Keshan disease and mitochondrial cardiomyopathy

Keshan disease (KD) is a potentially fatal form of cardiomyopathy (disease of the heart muscle) endemic in certain areas of China. From 1984 to 1986, a national comprehensive scientific investigation on KD in Chuxiong region of Yunnan Province in the southwest China was conducted. The investigation team was composed of epidemiologists, clinic doctors, pathologists, biochemists, biophysicists and specialists in ecological environment. Results of pathological, biochemical and biophysical as well as clinical studies showed: an obvious increase of enlarged and swollen mitochondria with distended crista membranes in myocardium from patients with KD; significant reductions in the activity of oxidative phosphorylation (succinate dehydrogenase, cytochrome oxidase, succinate oxidase, H⁺-ATPase) of affected mitochondria; decrease in CoQ, cardiolipin, Se and GSHPx activity, while obvious increase in the Ca²⁺ content. So, it was suggested that mitochondria are the predominant target of the pathogenic factors of KD. Before Chuxiong KD survey only a few cases of mitochondrial cardiomyopathy were studied. During the multidisciplinary scientific investigation on KD in Chuxiong a large amount of samples from KD cases and the positive controls were examined. On the basis of the results obtained it was suggested that KD might be classified as a “Mitochondrial Cardiomyopathy” endemic in China. This is one of the achievements in the three years’ survey in Chuxiong and is valuable not only to the deeper understanding of pathogenic mechanism of KD but also to the study of mitochondrial cardiomyopathy in general. Keshan disease is not a genetic disease, but is closely related to the malnutrition (especially microelement Se deficiency). KD occurs along a low Se belt, and Se supplementation has been effective in prevention of such disease. The incidence of KD has sharply decreased along with the steady raise of living standard and realization of preventive measures. At present, patients of KD are very sparse. In recent years the research on the non-KD mitochondrial cardiomyopathy has progressed rapidly. Given the advances in this aspect a minireview is written to evaluate the classification of KD as a kind of mitochondrial cardiomyopathy.     

克山病是一种“心肌线粒体病(Mitochondrial Cardiomyopathy)”

亚急克病人心肌线粒体内膜电子传递链的琥珀酸氧化酶系,琥珀酸脱氢酶和细胞色素氧化酶活性明显低于对照。H~ -ATP酶的活性及其对寡霉素的敏感性都明显下降。ATP能量化后线粒体膜电位的变化也比对照明显降低。膜脂流动性低于对照。亚急克病人心肌线粒体内观察到较多的电子致密无定形物质,经电镜X射线微区等方法分析,认为这些物质不是Ca_3(PO_4)_2,而可能是一种蛋白质凝聚物。此外,心肌线粒体的硒含量远低于对照,而Ca含量明显高于对照。上述结果都反映亚急克病人心肌线粒体明显损伤。根据克山病患者心肌细胞线粒体结构与功能方面呈现的如此广泛与明显的异常,可将克山病称为“心肌线粒体病(Mitochondrial Cardiomyopathy)”。     

克山病病区粮低Se对大白鼠心肌线粒体Ca转运影响的研究

以低Ｓｅ克山病病区粮喂养大白鼠为动物模型,在细胞及亚细胞水平上进行了低Ｓｅ与Ｃａ转运关系的研究,同时测定了线粒体的能量转换功能。结果显示,低Ｓｅ病区粮组动物心肌线粒体Ｃａ转运呈现明显异常,但线粒体能量转换功能尚未发生明显改变。提示线粒体Ｃａ转运功能损伤先于线粒体能量转换功能损伤之前发生。心肌线粒体Ｃａ转运功能可作为更灵敏的指标用于克山病发病机理的研究。上述结果进一步表明克山病是一种“心肌线粒体病”。     

克山病心肌线粒体氧化损伤的实验研究

用克山病区粮喂养豚鼠证明其红细胞、肝等组织及其线粒体、上清中的硒及谷胱甘肽过氧化物酶活性明显降低,心肌线粒体脂质氢过氧化物、荧光色脂等增加、同时膜脂组成异常,内膜界面脂的心磷脂(CL)减少,细胞色素C氧化酶(CCO)活性降低;园二色性(CD)异常,近208nm及222nm区的峰值降低,病区粮加喂青菜的动物,随其线粒体硒及CL水平的增加。CCO活性和CD谱均明显恢复;通过外源性磷脂与纯化CCO的重组复性实验,只有CL可使病区粮组酶活性完全达到正常对照水平。表明心肌线粒体膜结合酶CCO活性的降低是CL含量降低引起酶的二级结构(构象)改变的结果。     

Studies on the relations of selenium and Keshan disease

Keshan disease is an endemic cardiomyopathy of unknown cause in The People’s Republic of China that occurs most frequently in children under 15 years of age and women of child-bearing age. Studies of children 1–9 years old in Mianing County of Sichuan Province have indicated that Keshan disease is a selenium responsive condition. Incidence rates of 9.5–13.5/1000 in 1974–1975 were reduced to 1–2/1000 in children treated with a tablet weekly of 0.5–1 mg sodium selenite. During 1974–1977, only 21 cases of the disease occurred in 36,603 treated children, compared with 106 cases in 9430 untreated children, of whom 53 died and 5 still have insufficient heart function. Occurrence of the disease was invariably associated with a lower selenium content of cereals, and of hair (less than 0.12 ppm Se) in residents from affected, compared with non-affected, areas. The dose relationship between selenium and regional characteristics of Keshan disease suggests that it is probably a biogeochemical disease; other etiological factors have also been considered.     

Mitochondrial sensitivity to AZT

The possibility of tissue-specific effects regarding mitochondrial sensitivity to AZT was evaluated in this study. When mitochondria isolated from liver, kidney, skeletal and cardiac muscle were oxidizing glutamate, a dose-dependent inhibition by AZT of state 3 respiration was observed; using succinate as substrate the inhibition occurred only in skeletal and cardiac muscle mitochondria. The same results were obtained with FCCP-uncoupled mitochondria. NADH oxidase of intact and disrupted mitochondria, isolated from all four tissues was strongly inhibited. Succinate oxidase activity was inhibited by AZT only in intact mitochondria from skeletal and cardiac muscles, suggesting the involvement of succinate transport systems. Similarly, inhibition by the drug of the hydrolytic activity of H⁺-ATPase was observed only in mitochondria of these tissues. These effects taken together, indicate a tissue/carrier-specific inhibition in vitro, although its precise mechanism requires further research. © 1998 John Wiley & Sons, Ltd.     

Subcellular distribution of selenium during uptake and its influence on mitochondrial oxidations in germinatingVigna radiata L

The metabolic significance of Se in plants is not well documented, though the presence of many selenoenzymes in bacteria and the essentiality of Se in higher animals is established. Since germination is an active process in plant growth and metabolism, the effect of Se was investigated in germinatingVigna radiata L, a nonaccumulating Sedeficient legume. Growth and protein were enhanced in seedlings supplemented with selenium (Se) as sodium selenite in the medium up to 1 μg/mL. The pattern of uptake of⁷⁵Se in the differentiating tissues and the subcellular distribution were investigated. The percentage of incorporation of⁷⁵Se was greater in the mitochondria at the lowest level (0.5 μg/mL) of Se supplementation compared to higher levels of Se exposure. Proteins precipitated from the postmitochondrial supernatant fractions, when separated by means of polyacrylamide gel electrophoresis (PAGE), indicated a major selenoprotein in the seedlings germinated at 2.0 μg/mL Se. In seedlings grown with supplemented Se, enhanced respiratory control ratio and succinate dehydrogenase activity were observed in the mitochondria of tissues, indicative of a role for Se in mitochondrial membrane functions.     

Serum Biomarkers of Keshan Disease Assessed Using a Protein Profiling Approach Based on ClinProt Technique

The etiology of Keshan disease (KD), an endemic myocardiopathy in regions of China, is largely unknown. To show the protein changes in serum from KD patients versus controls and idiopathic dilated cardiomyopathy (IDCM) and to search specific biological markers for differential diagnosis for KD. Serum of 65 patients with KD was compared with 29 patients with IDCM, 62 controls from KD areas and 28 controls from non-KD areas by ClinProt/MALDI-ToF technique. The genetic algorithm, quick classifier algorithm and supervised neural network algorithm methods were used to screen marker proteins and establish diagnostic model. Thirty-four differential peaks were identified in KD patients compared with the healthy controls from non-KD areas. Thirty-eight differentially peaks were identified in KD patients and controls from KD areas; and sixty-seven differentially peaks were identified in patients with KD and patients with IDCM. We believe that marker protein peaks screened in KD patients, healthy controls and IDCM patients may provide clues for the differential diagnosis and treatment of KD.     

Mitochondrial-related gene expression profiles suggest an important role of PGC-1alpha in the compensatory mechanism of endemic dilated cardiomyopathy

Keshan disease (KD) is an endemic dilated cardiomyopathy with unclear etiology. In this study, we compared mitochondrial-related gene expression profiles of peripheral blood mononuclear cells (PBMCs) derived from 16 KD patients and 16 normal controls in KD areas. Total RNA was isolated, amplified, labeled and hybridized to Agilent human 4×44k whole genome microarrays. Mitochondrial-related genes were screened out by the Third-Generation Human Mitochondria-Focused cDNA Microarray (hMitChip3). Quantitative real-time PCR, immunohistochemical and biochemical parameters related mitochondrial metabolism were conducted to validate our microarray results. In KD samples, 34 up-regulated genes (ratios≥2.0) were detected by significance analysis of microarrays and ingenuity systems pathway analysis (IPA). The highest ranked molecular and cellular functions of the differentially regulated genes were closely related to amino acid metabolism, free radical scavenging, carbohydrate metabolism, and energy production. Using IPA, 40 significant pathways and four significant networks, involved mainly in apoptosis, mitochondrion dysfunction, and nuclear receptor signaling were identified. Based on our results, we suggest that PGC-1alpha regulated energy metabolism and anti-apoptosis might play an important role in the compensatory mechanism of KD. Our results may lead to the identification of potential diagnostic biomarkers for KD in PBMCs, and may help to understand the pathogenesis of KD.     

Analysis of glutathione peroxidase 1 gene polymorphism and Keshan disease in Heilongjiang Province, China

Keshan disease (KD) is an endemic cardiomyopathy associated with selenium deficiency. Recent studies indicate that glutathione peroxidase 1 (GPx1) mutation decreases GPx activity in myocardial cells and increases the risk of KD. To further clarify the correlation between GPx1 polymorphism and KD, we analyzed GPx1 polymorphism, blood selenium levels and GPx activity in KD patients and healthy controls in Heilongjiang Province. Four and 24 new mutation loci in the promoter and the exon region, respectively, of the GPx1 gene were found in the subjects, in contrast with the previously reported loci. There were no significant differences in the mutation frequency of these loci between the KD group and controls (chi-square test; P > 0.05). However, the mutation frequency of exon 474 was higher in the KD group (7/36) than in controls (2/41), and GPx activity was lower in the mutation group (90.475 ± 23.757 U/L) than in the non-mutation group (93.947 ± 17.463 U/L). Further investigation is necessary to clarify a possible causality between GPx1 exon 474 mutation and KD.     

Network Analysis of Se-and Zn-related Proteins in the Serum Proteomics Expression Profile of the Endemic Dilated Cardiomyopathy Keshan Disease

Keshan disease (KD) is an endemic cardiomyopathy with high mortality. Selenium (Se) and zinc (Zn) deficiencies are closely related to KD. The molecular mechanism of KD pathogenesis is still unclear. There are only few studies on the interaction of trace elements and proteins associated with the pathogenesis of KD. In this study, isobaric tags for relative and absolute quantitation (iTRAQ)-coupled two-dimensional liquid chromatography tandem mass spectrometry (2DLC-MS/MS) technique analysis was used to analyze the differential expression of proteins from serum samples. Comparative Toxicogenomics Database (CTD) was used to screen Se- and Zn-associated proteins. Then, pathway and network analyses of Se- and Zn-associated proteins were constituted by Cytoscape ClueGO and GeneMANIA plugins. One hundred and five differentially expressed proteins were obtained by 2DLC-MS/MS, among them 19 Se- and 3 Zn-associated proteins. Fifty-two pathways were identified from ClueGO and 1 network from GeneMANIA analyses. The results showed that Se-associated proteins STAT3 and MAPK1 and Zn-associated proteins HIF1A and PARP1, the proteins involved in HIF-1 signaling pathway and apoptosis pathway, may play significant roles in the pathogenesis of KD. The approach of this study would be also beneficial for further dissecting molecular mechanism of other trace element-associated disease.     

Interacting nutritional and infectious etiologies of Keshan disease

In 1979, Chinese scientists reported that selenium had been linked to Keshan disease, an endemic juvenile cardiomyopathy found in China. However, certain epidemiological features of the disease could not be explained solely on the basis of inadequate selenium nutrition. Fluctuations in the seasonal incidence of the disease suggested involvement of an infectious agent. Indeed, a coxsackievirus B4 isolated from a Keshan disease victim caused more heart muscle damage when inoculated into selenium-deficient mice than when given to selenium-adequate mice. Those results led us to study the relationship of nutritional status to viral virulence. Coxsackievirus B3/0 (CVB3/0), did not cause disease when inoculated into mice fed adequate levels of Se and vitamin E. However, mice fed diets deficient in either Se or vitamin E developed heart lesions when infected with CVB3/0. To determine if the change in viral phenotype was maintained, we passaged virus isolated from Se-deficient hosts, maintained, we passaged virus isolated from Se-deficient hosts, designated as CVB3/0 Se-, back into Se-adequate hosts. The CVB3/0 Se- virus caused disease in Se-adequate mice. To determine if the phenotype change was due to changes in the viral genome, we sequenced viruses isolated from Se-deficient mice and compared them with the input CVB3/0 virus. Six point mutations differed between the parent strain and the recovered CVB3/0 Se- isolates. When the experiment was repeated using vitamin E-deficient mice, the same 6 point mutations were found. This is the first report of a specific host nutritional deficiency altering viral genotype. Keshan disease may be the result of several interacting causes including a dominant nutritional deficiency (selenium), other nutritional factors (vitamin E, polyunsaturated fatty acids), and an infectious agent (virus).     

TLR2-ICAM1-Gadd45α Axis Mediates the Epigenetic Effect of Selenium on DNA Methylation and Gene Expression in Keshan Disease

Keshan disease (KD) is a fatal dilated cardiomyopathy with unknown etiology, and selenium deficiency is considered the main cause of KD. Several observations implicate a role for altered DNA methylation in selenium deficiency-related diseases. The aim of the present study was to investigate the epigenetic effects of selenium (Se) on DNA methylation and gene expression in Keshan disease. Using methylated DNA immunoprecipitation chip (MeDIP-Chip) and quantitative RT-PCR, we identified two inflammatory-related genes (TLR2 and ICAM1) that were differentially methylated and expressed between normal individuals and KD patients. Results from DNA methylation profile between KD patients and normal individuals showed that selenium deficiency decreased methylation of CpG islands in promoter regions of TLR2 and ICAM1 and upregulated messenger RNA (mRNA) and protein levels of TLR2 and ICAM1. In rat animal model of Keshan disease, selenite treatment could increase TLR2 and ICAM1 promoter methylation, suppress these genes expression, and reduce infiltration of myocardial inflammatory cells. In cell culture model of Keshan disease, we found 5-Aza-dC (DNMT1 inhibitor) treatment in the presence of selenium-reduced mRNA and protein levels of DNMT1 regardless of TLR2 and ICAM1 promoter methylation status and expression levels of these genes. Selenite treatment suppressed the expression of the Gadd45α, TLR2, and ICAM1 in a concentration-dependent manner, while selenium deficiency increased the expression of the Gadd45α, TLR2, and ICAM1 and decreased TLR2 and ICAM1 promoter methylation level in a time-dependent manner. Our results revealed that TLR2-ICAM1-Gadd45α axis might play an important role in gene-specific active DNA demethylation during inflammatory response in myocardium.     

Behaviour of some mitochondrial enzymes in ripening tomato fruit

The activities of four mitochondrial enzymes were studied in four stages of ripening tomato fruit. The highest enzyme activity was recorded for malate dehydrogenase followed by cytochrome c oxidase. Succinate dehydrogenase and NADH oxidase levels were low and could only be determined in the green stage of the fruit. However, peaks of various enzyme activities coincided in identical mitochondrial fractions on the sucrose density gradient. Moreover, the levels of malate dehydrogenase and cytochrome c oxidase were constant during the ripening process while the other two enzymes, succinate dehydrogenase and NADH oxidase, declined. This might indicate that mitochondria retain some of their essential functions through the ripening process.     

Metabolic relevance of selenium in the insectCorcyra cephalonica

Requirement, uptake, and subcellular distribution of Na₂ ⁷⁵SeO₃ in the larvae of the insectC. cephalonica was investigated. That Se is well tolerated byC. cephalonica upto an added level of 2 ppm in the diet is suggested by the observed increase in body weight, total protein, and succinate dehydrogenase levels. Significant increases in the State 3 respiration ensued with Se supplementation up to 2 ppm in the mitochondrial oxidation of D-glycerol 1-phosphate, succinate and NADH, along with concomitant unaltered State 4 respiration, leading to enhanced RCR values. Maximal uptake of⁷⁵Se was registered in the larvae maintained on basal diet when subjected to short-term exposure to 0.5 ppm⁷⁵Se level. When exposure level was further increased up to 20 ppm, the observed decrease in the uptake of⁷⁵Se suggested that Se status of larvae itself controlled the tissue uptake. Subcellular distribution pattern revealed maximal incorporation of⁷⁵Se (cpm/g tissue) in the supernatant fraction, whereas, maximal specific⁷⁵Se activity (cpm/mg protein) was associated with the mitochondrial fraction. Autoradiography of the soluble fractions indicated the presence of single selenoprotein in the larval group with short term 2 ppm⁷⁵Se exposure. Inherent Se controls both the extent and the nature of distribution of mitochondrial⁷⁵Se incorporation. Uptake of⁴⁵Ca by the insect mitochondria was enhanced by dietary Se up to 2 ppm but was unaffected by addition ofin vitro ⁷⁵Se in the medium. A more fundamental role for Se in the mitochondrial energy metabolism emerges from these studies.     

硒对心肌质膜(Ca~(2+)·Mg~(2+))-ATPase和肌浆网Ca~(2+)-ATPase活力的影响

本文以豚鼠和大白鼠心肌肌浆网膜(SR)Ca~(2+)-ATPase的活力,心肌质膜(SL)(Ca~(2+)Mg~(2+))-ATPase的活力和电子显微镜的方法探索克山病病区粮中低硒与心肌细胞钙转运调控的共系,实验结果为硒对克山病有预防作用的观点提供了新的理论依据,并进一步支持了“克山病是一种心肌线粒体病”的观点。     

Nitric oxide increases oxidative phosphorylation efficiency

We have studied the effect of nitric oxide (NO) and potassium cyanide (KCN) on oxidative phosphorylation efficiency. Concentrations of NO or KCN that decrease resting oxygen consumption by 10–20% increased oxidative phosphorylation efficiency in mitochondria oxidizing succinate or palmitoyl-L-carnitine, but not in mitochondria oxidizing malate plus glutamate. When compared to malate plus glutamate, succinate or palmitoyl-L-carnitine reduced the redox state of cytochrome oxidase. The relationship between membrane potential and oxygen consumption rates was measured at different degrees of ATP synthesis. The use of malate plus glutamate instead of succinate (that changes the H⁺/2e⁻ stoichiometry of the respiratory chain) affected the relationship, whereas a change in membrane permeability did not affect it. NO or KCN also affected the relationship, suggesting that they change the H⁺/2e⁻ stoichiometry of the respiratory chain. We propose that NO may be a natural short-term regulator of mitochondrial physiology that increases oxidative phosphorylation efficiency in a redox-sensitive manner by decreasing the slipping in the proton pumps.     

Biogenesis of flavoprotein and cytochrome components in hepatic mitochondria from riboflavin-deficient rats

Using difference spectrophotometry, measurements of succinate dehydrogenase activity, and SDS-polyacrylamide gels, the biochemical properties of hepatic mitochondria from riboflavin-deficient rats were monitored during recovery on riboflavin. [¹⁴C]Riboflavin was incorporated into four mitochondrial flavoproteins having covalently bound flavin coenzyme. Alterations in cytochromes, especially cytochrome oxidase, and the biosyntheses of succinate dehydrogenase, monoamine oxidase, sarcosine dehydrogenase, and an unknown flavoprotein were observed.     

A spatial study on serum selenoprotein P and Keshan disease in Heilongjiang Province,China

BackgroundFew spatial studies on serum selenoprotein P (SELENOP) and Keshan disease (KD) have been reported at the county-level in Heilongjiang province, China. This study aimed to provide visualized spatial epidemiological evidence of selenium molecular marker in residents living in endemic areas for the precise assessment of prevention, control, and elimination of KD.MethodsUsing a spatial ecological study design, 587 subjects living in cities, townships, and rural areas of 50 KD endemic counties and 37 non-endemic counties in Heilongjiang province were investigated. The serum SELENOP levels of the participants were measured by enzyme-linked immunosorbent assay. Thematic maps were created, and spatial regression analysis was conducted using ordinary least squares.ResultsThe mean serum SELENOP level of the 587 subjects was 7.4 ± 3.0 μg/mL. The mean levels of serum SELENOP were higher in cities (7.4 ± 2.9 μg/mL) and townships (7.9 ± 3.2 μg/mL) than in rural areas (6.0 ± 3.0 μg/mL). The mean levels of serum SELENOP were trending towards high levels in non-endemic areas (7.4 ± 3.0 μg/mL) than in KD endemic areas (6.3 ± 3.3 μg/mL). Spatial regression analysis showed that the serum SELENOP level was positively correlated with the per capita gross domestic product.ConclusionSelenium deficiency may still exist in some KD endemic counties in Heilongjiang province, including Lingdong, Nenjiang, and Baiquan; these counties should be considered as key areas for precision prevention, control, and elimination of KD. Inclusion of selenium in the national surveillance of KD will provide more evidence for the assessment of KD elimination from a selenium nutrition perspective.     

Selenium supplementation of children in a selenium-deficient area in China

Keshan disease is a cardiomyopathy restricted to the endemic areas of China and seen in residents having an extremely low selenium (Se) status. Prophylactic administration of sodium selenite has been shown to decrease significantly the incidence of acute and subacute cases. The aim of the study was to assess the relative bioavailability of selenite versus organic Se-yeast in a Se-deficient area in China with a randomized double-blind double-dummy design. Healthy children (n=30) between 14 and 16 yr of age were randomized into three equal groups receiving either 200 μg/d selenite Se or 200 μg/d Se-yeast or placebo for 12 wk. Blood was drawn at baseline, 4, 8, and 12 wk and 4 wk postsupplementation. The plasma Se concentration (mean ± SD) was 0.16±0.03 μmol/L at baseline. Selenite and Se-yeast supplementation increased plasma Se to plateau values, 1.0±0.2 and 1.3±0.2 μmol/L, respectively. In red cells, Se-yeast increased the selenium level sixfold and selenite threefold compared to placebo. The relative bioavailability of Se-yeast versus selenite measured as glutathione peroxidase (GSHPx) activity was similar in plasma, red blood cells, and platelets. GSHPx activity reached maximal levels in plasma and platelets of 300% and 200%, respectively, after 8 wk compared to the placebo group, but continued to increase in red cells for 16 wk. Our study showed that although both forms of Se were equally effective in raising GSHPx activity, Se-yeast provided a longer lasting body pool of Se. Se-yeast may be a better alternative to selenite in the prophylaxis of Keshan disease with respect to building up of body stores.