Hirotaka Nagashima

Novel Mechanism Associated With an Inherited Cardiac Arrhythmia Defective Protein Trafficking by the Mutant HERG (G601S) Potassium Channel

BACKGROUND The congenital long-QT syndrome (LQTS) is an inherited disorder characterized by a prolonged cardiac action potential and a QT interval that leads to arrhythmia. Mutations in the human ether-a-go-go-related gene (HERG), which encodes the rapidly activating component of the delayed rectifier current (IKr), cause chromosome 7-linked LQTS (LQT2). Studies of mutant HERG channels in heterologous systems indicate that the mechanisms mediating LQT2 are varied and include mutant subunits that form channels with altered kinetic properties or nonfunctional mutant subunits. We recently reported a novel missense mutation of HERG (G601S) in an LQTS family that we have characterized in the present work. METHODS AND RESULTS To elucidate the electrophysiological properties of the G601S mutant channels, we expressed these channels in mammalian cells and Xenopus oocytes. The G601S mutant produced less current than wild-type channels but exhibited no change in kinetic properties or dominant-negative suppression when coexpressed with wild-type subunits. To examine the cellular trafficking of mutant HERG channel subunits, enhanced green fluorescent protein tagging and Western blot analyses were performed. These showed deficient protein trafficking of the G601S mutant to the plasma membrane. CONCLUSIONS Our results from both the Xenopus oocyte and HEK293 cell expression systems and green fluorescent protein tagging and Western blot analyses support the conclusion that the G601S mutant is a hypomorphic mutation, resulting in a reduced current amplitude. Thus, it represents a novel mechanism underlying LQT2.

Influence of plasma lipoprotein(a) levels on coronary vasomotor response to acetylcholine

OBJECTIVES This study was undertaken to examine the influence of plasma lipoprotein(a) [Lp(a)] levels on coronary endothelial vasomotor function. BACKGROUND Epidemiologic studies have demonstrated a direct relation between elevated plasma levels of Lp(a) and increased risk of coronary artery disease. Well recognized coronary risk factors are known to affect endothelium-dependent vasomotion; however, the influence of Lp(a) on coronary vasomotor function has not been determined. METHODS We used quantitative coronary angiography to measure left anterior descending coronary artery diameter changes produced by intracoronary acetylcholine and isosorbide dinitrate in 30 patients with angiographically normal coronary arteries. Plasma Lp(a) levels were determined with enzyme-linked immunosorbent assay. RESULTS Vasomotor response to acetylcholine ranged from +13% to -47% in the proximal, from +23% to -53% in the middle and from +13% to -56% in the distal segment of the left anterior descending coronary artery. According to univariate linear regression analysis, Lp(a) had a significant inverse correlation with vasomotor response to acetylcholine: r = 0.47, p < 0.01 in the proximal; r = -0.61, p < 0.001 in the middle; and r = -0.52, p < 0.01 in the distal segment of the left anterior descending coronary artery. By multiple stepwise regression analysis, plasma Lp(a) was the significant predictor of vasomotion in response to acetylcholine in all tested segments (p < 0.01). CONCLUSIONS Elevated Lp(a) levels were associated with impairment of endothelium-dependent vasodilation even when atherosclerotic lesions were not recognizable by angiography. This finding suggests that elevated plasma levels of Lp(a) cause endothelial dysfunction and may contribute in part to later development of atherosclerosis, as shown in epidemiologic studies.

KL-6 as a potential new marker for amiodarone-induced pulmonary toxicity

mance and preliminary results. PACE 1998;21:1058–1068. 10. Danilovic D, Ohm O-J. Pacing threshold trends and variability in modern tined leads assessed using high resolution automatic measurements. Conversion of pulse width into voltage thresholds. PACE 1999;22:567–587. 11. Stokes K, Borzin G. The electrode-biointerface: stimulation. In: Barold SS, ed. Modern Cardiac Pacing. Mount Kisco, NY: Futura Publishing, 1985:33–77. 12. Stamato NJ, O‘Toole MF, Fetter JG, Enger EL. The safety and efficacy of chronic ventricular pacing at 1.6 volts using steroid eluting leads. PACE 1992; 15:248–251. 13. Schwaab B, Frohlig G, Schwerdt H, Heisel A, Berg M, Schieffer H. Telemetry guided pacemaker programming: impact of output amplitude and the use of low threshold leads on projected pacemaker longevity. PACE 1998;21:2055– 2063. 14. Schuller H, Kruse IB, Svennsson O, Mortensen P. Long-term benefits of autocapture—four years of follow-up (abstr). PACE 1999;22:807.

Aldosterone blockade by Spironolactone improves the hypertensive vascular hypertrophy and remodeling in angiotensin II overproducing transgenic mice.

OBJECTIVES AND BACKGROUND Recent evidence has revealed that aldosterone (ALDO) is produced in the vasculature, and acts directly in the cardiovascular system. This study was designed to examine the role of ALDO in the process of long-term renin-angiotensin system (RAS) induced vascular remodeling. MATERIAL AND METHOD Hypertensive transgenic mice that overproduce angiotensin II (AngII), i.e., Tsukuba-Hypertensive-Mice (THM), were given tap water or 1% salt water and treated with or without Spironolactone (SPRL: 20mg/kg/day) for 4 weeks. We also employed A7r5 cells and investigated the effect of SPRL on the AngII mediated signal transduction in the vascular smooth muscle cells. RESULTS Intimal hyperplasia, medial hypertrophy and degradation of medial elastic laminae were observed in the abdominal aorta, independent of blood pressure. Taking 1% salt water markedly enhanced these changes. In contrast, SPRL-treated THM showed almost complete disappearance of these intimal hyperplasia and medial hypertrophy. Osteopontin (OPN) was markedly up-regulated in the intima and media. However, it was inhibited by SPRL treatment in spite of high level of AngII. In A7r5 cells, AngII (10(-7)muM) induced OPN expression and pretreatment with MEK, PI3K, and EGFR inhibitor suppressed it. SPRL pretreatment also inhibited AngII-induced ERK and AKT phosphorylation, and resulted in the suppression of AngII-induced OPN expression. CONCLUSIONS ALDO blockade by SPRL restores the vascular remodeling caused by the long-term RAS enhancement even in the high level of AngII, independent of blood pressure. Blocking AngII alone may not be sufficient, and direct ALDO blockade is also important to prevent vascular disease.

Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in an adult

Accessory mitral valve (AMV) is a rare cause of left ventricular outflow tract (LVOT) obstruction and is extremely rare in adults. We report a case of an older adult with an AMV that caused severe LVOT obstruction. A parachute-like piece of tissue (the AMV) protruding into the LVOT during systole was first detected in a 45-year-old woman by echocardiography. Because the pressure gradient and dyspnea gradually progressed, she finally underwent a successful operation for removal when she was 48 years old.

Improvement of cardiac function and neurological remodeling in a patient with tachycardia-induced cardiomyopathy after catheter ablation.

Incessant ventricular tachycardia and long-standing ectopic beats lead to tachycardia-induced cardiomyopathy. Catheter ablation eliminates ventricular tachycardia and reverses left ventricular (LV) dysfunction. 201-Thallium ((201)Tl) scintigraphy demonstrates perfusion defects with ischemic cardiomyopathy. Reversible perfusion defects are observed even in non-ischemic cardiomyopathy, related to regional flow or metabolism derangements. 123-I-metaiodobezylguanidine ((123)I-MIBG) scintigraphy delineates regional cardiac sympathetic denervation and heterogeneity. We demonstrated the progression of tachycardia-induced cardiomyopathy in a patient with idiopathic LV outflow tract tachycardia using (201)Tl and (123)I-MIBG scintigraphic findings. Regional defects were reversed predominantly in the basal interventricular septal wall in (201)Tl scintigraphy and (123)I-MIBG scintigraphic findings. This report suggests that incessant ventricular tachycardia or long-standing ventricular ectopic beats may develop adverse myocardial remodeling and sympathetic neurological remodeling. Treatment with catheter ablation for tachycardia-induced cardiomyopathy can reverse sympathetic neurological remodeling as well as myocardial structural remodeling.

Functional activity of the CFTR Cl− channel in human myocardium

SummaryThe cyclic AMP (cAMP)-dependent chloride channel in the heart has been identified in various species as the cystic fibrosis transmembrane conductance regulator (CFTR). Although functional expression of the channel in the human atrium has been reported, we could not induce any cAMP-dependent chloride conductance in the atrial cells even with maximal cAMP stimulation, whereas the conductance could be induced in rabbit ventricular cells. To clarify the discrepancy between the results, we examined the level of CFTR mRNA expression in both conductance-positive (human colonic epithelium and rabbit ventricle) and -negative (human atrium) tissues. Total RNA samples prepared from these tissues were subjected to the reverse transcription-polymerase chain reaction (RT-PCR). While CFTR transcripts were amplified from the conductance-positive samples, no amplified products could be detected from the conductance-negative sample. A nested PCR performed on the RT-PCR products of the conductance-negative sample resulted in successful amplification of the transcripts, indicating that the level of the CFTR mRNA expression in human atrium is extremely low compared with that in colonic epithelium and rabbit ventricle. The same molecular results were observed in human ventricular tissues. A nucleotide sequencing of the amplified transcripts showed that exon 5 of the CFTR gene was not alternatively spliced in human atrium and ventricle, and both the exon 5 spliced and unspliced isoforms were expressed in rabbit ventricle, unlike the findings of previous reports. Our data suggest that the amount of CFTR expressed in human myocardium might be physiologically insufficient to activate detectable cAMP-dependent chloride conductance.

FGF-1 enhanced cardiogenesis in differentiating embryonal carcinoma cell cultures, which was opposite to the effect of FGF-2

To investigate the effect of fibroblast growth factors (FGFs) on cellular differentiation, we employed a multipotent mouse embryonal carcinoma cell line, P19, which differentiates into cardiac muscle, skeletal muscle and neural cells in the presence of the appropriate concentrations of retinoic acid (RA). Under conditions appropriate for cardiac muscle differentiation, the expression of FGF-1 was significantly enhanced before any tissue-specific gene was induced. In contrast, up-regulation of the FGF-2 gene was observed with skeletal muscle-inducing concentrations of RA. Exogenous FGF-1, under skeletal muscle-inducing conditions, suppressed the expression of marker genes for skeletal muscle and induced cardiac alpha myosin heavy chain (alphaMHC) gene with up-regulation of bone morphogenetic protein-4 (BMP-4) and GATA-4. Unlike FGF-1, exogenous FGF-2 promoted skeletal muscle differentiation. These results indicate that FGF-1 and FGF-2 play different roles in P19 cell differentiation induced by RA.

Therapeutic value of statins for vascular remodeling.

HMG-CoA reductase inhibitors (statins) are effective lipid-lowering drugs widely used in patients with dyslipidemia at risk of cardiovascular diseases. Primary and secondary prevention studies have revealed a significant reduction of risk for cardiovascular diseases. However, recent studies have demonstrated that statins have direct vascular effects (pleiotropic effects) independent of lipid-lowering action. Vascular remodeling, defined as changes in size and/or structure of adult vasculature, not only allows physiological adaptation and healing but also underlines the pathogenesis of major cardiovascular diseases. Vascular remodeling can be inward, occlusive, and outward. Various cardiovascular diseases probably represent a terminal phenotype of such vascular remodeling. In this review, we will focus on the basic actions and clinical implications of statin therapy to each type of vascular remodeling in response to various stimuli.

Electrical Connections between Persistent Left Superior Vena Cava and Left Atrium during Catheter Ablation for Atrial Tachycardia

A 74‐year‐old man presented with palpitation and 12‐lead ECG exhibited atrial premature contraction (APC) at general check‐up. Holter ECG demonstrated narrow QRS tachycardia with a rate of 160/min and more than 31,000/day atrial premature beats. The P wave morphology of atrial premature beats showed negative in II, III, aVF and biphasic in V1. Venography was performed and disclosed persistent left superior vena cava (LSVC) draining into the right atrium via the markedly dilated coronary sinus (CS). Electrogram recordings from LSVC and CS were obtained with an electrode catheter via the left subclavian vein. At the level where a ventricular potential disappeared, the intra‐LSVC potentials began to show a discrete second sharp potential after local left atrial signals. Double potentials were obtained within the LSVC from the lower left atrium (LA) to the higher LA. A proximal‐to‐distal activation sequence of the second components was observed. The interval between the 1st and 2nd component ranged from 8 to 22 msec between the proximal LSVC and distal LSVC. The double potentials resulted in fusion at the lower part of the LSVC, indicating the presence of an electrical connection between the LSVC and lower LA.