Heart scar tissue may take active role in promoting deadly arrhythmias

Susan Thompson, PhD student in biomedical engineering, and Craig Copeland, PhD student in physics and astronomy, observe a single non-beating heart cell called a myofibroblast growing on a micropost device. (Photo Jay VanRensselaer)

Johns Hopkins University biomedical engineers and physicists affiliated with the Institute for NanoBioTechnology have completed a study that suggests that mechanical forces exerted by cells that build scar tissue following a heart attack may later disrupt rhythms of beating heart cells and trigger deadly arrhythmias. Their findings, published in a recent issue of the journal Circulation, could result in a new target for heart disease therapies.

Principal investigator Leslie Tung, a School of Medicine professor in the department of biomedical engineering, led a team that looked at how heart cells that beat (called “cardiomyocytes”) were affected by the non-beating cells (called “myofibroblasts”). Myofibroblasts are called to arms at the site of injury following a heart attack.

“The role of the myofibroblast (non-beating cells) is to make the injured area as small as possible. Through contraction, the myofibroblasts close the wound and lay down a protein matrix to reduce the scar area,” said lead investigator Susan Thompson, a pre-doctoral fellow in Tung’s Cardiac Bioelectric Systems Laboratory. “In doing so, the myofibroblasts pull on the membranes of adjacent cardiomyocytes. We found that these forces were strong enough to decrease the electrical activity of the working heart cells through mechanical coupling.”

Thompson electrically stimulated cultures containing both the beating and non-beating cells growing together, and found that when the electrical impulses occurred, the non-beating myofibroblasts pulled on the membranes of beating cardiomyocytes and disturbed their electrical rhythm. Before this study, scientists were aware that myofibroblasts influenced the function of cardiomyocytes by depositing scar tissue, which produces regions of poor or no conductivity in healing cardiac tissue. But the “pulling” scenario described by Tung’s group indicates that myofibroblasts play a more active role than previously realized, Thompson said.

Biomedical engineering professor Leslie Tung collaborated with physics professor Daniel Reich to understand how heart scar tissue actively contributes to deadly arrhythmias. (Photo by Jay VanRensselaer)

In fact, images created using a voltage-sensitive dye showed that the spread of electrical waves was greatly impaired in the cultures with the most non-beating cells. Electrical conduction improved significantly, however, when drugs were added that inhibited contraction or that blocked so called “mechano-sensitive” channels.

“This is a truly exciting discovery because it radically affects our way of thinking about how cardiac arrhythmias might arise,” Tung said.

Tung and Thompson wanted to find out how strong the forces exerted by the myofibroblasts were and whether they changed when certain drugs were added. So they turned for answers to Daniel Reich, professor and chair of the Henry A. Rowland Department of Physics and Astronomy in the Krieger School of Arts and Sciences, and his pre-doctoral student Craig Copeland.

To measure the strength of the contractile forces of the myofibroblasts, the team used a device made up of a platform comprising an array of flexible “microposts.” The array resembled a carpet with widely spaced fibers upon which single cells can grow. As the cells responded to their environment, they pulled on the posts. How much the posts bent provided data about the direction and strength of forces exerted. Single layers of myofibroblasts were grown on the micropost device and tested in the presence of the same compounds Thompson used in her conductivity experiments.

“Imagine gripping a basketball with one hand, palm facing downward,” Copeland said. “The forces you apply to the ball with your fingertips to keep it suspended are similar to the forces cells exert on their environment. If you were to place your hand on a bed of rubber nails and apply the same gripping force with your fingertips as you did with the basketball, the nails would bend and their tips be deflected. This is exactly what happens with cells cultured on the post arrays.”

Thompson also explained that scientists previously thought that non-beating cells affected the beating cells simply through openings called “gap junctions,” where the two cells came into physical contact. The greater electrical charge of the myofibroblasts would flow passively downhill through the gap junctions toward the cardiomyocytes and disrupt their rhythms.

Photo by Jay VanRensselaer

The group’s new hypothesis suggests another type of membrane channel opened by physical force—the mechano-sensitive channels—may be more important in regulating electrical activity of the cardiomyocytes than mere junctions connecting membranes.

The results of both the conductivity and the micropost experiments fully support this new hypothesis, the team said. Although they acknowledge that both the passive gap channels and the active pulling forces can explain how myofibroblasts affect the electrical activity of cardiomyocytes, the researchers believe the pulling forces could be more relevant to the development of deadly arrhythmias.

“We are not ruling out the current theory,” Thompson said. “But we are saying there is something else we should be looking at, and we think the pulling forces are a major component. This could provide another lane of therapeutic investigation, especially if drugs could be targeted specifically to the contraction of the myofibroblasts.”

The next step in the project will be to combine the micropost device with electrical experiments on cultures containing cardiomyocyte and myofibroblast cell pairs.

“Although technically quite challenging, it will allow us to unravel how pulling forces applied by the myofibroblast to the cardiomyocyte affects the cardiomyocyte’s electrical activity,” said Tung.

Both Tung and Reich are affiliated faculty members of Johns Hopkins Institute for NanoBioTechnology. Thompson and Copeland are INBT fellows in the institute’s Integrative Graduated Education and Research Traineeship (IGERT), funded by the National Science Foundation (NSF). The National Institutes of Health, American Heart Association and the NSF IGERT funded their work. Findings were published in the May 17, 2011 issue of the journal Circulation.

Story by Mary Spiro

Photos by Jay VanRenesselaer/Homewood Photography

Platelets, coagulation and cancer metastasis: a sticky situation in the blood

Owen McCarty

Join the Chemical and Biomolecular Engineering department for the first seminar of 2011: “Platelets, Coagulation and Cancer Metastasis: a Sticky Situation in the Blood” at 10:45 a.m., Thursday, March 3 in room 301 of Shaffer Hall at the Homewood campus of Johns Hopkins University. Owen J.T. McCarty of Oregon Health and Science University is the invited speaker.

McCarty serves as an assistant professor at OHSU in Portland in the departments of Biomedical Engineering and Cell and Developmental biology. He studies the interplay between cell biology and fluid mechanics in the cardiovascular system. His investigation into the balance between hydrodynamic shear forces and chemical adhesive interactions could shed light on the underlying processes of cancer, cardiovascular disease, and inflammation.

An alumnus of Johns Hopkins University, McCarty’s 2002 Ph.D. dissertation in Chemical and Biomolecular Engineering focused on the role of platelets in cancer metastasis and thrombosis. At the Department of Pharmacology, Oxford University and Centre for Cardiovascular Sciences, University of Birmingham, UK, he continued his research as a Wellcome Trust Postdoctoral Fellow in the area of thrombosis, examining the signaling pathways that rule platelet cytoskeletal reorganization. McCarty’s talk is co-sponsored by the Johns Hopkins Physical Sciences Oncology Center.

Johns Hopkins Physical Sciences Oncology Center