Abnormalities in intracellular Ca2+ regulation contribute to the pathomechanism of Tako-Tsubo cardiomyopathy.
OBJECTIVE
The Tako-Tsubo cardiomyopathy (TTC) is characterized by a transient contractile dysfunction that has been assigned to excessive catecholamine levels after episodes of severe emotional or physical stress. Several studies have indicated that beta-adrenoceptor stimulation is associated with alteration in gene expression of Ca(2+)-regulatory proteins. Thus, the present study investigated the gene expression of crucial proteins [sarcoplasmic Ca(2+) ATPase (SERCA2a), sarcolipin (SLN), phospholamban (PLN), ryanodine receptor (RyR2), and sodium-calcium exchanger (NCX)] involved in the Ca(2+)-regulating system in TTC.


RESULTS
In 10 consecutive patients, TTC was diagnosed by coronary angiography, ventriculography, and echocardiography. Endomyocardial biopsies were taken during the phase of severely impaired left ventricular (LV) function and after functional recovery. Non-diseased LV tissue from three donor hearts not used for transplantation served as healthy controls. Expression levels of Ca(2+)-regulatory proteins were analysed by means of real-time PCR, western blot, and immunohistochemistry. SLN, predominantly expressed in the atrial component, showed a remarkable ventricular expression in TTC patients. Gene expression of SERCA2a was significantly down-regulated. Conversely, PLN/SERCA2a ratio was increased. For PLN, dephosphorylation was documented using western blot and immunostaining of PLN-Ser(16) and PLN-Thr(17). No changes could be documented for NCX and RyR2.


CONCLUSIONS
In TTC, ventricular expression of SLN and dephosphorylation of PLN potentially result in a reduced SERCA2a activity and its Ca(2+) affinity. Thus, the TTC is associated with specific alteration of Ca(2+)-handling proteins, which might be crucial for contractile dysfunction.
Nef
Holger M
HM
Department of Cardiology, Kerckhoff Heart Center, D-61231 Bad Nauheim, Germany. h.nef@kerckhoff-fgi.de
Möllmann
Helge
H
Troidl
Christian
C
Kostin
Sawa
S
Voss
Sandra
S
Hilpert
Pirmin
P
Behrens
Christopher B
CB
Rolf
Andreas
A
Rixe
Johannes
J
Weber
Michael
M
Hamm
Christian W
CW
Elsässer
Albrecht
A
D000368:Aged; D002135:Calcium-Binding Proteins / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D006352:Heart Ventricles / Q000378:metabolism; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009124:Muscle Proteins / Q000378:metabolism*; D010766:Phosphorylation; D054645:Protein Phosphatase 1 / Q000378:metabolism; D011510:Proteolipids / Q000378:metabolism*; D019837:Ryanodine Receptor Calcium Release Channel / Q000378:metabolism*; D053498:Sarcoplasmic Reticulum Calcium-Transporting ATPases / Q000378:metabolism*; D019831:Sodium-Calcium Exchanger / Q000378:metabolism*; D054549:Takotsubo Cardiomyopathy / Q000209:etiology* / Q000378:metabolism; D000099211:Phospholamban
D002135:Calcium-Binding Proteins; D009124:Muscle Proteins; D054645:Protein Phosphatase 1; D011510:Proteolipids; D019837:Ryanodine Receptor Calcium Release Channel; D053498:Sarcoplasmic Reticulum Calcium-Transporting ATPases; D019831:Sodium-Calcium Exchanger; D000099211:Phospholamban; C077258:sarcolipin