title: Heme oxygenase-1 expression in the left atrial myocardium of patients with chronic atrial fibrillation related to mitral valve disease: its regional relationship with structural remodeling.
abstract: Atrial fibrillation becomes a self-perpetuating arrhythmia as a consequence of electrophysiologic and structural remodeling involving the atrium. Oxidative stress may be a link between this rhythm disturbance and electrophysiologic remodeling. The aim of this study was to evaluate whether the heme oxygenase-1 (HO-1) marker of oxidative stress was more expressed in left atrial sites with stronger structural remodeling in patients affected by chronic atrial fibrillation (CAF) and mitral valve disease (MD). Myocardial samples were taken from the left atrial posterior wall (LAPW) and left atrial appendage (LAA) of 24 patients with CAF-MD in addition to 10 autopsy controls. The levels of HO-1 messenger RNA (mRNA) and HO-1 protein in each pathologic LAPW and LAA were quantified using reverse transcriptase polymerase chain reaction and enzyme-linked immunosorbent assay. Furthermore, light microscopy was used to morphometrically evaluate the differential myocyte and interstitial changes in the same CAF-MD LAPW and LAA samples. In controls, HO-1 protein was quantified using enzyme-linked immunosorbent assay. Unlike controls, patients with CAF-MD had higher levels of HO-1 mRNA and its protein product, expressed as LAPW/LAA ratios, in the LAPW (2.18 +/- 1.18, P < .0001, and 1.55 +/- 0.67, P < .005), and their LAPW also showed greater histologic changes in myocytolytic myocytes (15.1% +/- 3.1% versus 6.9% +/- 3.3%, P < .0001), interstitial fibrosis (8.2% +/- 2.2% versus 2.8% +/- 1.2%, P < .0001), and capillary density (816 +/- 120 number/mm(2) versus 1114 +/- 188 number/mm(2); P < .05). In addition, markers of oxidative stress were immunohistochemically studied with antinitrotyrosine and anti-iNOS antibodies. In patients with CAF-MD, the inducible enzyme HO-1 is more expressed in the left atrial areas that show greater structural remodeling. This finding strongly suggests a pathogenetic relationship between oxidative stress and the degree of histologic change.
authors.affiliation: Pathology Section, Department of Pathology and Laboratory Medicine, University of Parma, 43100 Parma, Italy. domenico.corradi@unipr.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Corradi
authors.forename: Sergio
authors.initials: S
authors.lastname: Callegari
authors.forename: Roberta
authors.initials: R
authors.lastname: Maestri
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.forename: Silvia
authors.initials: S
authors.lastname: Bosio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Palma
authors.forename: Rossella
authors.initials: R
authors.lastname: Alinovi
authors.forename: Andrea
authors.initials: A
authors.lastname: Caglieri
authors.forename: Matteo
authors.initials: M
authors.lastname: Goldoni
authors.forename: Paola
authors.initials: P
authors.lastname: Mozzoni
authors.forename: Paolo
authors.initials: P
authors.lastname: Pastori
authors.forename: Laura
authors.initials: L
authors.lastname: Manotti
authors.forename: Simona
authors.initials: S
authors.lastname: Nascimbene
authors.forename: Enrica
authors.initials: E
authors.lastname: Dorigo
authors.forename: Raffaella
authors.initials: R
authors.lastname: Rusconi
authors.forename: Ettore
authors.initials: E
authors.lastname: Astorri
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000201:enzymology* / Q000209:etiology / Q000473:pathology; D016275:Atrial Function; D002196:Capillaries / Q000473:pathology; D002908:Chronic Disease; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006325:Heart Atria / Q000201:enzymology; D051547:Heme Oxygenase-1 / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications*; D008946:Mitral Valve Stenosis / Q000150:complications*; D009206:Myocardium / Q000201:enzymology* / Q000473:pathology; D018384:Oxidative Stress; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D051547:Heme Oxygenase-1