S100A8/S100A9 Links Diabetic Stress to Cardiac Progenitor Cell Dysfunction and Fibrotic Heart Failure: An Integrated Transcriptomic, Single-Cell, and Functional Study.

BACKGROUND

Diabetes markedly increases the risk of heart failure, yet the molecular signals connecting metabolic stress, myocardial fibrosis, and impaired cardiac repair remain incompletely understood.

METHODS

We integrated bulk transcriptomic data from postischemic hearts (GSE26887), fibrosis-related genes from the CTD database, protein-protein interaction (PPI) analysis, and pathway enrichment (GO, KEGG, GSEA, and GSVA) to identify candidate mediators in diabetic versus nondiabetic heart failure. Single-cell RNA-sequencing datasets were analyzed with Seurat to map the cellular distribution of key genes. Pan-cancer analyses using TCGA cohorts were performed to evaluate prognostic, immune, and tumor mutation burden (TMB) correlations. Mechanistic validation was conducted in human cardiac progenitor cells (CPCs) exposed to normoglycemia or high glucose with S100A9 knockdown or overexpression, recombinant S100A8/A9, and a neutralizing S100A9 antibody. Cell viability (CCK-8); qPCR panels for fibrosis, inflammation, and metabolic genes; ROS production (DCF-DA and MitoSOX); and mitochondrial respiration were quantified.

RESULTS

Differential expression and PPI network analyses identified S100A8 as a fibrosis-related hub specifically enriched in diabetic heart failure. Single-cell mapping revealed predominant S100A8 expression in CPCs rather than mature cardiomyocytes. Pathway analyses linked S100A8 to collagen fibril organization, ECM-receptor interaction, oxidative phosphorylation, and fatty acid β-oxidation. Functionally, high glucose upregulated S100A8/S100A9 and profibrotic and proinflammatory genes in CPCs, increased total and mitochondrial ROS, and reduced basal, ATP-linked, and maximal respiration and spare capacity. S100A9 knockdown partially restored CPC proliferation, redox balance, and mitochondrial function, whereas S100A9 overexpression or recombinant S100A8/A9 further exacerbated oxidative stress and bioenergetic failure; S100A9 neutralization attenuated these effects. Pan-cancer analyses showed that high S100A8 expression was associated with adverse prognosis, altered immune infiltration, and increased TMB in several TCGA cohorts.

CONCLUSIONS

S100A8/S100A9 emerges as a central mediator linking hyperglycemia-induced oxidative stress, metabolic inflexibility, and fibrotic reprogramming of CPCs, thereby promoting diabetic heart failure. S100A8/S100A9 may serve as a biomarker and therapeutic target at the interface of immunometabolism, cardiac regeneration, and cardio-oncology.