Effects of spironolactone on atrial structural remodeling in rabbit model of chronic atrial fibrillation

AIM: To evaluate the effects and potential mechanism of spironolactone (SP) on atrial structural remodeling in rabbit model of chronic atrial fibrillation (AF). METHODS: The sternotomy was performed and the pacing electrodes were fixed to the left atria of New Zealand white rabbits. The animals were randomly divided into 3 groups. The rabbits were subjected to rapid atrial pacing (RAP) for 3 weeks in RAP group (intragastric administration with placebo) and RAP+SP group (intragastric administration with spironolactone at 20 mg·kg^-1·d^-1), respectively. The rabbits in sham group did not receive RAP and drugs. Before and after RAP, the structure and function of the atria were evaluated and AF inducibility was tested. After RAP, the atrial fibrosis was evaluated, and the expression levels of collagen I, collagen Ⅲ, matrix metalloproteinase (MMP)-2 and MMP-9 were determined. RESULTS: After 3 weeks of RAP, compared with sham group, obvious left atrial enlargement and dysfunction were observed in RAP group and RAP+SP group, but those had no significant differences in these 2 groups. Sustained AF was induced in 7, 5, and 0 rabbits in RAP group, RAP+SP group, and sham group, respectively. Compared with sham group, atrial interstitial fibrosis and the protein expression levels of collagen Ⅰ, collagen Ⅲ, MMP-2 and MMP-9 were all significantly increased in RAP group and RAP+SP group(P<0.05). Compared with RAP group, the the above indexes were all decreased in RAP+SP group(P<0.05). CONCLUSION: Spironolactone suppresses the atrial interstitial fibrosis and collagen expression, thus preventing atrial structural remodeling in rabbit model of chronic AF. The effect of spironolactone on reducing atrial MMP-2 and MMP-9 levels may be the potential mechanism.     

Effect of spironolactone on hyperthyroxine-induced atrial fibrillation and atrial remodeling in rabbits

AIM: To detect the effect of spironolactone on hyperthyroxine-induced atrial remodeling. METHODS: New Zealand rabbits were divided into control group (C), hyperthyroxine group (H) and spironolactone group (S). Thyroxin was given to the rabbits in group H and group S by intraperitoneal injection for 4 weeks, and then spironolactone was given in group S by gavage for 2 weeks. Atrial fibrillation (AF) was induced by "burst" stimulation after administration. The inducing rate of AF and atrial effective refractory period (AERP) were tested by intra-cardiac electrophysiologic instrument. The expression of AF-related Ca²⁺ channel (Cav1.2), K⁺ channels (Kv1.5 and Kv4.3) and connexins (Cx40 and Cx43) at mRNA and protein levels was detected by real-time PCR, immunohistochemistry and Western blot. RESULTS: Spironolactone reduced the inducing rate of AF. No significant difference of AERP between group H and group S was observed (CONCLUSION: Spironolactone attenuates the hyperthyroxine-induced atrial remodeling in rabbits, and reduces the susceptibility of the myocardium to AF.     

Effects of atorvastatin on atrial electrical remodeling in a rabbit model of chronic atrial fibrillation

AIM: To evaluate the effects of atorvastatin (ATO) on atrial electrical remodeling in a rabbit mo-del of chronic atrial fibrillation (AF) produced by 3 weeks of rapid atrial pacing (RAP). METHODS: The sternotomy was performed and the pacing and testing electrodes were fixed to the left atria of 24 New Zealand white rabbits. The animals were randomly divided into 3 groups. The rabbits in model group and ATO group were subjected to RAP for 3 weeks, and then were treated with placebo and ATO (2.5 mg·kg^-1·d^-1), respectively. The rabbits in sham group did not receive RAP and drugs. Electrophysiological examination was performed to test heart rate, P-wave duration, atrial effective refractory period (AERP) and AF inducibility. The protein expression levels of Cav1.2, Kv4.3 and myeloperoxidase (MPO) were detected by Western blot. RESULTS: Sustained AF was induced in 5 and 4 rabbilts in model group and atorvastatin group and no rabbits in sham group was found. After 3 weeks of RAP, compared with sham group, heart rate and P-wave duration were increased and AERP was shortened in model group and ATO group (P<0.05). Compared with model group, AERP was increased in ATO group (P<0.05), while heart rate and P-wave duration had no difference between these 2 groups. Compared with sham group, the protein levels of Cav1.2 and Kv4.3 were decreased, and protein level of MPO was increased in model group and ATO group (P<0.05). Compared with model group, Cav1.2 was increased and MPO was decreased in ATO group (P<0.05), while Kv4.3 had no difference between these 2 groups. CONCLUSION: Atorvastatin suppresses the down-regulation of atrial Cav1.2 protein level and the shortening of AERP, thus preventing atrial electrical remodeling in a rabbit model of chronic AF. The effect of atrovastatin on reducing atrial MPO level may be the potential mechanism.     

Over-expressed calreticulin interacts with integrin-α5 and calcineurin system to induce atrial remodeling in patients with atrial fibrillation and valvular disease

AIM: To determine whether calreticulin over-expression contributes to atrial fibrosis in the patients with atrial fibrillation (AF) and valvular heart disease (VHD).METHODS: Right and left atrial specimens were obtained from 78 patients undergoing valve replacement surgery. The patients were divided into sinus rhythm (SR) group, paroxysmal AF (PaAF) group and persistent AF (PeAF, AF lasting >6 months) group. The protein expression of calreticulin, integrin-α5, and transforming growth factor-β1 (TGF-β1) was measured. Immunoprecipitation was also performed to determine whether calreticulin interacted with either calcineurin B or integrin-α5. RESULTS: The protein expression of calreticulin, integrin-α5 and TGF-β1 was increased in AF groups, especially in the left atrium of the patients with mitral valve disease as compared with SR group. Calreticulin interacted with both calcineurin B and integrin-α5. The expression level of integrin-α5 was significantly correlated with the expression level of TGF-β1, while the expression level of calreticulin was correlated with that of integrin-α5 and TGF-β1. Under similar classification of the cardiac function, the expression level of calreticulin in PeAF group was higher than that in SR group. CONCLUSION: The expression of calreticulin, integrin-α5, and TGF-β1 is increased in the atrial tissues of the AF patients and is related to the AF type, suggesting that calreticulin is involved in atrial remodeling in AF and VHD patients.     

Relationship between fibrosis and remodeling of gap junction in atrium of patients with atrial fibrillation

AIM: To examine fibrosis and remodeling of gap junction in atrial myocardium of patients with or without atrial fibrillation and to investigate the relationship between them. METHODS: Right atrial appendage (RAA) samples were collected from 44 patients with rheumatic heart disease during heart operation, 28 of which were clinically diagnosed as atrial fibrillation (AF), the left remained sinus rhythm (SR). Fibrosis and remodeling of connexin 43 were examined by polarization microscope and microscopy respectively, and analyzed with an image analyzer. Meanwhile, intercalated disc was counted under transmission electron microscope. The collagen volume fraction of type I (CVF-I) and the volume fraction of Cx43 (Cx43VF) were studied between groups of atrial fibrillation and sinus rhythm. The relationship between CVF-I and fraction of remodeled intercalated disc was studied as well. RESULTS: (1) Polarization microscope demonstrated that CVF-I collagen increased (P<0.01) in atrial fibrillation group. (2) The ratio of remodeled of intercalated disc in patients with AF was higher (P<0.01) than that in SR group whereas the number of intercalated disc was not different (P>0.05) between the two groups. (3) Cx43VF decreased (P<0.01) in the AF patients compared to those with SR. (4) A positive correlation between fibrosis and the remodeling of intercalated disc (r=0.96, P<0.01) was observed. The CVF-I was negatively correlated with the Cx43VF (r=-0.98, P<0.01). CONCLUSION: These results suggest that both fibrosis of atrial muscle and remodeling of intercalated disc are involved in the pathogenesis of human atrial fibrillation. Fibrosis of atrial muscle may play an important role in the process of atrial fibrillation by interfering with remodeling of intercalated disc and thereby involves in the remodeling of connexins.     

Effects of serum from patients with atrial fibrillation on chemotaxis of cardiac fibroblasts

AIM: To investigate the effects of the serum from the patients with atrial fibrillation (AF) on the chemotaxis of rat cardiac fibroblasts.METHODS: Cardiac fibroblasts were isolated from the ventricles of neonatal Sprague-Dawley rats and primarily cultured with digestion and differential adhesion. The cells in 3 to 4 passages were used for Transwell chamber assay to determine the chemotatic effects of the sera.RESULTS: Compared with control group, the cells that migrated through the polycarbonate membrane were obviously increased in AF group. The strongest chemotaxis was induced by the serum from the patients with persistent atrial fibrillation(pers-AF).The number of migrated cells in non-AF atrial arrhythmia(AA) group was higher than that in paroxysmal atrial fibrillation(paro-AF) group, and that in control group was the lowest. The results of multiple Logistic regression analysis showed that the migrated cells were related to AF and left atrial diameter.CONCLUSION: The chemotactic effect of AF serum is obviously higher than that of control serum. The differences of AF sera among groups show that myocardial fibrosis is a chronic, insidious and delayed process. The migration and infiltration of cardiac fibroblasts indirectly reflect the presence, severity and extent of the myocardial damage. The changes of migrated cells precede the changes of left atrial diameter, indicating that the cause of fibrosis is more important, and the positive correlation between AF and left atrial diameter may not be the direct causality.     

Effect of high-rate left atrial pacing on atrial remodeling and functions of sinoatrial node and atrioventricular node in dogs

AIM: To determine whether sinoatrial node (SAN) and atrioventricular node (AVN) undergo functional remodeling during atrial fibrillation (AF). METHODS: The Beagle dogs were randomized into pacing group (n=9) and control group (n=6). In open-chest dogs, the electrode catheters were sutured at left atria for pacing and data recording. SAN and AVN conductive properties were studied. The dogs in pacing group underwent 4 weeks of high-rate left atrial pacing (400 min-1). The dogs in control group were not subject to pacing. RESULTS: The animal model of chronic AF was successfully established by pacing the left atrium at 400 min-1 in the dogs. Two of those animals were recorded with spontaneous AF at the end of 2 weeks, and the induction rate of AF reached 100% following 4 weeks of pacing. The incidences of paroxysmal AF and permanent AF were significantly increased by pacing compared to control group. After 4 weeks of pacing, atrial effective refractory periods (AERP) at various at pacing cycle lengths (PCL; 250 ms, 300 ms and 350 ms) were all statistically shorter than those in control group. Compared with control group, a longer AVN Wenckebach point ［(294.44±26.06)min-1 vs (328.33±24.01)min-1,P<0.05］ and longer atrioventricular node effective refractory period (AVERP) (P<0.01) in pacing group were observed. The sinus node recovery time (SNRT) and corrected SNRT both showed significant increases. No significant change of P-wave and PA interval between the two groups was found. The left atrial dimensions (anteroposterior, superoinferior and left-right diameters) and the right atrial superoinferior diameter were measured to be significantly increased after 2 weeks of pacing. CONCLUSION: The animal model of left atrium pacing can induce AF occurrence with a higher incidence. The characteristic electrophysiological indexes about atria, AVN and SAN were observed during AF in the canine model, indicating that electrical and structural remodeling accompanies with AVN and SAN remodeling during AF.     

Mitochondrial reactive oxygen species and atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Mitochondrial oxidative stress is supposed to contribute to development, progression and self-perpetuation of AF. Reactive oxygen species (ROS) is the major molecule mediating mitochondrial oxidative stress damage. ROS can alter the redox status of various molecular targets, which quite specifically leads to functional alterations of ion channel activity or activation of a variety of redox sensitive signal transduction pathways. Eventually, it leads to atrial electrical remodeling and promotes the development of AF. Therefore, mitochondrial oxidative stress pathways may be a new target for the therapy of atrial fibrillation.     

Non-contact mapping and frequency analysis of vagal-mediated atrial fibrillation

AIM: To explore the mechanism of the initiation and maintenance of vagal-mediated atrial fibrillation (AF) by non-contact mapping and frequency analysis of vagal-mediated atrial fibrillation in canine.METHODS: Atrial effective refractory period (AERP) and dispersion of AERP were measured in 8 canine during baseline and bilateral cervical vagal nerve stimulation (CVNS). Left atrium (LA) and right atrium (RA) electrical activity of AF was assessed by non-contact mapping and frequency analysis.RESULTS: Compared with baseline, CVNS attenuated left and right AERP, but only increased the dispersion of left AERP. During CVNS, AF was easily induced and maintained, repetitive organized activations rotated around a preferential route were only found in the LA, and dominant frequencies (DFs) from LA were higher than those of the RA ［(12.5±1.5)Hz vs (9.3±1.2)Hz, P<0.01］. After the cessation of CVNS, DFs of AF decreased in the LA and RA ［(9.2±0.5)Hz vs (8.5±0.6)Hz, P>0.05］, and AF was spontaneously terminated.CONCLUSION: The change of electrophysiological character, difference of activation pattern, and frequency gradient between the LA and RA suggest that the initiation and maintenance of vagal-mediated AF dependent on the LA.     

Expression of MPO,MMP-2 and MMP-9 in atrial myocardium of rabbit atrial fibrillation model

ATM: To investigate the expression of myeloperoxidase (MPO), matrix metalloproteinase (MMP)-2 and MMP-9 in the atrial myocardium, and their potential effects on atrial structural remodeling in a rabbit atrial fibrillation (AF) model. METHODS: The sternotomy was performed and the pacing electrode was fixed to the left atria of 20 New Zealand white rabbits. The animals were randomly divided into 2 groups:rapid atrial pacing (RAP) group and sham group. The rabbits in RAP group were subjected to RAP for 3 weeks. The structure and function of the atria and ventricle were analyzed by echocardiography. Atrial burst stimulation was performed to test AF inducibility. The atrial fibrosis was evaluated by Masson trichrome-staining. The mRNA and protein levels of MPO, MMP-2 and MMP-9 were detected by RT-qPCR and Western blot. RESULTS: After 3 weeks of RAP, obvious left atrial enlargement and dysfunction were observed, but almost no change of left ventricular diameter and function was found in RAP group compared with sham group. AF inducibility, atrial interstitial fibrosis and the mRNA and protein levels of MPO, MMP-2 and MMP-9 were all significantly increased in RAP group compared with sham group. CONCLUSION: Obvious atrial structural remodeling is found in the rabbit AF model induced by sustained RAP, and the up-regulation of MPO, MMP-2 and MMP-9 may be the potential molecular mechanism of atrial structural remodeling.     

Cx43 is involved in electrical remodeling of atrial myocytes through regulating L-type calcium current

AIM: To investigate whether the association of connexin 43(Cx43) and L-type calcium channel involved in the pathogenesis of atrial fibrillation (AF). METHODS: The biochemical assays and whole-cell patch-clamp technique were used to study the expression of Cx43 in human atrial tissue. The co-localization of Cx43 and L -type calcium channel, and the regulation of L-type calcium current in atrial myocytes were investigated. RESULTS: The expression of Cx43 at mRNA and protein levels was decreased in human atrial tissues of AF patients. In cultured atrium-derived myocytes (HL-1 cells), knockdown of Cx43 significantly inhibited the mRNA expression of L-type calcium channel α1c subunit, as well as L-type calcium current. Co-localization of Cx43 with L-type calcium channel α1c subunit in mouse atrial myocytes was observed. CONCLUSION: The decrease in Cx43 is involved in the pathogenesis of AF, probably through reducing the L-type calcium current in atrial myoctyes by co-localization with L-type calcium channel, thus representing the potential pathogenesis in atrial fibrillation.     

Activation of extracellular-signal regulated kinase and protein phosphatases in human atria during atrial fibrillation

AIM: The purpose of this study was to determine whether the signal transduction systems were activated at the molecular atrial tissue level in patients with atrial fibrillation (AF) and whether atrial expression of extracellular-signal regulated kinase (ERK) and protein phosphatases is altered. METHODS: Atrial tissue sample of 30 patients undergoing cardiac surgery were examined. 20 patients had AF, 10 patients had no history of AF. The mRNA expression of calcineurin B and MKP-1 were detected by semi-quantitative RT-PCR. ERK1 and phospho-ERK1 were analyzed at the protein level by Western blot. RESULTS: Western blot analysis showed that atrial fibrillation did not induce significant change in ERK1 expression level in the left atrium. In contrast , phospho-ERK1 content was increased in the patients with AF in comparison with those who had sinus rhythm (SR). The mRNA expression of calcineurin B and MKP-1 in the patients with AF were significantly higher than that in patients with SR. CONCLUSION: The activation of extracellular-signal regulated kinase and protein phosphatases may have correlation with the initiation or maintenance of atrial fibrillation.     

Effects of PPARγ agonist on calpain expression in model of acute experimental autoimmune encephalomyelitis

AIM: To explore the effects of peroxisome proliferator-activated receptor γ （PPARγ） agonist on calcium-activated neutral proteinase, calpain, expression in the brain of rats with acute experimental autoimmune encephalomyelitis (EAE). METHODS: EAE model was established in rats by inoculating the homogenate contained spinal cord of guinea pig and complete Freunds adjuvant. Respectively, the PPARγ agonist rosiglitazone and non-steroid anti-inflammatory drug (NSAID) ibuprofen were used to treat the EAE rats. Outcome measures (Kohs scale) were applied at baseline and after treatment to assess the improvement of clinical symptoms. Calpain expression levels were detected by RT-PCR and Western blotting. RESULTS: All the groups showed significant improvements of scales scores after treatment with rosiglitazone and ibuprofen. No significant difference of the expression of calpain mRNA was found among EAE group, rosiglitazone and ibuprofen groups (P>0.05), but the expression of calpain reduced markedly in rosiglitazone and ibuprofen groups compared with that in EAE group (P<0.05). CONCLUSION: Rosiglitazone and ibuprofen inhibit the expression of calpain and improve the clinical symptoms of EAE rats. PPARγ agonist plays a neuroprotective role in EAE rats.     

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AIM: To investigate the contribution of angiotensin-converting enzyme inhibitor (ACEI) to the regulation of calpain system in infarcted myocardium. METHODS: Rat myocardial infarction (MI) model was established by permanent ligation of the left coronary artery. The treatment with the ACEI inhibitor rampril (1 mg·kg-1·d-1) was started 7 days prior to surgery. On day 1, 3, 7 and 14 after MI, protein levels of calpainⅠ, Ⅱ and calpastatin were determined in left ventricular free wall (LVFW), interventricular septum (IS) and right ventricule. RESULTS: CalpainⅠprotein level was increased in IS 14 d post MI, whereas the protein level of calpainⅡ was maximally increased in LVFW 3 d post MI. Rampril decreased protein up-regulation of calpainⅠ and Ⅱ, and reduced infarct size and interstitial fibrosis. Calpastatin protein expression was not affected by ACEI. CONCLUSIONS: CalpainⅠ is involved in cardiac remodelling in the late and calpainⅡ contributes to cardiac tissue damage in the early phase of MI. The heart protective effect of ACEI may be related to the inhibition of calpain system in the pathogenesis of myocardial infarction.     

Effects of cardiac remodeling on atrial arrhythmogenesis in aged rabbit left atrium

AIM: To investigate the effects of myocardial remodeling of aged left atrium (LA) on atrial arrhythmogenesis in rabbits.METHODS: The male New Zealand rabbits were divided into young LA and aged LA groups. By observing the changes of monophasic action potential (MAP) and burst-pacing in LA of the rabbits in vivo, the main cardioelectrophysiological parameters such as resting membrane potential (RMP), action potential amplitude (APA), ma-ximum rise veloctiy of action potential (dv/dt_max), plateau potential and action potential duration at 30%, 50% and 90% (APD₃₀, APD₅₀ and APD₉₀), as well as the inducibility and duration of atrial arrhythmias were recorded. L-type calcium current (I_Ca,L) was analyzed via whole-cell patch-clamp technique in enzymatically dissociated single rabbit LA myocytes. The myocardial collagen content was quantified after Masson staining, and the ultrastructure of the LA cells was observed under scanning electron microscope. The expression of Cav1.2 in LA tissue of the 2 groups was detected by Western blot.RESULTS: Compared with young LA group, dv/dt_max and plateau potential were significantly decreased, APD₃₀ and APD₅₀ were shortened, and APD₉₀ was notably prolongated in aged LA group (P<0.01). The inducibility or duration of atrial arrhythmias was severely increased or prolongated in aged LA group (P<0.01). With voltage clamp model, the density of I_Ca,L in aged LA group was significantly decreased, and current-voltage curve was notably moved upward compared with young LA group. When the clamp potential was +20 mV, the density of I_Ca,L was notably modified from (11.72±1.39) pA/pF in young LA group to (6.08±0.98) pA/pF in aged LA group (P<0.01). Compared with young LA group, the protein level of collagen was significantly increased (P<0.01), and the arrange of atrial myocytes was irregular in LA of rabbits in aged LA group. The atrial myocytes of the LA wall in aged LA group exhibited abnormal ultrastructural alterations, such as karyopyknosis, irregular and swelling mitochondria with the presence of vacuoles, and mild and severe sarcomere degeneration. Compared with those in LA tissues of young rabbits, the expression levels of Cav1.2 in the LA tissues of aged rabbits were severely reduced (P<0.01), and had a significant positive correlation with the reduction of I_Ca,L (r=0.83, P<0.01).CONCLUSION: The pathophysiological characteristics of aged LA are significantly altered, and might contribute to vulnerability and susceptibility of occurrence of atrial fibillation in aged rabbits. The mechanisms might completely attribute to the notable reduction of I_Ca,L, abnormal alterations of ultrastructures and obvious decrease in the expression of Cav1.2 in the aged LA of aged rabbits.     

Protein kinase A regulates small-conductance calcium-activated potassium type 2 channel in chronic atrial fibrillation patients

AIM：To investigate the alteration of small-conductance calcium-activated potassium type 2 (SK2) channel currents in atrial myocytes from atrial fibrillation (AF) patients, and the relationship between protein kinase A (PKA) and SK2 channel. METHODS：Right auricular tissues were obtained from the patients undergoing open-heart surgery with extracorporeal circulation. Single atrial myocytes were isolated by modified enzymatic dissociation method. The SK2 channel currents in the isolated human atrial myocytes were recorded using whole-cell patch-clamp technique. The alteration of SK2 channel currents and the regulation of SK2 channel by PKA were compared between sinus rhythm (SR) group and AF group. The total protein and PKA levels in human atrial tissues were detected by BCA assay and ELISA, respectively. RESULTS：The SK2 channel current densities and the proportion of SK2 channel currents in the integrated inward currents were significantly increased in AF group (all P<0.05 vs SR group). PKA-selective inhibitor H-89 reduced SK2 channel current densities and the proportion of SK2 channel currents in the integrated inward currents in both SR and AF groups, with larger reduction in AF group (all P<0.05 vs SR group). The PKA level was significantly decreased in AF atrial tissues (P<0.05 vs SR group). CONCLUSION: The increase in SK2 channel currents underlies the occurrence and maintenance of AF. PKA-dependent regulation may be involved in the remodeling of SK2 channel in both SR and AF human atrial myocytes, with a more powerful effect in AF.