High-throughput sequencing of RNA provides an unprecedented opportunity to examine the pervasive transcription of the mammalian genome [
1]. While RNA-seq studies performed in the context of heart failure have demonstrated a wide variety of protein and non-protein coding transcripts that are up- and down-regulated in the diseased myocardium [
21,
22], transcripts arising from DNA repetitive elements in the cardiac genome have yet to be highlighted. Historically, repetitive DNA sequences have been refractory to many experimental approaches, particularly array-based ones that are dependent on hybridization. This problem is circumvented by MeDIP-seq because high-throughput sequencing provides excellent coverage for all major repeats [
8]. High-throughput sequencing may have other intrinsic disadvantages, such as GC-dependent differential amplification of sequences, but our work involving the comparison between healthy and diseased tissue means that such shortcomings apply equally to both sets of tissue. Hence, this emphasizes the significance of our finding of DMReps in SAT elements in EsCM heart. Our analysis also hints at Alu element hypermethylation in EsCM heart but the more compelling results with SAT DMReps convinced us to focus our study on SAT repetitive elements.
SAT repetitive elements are mainly centromeric or juxtacentromeric. Centromeres are marked by a distinct set of histone variants and organized into blocks of nucleosomes. Clear evidence shows that the specification and propagation of centromeres are not defined by the underlying DNA sequence but rather by epigenetic mechanisms such as the histone variants and, possibly, DNA methylation[
23,
24]. Methylation changes or changes in histone modifications at these repetitive elements may hence predispose to increased transcription of the underlying SAT elements. Our findings of increased SAT transcript expression correlating with SAT hypomethylation in EsCM heart indeed correspond to our previous report of hypermethylation of the
DUX4 subtelomeric tandem repeat and downregulation of the
DUX4 transcript [
10].
Overexpression of centromeric SAT transcripts in diseased hearts is reminiscent of centromeric-derived transcript upregulation in the conditional gene-targeted knockout of Dicer in embryonic stem cells [
25]. There, Dicer deficiency also generates defects in methylation of centromeric DNA and overexpression of SAT repeats. SAT repeats are transcribed into non-coding RNAs that are implicated in fundamental processes, including gene silencing and maintenance of chromosomal integrity [
26]. Like other non-coding RNA, the role of SAT transcripts seems likely to depend upon RNA-protein complexes. SAT transcripts assemble nucleoproteins at the centromere by directly binding to core centromeric proteins [
27]. A direct interaction between splicing factors and SAT transcripts also recruits splicing factors to nuclear stress bodies during conditions of cellular stress [
28]. Up to 100-fold upregulation of juxtacentromeric SAT transcripts has been reported in cancer, and whether SAT deregulation actively drives genomic instability in cancer or is merely a consequence of it remains to be shown [
26]. In our study, the use of human tissue also limits us from concluding whether SAT transcripts contribute to progression of heart failure. It is also unclear at this time whether only a specific cell type of the heart is responsible for repeat element expression. Similarly, other confounding factors that are characteristic of studies like ours also exist, including medications that patients were on, the presence of other disease co-morbidities or other disease risk factors. Despite all these limitations, it is very striking to find that SAT transcripts alone, and not other repeat elements, are very highly upregulated in diseased hearts. Whatever their origin, their possible role in disease progression now warrants urgent investigation. As in cancer, SAT expression may highlight a potential link between genomic damage and heart failure disease progression. In end-stage diseased hearts, we have certainly observed significant and widespread DNA damage [
29] that is out of proportion to the diminishingly low levels of myocyte cell death usually detected in end-stage failing hearts [
30]. Furthermore, juxtacentromeric hypomethylation and SAT transcript abundance may indeed be related to the observation of polyploidy in diseased human myocytes [
31].