Chronic atrial fibrillation alters the functional properties of If in the human atrium.

INTRODUCTION: Despite the evidence that the hyperpolarization-activated current (If) is highly modulated in human cardiomyopathies, no definite data exist in chronic atrial fibrillation (cAF). We investigated the expression, function, and modulation of If in human cAF. METHODS AND RESULTS: Right atrial samples were obtained from sinus rhythm (SR, n = 49) or cAF (duration >1 year, n = 31) patients undergoing corrective cardiac surgery. Among f-channel isoforms expressed in the human atrium (HCN1, 2 and 4), HCN4 mRNA levels measured by RT-PCR were significantly reduced. However, protein expression was preserved in cAF compared to SR (+85% for HCN4); concurrently, miR-1 expression was significantly reduced. In patch-clamped atrial myocytes, current-specific conductance (gf) was significantly increased in cAF at voltages around the threshold for If activation (-60 to -80 mV); accordingly, a 10-mV rightward shift of the activation curve occurred (P < 0.01). ß-Adrenergic and 5-HT4 receptor stimulation exerted similar effects on If in cAF and SR cells, while the ANP-mediated effect was significantly reduced (P < 0.02), suggesting downregulation of natriuretic peptide signaling. CONCLUSIONS: In human cAF modifications in transcriptional and posttranscriptional mechanisms of HCN channels occur, associated with a slight yet significant gain-of-function of If , which may contribute to enhanced atrial ectopy.

Molecular basis of funny current (If) in normal and failing human heart.

I(f) overexpression has been functionally demonstrated in ventricular myocytes from failing human hearts. Altered expression of I(f)-channels as a consequence of electrophysiological remodeling may represent an arrhythmogenic mechanism in heart failure; however, the molecular basis of I(f) overexpression in human cardiac disease is unknown. HCN1, 2 and 4 subtypes, which encode I(f)-channels, have been identified in the heart. The present study was designed to characterize HCN isoform expression in failing and non-failing hearts. Ventricular and atrial samples were obtained from normal or failing hearts explanted from patients with end-stage ischemic cardiomyopathy. I(f) was recorded in patch-clamped left ventricular myocytes. mRNA and protein expression of HCN subunits were measured in both atria and ventricles of control and diseased hearts. HCN2 and HCN4 were detected in human myocardium. Both mRNA and protein levels of HCN2/4 were significantly augmented in failing ventricles (p<0.01 for mRNA, p<0.05 for protein). These results are consistent with the electrophysiological data showing that, in failing ventricular myocytes, I(f) is of larger amplitude and activates at less negative potential. Changes in mRNA and protein expression of both HCN2/4 isoforms in atrial specimens from patients with heart failure mirrored those observed in ventricles (p<0.001 for mRNA, p<0.05 for protein). No disease-dependent alteration was detected for MiRP1, the putative beta-subunit of the I(f)-channel. In conclusion, HCN4 is the predominant channel subtype in normal human heart, and its expression is further amplified by disease. HCN upregulation likely contributes to increased I(f) and may play a role in ventricular and atrial arrhythmogenesis in heart failure.

Importancia de los ácidos grasos omega-3 en la prevención secundaria del infarto agudo de miocardio / Importance of omega-3 fatty acids in the secondary prevention of acute myocardial infarction

Desde la década de los sesenta, las simples observaciones de los hábitos alimentarios indicaban que los ácidos grasos poliinsaturados (AGPI) omega-3 podían ser beneficiosos para la prevención cardiovascular, tanto en los modelos animales como humanos. El efecto más evidente y directo parecía ser el antiarrítmico, al estabilizar la electrofisiología cardiaca. Sin embargo, con posterioridad se han investigado otros muchos efectos que han revelado otros posibles, y múltiples mecanismos de acción sobre diferentes objetivos celulares. De hecho, se ha demostrado la capacidad de estas moléculas para modular muchos de los procesos celulares y tisulares, como la inflamación, la proliferación celular, la migración, la apoptosis, etc. Por consiguiente, se plantearon diversas hipótesis para explicar los resultados observados y se diseñaron más estudios preclínicos y clínicos al respecto. En la actualidad disponemos de una gran cantidad de datos (epidemiológicos, experimentales y de ensayos clínicos) que han ido proporcionando gradualmente la base racional para el uso de estos compuestos en las enfermedades cardiovasculares, sobre todo en la prevención secundaria. Esta revisión pretende resumir las bases principales del conocimiento sobre los efectos de los AGPI omega-3, desde las observaciones epidemiológicas a los resultados de los ensayos clínicos, a través de los datos experimentales. Aunque ya hay una recomendación en las guías internacionales para el uso de los AGPI omega-3, aún se necesitan más investigaciones sobre su perfil de riesgo/beneficio y sus mecanismos de acción en diversos trastornos clínicos, como lo demuestra la existencia de muchos estudios clínicos en curso que aportarán nuevos datos en los próximos años (AU)

Since the 1970s, general observations of dietary habits in both animal models and humans have suggested that omega-3 polyunsaturated fatty acids might be beneficial in preventing cardiovascular disease. Their most apparent and direct action appears to be their antiarrhythmic effect, which involves the stabilization of cardiac electrophysiological activity. However, subsequent investigations into other actions have revealed that there may be numerous mechanisms of action affecting multiple cellular targets. In fact, it has been shown that these molecules are able to modulate many cellular and tissular processes, such as inflammation, and cell proliferation, migration and apoptosis. Consequently, several hypothesis have been proposed to explain these observations, with the result that better targeted preclinical and clinical studies have been designed. Today, a large body of evidence, from epidemiological, laboratory and clinical studies, is gradually expanding the rational basis for using these compounds in the treatment of cardiovascular disease, particularly for secondary prevention. The aim of this review was to summarize the range of findings that underlies our understanding of the effects of omega-3 polyunsaturated fatty acids, from epidemiological observations to the results of clinical trials, and including laboratory findings. Although recommendations on the use of these fatty acids are already included in international guidelines, it is important that their risk–benefit profile and mechanisms of action in various clinical conditions continue to be investigated, as is being done in many ongoing clinical studies, which should provide new data in coming years (AU)

Sinus node dysfunction and hyperpolarization-activated (HCN) channel subunit remodeling in a canine heart failure model.

BACKGROUND: The hyperpolarization-activated cation current I(f) contributes significantly to sinoatrial node pacemaker function and possibly to ectopic arrhythmogenesis. Little is known about the expression of corresponding hyperpolarization-activated cyclic nucleotide-gated (HCN) channel subunits in normal hearts and HCN remodeling by diseases, like congestive heart failure (CHF), associated with disturbances of cardiac rhythm. METHODS AND RESULTS: We assessed expression of HCN1, 2 and 4 in normal mongrel dogs and dogs subjected to 2-week ventricular tachypacing-induced CHF. Competitive RT-PCR, Western blot and immunohistochemistry were used to quantify HCN subunit mRNA and protein expression in the right atrium (RA) and sinoatrial node. CHF approximately doubled sinus node recovery time, indicating suppressed sinus node pacemaker function. HCN expression under control conditions was HCN4 > HCN2 >> HCN1. HCN2 and HCN4 expression was greater at both protein and mRNA levels in sinoatrial node than RA. CHF significantly decreased sinus node HCN expression at both mRNA and protein levels (HCN2 by 78% and 82%; HCN4 by 42% and 77%, respectively). RA HCN2 expression was unaltered by CHF, but HCN4 was significantly upregulated (by 209%). CONCLUSIONS: HCN4 is the dominant subunit in canine sinoatrial node and RA; strong sinus node HCN expression likely contributes to its pacemaker function; downregulation of HCN4 and HCN2 expression contribute to CHF-induced sinus node dysfunction; and upregulation of atrial HCN4 may help to promote atrial arrhythmia formation. These findings provide novel information about the molecular basis of normal and disease-related impairments of cardiac impulse formation.

Pharmacological modulation of the hyperpolarization-activated current (I f) in human atrial myocytes: focus on G protein-coupled receptors.

AIMS: In human atrial myocytes (HuAM) two beta-adrenergic receptors (beta-AR) and four splicing-variants of the serotonin 5-HT(4) receptor are present. Multiple coupling with G stimulatory (G(s)) and G inhibitory (G(i)) proteins has been proposed for both beta(2)-AR and 5-HT((4b)) subtypes, but no functional data exist in HuAM. Serotonin (5-HT) and catecholamines are able to trigger arrhythmias in human atrium, but the underlying cellular mechanisms are not completely understood. The pacemaker current (I(f)) is an inward Na(+)/K(+) current, constitutively present in HuAM and directly modulated by cAMP; I(f) could play a role in triggering human atrial arrhythmias. This study evaluated the different G protein coupling of beta(1)-AR, beta(2)-AR and 5-HT(4) receptors by assessing the modulation of I(f) by selective stimuli. METHODS: HuAM were isolated from right atrial appendages and utilized for patch-clamp recording. The coupling of receptor subtypes with G(i) proteins was tested by incubating HuAM in pertussis toxin (PTX). RESULTS: Beta(1)-AR stimulation (Isoprenaline [ISO] + ICI 118,551), and 5-HT caused a concentration-dependent significant shift of the half activation potential of I(f) activation curve (DeltaV(h)), P < 0.01. beta(2)-AR stimulation (ISO 1 microM + CGP 20712A) also significantly shifted V(h) (P < 0.0001), but with DeltaV(h)[beta(2)-AR] significantly smaller than the effect caused by 1 microM beta(1)-AR stimulation (P < 0.05). Pre-treatment of HuAM with PTX did not alter the effect of beta(1)-AR stimulation (both 0.1 and 1 microM) and 1 microM 5-HT on I(f), but significantly increased the effect in response to beta(2)-AR stimulation and 0.1 microM 5-HT (P < 0.05 for both), thus suggesting a G(i) protein coupling of these receptors. CONCLUSIONS: Our results provide the first functional evidence of the different G protein coupling of beta(1)-AR, beta(2)-AR and 5-HT(4) receptors in HuAM. Further they support the view that I(f) current might play an important role in triggering catecholamines and serotonin-induced atrial arrhythmias.

Atrial natriuretic peptide modulates the hyperpolarization-activated current (If) in human atrial myocytes.

OBJECTIVES: The relationship between atrial stretching and changes in cell excitability is well documented. Once stretched, human atrial myocytes (HuAM) release atrial natriuretic peptide (hANP). Receptors for hANP (NPR) are coupled to a guanylyl cyclase (GC) activity, and are present on HuAM, but the electrophysiological effects of hANP are largely unknown. We investigated the effect of hANP on If, the hyperpolarization-activated current present in HuAM, and the underlying intracellular pathway. METHODS: HuAM were isolated from atrial appendages and utilized for patch-clamp recording. RESULTS: hANP caused a significant and concentration dependent shift of the midpoint activation potential (DeltaVh) toward less negative potentials of 6.9 +/- 1.0 mV at 0.1 nM; 13.0 +/- 2.6 mV at 1 nM and 15.3 +/- 2.2 mV at 10 nM (p < 0.001 for all); a parallel increase of If rate of activation occurred. The effect of hANP was completely blocked by isatin, a potent antagonist of NPR (p < 0.01 vs. hANP). In the presence of the inhibitors of guanylyl cyclase (ODQ and LY83583), hANP caused a significantly smaller DeltaVh (p < 0.01 vs. hANP for both). 8Br-cGMP mimicked the effect of hANP, both in the presence and absence of KT5823, a selective inhibitor of Protein kinase G. Pretreatment with pertussis toxin (PTX) did not change the effect of hANP, thus excluding a major role for the coupling of NPR with the Gi-Proteins system. Pretreating cells with cyclopentyladenosine (CPA), an A1-adenosine receptor agonist, completely blocked hANP effect. Adding hANP to maximal serotonin concentration produced an additive response. CONCLUSIONS: Our data demonstrate for the first time that ANP is able to increase If, likely through a modulation of intracellular cGMP and cAMP levels. This effect could have implications in the relationship between stretch and arrhythmogenesis in the human atrium.

Restoration of cardiomyocyte functional properties by angiotensin II receptor blockade in diabetic rats.

Recent evidence suggests that blockade of the renin-angiotensin system ameliorates diabetes-induced cardiac dysfunction, but the mechanisms involved in this process remain elusive. We investigated the effect of treatment with an angiotensin II receptor blocker, losartan, on the metabolic and electrophysiological properties of cardiomyocytes isolated from streptozotocin-induced diabetic (STZ) rats. Glucose uptake and electrophysiological properties were measured in ventricular cardiomyocytes from normoglycemic and STZ-induced diabetic rats given vehicle or 20 mg x kg(-1) x day(-1) losartan for 8 weeks. Insulin and beta-adrenergic stimulation failed to increase the glucose uptake rate in STZ cardiomyocytes, whereas the alpha-adrenergic effect persisted. Concurrently, a typical prolongation of action potential duration (APD) and a decrease of transient outward current (I(to)) were recorded in patch-clamped STZ myocytes. Treatment with losartan did not affect body weight or glycemia of diabetic or control animals. However, in losartan-treated STZ-induced diabetic rats, beta-adrenergic-mediated enhancement of glucose uptake was completely recovered. APD and I(to) were similar to those measured in losartan-treated control rats. A significant (P < 0.0001) correlation between metabolic and electrophysiological parameters was found in control, diabetic, and losartan-treated diabetic rats. Thus, angiotensin receptor blockade protects the heart from the development of cellular alterations typically associated with diabetes. These data suggest that angiotensin receptor blockers may represent a new therapeutic strategy for diabetic cardiomyopathy.

Prenatal exposure to carbon monoxide affects postnatal cellular electrophysiological maturation of the rat heart: a potential substrate for arrhythmogenesis in infancy.

BACKGROUND: Maternal smoking is an independent risk factor for sudden infant death syndrome (SIDS). Carbon monoxide (CO) is a major component of smoke. No information is available about the effect of CO and/or smoking on postnatal maturation of the heart. The aim of this study was to investigate the effect of prenatal exposure to CO on cellular electrophysiological maturation in male Wistar rats. METHODS AND RESULTS: The patch-clamp technique was used to measure action potential (AP) and ionic currents (I(to) and I(Ca,L)) from rat ventricular myocytes. During growth, AP duration measured at -20 and -50 mV (APD(-)(20) and APD(-)(50)) decreased progressively in both groups; the process was significantly delayed in rats exposed prenatally to 150 ppm CO: At 4 weeks, APD(-)(20) and APD(-)(50) were 89.5+/-18.2 and 147.7+/-24.5 ms in CO (n=13) and 35.6+/-4.5 and 77.8+/-8.3 ms in control rats (Ctr; n=14; P<0.01 and P<0.05, respectively) and normalized at 8 weeks. At 4 weeks, the density of I(Ca,L) was significantly higher (21.3+/-1.6 pA/pF, n=17, versus 15.9+/-1.6 pA/pF, n=22; P<0.05) and the density of I(to) significantly lower (9.6+/-1.5, n=22, versus 15.2+/-2.2 pA/pF, n=19; P<0.01) in CO than in Ctr and normalized thereafter. CONCLUSIONS: Prenatal CO exposure affects the physiological shortening of APD in neonatal rats. We speculate that a prolonged myocyte repolarization induced by prenatal exposure to smoke may establish a period of vulnerability for life-threatening arrhythmias in infancy.

Treatment with irbesartan counteracts the functional remodeling of ventricular myocytes from hypertensive rats.

Changes in electrophysiological (action potential prolongation, decrease in transient outward current I(to), occurrence of the hyperpolarization-activated current I(f)) and contractile properties develop in hypertrophied ventricular myocytes, likely implicated in the increased propensity to arrhythmias. Angiotensin II is a key signal for myocyte hypertrophy; the effect of 8-week treatment with irbesartan, a type 1 angiotensin II receptor (AT(1)) antagonist, on cardiac remodeling was tested. Sixteen-month-old hypertensive rats (SHRs) were treated with irbesartan (20 mg/kg/d) or saline for 8 weeks. At the end of treatment, systolic blood pressure and heart weight to body weight ratio were reduced in irbesartan-treated compared with nontreated SHRs. Electrical and contractile properties were measured in isolated ventricular myocytes, by patch-clamp or video-dimension analysis, respectively. Action potential duration was significantly shorter in irbesartan-treated than in nontreated SHRs (at -60 mV: 119 +/- 24 ms vs 187 +/- 20 ms); correspondingly, maximal I(to) density was larger in irbesartan-treated than in nontreated SHRs (25.4 +/- 2.8 pA/pF vs 18.5 +/- 1.5 pA/pF). Maximal specific conductance of I(f) was lower in irbesartan-treated vs nontreated SHRs (24.8 +/- 3.0 pS/pF vs 35.2 +/- 4.0 pS/pF). Finally, the relaxation rate of shortening in field-stimulated intact myocytes was significantly faster in irbesartan-treated than in nontreated SHRs (7.3 +/- 0.5/s vs 5.7 +/- 0.3/s). Thus, AT(1) blockade with irbesartan, at an oral daily dosage that gave a slight but significant reduction of systolic blood pressure, largely counteracts the development of myocyte hypertrophy and associated functional alterations.

Does recombinant human interleukin-11 exert direct electrophysiologic effects on single human atrial myocytes?

Recombinant human interleukin-11 (rhIL-11) treatment given to alleviate side effects of cancer therapy is associated with an increased susceptibility to atrial arrhythmias in elderly patients. To elucidate the mechanism underlying this action, we investigated the direct electrophysiologic effect of rhIL-11 on single human atrial myocytes (HuAM) using the patch-clamp technique. Action potentials (AP) at different driving rates were recorded in the perforated-patch configuration, and L-type calcium current (I(Ca,L)), outward potassium currents (I(to) and I(K)), and the hyperpolarization-activated pacemaker current If were measured in the disrupted whole-cell configuration. At therapeutic concentrations (i.e., 10-100 ng/ml), rhIL-11 did not modify AP parameters and cycle-length dependence of AP duration. I(Ca,L) (measured at 0 mV) was 370 +/- 45 pA in control and 379 +/- 48 pA and 368 +/- 42 pA in the presence of 10 and 50 ng/ml rhIL-11, respectively (p = NS). The amplitude and activation of I(to) were not modified by rhIL-11 (i.e., I(to) was at +60 mV: 2.1 +/- 0.2 nA in control vs. 1.9 +/- 0.2 nA and 2.1 +/- 0.2 nA in the presence of 10 and 50 ng/ml rhIL-11, respectively, p = NS). Similarly, late currents measured at the end of the pulse were unchanged in the presence of 10 or 50 ng/ml of rhIL-11. If activation was not modified by rhIL-11: maximal current was 173 +/- 34 pA in control and 159 +/- 35 pA and 117 +/- 14 pA in the presence of 10 and 50 ng/ml of rhIL-11, respectively; midpoint activation was -99 +/- 3 mV in control and -98 +/- 4 mV and -94 +/- 2 mV in the presence of 10 and 50 ng/ml of rhIL-11, respectively (p = NS). Thus, it is unlikely that direct alterations of membrane potential and currents of HuAM caused by rhIL-11 are the basis for the genesis of atrial arrhythmias observed in patients treated with this agent.