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Hwang M, Lim CH, Leem CH, Shim EB. In silico models for evaluating proarrhythmic risk of drugs. APL Bioeng 2020; 4:021502. [PMID: 32548538 PMCID: PMC7274812 DOI: 10.1063/1.5132618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Abstract
Safety evaluation of drugs requires examination of the risk of generating Torsade de Pointes (TdP) because it can lead to sudden cardiac death. Until recently, the QT interval in the electrocardiogram (ECG) has been used in the evaluation of TdP risk because the QT interval is known to be associated with the development of TdP. Although TdP risk evaluation based on QT interval has been successful in removing drugs with TdP risk from the market, some safe drugs may have also been affected due to the low specificity of QT interval-based evaluation. For more accurate evaluation of drug safety, the comprehensive in vitro proarrhythmia assay (CiPA) has been proposed by regulatory agencies, industry, and academia. Although the CiPA initiative includes in silico evaluation of cellular action potential as a component, attempts to utilize in silico simulation in drug safety evaluation are expanding, even to simulating human ECG using biophysical three-dimensional models of the heart and torso under the effects of drugs. Here, we review recent developments in the use of in silico models for the evaluation of the proarrhythmic risk of drugs. We review the single cell, one-dimensional, two-dimensional, and three-dimensional models and their applications reported in the literature and discuss the possibility of utilizing ECG simulation in drug safety evaluation.
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Affiliation(s)
- Minki Hwang
- SiliconSapiens Inc., Seoul 06097, South Korea
| | - Chul-Hyun Lim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon 24341, South Korea
| | - Chae Hun Leem
- Department of Physiology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul 05505, South Korea
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Behar JA, Rosenberg AA, Weiser-Bitoun I, Shemla O, Alexandrovich A, Konyukhov E, Yaniv Y. PhysioZoo: A Novel Open Access Platform for Heart Rate Variability Analysis of Mammalian Electrocardiographic Data. Front Physiol 2018; 9:1390. [PMID: 30337883 PMCID: PMC6180147 DOI: 10.3389/fphys.2018.01390] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/12/2018] [Indexed: 12/19/2022] Open
Abstract
Background: The time variation between consecutive heartbeats is commonly referred to as heart rate variability (HRV). Loss of complexity in HRV has been documented in several cardiovascular diseases and has been associated with an increase in morbidity and mortality. However, the mechanisms that control HRV are not well understood. Animal experiments are the key to investigating this question. However, to date, there are no standard open source tools for HRV analysis of mammalian electrocardiogram (ECG) data and no centralized public databases for researchers to access. Methods: We created an open source software solution specifically designed for HRV analysis from ECG data of multiple mammals, including humans. We also created a set of public databases of mammalian ECG signals (dog, rabbit and mouse) with manually corrected R-peaks (>170,000 annotations) and signal quality annotations. The platform (software and databases) is called PhysioZoo. Results: PhysioZoo makes it possible to load ECG data and perform very accurate R-peak detection (F 1 > 98%). It also allows the user to manually correct the R-peak locations and annotate low signal quality of the underlying ECG. PhysioZoo implements state of the art HRV measures adapted for different mammals (dogs, rabbits, and mice) and allows easy export of all computed measures together with standard data representation figures. PhysioZoo provides databases and standard ranges for all HRV measures computed on healthy, conscious humans, dogs, rabbits, and mice at rest. Study of these measures across different mammals can provide new insights into the complexity of heart rate dynamics across species. Conclusion: PhysioZoo enables the standardization and reproducibility of HRV analysis in mammalian models through its open source code, freely available software, and open access databases. PhysioZoo will support and enable new investigations in mammalian HRV research. The source code and software are available on www.physiozoo.com.
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Affiliation(s)
| | - Aviv A. Rosenberg
- Faculty of Biomedical Engineering, Technion-IIT, Haifa, Israel
- Faculty of Computer Science, Technion-IIT, Haifa, Israel
| | | | - Ori Shemla
- Faculty of Biomedical Engineering, Technion-IIT, Haifa, Israel
| | | | | | - Yael Yaniv
- Faculty of Biomedical Engineering, Technion-IIT, Haifa, Israel
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Cardiac pacemaker channel (HCN4) inhibition and atrial arrhythmogenesis after releasing cardiac sympathetic activation. Sci Rep 2018; 8:7748. [PMID: 29773827 PMCID: PMC5958126 DOI: 10.1038/s41598-018-26099-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/24/2018] [Indexed: 01/22/2023] Open
Abstract
Clinical trials and studies with ivabradine implicate cardiac pacemaker channels (HCN4) in the pathogenesis of atrial arrhythmias. Because acute changes in cardiac autonomic tone predispose to atrial arrhythmias, we studied humans in whom profound cardiac sympathetic activation was rapidly relieved to test influences of HCN4 inhibition with ivabradine on atrial arrhythmias. We tested 19 healthy participants with ivabradine, metoprolol, or placebo in a double blind, randomized, cross-over fashion on top of selective norepinephrine reuptake inhibition with reboxetine. Subjects underwent combined head up tilt plus lower body negative pressure testing followed by rapid return to the supine position. In the current secondary analysis with predefined endpoints before data unblinding, continuous finger blood pressure and ECG recordings were analyzed by two experienced cardiac electrophysiologists and a physician, blinded for treatment assignment. The total atrial premature activity (referred to as atrial events) at baseline did not differ between treatments. After backwards tilting, atrial events were significantly higher with ivabradine compared with metoprolol or with placebo. Unlike beta-adrenoreceptor blockade, HCN4 inhibition while lowering heart rate does not protect from atrial arrhythmias under conditions of experimental cardiac sympathetic activation. The model in addition to providing insight in the role of HCN4 in human atrial arrhythmogenesis may have utility in gauging potential atrial pro-arrhythmic drug properties.
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Behar J, Yaniv Y. Age-related pacemaker deterioration is due to impaired intracellular and membrane mechanisms: Insights from numerical modeling. J Gen Physiol 2017; 149:935-949. [PMID: 28887411 PMCID: PMC5694941 DOI: 10.1085/jgp.201711792] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/22/2017] [Accepted: 07/28/2017] [Indexed: 12/19/2022] Open
Abstract
Pacemaker function deteriorates in advanced age. Behar and Yaniv show that both intracellular and membrane mechanisms are responsible for age-associated pacemaker function deterioration and explain why the maximal beating rate is restored as a result of changes in sensitivity of HCN4 to cAMP and phospholamban to PKA. Age-related deterioration of pacemaker function has been documented in mammals, including humans. In aged isolated sinoatrial node tissues and cells, reduction in the spontaneous action potential (AP) firing rate was associated with deterioration of intracellular and membrane mechanisms; however, their relative contribution to age-associated deficient pacemaker function is not known. Interestingly, pharmacological interventions that increase posttranslation modification signaling activities can restore the basal and maximal AP firing rate, but the identities of the protein targets responsible for AP firing rate restoration are not known. Here, we developed a numerical model that simulates the function of a single mouse pacemaker cell. In addition to describing membrane and intracellular mechanisms, the model includes descriptions of autonomic receptor activation pathways and posttranslation modification signaling cascades. The numerical model shows that age-related deterioration of pacemaker function is related to impaired intracellular and membrane mechanisms: HCN4, T-type channels, and phospholamban functions, as well as the node connecting these mechanisms, i.e., intracellular Ca2+ and posttranslation modification signaling. To explain the restored maximal beating rate in response to maximal phosphodiesterase (PDE) inhibition, autonomic receptor stimulation, or infused cyclic adenosine monophosphate (cAMP), the model predicts that phospholamban phosphorylation by protein kinase A (PKA) and HCN4 sensitivity to cAMP are altered in advanced age. Moreover, alteration in PKA and cAMP sensitivity can also explain age-reduced sensitivity to PDE inhibition and autonomic receptor stimulation. Finally, the numerical model suggests two pharmacological approaches and one gene manipulation method to restore the basal beating rate of aged pacemaker cells to that of normal adult cells. In conclusion, our numerical model shows that impaired membrane and intracellular mechanisms and the nodes that couple them can lead to deteriorated pacemaker function. By increasing posttranslation modification signaling, the deteriorated basal and maximal age-associated beating rate can be restored to adult levels.
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Affiliation(s)
- Joachim Behar
- Laboratory of Bioenergetic and Bioelectric Systems, Biomedical Engineering Faculty, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yael Yaniv
- Laboratory of Bioenergetic and Bioelectric Systems, Biomedical Engineering Faculty, Technion-Israel Institute of Technology, Haifa, Israel
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Abstract
Cardiac arrhythmias can follow disruption of the normal cellular electrophysiological processes underlying excitable activity and their tissue propagation as coherent wavefronts from the primary sinoatrial node pacemaker, through the atria, conducting structures and ventricular myocardium. These physiological events are driven by interacting, voltage-dependent, processes of activation, inactivation, and recovery in the ion channels present in cardiomyocyte membranes. Generation and conduction of these events are further modulated by intracellular Ca2+ homeostasis, and metabolic and structural change. This review describes experimental studies on murine models for known clinical arrhythmic conditions in which these mechanisms were modified by genetic, physiological, or pharmacological manipulation. These exemplars yielded molecular, physiological, and structural phenotypes often directly translatable to their corresponding clinical conditions, which could be investigated at the molecular, cellular, tissue, organ, and whole animal levels. Arrhythmogenesis could be explored during normal pacing activity, regular stimulation, following imposed extra-stimuli, or during progressively incremented steady pacing frequencies. Arrhythmic substrate was identified with temporal and spatial functional heterogeneities predisposing to reentrant excitation phenomena. These could arise from abnormalities in cardiac pacing function, tissue electrical connectivity, and cellular excitation and recovery. Triggering events during or following recovery from action potential excitation could thereby lead to sustained arrhythmia. These surface membrane processes were modified by alterations in cellular Ca2+ homeostasis and energetics, as well as cellular and tissue structural change. Study of murine systems thus offers major insights into both our understanding of normal cardiac activity and its propagation, and their relationship to mechanisms generating clinical arrhythmias.
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Affiliation(s)
- Christopher L-H Huang
- Physiological Laboratory and the Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
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Volland C, Bremer S, Hellenkamp K, Hartmann N, Dybkova N, Khadjeh S, Kutschenko A, Liebetanz D, Wagner S, Unsöld B, Didié M, Toischer K, Sossalla S, Hasenfuß G, Seidler T. Enhanced cardiac TBC1D10C expression lowers heart rate and enhances exercise capacity and survival. Sci Rep 2016; 6:33853. [PMID: 27667030 PMCID: PMC5036039 DOI: 10.1038/srep33853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 09/05/2016] [Indexed: 11/21/2022] Open
Abstract
TBC1D10C is a protein previously demonstrated to bind and inhibit Ras and Calcineurin. In cardiomyocytes, also CaMKII is inhibited and all three targeted enzymes are known to promote maladaptive cardiomyocyte hypertrophy. Here, in accordance with lack of Calcineurin inhibition in vivo, we did not observe a relevant anti-hypertrophic effect despite inhibition of Ras and CaMKII. However, cardiomyocyte-specific TBC1D10C overexpressing transgenic mice exhibited enhanced longevity. Ejection fraction and exercise capacity were enhanced in transgenic mice, but shortening of isolated cardiomyocytes was not increased. This suggests longevity resulted from enhanced cardiac performance but independent of cardiomyocyte contractile force. In further search for mechanisms, a transcriptome-wide analysis revealed expressional changes in several genes pertinent to control of heart rate (HR) including Hcn4, Scn10a, Sema3a and Cacna2d2. Indeed, telemetric holter recordings demonstrated slower atrial conduction and significantly lower HR. Pharmacological reduction of HR was previously demonstrated to enhance survival in mice. Thus, in addition to inhibition of stress signaling, TBC1D10C economizes generation of cardiac output via HR reduction, enhancing exercise capacity and survival. TBC1D10C may be a new target for HR reduction and longevity.
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Affiliation(s)
- Cornelia Volland
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Sebastian Bremer
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Kristian Hellenkamp
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Nico Hartmann
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Nataliya Dybkova
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Sara Khadjeh
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Anna Kutschenko
- Department of Clinical Neurophysiology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - David Liebetanz
- Department of Clinical Neurophysiology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Bernhard Unsöld
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Michael Didié
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
- Institute of Pharmacology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Samuel Sossalla
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pulmonology, Georg-August-University, Robert-Koch Str. 40, 37075 Göttingen, Germany
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Heusser K, Tank J, Brinkmann J, Schroeder C, May M, Großhennig A, Wenzel D, Diedrich A, Sweep FCGJ, Mehling H, Luft FC, Jordan J. Preserved Autonomic Cardiovascular Regulation With Cardiac Pacemaker Inhibition: A Crossover Trial Using High-Fidelity Cardiovascular Phenotyping. J Am Heart Assoc 2016; 5:e002674. [PMID: 26764413 PMCID: PMC4859385 DOI: 10.1161/jaha.115.002674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/03/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sympathetic and parasympathetic influences on heart rate (HR), which are governed by baroreflex mechanisms, are integrated at the cardiac sinus node through hyperpolarization-activated cyclic nucleotide-gated channels (HCN4). We hypothesized that HCN4 blockade with ivabradine selectively attenuates HR and baroreflex HR regulation, leaving baroreflex control of muscle sympathetic nerve activity intact. METHODS AND RESULTS We treated 21 healthy men with 2×7.5 mg ivabradine or placebo in a randomized crossover fashion. We recorded electrocardiogram, blood pressure, and muscle sympathetic nerve activity at rest and during pharmacological baroreflex testing. Ivabradine reduced normalized HR from 65.9±8.1 to 58.4±6.2 beats per minute (P<0.001) with unaffected blood pressure and muscle sympathetic nerve activity. On ivabradine, cardiac and sympathetic baroreflex gains and blood pressure responses to vasoactive drugs were unchanged. Ivabradine aggravated bradycardia during baroreflex loading. CONCLUSIONS HCN4 blockade with ivabradine reduced HR, leaving physiological regulation of HR and muscle sympathetic nerve activity as well as baroreflex blood pressure buffering intact. Ivabradine could aggravate bradycardia during parasympathetic activation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00865917.
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Affiliation(s)
- Karsten Heusser
- Institute of Clinical PharmacologyHannover Medical SchoolHannoverGermany
| | - Jens Tank
- Institute of Clinical PharmacologyHannover Medical SchoolHannoverGermany
| | - Julia Brinkmann
- Institute of Clinical PharmacologyHannover Medical SchoolHannoverGermany
| | | | - Marcus May
- Institute of Clinical PharmacologyHannover Medical SchoolHannoverGermany
| | - Anika Großhennig
- Institute of BiostatisticsHannover Medical SchoolHannoverGermany
| | - Daniela Wenzel
- Institute of BiostatisticsHannover Medical SchoolHannoverGermany
| | - André Diedrich
- Division of Clinical PharmacologyDepartment of MedicineAutonomic Dysfunction ServiceVanderbilt UniversityNashvilleTN
| | - Fred C. G. J. Sweep
- Department of Laboratory MedicineRadboud University Medical CentreNijmegenThe Netherlands
| | - Heidrun Mehling
- Experimental Clinical Research CenterCharité Medical Faculty and Max Delbrück Center for Molecular MedicineBerlinGermany
| | - Friedrich C. Luft
- Experimental Clinical Research CenterCharité Medical Faculty and Max Delbrück Center for Molecular MedicineBerlinGermany
| | - Jens Jordan
- Institute of Clinical PharmacologyHannover Medical SchoolHannoverGermany
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8
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Abstract
Optimal cardiac function depends on proper timing of excitation and contraction in various regions of the heart, as well as on appropriate heart rate. This is accomplished via specialized electrical properties of various components of the system, including the sinoatrial node, atria, atrioventricular node, His-Purkinje system, and ventricles. Here we review the major regionally determined electrical properties of these cardiac regions and present the available data regarding the molecular and ionic bases of regional cardiac function and dysfunction. Understanding these differences is of fundamental importance for the investigation of arrhythmia mechanisms and pharmacotherapy.
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Affiliation(s)
- Daniel C Bartos
- Department of Pharmacology, University of California Davis, Davis, California, USA
| | - Eleonora Grandi
- Department of Pharmacology, University of California Davis, Davis, California, USA
| | - Crystal M Ripplinger
- Department of Pharmacology, University of California Davis, Davis, California, USA
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9
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Hund TJ, Mohler PJ. Role of CaMKII in cardiac arrhythmias. Trends Cardiovasc Med 2014; 25:392-7. [PMID: 25577293 DOI: 10.1016/j.tcm.2014.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
Abstract
Protein phosphorylation is a central mechanism in vertebrates for the regulation of signaling. With regard to the cardiovascular system, phosphorylation of myocyte targets is critical for the regulation of excitation contraction coupling, metabolism, intracellular calcium regulation, mitochondrial activity, transcriptional regulation, and cytoskeletal dynamics. In fact, pathways that tune protein kinase signaling have been a mainstay for cardiovascular therapies for the past 60 years. The calcium/calmodulin-dependent protein kinase II (CaMKII) is a multifunctional serine/threonine kinase with numerous roles in human physiology. Dysfunction in CaMKII-based signaling has been linked with a host of cardiovascular phenotypes including heart failure and arrhythmia, and CaMKII levels are elevated in human and animal disease models of heart disease. While nearly a decade has been invested in targeting CaMKII for the treatment of heart failure and arrhythmia phenotypes, to date, approaches to target the molecule for antiarrhythmic benefit have been unsuccessful for reasons that are still not entirely clear, although (1) lack of compound specificity and (2) the multitude of downstream targets are likely contributing factors. This review will provide an update on current pathways regulated by CaMKII with the goal of illustrating potential upstream regulatory mechanisms and downstream targets that may be modulated for the prevention of cardiac electrical defects. While the review will cover multiple aspects of CaMKII dysfunction in cardiovascular disease, we have given special attention to the potential of CaMKII-associated late Na(+) current as a novel therapeutic target for cardiac arrhythmia.
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Affiliation(s)
- Thomas J Hund
- The Dorothy M. Davis Heart & Lung Research Institute, OH; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus, OH
| | - Peter J Mohler
- The Dorothy M. Davis Heart & Lung Research Institute, OH; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH.
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10
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Grandi E, Edwards AG, Herren AW, Bers DM. CaMKII comes of age in cardiac health and disease. Front Pharmacol 2014; 5:154. [PMID: 25071573 PMCID: PMC4080132 DOI: 10.3389/fphar.2014.00154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/12/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eleonora Grandi
- Department of Pharmacology, University of California, Davis Davis, CA, USA
| | - Andrew G Edwards
- Institute for Experimental Medicine, Oslo University Hospital Ullevål Oslo, Norway ; Simula Research Laboratory Lysaker, Norway
| | - Anthony W Herren
- Department of Pharmacology, University of California, Davis Davis, CA, USA
| | - Donald M Bers
- Department of Pharmacology, University of California, Davis Davis, CA, USA
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Vincent KP, McCulloch AD, Edwards AG. Toward a hierarchy of mechanisms in CaMKII-mediated arrhythmia. Front Pharmacol 2014; 5:110. [PMID: 24994983 PMCID: PMC4062880 DOI: 10.3389/fphar.2014.00110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/25/2014] [Indexed: 12/16/2022] Open
Abstract
Calcium/calmodulin-dependent protein kinase II (CaMKII) activity has been shown to contribute to arrhythmogenesis in a remarkably broad range of cardiac pathologies. Several of these involve significant structural and electrophysiologic remodeling, whereas others are due to specific channelopathies, and are not typically associated with arrhythmogenic changes to protein expression or cellular and tissue structure. The ability of CaMKII to contribute to arrhythmia across such a broad range of phenotypes suggests one of two interpretations regarding the role of CaMKII in cardiac arrhythmia: (1) some CaMKII-dependent mechanism is a common driver of arrhythmia irrespective of the specific etiology of the disease, or (2) these different etiologies expose different mechanisms by which CaMKII is capable of promoting arrhythmia. In this review, we dissect the available mechanistic evidence to explore these two possibilities and discuss how the various molecular actions of CaMKII promote arrhythmia in different pathophysiologic contexts.
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Affiliation(s)
- Kevin P Vincent
- Department of Bioengineering, University of California San Diego La Jolla, CA, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego La Jolla, CA, USA ; Department of Medicine, University of California San Diego La Jolla, CA, USA
| | - Andrew G Edwards
- Department of Bioengineering, University of California San Diego La Jolla, CA, USA ; Institute for Experimental Medicine, Oslo University Hospital Ullevål Oslo, Norway ; Simula Research Laboratory Lysaker, Norway
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