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钙循环蛋白与心力衰竭:机制与治疗。

Calcium cycling proteins and heart failure: mechanisms and therapeutics.

机构信息

Department of Physiology and Cellular Biophysics and The Clyde and Helen Wu Center for Molecular Cardiology, College of Physicians and Surgeons of Columbia University, New York, New York 10032, USA.

出版信息

J Clin Invest. 2013 Jan;123(1):46-52. doi: 10.1172/JCI62834. Epub 2013 Jan 2.

Abstract

Ca2+-dependent signaling is highly regulated in cardiomyocytes and determines the force of cardiac muscle contraction. Ca2+ cycling refers to the release and reuptake of intracellular Ca2+ that drives muscle contraction and relaxation. In failing hearts, Ca2+ cycling is profoundly altered, resulting in impaired contractility and fatal cardiac arrhythmias. The key defects in Ca2+ cycling occur at the level of the sarcoplasmic reticulum (SR), a Ca2+ storage organelle in muscle. Defects in the regulation of Ca2+ cycling proteins including the ryanodine receptor 2, cardiac (RyR2)/Ca2+ release channel macromolecular complexes and the sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a (SERCA2a)/phospholamban complex contribute to heart failure. RyR2s are oxidized, nitrosylated, and PKA hyperphosphorylated, resulting in "leaky" channels in failing hearts. These leaky RyR2s contribute to depletion of Ca2+ from the SR, and the leaking Ca2+ depolarizes cardiomyocytes and triggers fatal arrhythmias. SERCA2a is downregulated and phospholamban is hypophosphorylated in failing hearts, resulting in impaired SR Ca2+ reuptake that conspires with leaky RyR2 to deplete SR Ca2+. Two new therapeutic strategies for heart failure (HF) are now being tested in clinical trials: (a) fixing the leak in RyR2 channels with a novel class of Ca2+-release channel stabilizers called Rycals and (b) increasing expression of SERCA2a to improve SR Ca2+ reuptake with viral-mediated gene therapy. There are many potential opportunities for additional mechanism-based therapeutics involving the machinery that regulates Ca2+ cycling in the heart.

摘要

钙离子依赖的信号转导在心肌细胞中受到高度调节,决定了心肌收缩的力。钙离子循环是指细胞内钙离子的释放和再摄取,驱动肌肉收缩和松弛。在衰竭的心脏中,钙离子循环发生深刻改变,导致收缩功能受损和致命性心律失常。钙离子循环的关键缺陷发生在肌浆网(SR)水平,SR 是肌肉中的钙离子储存细胞器。调节钙离子循环蛋白的缺陷,包括肌质网钙释放通道大分子复合物中的 Ryanodine 受体 2(RyR2)/钙离子释放通道、肌浆网/内质网 Ca2+-ATP 酶 2a(SERCA2a)/磷酸化酶 b 复合物,导致心力衰竭。RyR2 被氧化、亚硝化和 PKA 过度磷酸化,导致衰竭心脏中的“渗漏”通道。这些渗漏的 RyR2 导致 SR 中的钙离子耗竭,渗漏的钙离子使心肌细胞去极化并引发致命性心律失常。SERCA2a 在衰竭心脏中下调,磷酸化酶 b 被低磷酸化,导致 SR 钙离子再摄取受损,与渗漏的 RyR2 一起耗尽 SR 钙离子。两种新的心力衰竭治疗策略目前正在临床试验中进行测试:(a)用一类新型的钙离子释放通道稳定剂 Rycals 修复 RyR2 通道的渗漏;(b)通过病毒介导的基因治疗增加 SERCA2a 的表达,以改善 SR 钙离子摄取。调节心脏钙离子循环的机制还有许多潜在的机会,可以开发基于机制的治疗方法。

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