Expression And Significance Of CARP And CaMKII/PKA In The Patients Of Sudden Coronary Death

Objection:Observe the expression of cardiac ankyrin repeat protein (CARP) and calcium dependent protein kinase Ⅱ (CaMKII)/Protein Kinase A(PKA) in myocardial tissue of sudden coronary death(SCD); confirm the correlation of CARP and CaMKII/PKA, and discuss the significance of forensic medicine.Methords:1. Experimental group comprised30cases of SCD autopsy myocardial tissue, while30of non-sudden coronary death served as controls.2. Routine pathological section, HE staining, the microscopic observation of myocardial pathological change.3. The expressions of CARP and CaMKII in myocardium were detected using immunohistochemical technique.4. SPSS statistical package was used for the analysis.Results:HE staining section results:1. It can be detected in SCD group that part of myocardial tissue fiber fractured, interstitial tissue edema, another part of the myocardial cells in vacuolar degeneration, myofibril and nucleus dissolved and disappeared; part of the myocardial infarction area was characterized by coagulative necrosis, the increase of myocardial cells of eosinophilic cytoplasm, nuclear disappeared, hyperemia and neutrophil infiltration can be detected on the edge of infarcts; there are myocardial cells swelling, with granules and irregular bands in the cytoplasm; the stenosis degree was above50%in left anterior descending coronary artery, left circumflex branch and right coronary artery; part of the lumens were deformity, intimal thickening, with increased fibrous connective tissue. Endoluminal fibrous caps are formed in5cases, containing macrophages, proliferative smooth muscle cells and lymphocytes, calcium salt deposits, thrombosis and fibrous tissue hyperplasia can be detected in part of the area.2. While in the control group, it can be detected in3cases that scattered myocardial tissue fiber fracture in part of the area, mild edema, myocardial tissue cells dotted eosinophilic enhancement; there is no stenosis or slightly narrow in left anterior descending coronary artery, left circumflex branch and right coronary artery, the stenosis degree was all under25%.Immunohistochemical results:1. In30cases of the SCD Group, the expression of CARP, CaMKII and PKA located in myocardial cell cytoplasm, yellowish-brown, stained deeply. In30cases of the control group, CARP, CaMKII and PKA expressed dispersively and pale yellow in only3cases. The rest are all negative.2. The expressions of CARP, CaMKII and PKA in myocardium of the SCD were significantly higher than that of the control(Z=-6.706、-7.018,-4.150, P<0.01).3. The expressions of CARP and CaMKII in myocardium of the SCD were positively correlated (r=0.833, P<0.01).Conclusion1. The expression of CARP in myocardial tissue of the sudden death of coronary heart disease (CHD) is significantly greater than the sudden death without coronary heart disease. The enhanced CARP expression may result from ischemia hypoxia myocardial tissue damage, which activate the CARP to induce angiogenesis, regulate cell apoptosis, and participate in the regulation of cardiac structure and function.2. The significant differences of CaMKII and PKA expression in myocardium between sudden death with and without coronary heart disease prompt that CaMKII and PKA may participate in the pathology of signal transduction pathways of sudden death of coronary heart diseas; The enhanced CARP and PKA expression and function may reduce the heart failure and sudden death of the coronary heart disease patients. So presumably the activation of CaMKII and PKA in the myocardium is the important link in the process of sudden death after myocardial infarction in coronary heart disease.3. CaMKII/PKA signal pathway abnormality may affect the myocardial CARP expression in the sudden death of coronary heart disease. They have a certain correlation, which may play a corporative action in the pathological changes of sudden death of coronary heart disease process, and participate in the regulation of myocardial cell apoptosis together.