Electrophysiological remodeling in tachycardia-induced cardiomyopathy

Background

Tachycardia-induced cardiomyopathy (TCM) is a reversible and likely underrecognized form of heart failure. Thus, a better understanding of the TCM-pathophysiology is warranted as the underlying early mechanisms that mediate the progression of TCM remain unclear.

Purpose

This study aimed to identify the cellular mechanisms of TCM.

Methods and results

Human induced pluripotent stem cell cardiomyocytes (iPSC-CM) were utilized as a translational human-based model. We performed chronic tachycardic (120 bpm) or normofrequent (control, 60bpm) cell culture pacing to study cellular changes during TCM progression.

Already after 24h of tachycardic stimulation of iPSC-CM, we detected a decrease in Ca transient amplitude compared to control (Fura-2, n=49/44 cells/9 differentiations). Diastolic Ca levels and cytosolic Ca elimination were not affected after 24h of tachycardia (n=49/44/9). We detected no difference in sarcoplasmic reticulum (SR) Ca load (assessed via caffeine application) or SERCA activity (Ksys-Kcaff) after 24h of tachycardia (n=13/15/5). However, demonstrating the progress of TCM, 7d of tachycardia resulted in progressive decline of Ca transient amplitude together with an impaired Ca elimination, while diastolic Ca concentration was unchanged (n=73/66/8). These changes may underlie the reduced systolic force and impaired relaxation in TCM. We could explain these results by a significantly reduced SR Ca load and a diminished SERCA activity after 7d tachycardia (n=13/7 vs. 13/4). Using confocal microscopy (Fluo-4) we detected no difference in SR Ca spark frequency after 24h of tachycardia (n=82/66/8), while 7d of tachycardia caused an increase of Ca spark frequency (n=76/79/7), which is a typical hallmark of maladaptive remodeling in HF and likely underlie the reduced SR Ca load. Voltage clamp data of late Na current (INaL) showed no difference in INaL after 24h of stimulation (n=17/6 vs. 19/7), whereas INaL was increased after 7d of tachycardia (n=26/7 vs. 19/6). Accordingly, whole-cell current clamp experiments revealed a prolongation of the action potential after 7d of tachycardia compared to control (n=21/6 vs. 19/5), while no difference of action potential duration could be detected after 24h (n=37/31/8). Resting membrane potential and action potential amplitude were not changed. Finally, we investigated tachycardia-mediated effects on explanted human failing hearts. 8h of tachycardic stimulation (120 bpm) of human failing ventricular trabeculae already compromised systolic force, and diastolic tension and relaxation time were markedly increased compared to control (60bpm, n=8/6 trabeculae /7/6 human hearts).

Conclusion

This study demonstrates that persistent tachycardia adversely alters cardiomyocyte excitation-contraction coupling via electrophysiological cellular remodeling. Our translational investigation in human myocardium may help to understand the pathophysiology of an underrated but prevalent disease.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Else Kröner-Fresenius-Stiftung (EKFS)Deutsche Gesellschaft für Innere Medizin

Effects of atrial fibrillation on ventricular remodeling in the human heart

 

Atrial fibrillation (AF) is often found in patients with heart failure (HF). Clinical data indicated that the arrhythmic component of AF alone could contribute to left-ventricular (LV) dysfunction. However, the effects of non-tachycardic AF with arrhythmic excitation of the human LV, are unknown.

We investigated human LV myocardium from patients with sinus rhythm (SR) or normofrequent AF (mean EF>50%, matched clinical data, derived from septal resections during AVR). In histological analysis we detected no difference between SR (n=17 patients) and AF patients (n=18) regarding the amount and distribution of fibrosis. We isolated human LV cardiomyocytes (CM) and studied cellular Ca-handling (Fura-2). Systolic Ca-transient amplitude of LV CM was reduced in patients suffering from AF (n=8 AF patients vs. 11 SR), while diastolic Ca-levels and Ca-transient kinetics were not significantly changed. These results were confirmed in LV CM from non-failing donors (NF) with AF (n=4 AF patients vs. 8 SR). For the standardized investigation of a normofrequent arrhythmia, we simulated AF in vitro by using arrhythmic (60 bpm, 40% beat-to-beat variability) or rhythmic (60 bpm) field stimulation. Human LV CM from NF SR patients (n=8) showed an impaired Ca-transient amplitude after 24h arrhythmic culture pacing without changes in diastolic Ca and Ca-transient kinetics. For studying a model suitable for more standardized chronic pacing, we utilized human iPSC cardiomyocytes (iPSC-CM) from healthy donors (n=6). After 7 days, arrhythmically paced iPSC-CM exhibited a reduced systolic Ca-transient amplitude, a trend towards a prolonged Ca-elimination time and a reduced sarcoplasmic reticulum Ca-load. Confocal line-scans of arrhythmically paced cells (Fluo-4 AM) showed an increased diastolic Ca-leak from the sarcoplasmic reticulum, possibly underlying the reduced Ca-load. Coupled with the Ca changes, cytosolic Na was elevated after arrhythmia. We found an increased late INa, which could explain the detrimentally altered Ca/Na-interplay. Accordingly, Patch-clamp experiments revealed a prolonged action potential duration after arrhythmia. We further elucidated the underlying mechanisms of this electrophysiological remodeling by showing that oxidative stress (H2O2, LPO) is increased in the LV of patients suffering from AF (n=6 AF patients vs. 6 SR), which was associated with an enhanced NOX2/-4 activity. Consecutively, Ca2+/calmodulin-dependent protein kinase IIδ (CaMKII) was found to be more oxidized (CaMKII-Met281/282) in the LV of AF patients (n=7 AF patients vs. 7 SR) leading to an increased CaMKII activity, which adversely regulated EC-coupling protein phosphorylation including RyR2 hyperphosphorylation.

Normofrequent arrhythmia/AF impairs human ventricular EC-coupling via increased oxidative stress and enhanced CaMKII. Thus, this translational study provides the first mechanistic characterization and the potential negative impact of isolated AF on the human LV.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Else Kröner-Fresenius-Stiftung (EKFS) and Deutsche Gesellschaft für Innere Medizin

Atrial fibrillation impairs ventricular function by altering excitation-contraction coupling in the human heart

 

Atrial fibrillation (AF) often co-exists in patients with heart failure (HF). Recent clinical evidence suggests that the arrhythmic component of AF alone may contribute to ventricular dysfunction. However, the pathophysiological effects of a non-tachycardic AF on the human ventricle are unknown. To investigate the effects of normofrequent AF on the human ventricle we investigated ventricular myocardium from patients with preserved ejection fraction with sinus rhythm (SR) or AF in the absence of HF (compensated hypertrophy, EF>50%, matched clinical characteristics). In histological analysis we detected no difference between SR (n=9) vs. AF (n=6) regarding the amount and distribution of fibrosis. For functional investigation, Ca-handling was studied (Fura-2 AM). While systolic Ca-transient amplitude was in trend reduced in isolated human ventricular AF cardiomyocytes, we found a significantly prolonged Ca-elimination time (n=17–22 cells/4 pat.). Using caffeine application, a decreased SR Ca-load in AF was detected, which may be explained by a significant decrease in SERCA2a activity (ksys-kCaff, n=10–12/4 pat.). Patch-clamp experiments revealed a prolonged action potential duration in AF cardiomyocytes (n=5/15 cells).

For the standardized evaluation of the mechanisms of persistent normofrequent arrhythmia, we simulated AF in vitro by using arrhythmic (1 Hz, 40% R-R-variability) or rhythmic (1 Hz) field stimulation. We performed contractility experiments using in-toto isolated human ventricular trabeculae from explanted human hearts. After 8h of pacing, arrhythmically stimulated human trabeculae showed a significantly reduced systolic force, an increase in diastolic tension and a prolonged relaxation (n=11–12 trabeculae/11 pat.). For studying the cellular effects of persistent normofrequent arrhythmia in a model suitable for chronic pacing (up to 7 days), we utilized human iPSC cardiomyocytes (iPSC-CM) from healthy donors (n=6). After 7 days, arrhythmic paced iPSC-CM showed a significantly reduced systolic Ca-transient amplitude, a prolonged Ca-elimination time (n=35/45 cells) as well as a reduced SR Ca-load and a trend towards a lower SERCA2a activity compared to control (n=11 cells). Confocal line-scans (Fluo-4 AM) showed an increased diastolic SR Ca-release, which might also explain the reduced SR Ca-content (n=45/35 cells). Moreover, in irregularly paced iPSC-CM we found significant increased levels of cytosolic Na (n=69 cells each) and in patch-clamp experiments a significantly prolonged action potential duration (n=14/11 cells/3 diff.).

This study demonstrates that a normofrequent arrhythmic ventricular excitation as it occurs in AF impairs human ventricular myocardial function by altering cardiomyocyte excitation-contraction coupling. Thus, this study provides the first translational mechanistic characterization and the potential negative impact of isolated AF in the absence of tachycardia on the human ventricle.

Funding Acknowledgement

Type of funding source: None

Cellular mechanisms of early tachycardia-induced ventricular dysfunction in the human heart

Background

Tachycardia-induced cardiomyopathy (TCM) is a reversible form of ventricular dysfunction caused by persistent tachycardia. Characterization of TCM is mainly based on artificially RV paced animal models. Moreover, the underlying mechanisms and time course from compensation to failure remain unclear. This study aimed to investigate early cellular remodeling of tachycardia-induced myocardial dysfunction in human myocardium.

Methods and results

To elucidate early cellular electrophysiological targets mediating the transition to TCM, we chronically paced (120bpm vs 60bpm control) human induced pluripotent stem cell cardiomyocytes (hiPS-CM) for up to 7d. As a major substrate of cellular myocardial dysfunction, we investigated the influence of chronic tachycardia on cellular Ca cycling. After 24h of persistent tachycardia we detected a significant decrease in Ca transient (CaT) amplitude and reduced diastolic Ca levels (Fura-2). Meanwhile, Ca elimination time (RT80) was unchanged compared to control (n=44/42 cells / 8 diff.). Caffeine application was performed to evaluate sarcoplasmic reticulum (SR) Ca load. We found a shortening of caffeine-induced CaT relaxation time, whereas SR Ca load was unchanged (n=12/13 /8). Further illustrating the transition to TCM, CaT amplitude was progressively decreased after 7d of chronic tachycardia. In contrast to 24h of tachycardia, 7d persistent stimulation resulted in slowed relaxation (RT80, n=75/65 /7). These findings could be explained by a significant reduction of SERCA activity (Ksys-Kcaff) and SR Ca load (n=14/12 / 7). Diastolic Ca concentration remained reduced (n=75/65 /7), in total suggesting a shift to transsarcolemmal Ca elimination.

Sodium measurements (SBFI) revealed a significant increase of intracellular sodium concentration (n=69/69 /5) after 7d of tachycardia.

In patch clamp experiments we detected a prolongation of action potential duration as early as 24h after onset of tachycardia (n=26/21 /4), which persisted throughout 7d of pacing (n=8/12 /3). Resting membrane potential and action potential amplitude were not changed.

Finally, we investigated tachycardia-mediated effects on pre-existing human heart failure (HF). 8h tachycardic stimulation (120bpm) of human HF ventricular trabeculae compromised systolic force, while diastolic tension and relaxation time were markedly increased compared to control (60bpm) (n=7/6 trabeculae /6 human hearts).

The extensive molecular characterization of involved ion channels and pathways mediating transition to TCM is currently under investigation.

Conclusion

This study demonstrates that a persistent tachycardia adversely alters cardiomyocyte excitation-contraction coupling via early electrophysiological cellular remodeling. In pre-existing HF persistent tachycardia strongly aggravates ventricular dysfunction. Our first translational investigation in human myocardium may help to understand the pathophysiology of an underrated and very prevalent disease.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Else-Kröner-Fresenius-Stiftung

4967Effects of atrial fibrillation on the human ventricle

Background

The consequence of normofrequent atrial fibrillation (AF) on the ventricle remains largely unknown.

Methods and results

To elucidate the effects of arrhythmic excitation on human ventricular myocardium we performed contractility experiments using ventricular trabecula from patients with heart failure (HF). Normofrequent AF was simulated using arrhythmic (60 bpm, 40% R-R interval variability) or rhythmic field stimulation (60 bpm). Within 8h of arrhythmic stimulation, human specimen showed an impaired systolic force, while diastolic tension increased pathologically (n=5–7 each/7 HF patients, Fig. 1). The characterization of the ventricular (in-vivo) phenotype in patients with AF was performed by utilizing ventricular myocardium from patients with sinus rhythm (SR) and from patients with AF in the absence of HF (compensated hypertrophy, EF>50%, matched clinical characteristics, LV myocardium obtained from aortic valve replacement surgery). Histological investigation showed increased levels of interstitial fibrosis in myocardium from patients with AF compared to SR (n=10 patients each). Studies of cellular Ca-homeostasis (epifluorescence microscopy, Fura-2) were performed using isolated human ventricular cardiomyocytes. While systolic Ca-transient amplitude (0.5 Hz) was preserved in ventricular cardiomyocytes from patients with AF, we found a significantly prolonged Ca-elimination time (RT80) by 22.0±7.7% and a trend towards increased diastolic Ca-levels (n=17–23 cells/4 patients each). This finding may be explained by a decrease in SERCA2a activity (ksys-kCaff, n=10–12/4 each) and an enhanced phospholamban expression in Western Blot experiments (n=5 patients each). For the standardized investigation of the involved targets/mechanisms mediating the pathological changes upon arrhythmic excitation, we utilized human induced pluripotent stem cell cardiomyocytes (iPSC-CM) from healthy donors for chronic arrhythmic culture stimulation (24h). Arrhythmic paced iPSC-CM showed no changes in systolic Ca-transient amplitude (0.5 Hz), whereas diastolic Ca-levels were increased, which fits nicely to the finding of disturbed trabeculae diastolic function (n=15 cells each). In patch clamp experiments, arrhythmic paced cells showed no alterations of resting membrane potential, upstroke velocity, action-potential amplitude or -duration (n=7–9 cells each). Protein expression levels of key Ca-handling proteins in iPSC-CM as well as regulated genes are already under investigation.

Conclusion

This study demonstrates that arrhythmic ventricular excitation deteriorates human myocardial contractility early in HF. In biopsies from patients with preserved EF, chronic AF was associated with increased levels of interstitial fibrosis and pathological diastolic Ca-handling, which could be causally confirmed in chronically arrhythmic paced iPSC-CM. Therefore, this study provides first mechanistic characterization of AF mediated effects on the human ventricle.

[Hypothyroidism and endocrine orbitopathy]

The 34-year old woman, by profession a farmer, presented herself with the symptoms of hypothyroidism, which were confirmed by laboratory investigations. Chronic autoimmune thyroiditis was assumed due to the constellation of primary hypothyroidism in association with elevated thyroid autoantibodies. Substitution with levothyroxine induced a full clinical recovery, but persistent hyperthyroidism occurred even after discontinuation of levothyroxine treatment. Mild ophthalmopathy developed and Graves disease was diagnosed. The primary manifestation of Graves' disease with hypothyroidism was caused by blocking TSH receptor antibodies. Chronic autoimmune thyroiditis, Graves' disease and the importance of thyroid autoantibodies are discussed.

Tumor-related angiogenesis

In recent years, tumor-related angiogenesis has become an important field of research in oncology. It could be stated that growth of solid tumors is completely dependent on neovascularization to provide the tumor with all required nutrients. Special compounds (tumor angiogenesis factor[s]) are released by tumor cells into the environment to stimulate different types of normal cells to become active for the tumor. In particular, endothelial cells of neighboring capillaries are induced to react. They disintegrate their own basal lamina, detach from their neighbors, enter the extracellular matrix, and migrate toward the tumor mass. Cell divisions occur within such sprouts, thereby increasing the number of migrating endothelial cells. Strands of such cells are formed, and inter- and intracellular lumina develop. Loops of these hollow strands anastomose to form a network of new vessels which become connected with the blood circulation. The tumor mass thus becomes vascularized and can continue to grow. The prevention of neoangiogenesis has an enormous impact on cancer treatment by inhibiting the growth of the tumor. In this review, all important aspects of tumor-related angiogenesis are presented.

Fractionation of synaptophysin-containing vesicles from rat brain and cultured PC12 pheochromocytoma cells

Synaptophysin is a transmembrane glycoprotein of neuroendocrine vesicles. Its content and distribution in subcellular fractions from cultured PC12 cells, rat brain and bovine adrenal medulla were determined by a sensitive dot immunoassay. Synaptophysin-containing fractions appeared as monodispersed populations similar to synaptic vesicles in density and size distribution. Membranes from synaptic vesicles contained approximately 100-times more synaptophysin than chromaffin granules. In conclusion, synaptophysin is located almost exclusively in vesicles of brain and PC12 cells which are distinct from dense core granules.

Electrotransfer of proteins after isoelectric focusing (with or without urea) on fabric-reinforced, immobilized pH gradient gels

In the present article a procedure is described which combines the horizontal isoelectric focusing (IEF) of proteins on fabric-reinforced polyacrylamide gels with the subsequent electrophoretic transfer of the proteins to nitrocellulose or Immobilon. The application of a carrier material that is permeable for current and molecules and that serves as a physical support of the IEF gel is one of the central prerequisites for the method to work. Moreover, it is important to fix the pH gradient topographically by the use of Immobilines mainly in order to avoid distortion of the protein pattern during the electrotransfer (Western blot). The Western blot can be performed either in the submerse or in the so-called "semi-dry" blotting system. Our procedure is compatible with IEF protocols employing buffer systems with or without urea. The efficacy of our method is demonstrated by the IEF and Western blotting of several known marker proteins.

Tumor-related reconstitutive vascularization. An ultrastructural study

The nonmetastatic derivative of the pancreatic adenocarcinoma BSp73 of the BDX rat, BSp73 AS (AS), was used to generate solid lung colonies by the intravenous route. Vascularization could be seen within the tumor nodules and in the surrounding, highly disorganized lung tissue. We concentrate here on the formation of capillaries in the surroundings of pulmonary AS foci. The formation of capillary lumina can be described as follows: first, a lumen is formed between an endothelial cell (EC) and its basal lamina (BL) by partial detachment of the EC. The denuded BL is then re-coated by EC protrusions until the lumen is newly lined. A similar process is observed at the abluminal surface of ECs of vessels just beneath the surface of alveolar lumina. In this case, ECs detach from their BL and generate stilts, thus bulging adluminally. The naked BL is then recoated by EC protrusions. Finally, small closed lumina are formed by the ECs. These events occurring during vascularization are interpreted as morphogenetic reactions of normal cells to tumor-derived stimuli. Vascularization of this kind takes place within peritumoral, disturbed alveolar tissue and appears to be aimed at reconstituting a normal alveolar histology in order to overcome the destruction caused by the tumor. In this study we show the highly complex reactions between normal and neoplastic tissue.

Ultrastructural analysis of experimentally induced invasion in the rat lung by tumor cells metastasizing lymphatically

The colonization of the lung by the rat tumor cells BSp73 ASML which have the ability to metastasize via the lymphatic system was studied at the ultrastructural level. Tumor cells arriving in the lung after i.v. injection become transiently embolized; within hours, however, they begin to extravasate from the blood capillaries. Swelling cellular protrusions open a limited area between endothelium and basal lamina through which tumor cells erupt. Tumor cells then form metastases in the interstitial tissue and, in an apparently lymphotropic action, intravasate the lymphatic vessels in a similar manner to a reverse diapedesis-like process. Within the lympatic system they settle, spread, and build up extensive tumor foci particularly in the subpleural region.

Ultrastructural studies on the lung colonization by nonmetastatic rat tumor cells

The events during the settlement of BSp73AS (AS) tumor cells in the syngeneic rat lung are described. Although AS cells show highly invasive behavior in vitro, subcutaneous primary tumors grow solidly without detectable metastatic spreading. However, AS cells when applied to the syngeneic rats via the tail vein give rise to lung colonies which grow rapidly at the site of the cells' primary arrest in the capillaries. The colonization comprises formation of microemboli, penetration of the endothelium including the basal lamina, and invasion of the lung tissue. Within two weeks, large colonies develop, thereby compressing, invading, and destroying their surroundings without detectable preference in direction. This establishment of AS tumors in the lung reflects the high invasive potential of AS cells and displays many of the morphological features observed during the formation of colonies of metastatic cell lines. Thus, we conclude that a nonmetastatic tumor cell line, such as AS, may possess almost the whole set of properties necessary for successful metastasis.