In the heart, the AT
1R is (mainly) expressed in cardiac fibroblasts, where it stimulates cellular proliferation thus promoting fibrosis, and in cardiac myocytes, where it again stimulates growth thus promoting cardiac hypertrophy [
43]. Whether it can also promote cardiomyocyte contractility however, is still a matter of debate [
43]. Nonetheless, combined with other cellular effects leading to inflammation and oxidative stress development in the heart, cardiac AT
1R effects are clearly maladaptive and damaging for both the structure and function of the cardiac muscle, playing a pivotal role in the so-called adverse remodeling of the post-MI heart progressing to HF [
4,
43]. AT
1R is a classic G
q/11-coupled receptor that can also couple to G
i/o proteins [
4]. With regards to their classical role as G protein-dependent signaling terminators (desensitizers), very little is known about βarrs and AT
1Rs and even less about cardiac βarrs and AT
1Rs. The AT
1R is a known GRK substrate, thus cardiac βarrs are bound to confer its desensitization in the heart secondary to its phosphorylation by GRKs, which has been demonstrated
in vivo [
4]. However, βarr-mediated AT
1R desensitization
per se has never been directly investigated
in vivo. Intriguingly, the AT
1R displays a somewhat peculiar behavior in terms of its desensitization. Not only is it subject to phosphorylation by other kinases (such as PKA and protein kinase C, PKC) in addition to GRKs [
44], but also its phosphorylation is sometimes not even required for desensitization [
45]. Thus, it apparently can desensitize through a plethora of different mechanisms and interactions with various other proteins, and what is more, some of the signaling pathways it elicits display different desensitization kinetics from others, e.g., Ca
2+ transients induced by AT
1Rs readily and rapidly desensitize, whereas ERK activation and Janus kinase/Signal transducer and activator of transcription (JAK/STAT) signaling emanating from this receptor persist for longer periods of time [
46]. Much more has come to light over the past several years about the physiological roles of cardiac βarrs when they mediate G protein-independent signal transduction by the AT
1Rs in the heart. The first such landmark study was conducted in 2005 and showed, remarkably, that an artificially constructed AT
1AR mutant (AT1-i2m), incapable of activating G proteins but able to interact with βarrs, led to significantly less myocardial apoptosis and fibrosis, and enhanced cardiomyocyte hypertrophy, bradycardia, and fetal cardiac gene expression upon its exogenous overexpression in cardiomyocytes of transgenic mice
in vivo, compared to wild type cardiac AT
1R expressed at similar receptor levels (
Bmax values) [
47]. In primary cardiomyocytes, the AT
1R βarr-”biased” agonist AngII peptide analog SII [
48] stimulates cardiomyocyte proliferation independently of G proteins [
49], but not hypertrophy, which requires G
q/11 protein signaling [
50,
51] (
Figure 1). In addition, this βarr agonist peptide produces positive inotropic and lusitropic effects in isolated murine cardiomyocytes through GRK6-mediated phosphorylation of the cardiomyocyte AT
1R and subsequent βarr2 activation [
49] (
Figure 1). Interestingly, GRK2-mediated phosphorylation of the AT
1R in cardiac myocytes leads to activation of the other βarr isoform (βarr1), and cardiac βarr1 seems to oppose these positive effects of βarr2 on AT
1R-elicited contractility and relaxation,
i.e., βarr1-mediated signaling results in negative inotropy and lusitropy upon AT
1R activation in cardiac myocytes [
49] (
Figure 1). These findings are entirely consistent with specialized roles of the various GRK isoforms described in transfected systems [
52], and also with the concept of GRK-induced receptor “barcoding”,
i.e., the phenomenon in which different GRK isoforms acting on the very same GPCR induce subsequent recruitment of different βarr isoforms resulting in different downstream signaling events and cellular responses, presumably by phosphorylating the same receptor at different sites/residues [
53]. In contrast with isolated murine cardiac myocytes however, SII-activated AT
1R (
i.e., AT
1R-bound βarrs) does not seem to produce any inotropic or chronotropic effects in isolated Langendorff-perfused cardiac preparations, despite the fact that ERK1/2, which presumably mediate the positive inotropic effects of βarr2 in isolated cardiac myocytes, are also activated by AT
1R-bound βarrs in Langendorff preparations [
54]. Thus, it seems that these positive inotropic effects of cardiac βarr2 are strongly cell type- and experimental condition-dependent. Nevertheless, a consensus has emerged, according to which cardiomyocyte-residing AT
1Rs promote hypertrophy and cardiomyocyte proliferation via βarrs, as well as contractility via (at least) βarr2, whereas cardiac fibroblast-residing AT
1Rs promote fibrosis and cardiac adverse remodeling via the classical G
q/11 protein-PKC-Ca
2+ signaling pathway (
Figure 1). Since βarr2 also terminates the G protein-mediated signaling of the AT
1R, stimulation of cardiac βarr2 activity and/or blockade of cardiac βarr1 activity at the AT
1Rs of the heart might be sought after for the treatment of post-MI HF and the cardiac hypertrophy and adverse remodeling that accompany this devastating disease. Indeed, a compound analogous to SII,
i.e., a βarr-”biased” AT
1R peptide agonist that selectively activates βarrs while blocking G-protein signaling, TRV120027, has shown very promising results in canine models of acute HF, blocking the undesirable G protein-mediated AT
1R-induced vasoconstriction, thereby preserving renal function, while, at the same time, enhancing the desirable (in acute HF) βarr-dependent contractility of cardiac myocytes [
55], and it is currently under development for the treatment of HF.
Another interesting example of cardiac AT
1R βarr-mediated signaling is that of the mechanical stretch-activated AT
1R. A recent study showed that simple mechanical stretch (in the absence of any ligand) can actually activate the AT
1AR leading to selective βarr recruitment and signaling without concomitant G protein activation [
56]. What is more, the authors went on to show in an
ex vivo murine heart model that this stretch-activated AT
1AR-elicited βarr signaling resulted in enhanced ERK1/2 and Akt kinase (protein kinase B, PKB) activation, as well as EGFR transactivation, effects believed to mediate enhanced cardiomyocyte survival and protection (inhibition of apoptosis) [
56]. In mouse hearts lacking βarrs or AT
1ARs, mechanical stretch failed, of course, to produce these responses and led, instead, to enhanced myocyte apoptosis [
56]. Thus, it appears that the heart is also capable of responding to acute increases in mechanical stress by activating cardiac βarr-mediated cell survival signals, which again argues in favor of a beneficial and therapeutically desirable physiological role for cardiac AT
1R βarr-dependent signaling (at least for the cardiac βarr2 isoform-dependent one).