Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 6 uppsatser.

Background-In cardiomyocytes from patients with hypertrophic cardiomyopathy, mechanical dysfunction and arrhythmogenicity are caused by mutation-driven changes in myofilament function combined with excitation-contraction (E-C) coupling abnormalities related to adverse remodeling. Whether myofilament or E-C coupling alterations are more relevant in disease development is unknown. Here, we aim to investigate whether the relative roles of myofilament dysfunction and E-C coupling remodeling in determining the hypertrophic cardiomyopathy phenotype are mutation specific. Methods and Results-Two hypertrophic cardiomyopathy mouse models carrying the R92Q and the E163R TNNT2 mutations were investigated. Echocardiography showed left ventricular hypertrophy, enhanced contractility, and diastolic dysfunction in both models; however, these phenotypes were more pronounced in the R92Q mice. Both E163R and R92Q trabeculae showed prolonged twitch relaxation and increased occurrence of premature beats. In E163R ventricular myofibrils or skinned trabeculae, relaxation following Ca2+ removal was prolonged; resting tension and resting ATPase were higher; and isometric ATPase at maximal Ca2+ activation, the energy cost of tension generation, and myofilament Ca2+ sensitivity were increased compared with that in wildtype mice. No sarcomeric changes were observed in R92Q versus wild-type mice, except for a large increase in myofilament Ca2+ sensitivity. In R92Q myocardium, we found a blunted response to inotropic interventions, slower decay of Ca2+ transients, reduced SERCA function, and increased Ca2+/calmodulin kinase II activity. Contrarily, secondary alterations of E-C coupling and signaling were minimal in E163R myocardium. Conclusions-In E163R models, mutation-driven myofilament abnormalities directly cause myocardial dysfunction. In R92Q, diastolic dysfunction and arrhythmogenicity are mediated by profound cardiomyocytesignaling and E-C coupling changes. Similar hypertrophic cardiomyopathy phenotypes can be generated through different pathways, implying different strategies for a precision medicine approach to treatment.

No description available.

Physical activity is a useful tool in the prevention of many diseases. Hospitalization after strenuous exercise from cardiac or noncardiac causes, even in young athletes without previous symptoms, can occur. These situations are not uncommon and e.g. after completing a half- marathon clinical symptoms suspicious from cardiac etiology can be present. Limitations of biomarkers used in daily clinical practice can lead to misinterpretation with additional consequences to the patient's outcome. Our goal was to describe changes of markers used in daily clinical practice after extreme physical activity and after exercise under laboratory conditions. We performed two studies in cooperation with Department of cardiology and Department of sports medicine. The goal of our first study was to examine high sensitivity troponin I (hsTnI), galectin-3, cystatin C, NGAL and ultrasensitive CRP (uCRP) after extremely long run during the competition in long distance running. The goal of our second study was to examine high- sensitivity troponin T (hsTnT) and hsTnI, creatinine and cystatin C, and urine albumin and NGAL after a standardized two-hour treadmill run under laboratory conditions and to find possible connection with echocardiographic, laboratory and other assessed parameters. The second goal of study under laboratory...

Muscle contraction is a highly fine-tuned process that requires the precise and timely construction of large protein sub-assemblies to form sarcomeres, the individual contractile units. Mutations in many of the genes encoding constituent proteins of this macromolecular machine result in defective functioning of the muscle tissue, and in humans, often lead to myopathic conditions like cardiomyopathies and muscular dystrophies, which affect a considerable number of people the world over. As more information regarding causative mutations becomes available, it becomes imperative to explore mechanisms of muscle development, maintenance and pathology. In striated muscles, contraction is regulated by the thin filament-specific tropomyosin (Tm) – troponin (Tn) complex (Ca2+-binding troponin-C, inhibitory troponin-I and tropomyosin-binding troponin-T). These troponin subunits are present in 1:1:1 ratio on thin filaments, with 1 Tm-Tn complex present on every 7th actin molecule. This stoichiometry is tightly regulated, and disturbances have been associated with functional defects. Each of these proteins has multiple isoforms, whose expression is controlled both spatially and temporally. The expression of specific combination of isoforms confers specific contractile properties to each muscle subtype. Drosophila melanogaster has been a preferred model of choice to study various aspects of muscle development for decades. In this study, the Indirect Flight Muscles (IFMs) of Drosophila have been used to investigate developmental and functional roles of two temporally regulated isoforms of a vital structural and regulatory component of the sarcomere – Troponin T (TnT). On a larger scale, whole genome expression profiles of mutants that are null for major myofbrillar proteins have also been discussed. IFMs serve as an excellent model system to address these questions, owing to the extreme ease of genetic manipulability in this system, and high degree of homology between mammalian and Dipteran cytoskeletal proteins. Chapter 1 covers basics of muscle biology, and the role of TnT in muscle contraction. Phenomena responsible for generating diversity in genes encoding muscle proteins – alternative splicing and isoform switching – have also been discussed. These mechanisms are highly conserved, as are patterns of TnT splicing and isoform expression across phyla. Mutations leading to altered splicing patterns lead to myopathic conditions, and the importance of model systems to study muscle biology has been emphasized. The advantages of studying Drosophila IFMs and a comprehensive overview of IFM development has been covered. The resources and experimental tools used have been described in Chapter 2. Two isoforms of TnT are alternatively spliced in the Drosophila thorax – one containing alternative exon 10a (expressed in adult IFMs and jump muscle); and one containing alternative exon 10b (expressed in pupae and newly eclosed flies). These exons are spliced in a mutually exclusive manner, and defects in splicing have been reported to cause uncontrolled, auto-destructive contractions. In Chapter 3, a splice mutant of TnT, up1, has been discussed, with respect to its developmental profile. Transgenic rescue experiments with two separate isoforms demonstrate rescue at the structural as well as functional level. Transgenic over-expression, however, leads to functional abnormalities, highlighting the importance of stoichiometry in multi-protein complexes. In Chapter 4, molecular signals that bring about the developmentally regulated TnT isoform switch are discussed. A splicing factor, Muscleblind, has been transgenically knocked down in normal and mutant IFMs to study effects on muscle function. Chapter 5 looks at whole genome transcriptional alterations in muscles null for either actin or myosin. All significant expression changes have been classified into categories based on different biological processes, and an attempt to differentiate generic muscle responses from filament-specific responses has been made. In conclusion, the studies have highlighted the importance of TnT isoform switching, and that extended expression of a pupal stage-specific isoform can partially compensate for loss of the adult isoform. Also, in the absence of major myofibrillar proteins, stress response pathways like heat shock response and protein degradation pathways are activated, along with a subset of metabolic responses that are unique to the thin or thick filament systems.

Hypertrophic cardiomyopathy (HCM) is a primary disease of the myocardium. 4-11% of HCM is caused by mutations in cardiac troponin T (cTnT) and 65% of them are within the tropomyosin (TM)-binding TNT1 domain. Two of the known mutational hotspots within TNT1 are in the N and C-terminal domains. Unlike the N-terminal domain; no high-resolution structure exists for the highly conserved C-terminal domain limiting both our ability to understand the functional role of this extended domain in myofilament activation and molecular mechanism(s) of HCM. The Δ160E mutation is an in-frame deletion of a glutamic acid residue at position 160 of cTnT. This TNT1 C-terminal mutation is associated with an especially poor prognosis. The Δ160E mutation is located in a putative "hinge region" immediately adjacent to the unstructured flexible linker connecting the TM-binding TNT1 domain to the Ca²⁺-sensitive TNT2 domain. Unwinding of this α-helical hinge may provide the flexibility necessary for thin filament function. Previous regulated in vitro motility assay (R-IVM) data showed mutation-induced impairment of weak actomyosin binding. Thus, we hypothesized that the Δ160E mutation repositions the flexible linker which impairs weak electrostatic binding and ultimately leads to severe cardiac remodeling. The goal of our studies is two-fold: 1) to gain high-resolution insight into the position of the cTnT linker with respect to the C-terminus of TM, and 2) to identify Δ160E-induced positional changes using Fluorescence Resonance Energy Transfer (FRET) in a fully reconstituted thin filament. To this end, residues in the middle and distal regions of the cTnT linker were sequentially cysteine-substituted (A168C, A177C, A192C and S198C) and labeled with the energy donor IAEDANS. The energy acceptor, DABMI was attached to cysteine 190 (C190) in the C-terminal region of TM and FRET measurements were obtained in the presence and absence of Ca²⁺ and myosin subfragment 1 (S1). An all-atom thin filament model in the Ca²⁺–on state was employed to predict the pathogenic effects of the Δ160E mutation on the structure and the dynamics of the cTnT linker region. Our data suggest that the linker domain runs alongside the C-terminus of TM and is differentially repositioned by calcium, myosin and the Δ160E mutation. The Δ160E mutation moves the linker closer to the C-terminus of TM. The in silico model supported this finding and demonstrated a mutation-induced decrease in linker flexibility. Moreover, the model predicted a pathogenic change in the orientation of the middle region of the linker and in the position of the Ca²⁺-sensitive TNT2 domain and the TM-binding TNT1 domain in response to Δ160E mutation. Collectively, our findings suggest that the Δ160E mutation-induced changes in the structure, position and dynamics of the linker region cause steric blocking of weak myosin binding sites on actin and subsequent impairment of contraction and disruption of sarcomeric integrity. These studies, for the first time, provided information regarding the role of the extended linker in both myofilament activation and disease.

A contração muscular esquelética é regulada pelo complexo troponina/tropomiosina de maneira dependente de Ca2+. O complexo troponina consiste de três subunidades: a troponina C (TnC), a troponina I (TnI) e a troponina T (TnT). A troponina C é a subunidade que liga Ca2+, a TnI é a subunidade inibitória e a TnT liga-se fortemente à tropomiosina. A TnI e a TnT são altamente insolúveis a baixas forças iônicas, a não ser que estejam complexadas com a TnC. O complexo troponina pode ser reconstituído \"in vitro\" a partir das subunidades isoladas simplesmente misturando-se as subunidades em razões equimolares em uréia, que depois é removida através de diálise. Na primeira parte deste trabalho um vetor para a co-expressão da TnC, TnI e TnT em E.coli foi construído. Utilizando este vetor nós produzimos um complexo troponina funcional montado no citoplasma de E.coli. A presença da TnT é requerida para regulação dependente de Ca2+ da contração muscular esquelética. O papel da TnT em conferir sensibilidade ao Ca2+ à atividade ATPásica da acto-miosina foi analisado. Mutantes de deleção da TnT foram construídos através de mutação sítio-dirigida e expressos em E.coli. Complexos troponina contendo os mutantes de TnT e/ou mutantes de TnI foram reconstituídos e analisados em ensaios de ligação ao filamento fino e ensaios de atividade ATPásica. Baseado nestes resultados a TnT foi subdividida em três domínios: o domínio ativatório (aminoácidos 157-216), o domínio inibitório (aminoácidos 157-216) e o domínio de ancoragem do dímero TnC/TnI (aminoácidos 216-263). Nós demonstramos que o dímero TnC/TnI está ancorado ao filamento fino através da interação entre a região amino-terminal da TnI e da região carbóxi-terminal da TnT (aminoácidos 216-263). Um modelo para o papel da TnT na regulação da contração muscular dependente de Ca2+ é proposto. / The contraction of skeletal muscle is regulated by troponin and tropomyosin in a Ca2+ dependent manner. The troponin complex consists of three subunits: troponin C (TnC), troponin I (TnI) and troponin T (TnT). Troponin C is the Ca2+ binding subunit, TnI is the inhibitory subunit and TnT binds tightly to tropomyosin. TnI and TnT are highly insoluble proteins at low ionic strengths, unless they are complexed with TnC. The troponin complex can be reconstituted \"in vitro\" from the isolated subunits simply by mixing the subunits at equimolar ratios in urea, which is then removed by dialysis. In the first part of this work a vector for the co-expression of TnC, TnI and TnT in E.coli was constructed. Using this vector we were able to produce a functional troponin complex assembled \"in vivo\" in the E.coli cytoplasm The presence of TnT is required for the Ca2+ dependente regulation of the skeletal muscle contraction. The role of TnT in conferring full Ca2+ sensitivity to the ATPase activity of acto-myosin was analyzed. Deletion mutants of TnT were constructed by site-directed mutagenesis and expressed in E.coli. Troponin complexes containing the TnT deletion mutants and/or TnI deletion mutants, were reconstituted and analyzed in thin filament binding assays and in ATPase activity assays. Based on these studies, TnT was subdivided into three domains: the activation domain (comprised of aminoacids 1-157), the inhibitory domain (comprised of amino acids 157-216) and the TnC/TnI dimer anchoring domain (aminoacids 216-263). We demonstrated that the TnC/TnI is anchored to the thin filament through interaction between the amino-terminal domain of TnI and the region comprised of aminoacids 216-263 of TnT. A model for the role of TnT in the Ca2+ dependent regulation of muscle contraction is proposed.

<p>In 101 patients with ST-elevation myocardial infarction treated with streptokinase the additional effects of lmw-heparin (dalteparin) were investigated. The prognostic value of troponin-T (TnT) was elucidated and the development of myocardial damage was investigated with Positron Emission Tomography (PET).</p><p>Dalteparin tended to provide a higher rate of TIMI grade 3 flow in the infarct-related artery at 24 h compared to placebo. In patients with signs of early reperfusion there was a higher rate of TIMI grade 3 flow in the dalteparin group compared to placebo. There were significantly fewer patients with ischemic episodes at 6-24 h in the dalteparin compared to placebo group.</p><p>The increase in coagulation activity was attenuated in the dalteparin group. There was a tendency to more ischemic episodes and lower frequency of TIMI grade 3 flow in patients with persistent elevation of coagulation activity at 18 h. Among deceased patients the coagulation activity was significantly higher than in survivors. </p><p>The association between elevated TnT on admission and long-term mortality might be explained by longer delay, episodes of chest pain during the last 24 h, less non-invasive signs of reperfusion at 90 minutes, and lower patency in the infarct-related artery at 24 h. </p><p>Eight patients were investigated with PET at 3h, 24 h and after 3 weeks. PET outlines the infarct region with reduced perfusion and metabolism. The oxidative metabolism in the infarct region at 3 h correlated with the water-Perfusable Tissue Fraction (PTF) and its improvement over time.</p><p>Dalteparin seems to improve maintenance of coronary patency, which can be explained by attenuation of the increased coagulation activity. Elevated TnT level on admission is associated with a worse outcome, which can partly be explained by less successful fibrinolytic treatment. PET investigations might to be a useful method in future trials evaluating new agents in the treatment of acute myocardial infarction.</p>

In 101 patients with ST-elevation myocardial infarction treated with streptokinase the additional effects of lmw-heparin (dalteparin) were investigated. The prognostic value of troponin-T (TnT) was elucidated and the development of myocardial damage was investigated with Positron Emission Tomography (PET). Dalteparin tended to provide a higher rate of TIMI grade 3 flow in the infarct-related artery at 24 h compared to placebo. In patients with signs of early reperfusion there was a higher rate of TIMI grade 3 flow in the dalteparin group compared to placebo. There were significantly fewer patients with ischemic episodes at 6-24 h in the dalteparin compared to placebo group. The increase in coagulation activity was attenuated in the dalteparin group. There was a tendency to more ischemic episodes and lower frequency of TIMI grade 3 flow in patients with persistent elevation of coagulation activity at 18 h. Among deceased patients the coagulation activity was significantly higher than in survivors. The association between elevated TnT on admission and long-term mortality might be explained by longer delay, episodes of chest pain during the last 24 h, less non-invasive signs of reperfusion at 90 minutes, and lower patency in the infarct-related artery at 24 h. Eight patients were investigated with PET at 3h, 24 h and after 3 weeks. PET outlines the infarct region with reduced perfusion and metabolism. The oxidative metabolism in the infarct region at 3 h correlated with the water-Perfusable Tissue Fraction (PTF) and its improvement over time. Dalteparin seems to improve maintenance of coronary patency, which can be explained by attenuation of the increased coagulation activity. Elevated TnT level on admission is associated with a worse outcome, which can partly be explained by less successful fibrinolytic treatment. PET investigations might to be a useful method in future trials evaluating new agents in the treatment of acute myocardial infarction.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 4 uppsatser.