Int J Biol Macromol. 2026 Jun 06. pii: S0141-8130(26)02850-3. [Epub ahead of print]370
152923
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia globally, marked by chaotic electrical impulses and irregular atrial contraction. At the cellular level, defective calcium (Ca+2) handling plays a central role in AF pathogenesis, with the sarco/endoplasmic reticulum Ca+2-ATPase (SERCA) pump being a critical determinant of intracellular Ca+2 reuptake and myocardial relaxation. Recent research has uncovered a class of small transmembrane micropeptides, phospholamban (PLB), sarcolipin (SLN), dwarf open reading frame (DWORF), myoregulin (MLN), endoregulin (ELN) and another-regulin (ALN), that directly modulate SERCA activity. Interestingly, these micropeptides exhibit chamber-specific expression and diverse regulatory mechanisms, functioning as inhibitors, uncouplers or facilitators of SERCA activity and are increasingly linked to atrial arrhythmogenesis. This review synthesizes current understanding on function of SERCA micropeptides, highlighting their distinct roles in atrial versus ventricular excitation-contraction (E-C) coupling. We explore evidence from genetically modified animal models and patient-derived data to elucidate how dysregulation of these peptides, particularly SLN and PLB, contributes to abnormal EC-coupling like Ca+2 cycling, delayed afterdepolarizations, oxidative stress and atrial remodeling. We also examine the influence of systemic metabolic regulators, such as thyroid hormones, catecholamines, dexamethasone and various exercise paradigms on micropeptide expression and function, offering insight into their intersection with AF progression. By dissecting the spatial, temporal and metabolic regulation of SERCA micropeptides, this review aims to offer current understanding about chamber-specific modulation of Ca+2 homeostasis and use these insights towards treatment of AF.
Keywords: Atrial fibrillation; Calcium handling; Micropeptides; Phospholamban; SERCA; Sarcolipin