Craig W. Clarkson

Characterization of cocaine-induced block of cardiac sodium channels

Recent evidence suggests that cocaine can produce marked cardiac arrhythmias and sudden death. A possible mechanism for this effect is slowing of impulse conduction due to block of cardiac Na channels. We therefore investigated its effects on Na channels in isolated guinea pig ventricular myocytes using the whole-cell variant of the patch clamp technique. Cocaine (10-50 microM) was found to reduce Na current in a use-dependent manner. The time course for block development and recovery were characterized. At 30 microM cocaine, two phases of block development were defined: a rapid phase (tau = 5.7 +/- 4.9 ms) and a slower phase (tau = 2.3 +/- 0.7 s). Recovery from block at -140 mV was also defined by two phases: (tau f = 136 +/- 61 ms, tau s = 8.5 +/- 1.7 s) (n = 6). To further clarify the molecular mechanisms of cocaine action on cardiac Na channels, we characterized its effects using the guarded receptor model, obtaining estimated Kd values of 328, 19, and 8 microM for channels predominantly in the rested, activated, and inactivated states. These data indicate that cocaine can block cardiac Na channels in a use-dependent manner and provides a possible cellular explanation for its cardiotoxic effects.

Characterization of the inhibitory effects of erythromycin and clarithromycin on the HERG potassium channel

Both erythromycin and clarithromycin have been reported to cause QT prolongation and the cardiac arrhythmia torsade de pointes in humans, however direct evidence documenting that these drugs produce this effect by blocking human cardiac ion channels is lacking. The goal of this study was to test the hypothesis that these macrolide antibiotics significantly block the delayed rectifier current (IKr) encoded by HERG (the human ether-a-go-go-related gene) at drug concentrations, temperature and ionic conditions mimicking those occurring in human subjects. Potassium currents in HEK 293 cells stably transfected with HERG were recorded using a whole cell voltage clamp method. Exposure of cells to erythromycin reduced the HERG encoded potassium current in a concentration dependent manner with an IC50 of 38.9 ± 1.2 μM and Hill Slope factor of 0.4 ± 0.1. Clarithromycin produced a similar concentration-dependent block with an IC50 of 45.7 ± 1.1 μM and Hill Slope factor of 1.0 ± 0.1. Erythromycin (25–250 μM) and clarithromycin (5 or 25 μM) also produced a significant decrease in the integral of the current evoked by an action potential shaped voltage clamp protocol. The results of this study document that both erythromycin and clarithromycin significantly inhibit the HERG potassium current at clinically relevant concentrations.

Description of a Nonselective Cation Current in Human Atrium

Ion currents were examined in isolated human atrial myocytes by using the whole-cell patch-clamp technique. When currents were recorded with a K(+)-containing pipette solution, depolarizing voltage pulses elicited a rapidly activating outward current that decayed to an apparent steady state. Exposure of cells to 10 mmol/L 4-aminopyridine markedly reduced current amplitude; however, a rapidly activating current that was approximately 30% of the steady state current amplitude remained. When pipette K+ was replaced with Cs+, a similar rapidly activating current that reversed polarity at approximately 0 mV was recorded. This current was seen in 100% of the cells tested from 17 different hearts (n = 142), and its amplitude was approximately 40% of the amplitude of the steady state current recorded in the presence of pipette K+. The current amplitude was not significantly different in cells isolated from adult (6.31 +/- 1.35 pA/pF, n = 8) and pediatric (5.54 +/- 1.04 pA/pF, n = 9) hearts. Studies designed to determine the charge-carrying species indicated that changes in bath Cl- concentration had no effect on either the amplitude or the reversal potential of this current, whereas removal of pipette Cs+ and bath Na+ dramatically reduced this current. In addition, this current was not modulated by either isoproterenol (1 mumol/L, 22 degrees C) or cell swelling. This study provides the first description of a nonselective cation current in human atrial myocytes, which may play an important role in repolarization in human atria.

Evidence for developmental changes in sodium channel inactivation gating and sodium channel block by phenytoin in rat cardiac myocytes.

The voltage-dependent properties of the voltage-activated sodium channel were studied in neonatal (1-2-day-old) and adult rat ventricular cardiac myocytes using the whole-cell variation of the patch-clamp technique (16 degrees C, [Na]i = 15 mM, [Na]o = 25 mM). The voltage dependence of the sodium conductance-membrane potential relation was similar in both neonatal and adult myocytes except for a difference in slope; the adult sodium conductance-membrane potential relation was slightly more steep. Neonatal cells also differed from adult cells by demonstrating a more negative voltage midpoint of their sodium availability curve, a slower rate of recovery from inactivation at hyperpolarized potentials, and a greater extent of slow inactivation development compared with adult cells. Phenytoin (40 microM) reduced the sodium current in a tonic and use-dependent manner in both adult and neonatal myocytes. However, phenytoin (40 microM) produced significantly more tonic block at negative holding potentials (e.g., -140 mV) in neonatal myocytes (22 +/- 5% [mean +/- SEM], n = 14) than in adult myocytes (10 +/- 2%, n = 11) (p less than 0.05). The amplitudes of use-dependent block obtained during trains of 1-second pulses to -20 mV were also significantly greater in neonatal myocytes than in adult myocytes when the diastolic interval was varied over a range of 0.1-1.5 seconds (p less than 0.05). Definition of the time courses of block development at -20 mV indicated that phenytoin had a slightly higher affinity for inactivated sodium channels in neonatal cells. In addition, the time constant of recovery from use-dependent block by phenytoin was found to be significantly longer in neonatal cells than in adult cells at membrane potentials between -160 and -100 mV (p less than 0.001). The marked differences in phenytoin effect on cardiac sodium channels in neonatal versus adult rat cardiac myocytes suggest that there may be significant developmental changes in the sodium channel blocking effects of class I antiarrhythmic drugs in cardiac tissue.

Quinidine Interactions With Human Atrial Potassium Channels Developmental Aspects

Clinical studies have suggested that quinidine is less effective when used for the treatment of atrial arrhythmias in pediatric patients compared with its clinical effectiveness in the adult patient population. Age-related changes in the cardiac actions of quinidine on action potential duration and interaction with potassium channels in several mammalian species also have been reported. We investigated the effects of postnatal development on quinidines interaction with major repolarizing currents (Ito, IKur, Ins, and IK1) in human atrial myocytes, using the whole-cell configuration of the voltage-clamp technique. Our results indicate that there are age-related changes in both the IC50 for quinidine blockade of Ito, as well as the mechanism of quinidine unblocking. In contrast, quinidine was found to inhibit both adult and pediatric IK1 and IKur in an age-independent manner, whereas the nonselective cation current (Ins), which contributes to the sustained outward current (Isus), was insensitive to quinidine. The results from this study help to clarify the electrophysiological mechanism by which quinidine elicits its antiarrhythmic effect in the pediatric and adult human population.

L-type calcium current in pediatric and adult human atrial myocytes : Evidence for developmental changes in channel inactivation

Animal studies have documented the presence of marked, species-dependent, developmental changes in the properties of the L-type calcium current in cardiac myocytes. In an effort to understand the postnatal changes which occur in the calcium current in human heart, we characterized the calcium current in atrial myocytes isolated from 17 pediatric and older children (ages 3 d to 14 y) and 12 adult (ages 43-79 y) human hearts using the whole-cell patch clamp technique. In contrast to animal models, we found no evidence for age-related changes in calcium current density, steady-state inactivation, or kinetics of recovery from inactivation, suggesting that, in human atrium, calcium channels are in many aspects functionally mature at the time of birth. However, statistically significant differences were found in the kinetics of calcium current inactivation, with calcium current measured in cells isolated from pediatric human atria inactivating approximately 2-fold faster than cells isolated from adult hearts. These results suggest a possible role for age-related changes in calcium current inactivation in the shortened action potential duration observed in pediatric compared with adult human atrium.

Evidence for voltage-dependent block of cardiac sodium channels by tetrodotoxin

The effects of tetrodotoxin (TTX) on cardiac sodium channels in guinea-pig ventricular muscle were investigated. Membrane potential was controlled using a single sucrose gap voltage clamp method, and the maximum upstroke velocity of the ventricular action potential (Vmax) was used as an indicator of drug-free sodium channels. Reduction of Vmax by TTX was found to be both voltage- and time-dependent, similar to the effects of many local anesthetic drugs, with the exception that TTX concentrations high enough to produce significant use-dependent block (e.g. 2 microM), also produced significant tonic block, even at potentials negative to -85 mV. The mechanism underlying use-dependent block was determined by defining the time course of block development at potentials between -40 and +20 mV, and the time course of recovery at -85 mV. In 2 microM TTX, the time course of block development at +20 mV contained two phases, a fast phase (tau less than 3 ms) having a mean amplitude of 8.1 +/- 3.2% of control Vmax, and a slow phase (tau = 429 +/- 43 ms) having an amplitude of 35 +/- 2% of control Vmax (n = 5). Recovery from use-dependent block at -85 mV occurred with a time constant of 324 +/- 58 ms (n = 5). The effects of TTX could be well-described by a modulated receptor model with an estimated 12 mV drug-induced shift of inactivation, and state-dependent dissociation constants of 10, 4 and 0.3 microM for rested, activated and inactivated channels. These same drug rate constants could also be used to adequately simulate the reported effects of TTX on plateau sodium currents in a variant model with slow inactivation kinetics.

Use of Lecture Recordings in Medical Education

Medical schools provide many educational resources in their basic science curriculum, including slide-based lectures, handouts, study guides, reviews, textbooks, primary literature, and web-based links. We recently instituted a web-based lecture recording system, which synchronizes lecture audio with visual components, as opposed to previous audio-only recordings. This study sought to determine how this recording system was being used by students, whether its availability impacted class attendance, and whether this resource had a positive effect on student performance. First- and second-year medical students were surveyed regarding class attendance and their use of lecture recordings. In addition, students indicated their impression of how lecture recordings influenced exam performance for several of their basic science courses. Student perception was compared with actual exam results. Of 206 students who completed the survey, 80.1% (N = 165) utilized the lecture recording system. Of 91 second-year students using the resource, only 14.4% (N = 13) mentioned a decline in lecture attendance. Despite how it was used, first- and second-year medical students overwhelmingly responded in favor of these audiovisual-synchronized recordings. 90.3% of responding medical students using recordings felt this resource improved exam performance. While student perception was positive, our multidisciplinary data suggest otherwise. With the exception of the second-year Pharmacology course, lecture recordings did not have an impact, either in a positive or negative direction on exam performance across seven first- and second-year basic science courses. Lecture recordings can be viewed as another useful tool, in addition to traditional lectures, that allows for flexibility in study habits and self-directed learning.

Stereoselective block of cardiac sodium channels by RAC109 in single guinea pig ventricular myocytes.

The effects of the optical stereoisomers of the local anesthetic RAC109 (RAC109-I and RAC109-II) on sodium current in isolated guinea pig ventricular myocytes were investigated by use of the whole-cell variation of the patch-clamp technique. RAC109-I and RAC109-1I produced similar levels of tonic block, but RAC109-I produced a significantly larger usedependent block on repetitive pulsing to potentials positive to -60 mV. Definition of the time courses of block development at -20 mV and recovery at -140 and -160 mV indicated that RAC109-I had a higher affinity for activated and inactivated channels and dissociated more slowly at hyperpolarized potentials compared with RAC109-II. Removal of fast inactivation by a-chymotrypsln intensified tonic block but did not reduce use-dependent block by RAC109-I; this finding suggests that channel inactivation is not necessary for use-dependent block. The guarded-receptor model was used to calculate apparent rate constants of drug binding and unbinding. According to the model, RAC109-I and RAC109-II have significantly different unbinding rate constants for channels when they exist predominantly in rested, activated, or inactivated states, as well as significantly different binding rate constants when channels are activated. However, the apparent rates of drug binding to closed (rested and inactivated) channels are not significantly different for the two isomers; this finding indicates that drug binding to dosed channels is not markedly stereospecific, in contrast to unbinding. The effects of RAC109 stereoisomers on cardiac sodium channels were also qualitatively similar to those previously reported in nerve; these findings suggest that the binding sites for local anesthetics in both tissue types have a similar structural topography.

Modification of Na channel inactivation by α-chymotrypsin in single cardiac myocytes

The effects of α-chymotrypsin and trypsin on the macroscopic Na current in isolated guinea pig ventricular myocytes at 16 ° C were investigated using the whole-cell voltage-clamp technique. Intracellular application of both enzymes reduced the extent of Na current inactivation during 20- to 50-ms depolarizing pulses. Elimination of fast inactivation by α-chymotrypsin was accompanied by a slowing of the rate of Na current decay through changes in both the time constants of current decay and the proportions of current undergoing a fast vs slow rate of decay. Treatment that reduced Na current decay to ⩽ 10 % within 20 ms was accompanied by a hyperpolarizing shift of the Na conductance/voltage relationship and an increase in the time-to-peak current that was most prominent for small depolarizations. Evidence for a significant slow inactivation process was obtained following removal of fast inactivation. The effect of trypsin (0.15–0.3 mg/ml) was less specific than α-chymotrypsin in that it also reduced Na conductance and increased leak current.