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Maizels L, Mansour M, Abu-Much A, Massalha E, Kalstein M, Beinart R, Sabbag A, Brodov Y, Goitein O, Chernomordik F, Berger M, Herscovici R, Kuperstein R, Arad M, Matetzky S, Beigel R. Prevalence of Cardiac Sarcoidosis in Middle-Aged Adults Diagnosed with High-Grade Atrioventricular Block. Am J Med 2024; 137:358-365. [PMID: 38113953 DOI: 10.1016/j.amjmed.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Atrioventricular block may be idiopathic or a secondary manifestation of an underlying systemic disease. Cardiac sarcoidosis is a significant underlying cause of high-grade atrioventricular block, posing diagnostic challenges and significant clinical implications. This study aimed to assess the prevalence and clinical characteristics of cardiac sarcoidosis among younger patients presenting with unexplained high-grade atrioventricular block. METHODS We evaluated patients aged between 18 and 65 years presenting with unexplained high-grade atrioventricular block, who were systematically referred for cardiac magnetic resonance imaging, positron emission tomography-computed tomography, or both, prior to pacemaker implantation. Subjects with suspected cardiac sarcoidosis based on imaging findings were further referred for tissue biopsy. Cardiac sarcoidosis diagnosis was confirmed based on biopsy results. RESULTS Overall, 30 patients with high-grade atrioventricular block were included in the analysis. The median age was 56.5 years (interquartile range 53-61.75, years). In 37%, cardiac magnetic resonance imaging, positron emission tomography-computed tomography, or both, were suggestive of cardiac sarcoidosis, and in 33% cardiac sarcoidosis was confirmed by tissue biopsy. Compared with idiopathic high-grade atrioventricular block patients, all cardiac sarcoidosis patients were males (100% vs 60%, P = .029), were more likely to present with heart failure symptoms (50% vs 10%, P = .047), had thicker inter-ventricular septum on echocardiography (12.2 ± 2.7 mm vs 9.45 ± 1.6 mm, P = .002), and were more likely to present with right ventricular dysfunction (33% vs 10%, P = .047). CONCLUSIONS Cardiac sarcoidosis was confirmed in one-third of patients ≤ 65 years, who presented with unexplained high-grade atrioventricular block. Cardiac sarcoidosis should be highly suspected in such patients, particularly in males who present with heart failure symptoms or exhibit thicker inter-ventricular septum and right ventricular dysfunction on echocardiography.
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Affiliation(s)
- Leonid Maizels
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel; Talpiot Sheba Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Mahmoud Mansour
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Arsalan Abu-Much
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Eias Massalha
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Maia Kalstein
- Internal Medicine Department C, Sheba Medical Center, Ramat Gan, Israel
| | - Roy Beinart
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Avi Sabbag
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Yafim Brodov
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel; Division of Diagnostic Imaging, Sheba Medical Center; Ramat Gan, Israel
| | - Orly Goitein
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel; Division of Diagnostic Imaging, Sheba Medical Center; Ramat Gan, Israel
| | - Fernando Chernomordik
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Michael Berger
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Romana Herscovici
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Rafael Kuperstein
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Michael Arad
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Shlomi Matetzky
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Roy Beigel
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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Maizels L, Heller E, Landesberg M, Glatstein S, Huber I, Arbel G, Gepstein A, Aronson D, Sharabi S, Beinart R, Segev A, Maor E, Gepstein L. Utilizing Human-Induced Pluripotent Stem Cells to Study Cardiac Electroporation Pulsed-Field Ablation. Circ Arrhythm Electrophysiol 2024; 17:e012278. [PMID: 38344845 PMCID: PMC10949974 DOI: 10.1161/circep.123.012278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/16/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Electroporation is a promising nonthermal ablation method for cardiac arrhythmia treatment. Although initial clinical studies found electroporation pulsed-field ablation (PFA) both safe and efficacious, there are significant knowledge gaps concerning the mechanistic nature and electrophysiological consequences of cardiomyocyte electroporation, contributed by the paucity of suitable human in vitro models. Here, we aimed to establish and characterize a functional in vitro model based on human-induced pluripotent stem cells (hiPSCs)-derived cardiac tissue, and to study the fundamentals of cardiac PFA. METHODS hiPSC-derived cardiomyocytes were seeded as circular cell sheets and subjected to different PFA protocols. Detailed optical mapping, cellular, and molecular characterizations were performed to study PFA mechanisms and electrophysiological outcomes. RESULTS PFA generated electrically silenced lesions within the hiPSC-derived cardiac circular cell sheets, resulting in areas of conduction block. Both reversible and irreversible electroporation components were identified. Significant electroporation reversibility was documented within 5 to 15-minutes post-PFA. Irreversibly electroporated regions persisted at 24-hours post-PFA. Per single pulse, high-frequency PFA was less efficacious than standard (monophasic) PFA, whereas increasing pulse-number augmented lesion size and diminished reversible electroporation. PFA augmentation could also be achieved by increasing extracellular Ca2+ levels. Flow-cytometry experiments revealed that regulated cell death played an important role following PFA. Assessing for PFA antiarrhythmic properties, sustainable lines of conduction block could be generated using PFA, which could either terminate or isolate arrhythmic activity in the hiPSC-derived cardiac circular cell sheets. CONCLUSIONS Cardiac electroporation may be studied using hiPSC-derived cardiac tissue, providing novel insights into PFA temporal and electrophysiological characteristics, facilitating electroporation protocol optimization, screening for potential PFA-sensitizers, and investigating the mechanistic nature of PFA antiarrhythmic properties.
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Affiliation(s)
- Leonid Maizels
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramt Gan, Israel (L.M., E.H., R.B., A.S., E.M.)
- Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel (L.M., R.B., A.S., E.M.)
- Talpiot Sheba Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel (L.M., E.M.)
- Department of Cardiology, Royal Melbourne Hospital, Australia (L.M.)
| | - Eyal Heller
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramt Gan, Israel (L.M., E.H., R.B., A.S., E.M.)
| | - Michal Landesberg
- Sohnis Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Technion, Haifa, Israel (M.L., S.G., I.H., G.A., A.G., L.G.)
| | - Shany Glatstein
- Sohnis Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Technion, Haifa, Israel (M.L., S.G., I.H., G.A., A.G., L.G.)
| | - Irit Huber
- Sohnis Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Technion, Haifa, Israel (M.L., S.G., I.H., G.A., A.G., L.G.)
| | - Gil Arbel
- Sohnis Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Technion, Haifa, Israel (M.L., S.G., I.H., G.A., A.G., L.G.)
| | - Amira Gepstein
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramt Gan, Israel (L.M., E.H., R.B., A.S., E.M.)
- Sohnis Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Technion, Haifa, Israel (M.L., S.G., I.H., G.A., A.G., L.G.)
| | - Doron Aronson
- Division of Cardiology, Rambam Health Care Campus, Haifa, Israel (D.A., L.G.)
| | - Shirley Sharabi
- Advanced Technology Center and Department of Radiology, Sheba Medical Center, Ramat Gan, Israel (S.S.)
| | - Roy Beinart
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramt Gan, Israel (L.M., E.H., R.B., A.S., E.M.)
- Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel (L.M., R.B., A.S., E.M.)
| | - Amit Segev
- Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel (L.M., R.B., A.S., E.M.)
| | - Elad Maor
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramt Gan, Israel (L.M., E.H., R.B., A.S., E.M.)
- Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel (L.M., R.B., A.S., E.M.)
- Talpiot Sheba Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel (L.M., E.M.)
| | - Lior Gepstein
- Sohnis Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Technion, Haifa, Israel (M.L., S.G., I.H., G.A., A.G., L.G.)
- Division of Cardiology, Rambam Health Care Campus, Haifa, Israel (D.A., L.G.)
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Moshkovits Y, Grynberg D, Heller E, Maizels L, Maor E. Differential effect of high-frequency electroporation on myocardium vs. non-myocardial tissues. Europace 2022; 25:748-755. [PMID: 36305566 PMCID: PMC9935033 DOI: 10.1093/europace/euac191] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Pulsed-field ablation (PFA) is an emerging non-thermal ablation method based on the biophysical phenomenon of electroporation. Data on PFA cardiac selectivity nature and tissue-specific thresholds are lacking. We aim to compare the in vivo differential effect of high-frequency irreversible electroporation (HF-IRE) protocols on various tissues. METHODS AND RESULTS Twenty-three Sprague-Dawle rodents were allocated into three different protocols of 300, 600, and 900 V, respectively, while delivering twenty 100 µs bursts of a 150 kHz biphasic square wave to five tissues; cardiac muscle, skeletal muscle, liver, carotid artery and sciatic nerve. Lesions were evaluated quantitatively by histologic analysis and by morphometric evaluation. There were eight, seven and eight animals in the 300, 600, and 900 V protocols, respectively. High-frequency electroporation protocols showed a graded effect on myocardial tissue with larger lesions in the 900 V protocol compared with the other two protocols as demonstrated by width (P = 0.02), length (P = 0.01) and fibrosis ratio (P = 0.001). This effect was not observed for other tissues with attenuated degree of damage. No damage to the carotid artery was observed in all protocols. Partial damage to the sciatic nerve was observed in only two samples (25%) in the 600 V group and in one sample (14.3%) in the 900 V group. CONCLUSION Electroporation effect is tissue-specific such that myocardium is more prone to electroporation damage compared with neural and vascular tissues. Our results suggest no neural or vascular damage with using a low-amplitude HF-IRE protocol. Further investigation is warranted to better identify other tissue-specific thresholds.
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Affiliation(s)
| | | | - Eyal Heller
- Leviev Heart Center, Sheba Medical Center, Derech Sheba 2, Ramat-Gan 52621, Israel,Sackler School of Medicine, Tel Aviv University, Tel-Aviv 39040, Israel
| | - Leonid Maizels
- Leviev Heart Center, Sheba Medical Center, Derech Sheba 2, Ramat-Gan 52621, Israel,Sackler School of Medicine, Tel Aviv University, Tel-Aviv 39040, Israel
| | - Elad Maor
- Corresponding author. Tel: +972546444022; fax: +97246385777. E-mail address:
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Hopton C, Tijsen AJ, Maizels L, Arbel G, Gepstein A, Bates N, Brown B, Huber I, Kimber SJ, Newman WG, Venetucci L, Gepstein L. Characterization of the mechanism by which a nonsense variant in RYR2 leads to disordered calcium handling. Physiol Rep 2022; 10:e15265. [PMID: 35439358 PMCID: PMC9017975 DOI: 10.14814/phy2.15265] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 06/14/2023] Open
Abstract
Heterozygous missense variants of the cardiac ryanodine receptor gene (RYR2) cause catecholaminergic polymorphic ventricular tachycardia (CPVT). These missense variants of RYR2 result in a gain of function of the ryanodine receptors, characterized by increased sensitivity to activation by calcium that results in an increased propensity to develop calcium waves and delayed afterdepolarizations. We have recently detected a nonsense variant in RYR2 in a young patient who suffered an unexplained cardiac arrest. To understand the mechanism by which this variant in RYR2, p.(Arg4790Ter), leads to ventricular arrhythmias, human induced pluripotent stem cells (hiPSCs) harboring the novel nonsense variant in RYR2 were generated and differentiated into cardiomyocytes (RYR2-hiPSC-CMs) and molecular and calcium handling properties were studied. RYR2-hiPSC-CMs displayed significant calcium handling abnormalities at baseline and following treatment with isoproterenol. Treatment with carvedilol and nebivolol resulted in a significant reduction in calcium handling abnormalities in the RYR2-hiPSC-CMs. Expression of the mutant RYR2 allele was confirmed at the mRNA level and partial silencing of the mutant allele resulted in a reduction in calcium handling abnormalities at baseline. The nonsense variant behaves similarly to other gain of function variants in RYR2. Carvedilol and nebivolol may be suitable treatments for patients with gain of function RYR2 variants.
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Affiliation(s)
- Claire Hopton
- Division of Evolution and Genomic SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Centre for Genomic MedicineManchester University NHS Foundation TrustHealth Innovation ManchesterManchesterUK
- Division of Cardiovascular SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Anke J. Tijsen
- The Rappaport Faculty of Medicine and Research InstituteTechnion‐Institute of TechnologyHaifaIsrael
- Amsterdam UMCDepartment of Experimental CardiologyAmsterdam Cardiovascular SciencesUniversity of AmsterdamAmsterdamThe Netherlands
| | - Leonid Maizels
- The Rappaport Faculty of Medicine and Research InstituteTechnion‐Institute of TechnologyHaifaIsrael
- Division of CardiologySheba Medical Center HospitalTel HashomerIsrael
- The Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- The Talpiot Sheba Medical Leadership ProgramIsrael
| | - Gil Arbel
- The Rappaport Faculty of Medicine and Research InstituteTechnion‐Institute of TechnologyHaifaIsrael
| | - Amira Gepstein
- The Rappaport Faculty of Medicine and Research InstituteTechnion‐Institute of TechnologyHaifaIsrael
| | - Nicola Bates
- Division of Cell Matrix Biology and Regenerative MedicineFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Benjamin Brown
- Department of CardiologyWythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Irit Huber
- The Rappaport Faculty of Medicine and Research InstituteTechnion‐Institute of TechnologyHaifaIsrael
| | - Susan J. Kimber
- Division of Cell Matrix Biology and Regenerative MedicineFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - William G. Newman
- Division of Evolution and Genomic SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Centre for Genomic MedicineManchester University NHS Foundation TrustHealth Innovation ManchesterManchesterUK
| | - Luigi Venetucci
- Division of Cardiovascular SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Manchester Heart CentreManchester University NHS Foundation TrustHealth Innovation ManchesterManchesterUK
| | - Lior Gepstein
- The Rappaport Faculty of Medicine and Research InstituteTechnion‐Institute of TechnologyHaifaIsrael
- Cardiology DepartmentRambam Health Care CampusHaifaIsrael
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Maizels L, Heller E, Landesberg M, Huber I, Arbel G, Gepstein A, Beinart R, Segev A, Gepstein L, Maor E. ESTABLISHING A NOVEL MODEL TO STUDY CARDIAC ELECTROPORATION ABLATION UTILIZING HUMAN INDUCED PLURIPOTENT STEM CELLS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)00992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maizels L, Wasserstrum Y, Fishman B, Segev A, Ben-Nun D, Younis A, Freimark D, Mazin I, Grupper A. Characterization of heart failure patients with reverse left ventricular remodelling post-angiotensin receptor blockers/neprilysin inhibitors therapy. ESC Heart Fail 2022; 9:1682-1688. [PMID: 35178886 PMCID: PMC9065862 DOI: 10.1002/ehf2.13801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/13/2021] [Accepted: 12/18/2021] [Indexed: 11/22/2022] Open
Abstract
Aims To assess the effect of angiotensin receptor blockers/neprilysin inhibitors (ARNI) on left ventricular (LV) ejection fraction (LVEF) and LV dimensions in a real‐life cohort of heart failure and reduced ejection fraction (HFrEF) patients, while analysing patient characteristics that may predict reverse LV remodelling. Methods and results The ARNI‐treated HFrEF patients followed at a single tertiary medical centre HF‐outpatient clinic were included in the study. Clinical and echocardiographic parameters were evaluated prior to ARNI initiation, and while on ARNI therapy, assessing patient characteristics associated with reverse LV remodelling. The cohort included 91 patients (mean age 60.5 years, 90% male) and 47 (52%) patients exhibited ARNI responsiveness, defined as an increase in LVEF during therapy. Overall, LVEF increased by 19% post‐ARNI (23.8 to 28.4%, P < 0.001). Subgroup analysis revealed several parameters associated with significant LVEF improvement, including baseline LVEF <30%, non‐ischaemic HF aetiology, lack of cardiac resynchronization therapy (CRT), better initial functional class and ARNI initiation within 3 years from HF diagnosis (P ≤ 0.001 for all). Significant reduction in LV dimensions was noted in patients with lower initial LVEF, non‐ischaemic HF and no CRT. Further combined subgrouping of the study population demonstrated that patients with both LVEF <30% and a non‐ischaemic HF gained most benefit from ARNI with an average of 51% improvement in LVEF (19.9 to 30%, P < 0.001). Conclusions The ARNI treatment response is not uniform among HFrEF patient subgroups. More pronounce reverse LV remodelling is associated with early ARNI treatment initiation in the course of HFrEF, and in those with LVEF <30%, non‐ischaemic HF and no CRT.
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Affiliation(s)
- Leonid Maizels
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Talpiot Sheba Medical Leadership Program, Tel-Aviv, Israel
| | - Yishay Wasserstrum
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Fishman
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Talpiot Sheba Medical Leadership Program, Tel-Aviv, Israel
| | - Amitai Segev
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Ben-Nun
- The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anan Younis
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dov Freimark
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Israel Mazin
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avishay Grupper
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Maizels L, Heller E, Landesberg M, Huber I, Arbel G, Gepstein A, Gepstein L, Maor E. Study and modulation of cardiac electroporation with a novel model utilizing human induced pluripotent stem cells. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac electroporation is a promising novel non-thermal ablation method, gaining significant interest with recent first-in-man data suggesting effective cardiac lesion generation with no collateral damage. Nevertheless, significant knowledge gaps exist regarding its electrophysiological consequences in cardiomyocytes, including; cell specificity, protocol optimization, irreversibility threshold, recovery time-constants, and the mechanistic nature of its cytolytic and anti-arrhythmic properties.
Purpose
Establishing an innovative in-vitro model for the study of cardiac electroporation-ablation, utilizing human induced pluripotent stem cells (hiPSCs).
Methods and results
Healthy-control hiPSC-derived cardiomyocytes were enzymatically dissociated and seeded as circular cell sheets (hiPSC-CCSs). Electroporation-ablation experiments were performed using a custom designed high-frequency electroporation (HF-EP) generator. Two needle-shaped electrodes were used for HF-EP delivery (Figure 1). Subsequently, detailed voltage- and Ca2+-mapping studies of the hiPSC-CCSs were conducted (Figure 2). HF-EP application resulted in the generation of electrically isolated lesions within the hiPSC-CCSs (Figure 3). Further characterization of the temporal changes and electrophysiological properties following electroporation revealed that; (1) lesions persisted over prolonged periods of time (days), indicating irreversible electroporation, (2) a temporal decrease in lesion dimensions was noted, consistent with a significant reversible electroporation component (Figures 3–5), (3) most tissue recovery had occurred within the first 15 minutes following electroporation, with little recovery beyond that time-frame, (4) increasing pulse-number augmented lesion area as well as the proportion of irreversible damage, and (5) electroporation sensitization was achieved by increasing extracellular Ca2+, indicating its crucial role in electroporation cytolysis, potentially via direct cellular toxicity and apoptosis facilitation (Figures 5–6). Finally, evaluating for HF-EP anti-arrhythmic properties, we targeted multiple rotors or focal triggered-activity generated in the hiPSC-CCSs. HF-EP application generated sustained line-blocks, isolating arrhythmogenic substrates within the hiPSC-CCSs while blocking the propagation of arrhythmic wavefronts (Figure 7).
Conclusion
Our results demonstrate the ability to study cardiac electroporation utilizing hiPSC-derived cardiomyocytes, provide novel insights into its temporal and electrophysiological characteristics, facilitate electroporation protocol optimization, screen for potential electroporation sensitizers, and to study its mechanistic nature and anti-arrhythmic properties.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Division of Cardiology, and Tamman Cardiovascular Research Institute, Leviev Heart Center, Sheba Medical Center - Tel Hashomer, Ramat-Gan, Israel Figures 1–4Figures 5–7
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Affiliation(s)
- L Maizels
- Sheba Medical Center, Division of Cardiology, and Tamman Cardiovascular Research Institute, Leviev Heart Center, Ramat Gan, Israel
| | - E Heller
- Sheba Medical Center, Division of Cardiology, and Tamman Cardiovascular Research Institute, Leviev Heart Center, Ramat Gan, Israel
| | - M Landesberg
- Technion - Israel Institute of Technology, Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Haifa, Israel
| | - I Huber
- Technion - Israel Institute of Technology, Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Haifa, Israel
| | - G Arbel
- Technion - Israel Institute of Technology, Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Haifa, Israel
| | - A Gepstein
- Technion - Israel Institute of Technology, Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Haifa, Israel
| | - L Gepstein
- Technion - Israel Institute of Technology, Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine, Haifa, Israel
| | - E Maor
- Sheba Medical Center, Division of Cardiology, and Tamman Cardiovascular Research Institute, Leviev Heart Center, Ramat Gan, Israel
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Glatstein S, Ghiringhelli M, Maizels L, Heller E, Maor E, Gepstein L. Isolated superfused rats atrial model for the investigation of atrial fibrillation mechanisms and treatment. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
One of the major barriers to an improved mechanistic understanding of atrial fibrillation (AF), and thus in the pipeline of drug development, has been a lack of appropriate tissue models, especially in small animals.
Aim
We propose an advanced anatomical ex-vivo model based on rat atria for acute assessment of AF susceptibility. This novel model could yield a better understanding of arrhythmia mechanisms as well as the development of potential therapeutic strategies for the prevention or termination of atrial arrhythmias.
Methods
Wistar rats atria (N=25) were isolated, flattened and pinned to a custom-made silicon plate. Atria were superfused with an oxygenized Tyrode's solution. Tissues were then loaded with a voltage-sensitive dye and mapped using a high-resolution optical mapping system. AF was induced with 1uM carbamylcholine (N=23) coupled with pacing maneuvers and treated with 30uM Vernakalant (N=10) or 10uM Flecainide (N=10). Finally, the feasibility of a new ablation technique (electroporation) was evaluated.
Results
Optical mapping results suggested that the superfusion procedure led to a fast atrial recovery. Sinus activity was conserved for all atria for a long period. All the anatomical landmarks were clearly visualized. The acquired optical signals were analyzed during sinus rhythm and pacing, which allowed the creation of detailed activation maps and measurements of action potential duration (APD) and conduction velocity (CV) at different pacing rates. The resulting APD restitution curves revealed electrical excitation at high pacing rates (cycle length between 50ms and 300ms) with a relatively flattened curve. AF was successfully induced and optically mapping confirmed the presence of reentrant activity. AF was successfully treated using Vernacalant and Flecainide. Finally, we demonstrated the feasibility of a new ablation approach (electroporation) for creation of a continuous linear lesion serving as a functional block.
Conclusion
The isolated superfused atria model, coupled with voltage-sensitive dyes, can be utilized for long-term high-resolution functional imaging of the atria during sinus rhythm, pacing and arrhythmogenic activity. This allows the study of the atrial electrophysiological properties, the mechanisms involved in AF initiation, perpetuation, and termination as well as the study of drug and new ablation modalities.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Council (ERC) Spontaneous activation of isolated atria
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Affiliation(s)
- S Glatstein
- Technion - Israel Institute of Technology, Haifa, Israel
| | - M Ghiringhelli
- Technion - Israel Institute of Technology, Haifa, Israel
| | - L Maizels
- Sheba Medical Center, Tel Hashomer, Israel
| | - E Heller
- Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Sheba Medical Center, Tel Hashomer, Israel
| | - L Gepstein
- Technion - Israel Institute of Technology, Haifa, Israel
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9
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Mulla W, Klempfner R, Natanzon S, Mazin I, Maizels L, Abu-Much A, Younis A. Female gender is associated with a worse prognosis amongst patients hospitalised for de-novo acute heart failure. Int J Clin Pract 2021; 75:e13902. [PMID: 33277771 DOI: 10.1111/ijcp.13902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recent evidence showed that new-onset (de-novo) acute heart failure (AHF) is a distinct type of AHF. However, the prognostic implication of gender on these patients remains unclear. AIMS We aimed to investigate the impact of gender on both short and long-term mortality outcomes after hospitalisation for de-novo AHF. METHODS We analysed the data of 721 patients with de-novo AHF, who were enrolled in the HF survey in Israel between March and April 2003 and were followed until December 2014. RESULTS Fifty-four percent (N = 387) of the patients were men. In comparison to women, men patients were more likely to be younger, smokers, and with ischemic HF aetiology. At 30 days, mortality rates were higher in women (12% vs 7%, P = .013). Survival analysis showed that at 1 and 10 years the all-cause mortality rates were significantly higher in women (28% vs 17%, and 78% vs 67%, 1 and 10 years, P < .001, respectively). Consistently, multivariable analysis showed that women had an independently 82% and 24% higher mortality risk at 1 and 10 years, respectively, (1-year hazard ratio = 1.82; 95% confidence interval = 1.07 to 3.11, P = .03; 10-year hazard ratio = 1.24; 95% confidence interval = 1.03 to 1.48, P = .02). CONCLUSIONS Amongst patients with de-novo AHF, women had higher mortality rates compared with men. The observed gender-related differences in de-novo AHF patients highlight the need for further and deeper research in this field.
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Affiliation(s)
- Wesam Mulla
- Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Robert Klempfner
- The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Natanzon
- The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Mazin
- The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Maizels
- The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arsalan Abu-Much
- The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anan Younis
- The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Maizels L, Huber I, Arbel G, Tijsen AJ, Gepstein A, Khoury A, Gepstein L. Patient-Specific Drug Screening Using a Human Induced Pluripotent Stem Cell Model of Catecholaminergic Polymorphic Ventricular Tachycardia Type 2. Circ Arrhythm Electrophysiol 2017. [PMID: 28630169 DOI: 10.1161/circep.116.004725] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia type 2 (CPVT2) results from autosomal recessive CASQ2 mutations, causing abnormal Ca2+-handling and malignant ventricular arrhythmias. We aimed to establish a patient-specific human induced pluripotent stem cell (hiPSC) model of CPVT2 and to use the generated hiPSC-derived cardiomyocytes to gain insights into patient-specific disease mechanism and pharmacotherapy. METHODS AND RESULTS hiPSC cardiomyocytes were derived from a CPVT2 patient (D307H-CASQ2 mutation) and from healthy controls. Laser-confocal Ca2+ and voltage imaging showed significant Ca2+-transient irregularities, marked arrhythmogenicity manifested by early afterdepolarizations and triggered arrhythmias, and reduced threshold for store overload-induced Ca2+-release events in the CPVT2-hiPSC cardiomyocytes when compared with healthy control cells. Pharmacological studies revealed the prevention of adrenergic-induced arrhythmias by β-blockers (propranolol and carvedilol), flecainide, and the neuronal sodium-channel blocker riluzole; a direct antiarrhythmic action of carvedilol (independent of its α/β-adrenergic blocking activity), flecainide, and riluzole; and suppression of abnormal Ca2+ cycling by the ryanodine stabilizer JTV-519 and carvedilol. Mechanistic insights were gained on the different antiarrhythmic actions of the aforementioned drugs, with carvedilol and JTV-519 (but not flecainide or riluzole) acting primarily through sarcoplasmic reticulum stabilization. Finally, comparable outcomes were found between flecainide and labetalol antiarrhythmic effects in vitro and the clinical results in the same patient. CONCLUSIONS These results demonstrate the ability of hiPSCs cardiomyocytes to recapitulate CPVT2 disease phenotype and drug response in the culture dish, to provide novel insights into disease and drug therapy mechanisms, and potentially to tailor patient-specific drug therapy.
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Affiliation(s)
- Leonid Maizels
- From the Rappaport Faculty of Medicine and Research Institute (L.M., I.H., G.A., A.J.T., A.G., L.G.); and Rambam Health Care Campus; Technion-Institute of Technology; Haifa, Israel (A.K., L.G.)
| | - Irit Huber
- From the Rappaport Faculty of Medicine and Research Institute (L.M., I.H., G.A., A.J.T., A.G., L.G.); and Rambam Health Care Campus; Technion-Institute of Technology; Haifa, Israel (A.K., L.G.)
| | - Gil Arbel
- From the Rappaport Faculty of Medicine and Research Institute (L.M., I.H., G.A., A.J.T., A.G., L.G.); and Rambam Health Care Campus; Technion-Institute of Technology; Haifa, Israel (A.K., L.G.)
| | - Anke J Tijsen
- From the Rappaport Faculty of Medicine and Research Institute (L.M., I.H., G.A., A.J.T., A.G., L.G.); and Rambam Health Care Campus; Technion-Institute of Technology; Haifa, Israel (A.K., L.G.)
| | - Amira Gepstein
- From the Rappaport Faculty of Medicine and Research Institute (L.M., I.H., G.A., A.J.T., A.G., L.G.); and Rambam Health Care Campus; Technion-Institute of Technology; Haifa, Israel (A.K., L.G.)
| | - Asaad Khoury
- From the Rappaport Faculty of Medicine and Research Institute (L.M., I.H., G.A., A.J.T., A.G., L.G.); and Rambam Health Care Campus; Technion-Institute of Technology; Haifa, Israel (A.K., L.G.)
| | - Lior Gepstein
- From the Rappaport Faculty of Medicine and Research Institute (L.M., I.H., G.A., A.J.T., A.G., L.G.); and Rambam Health Care Campus; Technion-Institute of Technology; Haifa, Israel (A.K., L.G.).
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11
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Shinnawi R, Huber I, Maizels L, Shaheen N, Gepstein A, Arbel G, Tijsen AJ, Gepstein L. Monitoring Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes with Genetically Encoded Calcium and Voltage Fluorescent Reporters. Stem Cell Reports 2015; 5:582-96. [PMID: 26372632 PMCID: PMC4624957 DOI: 10.1016/j.stemcr.2015.08.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
The advent of the human-induced pluripotent stem cell (hiPSC) technology has transformed biomedical research, providing new tools for human disease modeling, drug development, and regenerative medicine. To fulfill its unique potential in the cardiovascular field, efficient methods should be developed for high-resolution, large-scale, long-term, and serial functional cellular phenotyping of hiPSC-derived cardiomyocytes (hiPSC-CMs). To achieve this goal, we combined the hiPSC technology with genetically encoded voltage (ArcLight) and calcium (GCaMP5G) fluorescent indicators. Expression of ArcLight and GCaMP5G in hiPSC-CMs permitted to reliably follow changes in transmembrane potential and intracellular calcium levels, respectively. This allowed monitoring short- and long-term changes in action-potential and calcium-handling properties and the development of arrhythmias in response to several pharmaceutical agents and in hiPSC-CMs derived from patients with different inherited arrhythmogenic syndromes. Combining genetically encoded fluorescent reporters with hiPSC-CMs may bring a unique value to the study of inherited disorders, developmental biology, and drug development and testing. Expression of genetically encoded voltage and calcium reporters in hiPSC-CMs Analysis of the electrophysiological and calcium-handling properties of hiPSC-CMs Drug screening using the optically derived action potentials and calcium transients Modeling of inherited disorders with hiPSC-CMs expressing fluorescent reporters
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Affiliation(s)
- Rami Shinnawi
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Institute of Technology, POB 9649, Haifa 3109601, Israel
| | - Irit Huber
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Institute of Technology, POB 9649, Haifa 3109601, Israel
| | - Leonid Maizels
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Institute of Technology, POB 9649, Haifa 3109601, Israel
| | - Naim Shaheen
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Institute of Technology, POB 9649, Haifa 3109601, Israel
| | - Amira Gepstein
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Institute of Technology, POB 9649, Haifa 3109601, Israel
| | - Gil Arbel
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Institute of Technology, POB 9649, Haifa 3109601, Israel
| | - Anke J Tijsen
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Institute of Technology, POB 9649, Haifa 3109601, Israel
| | - Lior Gepstein
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Institute of Technology, POB 9649, Haifa 3109601, Israel; Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel.
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Caspi O, Huber I, Gepstein A, Arbel G, Maizels L, Boulos M, Gepstein L. Modeling of arrhythmogenic right ventricular cardiomyopathy with human induced pluripotent stem cells. ACTA ACUST UNITED AC 2013; 6:557-68. [PMID: 24200905 DOI: 10.1161/circgenetics.113.000188] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a primary heart muscle disorder resulting from desmosomal protein mutations. ARVC is characterized pathologically by fibrofatty infiltration and clinically by arrhythmias and sudden cardiac death. We aimed to establish a patient-/disease-specific human induced pluripotent stem cell (hiPSC) model of ARVC. METHODS AND RESULTS Dermal fibroblasts were obtained from 2 patients with ARVC with plakophilin-2 (PKP2) mutations, reprogrammed to generate hiPSCs, coaxed to differentiate into cardiomyocytes (CMs), and then compared with healthy control hiPSC-derived CMs (hiPSC-CMs). Real-time polymerase chain reaction showed a significant decrease in the expression of PKP2 in the ARVC-hiPSC-CMs. Immunostainings revealed reduced densities of PKP2, the associated desmosomal protein plakoglobin, and the gap-junction protein connexin-43. Electrophysiological assessment demonstrated prolonged field potential rise time in the ARVC-hiPSC-CMs. Transmission electron microscopy identified widened and distorted desmosomes in the ARVC-hiPSC-CMs. Clusters of lipid droplets were identified in the ARVC-CMs that displayed the more severe desmosomal pathology. This finding was associated with upregulation of the proadipogenic transcription factor peroxisome proliferator-activated receptor-γ. Exposure of the cells to apidogenic stimuli augmented desmosomal distortion and lipid accumulation. The latter phenomenon was prevented by application of a specific inhibitor of glycogen synthase kinase 3β (6-bromoindirubin-3'-oxime). CONCLUSIONS This study highlights the unique potential of the hiPSC technology for modeling inherited cardiac disorders in general and ARVC specifically. The hiPSC-CMs were demonstrated to recapitulate the ARVC phenotype in the dish, provide mechanistic insights into early disease pathogenesis, and provide a unique platform for drug discovery and testing in this disorder.
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Affiliation(s)
- Oren Caspi
- Sohnis Family Research Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa, Israel
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13
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Itzhaki I, Maizels L, Huber I, Gepstein A, Arbel G, Caspi O, Miller L, Belhassen B, Nof E, Glikson M, Gepstein L. Modeling of catecholaminergic polymorphic ventricular tachycardia with patient-specific human-induced pluripotent stem cells. J Am Coll Cardiol 2012; 60:990-1000. [PMID: 22749309 DOI: 10.1016/j.jacc.2012.02.066] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 01/25/2012] [Accepted: 02/15/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The goal of this study was to establish a patient-specific human-induced pluripotent stem cells (hiPSCs) model of catecholaminergic polymorphic ventricular tachycardia (CPVT). BACKGROUND CPVT is a familial arrhythmogenic syndrome characterized by abnormal calcium (Ca(2+)) handling, ventricular arrhythmias, and sudden cardiac death. METHODS Dermal fibroblasts were obtained from a CPVT patient due to the M4109R heterozygous point RYR2 mutation and reprogrammed to generate the CPVT-hiPSCs. The patient-specific hiPSCs were coaxed to differentiate into the cardiac lineage and compared with healthy control hiPSCs-derived cardiomyocytes (hiPSCs-CMs). RESULTS Intracellular electrophysiological recordings demonstrated the development of delayed afterdepolarizations in 69% of the CPVT-hiPSCs-CMs compared with 11% in healthy control cardiomyocytes. Adrenergic stimulation by isoproterenol (1 μM) or forskolin (5 μM) increased the frequency and magnitude of afterdepolarizations and also led to development of triggered activity in the CPVT-hiPSCs-CMs. In contrast, flecainide (10 μM) and thapsigargin (10 μM) eliminated all afterdepolarizations in these cells. The latter finding suggests an important role for internal Ca(2+) stores in the pathogenesis of delayed afterdepolarizations. Laser-confocal Ca(2+) imaging revealed significant whole-cell [Ca(2+)] transient irregularities (frequent local and large-storage Ca(2+)-release events, broad and double-humped transients, and triggered activity) in the CPVT cardiomyocytes that worsened with adrenergic stimulation and Ca(2+) overload and improved with beta-blockers. Store-overload-induced Ca(2+) release was also identified in the hiPSCs-CMs and the threshold for such events was significantly reduced in the CPVT cells. CONCLUSIONS This study highlights the potential of hiPSCs for studying inherited arrhythmogenic syndromes, in general, and CPVT specifically. As such, it represents a promising paradigm to study disease mechanisms, optimize patient care, and aid in the development of new therapies.
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Affiliation(s)
- Ilanit Itzhaki
- The Sohnis Family Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa, Israel
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Maizlin ZV, Ghandehari H, Maizels L, Shewchuk JR, Kirby JM, Vora P, Clement JJ. Linguistic history of posterior reversible encephalopathy syndrome: mirror of developing knowledge. J Neuroimaging 2011; 21:1-4. [PMID: 19555406 DOI: 10.1111/j.1552-6569.2009.00395.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND the term posterior reversible encephalopathy syndrome (PRES) was first proposed in 2000. Since then, the acronym PRES has become very popular in imaging and clinical literature as it is short, easy to say and remember, and neatly couples the frequent localization of neuroimaging findings along with the typical outcome of this syndrome. Another possible reason for the popularity of this acronym in clinical circles is the connotation of PRES with (elevated blood) PRESsure, as a majority of cases are believed to be associated with hypertension. However, problems exist with the interpretation and common understanding of PRES, questioning the appropriateness of "P" and "R" in the acronym. The linguistic issues related to the acronym of PRES are interesting. OBJECTIVES the aim of this work is to analyze the controversies related to the acronym of PRES. RESULTS in 2006, modifying the meaning of the acronym was suggested, renaming it Potentially Reversible Encephalopathy Syndrome in order to adjust to the cases when posterior involvement is not prominent and emphasize that the reversibility is not spontaneous. This meant the creation of a backronym, where the new phrase is constructed by starting with an existing acronym. CONCLUSION this new backronym indicates that the original acronym of PRES has become a misnomer.
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Affiliation(s)
- Zeev V Maizlin
- Department of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
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