Hisato Harada

Adriamycin cardiotoxicity: Possible pathogenic mechanisms

Abstract The antitumor agent, adriamycin, causes in humans a cardiomyopathy associated with elevated tissue Ca 2+ . Hence, adriamycin was tested for an ability to affect the Ca 2+ influx mediated by the slow channels in ventricular cells of isolated perfused chick hearts. The fast Na + channels were blocked by tetrodotoxin or voltage inactivated by elevated (25 m m ) K + , thus rendering the hearts inexcitable. Low concentrations of adriamycin (0.01 to 0.05 mg/ml) restored excitability in the form of slow action potentials (APs), and enhanced the maximum upstroke velocity ( + V max ) of slow APs induced by isoproterenol (10 −6 m ). Higher concentrations (0.1 to 0.5 mg/ml) did not induce slow APs, and actually depressed or blocked the isoproterenol-induced slow APs. On the contractions recorded from hearts perfused with normal Tyrode solution, adriamycin also had a dual effect: at low concentrations, it had a positive inotropic action, whereas at higher concentrations, it had a negative inotropic action. Adriamycin (0.05 mg/ml) caused the cyclic AMP level to increase by about 50% over the control within 15 min, thus suggesting that this might be responsible for its positive inotropism. Higher concentrations (0.3 mg/ml) also raised the cyclic AMP, but the ATP level was depressed. In isolated mitochondria, adriamycin (0.5 mg/ml) depressed ADP-stimulated respiration, suggesting that impaired mitochondrial function could cause the depressed ATP levels. The results indicate that low concentrations of adriamycin augment the slow current, possibly by an increase in cyclic AMP level, whereas high concentration (0.5 mg/ml) depresses the slow current, perhaps due to lowered ATP levels. The enhanced Ca 2+ influx (via stimulation of the slow channels) could be a factor in the Ca 2+ overload associated with the adriamycin-induced cardiomyopathy.

Calcium Overload-Induced Myocardial Damage Caused by Isoproterenol and by Adriamycin: Possible Role of Taurine in its Prevention

Calcium ion (Ca2+) is essential for excitation-contraction coupling and for maintenance of cell integrity in the myocardium. On the other hand, it is clear that cytosolic Ca2+ loading may be the first event leading to cell death in certain forms of myocytic injury, such as Ca2+ paradox and isoproterenol (ISO) toxicity. The Ca2+ overload injury is characterized by an exhaustion of tissue high-energy phosphate, massive release of enzymes and extensive ultrastructural damage, as well as excessive influx of Ca2+ into the myocardial cells.

Effect of taurine on intracellular calcium dynamics of cultured myocardial cells during the calcium paradox.

The “calcium paradox” phenomenon, first described by Zimmerman and Hulsman1, occurs when hearts are reperfused with calcium after a short period of calcium-free perfusion. The Ca2+ repletion phase causes irreversible myocardial damage, characterized by reduced electrical activity, extensive ultrastructural damage, depletion of tissue high-energy phosphate content, massive release of intracellular constituents and an increase in cytosolic Na+ and Ca2+2.

Cyclic adenosine monophosphate modulation of contractility via slow Ca2+ channels in chick heart

Abstract The catecholamines exert a positive inotropic effect associated with elevated tissue cyclic AMP levels and possibly with increase in the number of membrane slow cationic channels available for voltage activation. In the present study, catecholamines (isoproterenol, dopamine and dobutamine) were tested for their ability to affect the maximum upstroke velocity (+ V max ) of the slow action potentials, the first derivative ( d T d t ) of developed tension accompanying the slow responses, and the tissue cyclic AMP levels in the ventricular myocardium of isolated perfused chick hearts. To study the slow channels exclusively, the fast Na + channels were voltage inactivated by elevated (25 m m ) K + . In this condition of functional removal of the fast channels, the heart could not be excited by intense electrical stimulation. It was found that these catecholamines induced slow action potentials accompanied by contractions. Elevation of the concentration of these agents produced increases in + V max , d T d t , and cyclic AMP in a dose-dependent fashion; a close correlation was obtained between the cyclic AMP level, + V max and d T d t . These results support the hypothesis that the increases in + V max of the slow action potentials and in contraction are explained by increase in the number of available slow channels mediated by intracellular cyclic AMP levels, and the resulting increase in the Ca 2+ influx.

Mechanism of direct cardiostimulating actions of hydralazine.

The vasodilator, hydralazine, was reported to also exert a direct positive inotropic effect on the myocardium at high concentrations. In the present study we investigated the mechanism of this positive inotropic action by using the ventricular myocardium of isolated perfused chick hearts. Hydralazine (10(-3) M) enhanced contractile force and heart rate, and elevated the myocardial cyclic AMP level. To study the Ca2+-dependent slow action potentials, the fast N+ channels were voltage-inactivated with elevated K+ (25 mM), resulting in a loss of electrical excitability. Hydralazine (10(-4) M) rapidly (less than 3 min) allowed the generation of slow action potentials and accompanying contractions by electrical stimulation. These effects of hydralazine were only partially prevented by propranolol. The results suggest that the increase of myocardial contractility produced by hydralazine is the result, at least in part, of a direct effect on the myocardium to increase Ca2+ inflow. The increased Ca2+ influx and inward slow current is due partly to activation of beta-adrenoceptors, with resultant elevation of cyclic AMP, and partly to another mechanism.

Beneficial effect of coenzyme Q on myocardial slow action potentials in hearts subjected to decreased perfusion pressure—hypoxia—substrate-free perfusion

SummaryCoenzyme Q, an important component of the electron transfer system in mitochondria, plays a central role in energy production aerobically. The effect of pretreatment with coenzyme Q10 (Co Q) on myocardial slow action potentials (APs) and accompanying contractions and on myocardial high energy phosphate content was studied in perfused hearts subjected to decreased perfusion pressure—hypoxia—substrate-free. Post-hatched chicks were treated i.p. with 10 mg/kg of Co Q daily for 5 days. To study the slow APs exclusively, the fast Na+ channels were voltage-inactivated by elevated K+ (25 mM) Tyrode solution. The Ca++-dependent slow APs were induced by elevating [Ca]0 to 5.4 mM; hearts were paced at a rate of 40 per min. Hearts which had been pretreated with Co Q were protected against the deleterious effect of decreased perfusion pressure—hypoxia—substrate-free perfusion on mechanical performance accompanying the slow Ca++−Na+ APs. The slow APs in hearts pretreated with Co Q were also less affected than were non-treated hearts. However, the myocardial ATP and total adenine nucleotides were not affected by exogenous Co Q. It was suggested that exogenous Co Q could protect against the decline of cardiac contractions via improved availability of slow APs during decreased perfusion pressure—hypoxia—substrate-free, independently of the cellular high energy phosphate level.

Enhanced suppression of myocardial slow action potentials during hypoxia by free fatty acids

Effects of free fatty acids (palmitate and linoleate) on myocardial contractility and slow action potentials (APs) were examined in Langendorff-perfused chick hearts. To study the slow APs exclusively, the fast Na+ channels were voltage-inactivated in elevated K+ (25 mM), and the concentration of Ca2+ ion was increased to 5.4 mM in order to induce slow APs. Palmitate (0.18, 0.54 or 0.72 mM) along with albumin (0.12 mM) was added to the perfusate. Albumin by itself did not affect contractility or the slow APs during normoxia and hypoxia. Under well oxygenated conditions, palmitate had no effect on contractility or the slow APs. However, palmitate accelerated the decline of contractility during hypoxia in a dose-dependent fashion. Hypoxia suppressed the slow APs, and palmitate and linoleate further exacerbated the suppression of slow APs produced by hypoxia. Nevertheless, palmitate and linoleate did not enhance the hypoxic reduction of the tissue high energy phosphate level. The present results suggest that free fatty acids elicit cardio-depressant effects on hearts through their direct action on the myocardial cell membrane (slow channels) rather than through any metabolic effects.

Concentration-dependent effect of trapidil on slow action potentials in cardiac muscle

Trapidil, a coronary vasodilator and positive inotropic agent, was tested for its ability to affect the normal fast action potentials and the slow action potentials and contractions of isolated perfused chick hearts, and to affect the tissue cyclic AMP level. At 5 X 10(-3) M, trapidil completely blocked the fast Na+ channels in hearts perfused with normal Tyrode solution, since this dose abolished the action potential when verapamil (2 X 10(-6) M) was present to eliminate the inward slow current. To study effects on the slow channels, the fast Na+ channels were voltage-inactivated by partial depolarization to about -40 mV with an elevated (25 mM) K+-Tyrode solution, resulting in loss of excitability. At low concentrations (1 X 10(-4) - 1 X 10(-3) M), trapidil induced slow action potentials accompanied by contractions, even in the presence of a beta-adrenergic blocker. In contrast, at high concentrations (3 X 10(-3) - 1 X 10(-2) M), trapidil markedly depressed or blocked the isoproterenol-induced slow action potentials. Consistent with this dual action, in hearts perfused with normal Tyrode solution, trapidil exerted a small positive inotropic action at low doses and a considerable negative inotropic action at high doses, even though the intracellular cyclic AMP level was substantially elevated. That is, trapidil has actions similar to those of papaverine. It is concluded that trapidil blocks both fast Na+ channels and slow channels in cardiac muscle, the fast Na+ channels being more sensitive, and that low concentrations of trapidil induce slow channels by elevating the cyclic AMP level because of phosphodiesterase inhibition.

Taurine attenuates contracture induced by perfusion with low sodium, high calcium medium in chick hearts.

Taurine is the most abundant free amino acid in heart. It has various effects on cardiac function, including improved cardiac performance in congestive heart failure1 and regulation of calcium homeostasis2. Because taurine prevents calcium overload in several heart failure models, it was felt that it might improve cardiac function in hearts subjected to a low sodium, high calcium medium. It is known that a remarkable decrease in extracellular sodium concentration leads to contracture3. Thus, in this study we examined the effect of taurine on changes in intracellular calcium concentration and tissue high energy phosphate content of perfused chick heart exposed to buffer containing a low sodium and high calcium concentration.