Die Ergebnisse dieser Arbeit lassen vermuten, dass die Connexin43 Anordnung an der der Zellmembran humaner Herzmuskelzellen pharmakologisch beeinflussbar ist. Es ist bekannt, dass sich Connexin43 an der polaren und lateralen Zellmembran beim Vorhofflimmern und Sinusrhythmus unterschiedlich anordnet. Während beim Sinusrhythmuspatienten Connexin43 kaum an der lateralen Zellmembran zu finden ist, zeigt sich beim Vorhofflimmern vor allem an der lateralen Zellmembran eine verstärkte Connexin43 Anhäufung. Neben dem Rhythmustyp hat auch β-Adrenozeptorstimulation Einfluss auf die Connexin43 Expression. Aus diesem Grund untersucht die vorliegende Arbeit den Einfluss einer pharmakologischen Blockade der β-Adrenozeptoren durch Betablocker. Dafür wurden 38 die untersuchten Patienten anhand ihres Rhythmustyps, ihrer kardialen Begleiterkrankung und ihrer Pharmakotherapie (Betablocker: ja/nein) unterteilt und neben deren klinischen Daten ihre intraoperativ gewonnenen Herzohrbiopsien immunhistochemisch gefärbt und anschließend ausgewertet. Dabei zeigte sich, dass es zum einen zu einer unterschiedlichen Anordnung von Connexin43 bei den beiden Rhythmustypen kommt. Während beim Sinusrhythmus Connexin43 vor allem polar an der Zellmembran zu finden ist, ist es beim Vorhofflimmern vor allem an den lateralen Zellgrenzen zu finden. Betablockade geht hierbei vor allem beim Patienten mit Vorhofflimmern und Mitralklappenvitium mit einer Reduktion der Lateralisierung und einem positiven Effekt auf die Polarisierung einher.

Atrial fibrillation (AF) is a common and serious arrhythmia. Current treatments are of limited efficacy, and most do not treat the atrial structural remodeling (hypertrophy and fibrosis) that underlies most clinical AF. Our group has created an experimental dog model of atrial mechanical stretch called the simultaneous atrial and ventricular pacing (SAVP) model (which results in atrial fibrosis and susceptibility to AF) in order to study novel treatments for structural remodeling induced AF. Omega-3 polyunsaturated fatty acids (n3 PUFAs), particularly the marine derived forms eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been shown to be effective in treating arrhythmias (including AF) in some animal studies and clinical trials. The mechanism for this effect of n3 PUFAs is not well understood. In this study we sought to characterize the n3 PUFA effect on AF vulnerability, atrial electrophysiology, histology, and gene expression, and determine relevant mechanisms. Dogs were paced for 0, 2, 7 or 14 days and given n3 PUFAs, olive oil or nothing. Prophylactic n3 PUFAs significantly reduced both AF vulnerability and conduction slowing in SAVP dogs (%AF inducibility: 9.2±8.8 vs. 4.7±6.3; global atrial conduction time: 75±11ms vs. 65±6ms [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05 for both comparisons]). Prophylactic n3 PUFAs also reduced inflammation (mean CD18 grade: 2.1±0.8 vs. 1.3±0.6 [SAVP 2 days vs. SAVP 2 days with n3 PUFAs, P=0.055]), hypertrophy (myocyte cross-sectional area: 498±64µm2 vs. 322±111µm2 [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05]), and fibrosis (%collagen area vs. unpaced dogs: 178±58 vs. 127±37 [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05]). N3 PUFAs were also found to reduce the expression of structural remodeling related molecules such as TGF-β, EGF, ERK and Akt. N3 PUFAs given after some pacing had already occurred were found to be less effective at reducing AF vulnerability and structural remodeling. The results of this study suggest that, in the SAVP model, n3 PUFAs reduce vulnerability to AF by attenuation of adverse structural remodeling at the genetic level.

Background: Modulation of ischemia-dependent pathways alters electrophysiological evolution of ventricular fibrillation(VF). Hypothesis: 1)There is regional disease-related expression of KATP-channels in human cardiomyopathic hearts. 2)KATP-channel blockade promotes spontaneous VF termination by attenuating spatiotemporal dispersion of refractoriness(ΔERP). Methods and Results: Electric mapping of control(n=6) and treatment(n=9) (10 μmol/L glibenclamide) isolated human cardiomyopathic hearts was performed. Spontaneous defibrillation and KATP-subunit gene expression were studied. Spontaneous VF termination occurred in 1/6 control and 7/8 treated hearts (P=0.026). After 180 seconds of ischemia, LV transmural dispersion in VF cycle length was observed(p=0.001), which was attenuated by glibenclamide. There was greater gene expression of all KATP-subunit on the endocardium compared with the epicardium(P<0.02). In ischemic rat heart model, ΔERP was verified with pacing protocols (36±5ms vs 4.9±4ms, p=0.019). Conclusions: KATP channel subunit gene expression is heterogeneously altered in the cardiomyopathic human heart. Blockade of KATP channels promotes spontaneous defibrillation by attenuating ischemia-dependent ΔERP during VF.

Background: Modulation of ischemia-dependent pathways alters electrophysiological evolution of ventricular fibrillation(VF). Hypothesis: 1)There is regional disease-related expression of KATP-channels in human cardiomyopathic hearts. 2)KATP-channel blockade promotes spontaneous VF termination by attenuating spatiotemporal dispersion of refractoriness(ΔERP). Methods and Results: Electric mapping of control(n=6) and treatment(n=9) (10 μmol/L glibenclamide) isolated human cardiomyopathic hearts was performed. Spontaneous defibrillation and KATP-subunit gene expression were studied. Spontaneous VF termination occurred in 1/6 control and 7/8 treated hearts (P=0.026). After 180 seconds of ischemia, LV transmural dispersion in VF cycle length was observed(p=0.001), which was attenuated by glibenclamide. There was greater gene expression of all KATP-subunit on the endocardium compared with the epicardium(P<0.02). In ischemic rat heart model, ΔERP was verified with pacing protocols (36±5ms vs 4.9±4ms, p=0.019). Conclusions: KATP channel subunit gene expression is heterogeneously altered in the cardiomyopathic human heart. Blockade of KATP channels promotes spontaneous defibrillation by attenuating ischemia-dependent ΔERP during VF.

Atrial fibrillation (AF) is a common and serious arrhythmia. Current treatments are of limited efficacy, and most do not treat the atrial structural remodeling (hypertrophy and fibrosis) that underlies most clinical AF. Our group has created an experimental dog model of atrial mechanical stretch called the simultaneous atrial and ventricular pacing (SAVP) model (which results in atrial fibrosis and susceptibility to AF) in order to study novel treatments for structural remodeling induced AF. Omega-3 polyunsaturated fatty acids (n3 PUFAs), particularly the marine derived forms eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been shown to be effective in treating arrhythmias (including AF) in some animal studies and clinical trials. The mechanism for this effect of n3 PUFAs is not well understood. In this study we sought to characterize the n3 PUFA effect on AF vulnerability, atrial electrophysiology, histology, and gene expression, and determine relevant mechanisms. Dogs were paced for 0, 2, 7 or 14 days and given n3 PUFAs, olive oil or nothing. Prophylactic n3 PUFAs significantly reduced both AF vulnerability and conduction slowing in SAVP dogs (%AF inducibility: 9.2±8.8 vs. 4.7±6.3; global atrial conduction time: 75±11ms vs. 65±6ms [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05 for both comparisons]). Prophylactic n3 PUFAs also reduced inflammation (mean CD18 grade: 2.1±0.8 vs. 1.3±0.6 [SAVP 2 days vs. SAVP 2 days with n3 PUFAs, P=0.055]), hypertrophy (myocyte cross-sectional area: 498±64µm2 vs. 322±111µm2 [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05]), and fibrosis (%collagen area vs. unpaced dogs: 178±58 vs. 127±37 [SAVP 14 days vs. SAVP 14 days with n3 PUFAs, P<0.05]). N3 PUFAs were also found to reduce the expression of structural remodeling related molecules such as TGF-β, EGF, ERK and Akt. N3 PUFAs given after some pacing had already occurred were found to be less effective at reducing AF vulnerability and structural remodeling. The results of this study suggest that, in the SAVP model, n3 PUFAs reduce vulnerability to AF by attenuation of adverse structural remodeling at the genetic level.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成24年3月26日 櫛山泰規氏の博士論文として提出された

Patienter med förmaksflimmer är en grupp vars symtom ofta underskattas. Symtomen påminner om de som uppkommer vid en hjärtinfarkt med bröstsmärta, hjärtklappning, andnöd och trötthet. Syftet med studien var att belysa hur det kan vara att leva med förmaksflimmer. En litteraturstudie utfördes där vetenskapliga artiklar analyserades och sammanställdes. Resultatet visade att patienternas livskvalitet var kraftigt nedsatt och även anhöriga påverkades. En ökning av ångest och depression sågs vid uppföljning sex och tolv månader efter fastställd diagnos. Informationen och omvårdnaden var bristfällig och ett kunskapsbehov identifierades. Evidensbaserade riktlinjer för omvårdnad och information har utarbetats för denna patientgrupp, men resultatet visade att det inte fanns några utarbetade vårdprogram att tillgå i Sverige. Baskunskaper i omvårdnaden saknades hos personalen som vårdade patienterna. Här ses ett stort behov av omvårdnadsforskning inom området. Ett ökat samarbete mellan forskare och kliniskt verksamma sjuksköterskor behövs för att nya rön ska kunna implementeras i den dagliga vården. / Patients with atrial fibrillation is a group whose symptoms are often underestimated. Symptoms are similar to those arising from a heart attack with chest pain, palpitations, shortness of breath and fatigue. The purpose of this study was to illustrate how it can be to live with atrial fibrillation. A literature review was conducted in which scientific articles were analyzed and summarized. The results showed that patients' quality of life was dramatically reduced and even relatives were affected. An increase in anxiety and depression were seen at follow-up six and twelve months after the established diagnosis. The information and care was poor and the knowledge needs were identified. Evidence-based guidelines for care and information has been prepared for this group of patients, but the result showed that there were no prepared programs of care available in Sweden. Basic knowledge of nursing was missing the nursing staff who cared for the patients. Seen here is a great need for nursing research in the field. Increased cooperation between academics and clinical nurses is needed so that new findings could be implemented in the daily care.

Reproduction de : Thèse de doctorat : Médecine. Sciences de la vie et de la santé. Aspects moléculaires et cellulaires de la biologie : Nantes : 2007. / Bibliogr.

published_or_final_version / Medicine / Master / Master of Research in Medicine

My PhD project investigated the regulation of human cardiac transient outward potassium current (Ito) by protein tyrosine kinases (PTKs) and the functional expression of transient receptor potential (TRP) channels in human atrial myocytes to make an advanced understanding of human cardiac electrophysiology and pathophysiology. The modulation of human cardiac Itoby PTKs was studied in human atrial myocytes and HEK 293 cells expressing hKv4.3 (coding human cardiac Ito). We found that the broad-spectrum PTK inhibitor genistein, the selective EGFR kinase inhibitor AG556, and the Src-family kinases inhibitor PP2 inhibited human atrial Itoand the inhibitory effect was countered by the protein tyrosine phosphatase (PTP) inhibitor orthovanadate. Similar results were observed in hKv4.3-HEK cells. Interestingly, tyrosine phosphorylation of hKv4.3channels was reduced by genistein, AG556, and PP2,and the reduction was antagonized by orthovanadate. The mutant Y136F of hKv4.3 lost the inhibitory response to AG556, whileY108F lost the response to PP2.The double mutant Y108F-Y136F hKv4.3 failed to respond to both AG556 and PP2, and exhibited a dramatic reduction of tyrosine phosphorylation. These results indicate that native cardiac Itois regulated by both EGFR and Src family kinases. In the second part, we studied whether TRPC channels would mediate the nonselective cation current described previously in human atrial myocytes. It was found that TRPC1 channel activator thapsigargin activated the current, and the effect was suppressed by La3+or prevented by intracellular anti-TRPC1 antibody. Endothelin-1 and angiotensin II stimulated the current, andthe effect was inhibited by La3+and/or 2-APB. RT-PCR and Western blot analysis revealed that in addition to the TRPC1 channels mediating the nonselective cation current, the components of store-operated Ca2+channels (SOCs), STIM1 and Orai1 were abundantly expressed in human atria. The interaction of TRPC1, STIM1, and Orai1 was confirmed by co-immunoprecipitation. Interestingly, we found that protein expression of TRPC1 and STIM1, but not Orai1, was up-regulated in human atria with atrial fibrillation. The third part of the project determined whether TRPM7 channels were expressed in human atrial myocytes, since this channel was reported in human atrial fibroblasts, conferring atrial fibrosis in human atria with atrial fibrillation. We found a TRPM7 -like current which was potentiated by acidic pH, and inhibited by La3+and 2-APB, and a Ca2+-activated TRPM4 current. RT-PCR and Western blot analysis confirmed the expression of TRPM7 and TRPM4 channels in human atria. Moreover, we found TRPM7 protein, but not TRPM4 protein was significantly up-regulated in human atria with atrial fibrillation, suggesting the potential participation of TRPM7 channels in atrial remodeling of human atria with atrial fibrillation. Collectively, this PhD thesis project has demonstrated for the first time that human cardiac Itois modulated by EGFR kinase and Src kinases via phosphorylating Y136and Y108, respectively. TRPC1 channels mediate the nonselective cation current and SOCs.TRPM7 channels are expressed in human atrial myocytes. The up-regulation of TRPC1, STIM1, and TRPM7 channels in human atria with atrial fibrillation suggest that they are likely involved in atrial electrical and/or structure remodeling in patients with atrial fibrillation. / published_or_final_version / Medicine / Doctoral / Doctor of Philosophy