J. Prestle

Relationship Between Na+-Ca2+–Exchanger Protein Levels and Diastolic Function of Failing Human Myocardium

BACKGROUND In the failing human heart, sarcoplasmic reticulum (SR) calcium handling is impaired, and therefore, calcium elimination and diastolic function may depend on the expression of sarcolemmal Na+-Ca2+ exchanger. METHODS AND RESULTS Force-frequency relations were studied in ventricular muscle strip preparations from failing human hearts (n=29). Protein levels of Na+-Ca2+ exchanger and SR Ca2+-ATPase were measured in the same hearts. Hearts were divided into 3 groups by discriminant analysis according to the behavior of diastolic function when stimulation rate of muscle strips was increased from 30 to 180 min-1. At 180 compared with 30 min-1, diastolic force was increased by 160%, maximum rate of force decline was decreased by 46%, and relaxation time was unchanged in group III. In contrast, in group I, diastolic force and maximum rate of force decline did not change, and relaxation time decreased by 20%. Na+-Ca2+ exchanger was 66% higher in group I than in group III. Na+-Ca2+ exchanger was inversely correlated with the frequency-dependent rise of diastolic force when stimulation rate was increased (r=-0.74; P<0.001). Compared with nonfailing human hearts (n=6), SR Ca2+-ATPase was decreased and Na+-Ca2+ exchanger unchanged in group III, whereas Na+-Ca2+ exchanger was increased and SR Ca2+-ATPase unchanged in group I. Results with group II hearts were between those of group I and group III hearts. CONCLUSIONS By discriminating failing human hearts according to their diastolic function, we identified different phenotypes. Disturbed diastolic function occurs in hearts with decreased SR Ca2+-ATPase and unchanged Na+-Ca2+ exchanger, whereas increased expression of the Na+-Ca2+ exchanger is associated with preserved diastolic function.

Overexpression of FK506-Binding Protein FKBP12.6 in Cardiomyocytes Reduces Ryanodine Receptor–Mediated Ca2+ Leak From the Sarcoplasmic Reticulum and Increases Contractility

Abstract — The FK506-binding protein FKBP12.6 is tightly associated with the cardiac sarcoplasmic reticulum (SR) Ca2+-release channel (ryanodine receptor type 2 [RyR2]), but the physiological function of FKBP12.6 is unclear. We used adenovirus (Ad)-mediated gene transfer to overexpress FKBP12.6 in adult rabbit cardiomyocytes. Western immunoblot and reverse transcriptase–polymerase chain reaction analysis revealed specific overexpression of FKBP12.6, with unchanged expression of endogenous FKBP12. FKBP12.6-transfected myocytes displayed a significantly higher (21%) fractional shortening (FS) at 48 hours after transfection compared with Ad-GFP–infected control cells (4.8±0.2% FS versus 4±0.2% FS, respectively; n=79 each;P =0.001). SR-Ca2+ uptake rates were monitored in &bgr;-escin–permeabilized myocytes using Fura-2. Ad-FKBP12.6–infected cells showed a statistically significant higher rate of Ca2+ uptake of 0.8±0.09 nmol/s−1/106 cells (n=8, P <0.05) compared with 0.52±0.1 nmol/s−1/106 cells in sham-infected cells (n=8) at a [Ca2+] of 1 &mgr;mol/L. In the presence of 5 &mgr;mol/L ruthenium red to block Ca2+ efflux via RyR2, SR-Ca2+ uptake rates were not significantly different between groups. From these measurements, we calculate that SR-Ca2+ leak through RyR2 is reduced by 53% in FKBP12.6-overexpressing cells. Caffeine-induced contractures were significantly larger in Ad-FKBP12.6–infected myocytes compared with Ad-GFP–infected control cells, indicating a higher SR-Ca2+ load. Taken together, these data suggest that FKBP12.6 stabilizes the closed conformation state of RyR2. This may reduce diastolic SR-Ca2+ leak and consequently increase SR-Ca2+ release and myocyte shortening.

Downregulation of the Na+-Creatine Cotransporter in Failing Human Myocardium and in Experimental Heart Failure

BACKGROUND The failing myocardium is characterized by depletion of phosphocreatine and of total creatine content. We hypothesized that this is due to loss of creatine transporter protein. METHODS AND RESULTS Creatine transporter protein was quantified in nonfailing and failing human myocardium (explanted hearts with dilated cardiomyopathy [DCM; n=8] and healthy donor hearts [n=8]) as well as in experimental heart failure (residual intact left ventricular tissue, rats 2 months after left anterior descending coronary artery ligation [MI; n=8] or sham operation [sham; n=6]) by Western blotting. Total creatine content was determined by high-performance liquid chromatography. Donor and DCM hearts had total creatine contents of 136.4+/-6.1 and 68.7+/-4.6 nmol/mg protein, respectively (*P<0.05); creatine transporter protein was 25.4+/-2.2 optical density units in donor and 17.7+/-2.5 in DCM (*P<0.05). Total creatine was 87.5+/-4.2 nmol/mg protein in sham and 65.7+/-4.2 in MI rats (*P<0.05); creatine transporter protein was 139.0+/-8.7 optical density units in sham and 82.1+/-4.0 in MI (*P<0.05). CONCLUSIONS Both in human and in experimental heart failure, creatine transporter protein content is reduced. This mechanism may contribute to the depletion of creatine compounds and thus to the reduced energy reserve in failing myocardium. This finding may have therapeutic implications, suggesting a search for treatment strategies targeted toward creatine transport.

Impaired Contractile Performance of Cultured Rabbit Ventricular Myocytes After Adenoviral Gene Transfer of Na+-Ca2+ Exchanger

Na+-Ca2+ exchanger (NCX) gene expression is increased in the failing human heart. We investigated the hypothesis that upregulation of NCX can induce depressed contractile performance. Overexpression of NCX was achieved in isolated rabbit ventricular myocytes through adenoviral gene transfer (Ad-NCX). After 48 hours, immunoblots revealed a virus dose-dependent increase in NCX protein. Adenoviral &bgr;-galactosidase transfection served as a control. The fractional shortening (FS) of electrically stimulated myocytes was analyzed. At 60 min−1, FS was depressed by 15.6% in the Ad-NCX group (n=143) versus the control group (n=163, P <0.05). Analysis of the shortening-frequency relationship showed a steady increase in FS in the control myocytes (n=26) from 0.027±0.002 at 30 min−1 to 0.037±0.002 at 120 min−1 (P <0.05 versus 30 min−1) and to 0.040±0.002 at 180 min−1 (P <0.05 versus 30 min−1). Frequency potentiation of shortening was blunted in NCX-transfected myocytes (n=27). The FS was 0.024±0.002 at 30 min−1, 0.029±0.002 at 120 min−1 (P <0.05 versus 30 min−1, P <0.05 versus control), and 0.026±0.002 at 180 min−1 (NS versus 30 min−1, P <0.05 versus control). Caffeine contractures, which indicate sarcoplasmic reticulum Ca2+ load, were significantly reduced at 120 min−1 in NCX-transfected cells. An analysis of postrest behavior showed a decay of FS with longer rest intervals in control cells. Rest decay was significantly higher in the Ad-NCX group; after 120 seconds of rest, FS was 78±4% in control and 65±3% in the Ad-NCX group (P <0.05) relative to steady-state FS before rest (100%). In conclusion, the overexpression of NCX in rabbit cardiomyocytes results in the depression of contractile function. This supports the hypothesis that upregulation of NCX can result in systolic myocardial failure.

Over‐expression of FK506‐binding protein FKBP12.6 alters excitation–contraction coupling in adult rabbit cardiomyocytes

This study investigated the function of FK506‐binding protein (FKBP12.6) using adenoviral‐mediated gene transfer to over‐express FKBP12.6 (Ad‐FKBP12.6) in adult rabbit ventricular cardiomyocytes. Infection with a β‐galactosidase‐expressing adenovirus (Ad‐LacZ) was used as a control. Peak‐systolic intracellular [Ca2+] (measured with Fura‐2) was higher in the Ad‐FKBP12.6 group compared to Ad‐LacZ (1 Hz field stimulation at 37°C). The amplitude of caffeine‐induced Ca2+ release was also greater, indicating a higher SR Ca2+ content in the Ad‐FKBP12.6 group. Voltage clamp experiments indicated that FKBP12.6 over‐expression did not change L‐type Ca2+ current amplitude or Ca2+ efflux rates via the Na+–Ca2+ exchanger. Ca2+ transients comparable to those after Ad‐FKBP12.6 transfection could be obtained by enhancing SR Ca2+ content of Ad‐LacZ infected cells with periods of high frequency stimulation. Line‐scan confocal microscopy (Fluo‐3 fluorescence) of intact cardiomyocytes stimulated at 0.5 Hz (20−21°C) revealed a higher degree of synchronicity of SR Ca2+ release and fewer non‐responsive Ca2+ release sites in the Ad‐FKBP12.6 group compared to control. Ca2+ spark morphology was measured in β‐escin‐permeabilized cardiomyocytes at a free [Ca2+]i of 150 nm. The average values of the spark parameters (amplitude, duration, width and frequency) were reduced in the Ad‐FKBP12.6 group. Increasing [Ca2+]i to 400 nm caused coherent propagating Ca2+ waves in the Ad‐FKBP12.6 group but only limited Ca2+ release events were recorded in the control group. These data indicate that FKBP12.6 over‐expression enhances Ca2+ transient amplitude predominately by increasing SR Ca2+ content. Moreover, there is also evidence that FKBP12.6 can enhance the coupling between SR Ca2+ release sites independently of SR content.

The trabecula culture system: a novel technique to study contractile parameters over a multiday time period

In the intact heart, various triggers induce alterations in gene expression that impact on contractile function. Because changes in gene expression reflect altered protein expression patterns after 12-48 h, we developed a system in which intact twitching cardiac trabeculae can be studied for multiday periods. Right ventricular trabeculae from pentobarbital sodium-anesthetized rabbits were mounted in a sterile, closed muscle chamber. Over the first 48 h, developed force (Fdev) did not significantly change: 102.3 and 98.9% of the initial Fdev was observed after 24 and 48 h, respectively ( n = 8). Also, neither diastolic force, time from peak to 50% relaxation (RT50), nor protein synthesis measured by a [3H]leucine incorporation assay changed significantly over time. Contractile response after >48 h to an increase in extracellular calcium concentration (1.8 to 2.5 mM; Fdevincreased 43.5%, n = 2) or to 1 μM isoproterenol (Fdevincreased 138.6% and RT50decreased 34.9%, n = 2) was similar to those observed in freshly dissected preparations. In conclusion, this system can investigate contractile function of multicellular preparations under well-defined physiological conditions after events that alter gene and consequent protein expression.In the intact heart, various triggers induce alterations in gene expression that impact on contractile function. Because changes in gene expression reflect altered protein expression patterns after 12-48 h, we developed a system in which intact twitching cardiac trabeculae can be studied for multiday periods. Right ventricular trabeculae from pentobarbital sodium anesthetized rabbits were mounted in a sterile, closed muscle chamber. Over the first 48 h, developed force (Fdev) did not significantly change: 102.3 and 98.9% of the initial Fdev was observed after 24 and 48 h, respectively (n = 8). Also, neither diastolic force, time from peak to 50% relaxation (RT50), nor protein synthesis measured by a [3H]leucine incorporation assay changed significantly over time. Contractile response after > 48 h to an increase in extracellular calcium concentration (1.8 to 2.5 mM; Fdev increased 43.5%, n = 2) or to 1 microM isoproterenol (Fdev increased 138.6% and RT50 decreased 34.9%, n = 2) was similar to those observed in freshly dissected preparations. In conclusion, this system can investigate contractile function of multicellular preparations under well-defined physiological conditions after events that alter gene and consequent protein expression.

Ca2+-handling proteins and heart failure: Novel molecular targets?

Calcium (Ca(2+)) ions are the currency of heart muscle activity. During excitation-contraction coupling Ca(2+) is rapidly cycled between the cytosol (where it activates the myofilaments) and the sarcoplasmic reticulum (SR), the Ca(2+) store. These fluxes occur by the transient activity of Ca(2+)-pumps and -channels. In the failing human heart, changes in activity and expression profile of Ca(2+)-handling proteins, in particular the SR Ca(2+)-ATPase (SERCA2a), are thought to cause an overall reduction in the amount of SR-Ca(2+) available for contraction. In the steady state, the Ca(2+)-content of the SR is essentially a balance between Ca(2+)-uptake via SERCA2a pump and Ca(2+)-release via the cardiac SR Ca(2+)-release channel complex (Ryanodine receptor, RyR2). This review discusses current pharmacological options available to enhance cardiac SR Ca(2+) content and the implications of this approach as an inotropic therapy in heart failure. Two options are considered: (i) activation of the SERCA2a pump to increase SR Ca(2+)-uptake, and (ii) reduction of SR Ca(2+)-leakage through RyR2. RyR2 forms a macromolecular complex with a number of regulatory proteins that either remain permanently bound or that interact in a time- and/or Ca(2+)-dependant manner. These regulatory proteins can dramatically affect RyR2 function, e.g. over-expression of the accessory protein FK 506-binding protein 12.6 (FKBP12.6) has recently been shown to reduce SR Ca(2+)-leak. Recent attempts to design positive inotropes for chronic administrations have focussed on the use of phosphodiesterase III inhibitors (PDE III inhibitors). These compounds, which increase intracellular cAMP-levels, have failed in clinical trials. Therefore medical researchers are seeking new drugs that act through alternative pathways. Novel cardiac inotropes targeting SR Ca(2+)-cycling proteins may have the potential to fill this gap.

Adenovirus-mediated transfection of multicellular cardiac preparations

The study of altered protein expression patterns in diseased myocardium has greatly contributed to our understanding of cardiac dysfunction. Adenovirus-mediated changes in this protein expression pattern in order to correct deregulated protein synthesis is currently undergoing widespread interest and is emerging as a possible future therapy. In an in vitro setting, most experiments to date have used primary adult myocyte cultures to study the impact of adenovirus-mediated gene transfer on the function of the myocardium. Several studies have already indicated that the isotonic shortening behavior of isolated myocytes can be successfully changed through adenoviralmediated gene transfer. However, under cell culture conditions active loaded contractions do not occur as they do in situ,thereby hampering interpretation to this in vivo situation. Although multicellular cardiac preparations may not represent every single aspect of the beating heart, loading conditions can be influenced and these preparations have a multicellular architecture contracting under loaded conditions as occur in heart. The latter implies that impact of secretory factors and interaction between different cell types is possible. Moreover, cell-to-cell connections allow for passing-on of intracellular signals and physical loading conditions, between myocytes specifically, in these multicellular preparations.

Distinct phenotype patterns of Ca2+ handling proteins in end-stage failing human hearts

Downregulation of SR Ca2+-ATPase (SERCA2a) and upregulation of Na+/Ca2+-exchanger (NCX1) is regarded to be relevant for altered systolic and diastolic performance of the failing human heart. We tested the hypothesis that large variations in the degree of altered expression of these proteins exist between failing hearts, determining the extent of impaired contractile function. Furthermore, we evaluated whether differences in protein expression can also be observed in different regions of individual hearts.