Adipose, sex steroids and atrial arrhythmia vulnerability

© 2018 Dr. Gabriel Brian BernasochiBackground: Pericardial adipose deposition occurs in ageing and obesity, and independently contributes to the development of atrial fibrillation. The mechanisms underlying this association are not yet understood. Investigations to date have focused on physical conduction block posed by infiltrating adipose and the secretion of pro-inflammatory/pro-fibrotic paracrine factors into the atria. Though not yet investigated in the pericardial adipose, white adipose depots are established sites of oestrogen synthesis. Considering the reported actions of oestrogens on the heart, it is hypothesised that pericardial adipose may represent an important source of local oestrogen synthesis, exerting paracrine actions on the myocardium. Research questions: 1. Do myocardial and pericardial adipose tissues express aromatase, and do locally-derived oestrogens affect the vulnerability to atrial arrhythmia? (Chapter 2) 2. Does disruption of aromatase activity in aged and obese mice influence basal cardiac electrophysiology and the susceptibility to atrial arrhythmia? (Chapter 3) 3. Can liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) sensitive methodology be used to quantify androgens and oestrogens in human and mouse myocardium and pericardial adipose tissues? (Chapter 4) Methods: Aromatase expression in human and rodent myocardium and pericardial adipose was measured by Western immunoblotting. Arrhythmia vulnerability was assessed in isolated hearts from male C57BL/6 mice (‘young’, ‘aged’ or ‘aged’ + high fat diet). Hearts were perfused with a hypokalaemic solution (2 mmol [K+]) and subjected to programmed electrical stimulation to provoke arrhythmias. In addition, hearts were perfused with acute perfusion with 17β-oestradiol (or vehicle) and arrhythmic provocation repeated. Aromatase knockout and wild type mice (male and female) were fed a control or high fat diet for 40 weeks. Mice were subjected to electrocardiographic and echocardiographic assessment prior to isolated heart atrial arrhythmia provocation experiments. Human and mouse myocardium and adipose tissues were homogenised, derivatised with dansyl chloride and subjected to LC-MS/MS for sex steroid quantification. Mass spectrometric technique was developed using the aromatase knockout as a positive control for androgens and a negative control for oestrogens. Results: 1. Aromatase is expressed in human/rodent myocardium and pericardial adipose, conferring the capacity for local androgen to oestrogen synthesis. Pericardial adipose capacity to synthesise oestrogens increased by 30-50x in aged hearts, which were significantly more vulnerable to atrial arrhythmias. (Chapter 2) 2. The aromatase knockout model of oestrogen depletion and androgen excess revealed a sex-differential phenotype in the susceptibility to atrial arrhythmia. Left atrial action potential duration was prolonged and arrhythmia vulnerability greater in female aromatase knockout mice compared to all other groups. The combined influence of extensive pericardial adipose deposition and a highly androgenic/oestrogen-depleted environment was unique to the female aromatase knockout mice and may have been decisive in driving the exacerbated vulnerability to atrial arrhythmias. (Chapter 3) 3. LC-MS/MS methodologies were optimised for the detection and quantification of sex steroids in human/mouse myocardium and adipose. Successful quantification of testosterone and progesterone was achievable, but concentrations of oestrogens in tissues were below the technical limits of detection. (Chapter 4) Conclusions: This thesis identifies that pericardial adipose expresses aromatase and indicates a probable capacity for oestrogen synthesis, hence supporting the presence of a local cardiac androgen-oestrogen system. Pericardial adipose derived oestrogens (and androgens) are recognised as probable paracrine mediators capable of altering atrial arrhythmic vulnerability. In addition, the data support the clinically observed correlation between pericardial adipose accumulation and atrial fibrillation. Mass spectrometric methodology is capable of quantifying tissue testosterone and progesterone concentrations, but tissue oestrogens are below the limits of detection. Taken together, this thesis advances the mechanistic understanding of the link between pericardial adipose accumulation and greater atrial arrhythmia vulnerability

Cardiomyocyte functional screening: interrogating comparative electrophysiology of high-throughput model cell systems.

Cardiac arrhythmias of both atrial and ventricular origin are an important feature of cardiovascular disease. Novel antiarrhythmic therapies are required to overcome current drug limitations related to effectiveness and pro-arrhythmia risk in some contexts. Cardiomyocyte culture models provide a high-throughput platform for screening antiarrhythmic compounds, but comparative information about electrophysiological properties of commonly used types of cardiomyocyte preparations is lacking. Standardization of cultured cardiomyocyte microelectrode array (MEA) experimentation is required for its application as a high-throughput platform for antiarrhythmic drug development. The aim of this study was to directly compare the electrophysiological properties and responses to isoproterenol of three commonly used cardiac cultures. Neonatal rat ventricular myocytes (NRVMs), immortalized atrial HL-1 cells, and custom-generated human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were cultured on microelectrode arrays for 48-120 h. Extracellular field potentials were recorded, and conduction velocity was mapped in the presence/absence of the β-adrenoceptor agonist isoproterenol (1 µM). Field potential amplitude and conduction velocity were greatest in NRVMs and did not differ in cardiomyocytes isolated from male/female hearts. Both NRVMs and hiPSC-CMs exhibited longer field potential durations with rate dependence and were responsive to isoproterenol. In contrast, HL-1 cells exhibited slower conduction and shorter field potential durations and did not respond to 1 µM isoproterenol. This is the first study to compare the intrinsic electrophysiologic properties of cultured cardiomyocyte preparations commonly used for in vitro electrophysiology assessment. These findings offer important comparative data to inform methodological approaches in the use of MEA and other techniques relating to cardiomyocyte functional screening investigations of particular relevance to arrhythmogenesis

Epicardial adipose tissue accumulation confers atrial conduction abnormality

Background: Clinical studies have reported that epicardial adipose tissue (EpAT) accumulation associates with the progression of atrial fibrillation (AF) pathology and adversely affects AF management. The role of local cardiac EpAT deposition in disease progression is unclear, and the electrophysiological, cellular, and molecular mechanisms involved remain poorly defined. Objectives: The purpose of this study was to identify the underlying mechanisms by which EpAT influences the atrial substrate for AF. Methods: Patients without AF undergoing coronary artery bypass surgery were recruited. Computed tomography and high-density epicardial electrophysiological mapping of the anterior right atrium were utilized to quantify EpAT volumes and to assess association with the electrophysiological substrate in situ. Excised right atrial appendages were analyzed histologically to characterize EpAT infiltration, fibrosis, and gap junction localization. Co-culture experiments were used to evaluate the paracrine effects of EpAT on cardiomyocyte electrophysiology. Proteomic analyses were applied to identify molecular mediators of cellular electrophysiological disturbance. Results: Higher local EpAT volume clinically correlated with slowed conduction, greater electrogram fractionation, increased fibrosis, and lateralization of cardiomyocyte connexin-40. In addition, atrial conduction heterogeneity was increased with more extensive myocardial EpAT infiltration. Cardiomyocyte culture studies using multielectrode arrays showed that cardiac adipose tissue-secreted factors slowed conduction velocity and contained proteins with capacity to disrupt intermyocyte electromechanical integrity. Conclusions: These findings indicate that atrial pathophysiology is critically dependent on local EpAT accumulation and infiltration. In addition to myocardial architecture disruption, this effect can be attributed to an EpAT-cardiomyocyte paracrine axis. The focal adhesion group proteins are identified as new disease candidates potentially contributing to arrhythmogenic atrial substrate.Chrishan J. Nalliah, James R. Bell, Antonia J.A. Raaijmakers, Helen M. Waddell, Simon P. Wells, Gabriel B. Bernasochi … et al