Additionally, in a myocardial hypertrophy model induced by endothelin-1 (ET-1), TGR5 activation significantly suppressed the increase in cardiomyocyte surface area and total protein, as well as the expression of hypertrophic markers such as atrial natriuretic peptide (ANF) and β-myosin heavy chain (β-MHC) (Chi et al., 2024; Jen et al., 2017; Wang et al., 2024). This evidence concerns the gene NPPA and cardiac hypertrophy.