated Ca2+ entry in VSMCs. LCCBs act on the STIM N terminus to cause STIM relocalization to junctions and subsequent ORAI activation in a Cav1.2-independent and store depletion-independent manner. LCCB-induced promotion of VSMC remodeling requires STIM1, which is up-regulated in VSMCs from hypertensive rats. Epidemiology showed that LCCBs are more associated with heart failure than other antihypertensive drugs in patients. Our findings unravel a mechanism of LCCBs action on Ca2+ signaling and demonstrate that LCCBs promote vascular remodeling through STIM-mediated activation of ORAI. Our data indicate caution against the use of LCCBs in elderly patients or patients with advanced hypertension and/or onset of cardiovascular remodeling, where levels of STIM and ORAI are elevated.

Original languageEnglish (US)
Pages (from-to)17369-17380
Number of pages12
JournalProceedings of the National Academy of Sciences of the United States of America
Issue number29
StatePublished - Jul 21 2020

All Science Journal Classification (ASJC) codes

  • General


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