On the mechanisms underlying diastolic voltage oscillations in the sinoatrial node

Stress-Induced Proteasome Sub-Cellular Translocation in Cardiomyocytes Causes Altered Intracellular Calcium Handling and Arrhythmias

The ubiquitin-proteasome system (UPS) is an essential mechanism responsible for the selective degradation of substrate proteins via their conjugation with ubiquitin. Since cardiomyocytes have very limited self-renewal capacity, as they are prone to protein damage due to constant mechanical and metabolic stress, the UPS has a key role in cardiac physiology and pathophysiology. While altered proteasomal activity contributes to a variety of cardiac pathologies, such as heart failure and ischemia/reperfusion injury (IRI), the environmental cues affecting its activity are still unknown, and they are the focus of this work. Following a recent study by Ciechanover's group showing that amino acid (AA) starvation in cultured cancer cell lines modulates proteasome intracellular localization and activity, we tested two hypotheses in human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs, CMs): (i) AA starvation causes proteasome translocation in CMs, similarly to the observation in cultured cancer cell lines; (ii) manipulation of subcellular proteasomal compartmentalization is associated with electrophysiological abnormalities in the form of arrhythmias, mediated via altered intracellular Ca2+ handling. The major findings are: (i) starving CMs to AAs results in proteasome translocation from the nucleus to the cytoplasm, while supplementation with the aromatic amino acids tyrosine (Y), tryptophan (W) and phenylalanine (F) (YWF) inhibits the proteasome recruitment; (ii) AA-deficient treatments cause arrhythmias; (iii) the arrhythmias observed upon nuclear proteasome sequestration(-AA+YWF) are blocked by KB-R7943, an inhibitor of the reverse mode of the sodium-calcium exchanger NCX; (iv) the retrograde perfusion of isolated rat hearts with AA starvation media is associated with arrhythmias. Collectively, our novel findings describe a newly identified mechanism linking the UPS to arrhythmia generation in CMs and whole hearts.

Synergy between Membrane Currents Prevents Severe Bradycardia in Mouse Sinoatrial Node Tissue

Bradycardia is initiated by the sinoatrial node (SAN), which is regulated by a coupled-clock system. Due to the clock coupling, reduction in the 'funny' current (I_f), which affects SAN automaticity, can be compensated, thus preventing severe bradycardia. We hypothesize that this fail-safe system is an inherent feature of SAN pacemaker cells and is driven by synergy between I_f and other ion channels. This work aimed to characterize the connection between membrane currents and their underlying mechanisms in SAN cells. SAN tissues were isolated from C57BL mice and Ca²⁺ signaling was measured in pacemaker cells within them. A computational model of SAN cells was used to understand the interactions between cell components. Beat interval (BI) was prolonged by 54 ± 18% (N = 16) and 30 ± 9% (N = 21) in response to I_f blockade, by ivabradine, or sodium current (I_Na) blockade, by tetrodotoxin, respectively. Combined drug application had a synergistic effect, manifested by a BI prolonged by 143 ± 25% (N = 18). A prolongation in the local Ca²⁺ release period, which reports on the level of crosstalk within the coupled-clock system, was measured and correlated with the prolongation in BI. The computational model predicted that I_Na increases in response to I_f blockade and that this connection is mediated by changes in T and L-type Ca²⁺ channels.

Patient Specific Induced Pluripotent Stem Cell-Derived Cardiomyocytes for Drug Development and Screening In Catecholaminergic Polymorphic Ventricular Tachycardia

Catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited arrhythmia often leading to sudden cardiac death in children and young adults, is characterized by polymorphic/bidirectional ventricular tachycardia induced by adrenergic stimulation associated with emotionally stress or physical exercise. There are two forms of CPVT: 1. CPVT1 is caused by mutations in the RYR2 gene, encoding for ryanodine receptor type 2. CPVT1 is the most common form of CPVT in the population, and is inherited by a dominant mechanism. 2. CPVT2 is caused by mutations in the CASQ2 gene, encoding for cardiac calsequestrin 2 and is inherited by recessive mechanism. Patient-specific induced Pluripotent Stem Cells (iPSC) have the ability to differentiate into cardiomyocytes carrying the patient's genome including CPVT-linked mutations and expressing the disease phenotype in vitro at the cellular level. The potency for in vitro modeling using iPSC-derived cardiomyocytes (iPSC-CMs) has been exploited to investigate a variety of inherited diseases including cardiac arrhythmias such as CPVT. In this review we attempted to cover the majority of CPVT patient specific iPSC research studies previously published. CPVT patient-specific iPSC model enables the in vitro investigation of the molecular and cellular disease-mechanisms by the means of electrophysiologycal and Ca⁺² imaging methodologies. Furthermore, this in vitro model allows the screening of various antiarrhythmic drugs, specifically for each patient, also known as "personalized medicine".

Modeling Catecholaminergic Polymorphic Ventricular Tachycardia using Induced Pluripotent Stem Cell-derived Cardiomyocytes

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmogenic cardiac disorder characterized by life-threatening arrhythmias induced by physical or emotional stress, in the absence structural heart abnormalities. The arrhythmias may cause syncope or degenerate into cardiac arrest and sudden death which usually occurs during childhood. Recent studies have shown that CPVT is caused by mutations in the cardiac ryanodine receptor type 2 (RyR2) or calsequestrin 2 (CASQ2) genes. Both proteins are key contributors to the intracellular Ca(2+) handling process and play a pivotal role in Ca(2+) release from the sarcoplasmic reticulum to the cytosol during systole. Although the molecular pathogenesis of CPVT is not entirely clear, it was suggested that the CPVT mutations promote excessive sarcoplasmic reticulum Ca(2+) leak, which initiates delayed afterdepolarizations (DADs) and triggered arrhythmias in cardiac myocytes. The recent breakthrough discovery of induced pluripotent stem cells (iPSC) generated from somatic cells (e.g. fibroblasts, keratinocytes) now enables researches to investigate mutated cardiomyocytes generated from the patient's iPSC. To this end, in the present article we review recent studies on CPVT iPSC-derived cardiomyocytes, thus demonstrating in the mutated cells catecholamine-induced DADs and triggered arrhythmias.

Cardiomyocytes generated from CPVTD307H patients are arrhythmogenic in response to β-adrenergic stimulation

Sudden cardiac death caused by ventricular arrhythmias is a disastrous event, especially when it occurs in young individuals. Among the five major arrhythmogenic disorders occurring in the absence of a structural heart disease is catecholaminergic polymorphic ventricular tachycardia (CPVT), which is a highly lethal form of inherited arrhythmias. Our study focuses on the autosomal recessive form of the disease caused by the missense mutation D307H in the cardiac calsequestrin gene, CASQ2. Because CASQ2 is a key player in excitation contraction coupling, the derangements in intracellular Ca²⁺ handling may cause delayed afterdepolarizations (DADs), which constitute the mechanism underlying CPVT. To investigate catecholamine-induced arrhythmias in the CASQ2 mutated cells, we generated for the first time CPVT-derived induced pluripotent stem cells (iPSCs) by reprogramming fibroblasts from skin biopsies of two patients, and demonstrated that the iPSCs carry the CASQ2 mutation. Next, iPSCs were differentiated to cardiomyocytes (iPSCs-CMs), which expressed the mutant CASQ2 protein. The major findings were that the β-adrenergic agonist isoproterenol caused in CPVT iPSCs-CMs (but not in the control cardiomyocytes) DADs, oscillatory arrhythmic prepotentials, after-contractions and diastolic [Ca²⁺]_i rise. Electron microscopy analysis revealed that compared with control iPSCs-CMs, CPVT iPSCs-CMs displayed a more immature phenotype with less organized myofibrils, enlarged sarcoplasmic reticulum cisternae and reduced number of caveolae. In summary, our results demonstrate that the patient-specific mutated cardiomyocytes can be used to study the electrophysiological mechanisms underlying CPVT.

Novel oscillatory mechanisms in the cholinergic control of Guinea pig sino-atrial node discharge

Oscillatory Mechanisms in Sinus Node Cholinergic Control. 

INTRODUCTION

The role of the oscillatory after-potential V(os) and pre-potential ThV(os) in cholinergic control of discharge was studied in sino-atrial node (SAN).

METHODS AND RESULTS

A microelectrode technique was used in isolated guinea-pig SAN superfused in vitro in high [K(+) ](o) to visualize V(os) and ThV(os) . The cholinergic agonist carbachol (CCh) decreased the amplitude and slope of V(os) and ThV(os) at a time when there was no increase in maximum diastolic potential. The slowing in SAN rate was due to slower and smaller ThV(os) that missed intermittently the threshold and occurred gradually later in diastole, but not to a decrease in the intrinsic rate of ThV(os) . Eventually, quiescence followed. Larger CCh concentrations quickly induced a hyperpolarization that altogether prevented the occurrence of oscillatory potentials. During CCh washout, ThV(os) reappeared and consistently reinitiated discharge. Lower [Ca(2+) ](o) also decreased slopes and amplitude of V(os) and ThV(os) , thereby slowing and stopping SAN discharge, as CCh did. Overdrive temporarily offset the negative chronotropic effects of CCh and of low [Ca(2+) ](o.) Cesium (a blocker of hyperpolarization-activated current I(f) ) did not abolish CCh inhibitory effects on oscillatory potentials.

CONCLUSIONS

The cholinergic agonist CCh: (1) slows SAN discharge by decreasing the amplitude of V(os) and ThV(os) , but not the rate of ThV(os) ; (2) can cause hyperpolarization that altogether suppresses the oscillatory potentials; (3) is mimicked in its effects by low [Ca(2+) ](o) ; (4) is antagonized by procedures that increase cellular calcium; and (5) modifies the oscillatory potentials independently of I(f) .

Essential role of diastolic oscillatory potentials in adrenergic control of guinea pig sino-atrial node discharge

Background

The diastolic oscillatory after-potential V_os and pre-potential ThV_os play an essential role in the pacemaker mechanism of sino-atrial node (SAN). The aim of this study was to investigate whether these oscillatory potentials are also involved in adrenergic control of SAN discharge.

Methods

V_os and ThV_os were visualized by superfusing guinea pig SAN in high [K⁺]_o. The actions of adrenergic agonists on oscillatory potentials were studied by means of a microelectrode technique. Statistical significance was determined by means of Student's paired t-test.

Results

In non-spontaneous SAN, norepinephrine (NE) decreased the resting potential into a voltage range ("oscillatory zone") where increasingly larger ThV_os appeared and initiated spontaneous discharge. In slowly discharging SAN, NE gradually increased the rate by increasing the amplitude and slope of earlier-occurring ThV_os and of V_os until these oscillations fused with initial diastolic depolarization (DD₁). In the presence of NE, sudden fast rhythms were initiated by large V_os that entered a more negative oscillatory zone and initiated a large ThV_os. Recovery from NE exposure involved the converse changes. The β-adrenergic agonist isoproterenol had similar actions. Increasing calcium load by decreasing high [K⁺]_o, by fast drive or by recovery in Tyrode solution led to growth of V_os and ThV_os which abruptly fused when a fast sudden rhythm was induced. Low [Ca²⁺]_o antagonized the adrenergic actions. Cesium (a blocker of I_f) induced spontaneous discharge in quiescent SAN through ThV_os. In spontaneous SAN, Cs⁺increased V_os and ThV_os, thereby increasing the rate. Cs⁺ did not hinder the positive chronotropic action of NE. Barium increased the rate, as Cs⁺ did.

Conclusion

Adrenergic agonists: (i) initiate SAN discharge by decreasing the resting potential and inducing ThV_os; (ii) gradually accelerate SAN rate by predominantly increasing size and slope of earlier and more negative ThV_os; (iii) can induce sudden fast rhythms through the abrupt fusion of large V_os with large ThV_os; (iv) increase V_os and ThV_osby increasing cellular calcium; and (v) do not modify the oscillatory potentials by means of the hyperpolarization-activated current I_f. The results provide evidence for novel mechanisms by which the SAN dominant pacemaker activity is initiated and enhanced by adrenergic agonists.

The vicissitudes of the pacemaker current I Kdd of cardiac purkinje fibers

The mechanisms underlying the pacemaker current in cardiac tissues is not agreed upon. The pacemaker potential in Purkinje fibers has been attributed to the decay of the potassium current I (Kdd). An alternative proposal is that the hyperpolarization-activated current I (f) underlies the pacemaker potential in all cardiac pacemakers. The aim of this review is to retrace the experimental development related to the pacemaker mechanism in Purkinje fibers with reference to findings about the pacemaker mechanism in the SAN as warranted. Experimental data and their interpretation are critically reviewed. Major findings were attributed to K(+) depletion in narrow extracellular spaces which would result in a time dependent decay of the inward rectifier current I (K1). In turn, this decay would be responsible for a "fake" reversal of the pacemaker current. In order to avoid such a postulated depletion, Ba(2+) was used to block the decay of I (K1). In the presence of Ba(2+) the time-dependent current no longer reversed and instead increased with time and more so at potentials as negative as -120 mV. In this regard, the distinct possibility needs to be considered that Ba(2+) had blocked I (Kdd) (and not only I (K1)). That indeed this was the case was demonstrated by studying single Purkinje cells in the absence and in the presence of Ba(2+). In the absence of Ba(2+), I (Kdd) was present in the pacemaker potential range and reversed at E (K). In the presence of Ba(2+), I (Kdd) was blocked and I (f) appeared at potentials negative to the pacemaker range. The pacemaker potential behaves in a manner consistent with the underlying I (Kdd) but not with I (f). The fact that I (f) is activated on hyperpolarization at potential negative to the pacemaker range makes it suitable as a safety factor to prevent the inhibitory action of more negative potentials on pacemaker discharge. It is concluded that the large body of evidence reviewed proves the pacemaker role of I (Kdd) (but not of I (f)) in Purkinje fibers.

Mechanisms underlying overdrive suppression and overdrive excitation in guinea pig sino-atrial node

The hypothesis that the pause that follows overdrive of the sino-atrial node (SAN) might be the net result of overdrive excitation and overdrive suppression was tested by studying rate and force patterns induced by overdrive in isolated guinea pig SAN superfused in vitro. In Tyrode solution, the pause is short and changes but little with longer or faster drives. In high [K(+)](o) solution, longer overdrives increase force percent-wise more than in Tyrode solution, shorten the pause and are followed by greater rate and force. When the SAN (quiescent in high [K(+)](o)) is driven at 6/min, faster overdrives are followed by stronger, slowly decreasing contractions. Alternating 10 s drives with 10 s pauses have little effect on force and rate in Tyrode solution, but progressively increase force and rate in high [K(+)](o). Cesium has effects similar to high [K(+)](o). High [Ca(2+)](o) increases force and in high [K(+)](o) increases the rate as well as it shortens the pause, whereas Ni(2+) decreases force as well as rate and lengthens the pause. Barium dissociates the effects on force and rate. Lidocaine and tetrodotoxin decrease rate and force, and increase the pause duration. In overdrive excitation, the increase in rate is associated with an enhancement of diastolic voltage oscillations. It is concluded that in SAN the prevalence of Ca(2+) load leads to overdrive excitation whereas the prevalence of Na(+) load leads to overdrive suppression. In Tyrode solution, the pause after drive appears to be the net result of these two different mechanisms.