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Lakin R, Polidovitch N, Yang S, Parikh M, Liu X, Debi R, Gao X, Chen W, Guzman C, Yakobov S, Izaddoustdar F, Wauchop M, Lei Q, Xu W, Nedospasov SA, Christoffels VM, Backx PH. Cardiomyocyte and endothelial cells play distinct roles in the tumour necrosis factor (TNF)-dependent atrial responses and increased atrial fibrillation vulnerability induced by endurance exercise training in mice. Cardiovasc Res 2023; 119:2607-2622. [PMID: 37713664 PMCID: PMC10730243 DOI: 10.1093/cvr/cvad144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 09/17/2023] Open
Abstract
AIMS Endurance exercise is associated with an increased risk of atrial fibrillation (AF). We previously established that adverse atrial remodelling and AF susceptibility induced by intense exercise in mice require the mechanosensitive and pro-inflammatory cytokine tumour necrosis factor (TNF). The cellular and mechanistic basis for these TNF-mediated effects is unknown. METHODS AND RESULTS We studied the impact of Tnf excision, in either atrial cardiomyocytes or endothelial cells (using Cre-recombinase expression controlled by Nppa or Tie2 promoters, respectively), on the cardiac responses to six weeks of intense swim exercise training. TNF ablation, in either cell type, had no impact on the changes in heart rate, autonomic tone, or left ventricular structure and function induced by exercise training. Tnf excision in atrial cardiomyocytes did, however, prevent atrial hypertrophy, fibrosis, and macrophage infiltration as well as conduction slowing and increased AF susceptibility arising from exercise training. In contrast, endothelial-specific excision only reduced the training-induced atrial hypertrophy. Consistent with these cell-specific effects of Tnf excision, inducing TNF loss from atrial cardiomyocytes prevented activation of p38MAPKinase, a strain-dependent downstream mediator of TNF signalling, without affecting the atrial stretch as assessed by atrial pressures induced by exercise. Despite TNF's established role in innate immune responses and inflammation, neither acute nor chronic exercise training caused measurable NLRP3 inflammasome activation. CONCLUSIONS Our findings demonstrate that adverse atrial remodelling and AF vulnerability induced by intense exercise require TNF in atrial cardiomyocytes whereas the impact of endothelial-derived TNF is limited to hypertrophy modulation. The implications of the cell autonomous effects of TNF and crosstalk between cells in the atria are discussed.
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Affiliation(s)
- Robert Lakin
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Nazari Polidovitch
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Sibao Yang
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130022, China
| | - Mihir Parikh
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Xueyan Liu
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130022, China
| | - Ryan Debi
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Xiaodong Gao
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Wenliang Chen
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Camilo Guzman
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Simona Yakobov
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Farzad Izaddoustdar
- Department of Physiology, University of Toronto, Toronto, ON M5S 3E2, Canada
| | - Marianne Wauchop
- Department of Physiology, University of Toronto, Toronto, ON M5S 3E2, Canada
| | - Qian Lei
- Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Weimin Xu
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130022, China
| | - Sergei A Nedospasov
- Laboratory of Molecular Mechanisms of Immunity, Engelhardt Institute of Molecular Biology, Moscow 119991, Russia
- Division of Immunobiology and Biomedicine, Sirius University of Science and Technology, Sirius 354349, Russia
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter H Backx
- Department of Biology, York University, 354 & 357 Farquharson Building, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
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Oh Y, Yang S, Liu X, Jana S, Izaddoustdar F, Gao X, Debi R, Kim DK, Kim KH, Yang P, Kassiri Z, Lakin R, Backx PH. Transcriptomic Bioinformatic Analyses of Atria Uncover Involvement of Pathways Related to Strain and Post-translational Modification of Collagen in Increased Atrial Fibrillation Vulnerability in Intensely Exercised Mice. Front Physiol 2020; 11:605671. [PMID: 33424629 PMCID: PMC7793719 DOI: 10.3389/fphys.2020.605671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023] Open
Abstract
Atrial Fibrillation (AF) is the most common supraventricular tachyarrhythmia that is typically associated with cardiovascular disease (CVD) and poor cardiovascular health. Paradoxically, endurance athletes are also at risk for AF. While it is well-established that persistent AF is associated with atrial fibrosis, hypertrophy and inflammation, intensely exercised mice showed similar adverse atrial changes and increased AF vulnerability, which required tumor necrosis factor (TNF) signaling, even though ventricular structure and function improved. To identify some of the molecular factors underlying the chamber-specific and TNF-dependent atrial changes induced by exercise, we performed transcriptome analyses of hearts from wild-type and TNF-knockout mice following exercise for 2 days, 2 or 6 weeks of exercise. Consistent with the central role of atrial stretch arising from elevated venous pressure in AF promotion, all 3 time points were associated with differential regulation of genes in atria linked to mechanosensing (focal adhesion kinase, integrins and cell-cell communications), extracellular matrix (ECM) and TNF pathways, with TNF appearing to play a permissive, rather than causal, role in gene changes. Importantly, mechanosensing/ECM genes were only enriched, along with tubulin- and hypertrophy-related genes after 2 days of exercise while being downregulated at 2 and 6 weeks, suggesting that early reactive strain-dependent remodeling with exercise yields to compensatory adjustments. Moreover, at the later time points, there was also downregulation of both collagen genes and genes involved in collagen turnover, a pattern mirroring aging-related fibrosis. By comparison, twofold fewer genes were differentially regulated in ventricles vs. atria, independently of TNF. Our findings reveal that exercise promotes TNF-dependent atrial transcriptome remodeling of ECM/mechanosensing pathways, consistent with increased preload and atrial stretch seen with exercise. We propose that similar preload-dependent mechanisms are responsible for atrial changes and AF in both CVD patients and athletes.
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Affiliation(s)
- Yena Oh
- Department of Biology, York University, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sibao Yang
- Department of Biology, York University, Toronto, ON, Canada.,Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xueyan Liu
- Department of Biology, York University, Toronto, ON, Canada.,Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Sayantan Jana
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, AB, Canada
| | | | - Xiaodong Gao
- Department of Biology, York University, Toronto, ON, Canada
| | - Ryan Debi
- Department of Biology, York University, Toronto, ON, Canada
| | - Dae-Kyum Kim
- Donnelly Centre, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Kyoung-Han Kim
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ping Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zamaneh Kassiri
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, AB, Canada
| | - Robert Lakin
- Department of Biology, York University, Toronto, ON, Canada
| | - Peter H Backx
- Department of Biology, York University, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
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Lakin R, Polidovitch N, Yang S, Guzman C, Gao X, Wauchop M, Burns J, Izaddoustdar F, Backx PH. Inhibition of soluble TNFα prevents adverse atrial remodeling and atrial arrhythmia susceptibility induced in mice by endurance exercise. J Mol Cell Cardiol 2019; 129:165-173. [DOI: 10.1016/j.yjmcc.2019.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/17/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
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Lee E, Choi EK, Han KD, Lee H, Choe WS, Lee SR, Cha MJ, Lim WH, Kim YJ, Oh S. Mortality and causes of death in patients with atrial fibrillation: A nationwide population-based study. PLoS One 2018; 13:e0209687. [PMID: 30586468 PMCID: PMC6306259 DOI: 10.1371/journal.pone.0209687] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/10/2018] [Indexed: 01/12/2023] Open
Abstract
Background Patients with atrial fibrillation are known to have a high risk of mortality. There is a paucity of population-based studies about the impact of atrial fibrillation on the mortality risk stratified by age, sex, and detailed causes of death. Methods A total of 15,411 patients with atrial fibrillation from the Korean National Health Insurance Service-National Sample Cohort were enrolled, and causes of death were identified according to codes of the 10th revision of the International Classification of Diseases. Results From 2002 to 2013, a total of 4,479 (29%) deaths were confirmed, and the crude mortality rate for all-cause death was 63.3 per 1,000 patient-years. Patients with atrial fibrillation had a 3.7-fold increased risk of all-cause death compared with the general population. The standardized mortality ratio for all-cause death was the highest in young patients and decreased with increasing age (standardized mortality ratio 21.93, 95% confidence interval 7.60–26.26 in patients aged <20 years; standardized mortality ratio 2.77, 95% confidence interval 2.63–2.91 in patients aged ≥80 years). Women with atrial fibrillation exhibited a greater excess mortality risk than men (standardized mortality ratio 3.81, 95% confidence interval 3.65–3.98 in women; standardized mortality ratio 3.35, 95% confidence interval 3.21–3.48 in men). Cardiovascular disease was the leading cause of death (38.5%), and cerebral infarction was the most common specific disease. Patients with atrial fibrillation had an about 5 times increased risk of death due to cardiovascular disease compared with the general population. Conclusions Patients with atrial fibrillation had a 4 times increased risk of mortality compared with the general population. However, the impact of atrial fibrillation on mortality decreased with age and in men. Cerebral infarction was the most common cause of death, and more attention should be paid to reducing the risk of stroke.
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Affiliation(s)
- Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - HyunJung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won-Seok Choe
- Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, SoonChunHyang University Hospital Seoul, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Sarcevic Z, Tepavcevic A. Competitive Endurance Activities of Middle-aged Athletes as a Risk Factor for Atrial Fibrillation. Curr Sports Med Rep 2018; 17:391-395. [PMID: 30407947 DOI: 10.1249/jsr.0000000000000535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in athletes. Epidemiological studies have documented a greater prevalence of AF in athletes engaged in long-term endurance sports. Several mechanisms were proposed to underlie the association between exercise and AF, but the exact pathophysiology remains unclear. The studies up to now have been concentrated on the competitive middle-aged endurance athletes, but there is no evidence of AF prevalence among highly active noncompetitive athletes of the same age. Endurance athletes who do not compete might be at a lower risk for AF than their competitive peers. This hypothesis is theoretically examined, and the current evidence summarized in this article.
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Affiliation(s)
- Zoran Sarcevic
- Novi Sad Health Care Centre, Sports Medicine Centre, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Serbia
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Morseth B, Løchen ML, Ariansen I, Myrstad M, Thelle DS. The ambiguity of physical activity, exercise and atrial fibrillation. Eur J Prev Cardiol 2018; 25:624-636. [DOI: 10.1177/2047487318754930] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although commonly associated with cardiovascular disease or other medical conditions, atrial fibrillation may also occur in individuals without any known underlying conditions. This manifestation of atrial fibrillation has been linked to extensive and long-term exercise, as prolonged endurance exercise has shown to increase prevalence and risk of atrial fibrillation. In contrast, more modest physical activity is associated with a decreased risk of atrial fibrillation, and current research indicates a J-shaped association between atrial fibrillation and the broad range of physical activity and exercise. This has led to the hypothesis that the mechanisms underlying an increased risk of atrial fibrillation with intensive exercise are different from those underlying a reduced risk with moderate physical activity, possibly linked to distinctive characteristics of the population under study. High volumes of exercise over many years performed by lean, healthy endurance trained athletes may lead to cardiac (patho)physiological alterations involving the autonomic nervous system and remodelling of the heart. The mechanisms underlying a reduced risk of atrial fibrillation with light and moderate physical activity may involve a distinctive pathway, as physical activity can potentially reduce the risk of atrial fibrillation through favourable effects on cardiovascular risk factors.
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Affiliation(s)
- Bente Morseth
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Clinical Research and Education, University Hospital of North Norway Trust, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Ariansen
- Physical and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Marius Myrstad
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Norway
| | - Dag S Thelle
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Norway
- Department of Community Medicine and Public Health, Institute of Medicine, Gothenburg University, Sweden
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