Rohr Stephan
Department of Physiology, University of Bern, Bern, Switzerland.
Heart Rhythm. 2009 Jun;6(6):848-56. doi: 10.1016/j.hrthm.2009.02.038. Epub 2009 Feb 25.
Cardiac pathologies leading to the development of organ fibrosis typically are associated with the appearance of interstitial myofibroblasts. This cell type plays a central role in excessive extracellular matrix deposition, thereby contributing to arrhythmogenic slow and discontinuous conduction by causing disorganization of the three-dimensional network of electrically coupled cardiomyocytes. Besides this involvement in structural remodeling, myofibroblasts recently have been discovered in-vitro to promote arrhythmogenesis by direct modification of cardiomyocyte electrophysiology following establishment of heterocellular electrical coupling. In particular, myofibroblasts were found to rescue impulse conduction between disjoined cardiac tissues by acting as passive electrical conduits for excitatory current flow. Although, in principle, such recovery of blocked conduction might be beneficial, propagation across myofibroblast conduits is substantially delayed, thereby promoting arrhythmogenic slow and discontinuous conduction. Second, moderately polarized myofibroblasts were found to induce cell density-dependent depolarization of cardiomyocytes, which causes arrhythmogenic slow conduction due to the reduction of fast inward currents. Finally, critical depolarization of cardiomyocytes by myofibroblasts was discovered to lead to the appearance of ectopic activity in a model of the infarct border zone. These findings obtained in vitro suggest that electrotonic interactions following gap junctional coupling between myofibroblasts and cardiomyocytes in structurally remodeled fibrotic hearts might directly initiate the main mechanisms underlying arrhythmogenesis, that is, abnormal automaticity and abnormal impulse conduction. If, in the future, similar arrhythmogenic mechanisms can be shown to be operational in intact hearts, myofibroblasts might emerge as a novel noncardiomyocyte target for antiarrhythmic therapy.
导致器官纤维化发展的心脏病理通常与间质肌成纤维细胞的出现有关。这种细胞类型在细胞外基质过度沉积中起核心作用,从而通过导致电偶联心肌细胞三维网络的紊乱,促成致心律失常的缓慢和不连续传导。除了参与结构重塑外,最近在体外发现肌成纤维细胞在建立异细胞电偶联后通过直接改变心肌细胞电生理来促进心律失常的发生。特别是,发现肌成纤维细胞通过充当兴奋性电流流动的被动电传导通道来挽救分离的心脏组织之间的冲动传导。虽然原则上这种传导阻滞的恢复可能是有益的,但通过肌成纤维细胞通道的传播会显著延迟,从而促成致心律失常的缓慢和不连续传导。其次,发现中度极化的肌成纤维细胞可诱导心肌细胞的细胞密度依赖性去极化,这由于快速内向电流的减少而导致致心律失常的缓慢传导。最后,在梗死边缘区模型中发现肌成纤维细胞引起的心肌细胞临界去极化会导致异位活动的出现。这些体外研究结果表明,在结构重塑的纤维化心脏中,肌成纤维细胞与心肌细胞之间间隙连接偶联后的电紧张相互作用可能直接引发心律失常发生的主要机制,即异常自律性和异常冲动传导。如果在未来能够证明类似的致心律失常机制在完整心脏中起作用,肌成纤维细胞可能会成为抗心律失常治疗的新型非心肌细胞靶点。