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Integrative Physiology |
From the Division of Cardiology (F.I.), Department of Pediatrics, The Childrens Hospital of Philadelphia, Philadelphia, Pa; Division of Cardiovascular Medicine (M.Z., B.H., V.A.F., J.A.E., V.V.P.) and the Department of Radiology (R.Z.), University of Pennsylvania, Philadelphia, Pa; and the Department of Pharmacology and Medical Research Center for Gene Regulation (H.K.), Chonnam National University Medical School, Gwangju, South Korea.
Correspondence to Vickas V. Patel, MD, PhD, 906 Biomedical Research Bldg II/III, 421 Curie Blvd, Philadelphia, PA 19104. E-mail vickas.patel{at}uphs.upenn.edu
| Abstract |
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Key Words: Hop conduction connexin40 Nkx25 mouse mutants
| Introduction |
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We and others recently identified Hop, a novel homeodomain protein in the embryonic heart functioning downstream of Nkx25.7,8 Hop encodes a 73 amino acid protein that contains a domain (the 60 amino acid homeodomain) homologous to those seen in homeobox (Hox) transcription factors. Unlike all other known Hox transcription factors, Hop does not directly bind DNA.9 Hop is known to interact with serum response factor (SRF) and interfere with SRF-mediated gene transcription.7,8 Mice lacking Hop (Hop/) are born at
50% of the expected frequency, with loss of embryos between E10.5 and E12.5.7 Hop expression also continues into the postnatal period and transgenic overexpression in adult myocardium leads to cardiac hypertrophy and heart failure.9 In this study, we present evidence that Hop is highly expressed in the adult mouse CCS and is required for proper function during adulthood.
| Materials and Methods |
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ß-Galactosidase Activity Staining
Specimens were stained for ß-galactosidase activity using a previously described protocol,13 both for whole-mounted tissue and individual slides, as noted.
Acetylcholinesterase Activity Staining
Staining for acetylcholinesterase activity was performed using a previously described protocol.14
Connexing40 Protein Quantification
The superior portion of the interventricular septum was isolated from adult littermates (Hop+/+, Hop+/, and Hop/). Western blots using anti-connexin40 antibody at 1 mcg/mL (Chemicon) and anti-
-tubulin antibody at 0.1 µg/mL (Sigma) were quantified using ImageJ software (NIH).
Immunohistochemistry
Frozen sections of hearts from Hop+/ and Hop/ mice were stained for connexin40. Hearts were embedded unfixed. Slides were air dried, fixed with 4% paraformaldehyde, washed with PBS, and briefly dehydrated through an ethanol series and then rehydrated before washes with PBST (PBS +0.5% Tween-20). They were then blocked with 10% goat serum in PBST, incubated with anti-Cx40 antibody 1:100 in 5% goat serum in 0.1%PBST, washed in PBS, and incubated with fluorescent secondary antibody at 1:500 (Molecular Probes).
Cardiac-Gated Magnetic Resonance Imaging
Hop/ and wild-type mice underwent cardiac-gated magnetic resonance imaging (MRI) to compare left ventricular morphology and function, as previously described.18 Left ventricular (LV) wall thickness, mass, and ejection fraction were measured in the short-axis planes.
EPS Preparation and Protocol
Surface ECG and invasive mouse electrophysiology studies were performed as previously described.15,16 Briefly, surface ECG recordings and complete in vivo electrophysiological studies (EPS) were obtained from Hop/ adult mice (10 to 14 weeks old) and age-matched Hop+/+ littermates. Each mouse was anesthetized with pentobarbital (0.033 mg/kg IP), and multi-lead ECGs were obtained using 26-gauge subcutaneous electrodes. A jugular vein cutdown was performed and an octapolar 2-French electrode catheter (CIBer mouse-EP; NuMED, Inc) placed in the right atrium and ventricle under electrogram guidance to confirm catheter position. A programmed digital stimulator (DTU-215A, Bloom Associates Ltd) was used to deliver electrical impulses at approximately twice diastolic threshold. Surface ECG and intracardiac electrograms were simultaneously displayed on a multi-channel oscilloscope recorder (Quinton Electrophysiology, Inc) at a digitization rate of 2 kHz and stored on optical media for offline analysis. ECG channels were filtered from 0.5 to 250 Hz and intracardiac electrograms were filtered from 5 to 400 Hz. ECG intervals were measured by two independent observers blinded to the animals genotype.
Ambulatory ECG Recordings
Ambulatory ECG recordings were obtained by aseptic, subcutaneous implantation of a 3.5-g wireless radiofrequency telemetry device (Data Sciences International) configured to record a signal analogous to ECG lead I as previously described.17 Following a 72-hour recovery period after surgical instrumentation, ECG recordings were obtained from Hop/ and Hop+/+ mice, each placed in a separate cage overlying a receiver.
CCS Volume Calculations
Digital photomicrographs of all sections through the AVN and proximal CCS were obtained with an Axiophot2 microscope (Carl Zeiss) and Nikon DXM1200 digital camera after staining for ß-galactosidase activity. The structural regions of the CCS were defined according to the method of Rentschler et al10 where stained sections above the bifurcation of the bundle branches, encompassed by atrial tissues, were taken as the AVN and stained tissues distal to the AVN, but proximal to the division of the bundle branches, were taken as the His-bundle. Measurement of the area of interest (the AVN proper and His-bundle) was performed with ImageJ software. The sum of the areas of interest multiplied by the section thickness (6 to 8 µm) was used to compute the estimated volume.
Quantitative RT-PCR
Quantitative RT-PCR was performed using SYBR Green according to the manufacturers protocol. Total RNA was isolated from whole hearts for real-time RT-PCR with TRIzol (Invitrogen, Inc). PCR was preformed with 5 µL of reverse transcribed cDNA reaction mixture, 400 nmol/L of specific forward and reverse primers and 1xSYBR Green PCR Master Mix (Applied Biosystems, Inc.). The following primer pairs were used: (1) connexin40 (Cx40), 5'-ACAAGCACT-CCACAGTCATCGGC-3' and 5'-AGCAGGACAGCTCGGCCTT-TTC-3'; (2) connexin43 (Cx43), 5'-CCTTGGGGAAGCTGCTGG-ACAA-3' and 5'-CAGCAGGCCACCTCTCATCTTCA-3'; (3) glyceraldehyde-3-phosphate dehydrogenase (GAPDH), 5'-GTGGCAAAGTGGATTGTTGCC-3' and 5'-GATGATGACCCG-TTTGGCTCC-3'. Quantification of the reaction product was performed using the MJ Research DNA Engine Opticon 2 real-time detection system. PCR cycle conditions were 95°C for 10 minutes, followed by 40 cycles of denaturation at 95°C for 15 seconds and annealing and extension at 60°C for 1 minute. All reactions were performed in triplicate with and without RT as controls. Cycle threshold values were converted to relative gene expression levels using the 2
C(t) method.
Statistical Analysis
Continuous variables, such as ECG intervals and cardiac conduction properties, were compared using a two-tailed Student t test. All values are reported as the mean±1SD, unless otherwise noted. A probability value <0.05 was considered significant.
| Results |
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ECG and Electrophysiologic Analysis of Hop/ Mice
With our initial anatomical observations, we sought to determine whether Hop played a functional role in cardiac conduction. ECG analysis revealed a wider QRS-complex, longer QT-interval, and wider p-wave in Hop/ mice compared with wild-type mice (Figure 2A through 2D). Resting heart rates and baseline PR-intervals were similar between Hop/ and wild-type mice. In addition, ECG recordings in 5 of 10 Hop/ mice showed right axis deviation that was not present in any wild-type littermates. Similar findings were seen in unsedated, ambulatory ECG recordings (Table 3) with no evidence of spontaneous arrhythmias in either group.
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Intracardiac EPS revealed a longer HV interval in Hop/ mice compared with wild-type controls, whereas the AH interval trended toward being longer in Hop/ mice but did not reach statistical significance. These results suggest that conduction delay accounting for the widened QRS complex on surface ECGs is due predominantly to defective conduction below the AVN and is consistent with strong expression of Hop in the infra-His region and bundle branches. In addition, the atrial effective refractory period (AERP) was prolonged in Hop/ mice (Table 4).
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Connexin40 Expression Is Reduced in Adult Hop/ Mice
Because cardiac connexin expression is dependent on proper expression of Nkx25 in the heart and Hop functions downstream of Nkx25, we sought to determine whether deletion of Hop might also affect expression of cardiac connexins. RT-PCR analysis showed a significant reduction in Cx40/GAPDH normalized mRNA expression in hearts from Hop/ mice versus wild-type littermates (1.64±0.06 versus 2.31±0.13; P<0.01). However, Cx43/GAPDH normalized mRNA was not different in the hearts of Hop/ mice compared with littermate controls and similar results were obtained from microarray analysis (data not shown). Further, there was a reduction of connexin40 protein in the proximal CCS of Hop/ mice, whereas there was no difference between wild-type and Hop+/ mice (Figure 3A and 3B). In the atria, we also found reduced connexin40 in Hop/ compared with Hop+/ mice (Figure 3E and 3H). Further, we examined connexin40 protein expression by immunohistochemistry in Hop+/ and Hop/ littermates. Areas of intense ß-galactosidase activity in adjacent sections were observed in the region of the AVN and proximal CCS, but connexin40 expression was markedly downregulated in Hop/ as compared with Hop+/ mice in all observed sections through the CCS. This difference was most dramatic in the more distal portions of the CCS (Figure 3D and 3G).
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| Discussion |
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In this report, we show that Hop is highly expressed in the adult CCS of mice and modulates cardiac conduction system function. Hop is a transcriptional target of Nkx25, which is also highly expressed in the CCS12 and is required for normal development and maintenance of adult cardiac conduction tissue.4,5 Mutations in Nkx25 are associated with proximal conduction system defects in humans and with congenital heart disease.6 Tissue-specific inactivation of Nkx25 in adult mouse hearts leads to progressive loss of conduction tissue and downregulation of Hop.4 Our data suggest that Hop is robustly expressed in the adult CCS. However, unlike Nkx25, Hop does not appear necessary for maintenance or survival of conduction tissue, because the size and integrity of the AVN and His-bundle were normal in Hop/ mice.
Although both Nkx25 and Hop mutant mice display conduction system disease, the precise location of conduction delay appears different. Although the AH interval was longer in Hop/ mice compared with Hop+/+ mice, albeit not significantly, the PR intervals between the two groups were almost identical. This suggests no significant alteration in AVN conduction in the absence of Hop. On the other hand, the QRS duration was significantly different between these two groups, consistent with the longer HV intervals we observed in Hop/ mice. Therefore, although it has been shown that Nkx25 mutant mice display predominantly proximal conduction defects,4,5 Hop mutant mice appear to have more distal, infrahisian delay. Our electrophysiological observations are consistent with the fact that connexin40 expression is lower, but still present, in the AVN of Hop/ mice and absent from the infrahisian conduction system. These findings are distinct from those found in the absence of Nkx25, where there is hypoplasia of the CCS with loss of specific connexin expressing cells, but preservation of overall connexin40 density in the remnant CCS.5 This may reflect a particular sensitivity of the conduction tissue just below the His-bundle to Hop function or to loss of connexin40 expression.19
In addition, atrial electrophysiological defects (increased p-wave duration and prolonged AERP) were observed in the absence of Hop. Our observed downregulation of connexin40, the major connexin in the atrium, likely contributes to slowed atrial conduction but not to increased refractoriness. Increased refractoriness is predominantly a function of increased action potential duration, which is determined largely by transmembrane ionic fluxes. We are currently investigating the role of Hop in regulating transmembrane ionic currents in the heart. The electrophysiological defects reported in this study are not likely to be secondary to structural heart disease because Hop/ mice have normal hemodynamics, as assessed by invasive analysis,9 and have normal cardiac structure and function as assessed by cardiac-gated MRI.
Taken together, these results support the existence of a molecular hierarchy in which Nkx25 functions upstream of Hop with conservation of this molecular program between embryonic myocardium and adult conduction tissue. Hop is likely to mediate some, but not all, downstream functions of Nkx25 in cardiac conduction tissues and suggests that individual segments of the adult CCS are regulated by separate molecular programs. Further characterization of the molecular programs involved with CCS function and maintenance should lead to improved diagnosis and therapy of conduction system disease.
| Acknowledgments |
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| Footnotes |
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| References |
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