Nobuhisa Awata

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.

Impact of cilostazol on intimal proliferation after directional coronary atherectomy

Cilostazol, a novel platelet aggregation inhibitor, inhibits intimal proliferation in animal models. We randomly assigned 41 patients with lesions suitable for directional coronary atherectomy to the cilostazol group (200 mg/day) or the aspirin (250 mg/day) group. Medication was started before directional coronary atherectomy and was continued to a 6-month follow-up. Serial quantitative coronary angiography and intravascular ultrasound study were performed. Baseline characteristics were not different between the two groups. However, the minimal lumen diameter at follow-up was larger (2.33 +/- 0.60 mm vs 1.81 +/- 0.68 mm, p = 0.016) and the percent diameter stenosis (24.5% +/- 16.6% vs 40.9% +/- 21.0%, p = 0.010) was smaller in the cilostazol group. The change in vessel area was not different, but the percent plaque area at follow-up was smaller in the cilostazol group (55.7% +/- 11.2% vs 64.5% +/- 14.5%, p = 0.044). The restenosis rate was significantly lower in the cilostazol group (0% vs 26%, p = 0.020). We conclude that cilostazol appears to have an inhibitory effect on intimal proliferation after directional coronary atherectomy and may reduce restenosis.

Taurine's possible protective role in age-dependent response to calcium paradox

When hearts were reperfused with Ca++ after a short period of Ca++-free perfusion, irreversible loss of electrical and mechanical activity was observed. This phenomenon, first described by Zimmerman and Hulsmann, was termed the calcium paradox. Chizzonite and Zak recently reported that rat hearts exhibited an age-dependent response in a calcium paradox model. The taurine (2-aminoethanesulfonic acid) content of hearts in the newborn animal is high, and decreases rapidly during the first few days of life. The present experiments were performed to test whether the myocardial taurine content was closely linked to an age-dependent response in the calcium paradox model, using post-hatched chicks. The mechanical dysfunction of the heart was much more severe in 9-day-old post-hatched chicks than in 2-day-old chicks when the hearts were subjected to the calcium paradox. Myocardial taurine content was lower in the 9-day-old chicks than in the 2-day-old chicks. The age-related response to the calcium paradox was partially protected by oral pretreatment with taurine, and there was a small increase in myocardial taurine level. It is proposed that myocardial taurine is one factor in the protection against the calcium paradox phenomenon.

Final results of the STent versus directional coronary Atherectomy Randomized Trial (START)

OBJECTIVESnThis study was designed to compare primary stenting with optimal directional coronary atherectomy (DCA).nnnBACKGROUNDnNo previous prospective randomized trial comparing stenting and DCA has been performed.nnnMETHODSnOne hundred and twenty-two lesions suitable for both Palmaz-Schatz stenting and DCA were randomly assigned to stent (62 lesions) or DCA (60 lesions) arm. Single or multiple stents were implanted with high-pressure dilation in the stent arm. Aggressive debulking using intravascular ultrasound (IVUS) was performed in the DCA arm. Serial quantitative angiography and IVUS were performed preprocedure, postprocedure and at six months. The primary end point was restenosis, defined as > or =50% diameter stenosis at six months. Clinical event rates at one year were also assessed.nnnRESULTSnBaseline characteristics were similar. Procedural success was achieved in all lesions. Although the postprocedural lumen diameter was similar (2.79 vs. 2.90 mm, stent vs. DCA), the follow-up lumen diameter was significantly smaller (1.89 vs. 2.18 mm; p = 0.023) in the stent arm. The IVUS revealed that intimal proliferation was significantly larger in the stent arm than in the DCA arm (3.1 vs. 1.1 mm ; p < 0.0001), which accounted for the significantly smaller follow-up lumen area of the stent arm (5.3 vs. 7.0 mm2; p = 0.030). Restenosis was significantly lower (32.8% vs. 15.8%; p = 0.032), and target vessel failure at one year tended to be lower in the DCA arm (33.9% vs. 18.3%; p = 0.056).nnnCONCLUSIONSnThese results suggest that aggressive DCA may provide superior angiographic and clinical outcomes to primary stenting.

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.

Protective effect of taurine against isoprenaline-induced myocardial damage

SummaryThe effect of the sulfur amino acid, taurine, was examined on histological and biochemical changes induced by a toxic dose of isoprenaline in chick hearts. Isoprenaline treatment (80 or 240 mg/kg id twice daily for 4 days) caused a dose-dependent increase in heart weight and decrease in myocardial ATP. Isoprenaline administration (240 mg/kg id twice daily) produced necrotic changes in hearts, such as eosinophilic degeneration, myolysis, interstitial oedema, fibrosis, and inflammatory cell infiltration. Substantial accumulation of calcium was also observed. Taurine content of the heart was not significantly decreased. Parenteral administration of taurine (200 mg/day for 7 days) partially protected against these necrotic changes induced by isoprenaline. It is suggested that the protective effect of taurine against isoprenaline-induced myocardial injury might be due in part to the prevention of the massive overloading with calcium which is thought to cause myocardial cell necrosis.

Disruption of cell-cell adhesion in an inbred strain of hereditary cardiomyopathic hamster (Bio 14.6)

OBJECTIVEnDisarrangement of cardiomyocytes is a pathological characteristic of dilated cardiomyopathy. Hereditary cardiomyopathic hamster Bio 14.6, a model of dilated cardiomyopathy, displays disorder of cardiomyocyte arrangement. The aim of this study was to analyse the disturbance of cell alignment from the point of view of the cell-cell adhesion system in Bio 14.6.nnnMETHODnCardiomyopathic hamster Bio 14.6 was used as a model of dilated cardiomyopathy. Histological study was performed by light and electron microscopy. Disorder of the adherens junction-specific cell-adhesion molecule (A-CAM) was analysed by immunofluorescent microscopy and immunoblotting with anti-A-CAM antibody.nnnRESULTSnHematoxylin-eosin staining revealed that intercalated disks were identifiable less clearly in cardiomyopathy than in a normal cardiac muscle. It was disclosed by electron microscopy that cardiomyocytes adhered to each other with reduction in subsarcolemmal electron density at intercalated disks in Bio 14.6 compared with normal hamsters. We examined the localization of the A-CAM molecule in heart by immunofluorescent microscopy. In contrast to normal cardiac samples, fluorescence was weak in intensity and unclearly demarcated in the Bio 14.6 hamsters. We measured the content of A-CAM in the heart. In Bio 14.6 hamsters, the content of A-CAM was 60 +/- 11% of that measured in normal adult hamsters. A-CAM was reduced to a lesser extent (81 +/- 12%) in the newborn hamsters.nnnCONCLUSIONSnIn Bio 14.6 hamster, structural disturbance of the intercalated disks was found on histological examination of the heart. Biochemically, A-CAM, which plays a role in intercellular adhesion in intercalated disk areas, decreased significantly. These results suggest that cardiomyopathy may be accompanied by structural disruption of cell-cell adhesion in intercalated disk regions, which may lead to the pathological feature of disarranged cardiomyocytes.

The effect of taurine on age-related immune decline in mice: the effect of taurine on T cell and B cell proliferative response under costimulation with ionomycin and phorbol myristate acetate.

Proliferative responses to the costimulation with phorbol-12-myristate-13-acetate (PMA) and suboptimal doses of ionomycin in the purified T and B cells from old mice were lower than those from young mice. The degree of the age-related decline was more significant in T cells than in B cells. Taurine, a sulfur containing amino acid, augmented the proliferative responses of T cells from both young and old mice. The augmentation of the proliferative response by taurine was more marked in old T cells than in young ones. The concentration of intracellular free calcium ion ([Ca2+]i) was significantly lower in the old T cells under the stimulation with PMA and ionomycin than that in the young ones. In the presence of taurine, the concentration of [Ca2+]i in the old T cell significantly increased under the stimulation. The results indicate that taurine improved the proliferative response of old T cells by the restoration of the increment of the concentration of [Ca2+]i under the stimulation.

Protective effect of taurine on the irregular beating pattern of cultured myocardial cells induced by high and low extracellular calcium ion

Abnormal beating patterns were induced in spontaneously contracting cultured embryonic mouse myocardial cells either by elevating or by lowering extracellular calcium. At low calcium (0.4 mM), the number of beating cells and beating rate decreased while the number of arrhythmic cells increased. By contrast, at high calcium (20 mM), the number of beating cells decreased while beating rate and the number of arrhythmic cells increased. Addition of taurine (20 mM) to the medium attenuated the response to varying calcium; the taurine effect appeared to be specific since neither taurine analog tested (beta-alanine nor glycine) provided much protection against these abnormalities. The protective effect of taurine also appeared to differ from that of verapamil, which was effective only in decreasing beating rate in the high calcium condition. Uptake of 14C-taurine by the cells was higher at both low and high extracellular calcium when compared to the normal calcium (2 mM) concentration. The results raise the possibility that the protective effect of taurine on beating abnormalities caused by low or high calcium is related to taurine uptake.

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.