The plasma membrane of leading pacemaker cells in the rabbit sinus node. A qualitative and quantitative ultrastructural analysis

Adherens junction engagement regulates functional patterning of the cardiac pacemaker cell lineage

Cardiac pacemaker cells (CPCs) rhythmically initiate the electrical impulses that drive heart contraction. CPCs display the highest rate of spontaneous depolarization in the heart despite being subjected to inhibitory electrochemical conditions that should theoretically suppress their activity. While several models have been proposed to explain this apparent paradox, the actual molecular mechanisms that allow CPCs to overcome electrogenic barriers to their function remain poorly understood. Here, we have traced CPC development at single-cell resolution and uncovered a series of cytoarchitectural patterning events that are critical for proper pacemaking. Specifically, our data reveal that CPCs dynamically modulate adherens junction (AJ) engagement to control characteristics including surface area, volume, and gap junctional coupling. This allows CPCs to adopt a structural configuration that supports their overall excitability. Thus, our data have identified a direct role for local cellular mechanics in patterning critical morphological features that are necessary for CPC electrical activity.

Cellular and Molecular Mechanisms of Functional Hierarchy of Pacemaker Clusters in the Sinoatrial Node: New Insights into Sick Sinus Syndrome

The sinoatrial node (SAN), the primary pacemaker of the heart, consists of a heterogeneous population of specialized cardiac myocytes that can spontaneously produce action potentials, generating the rhythm of the heart and coordinating heart contractions. Spontaneous beating can be observed from very early embryonic stage and under a series of genetic programing, the complex heterogeneous SAN cells are formed with specific biomarker proteins and generate robust automaticity. The SAN is capable to adjust its pacemaking rate in response to environmental and autonomic changes to regulate the heart's performance and maintain physiological needs of the body. Importantly, the origin of the action potential in the SAN is not static, but rather dynamically changes according to the prevailing conditions. Changes in the heart rate are associated with a shift of the leading pacemaker location within the SAN and accompanied by alterations in P wave morphology and PQ interval on ECG. Pacemaker shift occurs in response to different interventions: neurohormonal modulation, cardiac glycosides, pharmacological agents, mechanical stretch, a change in temperature, and a change in extracellular electrolyte concentrations. It was linked with the presence of distinct anatomically and functionally defined intranodal pacemaker clusters that are responsible for the generation of the heart rhythm at different rates. Recent studies indicate that on the cellular level, different pacemaker clusters rely on a complex interplay between the calcium (referred to local subsarcolemmal Ca²⁺ releases generated by the sarcoplasmic reticulum via ryanodine receptors) and voltage (referred to sarcolemmal electrogenic proteins) components of so-called "coupled clock pacemaker system" that is used to describe a complex mechanism of SAN pacemaking. In this review, we examine the structural, functional, and molecular evidence for hierarchical pacemaker clustering within the SAN. We also demonstrate the unique molecular signatures of intranodal pacemaker clusters, highlighting their importance for physiological rhythm regulation as well as their role in the development of SAN dysfunction, also known as sick sinus syndrome.

Cardiac Pacemaker Activity and Aging

A progressive decline in maximum heart rate (mHR) is a fundamental aspect of aging in humans and other mammals. This decrease in mHR is independent of gender, fitness, and lifestyle, affecting in equal measure women and men, athletes and couch potatoes, spinach eaters and fast food enthusiasts. Importantly, the decline in mHR is the major determinant of the age-dependent decline in aerobic capacity that ultimately limits functional independence for many older individuals. The gradual reduction in mHR with age reflects a slowing of the intrinsic pacemaker activity of the sinoatrial node of the heart, which results from electrical remodeling of individual pacemaker cells along with structural remodeling and a blunted β-adrenergic response. In this review, we summarize current evidence about the tissue, cellular, and molecular mechanisms that underlie the reduction in pacemaker activity with age and highlight key areas for future work.

Ultrastructure of primary pacemaking cells in rabbit sino-atrial node cells indicates limited sarcoplasmic reticulum content

The main mammalian heart pacemakers are spindle-shaped cells compressed into tangles within protective layers of collagen in the sino-atrial node (SAN). Two cell types, "dark" and "light," differ on their high or low content of intermediate filaments, but share scarcity of myofibrils and a high content of glycogen. Sarcoplasmic reticulum (SR) is scarce. The free SR (fSR) occupies 0.04% of the cell volume within ~0.4 µm wide peripheral band. The junctional SR (jSR), constituting peripheral couplings (PCs), occupies 0.03% of the cell volume. Total fSR + jSR volume is 0.07% of cell volume, lower than the SR content of ventricular myocytes. The average distance between PCs is 7.6 µm along the periphery. On the average, 30% of the SAN cells surfaces is in close proximity to others. Identifiable gap junctions are extremely rare, but small sites of close membrane-to-membrane contacts are observed. Possibly communication occurs via these very small sites of contact if conducting channels (connexons) are located within them. There is no obvious anatomical detail that might support ephaptic coupling. These observations have implications for understanding of SAN cell physiology, and require incorporation into biophysically detailed models of SAN cell behavior that currently do not include such features.

Transcriptome analysis of mouse and human sinoatrial node cells reveals a conserved genetic program

The rate of contraction of the heart relies on proper development and function of the sinoatrial node, which consists of a small heterogeneous cell population, including Tbx3⁺ pacemaker cells. Here, we have isolated and characterized the Tbx3⁺ cells from Tbx3 ^+/Venus knock-in mice. We studied electrophysiological parameters during development and found that Venus-labeled cells are genuine Tbx3⁺ pacemaker cells. We analyzed the transcriptomes of late fetal FACS-purified Tbx3⁺ sinoatrial nodal cells and Nppb-Katushka⁺ atrial and ventricular chamber cardiomyocytes, and identified a sinoatrial node-enriched gene program, including key nodal transcription factors, BMP signaling and Smoc2, the disruption of which in mice did not affect heart rhythm. We also obtained the transcriptomes of the sinoatrial node region, including pacemaker and other cell types, and right atrium of human fetuses, and found a gene program including TBX3, SHOX2, ISL1 and HOX family members, and BMP and NOTCH signaling components conserved between human and mouse. We conclude that a conserved gene program characterizes the sinoatrial node region and that the Tbx3 ^+/Venus allele provides a reliable tool for visualizing the sinoatrial node, and studying its development and function.

Analysis of heterogeneous cardiac pacemaker tissue models and traveling wave dynamics

The sinoatrial-node (SAN) is a complex heterogeneous tissue that generates a stable rhythm in healthy hearts, yet a general mechanistic explanation for when and how this tissue remains stable is lacking. Although computational and theoretical analyses could elucidate these phenomena, such methods have rarely been used in realistic (large-dimensional) gap-junction coupled heterogeneous pacemaker tissue models. In this study, we adapt a recent model of pacemaker cells (Severi et al., 2012), incorporating biophysical representations of ion channel and intracellular calcium dynamics, to capture physiological features of a heterogeneous population of pacemaker cells, in particular "center" and "peripheral" cells with distinct intrinsic frequencies and action potential morphology. Large-scale simulations of the SAN tissue, represented by a heterogeneous tissue structure of pacemaker cells, exhibit a rich repertoire of behaviors, including complete synchrony, traveling waves of activity originating from periphery to center, and transient traveling waves originating from the center. We use phase reduction methods that do not require fully simulating the large-scale model to capture these observations. Moreover, the phase reduced models accurately predict key properties of the tissue electrical dynamics, including wave frequencies when synchronization occurs, and wave propagation direction in a variety of tissue models. With the reduced phase models, we analyze the relationship between cell distributions and coupling strengths and the resulting transient dynamics. Further, the reduced phase model predicts parameter regimes of irregular electrical dynamics. Thus, we demonstrate that phase reduced oscillator models applied to realistic pacemaker tissue is a useful tool for investigating the spatial-temporal dynamics of cardiac pacemaker activity.

Contribution of small conductance K+ channels to sinoatrial node pacemaker activity: insights from atrial-specific Na+ /Ca2+ exchange knockout mice

KEY POINTS

Repolarizing currents through K⁺ channels are essential for proper sinoatrial node (SAN) pacemaking, but the influence of intracellular Ca²⁺ on repolarization in the SAN is uncertain. We identified all three isoforms of Ca²⁺ -activated small conductance K⁺ (SK) channels in the murine SAN. SK channel blockade slows repolarization and subsequent depolarization of SAN cells. In the atrial-specific Na⁺ /Ca²⁺ exchanger (NCX) knockout mouse, cellular Ca²⁺ accumulation during spontaneous SAN pacemaker activity produces intermittent hyperactivation of SK channels, leading to arrhythmic pauses alternating with bursts of pacing. These findings suggest that Ca²⁺ -sensitive SK channels can translate changes in cellular Ca²⁺ into a repolarizing current capable of modulating pacemaking. SK channels are a potential pharmacological target for modulating SAN rate or treating SAN dysfunction, particularly under conditions characterized by abnormal increases in diastolic Ca²⁺ .

ABSTRACT

Small conductance K⁺ (SK) channels have been implicated as modulators of spontaneous depolarization and electrical conduction that may be involved in cardiac arrhythmia. However, neither their presence nor their contribution to sinoatrial node (SAN) pacemaker activity has been investigated. Using quantitative PCR (q-PCR), immunostaining and patch clamp recordings of membrane current and voltage, we identified all three SK isoforms (SK1, SK2 and SK3) in mouse SAN. Inhibition of SK channels with the specific blocker apamin prolonged action potentials (APs) in isolated SAN cells. Apamin also slowed diastolic depolarization and reduced pacemaker rate in isolated SAN cells and intact tissue. We investigated whether the Ca²⁺ -sensitive nature of SK channels could explain arrhythmic SAN pacemaker activity in the atrial-specific Na⁺ /Ca²⁺ exchange (NCX) knockout (KO) mouse, a model of cellular Ca²⁺ overload. SAN cells isolated from the NCX KO exhibited higher SK current than wildtype (WT) and apamin prolonged their APs. SK blockade partially suppressed the arrhythmic burst pacing pattern of intact NCX KO SAN tissue. We conclude that SK channels have demonstrable effects on SAN pacemaking in the mouse. Their Ca²⁺ -dependent activation translates changes in cellular Ca²⁺ into a repolarizing current capable of modulating regular pacemaking. This Ca²⁺ dependence also promotes abnormal automaticity when these channels are hyperactivated by elevated Ca²⁺ . We propose SK channels as a potential target for modulating SAN rate, and for treating patients affected by SAN dysfunction, particularly in the setting of Ca²⁺ overload.

L-type Cav1.3 channels regulate ryanodine receptor-dependent Ca2+ release during sino-atrial node pacemaker activity

AIMS

Sino-atrial node (SAN) automaticity is an essential mechanism of heart rate generation that is still not completely understood. Recent studies highlighted the importance of intracellular Ca(2+) ([Ca(2+)]i) dynamics during SAN pacemaker activity. Nevertheless, the functional role of voltage-dependent L-type Ca(2+) channels in controlling SAN [Ca(2+)]i release is largely unexplored. Since Cav1.3 is the predominant L-type Ca(2+) channel isoform in SAN cells, we studied [Ca(2+)]i dynamics in isolated cells and ex vivo SAN preparations explanted from wild-type (WT) and Cav1.3 knockout (KO) mice (Cav1.3(-/-)).

METHODS AND RESULTS

We found that Cav1.3 deficiency strongly impaired [Ca(2+)]i dynamics, reducing the frequency of local [Ca(2+)]i release events and preventing their synchronization. This impairment inhibited the generation of Ca(2+) transients and delayed spontaneous activity. We also used action potentials recorded in WT SAN cells as voltage-clamp commands for Cav1.3(-/-) cells. Although these experiments showed abolished Ca(2+) entry through L-type Ca(2+) channels in the diastolic depolarization range of KO SAN cells, their sarcoplasmic reticulum Ca(2+) load remained normal. β-Adrenergic stimulation enhanced pacemaking of both genotypes, though, Cav1.3(-/-) SAN cells remained slower than WT. Conversely, we rescued pacemaker activity in Cav1.3(-/-) SAN cells and intact tissues through caffeine-mediated stimulation of Ca(2+)-induced Ca(2+) release.

CONCLUSIONS

Cav1.3 channels play a critical role in the regulation of [Ca(2+)]i dynamics, providing an unanticipated mechanism for triggering local [Ca(2+)]i releases and thereby controlling pacemaker activity. Our study also provides an additional pathophysiological mechanism for congenital SAN dysfunction and heart block linked to Cav1.3 loss of function in humans.

Ca(2+) cycling properties are conserved despite bradycardic effects of heart failure in sinoatrial node cells

BACKGROUND

In animal models of heart failure (HF), heart rate decreases due to an increase in intrinsic cycle length (CL) of the sinoatrial node (SAN). Pacemaker activity of SAN cells is complex and modulated by the membrane clock, i.e., the ensemble of voltage gated ion channels and electrogenic pumps and exchangers, and the Ca(2+) clock, i.e., the ensemble of intracellular Ca(2+) ([Ca(2+)]i) dependent processes. HF in SAN cells results in remodeling of the membrane clock, but few studies have examined its effects on [Ca(2+)]i homeostasis.

METHODS

SAN cells were isolated from control rabbits and rabbits with volume and pressure overload-induced HF. [Ca(2+)]i concentrations, and action potentials (APs) and Na(+)-Ca(2+) exchange current (INCX) were measured using indo-1 and patch-clamp methodology, respectively.

RESULTS

The frequency of spontaneous [Ca(2+)]i transients was significantly lower in HF SAN cells (3.0 ± 0.1 (n = 40) vs. 3.4 ± 0.1 Hz (n = 45); mean ± SEM), indicating that intrinsic CL was prolonged. HF slowed the [Ca(2+)]i transient decay, which could be explained by the slower frequency and reduced sarcoplasmic reticulum (SR) dependent rate of Ca(2+) uptake. Other [Ca(2+)]i transient parameters, SR Ca(2+) content, INCX density, and INCX-[Ca(2+)]i relationship were all unaffected by HF. Combined AP and [Ca(2+)]i recordings demonstrated that the slower [Ca(2+)]i transient decay in HF SAN cells may result in increased INCX during the diastolic depolarization, but that this effect is likely counteracted by the HF-induced increase in intracellular Na(+). β-adrenergic and muscarinic stimulation were not changed in HF SAN cells, except that late diastolic [Ca(2+)]i rise, a prominent feature of the Ca(2+) clock, is lower during β-adrenergic stimulation.

CONCLUSIONS

HF SAN cells have a slower [Ca(2+)]i transient decay with limited effects on pacemaker activity. Reduced late diastolic [Ca(2+)]i rise during β-adrenergic stimulation may contribute to an impaired increase in intrinsic frequency in HF SAN cells.

Qualitative support for the gradient model of cardiac pacemaker heterogeneity

In this study, we investigate the role of sinoatrial node (SAN) cellular heterogeneity in normal cardiac pacemaker function. Using detailed ionic models of electrical activity in SAN and atrial myocytes, we have formulated a number of models of SAN heterogeneity based on discrete-region (in which central and peripheral SAN type cell are separated into discrete regions), gradient and mosaic models of SAN organisation. Simulations of each of the different models were performed in one and two dimensions in the presence of both uniform and linearly increasing conductivity profiles. Simulation results suggest that the gradient model, in which cells display a smooth variation in membrane properties from the center to the periphery of the SAN, best reproduces action potential waveshapes and a site of earliest activation consistent with experimental observations in the intact SAN. We therefore propose that the gradient model of SAN heterogeneity represents the most plausible model of SAN organisation.

Autophagy is constitutively active in normal mouse sino-atrial nodal cells

This study was designed to examine the autophagy in sino-atrial (SA) nodal cells from the normal adult mouse heart. Autophagy is the cellular process responsible for the degradation and recycling of long-lived and/or damaged cytoplasmic components by lysosomal digestion. In the heart, autophagy is known to occur at a low level under physiological conditions, but to become upregulated when cells are exposed to certain stresses, such as ischemia. We examined whether the basal level of autophagy in SA nodal cells was different from that in ventricular or atrial myocytes. An ultrastructural analysis revealed that the SA nodal cells contained a number of autophagic vacuoles (autophagosomes) with various stages of degradation by lysosomal digestion, whereas the number of those in ventricular or atrial myocytes was either negligible or very small. The immunostaining of autophagosome marker microtubule-associated protein 1 light chain 3 (LC3) and lysosome marker lysosome-associated membrane protein 1 (LAMP1) indicated that the content of both autophagosomes and lysosomes were much greater in SA nodal cells than in ordinary cardiomyocytes. Our results provide evidence that the autophagy is active in normal SA nodal cells, which is not a stress-activated process but a constitutive event in the mouse heart.

Determinants of heterogeneity, excitation and conduction in the sinoatrial node: a model study

The sinoatrial node (SAN) is a complex structure that exhibits anatomical and functional heterogeneity which may depend on: 1) The existence of distinct cell populations, 2) electrotonic influences of the surrounding atrium, 3) the presence of a high density of fibroblasts, and 4) atrial cells intermingled within the SAN. Our goal was to utilize a computer model to predict critical determinants and modulators of excitation and conduction in the SAN. We built a theoretical “non-uniform” model composed of distinct central and peripheral SAN cells and a “uniform” model containing only central cells connected to the atrium. We tested the effects of coupling strength between SAN cells in the models, as well as the effects of fibroblasts and interspersed atrial cells. Although we could simulate single cell experimental data supporting the “multiple cell type” hypothesis, 2D “non-uniform” models did not simulate expected tissue behavior, such as central pacemaking. When we considered the atrial effects alone in a simple homogeneous “uniform” model, central pacemaking initiation and impulse propagation in simulations were consistent with experiments. Introduction of fibroblasts in our simulated tissue resulted in various effects depending on the density, distribution, and fibroblast-myocyte coupling strength. Incorporation of atrial cells in our simulated SAN tissue had little effect on SAN electrophysiology. Our tissue model simulations suggest atrial electrotonic effects as plausible to account for SAN heterogeneity, sequence, and rate of propagation. Fibroblasts can act as obstacles, current sinks or shunts to conduction in the SAN depending on their orientation, density, and coupling.

It is well known that a small structure in the atrium called the sinoatrial node (SAN) is the pacemaker for the heart. However, the complexity and heterogeneity intrinsic to this structure has made it difficult to determine some aspects of sinoatrial node function. Here we use a computational approach, based on experimental data, to tease out the individual contributions of cellular and tissue heterogeneities and the effect of fibroblasts and atrial cells on sinoatrial node function. The computational models suggest that the complex features of the intact sinoatrial node can be reconstructed with a relatively simple model. Our simulations also predict that the presence of non-cardiac cells in the node likely contribute to its function.

Effects of muscarinic receptor stimulation on Ca2+ transient, cAMP production and pacemaker frequency of rabbit sinoatrial node cells

We investigated the contribution of the intracellular calcium (Ca_i²⁺) transient to acetylcholine (ACh)-mediated reduction of pacemaker frequency and cAMP content in rabbit sinoatrial nodal (SAN) cells. Action potentials (whole cell perforated patch clamp) and Ca_i²⁺ transients (Indo-1 fluorescence) were recorded from single isolated rabbit SAN cells, whereas intracellular cAMP content was measured in SAN cell suspensions using a cAMP assay (LANCE^®). Our data show that the Ca_i²⁺ transient, like the hyperpolarization-activated “funny current” (I_f) and the ACh-sensitive potassium current (I_K,ACh), is an important determinant of ACh-mediated pacemaker slowing. When I_f and I_K,ACh were both inhibited, by cesium (2 mM) and tertiapin (100 nM), respectively, 1 μM ACh was still able to reduce pacemaker frequency by 72%. In these I_f and I_K,ACh-inhibited SAN cells, good correlations were found between the ACh-mediated change in interbeat interval and the ACh-mediated change in Ca_i²⁺ transient decay (r² = 0.98) and slow diastolic Ca_i²⁺ rise (r² = 0.73). Inhibition of the Ca_i²⁺ transient by ryanodine (3 μM) or BAPTA-AM (5 μM) facilitated ACh-mediated pacemaker slowing. Furthermore, ACh depressed the Ca_i²⁺ transient and reduced the sarcoplasmic reticulum (SR) Ca²⁺ content, all in a concentration-dependent fashion. At 1 μM ACh, the spontaneous activity and Ca_i²⁺ transient were abolished, but completely recovered when cAMP production was stimulated by forskolin (10 μM) and I_K,ACh was inhibited by tertiapin (100 nM). Also, inhibition of the Ca_i²⁺ transient by ryanodine (3 μM) or BAPTA-AM (25 μM) exaggerated the ACh-mediated inhibition of cAMP content, indicating that Ca_i²⁺ affects cAMP production in SAN cells. In conclusion, muscarinic receptor stimulation inhibits the Ca_i²⁺ transient via a cAMP-dependent signaling pathway. Inhibition of the Ca_i²⁺ transient contributes to pacemaker slowing and inhibits Ca_i²⁺-stimulated cAMP production. Thus, we provide functional evidence for the contribution of the Ca_i²⁺ transient to ACh-induced inhibition of pacemaker activity and cAMP content in rabbit SAN cells.

In situ co-distribution and functional interactions of SAP97 with sinoatrial isoforms of HCN channels

The sinoatrial node is a region of specialized cardiomyocytes that is responsible for the repetitive activity of the adult heart. The sinoatrial node is heavily innervated compared to the other regions of the heart, and the specialized cardiomyocytes of this region receive neural and hormonal input from the autonomic nervous system, which leads to changes in heart rate. A key regulator of sinoatrial beating frequency in response to autonomic input is the hyperpolarization-activated cyclic nucleotide gated (HCN) channel, a mixed cationic channel whose activity is increased by the binding of cAMP to its cytoplasmic side. HCN channels localize to distinct regions or "hot spots" on the cell surface of sinoatrial myocytes, but how these regions are formed, whether they correspond to specific signaling domains and the specific HCN isoforms and other proteins therein are not known. In this paper, we show that both HCN2 and HCN4 isoforms co-distribute with the adapter protein SAP97, an important component of distinct punctae in the sinoatrial node of the rabbit heart. HCN4, but not HCN2, also co-distributes with the post-synaptic marker beta-catenin, thus identifying diverse organized domains within this tissue. Furthermore, we show, using heterologous expression systems, whole-cell patch clamp electrophysiology and imaging, that SAP97 interacts functionally with HCN in a manner that depends upon the PDZ compatible binding motif of the C-terminus, but that its effects on I(f) behaviour are HCN isoform and context dependent. Together, the data suggest that SAP97 contributes to isoform specific organization of HCN channels within specific domains in the sinoatrial node of the rabbit.

Ca(2+) -stimulated basal adenylyl cyclase activity localization in membrane lipid microdomains of cardiac sinoatrial nodal pacemaker cells

Spontaneous, rhythmic subsarcolemmal local Ca(2+) releases driven by cAMP-mediated, protein kinase A (PKA)-dependent phosphorylation are crucial for normal pacemaker function of sinoatrial nodal cells (SANC). Because local Ca(2+) releases occur beneath the cell surface membrane, near to where adenylyl cyclases (ACs) reside, we hypothesized that the dual Ca(2+) and cAMP/PKA regulatory components of automaticity are coupled via Ca(2+) activation of AC activity within membrane microdomains. Here we show by quantitative reverse transcriptase PCR that SANC express Ca(2+)-activated AC isoforms 1 and 8, in addition to AC type 2, 5, and 6 transcripts. Immunolabeling of cell fractions, isolated by sucrose gradient ultracentrifugation, confirmed that ACs localize to membrane lipid microdomains. AC activity within these lipid microdomains is activated by Ca(2+) over the entire physiological Ca(2+) range. In intact SANC, the high basal AC activity produces a high level of cAMP that is further elevated by phosphodiesterase inhibition. cAMP and cAMP-mediated PKA-dependent activation of ion channels and Ca(2+) cycling proteins drive sarcoplasmic reticulum Ca(2+) releases, which, in turn, activate ACs. This feed forward "fail safe" system, kept in check by a high basal phosphodiesterase activity, is central to the generation of normal rhythmic, spontaneous action potentials by pacemaker cells.

A comparison of 1-D models of cardiac pacemaker heterogeneity

In this paper, we investigate the role of sinoatrial node (SAN) cellular heterogeneity in two key aspects of normal cardiac pacemaker function: frequency entrainment of the SAN, and propagation of excitation into the atrial tissue. Using detailed ionic models of electrical activity in SAN and atrial myocytes, we have formulated a number of one-dimensional models of SAN heterogeneity based on discrete-region (in which central and peripheral SAN type cell are separated into discrete regions), gradient and mosaic models of SAN organization. Each of the different models were assessed on their ability to achieve frequency entrainment of the SAN and activation of the adjoining atrial tissue in the presence of both uniform and linearly increasing conductivity profiles. Simulation results suggest that the gradient model of SAN heterogeneity, in which cells display a smooth variation in membrane properties from the center to the periphery of the SAN, produces action potential waveshapes and a site of earliest activation consistent with experimental observations in the intact SAN. The gradient model also achieves frequency entrainment of the SAN more easily than other models of SAN heterogeneity. Based on these results, we conclude that the gradient model of SAN heterogeneity, in the presence of a uniform conductivity profile, is the most likely model of SAN organization.

Evidence of specialized conduction cells in human pulmonary veins of patients with atrial fibrillation

Specialized Conducting Cells in Human PV.

INTRODUCTION

Depolarizations similar to those from the sinus node have been documented from the pulmonary veins after isolation procedures. We assessed the hypothesis that sinus node-like tissue is present in the pulmonary veins of humans.

METHODS AND RESULTS

Pulmonary vein tissue was obtained from five autopsies (four individuals with a history of atrial fibrillation and one without a history of atrial arrhythmias) and five transplant heart donors. Autopsy veins were fixed in formaldehyde and processed for light microscopy to identify areas having possible conductive-like tissue. Areas requiring additional study were extracted from paraffin blocks and reprocessed for electron microscopy. Donor specimens were fixed in formaldehyde for histologic sections and glutaraldehyde for electron microscopy. Myocardial cells with pale cytoplasm were identified by light microscopy in 4 of the 5 autopsy subjects. Electron microscopy confirmed the presence of P cells, transitional cells, and Purkinje cells in the pulmonary veins of these cases.

CONCLUSION

Our report is the first to show the presence of P cells, transitional cells, and Purkinje cells in human pulmonary veins. Whether these cells are relevant in the genesis of atrial fibrillation requires further study.

Phase transition to frequency entrainment in a long chain of pulse-coupled oscillators

A long chain of pulse-coupled oscillators was studied. The oscillators interacted via a phase response curve similar to those obtained from pacemaker cells in the heart. The natural frequencies were random numbers from a distribution with finite bandwidth. Stable frequency-entrained states were shown always to exist above a critical coupling strength. Below the critical coupling, the probability to have such states was shown to be zero if the number of oscillators is infinite. This discontinuity establishes the existence of a phase transition in the thermodynamic limit. For weak coupling, clusters of frequency-entrained oscillators emerged. The cluster sizes were exponentially distributed, even when the critical coupling was approached. At this coupling, the mean cluster size diverged to infinity according to a power law. The standard deviation of the distribution of mean frequencies in the chain converged to zero, also according to a power law.

Gap junctions in the rabbit sinoatrial node

In comparison to the cellular basis of pacemaking, the electrical interactions mediating synchronization and conduction in the sinoatrial node are poorly understood. Therefore, we have taken a combined immunohistochemical and electrophysiological approach to characterize gap junctions in the nodal area. We report that the pacemaker myocytes in the center of the rabbit sinoatrial node express the gap junction proteins connexin (Cx)40 and Cx46. In the periphery of the node, strands of pacemaker myocytes expressing Cx43 intermingle with strands expressing Cx40 and Cx46. Biophysical properties of gap junctions in isolated pairs of pacemaker myocytes were recorded under dual voltage clamp with the use of the perforated-patch method. Macroscopic junctional conductance ranged between 0.6 and 25 nS with a mean value of 7.5 nS. The junctional conductance did not show a pronounced sensitivity to the transjunctional potential difference. Single-channel recordings from pairs of pacemaker myocytes revealed populations of single-channel conductances at 133, 202, and 241 pS. With these single-channel conductances, the observed average macroscopic junctional conductance, 7.5 nS, would require only 30-60 open gap junction channels.

Connexins and impulse propagation in the mouse heart

Gap junction channels are essential for normal cardiac impulse propagation. Three gap junction proteins, known as connexins, are expressed in the heart: Cx40, Cx43, and Cx45. Each of these proteins forms channels with unique biophysical and electrophysiologic properties, as well as spatial distribution of expression throughout the heart. However, the specific functional role of the individual connexins in normal and abnormal propagation is unknown. The availability of genetically engineered mouse models, together with new developments in optical mapping technology, makes it possible to integrate knowledge about molecular mechanisms of intercellular communication and its regulation with our growing understanding of the microscopic and global dynamics of electrical impulse propagation during normal and abnormal cardiac rhythms. This article reviews knowledge on the mechanisms of cardiac impulse propagation, with particular focus on the role of cardiac connexins in electrical communication between cells. It summarizes results of recent studies on the electrophysiologic consequences of defects in the functional expression of specific gap junction channels in mice lacking either the Cx43 or Cx40 gene. It also reviews data obtained in a transgenic mouse model in which cell loss and remodeling of gap junction distribution leads to increased susceptibility to arrhythmias and sudden cardiac death. Overall, the results demonstrate that these are potentially powerful strategies for studying fundamental mechanisms of cardiac electrical activity and for testing the hypothesis that certain cardiac arrhythmias involve gap junction or other membrane channel dysfunction. These new approaches, which permit one to manipulate electrical wave propagation at the molecular level, should provide new insight into the detailed mechanisms of initiation, maintenance, and termination of cardiac arrhythmias, and may lead to more effective means to treat arrhythmias and prevent sudden cardiac death.

Connexin45, a major connexin of the rabbit sinoatrial node, is co-expressed with connexin43 in a restricted zone at the nodal-crista terminalis border

The pacemaker of the heart, the sinoatrial (SA) node, is characterized by unique electrical coupling properties. To investigate the contribution of gap junction organization and composition to these properties, the spatial pattern of expression of three gap junctional proteins, connexin45 (Cx45), connexin40 (Cx40), and connexin43 (Cx43), was investigated by immunocytochemistry combined with confocal microscopy. The SA nodal regions of rabbits were dissected and rapidly frozen. Serial cryosections were double labeled for Cx45 and Cx43 and for Cx40 and Cx43, using pairs of antibody probes raised in different species. Dual-channel scanning confocal microscopy was applied to allow simultaneous visualization of the different connexins. Cx45 and Cx40, but not Cx43, were expressed in the central SA node. The major part of the SA nodal-crista terminalis border revealed a sharply demarcated boundary between Cx43-expressing myocytes of the crista terminalis and Cx45/Cx40-expressing myocytes of the node. On the endocardial side, however, a transitional zone between the crista terminalis and the periphery of the node was detected in which Cx43 and Cx45 expression merged. These distinct patterns of connexin compartmentation and merger identified suggest a morphological basis for minimization of contact between the tissues, thereby restricting the hyperpolarizing influence of the atrial muscle on the SA node while maintaining a communication route for directed exit of the impulse into the crista terminalis.

Local cholinergic suppression of pacemaker activity in the rabbit sinoatrial node

The effects of transmural vagal stimulation and acetylcholine (ACh) superfusion on primary and latent pacemaker cells of the rabbit sinoatrial node were studied by using microelectrodes. Both ACh and vagal stimulation lengthened atrial cycle length by 40-60% as compared with control. In the cells from the primary pacemaker area, both ACh superfusion and vagal stimulation suppressed action potential (AP) amplitude and then induced inexcitability. In contrast, cells from subsidiary pacemaker area as well as atrium remained excitable. These effects were completely reversible and also were abolished by atropine, 10(-7) M. Cholinergically induced suppression of AP amplitude is predictable based on the maximal rate of AP upstroke (dV/dt). The probability of amplitude suppression was the highest among pacemaker cells (dV/dt, <3 V/s), in which ACh suppressed amplitude in 27 (93%) of 29 cells, and vagal stimulation did so in 38 (81%) of 47 cells. With increasing upstroke velocity, the probability of amplitude suppression decreased. Inexcitability did not occur in cells whose dV/dt was >15 V/s. The suppression of AP amplitude by ACh occurred in a concentration-dependent manner: the concentration inducing suppression of amplitude in 50% of pacemaker cells was approximately 10 microM. These results indicate that cholinergic effects on typical pacemaker and subsidiary pacemaker cells are different: whereas subsidiary pacemaker cells remain excitable, typical pacemaker cells become quiescent. We hypothesize that quiescent cells create quiescent regions in the center of the sinoatrial node that might functionally be an obstacle for reentrant tachycardias.

Pacemaker synchronization of electrically coupled rabbit sinoatrial node cells

The effects of intercellular coupling conductance on the activity of two electrically coupled isolated rabbit sinoatrial nodal cells were investigated. A computer-controlled version of the "coupling clamp" technique was used in which isolated sinoatrial nodal cells, not physically in contact with each other, were electrically coupled at various values of ohmic coupling conductance, mimicking the effects of mutual interaction by electrical coupling through gap junctional channels. We demonstrate the existence of four types of electrical behavior of coupled spontaneously active cells. As the coupling conductance is progressively increased, the cells exhibit: (a) independent pacemaking at low coupling conductances, (b) complex dynamics of activity with mutual interactions, (c) entrainment of action potential frequency at a 1:1 ratio with different action potential waveforms, and (d) entrainment of action potentials at the same frequency of activation and virtually identical action potential waveforms. The critical value of coupling conductance required for 1:1 frequency entrainment was <0.5 nS in each of the five cell pairs studied. The common interbeat interval at a relatively high coupling conductance (10 nS), which is sufficient to produce entrainment of frequency and also identical action potential waveforms, is determined most by the intrinsically faster pacemaker cell and it can be predicted from the diastolic depolarization times of both cells. Evidence is provided that, at low coupling conductances, mutual pacemaker synchronization results mainly from the phase-resetting effects of the action potential of one cell on the depolarization phase of the other. At high coupling conductances, the tonic, diastolic interactions become more important.

Structural determinants of slow conduction in the canine sinus node

INTRODUCTION

To elucidate the role of tissue structure as a determinant of the unique conduction properties of the sinus node, we compared the spatial distribution of intercellular connections at gap junctions in the sinus node to the more rapidly conducting crista terminalis and left ventricle, which have been studied previously.

METHODS AND RESULTS

Samples of four canine sinus nodes were prepared for electron microscopy. The total number and spatial orientation of neighboring myocytes connected by ultrastructurally identified intercalated disks and gap junctions to nine randomly selected index cells were determined by sequentially examining subserial sections. Sinus node cells were sparsely interconnected compared to the extent of interconnections observed previously in other tissues. A typical sinus node cell was connected to only 4.8 +/- 0.7 neighbors compared with 11.3 +/- 2.2 cells in the left ventricle and 6.4 +/- 1.7 cells in the crista terminalis. Sinus node interconnections occurred at small intercalated disks that usually connected cells in partial side-to-side and end-to-end juxtaposition. In contrast, left ventricular myocytes are interconnected at large intercalated disks that adjoin many cells in pure side-to-side and end-to-end orientations. Crista terminalis myocytes are connected primarily in end-to-end fashion. The aggregate gap junction profile length per unit myocyte area was 26.5 times greater in the left ventricle and 5.0 times greater in the crista terminalis than in the sinus node.

CONCLUSION

Sinus node myocytes exhibit small, sparsely distributed gap junctions that interconnect cells in complex patterns of lateral and terminal apposition. These structural features are consistent with the unique conduction properties of the sinus node.

The effects of phosphocreatine introduced simultaneously into many cardiac cells

The aim of the present study was to ascertain whether or not phosphocreatine (PC) could produce electrophysiological and inotropic effects in isolated rabbit cardiac preparations. Exogenous PC (50 mmol/l) was introduced into many cells simultaneously by the "cut-end" and "saponinated-end" methods. PC that entered the cells (opened by cutting or chemical disruption of the sarcolemma) in the loading region, passed through the preparation intercellularly and evoked the following effects in the test region. PC enhanced the spontaneous rate and probably shifted the pacemaker in sinus node strips. On the other hand, PC elevated the action potential amplitude and duration and increased the isometric tension in atrial and ventricular strips. Furthermore, PC applied into ventricular cells partially prevented the effects of hypoxia. These findings suggest that PC may act in cardiac muscle as an intercellular energy carrier. The effects of PC introduced intracellularly resembled these evoked by O-benzyl-phosphocreatine--a permanent synthetic phosphagen--applied via superfusion.

Gap junction protein phenotypes of the human heart and conduction system

INTRODUCTION

Gap junction channels are major determinants of intercellular resistance to current flow between cardiac myocytes. Alterations in gap junctions may contribute to development of arrhythmia substrates in patients. However, there is significant interspecies variation in the types and amounts of gap junction subunit proteins (connexins) expressed in disparate regions of mammalian hearts. To elucidate determinants of conduction properties in the human heart, we characterized connexin phenotypes of specific human cardiac tissues with different conduction properties.

METHODS AND RESULTS

The distribution and relative abundance of Cx37, Cx40, Cx43, Cx45, and Cx46 were studied immunohistochemically using monospecific antibodies and frozen sections of the sinoatrial node and adjacent atria. AV node and His bundle, the bundle branches, and the left and right ventricular walls. Patterns of expression of these connexins in the human heart differed from those in previous animal studies. Sinus node gap junctions were small and sparse and contained Cx45 and apparently smaller amounts of Cx40 but no Cx43. AV node gap junctions were also small and contained mainly Cx45 and Cx40 but, unlike the sinus node, also expressed Cx43. Atrial gap junctions were larger than nodal junctions and contained moderate amounts of Cx40, Cx43, and Cx45. Junctions in the bundle branches were the largest in size and contained abundant amounts of Cx40, Cx43, and Cx45. Gap junctions in ventricular myocardium contained mainly Cx43 and Cx45; only a very small and amount of ventricular Cx40 was detected in subendocardial myocyte junctions and endothelial cells of small to medium sized intramural coronary arteries. Minimal Cx37 and Cx46 immunoreactivity was detected between occasional atrial or ventricular myocytes.

CONCLUSIONS

The relative amounts of individual connexins and the number and size of gap junctions vary greatly in specific regions of the human heart with different conduction properties. These differences likely play a role in regulating cardiac conduction velocity. Differences in the connexin phenotypes of specific regions of the human heart and experimental animal hearts must be considered in future experimental or modeling studies of cardiac conduction.

Spatial organization of cardiac gap junctions can affect access resistance

In the heart, gap junctions electrically couple myocytes together. Electron- and light-microscope-based analyses have revealed that cardiac gap junctions show a variety of organizational patterns. At the level of gap-junctional channel aggregates, freeze fracture has demonstrated diverse channel packing arrangements in the membranes of different myocardial tissues. Ultrastructural and immunohistochemical studies have shown variation and specialization in the 3-dimensional spatial distribution of gap junctional contacts between different types of myocardial cells. Here, we estimate the access resistance of various configurations of gap junctions using physical principles and explore how certain of these specializations in gap-junctional organization may influence access resistance, a potentially important determinant of electrical conductance between coupled myocardial cells.

Distinct gap junction protein phenotypes in cardiac tissues with disparate conduction properties

OBJECTIVES

We sought to characterize the connexin phenotypes of selected regions of the canine heart with different conduction properties to determine whether variations in connexin expression might contribute to the differences in intercellular resistance and conduction velocity that occur in different cardiac tissues.

BACKGROUND

Gap junctions connect cardiac myocytes, allowing propagation of action potentials. Intercellular channels with different electrophysiologic properties are formed by different connexin proteins.

METHODS

To determine which connexins were likely to be expressed in the sinus node, atrioventricular (AV) node and atrial and ventricular myocardium, messenger ribonucleic acids (RNAs) from each of these sites were hybridized with probes for connexin26, connexin31, connexin32, connexin37, connexin40, connexin43, connexin45, connexin46 and connexin50. Immunostaining with monospecific antibodies to connexin40, connexin43 and connexin45 was used to delineate the distribution of connexins in frozen sections of these different cardiac tissues.

RESULTS

Only messenger RNAs coding for connexin40, connexin43 and connexin45 were detected by Northern blot analysis. By immunohistochemical staining, junctions in the sinus and AV nodes and proximal His bundle were virtually devoid of connexin43 but contained both connexin40 and connexin45. Gap junctions in the distal His bundle and the proximal bundle branches stained intensely for connexin40 and connexin43 and to a lesser extent for connexin45. Atrial gap junctions showed abundant staining of connexin43, connexin40 and connexin45. Ventricular gap junctions were characterized by abundant staining of connexin43 and connexin45 and much less staining of connexin40.

CONCLUSIONS

Although most cardiac gap junctions contain connexin40, connexin43 and connexin45, the relative amounts of each of these connexins vary considerably in cardiac tissues with different conduction properties.

Restricted distribution of connexin40, a gap junctional protein, in mammalian heart

Connexin40 (Cx40) is a member of the connexin family of gap junction proteins. Its mRNA, abundant in lung, is also present in mammalian heart, although in lower amount. Rabbit antipeptide antibodies directed to the COOH terminus (residues 335 to 356) of rat Cx40 were characterized to investigate the distribution of Cx40 in rat and guinea pig cardiac tissues. The affinity-purified antibodies detect specifically a major protein (M(r), 40,000) in immunoblots of total extracts from rat lung and rat and guinea pig heart. In sections of guinea pig atrial tissue treated for immunofluorescence, a strong labeling associated with myocytes was seen with a distribution consistent with that of intercalated disks. The results of immunoelectron microscopy carried out with guinea pig atrial tissue showed that epitopes recognized by these antibodies were exclusively associated with gap junctions. These results, added to those of control experiments, demonstrate that antibodies 335-356 are specific for Cx40. Double-labeling experiments carried out with lung sections using anti-factor VIII and anti-Cx40 antibodies suggest that Cx40 is expressed in blood vessel endothelial cells. In guinea pig and rat heart sections, investigated using both immunofluorescence and immunoperoxidase techniques, a signal was also found to be associated with vascular walls. In guinea pig heart, only atrial myocytes are Cx40-positive. No labeling was detected in ventricular myocytes, including those of the His bundle and the bundle branches, which otherwise do express connexin43 (Cx43). In rat heart Cx40-expressing myocytes are localized in branches, and the Purkinje fibers. Cx43 is not detected either in the His bundle or in the proximal parts of the bundle branches, and consequently, Cx40 is the first connexin demonstrated in this region of the rat conduction system. Cx40 was not detected in the working ventricular myocytes. Double-labeling experiments carried out with hen anti-Cx43 antibodies and rabbit anti-Cx40 antibodies demonstrated that, in tissues expressing both Cx43 and Cx40, these two connexins were localized in the same immunoreactive sites. A few sites, however, appear to contain only one or the other of these two connexins.

Immunohistochemical localization of gap junction protein channels in hamster sinoatrial node in correlation with electrophysiologic mapping of the pacemaker region

INTRODUCTION

Gap junction proteins are thought to form the low resistance pathways that connect neighboring cells within the sinoatrial node, and to mediate pacemaker synchronization.

METHODS AND RESULTS

We have carried out microelectrode mapping experiments of the hamster sinoatrial region to localize the primary pacemaker area for subsequent light, electron, and immunofluorescence microscopic studies aimed at testing the hypothesis that the major cardiac gap junction protein (connexin43) is present in such an area. The site of earliest activation is unifocal and the pattern of activation, obtained by multiple sequential microelectrode recordings of the sinoatrial region, is qualitatively similar to that previously described for other species. However, quantitatively, the impulse transmission time from the primary pacemaker area to the crista (sulcus) terminalis in the hamster sinoatrial node is about 50% briefer than that of the guinea pig and five times faster than that of the rabbit. Immunolocalization studies in the hamster sinoatrial node using anti-connexin43 antisera demonstrated specific staining at the areas of cell-to-cell apposition and suggested that the apparently high degree of electrical coupling in this tissue is the result of abundant connexin43 expression. The immunofluorescence data were supported by light microscopic studies, which demonstrated the typical morphologic characteristics of sinus nodal cells in the pacemaker area. In addition, an electron microscopic study of the sinoatrial region revealed the presence of gap junctions in the junctional complex at areas of cell-to-cell contact.

CONCLUSION

Our results demonstrate that cells in the sinoatrial region of the hamster heart are electrically well coupled and strongly suggest that such coupling is mediated by gap junctional channels formed by connexin43.

Immunohistochemical delineation of the conduction system. I: The sinoatrial node

We have raised a mouse monoclonal antibody that reacts specifically with the myocytes of the sinoatrial node of the bovine heart. By use of this antibody (445-6E10) and antibodies against the gap junction protein connexin43, the periphery of the sinoatrial node and the distribution of gap junctions in the nodal region were studied. The reaction patterns of 445-6E10 and anti-connexin43 are exactly complementary; ie, connexin43 was not detected in the nodal myocytes but was clearly present in the atrial myocytes. Both reaction patterns demonstrate that nodal myocytes and atrial myocytes can unambiguously be distinguished by their characteristic molecular phenotype. The transitional nodal myocytes at the periphery of the node that have intermediate morphological and electrophysiological characteristics could now clearly be defined as nodal by our immunohistochemical criteria. The center of the node is surrounded by a region of interdigitating nodal and atrial bundles. Nodal bundles, coming from the center of the node, penetrate the atrial myocardium aligned at atrial bundles, forming histological connections between nodal and atrial myocytes at regular distances. This interdigitating arrangement of bundles of connexin43-negative nodal and connexin43-positive atrial myocytes is also found in the human and rat heart. We hypothesize that the architecture of the periphery of the node is important to prevent silencing of the pacemaking nodal myocytes by the atrium while ensuring a sufficient source loading of the nodal myocytes.

The spatial distribution and relative abundance of gap-junctional connexin40 and connexin43 correlate to functional properties of components of the cardiac atrioventricular conduction system

Electrical coupling between heart muscle cells is mediated by specialised regions of sarcolemmal interaction termed gap junctions. In previous work, we have demonstrated that connexin42, a recently identified gap-junctional protein, is present in the specialised conduction tissues of the avian heart. In the present study, the spatial distribution of the mammalian homologue of this protein, connexin40, was examined using immunofluorescence, confocal scanning laser microscopy and quantitative digital image analysis in order to determine whether a parallel distribution occurs in rat. Connexin40 was detected by immunofluorescence in all main components of the atrioventricular conduction system including the atrioventricular node, atrioventricular bundle, and Purkinje fibres. Quantitation revealed that levels of connexin40 immunofluorescence increased along the axis of atrioventricular conduction, rising over 10-fold between atrioventricular node and atrioventricular bundle and a further 10-fold between atrioventricular bundle and Purkinje fibres. Connexin40 and connexin43, the principal gap-junctional protein of the mammalian heart, were co-localised within atrioventricular nodal tissues and Purkinje fibres. By applying a novel photobleach/double-labelling protocol, it was demonstrated that connexin40 and connexin43 are co-localised in precisely the same Purkinje fibre myocytes. A model, integrating data on the spatial distribution and relative abundance of connexin40 and connexin43 in the heart, proposes how myocyte-type-specific patterns of connexin isform expression account for the electrical continuity of cardiac atrioventricular conduction.

Anatomy, histology, and pathology of the cardiac conduction system: Part I

Normal anatomic and histologic features of the sinus node, atrial myocardium, and interatrial conduction of the cardiac impulse are reviewed. The controversy surrounding atrial conduction via specialized atrial cells versus specific internodal tracts (between sinus and atrioventricular nodes) is discussed.

Evidence for a distinct gap-junctional phenotype in ventricular conduction tissues of the developing and mature avian heart

The gap-junctional proteins connexin43 and connexin42 have been shown to be expressed in the developing and mature avian heart, but their respective spatiotemporal distributions are unknown. In the present study, we have immunolocalized connexin42 in the conduction tissues of the adult avian heart (nonbranching bundle, bundle branches, and Purkinje fibers) and vascular endothelial cells. Connexin43 immunolabeling was confined to vascular smooth muscle. A novel microwave-based method was used to label connexin42 and connexin43 in the same tissue section. Neither connexin42 nor connexin43 was immunolocalized in working myocardium, atrioventricular node, and atrioventricular ring tissue of the bird heart. Although connexin42 first appeared in periarterial conduction myocytes and vascular endothelium at 9-10 embryonic days, the central conduction tissues, including the nonbranching bundle and proximal branches, remained immunonegative for connexin42 up until hatching (approximately 20 embryonic days). During the early postnatal period (1-14 days), connexin42 immunolabeling progressively spread up the bundle branches toward the nonbranching bundle. Connexin42 appeared uniformly distributed along the left bundle branch by 14 postnatal days. The distribution and spread of connexin42 immunoreactivity suggest that the emergence of specialized junctional contacts along ventricular fascicles occurs relatively late in heart development and coincides with the emergence of the chick from incubation within the egg.

Gap junctional channels in adult mammalian sinus nodal cells. Immunolocalization and electrophysiology

The subcellular mechanism of cell-to-cell communication in the natural pacemaker region of the mammalian heart was studied using electrophysiological and immunofluorescence techniques in isolated pairs of rabbit sinus nodal cells. By measuring whole-cell currents using a double patch-clamp approach, it was demonstrated that communication in the sinus node is mediated through gap junctional channels similar to those in other types of adult cardiac cell pairs. Macroscopic sinus nodal junctional resistance had a mean value of 387.9 +/- 97.1 M omega (mean +/- SEM, n = 10) and was greatly increased by superfusion with alkanols. Single-channel junctional conductance could be resolved in three cell pairs. Given their high membrane resistance (1.16 +/- 0.32 G omega, n = 12), the electrical coupling provided by as few as three gap junctional channels between nodal cells will allow for pacemaker synchronization. Further evidence for the presence of the channels was obtained from immunofluorescent double-labeling of desmin and the gap junction protein (connexin43) in sinus nodal tissue as well as in cultured sinus nodal cells. Using antisera against residues 243-257 of the connexin43 protein, a specific staining at the site of cell-to-cell apposition was demonstrated. These data provide direct evidence in favor of electronic coupling as the means for achieving pacemaker synchronization in the rabbit sinus node.

Spatial distribution of connexin43, the major cardiac gap junction protein, in the developing and adult rat heart

The developmental appearance and spatial distribution pattern of gap junctions were studied in prenatal and adult rat hearts. Gap junctions were visualized immunohistochemically with an antibody raised against a unique cytoplasmic epitope of connexin43, and the spatial distribution pattern was determined by three-dimensional reconstruction. The results demonstrate that from embryonic day 13 onward, connexin43 becomes detectable immunohistochemically in the myocardium of atria and ventricles. No expression is initially detectable in the myocardium of the sinus venosus, the sinoatrial node, the posterior wall of the atrium and pulmonary veins, the interatrial septum, the atrioventricular canal, including atrioventricular node and bundle, the interventricular septum, and the outflow tract. The developmental increase in the density of gap junctions in atria and ventricles of prenatal hearts correlates well with the reported developmental increase in conduction velocity. Whereas connexin43 becomes expressed in the derivatives of the sinus venosus (except for the sinoatrial node) and in the subepicardial layer of the ventricular free wall shortly before birth, it remains undetectable in the atrioventricular node and bundle and the proximal part of the ventricular conduction tissue, even in the adult heart. The apparent absence of an abundant expression of connexin43 at a location with a supposedly high conduction velocity (i.e., the atrioventricular bundle and bundle branches) is unexpected. These observations were confirmed in studies of the adult mouse heart, which showed, in addition, that connexin32 is not expressed in any part of the heart.

Ultrastructure of electrophysiologically identified human sinoatrial nodes

The ultrastructure of freshly excised human sinus node tissue was studied. In three female patients (ages 20, 30, and 36 years) medically refractory disabling episodes of inappropriate sinus tachycardia were surgically treated by extirpation of the sinus node. Each patient underwent intraoperative electrophysiological mapping to determine the area of earliest atrial activation. This area corresponded anatomically to the region of the sinoatrial node and was excised in each patient, the defect repaired using a pericardial patch. The freshly excised SA nodes underwent ultrastructural study. Three types of myocardial cells were identified: pacemaker or polygonal cells with clear cytoplasm, few mitochondria and sparse numbers of contractile elements (P cells); a transitional cell with slightly increased numbers of myofibrils (T cells); and typical atrial myocardial cells with normal numbers of contractile elements. These cell types have previously been identified in post-mortem studies of presumed SA node. The current study confirms the cell types in electrophysiologically documented SA nodes. The one abnormal finding observed in transitional cells in all patients was an increased number of lipofuscin-laden vacuoles. These vacuoles are considered a sign of cell degeneration and their occurrence was totally unexpected in these young adults. In summary, ultrastructural study of electrophysiologically documented human SA nodes confirmed the cell types identified in post-mortem studies. Furthermore, lipofuscin-laden vacuoles were increased in these three patients and this finding may serve as an ultrastructural marker associated with the syndrome of inappropriate sinus tachycardia.

The mammalian sinoatrial node

The sinoatrial node (SAN) was discovered in 1906 by Keith and Flack. The relation between its ultrastructure and function was first studied by Trautwein and Uchizono in 1963, whereas this relation was definitely established by Taylor and coworkers in 1978. The impulse originates from cells with a relatively low percentage of myofilaments. Earliest discharge is restricted to one site only in rabbit, guinea pig, cat, and pig and presumably also in larger animals. From this primary pacemaker area, the impulse is preferentially conducted towards the crista terminalis. The amount of cells in the primary pacemaker area may vary from a few hundred to a few thousand. In rabbit, guinea pig, cat, and pig, the amount of collagen is considerable. Normal SAN function was observed in the cat although the SAN volume occupied by myocytes was less than 5%. Changes in ionic composition of the perfusion fluid and the addition of autonomic substances may cause pacemaker shifts and altered activation patterns.

Propagation through electrically coupled cells. How a small SA node drives a large atrium

Each normal cardiac cycle is started by an action potential that is initiated in the sino-atrial (SA) node by automaticity of the SA nodal cells. This action potential then propagates from the SA node into the surrounding atrial cells. We have done numerical simulations of electrically coupled cells to understand how a small SA node can be spontaneously active and yet be sufficiently electrically coupled to the surrounding quiescent atrial cells to initiate an action potential in the atrial cells. Our results with a simple model of two coupled cells and a more complex model of a two-dimensional sheet of cells suggest that some degree of electrical uncoupling of the cells within the SA node may be an essential design feature of the normal SA-atrial system.

Intercalated discs of mammalian heart: a review of structure and function

Intercalated discs are exceptionally complex entities, and possess considerable functional significance in terms of the workings of the myocardium. Examination of different species and heart regions indicates that the original histological term has become out-moded; it is likely, however, that all such complexes will continue to fall under the generic heading of 'intercalated discs'. The membranes of the intercalated discs establish specific associations with a variety of intracellular and extracellular structures, as well as with numerous types of proteins and glycoproteins. Characterization of discs and their components has already brought together a large number of research disciplines, including microscopy, cytochemistry, morphometry, cell isolation and culture, cell fractionation, cryogenics, immunology, biochemistry, and electrophysiology. The continued dissection of substance and function of intercalated discs will depend on such interdisciplinary approaches. The intercalated disc component which continues to attract the greatest amount of interest is the so-called gap junction. All indications thus far point to a great deal of inherent lability in the architecture of the gap junction. There is thus considerable potential for the creation of artefact while preserving and observing gap junctions, and this problem will doubtless continue to hamper the understanding of their functions. A question of special interest concerns whether the gap junctions of intercalated discs are required for transfer of electrical excitation between cells, or maintain cell-to-cell adhesion, or in fact subserve both electrical and structural phenomena. Two schools of thought exist with respect to cell-to-cell coupling in the heart. One proposes that low-resistance junctions in the discs mediate electrical coupling, whereas the other supports the possibility of coupling across ordinary high-resistance membranes. Thus the intercalated discs continue to be a source of controversy, just as they have been since they were originally discovered in heart muscle over a century ago.

Intercellular coupling in frog heart muscle. Electrophysiological and morphological aspects

Passive electrical parameters of bullfrog atrial trabeculae were measured in a single gap arrangement. Attention was focussed on the resistance of internal longitudinal pathway. The influence of external Ca2+ depletion was tested using EGTA as chelating agent. Morphometry of trabeculae, fine structure of junctional complexes, and distribution of membrane-bound Ca were investigated by light and electron microscopic methods. The specific internal resistance to longitudinal current flow was 523 omega cm with normal Ringer as perfusing fluid and 1140 omega cm in EGTA-containing solution. These values are considered to represent the sum of myoplasmic and junctional resistivity. Morphometrical studies indicated an interstitial space of 12%, a mean cell length of 358 micron, and a mean cell diameter of 3.2 micron. In freeze-fractured preparations junctional structures were observed in the form of "atypical gap junctions" consisting of 10 nm particles arranged in a circular or linear array. The number of gap junctions was estimated to range between 20 and 50/cell which is equivalent to a junctional area of 0.01 or 0.03% of total surface area. A mean number of 55 particles/gap junction was calculated. After 20 min of exposure to EGTA the majority of junctional complexes were converted to clusters; the number of particles/gap junction was not significantly altered. The fluorescent dye CTC was used as a probe for membrane-bound Ca of isolated living cells. In normal Ringer a strong fluorescence was seen at the cell surface and in different intracellular compartments. With EGTA both superficial and internal fluorescence disappeared completely. From a combination of electrical and morphometrical data the resistance of intercellular junctions was calculated. Under normal conditions the specific resistance of junctional membrane amounted to 0.4 omega cm2 and the resistance of an individual connection was of the order of 10(11) omega. With EGTA, the respective values were increased by about 230%. The mechanism underlying this depression of junctional conductance is not clear. It seems not related to a rise of cytoplasmic free Ca2+. The EGTA-induced increase in internal resistance was reflected by a decrease of the length constant of a bundle. The nature of "atypical gap junctions" and their relation to tight junctions are discussed. It is concluded that the junctions observed in frog atrial muscle are analogous to gap junctions of insect or mammalian cells in spite of the different size and arrangement of the particles. A theoretical model is presented for the electrical behaviour of a bundle in a single gap arrangement.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrical coupling among heart cells in the absence of ultrastructurally defined gap junctions

Cells from the ventricles of 7-day chick embryos were aggregated into spheroidal clusters by 48 hr of culture on a gyratory platform. All aggregates beat spontaneously and rhythmically. Microelectrode impalement of widely separated cells within aggregates indicated that they were coupled, as evidenced by a mean coupling ratio (delta V2/ delta V1) of 0.81 +/- 0.09, and by simultaneity of intrinsic electrical activity (action potentials and subthreshold voltage fluctuation). In freeze-fracture preparations, the cell surfaces contained numerous small groups of intramembrane protein (IMP) particles, arranged in macular clusters, and linear and circular arrays. Using the criterion of 4 clustered IMP particles to defined a minimal gap junction, 0.27% of the total P-face examined was devoted to gap junctional area. Within such clusters particles were packed at about 8200/micrometer2; in nonjunctional regions, particles were scattered at a density of about 2000/micrometer2. When exposed to cycloheximide (CHX: 50 micrograms/ml) for 24--48 hr, coupling ratio declined to 0.44. This decrease could be attributed largely to leakiness of the nonjunctional membrane. Aggregates continued to beat rhythmically and in a coordinated fashion even after 72 hr in inhibitor. However, between 3--21 hr in CHX gap junctional area declined to 0.10%, and all particle clusters disappeared from the P-faces of aggregates in CHX for 24 or 48 hr. Neither macular nor linear particle arrays were seen. We conclude that organized gap junctions are unnecessary for electrotonic coupling between embryonic heart cells. These findings support the idea that low-resistance cell-to-cell pathways may exist as isolated channels scattered throughout the area of closely apposed plasma membranes.