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      CTRP9 Ameliorates Atrial Inflammation, Fibrosis, and Vulnerability to Atrial Fibrillation in Post‐Myocardial Infarction Rats

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          Abstract

          Background

          Inflammation and fibrosis play an important role in the pathogenesis of atrial fibrillation ( AF) after myocardial infarction ( MI). CTRP9 (C1q/tumor necrosis factor‐related protein‐9) as a secreted glycoprotein can reverse left ventricle remodeling post‐ MI, but its effects on MI‐induced atrial inflammation, fibrosis, and associated AF are unknown.

          Methods and Results

          MI model rats received adenoviral supplementation of CTRP9 (Ad‐ CTRP9) by jugular‐vein injection. Cardiac function, inflammatory, and fibrotic indexes and related signaling pathways, electrophysiological properties, and AF inducibility of atria in vivo and ex vivo were detected in 3 or 7 days after MI. shCTRP9 (short hairpin CTRP9) and sh RNA were injected into rat and performed similar detection at day 5 or 10. Adverse atrial inflammation and fibrosis, cardiac dysfunction were induced in both MI and Ad‐GFP (adenovirus‐encoding green fluorescent protein)+ MI rats. Systemic CTRP9 treatment improved cardiac dysfunction post‐ MI. CTRP9 markedly ameliorated macrophage infiltration and attenuated the inflammatory responses by downregulating interleukin‐1β and interleukin‐6, and upregulating interleukin‐10, in 3 days post‐ MI; depressed left atrial fibrosis by decreasing the expressions of collagen types I and III, α‐ SMA, and transforming growth factor β1 in 7 days post‐ MI possibly through depressing the Toll‐like receptor 4/nuclear factor‐κB and Smad2/3 signaling pathways. Electrophysiologic recordings showed that increased AF inducibility and duration, and prolongation of interatrial conduction time induced by MI were attenuated by CTRP9; moreover, CTRP9 was negatively correlated with interleukin‐1β and AF duration. Downregulation of CTRP9 aggravated atrial inflammation, fibrosis, susceptibility of AF and prolonged interatrial conduction time, without affecting cardiac function.

          Conclusions

          CTRP9 is effective at attenuating atrial inflammation and fibrosis, possibly via its inhibitory effects on the Toll‐like receptor 4/nuclear factor‐κB and Smad2/3 signaling pathways, and may be an original upstream therapy for AF in early phase of MI.

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          Most cited references51

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          Inflammation and the pathogenesis of atrial fibrillation.

          Atrial fibrillation (AF) is the most common cardiac arrhythmia. However, the development of preventative therapies for AF has been disappointing. The infiltration of immune cells and proteins that mediate the inflammatory response in cardiac tissue and circulatory processes is associated with AF. Furthermore, the presence of inflammation in the heart or systemic circulation can predict the onset of AF and recurrence in the general population, as well as in patients after cardiac surgery, cardioversion, and catheter ablation. Mediators of the inflammatory response can alter atrial electrophysiology and structural substrates, thereby leading to increased vulnerability to AF. Inflammation also modulates calcium homeostasis and connexins, which are associated with triggers of AF and heterogeneous atrial conduction. Myolysis, cardiomyocyte apoptosis, and the activation of fibrotic pathways via fibroblasts, transforming growth factor-β and matrix metalloproteases are also mediated by inflammatory pathways, which can all contribute to structural remodelling of the atria. The development of thromboembolism, a detrimental complication of AF, is also associated with inflammatory activity. Understanding the complex pathophysiological processes and dynamic changes of AF-associated inflammation might help to identify specific anti-inflammatory strategies for the prevention of AF.
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            Atrial remodeling and atrial fibrillation: mechanisms and implications.

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              Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression.

              Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and is associated with increased morbidity and mortality. The incidence of AF is expected to continue to rise with the aging of the population. AF is generally considered to be a progressive condition, occurring first in a paroxysmal form, then in persistent, and then long-standing persistent (chronic or permanent) forms. However, not all patients go through every phase, and the time spent in each can vary widely. Research over the past decades has identified a multitude of pathophysiological processes contributing to the initiation, maintenance, and progression of AF. However, many aspects of AF pathophysiology remain incompletely understood. In this review, we discuss the cellular and molecular electrophysiology of AF initiation, maintenance, and progression, predominantly based on recent data obtained in human tissue and animal models. The central role of Ca(2+)-handling abnormalities in both focal ectopic activity and AF substrate progression is discussed, along with the underlying molecular basis. We also deal with the ionic determinants that govern AF initiation and maintenance, as well as the structural remodeling that stabilizes AF-maintaining re-entrant mechanisms and finally makes the arrhythmia refractory to therapy. In addition, we highlight important gaps in our current understanding, particularly with respect to the translation of these concepts to the clinical setting. Ultimately, a comprehensive understanding of AF pathophysiology is expected to foster the development of improved pharmacological and nonpharmacological therapeutic approaches and to greatly improve clinical management.
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                Author and article information

                Contributors
                huangcongxin@vip.163.com
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                18 October 2019
                05 November 2019
                : 8
                : 21 ( doiID: 10.1002/jah3.v8.21 )
                : e013133
                Affiliations
                [ 1 ] Department of Cardiology Renmin Hospital of Wuhan University Hubei China
                [ 2 ] Cardiovascular Research Institute of Wuhan University Hubei China
                [ 3 ] Hubei Key Laboratory of Cardiology Hubei China
                Author notes
                [*] [* ] Correspondence to: Congxin Huang, MD, PhD, Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan 430060, Hubei, China. E‐mail: huangcongxin@ 123456vip.163.com
                [†]

                Dr Liu and Dr Li contributed equally to this work.

                Article
                JAH34529
                10.1161/JAHA.119.013133
                6898814
                31623508
                5105f8e4-f712-4367-8d52-21ed3d122706
                © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 30 April 2019
                : 18 September 2019
                Page count
                Figures: 8, Tables: 1, Pages: 16, Words: 9161
                Funding
                Funded by: Technology Innovation of Hubei Province
                Award ID: 2016ACA153
                Categories
                Original Research
                Original Research
                Arrhythmia and Electrophysiology
                Custom metadata
                2.0
                jah34529
                5 November 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.7.1 mode:remove_FC converted:12.11.2019

                Cardiovascular Medicine
                atrial fibrillation,ctrp9,fibrosis,inflammation,myocardial infarction,electrophysiology

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