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Sagris M, Vardas EP, Theofilis P, Antonopoulos AS, Oikonomou E, Tousoulis D. Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics. Int J Mol Sci 2021; 23:ijms23010006. [PMID: 35008432 PMCID: PMC8744894 DOI: 10.3390/ijms23010006] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 02/07/2023] Open
Abstract
Atrial fibrillation (AF) is the most frequent arrhythmia managed in clinical practice, and it is linked to an increased risk of death, stroke, and peripheral embolism. The Global Burden of Disease shows that the estimated prevalence of AF is up to 33.5 million patients. So far, successful therapeutic techniques have been implemented, with a high health-care cost burden. As a result, identifying modifiable risk factors for AF and suitable preventive measures may play a significant role in enhancing community health and lowering health-care system expenditures. Several mechanisms, including electrical and structural remodeling of atrial tissue, have been proposed to contribute to the development of AF. This review article discusses the predisposing factors in AF including the different pathogenic mechanisms, sedentary lifestyle, and dietary habits, as well as the potential genetic burden.
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Affiliation(s)
- Marios Sagris
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
- Correspondence: ; Tel.: +30-213-2088099; Fax: +30-213-2088676
| | - Emmanouil P. Vardas
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
- Department of Cardiology, General Hospital of Athens “G. Gennimatas”, 11527 Athens, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
| | - Alexios S. Antonopoulos
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
| | - Evangelos Oikonomou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
- 3rd Department of Cardiology, “Sotiria” Thoracic Diseases Hospital of Athens, University of Athens Medical School, 11527 Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.P.V.); (P.T.); (A.S.A.); (E.O.); (D.T.)
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Yamada N, Asano Y, Fujita M, Yamazaki S, Inanobe A, Matsuura N, Kobayashi H, Ohno S, Ebana Y, Tsukamoto O, Ishino S, Takuwa A, Kioka H, Yamashita T, Hashimoto N, Zankov DP, Shimizu A, Asakura M, Asanuma H, Kato H, Nishida Y, Miyashita Y, Shinomiya H, Naiki N, Hayashi K, Makiyama T, Ogita H, Miura K, Ueshima H, Komuro I, Yamagishi M, Horie M, Kawakami K, Furukawa T, Koizumi A, Kurachi Y, Sakata Y, Minamino T, Kitakaze M, Takashima S. Mutant KCNJ3 and KCNJ5 Potassium Channels as Novel Molecular Targets in Bradyarrhythmias and Atrial Fibrillation. Circulation 2020; 139:2157-2169. [PMID: 30764634 DOI: 10.1161/circulationaha.118.036761] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bradyarrhythmia is a common clinical manifestation. Although the majority of cases are acquired, genetic analysis of families with bradyarrhythmia has identified a growing number of causative gene mutations. Because the only ultimate treatment for symptomatic bradyarrhythmia has been invasive surgical implantation of a pacemaker, the discovery of novel therapeutic molecular targets is necessary to improve prognosis and quality of life. METHODS We investigated a family containing 7 individuals with autosomal dominant bradyarrhythmias of sinus node dysfunction, atrial fibrillation with slow ventricular response, and atrioventricular block. To identify the causative mutation, we conducted the family-based whole exome sequencing and genome-wide linkage analysis. We characterized the mutation-related mechanisms based on the pathophysiology in vitro. After generating a transgenic animal model to confirm the human phenotypes of bradyarrhythmia, we also evaluated the efficacy of a newly identified molecular-targeted compound to upregulate heart rate in bradyarrhythmias by using the animal model. RESULTS We identified one heterozygous mutation, KCNJ3 c.247A>C, p.N83H, as a novel cause of hereditary bradyarrhythmias in this family. KCNJ3 encodes the inwardly rectifying potassium channel Kir3.1, which combines with Kir3.4 (encoded by KCNJ5) to form the acetylcholine-activated potassium channel ( IKACh channel) with specific expression in the atrium. An additional study using a genome cohort of 2185 patients with sporadic atrial fibrillation revealed another 5 rare mutations in KCNJ3 and KCNJ5, suggesting the relevance of both genes to these arrhythmias. Cellular electrophysiological studies revealed that the KCNJ3 p.N83H mutation caused a gain of IKACh channel function by increasing the basal current, even in the absence of m2 muscarinic receptor stimulation. We generated transgenic zebrafish expressing mutant human KCNJ3 in the atrium specifically. It is interesting to note that the selective IKACh channel blocker NIP-151 repressed the increased current and improved bradyarrhythmia phenotypes in the mutant zebrafish. CONCLUSIONS The IKACh channel is associated with the pathophysiology of bradyarrhythmia and atrial fibrillation, and the mutant IKACh channel ( KCNJ3 p.N83H) can be effectively inhibited by NIP-151, a selective IKACh channel blocker. Thus, the IKACh channel might be considered to be a suitable pharmacological target for patients who have bradyarrhythmia with a gain-of-function mutation in the IKACh channel.
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Affiliation(s)
- Noriaki Yamada
- Departments of Cardiovascular Medicine (N.Y., Y.A., A.T., H. Kioka, Y.M., H.S., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshihiro Asano
- Departments of Cardiovascular Medicine (N.Y., Y.A., A.T., H. Kioka, Y.M., H.S., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Masashi Fujita
- Department of Onco-cardiology, Osaka International Cancer Institute, Japan (M.F.)
| | - Satoru Yamazaki
- Departments of Cell Biology (S.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Atsushi Inanobe
- Pharmacology (A.I., Y.K.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Norio Matsuura
- Departments of Health and Environmental Sciences (N.M.), Kyoto University Graduate School of Medicine, Japan
| | - Hatasu Kobayashi
- Department of Biomedical Sciences, College of Life and Health Sciences Chubu University, Kasugai, Japan (H. Kobayashi)
| | - Seiko Ohno
- Bioscience and Genetics (S.O.), National Cerebral and Cardiovascular Center, Suita, Japan.,Center for Epidemiologic Research in Asia (S.O., K.M., H.U., M.H.), Shiga University of Medical Science, Otsu, Japan
| | - Yusuke Ebana
- Life Science and Bioethics Research Center (Y.E.), Tokyo Medical and Dental University, Japan
| | - Osamu Tsukamoto
- Medical Biochemistry (O.T., H. Kato, Y.N., S.T.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Saki Ishino
- Center of Medical Innovation and Translational Research (S.I.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Ayako Takuwa
- Departments of Cardiovascular Medicine (N.Y., Y.A., A.T., H. Kioka, Y.M., H.S., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidetaka Kioka
- Departments of Cardiovascular Medicine (N.Y., Y.A., A.T., H. Kioka, Y.M., H.S., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Yamashita
- Pharmaceuticals Division, Nissan Chemical Corporation, Tokyo, Japan (T.Y., N.H.)
| | - Norio Hashimoto
- Pharmaceuticals Division, Nissan Chemical Corporation, Tokyo, Japan (T.Y., N.H.)
| | - Dimitar P Zankov
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology (D.P.Z., A.S., H.O.), Shiga University of Medical Science, Otsu, Japan
| | - Akio Shimizu
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology (D.P.Z., A.S., H.O.), Shiga University of Medical Science, Otsu, Japan
| | - Masanori Asakura
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (M.A.)
| | - Hiroshi Asanuma
- Department of Internal Medicine, Meiji University of Integrative Medicine, Nantan, Japan (H.A.)
| | - Hisakazu Kato
- Medical Biochemistry (O.T., H. Kato, Y.N., S.T.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuya Nishida
- Medical Biochemistry (O.T., H. Kato, Y.N., S.T.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Yohei Miyashita
- Departments of Cardiovascular Medicine (N.Y., Y.A., A.T., H. Kioka, Y.M., H.S., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Haruki Shinomiya
- Departments of Cardiovascular Medicine (N.Y., Y.A., A.T., H. Kioka, Y.M., H.S., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobu Naiki
- Departments of Cardiovascular Medicine (N.N., M.H.), Shiga University of Medical Science, Otsu, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., M.Y.)
| | - Takeru Makiyama
- Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine, Japan
| | - Hisakazu Ogita
- Division of Molecular Medical Biochemistry, Department of Biochemistry and Molecular Biology (D.P.Z., A.S., H.O.), Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia (S.O., K.M., H.U., M.H.), Shiga University of Medical Science, Otsu, Japan.,Public Health (K.M., H.U.), Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia (S.O., K.M., H.U., M.H.), Shiga University of Medical Science, Otsu, Japan.,Public Health (K.M., H.U.), Shiga University of Medical Science, Otsu, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Japan (I.K.)
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan (K.H., M.Y.).,Department of Human Sciences, Osaka University of Human Sciences, Settsu, Japan (M.Y.)
| | - Minoru Horie
- Center for Epidemiologic Research in Asia (S.O., K.M., H.U., M.H.), Shiga University of Medical Science, Otsu, Japan.,Departments of Cardiovascular Medicine (N.N., M.H.), Shiga University of Medical Science, Otsu, Japan
| | - Koichi Kawakami
- Division of Molecular and Developmental Biology, National Institute of Genetics, Mishima, Japan (K.K.).,Department of Genetics, SOKENDAI (The Graduate University for Advanced Studies), Mishima, Japan (K.K.)
| | - Tetsushi Furukawa
- Department of Bioinformational Pharmacology (T.F.), Tokyo Medical and Dental University, Japan
| | - Akio Koizumi
- Public Interest Foundation Kyoto Hokenkai, Japan (A.K.)
| | - Yoshihisa Kurachi
- Pharmacology (A.I., Y.K.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Departments of Cardiovascular Medicine (N.Y., Y.A., A.T., H. Kioka, Y.M., H.S., Y.S.), Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuo Minamino
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Japan (T. Minamino)
| | - Masafumi Kitakaze
- Clinical Medicine and Development (M.K.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Seiji Takashima
- Medical Biochemistry (O.T., H. Kato, Y.N., S.T.), Osaka University Graduate School of Medicine, Suita, Japan
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Szirák K, Soltész B, Hajas O, Urbancsek R, Nagy-Baló E, Penyige A, Csanádi Z, Nagy B. PITX2 and NEURL1 SNP polymorphisms in Hungarian atrial fibrillation patients determined by quantitative real-time PCR and melting curve analysis. J Biotechnol 2019; 299:44-49. [PMID: 31039368 DOI: 10.1016/j.jbiotec.2019.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting 1-2% of the general population. Some common variants located in or next to PITX2 and NEURL1 genes are proved to play role in the occurrence of AF. The aim of our study was to investigate whether rs2595104 in the 4q25 chromosome region and rs6584555 SNP in the NEURL1 gene on chromosome 10 is associated with AF in a Caucasian population. We genotyped DNA samples of 76 AF patients and 77 healthy controls using quantitative real-time PCR followed by melting curve analysis. The minor A allele frequency of rs2595104 in PITX2 was 0.38 and 0.44 in the control group and in AF patients, respectively. There was no significant difference in allele and genotype distribution between the two groups (p = 0.52). The allele frequency based log additive odds ratio is 1.22 (C.I. = 0.76-1.94; p = 0.42). The frequency of minor rs6584555 C allele in NEURL1 was 0.22 in the control group and 0.23 in AF patients. Again there were no significant differences in allele and genotype frequencies between AF patients and controls (p = 0.92). The log additive odds ratio is 1,15 (C.I. = 0.66-2.01; p = 0,63). The heterozygous genotype of rs2595104 had the highest frequency compared to the other genotypes in both groups. In case of the rs6584555 SNP the homozygous genotype of the major allele (TT) had the highest frequency in both groups (0.59). The frequency of homozygous genotype for risk allele had the lowest frequency for both SNPs [rs2595104 (AA): 0.19 in patients, 0.12 in controls; rs6584555 (CC): 0.05 in patients, 0.03 in controls]. We did not find significant association between SNP rs2595104 and rs6584555 andAF. We performed a protein-protein network analysis to assess functional connection among the protein products. The proteins coded by PITX2 and NEURL1 are connected indirectly via CTNNB1 and either JAG1 or DLL4 proteins. These interactive proteins are components of two major channels of cell communication pathways, the Wnt and Notch signaling pathways.
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Affiliation(s)
- Krisztina Szirák
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Beáta Soltész
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Hajas
- Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Réka Urbancsek
- Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Edina Nagy-Baló
- Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - András Penyige
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Csanádi
- Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Bálint Nagy
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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