Myocardial infarction: Rush-hour for neutrophils

June 08, 2016

Researchers at Ludwig-Maximilians-Universitaet (LMU) in Munich have shown that circadian oscillations in the influx of immune cells into the damaged tissue play a crucial role in exacerbating the effects of an acute heart attack in the early morning hours.

The extent of the inflammatory reaction triggered by an acute heart attack, and of the resulting damage to the heart muscle, varies depending on the time of day at which the infarct occurs. In a new study, researchers led by Sabine Steffens, Professor of Clinical Pathobiochemistry in the Institute for Cardiovascular Prevention (IPEK) at the LMU Medical Center confirm that the intensity of the immune reaction is correlated with the level of recruitment of immune cells called neutrophilic granulocytes to the damaged heart. More importantly, they show that the number of neutrophils present in the circulation naturally fluctuates with the time of day, and that circadian variations in the expression of chemokine receptor CXCR2 play a crucial role in regulating the migration of granulocytes into the damaged tissue. The new findings appear in the journal EMBO Molecular Medicine.

Myocardial infarctions are precipitated by an acute decrease in the supply of oxygen to the heart, which results in the death of the muscle cells affected. In response to this cell loss, neutrophilic granulocytes are recruited to the site of tissue damage by molecular messages called chemokines. The neutrophils then trigger an inflammatory reaction by attracting other types of immune cells that facilitate the degradation and disposal of the dead cells. In an earlier report published in the European Heart Journal, Steffens and her colleagues had shown that these neutrophils play a critical role in the healing of the heart following an acute infarct -- provided that their recruitment is restricted and the inflammatory reaction does not get out of hand.

Many studies have shown that the risk of suffering a heart attack reaches a peak in the early morning, soon after the end of the sleep phase. The consequences of an infarct are also influenced by the time of day: Attacks that occur in the forenoon are more likely to be fatal, and are associated with a poorer long-term outcome. However, the molecular mechanisms responsible for these striking effects have remained largely unclear. Steffens and her team have now shown that recruitment of neutrophils to the damaged heart muscle is itself controlled by the body's circadian clock. About an hour after resumption of activity soon after waking up, more cells migrate into the heart muscle and induce a stronger inflammatory response than if the acute attack occurs during sleep or later in the day.

"We show that at the onset of the active phase, more neutrophils leave the bone marrow than at other times. In humans, this phase occurs early in the morning. A myocardial infarction at this time of day thus leads to an exaggerated inflammation reaction induced by the availability of more neutrophils in the bloodstream," Steffens explains. This has a deleterious effect on the clinical prognosis, because it stimulates scar formation. Scarring induces enlargement of the heart muscle and reduces its ability to contract, which eventually leads to heart failure.

In addition, the LMU team showed that the level of the receptor CXCR2 found on the surface of neutrophils also varies with the time of day, being expressed at high levels immediately after waking. When the team prevented activation of the receptor by blocking the binding of its chemokine ligand, the degree of cardiac inflammation and the amount of damage to the heart muscle was reduced. "Our study shows that time of day plays an important role in determining the optimal treatment for an acute heart attack, and that CXCR2 constitutes an interesting target for drugs designed to control the recruitment of neutrophils to the site of damage in the aftermath of a heart attack," says Steffens.

Ludwig-Maximilians-Universität München

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to