José Raúl Medina López

Potassium channel openers prevent potassium-induced calcium loading of cardiac cells: Possible implications in cardioplegia☆☆☆★★★♢

Hyperkalemic solutions that are used as cardioplegic agents, while effective in inducing electromechanical arrest, are only partially cardioprotective, and ventricular dysfunction has been observed. The underlying pathophysiology of cardioplegia-associated ventricular dysfunction is complex and not fully understood, but it could be related, in part, to intracellular Ca2+ loading induced by high K+ concentrations present in cardioplegic solutions. Yet no effective cytoprotective means against possible intracellular Ca2+ loading, under these conditions, has been described. Recently, potassium channel openers, which open adenosine triphosphate-sensitive K+ channels, have been reported to possess cardioprotective properties under global ischemic conditions. However, it is not known whether these novel agents could prevent intracellular Ca2+ loading that could occur during cardioplegia. Intracellular Ca2+ was monitored in ventricular myocytes, loaded with the Ca(2+)-sensitive fluorescent probe Fluo-3AM, using epifluorescent digital imaging and laser confocal microscopy. Exposure of a myocyte to a 16 mmol/L concentration of K+, a concentration of K+ commonly used in cardioplegic solutions, induced a nonhomogeneous increase in intracellular Ca2+. Potassium channel opening drugs, such as aprikalim or nicorandil, effectively prevented these solutions from increasing intracellular Ca2+. The preventive effect of potassium channel opening drugs was antagonized by glyburide, a selective blocker of adenosine triphosphate-sensitive K+ channels. This study demonstrates, at the single cardiac cell level, that solutions containing a 16 mmol/L concentration of K+ promote intracellular Ca2+ loading, which can be prevented by potassium channel opening drugs. Therefore, potassium channel opening drugs should be considered to prevent intracellular Ca2+ loading associated with the use of cardioplegic solutions.

Adenosine Prevents Hyperkalemia-Induced Calcium Loading in Cardiac Cells: Relevance for Cardioplegia

BACKGROUNDnHyperkalemic cardioplegic solutions effectively arrest the heart but also induce membrane depolarization, which could lead to intracellular Ca2+ loading and contribute to ventricular dysfunction associated with cardiac operations. Adenosine, which possesses cardioprotective properties, has been proposed as an adjunct to conventional cardioplegic solutions. However, it is not known whether adenosine supplementation enables cardiac cells to withstand hyperkalemia-induced Ca2+ loading.nnnMETHODSnSingle ventricular cardiomyocytes were isolated from guinea pig hearts, loaded with a Ca(2+)-sensitive fluorescent probe, and imaged by digital epifluorescent microscopy. The emitted fluorescence of the probe, a measure of the intracellular Ca2+ concentration, was recorded from single myocytes during hyperkalemic challenges in the absence and the presence of adenosine to assess the protective effectiveness of this agent.nnnRESULTSnHyperkalemic solutions induced intracellular Ca2+ loading (estimated intracellular Ca2+ concentration, 88 +/- 5 nmol/L before and 1,825 +/- 112 nmol/L after addition of 16 mmol/L KCl). Adenosine (1 mmol/L) prevented K(+)-induced Ca2+ loading (intracellular Ca2+ concentration, 86 +/- 6 nmol/L before and 85 +/- 8 nmol/L after exposure to K+). Whereas glyburide (3 mumol/L), an antagonist of adenosine triphosphate-sensitive K+ channels, had no effect, staurosporine (200 nmol/L) and chelerythrine (5 mumol/L), two inhibitors of protein kinase C, did abolish the action of adenosine.nnnCONCLUSIONSnAdenosine prevents hyperkalemia-induced Ca2+ loading in cardiomyocytes. This effect is due to a direct action on ventricular cells, as the preparation employed was free from atrial, neuronal, and vascular elements, and appears to be mediated through a protein kinase C-dependent mechanism. The property of adenosine to prevent hyperkalemia-induced Ca2+ loading may contribute to the cytoprotective efficacy of this agent as an adjunct to conventional hyperkalemic cardioplegic solutions.

Dual effect of glyburide, an antagonist of KATP channels, on metabolic inhibition-induced Ca2+ loading in cardiomyocytes

Whether sulfonylurea therapy, which blocks ATP-sensitive K+ (KATP) channels, impedes endogenous cardioprotective mechanisms during cellular metabolic impairment remains controversial. Therefore, the effect of glyburide, a prototype sulphonylurea drug, on cytosolic Ca2+ concentration and KATP channel activity, was measured in 2-4-dinitrophenol-treated guinea-pig cardiomyocytes, using epifluorescent digital-imaging and cell-attached patch-clamp electrophysiology. Dinitrophenol (200 microM), which uncouples oxidative phosphorylation, induced opening of KATP channels and Ca2+ loading. Glyburide (6 microM) which reduced the opening of KATP channels, aggravated Ca2+ loading only when applied to dinitrophenol-pretreated myocytes but not when applied with dinitrophenol treatment. We conclude that a blocker of KATP channels has differential effects upon dinitrophenol-induced intracellular Ca2+ loading, which appear to depend upon the stage of metabolic insult.

Adenosine Prevents K-Induced Ca2 Loading: Insight Into Cardioprotection During Cardioplegia

In clinical practice, hyperkalemic cardioplegia induces sarcolemmic depolarization, and therefore is used to arrest the heart during open heart operations. However, the elevated concentration of K+ that is present in cardioplegic solutions promotes intracellular Ca2+ loading, which could aggravate ventricular dysfunction after cardiac operations. This review highlights recent findings that have established, at the single cell level, the protective action of adenosine against hyperkalemia-induced Ca2+ loading. When it was added to hyperkalemic cardioplegic solutions, adenosine, at millimolar concentrations and through a direct action on ventricular cardiomyocytes, prevented K+-induced Ca2+ loading. This action of adenosine required the activation of protein kinase C, and it was effective only in cardiomyocytes with low diastolic Ca2+ levels. Of importance, adenosine did not diminish the magnitude of K+-induced membrane depolarization, allowing unimpeded cardiac arrest. Taken together, these findings provide direct support for the idea that adenosine is valuable when used as an adjunct to hyperkalemic cardioplegia. This idea has emerged from previous clinical studies that have shown improvement of the clinical outcome after cardiac operations when adenosine or related substances were used to supplement cardioplegic solutions. Further studies are required to define more precisely the mechanism of action of adenosine, and the conditions that may determine the efficacy of adenosine as a cytoprotective supplement to cardioplegia.

High-performance liquid chromatographic assay for metamizol metabolites in rat plasma: application to pharmacokinetic studies.

In order to evaluate the pharmacokinetics of metamizol in the presence of morphine in arthritic rats, after subcutaneous administration of the drugs, an easy, rapid, sensitive and selective analytical method was proposed and validated. The four main metamizol metabolites (4-methylaminoantipyrine, 4-aminoantipyrine, 4-acetylaminoantipyrine and 4-formylaminoantipyrine) were extracted from plasma samples (50-100μl) by a single solid-phase extraction method prior to reverse-phase high performance liquid chromatography with diode-array detection. Standard calibration graphs for all metabolites were linear within a range of 1-100μg/ml (r(2)≥0.99). The intra-day coefficients of variation (CV) were in the range of 1.3-8.4% and the inter-day CV ranged from 1.5 to 8.4%. The intra-day assay accuracy was in the range of 0.6-9.6% and the inter-day assay accuracy ranged from 0.9 to 7.5% of relative error. The lower limit of quantification was 1μg/ml for all metabolites using a plasma sample of 100μl. Plasma samples were stable at least for 4 weeks at -20°C. This method was found to be suitable for studying metamizol metabolites pharmacokinetics in arthritic rats, after simultaneous administration of metamizol and morphine, in single dose.

Cytosolic Ca2+ domain-dependent protective action of adenosine in cardiomyocytes.

Recently, in beating cardiac cells heterogeneous spatiotemporal patterns in cytosolic Ca2+ distribution have been visualized, and associated with cell contraction. In non-beating cardiomyocytes, spatial heterogeneity of intracellular Ca2+ distribution has also been observed, yet its functional implication in resting cardiac cells is not known. Herein, distinct domains of lower versus higher concentrations of cytosolic Ca2+ (0.17 and 0.37 microM, respectively) were observed using epifluorescent digital imaging in single, non-beating, fluo-3-loaded cardiomyocytes. Extracellular K+ (16 mM) induced a uniform increase of cytosolic Ca2+, despite the initial presence of distinct domains of cytosolic Ca2+ (from 0.17 to 1.82 microM in domains with lower, and from 0.37 to 2.03 microM in domains with higher Ca2+ concentration, respectively). In contrast, adenosine (1 mM) prevented exracellular K+ to induce cytosolic Ca2+ loading selectively within domains with lower (from 0.17 to 0.18 microM), but not in domains with higher (from 0.37 to 1.4 microM) basal Ca2+ concentration. Thus, the response of a cardiomyocyte to the protective action of adenosine is heterogeneous within a resting single cell. The domain-distinct cytoprotective action of adenosine appears to be set by the basal Ca2+ concentration within a cytosolic domain.

HPLC Method with Solid-Phase Extraction for Determination of (R)- and (S)-Ketoprofen in Plasma without Caffeine Interference: Application to Pharmacokinetic Studies in Rats

A fast and reproducible high-performance liquid chromatography method has been developed for the determination of (R)- and (S)-ketoprofen. Ketoprofen enantiomers were determined in plasma samples (50 µL), after solid-phase extraction, using diclofenac as internal standard. Analyses were performed on a (S, S)-Whelk-O 1 stainless steel column (5 µm, 250 × 4.6 mm) using hexane-ethanol-acetic acid (93:7:0.5, v/v/v) as the mobile phase and detection at 254 nm. The method was selective for ketoprofen enantiomers in the presence of caffeine and endogenous plasma compounds. Standard curves were linear (R(2) > 0.999) over the concentration range of 0.25-12.50 and 0.25 µg/mL was taken as the limit of quantification. The intra- and interday precision (relative standard deviation) values were <15.0% and the accuracy (relative error) was within ±12.0% at 1.0, 5.0 and 10.0 µg/mL. Enantiomer recoveries yielded 100.0 ± 15%. No significant differences were determined in plasma samples stored at room temperature for 24.0 h, after two freeze-thaw cycles, and between 0 and 4 weeks at -20°C (P > 0.05). The validated method was successfully applied in determination of (S)-ketoprofen in Wistar rats after oral administration of 3.2 mg/kg of (S)-ketoprofen alone or 3.2 mg/kg of (S)-ketoprofen + 17.8 mg/kg of caffeine.

Cardiac hypertrophy determines digitalis action on intracellular Ca2+ in human myocardium

Ventricular hypertrophy alters transporters associated with digitalis action, but the outcome of digitalis treatment on intracellular cations in the hypertrophied human myocardium remains unknown. Using double-barreled Ca2+-selective microelectrodes, we simultaneously measured Ca2+ activity and membrane potential in myocardial samples from patients without and with ventricular hypertrophy, prior to and following exposure to strophanthidin, a prototype digitalis. We found that ventricular hypertrophy is associated with greater strophanthidin-induced increase in diastolic Ca2+ levels compared to that observed in the absence of hypertrophy. Furthermore, in hypertrophied myocardium the magnitude of the increase in Ca2+ induced by strophanthidin was inversely related to increase in myocardial mass. Thus, the extent of ventricular hypertrophy determines digitalis action on intracellular Ca2+ within the human myocardium.

Dantrolene reverses the increase in intracellular Ca2+ associated with exertional rhabdomyolysis in human skeletal muscle

Clinical Pharmacology & Therapeutics (1996) 59, 187–187; doi: 10.1038/sj.clpt.1996.247

Potassium channel opening drugs prevent cardioplegic solution‐induced intracellular Ca2+ loading in cardiac cells

Clinical Pharmacology & Therapeutics (1996) 59, 175–175; doi: 10.1038/sj.clpt.1996.198