Vascular smooth muscle cells (VSMCs), the major cell type in the arterial vessel wall, have a contractile phenotype that maintains the normal vessel structure and function under physiological conditions. In response to stress or vascular injury, contractile VSMCs can switch to a less differentiated state (synthetic phenotype) to acquire the proliferative, migratory, and synthetic capabilities for tissue reparation. Imbalances in VSMCs phenotypic switching can result in a variety of cardiovascular diseases, including atherosclerosis, in-stent restenosis, aortic aneurysms, and vascular calcification. It is very important to identify the molecular mechanisms regulating VSMCs phenotypic switching to prevent and treat cardiovascular diseases with high morbidity and mortality. However, the key molecular mechanisms and signaling pathways participating in VSMCs phenotypic switching have still not been fully elucidated despite long-term efforts by cardiovascular researchers. In this review, we provide an updated summary of the recent studies and systematic knowledge of VSMCs phenotypic switching in atherosclerosis, in-stent restenosis, aortic aneurysms, and vascular calcification, which may help guide future research and provide novel insights into the prevention and treatment of related diseases.

N6-methyladenosine (m6A) is the most common and abundant internal co-transcriptional modification in eukaryotic RNAs. This modification is catalyzed by m6A methyltransferases, known as “writers”, including METTL3/14 and WTAP, and removed by demethylases, or “erasers”, such as FTO and ALKBH5. It is recognized by m6A-binding proteins, or “readers”, such as YTHDF1/2/3, YTHDC1/2, IGF2BP1/2/3, and HNRNPA2B1. Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide. Recent studies indicate that m6A RNA modification plays a critical role in both the physiological and pathological processes involved in the initiation and progression of CVDs. In this review, we will explore how m6A RNA methylation impacts both the normal and disease states of the cardiovascular system. Our focus will be on recent advancements in understanding the biological functions, molecular mechanisms, and regulatory factors of m6A RNA methylation, along with its downstream target genes in various CVDs, such as atherosclerosis, ischemic diseases, metabolic disorders, and heart failure. We propose that the m6A RNA methylation pathway holds promise as a potential therapeutic target in cardiovascular disease.

Pathological cardiac remodeling is a significant contributor to heart failure and mortality. Studies have demonstrated that extracellular signal regulated kinase 3 (ERK3) in cardiac fibroblasts aggravates pressure overload-evoked pathological cardiac remodeling via mitogen activated protein kinase-activated protein kinase-5 (MK5). However, myocardial ERK3 does not activate MK5, thus the role of myocardial ERK3 remains unclear. Through in vivo and in vitro experiments, we revealed that myocardial ERK3 expression increases under pressure overload and the protein accumulates significantly in the nucleus. Using cardiomyocyte-specific Erk3 -deficient mice, neonatal rat cardiomyocytes and adult mouse cardiomyocytes, we found that cardiomyocyte-specific Erk3 deficiency ameliorated pressure overload-induced pathological cardiac remodeling in vivo. Co-immunoprecipitation, mass spectrometry, and single nucleus RNA sequencing were used to analyse for the nuclear translocation and downstream signaling mechanisms of ERK3. Specifically, pressure overload enhances the binding of Aly/REF export factor (ALY) to ERK3, resulting in the truncation of the ERK3 C-terminal and its subsequent nuclear translocation to activate the thioredoxin-interacting protein (TXNIP)/NOD-like receptor thermal protein domain associated protein 3 (NLRP3) pathway through the expression of the splicing factor proline and glutamine rich (SFPQ). To screen for targeted drugs, we conducted a virtual screening and identified estrone sulfate as an inhibitor of ALY to counteract hypertrophic effects. Collectively, our findings indicate that estrone sulfate functions as a novel inhibitor of the ALY-ERK3 signaling pathway, potentially serving as a promising therapeutic candidate for the management of pathological cardiac remodeling.

N6-methyladenosine (m6A) is the most common and abundant internal co-transcriptional modification in eukaryotic RNAs. This modification is catalyzed by m6A methyltransferases, known as "writers," including METTL3/14 and WTAP, and removed by demethylases, or "erasers," such as FTO and ALKBH5. It is recognized by m6A-binding proteins, or "readers," such as YTHDF1/2/3, YTHDC1/2, IGF2BP1/2/3, and HNRNPA2B1. Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide. Recent studies indicate that m6A RNA modification plays a critical role in both the physiological and pathological processes involved in the initiation and progression of CVDs. In this review, we will explore how m6A RNA methylation impacts both normal and disease states of the cardiovascular system. Our focus will be on recent advancements in understanding the biological functions, molecular mechanisms, and regulatory factors of m6A RNA methylation, along with its downstream target genes in various CVDs, such as atherosclerosis, ischemic diseases, metabolic disorders, and heart failure. We propose that the m6A RNA methylation pathway holds promise as a potential therapeutic target in cardiovascular disease.