Manoach M, Tribulova N, Vogelezang D, Thomas S, Podzuweit T
Tel Aviv University Medical School, Tel Aviv, Israel.
J Cell Mol Med. 2007 Jan-Feb;11(1):171-4. doi: 10.1111/j.1582-4934.2007.00016.x.
The present paper deals with spontaneous ventricular defibrillation in mammals and the possibility to facilitate its occurrence. Clinical and experimental evidence suggest that in the majority of cases, ventricular fibrillation (VF) is permanent, requiring defibrillation by electric shock. However, a growing number of reports show that VF can terminate spontaneously in various mammals, including human beings. The mechanisms involved in spontaneous ventricular defibrillation are controversial. Available reports imply that intracellular Ca2+ overload is the key event triggering VF and preventing its reversal. Since the sarcoplasmatic reticulum is the main intracellular Ca2+ regulating organelle and the activity of the cardiac SR Ca2+ ATPase (SERCA 2a) is its prime element of Ca2+ sequestration, spontaneous ventricular defibrillation likely requires high level of SERCA 2a activity. We suggest that mammalian hearts with high SERCA 2a activity defibrillate spontaneously and those with low activity only after its enhancement. Since high SERCA 2a activity is co-expressed with the myosin heavy chain (MHC) isoform V1, we assumed that those hearts preferentially expressing V1 MHC are able to defibrillate spontaneously. Hearts with small amounts of V1 MHC and correspondingly lower level of SERCA 2a activity can only defibrillate following administration of compounds that augment SERCA 2a activity and prevent intracellular Ca2+ overload.
本文探讨了哺乳动物的自发性心室除颤及其发生的可能性。临床和实验证据表明,在大多数情况下,心室颤动(VF)是永久性的,需要电击除颤。然而,越来越多的报告显示,VF可在包括人类在内的各种哺乳动物中自发终止。自发性心室除颤的机制存在争议。现有报告表明,细胞内Ca2+过载是触发VF并阻止其逆转的关键事件。由于肌浆网是细胞内主要的Ca2+调节细胞器,而心脏SR Ca2+ ATP酶(SERCA 2a)的活性是其Ca2+摄取的主要因素,自发性心室除颤可能需要高水平的SERCA 2a活性。我们认为,具有高SERCA 2a活性的哺乳动物心脏会自发除颤,而低活性的心脏只有在SERCA 2a活性增强后才会除颤。由于高SERCA 2a活性与肌球蛋白重链(MHC)同工型V1共同表达,我们推测那些优先表达V1 MHC的心脏能够自发除颤。含有少量V1 MHC且SERCA 2a活性相应较低的心脏,只有在给予增强SERCA 2a活性并防止细胞内Ca2+过载的化合物后才能除颤。