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