心外膜脂肪组织与心房颤动的分子机制研究进展

心房颤动(atrial fibrillation,AF)是临床上常见的心律失常,与心血管疾病的发病率和死亡率增加相关.心外膜脂肪组织(epicardial adipose tissue,EAT)是具有重要内分泌功能的生物活性器官.近年来已有大量的研究显示EAT的体积、厚度与AF的发生、严重程度及复发相关,但EAT在AF发病机理中的确切作用尚需进一步阐明,为通过干预EAT来治疗AF提供新思路.     

迷走神经功能调节与心肌缺血保护

心血管系统的生理活动受自主神经系统(autonomic nervous system,ANS)调节.已有研究表明,自主神经功能紊乱,尤其是迷走神经功能低下,与心血管疾病(cardiovascular disease,CVD)的发生、发展及预后密切相关.本文结合国内外研究现状,就本研究室在迷走神经对心脏不同部位的调控及其对心肌的保护作用机制方面的研究成果进行阐述.通过收缩功能检测及标准玻璃微电极细胞内记录技术,发现迷走神经递质--乙酰胆碱对哺乳动物心室肌有直接作用,可抑制细胞收缩力及动作电位时程;通过组织化学染色及分子生物学方法进一步证明心室有毒蕈碱受体分布;通过膜片钳技术显示在部分动物心室肌上存在乙酰胆碱激活的内向整流钾通道(acetylcholine-activated potassium channel,KACh),并且其电流(IK·ACh)和心房肌一样具有衰减现象.前期研究证明心房肌IK·ACh的衰减与毒蕈碱受体、G蛋白或钾通道磷酸化有关;而心室肌的IK·ACh还有待于进一步研究.我们建立了相关动物模型,结合心率变异性分析等自主神经评价方法,探讨ANS在健康和疾病状态下的变化情况,证明了迷走神经对心脏调节的增龄性改变及代偿效应.通过提高迷走张力(乙酰胆碱缺血预/后适应、有氧运动、β受体阻断剂),研究改善自主神经平衡对缺血心肌的保护作用以及胆碱能抗炎通路防御缺血,再灌注诱导的炎症损伤机制.综合评价心脏自主神经调节,改善交感和迷走张力平衡,将为CVD防治的基础研究提供重要的理论依据.     

血管外周脂肪与血管稳态失衡

血管外周脂肪(perivascular adipose tissue, PVAT)是贴近血管外膜的脂肪组织,是活跃的旁自分泌器官,能够分泌多种活性物质,由外而内地影响着血管的稳态。PVAT是一种起源于独特前体细胞的脂肪组织,它兼具白色和棕色脂肪组织样特征。生理状态下,PVAT具有产热能力,并发挥机械保护和血管扩张的作用。病理状态下,比如肥胖、糖尿病、高脂血症、高血压和衰老等,PVAT表型改变和功能失调,表现为脂肪组织扩张、棕色脂肪“白色化”、脂肪细胞中脂质的异常积累和脂肪因子的异常分泌等。近年研究显示,PVAT表型的改变参与了血管重塑、动脉粥样硬化、腹主动脉瘤和高血压等多种病理过程或疾病的发生发展。     

心外膜脂肪厚度与冠脉病变严重程度的相关性研究

目的:探讨心外膜脂肪组织(Epicardial adipose tissue,EAT)厚度与冠状动脉病变严重程度的相关性。方法:收集167名符合纳入标准的患者,根据冠状动脉造影(coronary arteriography,CAG)结果分2组:正常冠脉组(65例)及冠心病冠脉病变组(≥1支冠状动脉病变狭窄程度≥50%)(102例)。同期经胸超声心动图测量EAT厚度,并依据CAG图像计算Gensini评分、Syntax评分。结果:冠脉正常组和冠心病病变组EAT厚度分别为(3.89±0.2 mm)、(6.19±1.19 mm),冠心病病变组显著高于冠脉正常组(P0.001)。进一步分析EAT的厚度分别为5 mm、5-7 mm和7 mm时,Gensini评分分别为:7.21±7.73,37.80±29.55和62.77±27.26;Syntax评分分别为:7.13±7.70,19.71±7.27和24.95±4.31。EAT的厚度与Gensini评分(r=0.621;P0.001)、Syntax评分(r=0.689;P0.001)呈正相关。结论:心外膜脂肪组织厚度与冠状动脉狭窄的复杂程度评分Gensini评分、Syntax评分呈正相关。     

多胺在老年心血管疾病中的保护作用

多胺(polyamines)主要包括腐胺(putrescine)、亚精胺(spermidine)和精胺(spermine),普遍存在于细胞和生物体中。多胺在细胞生长、发育、蛋白质/核酸合成和细胞信号传导等过程中发挥重要的作用。但是在衰老过程中,人体内的多胺水平逐渐降低。研究发现,老年人心血管系统中的多胺水平明显低于年轻人,而补充外源多胺能有效增加血液多胺水平,并且可以改善年龄相关的心血管疾病(cardiovasculardiseases,CVD)。因此,本文就多胺在老年CVD中的保护作用作一综述,以期为老年CVD的预防和治疗提供参考资料。     

乳腺脂肪组织调节乳腺发育的研究进展

乳腺是哺乳动物哺育子代的重要器官,其通过分泌乳汁给子代提供充足的营养物质,乳腺的健康发育对泌乳以及提高子代的存活率具有重要意义.脂肪组织是乳腺重要的组成部分,在乳腺发育和循环重构过程中,乳腺脂肪组织随之呈现规律性的形态和功能变化,乳腺脂肪组织的动态变化是乳腺循环性发育重构的重要特征.脂肪组织能够分泌特殊的"脂肪因子"调节上皮细胞的功能和乳腺的发育,并且存在与上皮细胞相互转换的潜能.本综述综合近年来乳腺脂肪组织的相关研究进展,为后续研究脂肪组织调节乳腺发育的机制提供基础数据.     

脂肪细胞因子对代谢的调节

脂肪组织可将多余能量以甘油三酯(triglycerides,TG)形式储存,在饥饿状态下可分解TG产生游离脂肪酸(free fatty acids,FFAs)为机体供能。此外,脂肪组织还具有体温调节和器官保护功能,并且越来越多的证据表明,脂肪组织也是一种重要的内分泌组织。脂肪组织分泌的蛋白质物质被称为脂肪细胞因子(adipokine),可通过自分泌、旁分泌和内分泌方式发挥多种生物学功能,例如调节能量摄入和能量消耗,调节糖脂代谢,抗炎和促炎反应。对整体而言,脂肪细胞因子可调节大脑、肝、肌肉、血管系统、心、胰腺和免疫系统等不同靶器官的生物反应。其中,脂肪细胞因子在糖脂代谢中发挥特定的作用,包括:葡萄糖代谢[瘦素(leptin)、脂联素(adiponectin)、抵抗素(resistin)];胰岛素敏感性 [瘦素、脂联素、锌-α2-糖蛋白(zinc-α2-glycoprotein,ZAG)];脂肪形成[骨形成蛋白4(bone morphogenetic protein 4,BMP4)]等生物反应过程。但目前对脂肪组织功能障碍与代谢之间机制的理解尚不完善。脂肪组织功能发生紊乱时,脂肪细胞因子的分泌会发生改变,并可能导致一系列与肥胖相关的代谢性疾病的发生。临床前和临床研究表明,激活或抑制特定脂肪细胞因子的信号转导可能是一种适合干预代谢疾病的方法。本文就部分脂肪细胞因子对代谢的调控作用做出综述,以增强对脂肪细胞因子功能的理解。     

棕色脂肪组织与心血管疾病的关系

棕色脂肪组织 (BAT)是由棕色脂肪细胞和血管基质成分 (SVF)组成,其中SVF中包括内皮细胞、淋巴细胞、成纤维细胞以及具有多种分化功能的干细胞,在调节心血管健康与疾病上扮演着重要角色,参与心血管疾病的发生与发展。一方面,BAT通过能量代谢以及自分泌或旁分泌方式分泌的细胞因子对机体产生重要影响。BAT可以作用于心血管系统,发挥抗炎、抗心室重构等作用,从而对心血管起到保护作用。另一方面,脂肪组织来源干细胞的发现与应用,也为心血管疾病的治疗提供了有效途径。本文回顾了BAT自发现以来在人体及动物模型上的相关研究进展,论述了其与心血管损伤的相关性。     

超声检测心外膜脂肪组织厚度与冠心病危险因素相关性分析

目的:探讨高频超声测量冠心病患者心外膜脂肪(EAT)厚度与冠心病危险因素的相关性。方法:96例患者根据冠脉造影结果分为正常组(30例)、冠心病组(66例),用高频超声测量EAT厚度,对EAT厚度与颈动脉内中膜厚度(IMT)等冠心病危险因素进行相关性分析。结果:EAT与IMT、年龄、体质量、腰围、BMI、FPG、LDL-C、UA、CRP呈正相关(P<0.01或P<0.05),与HDL-C呈负相关(P<0.05),与身高、收缩压、舒张压、TC、TG无相关性。结论:超声测量EAT厚度对于冠心病的早期发现具有一定的预测价值。     

京尼平对小鼠棕色和白色脂肪组织UCP1表达的影响

目的:棕色脂肪组织活化和白色脂肪组织棕化是改善减肥的良好策略。本研究利用冷刺激作为阳性对照,观察京尼平对小鼠脂肪组织活化与棕化的作用。方法:8周龄雄性C57BL/6J小鼠30只,随机分为正常对照组、京尼平组、冷刺激组, 每组10只。京尼平组小鼠腹腔注射给予京尼平处理(15 mg/(kg·d),连续9 d),对照组用生理盐水处理,冷刺激组小鼠在室温(22℃±2℃)下处理4 d后,置于4℃环境中进行冷刺激处理5 d(24 h/d)。检测各组小鼠每天摄食量、体重和体温变化,取肩胛下区、腹股沟区及附睾周围部分脂肪组织观察形态学的变化,测定棕色脂肪组织、皮下白色脂肪组织以及内脏白色脂肪组织解偶联蛋白1(UCP1)的表达。结果:与正常对照组相比,京尼平组小鼠白色脂肪湿重下降16%,冷刺激组下降28%,均有明显差异(P＜0.05);京尼平组和冷刺激组白色脂肪组织颜色变深,HE染色显示脂肪细胞内的脂滴变小,数量增加;京尼平组小鼠的皮下、内脏白色脂肪组织和棕色3种脂肪组织中的UCP1表达量均明显增加(P＜0.05)。结论:京尼平通过上调UCP1的表达促进棕色脂肪组织活化和白色脂肪组织棕化,此效应是京尼平降脂减轻体重的作用机制之一。     

The role of epicardial and perivascular adipose tissue in the pathophysiology of cardiovascular disease

Obesity, insulin resistance and the metabolic syndrome, are characterized by expansion and inflammation of adipose tissue, including the depots surrounding the heart and the blood vessels. Epicardial adipose tissue (EAT) is a visceral thoracic fat depot located along the large coronary arteries and on the surface of the ventricles and the apex of the heart, whereas perivascular adipose tissue (PVAT) surrounds the arteries. Both fat depots are not separated by a fascia from the underlying tissue. Therefore, factors secreted from epicardial and PVAT, like free fatty acids and adipokines, can directly affect the function of the heart and blood vessels. In this review, we describe the alterations found in EAT and PVAT in pathological states like obesity, type 2 diabetes, the metabolic syndrome and coronary artery disease. Furthermore, we discuss how changes in adipokine expression and secretion associated with these pathological states could contribute to the pathogenesis of cardiac contractile and vascular dysfunction.     

Momordica charantia (Bitter Melon) Reduces Obesity-Associated Macrophage and Mast Cell Infiltration as well as Inflammatory Cytokine Expression in Adipose Tissues

Obesity is a world-wide epidemic disease that correlates closely with type 2 diabetes and cardiovascular diseases. Obesity-induced chronic adipose tissue inflammation is now considered as a critical contributor to the above complications. Momordica charantia (bitter melon, BM) is a traditional Chinese food and well known for its function of reducing body weight gain and insulin resistance. However, it is unclear whether BM could alleviate adipose tissue inflammation caused by obesity. In this study, C57BL/6 mice were fed high fat diet (HFD) with or without BM for 12 weeks. BM-contained diets ameliorated HFD-induced obesity and insulin resistance. Histological and real-time PCR analysis demonstrated BM not only reduced macrophage infiltration into epididymal adipose tissues (EAT) and brown adipose tissues (BAT). Flow cytometry show that BM could modify the M1/M2 phenotype ratio of macrophages in EAT. Further study showed that BM lowered mast cell recruitments in EAT, and depressed pro-inflammatory cytokine monocyte chemotactic protein-1 (MCP-1) expression in EAT and BAT as well as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) expression in EAT. Finally, ELISA analysis showed BM-contained diets also normalized serum levels of the cytokines. In summary, in concert with ameliorated insulin resistance and fat deposition, BM reduced adipose tissue inflammation in diet-induced obese (DIO) mice.     

Epicardial fat: from the biomolecular aspects to the clinical practice

Epicardial fat is the visceral fat depot of heart. It is a metabolically active organ with anatomical and functional contiguity to the myocardium. A dichotomous role has been attributed to the epicardial fat. Under physiological conditions, epicardial fat displays biochemical and thermogenic cardio-protective properties. Under pathological circumstances epicardial fat can locally affect the heart and coronary arteries through vasocrine or paracrine secretion of pro-inflammatory cytokines. Epicardial fat can be measured with imaging techniques. Epicardial fat thickness reflects intra-abdominal and myocardial fat and correlates with metabolic syndrome and coronary artery disease. Epicardial fat measurement may play a role in the stratification of the cardio-metabolic risk and serve as therapeutic target. Weight loss and anti-inflammatory drugs targeting the fat may modulate epicardial fat. Because epicardial and myocardial tissues share the same coronary arterial supply it is reasonable to hypothesize that improved local vascularisation may resume epicardial fat to its physiological role.     

Epicardial adipose tissue extent: relationship with age, body fat distribution, and coronaropathy

Epicardial fat is a relatively neglected component of the heart and could be an important risk factor of cardiac disease. The objective of our study was to assess the relationship between epicardial adipose tissue (EAT) extent, fat distribution, and coronaropathy in a group of adult victims of accidental or suspicious sudden death. In 56 cadavers, we performed 34 measurements of EAT from five computerized photographs of the heart (anterior and posterior faces, and three ventricle transversal slices) and analyzed their relationship with anthropometric markers of adiposity (BMI, waist and leg circumference, thickness of abdominal and thigh subcutaneous adipose tissue (SAT)), with the presence and staging of coronary artery disease (CAD), and with markers of myocardial hypertrophy. Simple linear regressions showed that EAT measurements are highly intercorrelated (r from 0.4 to 0.6, P < 0.001), and correlate with age, waist circumference, and heart weight, and to a lesser extent, with BMI, abdominal SAT thickness, and leg SAT thickness. Multiple regression showed that age, waist circumference, and heart weight significantly and independently correlate with EAT (P < 0.0001). No other anthropometric measurement was found independently correlated with EAT. The EAT/myocardium ratios correlated positively with age and waist circumference. Anterior and posterior areas of EAT were found significantly increased in patients with CAD and correlated positively with CAD staging (P = 0.0034, r = 0.38). Anterior EAT surface was found positively associated with CAD (P = 0.01), independently of age and other adiposity measurements. Prospective studies are needed to assess the risk of occurrence/progression of CAD that relate to EAT excess.     

综述: 自噬参与心脏疾病调控的研究进展

细胞自噬(autophagy)是将细胞内受损、变性或衰老的蛋白质以及细胞器运输到溶酶体内进行消化降解的过程．细胞自噬既是一种广泛存在的正常生理过程,又是细胞对不良环境的一种防御机制,参与多种疾病的病理过程．正常水平的自噬可以保护细胞免受环境刺激的影响,但自噬过度和自噬不足却可能导致疾病的发生．在心脏中,心肌细胞自噬对维持心肌功能具有重要的作用,自噬的异常可能导致各种心肌疾病如溶酶体储积症(Danon disease)等．各种心血管刺激如心肌缺血(ischemia)、再灌注(reperfusion)损伤、慢性缺氧(chronic hypoxia)等均可诱导心肌细胞自噬增强．而这些情况下心肌细胞自噬的作用还不清楚：它是否是一种潜在的细胞存活机制还是导致细胞死亡或疾病发生的病理性机制,或者是同时具有两种作用,目前还没有定论．心脏疾病是心肌功能出现异常时产生的各种病理状态的总称．在多种心脏疾病中,均伴随有心肌细胞自噬的改变,且影响着疾病的发生发展．在心肌肥厚(hypertrophic cardiomyopathy)中,细胞自噬程度降低而加剧心肌肥厚;在心力衰竭(heart failure,HF)中,细胞自噬增强可导致心肌细胞自噬性死亡;而在心肌梗死(myocardial infarction,MI)中,细胞自噬增强可减小梗死面积．但是细胞自噬在心脏疾病中到底扮演着怎样的角色,取决于细胞自噬发生的水平及病理状态．目前越来越多的人开始关注药物与细胞自噬调节之间的联系,且主要集中于抗肿瘤药物及心血管调节药物的研究．另外,有报道维生素类以及雌激素受体拮抗剂他莫西芬对细胞自噬也具有调节作用．研究心肌细胞自噬与心脏疾病的关系,以及药物对细胞自噬的调节,将有利于从自噬的角度探讨心脏疾病的发生发展过程及机制,开发出治疗心脏疾病的药物．     

Cholinergic activity regulates the secretome of epicardial adipose tissue: Association with atrial fibrillation

Botulinum toxin injection on epicardial fat, which inhibits acetylcholine (ACh) release, reduced the presence of atrial fibrillation (AF) in patients after heart surgery. Thus, we wanted to study the profile of the released proteins of epicardial adipose tissue (EAT) under cholinergic activity (ACh treatment) and their value as AF predictors. Biopsies, explants, or primary cultures were obtained from the EAT of 85 patients that underwent open heart surgery. The quantification of muscarinic receptors (mAChR) by real-time polymerase chain reaction or western blot showed their expression in EAT. Moreover, mAChR Type 3 was upregulated after adipogenesis induction (p < 0.05). Cholinergic fibers in EAT were detected by vesicular ACh transporter levels and/or acetylcholinesterase activity. ACh treatment modified the released proteins by EAT, which were identified by nano-high-performance liquid chromatography and TripleTOF analysis. These differentially released proteins were involved in cell structure, inflammation, or detoxification. After testing the plasma levels of alpha-defensin 3 (inflammation-involved protein) of patients who underwent open heart surgery ( n = 24), we observed differential levels between the patients who developed or did not develop postsurgery AF (1.58 ± 1.61 ng/ml vs. 6.2 ± 5.6 ng/ml; p < 0.005). The cholinergic activity on EAT might suggest a new mechanism for studying the interplay among EAT, autonomic nervous system dysfunction, and AF.     

The role of SIRT2 in vascular-related and heart-related diseases: A review

At present, cardiovascular disease is one of the important factors of human death, and there are many kinds of proteins involved. Sirtuins family proteins are involved in various physiological and pathological activities of the human body. Among them, there are more and more studies on the relationship between sirtuin2 (SIRT2) protein and cardiovascular diseases. SIRT2 can effectively inhibit pathological cardiac hypertrophy. The effect of SIRT2 on ischaemia-reperfusion injury has different effects under different conditions. SIRT2 can reduce the level of reactive oxygen species (ROS), which may help to reduce the severity of diabetic cardiomyopathy. SIRT2 can affect a variety of cardiovascular diseases, energy metabolism and the ageing of cardiomyocytes, thereby affecting heart failure. SIRT2 also plays an important role in vascular disease. For endothelial cell damage used by oxidative stress, the role of SIRT2 is bidirectional, which is related to the degree of oxidative stress stimulation. When the degree of stimulation is small, SIRT2 plays a protective role, and when the degree of stimulation increases to a certain level, SIRT2 plays a negative role. In addition, SIRT2 is also involved in the remodelling of blood vessels and the repair of skin damage.     

Drosophila as a model to study the genetic mechanisms of obesity-associated heart dysfunction

Obesity and cardiovascular disease are among the world's leading causes of death, especially in Western countries where consumption of high caloric food is commonly accompanied by low physical activity. This lifestyle often leads to energy imbalance, obesity, diabetes and their associated metabolic disorders, including cardiovascular diseases. It has become increasingly recognized that obesity and cardiovascular disease are metabolically linked, and a better understanding of this relationship requires that we uncover the fundamental genetic mechanisms controlling obesity-related heart dysfunction, a goal that has been difficult to achieve in higher organisms with intricate metabolic complexity. However, the high degree of evolutionary conservation of genes and signalling pathways allows researchers to use lower animal models such as Drosophila, which is the simplest genetic model with a heart, to uncover the mechanistic basis of obesity-related heart disease and its likely relevance to humans. Here, we discuss recent advances made by using the power of the Drosophila as a powerful model to investigate the genetic pathways by which a high fat diet may lead to heart dysfunction.     

Expression of NTPDase1 and caveolins in human cardiovascular disease

Pathological circumstances like inflammation or ischemic insult facilitate the release of adenine nucleotides from several types of cells. These extracellular nucleotides are rapidly converted to adenosine by ectonucleotidases, mainly ectonucleoside triphosphate diphosphohydrolase1 (NTPDase1/CD39) and CD73. NTPDase1/CD39 can interact with caveolins, structural proteins of signal-transducing microdomains termed caveolae. Caveolins are thought to have physiological roles in heart ageing and cardiac diseases. The aim of this study was to investigate the expression of NTPDase1 together with caveolins in chronic human cardiovascular diseases and elucidate their role in human heart. The HPLC analysis showed significant increase in ATPase activity in pathological samples from patients with ischemic heart disease. Immunostaining also showed alterations in the expression and distribution of NTPDase1. Caveolin-1 and caveolin-2 expression was much alike in control and pathological cases, while expression of caveolin-3 was lower in pathological samples. Changes in the expression of NTPDase1 and caveolins seem to be independent of human cardiovascular disease.