No description available.

Introduction: Beat-to-beat variability in cycle length exists in spontaneously beating cardiac preparations of varying complexities from the level of the isolated whole heart to the single sinoatrial nodal cell (SANC). The nature of this variability is poorly characterised as are its fundamental physiological origins. Methods: Recordings of spontaneous electrical activity were made from hearts in vivo, during Langendorff-perfusion, and from single SANC. Heart rate variability (HRV) was calculated in the time- and frequency-domains at baseline and in response to pharmacological mediators that interfered with critical processes involved in automaticity (catecholamines, carbachol, ivabradine, zatebradine, ryanodine and thapsigargin). In addition, a novel 2D technique for imaging Ca2+ fluorescence in spontaneously beating, fluo4-AM loaded, patched single sinoatrial nodal cells was developed to investigate the biophysical behaviour of Ca2+ during pacemaking to see if variability in this was responsible for SANC HRV. Results: Under baseline, temperature-stable conditions, levels of HRV were greatest in vivo (human > rat). SANC exhibited slightly lower levels of HRV, whereas HRV levels expressed by Langendorff-perfused hearts were the least (rabbit > rat), although still comprised a significant proportion of the variability witnessed in vivo. Anaesthetising in vivo rabbits decreased HRV to levels similar to those seen in the Langendorff-perfused heart. HRV was decreased by catecholamines and by ryanodine/thapsigargin in the Langendorff heart. Conversely, HRV was increased by carbachol, ivabradine, zatebradine and ryanodine in SANC. Heart rate changes had a marked effect on levels of HRV. 2D Ca2+ imaging of SANC showed that diastolic local Ca2+ releases (LCRs) occurred earlier than previously thought, with early LCRs having characteristics that were distinct from later LCRs. Mean time of occurrence of all the LCRs within a given diastole closely predicted the duration of the cycle. The rate of restitution of the whole cell Ca2+ transient (used as a surrogate for the pumping function of SERCA) in turn closely predicted the mean time of occurrence of LCRs. Tight synchronisation of the electrical activity of the cell with the biophysical behaviour of Ca2+ appeared to predict shorter cycle lengths. Isoprenaline increased LCR amplitude, though did not increase LCR number, size or duration. Isoprenaline caused LCRs to occur earlier, and synchronised their occurrence and the rate of pumping of Ca2+ back into the sarcoplasmic reticulum. Finally, LCRs were found to preferentially recur in certain regions of the cell, dubbed hotspots. Isoprenaline favoured hotspot production. Conclusion: Whilst greatest in vivo, significant HRV exists in spontaneously beating cardiac preparations devoid of a functioning autonomic nervous system. Studies in SANC indicate that the origin of this is likely to be variability in release of LCRs from the SR via ryanodine receptors. This in turn is controlled by SR refilling kinetics via SR Ca2+ pumping. The coupled system of membrane- and Ca2+-pacemaker clocks are so heavily intertwined that myriad factors will come to bear on generating such variability, including the amount of Ca2+ available for pumping and the phosphorylation state of key proteins, to the extent that variability in no one process can take the credit for generating such HRV.

During excitation-contraction coupling, Ca2+ transient induced by the depolarization of membrane potential is the trigger of mechanical contraction in cardiac myocytes, which is responsible for the pumping function of the heart. However, mechanisms underlying intracellular Ca2+ regulation and the coupling between Ca2+ transient and membrane potential are not completely understood. Abnormalities in intracellular Ca2+ regulation have been observed during heart failure and cardiac arrhythmias, such as intracellular Ca2+ alternans and T-tubule disorganization. In this project, intracellular Ca2+ dynamics in different types of cardiac myocytes were investigated by using computer modelling. For atrial myocytes, a biophysically detailed computer model was developed to describe the observations of Ca2+ alternans and Ca2+ wave propagation in cardiac myocytes lacking T-tubules. The model was validated by its ability to reproduce experimental observed Ca2+ wave propagation under normal condition and the influences on spatial Ca2+ distribution by modifying various aspects of Ca2+ cycling, such as Ca2+ influx, SR Ca2+ uptake and SR Ca2+ release in cardiac myocytes lacking T-tubules. Mechanisms underlying the genesis of Ca2+ alternans in this type of cell were investigated by the model. Furthermore, a spontaneous second Ca2+ release was observed in response to a single voltage stimulus pulse with enhanced Ca2+ influx as well as SR Ca2+ overload. For the ventricular myocytes, an existing canine model was used to study the genesis of APD and intracellular Ca2+ alternans under various conditions. The genesis of Ca2+ alternans was investigated by analyzing the relationship between systolic Ca2+ concentration and SR Ca2+ content. On the other side, the roles of SR Ca2+ regulation and action potential restitution in the genesis of intracellular Ca2+ and APD alternans were also examined under various conditions. In addition, it was shown that spatially discordant Ca2+ alternans was generated when the Ca2+-dependent inactivation of ICa,L was strong. It tended to be concordant for weak Ca2+-dependent inactivation of ICa,L. For the sinoatrial node cells, a mathematical model was developed to simulate stochastic opening of unitary L-type Ca2+ channel and single RyR channel, thereby reproducing experimental observed local Ca2+ release during diastolic depolarization phase of the action potential. Simulation results of ionic channel block and modifications of SR Ca2+ regulation suggested a limited role of intracellular Ca2+ in the automaticity of central SA node cells.

Le noeud sinusal (NS) est le centre de l‟automatisme cardiaque. Grâce à son activité électrique spontanée, il dicte la fréquence cardiaque (FC) en réponse aux demandes physiologiques. A ce jour, le NS demeure un sujet de recherche important puisque les mécanismes moléculaires responsables de sa régulation sont encore méconnus. Par exemple, les processus menant à la bradycardie sinusale et à la maladie du sinus (MS) chez les personnes âgées sont mécompris et présentement l‟implantation d‟un stimulateur cardiaque demeure le seul traitement disponible. Ainsi, l‟objectif de cette thèse était de déterminer les changements moléculaires et cellulaires se produisant au niveau du NS en réponse à divers stimuli physiologiques et pathologiques afin d'établir leurs rôles potentiels dans la régulation de la FC et le développement de la MS. Dans les deux premiers chapitres, la grossesse est présentée comme modèle physiologique. En effet, la réponse adaptative aux demandes croissantes de la mère et du foetus engendre des changements physiologiques considérables au niveau du myocarde, dont une augmentation de la FC essentielle pour la perfusion adéquate des organes. Toutefois, cette augmentation peut aussi favoriser le développement d‟arythmies. Dans le troisième chapitre, l‟inflammation, un facteur présent lors du vieillissement et dans plusieurs pathologies où la MS se manifeste, a fait l‟objet d‟une étude dans le but de déterminer son rôle dans le développement de la MS. Les résultats obtenus dans cette thèse démontrent que la grossesse induit une hausse de la FC chez la souris gestante similaire à celle retrouvée chez la femme enceinte. Cette accélération était due à un remodelage électrique du NS. Plus spécifiquement, la fréquence des potentiels d‟action ainsi que la densité et l‟expression des courants pacemaker (If) et calcique de type L (ICaL) étaient augmentées. De plus, une accélération des transitoires calciques spontanés et de la vitesse de relâche calcique du réticulum sarcoplasmique a été observée. La régulation de l‟automaticité par un stimulus pathologique, l‟interleukine-1β, est abordée par la suite. L‟interleukine-1β, une cytokine ayant un rôle majeur comme médiateur inflammatoire, se retrouve en concentrations élevées dans plusieurs maladies associées avec la ii MS. Nos résultats démontrent que l‟interleukine-1β engendre une diminution de l‟automaticité associée à une réduction de If et ICaL dans les cardiomyocytes humains de type nodal dérivés de cellules souches induites pluripotentes (hiPSC-CM). En parallèle, le phénotype électrophysiologique et moléculaire des hiPSC-CM a été caractérisé démontrant leur homologie avec les cellules du NS humain adulte, les validant comme modèle in vitro de cellules nodales humaines. En conclusion, les études présentées dans cette thèse démontrent que le NS est plus qu‟un simple tissu régulé par l‟innervation autonome. En effet, son automaticité est dynamique et peut être influencée par des facteurs physiologiques ou pathologiques. Nos résultats contribuent ainsi à une meilleure compréhension des mécanismes sous-jacents à l‟automaticité. Ces avancées sont importantes non seulement pour la santé des femmes, mais aussi pour les individus souffrant de la MS. À terme, nous espérons que ces résultats contribueront au développement de stratégies thérapeutiques pour traiter des complications liées aux troubles d‟automaticité cardiaque. / The sinoatrial node (SAN) is the dominant cardiac pacemaker. With its spontaneous automaticity, it dictates rhythm and controls heart rate in response to varying physiological demands. Despite its modest size, the SAN is a very heterogeneous and complex structure that remains the topic of research efforts due, in part, to uncertainties in the mechanisms that regulate pacemaking in various conditions. For instance, the processes that lead to severe sinus bradycardia and SAN dysfunction (SND) in the elderly are unknown and to date, the implantation of electronic pacemaker remains the only SND treatment. Accordingly, the overall objective of this thesis was to explore and highlight the molecular and cellular changes that occur within the SAN in both physiological and pathological states, while determining how they contribute to regulation of heart rate and potentially SND. In the first two chapters, we present pregnancy as a physiological model considering it is a period during which substantial adaptive changes to the myocardium and increases in heart rate occur. Paradoxically, the rapid rate, which is essential for adequate organ perfusion of both mother and foetus, may also increase vulnerability to certain arrhythmias. In the third chapter, inflammation, a central process in pathology and common factor to several diseases and even ageing, was evaluated as potential underlying circumstance contributing to the development of sinus bradycardia and SND. Combinations of in vivo, ex vivo, biochemical, molecular and cellular approaches were used in order to generate an integrated understanding of the models we examined. Our data shows that in pregnant mice, an increase in heart rate similar to that of pregnant women occurs and was due to an electrical remodelling of the SAN. Specifically, an increase in action potential frequency of isolated individual SAN cells was observed. This was attributed to increased expression and density of pacemaker (If) and L-type Ca2+ currents (ICaL) along with a rapid spontaneous Ca2+ transient rate and faster intracellular sarcoplasmic reticulum Ca2+ release. We then demonstrate that the pro-inflammatory cytokine interleukin-1β which is a major inflammatory mediator that is upregulated in several diseases associated with SND, iv dramatically slows automaticity by reducing If and ICaL density in nodal-like cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CM). Importantly, in that study, hiPSC-CMs were also physiologically and molecularly characterized revealing their high resemblance to adult human SAN and a potential use as a novel in vitro model to study pacemaking in humans. In conclusion, the results of this thesis demonstrate that the SAN is not a simple, neurally controlled tissue, but a rather dynamic pacemaker that undergoes extensive intrinsic remodelling during states of health and disease. The results contribute to understanding physiological mechanisms of pacemaking and how they are altered by disease and may be relevant for both women‟s health and the individuals affected by SND. Ultimately, we hope these findings will be helpful in the development of therapeutic strategies to treat pacemaking-related complications.