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Zarowitz BJ, Tisdale JE. Navigating the Minefield of QTc Interval-Prolonging Therapy in Nursing Facility Residents. J Am Geriatr Soc 2019; 67:1508-1515. [PMID: 30747995 DOI: 10.1111/jgs.15810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/28/2018] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The exponential increase in the number of medications associated with clinically important prolongation of the heart rate-corrected QT interval (QTc) places older adults at increased risk of arrhythmias including life-threatening torsade de pointes (TdP) and sudden death. Risk factors, other than age older than 65 years and female sex, include multiple concurrent drugs that prolong QTc and a variety of underlying predisposing conditions. Although electronic medical records and pharmacy dispensing systems can alert clinicians to the risk of QTc-prolonging therapy, more than 95% of safety alerts are overridden, and many systems have deactivated QTc drug interaction alerts. The clinical consequences, magnitude of the effect, mitigation strategies, and recommended monitoring are not well defined for nursing facility (NF) residents. DESIGN Narrative review. SETTING NFs in the United States. PARTICIPANTS NF residents. RESULTS Medications known to prolong QTc include selected anti-infectives, antidepressants, urinary anticholinergics, antipsychotics, and cholinesterase inhibitors (eg, donepezil), used commonly in NFs. Drug-drug interactions are a risk when adding a medication that exaggerates the effect or inhibits the metabolism of a QTc-prolonging medication. The vast majority of patients in whom TdP is induced by noncardiac drugs have risk factors that are easily identifiable. CONCLUSIONS Recommendations are provided to improve standardization and use of drug interaction alerts, evaluate the risk of QTc-prolonging drugs in older adults receiving generally lower doses, validate a QTc risk score addressing complex multimorbidity, garner evidence to guide clinical decision making, avail NFs of access to electrocardiograms and interpretive recommendations, and develop standards of practice for hosting risk discussions with residents and their families. J Am Geriatr Soc, 1-8, 2019.
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Affiliation(s)
- Barbara J Zarowitz
- The Peter Lamy Center on Drug Therapy and Aging, University of Maryland, College of Pharmacy, West Bloomfield, Michigan
| | - James E Tisdale
- College of Pharmacy, Purdue University, School of Medicine, Indiana University, Indianapolis, Indiana
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Carstensen H, Hesselkilde EZ, Haugaard MM, Flethøj M, Carlson J, Pehrson S, Jespersen T, Platonov PG, Buhl R. Effects of dofetilide and ranolazine on atrial fibrillatory rate in a horse model of acutely induced atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:596-606. [PMID: 30661267 PMCID: PMC6849868 DOI: 10.1111/jce.13849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The atrial fibrillatory rate is a potential biomarker in the study of antiarrhythmic drug effects on atrial fibrillation (AF). The purpose of this study was to evaluate whether dose-dependent changes in the atrial fibrillatory rate can be monitored on surface electrocardiography (ECG) following treatment with dofetilide, ranolazine, and a combination of the two in an acute model of AF in horses. METHODS AND RESULTS Eight horses were subjected to pacing-induced AF on 4 separate days. Saline (control), dofetilide, ranolazine, or a combination of dofetilide and ranolazine was administered in four incremental doses. Atrial fibrillatory activity was extracted from surface ECGs using spatiotemporal QRST cancellation. The mean atrial fibrillatory rate before drug infusion was 297 ± 27 fpm. Dofetilide reduced the atrial fibrillatory rate following the infusion of low doses (0.89 µg/kg, P < 0.05) and within 5 minutes preceding cardioversion (P < 0.05). Cardioversion with ranolazine was preceded by a reduction in the atrial fibrillatory rate in the last minute (P < 0.05). The combination of drugs reduced the atrial fibrillatory rate in a similar manner to dofetilide used alone. A trend toward a lower atrial fibrillatory rate before drug infusion was found among horses cardioverting on low doses of the drugs. CONCLUSION The atrial fibrillatory rate derived from surface ECGs showed a difference in the mode of action on AF between dofetilide and ranolazine. Dofetilide reduced the atrial fibrillatory rate, whereas ranolazine displayed a cardioverting mechanism that was distinct from a slowing of the fibrillatory process.
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Affiliation(s)
- Helena Carstensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Eva Zander Hesselkilde
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Maria Mathilde Haugaard
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Mette Flethøj
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Jonas Carlson
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Steen Pehrson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Taastrup, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.,Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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Kroncke BM, Yang T, Roden DM. Multiple mechanisms underlie increased cardiac late sodium current. Heart Rhythm 2019; 16:1091-1097. [PMID: 30677491 DOI: 10.1016/j.hrthm.2019.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND We recently reported a quantitative relationship between the degree of functional perturbation reported in the literature for 356 variants in the cardiac sodium channel gene SCN5A and the penetrance of resulting arrhythmia phenotypes. In the course of that work, we identified multiple SCN5A variants, including R1193Q, that are common in populations but are reported in human embryonic kidney (HEK) cells to generate large late sodium current (INa-L). OBJECTIVE The purpose of this study was to compare the functional properties of R1193Q with those of the well-studied type 3 long QT syndrome mutation ΔKPQ. METHODS We compared functional properties of SCN5A R1193Q with those of ΔKPQ in Chinese hamster ovary (CHO) cells at baseline and after exposure to intracellular phosphatidylinositol (3,4,5)-trisphosphate (PIP3), which inhibits INa-L generated by decreased Phosphoinositide 3-kinase (PI3K) activity. We also used CRISPR/Cas9 editing to generate R1193Q in human-induced pluripotent stem cells differentiated to cardiomyocytes (hiPSC-CMs). RESULTS Both R1193Q and ΔKPQ generated robust INa-L in CHO cells. PIP3 abrogated the late current phenotype in R1193Q cells but had no effect on ΔKPQ. Homozygous R1193Q hiPSC-CMs displayed increased INa-L and long action potentials with frequent triggered beats, which were reversed with the addition of PIP3. CONCLUSION The consistency between the late current produced in HEK cells, CHO cells, and hiPSC-CMs suggests that the late current is a feature of the SCN5A R1193Q variant in human cardiomyocytes but that the mechanism by which the late current is produced is distinct and indirect, as compared with the more highly penetrant ΔKPQ. These data suggest that observing a late current in an in vitro setting does not necessarily translate to highly pathogenic type 3 long QT syndrome phenotype but depends on the underlying mechanism.
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Affiliation(s)
- Brett M Kroncke
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Tao Yang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dan M Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
BACKGROUND Among his major cardiac electrophysiological contributions, Miles Vaughan Williams (1918-2016) provided a classification of antiarrhythmic drugs that remains central to their clinical use. METHODS We survey implications of subsequent discoveries concerning sarcolemmal, sarcoplasmic reticular, and cytosolic biomolecules, developing an expanded but pragmatic classification that encompasses approved and potential antiarrhythmic drugs on this centenary of his birth. RESULTS We first consider the range of pharmacological targets, tracking these through to cellular electrophysiological effects. We retain the original Vaughan Williams Classes I through IV but subcategorize these divisions in light of more recent developments, including the existence of Na+ current components (for Class I), advances in autonomic (often G protein-mediated) signaling (for Class II), K+ channel subspecies (for Class III), and novel molecular targets related to Ca2+ homeostasis (for Class IV). We introduce new classes based on additional targets, including channels involved in automaticity, mechanically sensitive ion channels, connexins controlling electrotonic cell coupling, and molecules underlying longer-term signaling processes affecting structural remodeling. Inclusion of this widened range of targets and their physiological sequelae provides a framework for a modernized classification of established antiarrhythmic drugs based on their pharmacological targets. The revised classification allows for the existence of multiple drug targets/actions and for adverse, sometimes actually proarrhythmic, effects. The new scheme also aids classification of novel drugs under investigation. CONCLUSIONS We emerge with a modernized classification preserving the simplicity of the original Vaughan Williams framework while aiding our understanding and clinical management of cardiac arrhythmic events and facilitating future developments in this area.
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Affiliation(s)
- Ming Lei
- Department of Pharmacology, University of Oxford, United Kingdom (M.L., D.A.T.)
- Key Laboratory of Medical Electrophysiology of the Ministry of Education and Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China (M.L., L.W.)
| | - Lin Wu
- Department of Cardiology, Peking University First Hospital, Beijing, China (L.W.)
- Key Laboratory of Medical Electrophysiology of the Ministry of Education and Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China (M.L., L.W.)
| | - Derek A Terrar
- Department of Pharmacology, University of Oxford, United Kingdom (M.L., D.A.T.)
| | - Christopher L-H Huang
- Physiological Laboratory (C.L.-H.H.), University of Cambridge, United Kingdom
- Department of Biochemistry (C.L.-H.H.). University of Cambridge, United Kingdom
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55
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Chen X, Zhu C, Zhou H, Zhang Y, Cai Z, Wu H, Ren X, Gao L, Zhang J, Li Y. Key Role of the Membrane Trafficking of Nav1.5 Channel Protein in Antidepressant-Induced Brugada Syndrome. Front Physiol 2018; 9:1230. [PMID: 30233406 PMCID: PMC6134322 DOI: 10.3389/fphys.2018.01230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/15/2018] [Indexed: 12/28/2022] Open
Abstract
Anti-depressant treatment has been found to be associated with the development of Brugada syndrome (BrS) through poorly defined mechanisms. Herein, this study aimed to explore the molecular basis for amitriptyline-induced BrS. The effects of long-term treatments of amitriptyline on Nav1.5 were investigated using neonatal rat ventricular myocytes. The electrophysiological properties, expression and distribution of Nav1.5 were studied using the patch clamp, Western blot and confocal laser microscopy assays. Interactions between Nav1.5 and its interacting proteins, including ankyrin-G and dystrophin, were evaluated by co-immunoprecipitation. A larger decrease in the peak INa occurred after long-term treatments to amitriptyline (56.64%) than after acute exposure to amitriptyline (28%). Slow recovery from inactivation of Nav1.5 was observed after acute or long-term treatments to amitriptyline. The expression of Nav1.5 on the cell membrane showed a larger decrease by long-term treatments to amitriptyline than by acute exposure to amitriptyline. After long-term treatments to amitriptyline, we observed reduced Nav1.5 proteins on the cell membrane and the disrupted co-localization of Nav1.5 and ankyrin-G or dystrophin. Co-immunoprecipitation experiments further testified that the combination of Nav1.5 and ankyrin-G or dystrophin was severely weakened after long-term treatments to amitriptyline, implying the failed interaction between Nav1.5 and ankyrin-G or dystrophin. Our data suggest that the long-term effect of amitriptyline serves as an important contribution to BrS induced by amitriptyline. The mechanisms of BrS induced by amitriptyline were related to Nav1.5 trafficking and could be explained by the disrupted interaction of ankyrin-G, dystrophin and Nav1.5.
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Affiliation(s)
- Xi Chen
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chao Zhu
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hao Zhou
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Zhang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhongqi Cai
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Honglin Wu
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China
| | - Xiaomeng Ren
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lei Gao
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiancheng Zhang
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China
| | - Yang Li
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
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Christidi E, Huang HM, Brunham LR. CRISPR/Cas9-mediated genome editing in human stem cell-derived cardiomyocytes: Applications for cardiovascular disease modelling and cardiotoxicity screening. DRUG DISCOVERY TODAY. TECHNOLOGIES 2018; 28:13-21. [PMID: 30205876 DOI: 10.1016/j.ddtec.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 12/18/2022]
Abstract
Cardiovascular diseases (CVDs) are leading causes of death worldwide, and drug-induced cardiotoxicity is among the most common cause of drug withdrawal from the market. Improved models of cardiac tissue are needed to study the mechanisms of CVDs and drug-induced cardiotoxicity. Human pluripotent stem cell-derived cardiomyocytes (hPSC-CM) have provided a major advance to our ability to study these conditions. Combined with efficient genome editing technologies, such as CRISPR/Cas9, we now have the ability to study with greater resolution the genetic causes and underlying mechanisms of inherited and drug-induced cardiotoxicity, and to investigate new treatments. Here, we review recent advances in the use of hPSC-CMs and CRISPR/Cas9-mediated genome editing to study cardiotoxicity and model CVD.
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Affiliation(s)
- Effimia Christidi
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Haojun Margaret Huang
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Liam R Brunham
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, Canada; Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore; Department of Medicine, National University of Singapore, Singapore.
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57
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Wit AL. Afterdepolarizations and triggered activity as a mechanism for clinical arrhythmias. Pacing Clin Electrophysiol 2018; 41:883-896. [PMID: 29920724 DOI: 10.1111/pace.13419] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/12/2018] [Indexed: 01/08/2023]
Abstract
Afterdepolarizations cause triggered arrhythmias. One kind occurs after repolarization is complete, delayed afterdepolarizations (DADs). Another occurs as an interruption in repolarization, early afterdepolarizations (EADs). Afterdepolarizations initiate arrhythmias when they depolarize membrane potential to threshold potential for triggering action potentials. DADs usually occur mostly when Ca2+ in the sarcoplasmic reticulum (SR) is elevated. The SR leaks some of the Ca2+ into the myoplasm through Ca2+ release channels controlled by ryanodine receptors (RyR2) during diastole. The Na+ -Ca2+ exchanger extrudes elevated diastolic Ca2+ from the cell in exchange for Na+ (1 Ca2+ for 3 Na+ ) generating inward current causing DADs. DAD amplitude increases with decreasing cycle length, causing triggered activity during an increase in heart rate or during programmed electrical stimulation (PES). Coupling interval of the first triggered impulse is directly related to initiating cycle length. EADs are associated with an increased action potential duration (APD) causing long QT (LQT). EADs are caused by net inward currents (ICaL , INCX ) as a consequence. Hundreds of mutations can cause congenital LQT by altering repolarizing ion channels. Acquired LQT results from drug interaction with repolarizing ion channels. EAD-triggered ventricular tachycardia is polymorphic and called "torsade de pointes." Effects of PES on EAD-triggered activity is related to effects of cycle length on APD. Shortening cycle length prevents EADs by accelerating repolarization. Typical PES protocols inhibit formation of EADs which can be therapeutic.
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Affiliation(s)
- Andrew L Wit
- Department of Pharmacology, College of Physicians and Surgeons of Columbia University, New York City, NY, USA
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58
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Giudicessi JR, Ackerman MJ, Camilleri M. Cardiovascular safety of prokinetic agents: A focus on drug-induced arrhythmias. Neurogastroenterol Motil 2018; 30:e13302. [PMID: 29441683 PMCID: PMC6364982 DOI: 10.1111/nmo.13302] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastrointestinal sensorimotor dysfunction underlies a wide range of esophageal, gastric, and intestinal motility and functional disorders that collectively constitute nearly half of all referrals to gastroenterologists. As a result, substantial effort has been dedicated toward the development of prokinetic agents intended to augment or restore normal gastrointestinal motility. However, the use of several clinically efficacious gastroprokinetic agents, such as cisapride, domperidone, erythromycin, and tegaserod, is associated with unfavorable cardiovascular safety profiles, leading to restrictions in their use. PURPOSE The purpose of this review is to detail the cellular and molecular mechanisms that lead commonly to drug-induced cardiac arrhythmias, specifically drug-induced long QT syndrome, torsades de pointes, and ventricular fibrillation, to examine the cardiovascular safety profiles of several classes of prokinetic agents currently in clinical use, and to explore potential strategies by which the risk of drug-induced cardiac arrhythmia associated with prokinetic agents and other QT interval prolonging medications can be mitigated successfully.
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Affiliation(s)
- J. R. Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - M. J. Ackerman
- Departments of Cardiovascular Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - M. Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, MN, USA
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Alexandre J, Moslehi JJ, Bersell KR, Funck-Brentano C, Roden DM, Salem JE. Anticancer drug-induced cardiac rhythm disorders: Current knowledge and basic underlying mechanisms. Pharmacol Ther 2018; 189:89-103. [PMID: 29698683 DOI: 10.1016/j.pharmthera.2018.04.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significant advances in cancer treatment have resulted in decreased cancer related mortality for many malignancies with some cancer types now considered chronic diseases. Despite these improvements, there is increasing recognition that many cancer patients or cancer survivors can develop cardiovascular diseases, either due to the cancer itself or as a result of anticancer therapy. Much attention has focused on heart failure; however, other cardiotoxicities, notably cardiac rhythm disorders, can occur without underlying cardiomyopathy. Supraventricular tachycardias occur in cancer patients treated with cytotoxic chemotherapy (anthracyclines, gemcitabine, cisplatin and alkylating-agents) or kinase-inhibitors (KIs) such as ibrutinib. Ventricular arrhythmias, with a subset of them being torsades-de-pointes (TdP) favored by QTc prolongation have been reported: this may be the result of direct hERG-channel inhibition or a more recently-described mechanism of phosphoinositide-3-kinase inhibition. The major anticancer drugs responsible for QTc prolongation in this context are KIs, arsenic trioxide, anthracyclines, histone deacetylase inhibitors, and selective estrogen receptor modulators. Anticancer drug-induced cardiac rhythm disorders remain an underappreciated complication even by experienced clinicians. Moreover, the causal relationship of a particular anticancer drug with cardiac arrhythmia occurrence remains challenging due in part to patient comorbidities and complex treatment regimens. For example, any cancer patient may also be diagnosed with common diseases such as hypertension, diabetes or heart failure which increase an individual's arrhythmia susceptibility. Further, anticancer drugs are generally usually used in combination, increasing the challenge around establishing causation. Thus, arrhythmias appear to be an underappreciated adverse effect of anticancer agents and the incidence, significance and underlying mechanisms are now being investigated.
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Affiliation(s)
- Joachim Alexandre
- CHU Caen, PICARO Cardio-oncology Program, Department of Pharmacology, F-14033 Caen, France; Normandie Univ, UNICAEN, CHU Caen, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, 14000 Caen, France
| | - Javid J Moslehi
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA
| | - Kevin R Bersell
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joe-Elie Salem
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France.
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Chun YW, Durbin MD, Hong CC. Genome Editing and Induced Pluripotent Stem Cell Technologies for Personalized Study of Cardiovascular Diseases. Curr Cardiol Rep 2018; 20:38. [PMID: 29666931 PMCID: PMC6204334 DOI: 10.1007/s11886-018-0984-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to highlight the potential of induced pluripotent stem cell (iPSC)-based modeling as a tool for studying human cardiovascular diseases. We present some of the current cardiovascular disease models utilizing genome editing and patient-derived iPSCs. RECENT FINDINGS The incorporation of genome-editing and iPSC technologies provides an innovative research platform, providing novel insight into human cardiovascular disease at molecular, cellular, and functional level. In addition, genome editing in diseased iPSC lines holds potential for personalized regenerative therapies. The study of human cardiovascular disease has been revolutionized by cellular reprogramming and genome editing discoveries. These exceptional technologies provide an opportunity to generate human cell cardiovascular disease models and enable therapeutic strategy development in a dish. We anticipate these technologies to improve our understanding of cardiovascular disease pathophysiology leading to optimal treatment for heart diseases in the future.
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Affiliation(s)
- Young Wook Chun
- Departments of Medicine - Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, 2220 Pierce Avenue, PRB 383, Nashville, TN, 37232, USA
| | - Matthew D Durbin
- Department of Pediatrics - Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Charles C Hong
- Departments of Medicine - Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, 2220 Pierce Avenue, PRB 383, Nashville, TN, 37232, USA.
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61
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El-Sherif N, Turitto G, Boutjdir M. Acquired long QT syndrome and torsade de pointes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:414-421. [PMID: 29405316 DOI: 10.1111/pace.13296] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/13/2017] [Accepted: 12/22/2017] [Indexed: 01/08/2023]
Abstract
Since its initial description by Jervell and Lange-Nielsen in 1957, the congenital long QT syndrome (LQTS) has been the most investigated cardiac ion channelopathy. Although congenital LQTS continues to remain the domain of cardiologists, cardiac electrophysiologists, and specialized centers, the by far more frequent acquired drug-induced LQTS is the domain of all physicians and other members of the health care team who are required to make therapeutic decisions. This report will review the electrophysiological mechanisms of LQTS and torsade de pointes, electrocardiographic characteristics of acquired LQTS, its clinical presentation, management, and future directions in the field.
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Affiliation(s)
- Nabil El-Sherif
- Downstate Medical Center, State University of New York, New York, NY, USA.,VA NY Harbor Healthcare System, New York, NY, USA
| | - Gioia Turitto
- New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Mohamed Boutjdir
- Downstate Medical Center, State University of New York, New York, NY, USA.,VA NY Harbor Healthcare System, New York, NY, USA.,NYU School of Medicine, New York, NY, USA
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62
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Yang T, Meoli DF, Moslehi J, Roden DM. Inhibition of the α-Subunit of Phosphoinositide 3-Kinase in Heart Increases Late Sodium Current and Is Arrhythmogenic. J Pharmacol Exp Ther 2018; 365:460-466. [PMID: 29563327 DOI: 10.1124/jpet.117.246157] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/28/2018] [Indexed: 02/06/2023] Open
Abstract
Although inhibition of phosphoinositide 3-kinase (PI3K) is an emerging strategy in cancer therapy, we and others have reported that this action can also contribute to drug-induced QT prolongation and arrhythmias by increasing cardiac late sodium current (INaL). Previous studies in mice implicate the PI3K-α isoform in arrhythmia susceptibility. Here, we have determined the effects of new anticancer drugs targeting specific PI3K isoforms on INaL and action potentials (APs) in mouse cardiomyocytes and Chinese hamster ovary cells (CHO). Chronic exposure (10-100 nM; 5-48 hours) to PI3K-α-specific subunit inhibitors BYL710 (alpelisib) and A66 and a pan-PI3K inhibitor (BKM120) increased INaL in SCN5A-transfected CHO cells and mouse cardiomyocytes. The specific inhibitors (10-100 nM for 5 hours) markedly prolonged APs and generated triggered activity in mouse cardiomyocytes (9/12) but not in controls (0/6), and BKM120 caused similar effects (3/6). The inclusion of water-soluble PIP3, a downstream effector of the PI3K signaling pathway, in the pipette solution reversed these arrhythmogenic effects. By contrast, inhibition of PI3K-β, -γ, and -δ isoforms did not alter INaL or APs. We conclude that inhibition of cardiac PI3K-α is arrhythmogenic by increasing INaL and this effect is not seen with inhibition of other PI3K isoforms. These results highlight a mechanism underlying potential cardiotoxicity of PI3K-α inhibitors.
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Affiliation(s)
- Tao Yang
- Departments of Medicine (T.Y., D.F.M, J.M., D.M.R.), Pharmacology (T.Y., D.M.R.), and Biomedical Informatics (D.M.R.), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David F Meoli
- Departments of Medicine (T.Y., D.F.M, J.M., D.M.R.), Pharmacology (T.Y., D.M.R.), and Biomedical Informatics (D.M.R.), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Javid Moslehi
- Departments of Medicine (T.Y., D.F.M, J.M., D.M.R.), Pharmacology (T.Y., D.M.R.), and Biomedical Informatics (D.M.R.), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dan M Roden
- Departments of Medicine (T.Y., D.F.M, J.M., D.M.R.), Pharmacology (T.Y., D.M.R.), and Biomedical Informatics (D.M.R.), Vanderbilt University School of Medicine, Nashville, Tennessee
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Ezeani M, Elom S. Necessity to evaluate PI3K/Akt signalling pathway in proarrhythmia. Open Heart 2017; 4:e000596. [PMID: 29259786 PMCID: PMC5729307 DOI: 10.1136/openhrt-2017-000596] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 11/13/2017] [Accepted: 11/19/2017] [Indexed: 01/04/2023] Open
Abstract
The incidence of QT prolongation and torsades de pointes is on the rise due to the use of cardiovascular and non-cardiovascular drugs. Robust efforts have been made and are still ongoing to understand the underlying mechanisms that can enhance or prevent the development of drug-induced proarrhythmia. A caveat in the use of antiarrhythmic drugs is the ability to obtain safe action potential prolongation therapeutic effects, through IKr blockade. This remains as yet completely unachievable, as blockers of the potassium channel have not provided complete safe measures. Because of this, efforts at understanding the mechanisms of proarrhythmia have continued. PI3K/Akt signalling pathway appears to possess some potential advantage in this regard because cardiomyocytes intracellular dialysis with phosphatidylinositol (3,4,5)-trisphosphate (PIP3) normalises ion channel alterations and eliminates proarrhythmic features. However, there is a conundrum. Increased activities of PIP3 signalling can enhance cell proliferation and survival, and reduced activities of PIP3 signalling can lead to proarrhythmia. PI3K inhibitors used in cancer treatment have been found to cause proarrhythmia, and represent a potential avenue for the research and evaluation of potential effectiveness of a battery of antiarrhythmic and cancer drugs that are either currently in use or in development. Despite this knowledge, limited information is available on PI3K/Akt signalling and arrhythmogenesis. This highlights the need to search for new ways to improve testing of antiarrhythmic drugs and increase our understanding in PI3K/Akt signalling and arrhythmogenesis.
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Affiliation(s)
- Martin Ezeani
- Department of Chemical Pathology, Faculty of Health Science and Technology, College of Health Science, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria
| | - Sunday Elom
- Department of Medical Biochemistry, Federal University Ndufu-Alike, Ikwo, Ebonyi State, Nigeria
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64
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Rehnelt S, Malan D, Juhasz K, Wolters B, Doerr L, Beckler M, Kettenhofen R, Bohlen H, Bruegmann T, Sasse P. Frequency-Dependent Multi-Well Cardiotoxicity Screening Enabled by Optogenetic Stimulation. Int J Mol Sci 2017; 18:E2634. [PMID: 29211031 PMCID: PMC5751237 DOI: 10.3390/ijms18122634] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 11/17/2022] Open
Abstract
Side effects on cardiac ion channels causing lethal arrhythmias are one major reason for drug withdrawals from the market. Field potential (FP) recording from cardiomyocytes, is a well-suited tool to assess such cardiotoxic effects of drug candidates in preclinical drug development, but it is currently limited to the spontaneous beating of the cardiomyocytes and manual analysis. Herein, we present a novel optogenetic cardiotoxicity screening system suited for the parallel automated frequency-dependent analysis of drug effects on FP recorded from human-induced pluripotent stem cell-derived cardiomyocytes. For the expression of the light-sensitive cation channel Channelrhodopsin-2, we optimised protocols using virus transduction or transient mRNA transfection. Optical stimulation was performed with a new light-emitting diode lid for a 96-well FP recording system. This enabled reliable pacing at physiologically relevant heart rates and robust recording of FP. Thereby we detected rate-dependent effects of drugs on Na⁺, Ca2+ and K⁺ channel function indicated by FP prolongation, FP shortening and the slowing of the FP downstroke component, as well as generation of afterdepolarisations. Taken together, we present a scalable approach for preclinical frequency-dependent screening of drug effects on cardiac electrophysiology. Importantly, we show that the recording and analysis can be fully automated and the technology is readily available using commercial products.
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Affiliation(s)
- Susanne Rehnelt
- Institute of Physiology I, Medical Faculty, University of Bonn, 53127 Bonn, Germany.
| | - Daniela Malan
- Institute of Physiology I, Medical Faculty, University of Bonn, 53127 Bonn, Germany.
| | - Krisztina Juhasz
- Nanion Technologies GmbH, 80636 Munich, Germany.
- Present address: Institute for Nanoelectronics, Department of Electrical Engineering and Information Technology, Technische Universität München, 80339 Munich, Germany.
| | - Benjamin Wolters
- Part of the Ncardia Group, Axiogenesis AG, 50829 Cologne, Germany.
| | - Leo Doerr
- Nanion Technologies GmbH, 80636 Munich, Germany.
| | | | - Ralf Kettenhofen
- Part of the Ncardia Group, Axiogenesis AG, 50829 Cologne, Germany.
| | - Heribert Bohlen
- Part of the Ncardia Group, Axiogenesis AG, 50829 Cologne, Germany.
| | - Tobias Bruegmann
- Institute of Physiology I, Medical Faculty, University of Bonn, 53127 Bonn, Germany.
- Research Training Group 1873, University of Bonn, 53127 Bonn, Germany.
| | - Philipp Sasse
- Institute of Physiology I, Medical Faculty, University of Bonn, 53127 Bonn, Germany.
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65
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Parikh J, Gurev V, Rice JJ. Novel Two-Step Classifier for Torsades de Pointes Risk Stratification from Direct Features. Front Pharmacol 2017; 8:816. [PMID: 29184497 PMCID: PMC5694470 DOI: 10.3389/fphar.2017.00816] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/27/2017] [Indexed: 12/16/2022] Open
Abstract
While pre-clinical Torsades de Pointes (TdP) risk classifiers had initially been based on drug-induced block of hERG potassium channels, it is now well established that improved risk prediction can be achieved by considering block of non-hERG ion channels. The current multi-channel TdP classifiers can be categorized into two classes. First, the classifiers that take as input the values of drug-induced block of ion channels (direct features). Second, the classifiers that are built on features extracted from output of the drug-induced multi-channel blockage simulations in the in-silico models (derived features). The classifiers built on derived features have thus far not consistently provided increased prediction accuracies, and hence casts doubt on the value of such approaches given the cost of including biophysical detail. Here, we propose a new two-step method for TdP risk classification, referred to as Multi-Channel Blockage at Early After Depolarization (MCB@EAD). In the first step, we classified the compound that produced insufficient hERG block as non-torsadogenic. In the second step, the role of non-hERG channels to modulate TdP risk are considered by constructing classifiers based on direct or derived features at critical hERG block concentrations that generates EADs in the computational cardiac cell models. MCB@EAD provides comparable or superior TdP risk classification of the drugs from the direct features in tests against published methods. TdP risk for the drugs highly correlated to the propensity to generate EADs in the model. However, the derived features of the biophysical models did not improve the predictive capability for TdP risk assessment.
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Affiliation(s)
| | | | - John J. Rice
- IBM T. J. Watson Research Center, Yorktown Heights, NY, United States
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66
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Trenor B, Cardona K, Saiz J, Noble D, Giles W. Cardiac action potential repolarization revisited: early repolarization shows all-or-none behaviour. J Physiol 2017; 595:6599-6612. [PMID: 28815597 PMCID: PMC5663823 DOI: 10.1113/jp273651] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/09/2017] [Indexed: 12/15/2022] Open
Abstract
In healthy mammalian hearts the action potential (AP) waveform initiates and modulates each contraction, or heartbeat. As a result, AP height and duration are key physiological variables. In addition, rate-dependent changes in ventricular AP duration (APD), and variations in APD at a fixed heart rate are both reliable biomarkers of electrophysiological stability. Present guidelines for the likelihood that candidate drugs will increase arrhythmias rely on small changes in APD and Q-T intervals as criteria for safety pharmacology decisions. However, both of these measurements correspond to the final repolarization of the AP. Emerging clinical evidence draws attention to the early repolarization phase of the action potential (and the J-wave of the ECG) as an additional important biomarker for arrhythmogenesis. Here we provide a mechanistic background to this early repolarization syndrome by summarizing the evidence that both the initial depolarization and repolarization phases of the cardiac action potential can exhibit distinct time- and voltage-dependent thresholds, and also demonstrating that both can show regenerative all-or-none behaviour. An important consequence of this is that not all of the dynamics of action potential repolarization in human ventricle can be captured by data from single myocytes when these results are expressed as 'repolarization reserve'. For example, the complex pattern of cell-to-cell current flow that is responsible for AP conduction (propagation) within the mammalian myocardium can change APD and the Q-T interval of the electrocardiogram alter APD stability, and modulate responsiveness to pharmacological agents (such as Class III anti-arrhythmic drugs).
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Affiliation(s)
- Beatriz Trenor
- Centro de Investigación e BioingenieríaUniversitat Politècnica de ValènciaValenciaSpain
| | - Karen Cardona
- Centro de Investigación e BioingenieríaUniversitat Politècnica de ValènciaValenciaSpain
| | - Javier Saiz
- Centro de Investigación e BioingenieríaUniversitat Politècnica de ValènciaValenciaSpain
| | - Denis Noble
- University Laboratory of PhysiologyUniversity of OxfordOxfordOX1 3PTUK
| | - Wayne Giles
- Faculties of Kinesiology and MedicineUniversity of CalgaryCalgaryAlbertaCanadaT2N 1N4
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67
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Agrawal DK, Boosani CS. Gene therapy to keep the QT rhythms “on the QT”. J Thorac Cardiovasc Surg 2017; 154:1641-1643. [DOI: 10.1016/j.jtcvs.2017.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/10/2017] [Indexed: 01/05/2023]
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68
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Saxena P, Hortigon‐Vinagre MP, Beyl S, Baburin I, Andranovits S, Iqbal SM, Costa A, IJzerman AP, Kügler P, Timin E, Smith GL, Hering S. Correlation between human ether-a-go-go-related gene channel inhibition and action potential prolongation. Br J Pharmacol 2017; 174:3081-3093. [PMID: 28681507 PMCID: PMC5573420 DOI: 10.1111/bph.13942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/08/2017] [Accepted: 06/16/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Human ether-a-go-go-related gene (hERG; Kv 11.1) channel inhibition is a widely accepted predictor of cardiac arrhythmia. hERG channel inhibition alone is often insufficient to predict pro-arrhythmic drug effects. This study used a library of dofetilide derivatives to investigate the relationship between standard measures of hERG current block in an expression system and changes in action potential duration (APD) in human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs). The interference from accompanying block of Cav 1.2 and Nav 1.5 channels was investigated along with an in silico AP model. EXPERIMENTAL APPROACH Drug-induced changes in APD were assessed in hiPSC-CMs using voltage-sensitive dyes. The IC50 values for dofetilide and 13 derivatives on hERG current were estimated in an HEK293 expression system. The relative potency of each drug on APD was estimated by calculating the dose (D150 ) required to prolong the APD at 90% (APD90 ) repolarization by 50%. KEY RESULTS The D150 in hiPSC-CMs was linearly correlated with IC50 of hERG current. In silico simulations supported this finding. Three derivatives inhibited hERG without prolonging APD, and these compounds also inhibited Cav 1.2 and/or Nav 1.5 in a channel state-dependent manner. Adding Cav 1.2 and Nav 1.2 block to the in silico model recapitulated the direction but not the extent of the APD change. CONCLUSIONS AND IMPLICATIONS Potency of hERG current inhibition correlates linearly with an index of APD in hiPSC-CMs. The compounds that do not correlate have additional effects including concomitant block of Cav 1.2 and/or Nav 1.5 channels. In silico simulations of hiPSC-CMs APs confirm the principle of the multiple ion channel effects.
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Affiliation(s)
- P Saxena
- Institute of Pharmacology and ToxicologyUniversity of ViennaViennaAustria
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - M P Hortigon‐Vinagre
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
- Clyde Biosciences LtdGlasgowUK
| | - S Beyl
- Institute of Pharmacology and ToxicologyUniversity of ViennaViennaAustria
| | - I Baburin
- Institute of Pharmacology and ToxicologyUniversity of ViennaViennaAustria
| | - S Andranovits
- Institute of Pharmacology and ToxicologyUniversity of ViennaViennaAustria
| | - S M Iqbal
- Institute of Pharmacology and ToxicologyUniversity of ViennaViennaAustria
| | - A Costa
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - A P IJzerman
- Division of Medicinal Chemistry, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenNetherlands
| | - P Kügler
- Institute for Applied Mathematics and StatisticsUniversity of HohenheimStuttgartGermany
- Radon Institute for Computational and Applied MathematicsAustrian Academy of SciencesViennaAustria
| | - E Timin
- Institute of Pharmacology and ToxicologyUniversity of ViennaViennaAustria
| | - G L Smith
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
- Clyde Biosciences LtdGlasgowUK
| | - S Hering
- Institute of Pharmacology and ToxicologyUniversity of ViennaViennaAustria
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69
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Lapp H, Bruegmann T, Malan D, Friedrichs S, Kilgus C, Heidsieck A, Sasse P. Frequency-dependent drug screening using optogenetic stimulation of human iPSC-derived cardiomyocytes. Sci Rep 2017; 7:9629. [PMID: 28851973 PMCID: PMC5575076 DOI: 10.1038/s41598-017-09760-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/31/2017] [Indexed: 11/29/2022] Open
Abstract
Side effects on cardiac ion channels are one major reason for new drugs to fail during preclinical evaluation. Herein we propose a simple optogenetic screening tool measuring extracellular field potentials (FP) from paced cardiomyocytes to identify drug effects over the whole physiological heart range, which is essential given the rate-dependency of ion channel function and drug action. Human induced pluripotent stem cell-derived cardiomyocytes were transduced with an adeno-associated virus to express Channelrhodopsin2 and plated on micro-electrode arrays. Global pulsed illumination (470 nm, 1 ms, 0.9 mW/mm2) was applied at frequencies from 1 to 2.5 Hz, which evoked FP simultaneously in all cardiomyocytes. This synchronized activation allowed averaging of FP from all electrodes resulting in one robust FP signal for analysis. Field potential duration (FPD) was ~25% shorter at 2.5 Hz compared to 1 Hz. Inhibition of hERG channels prolonged FPD only at low heart rates whereas Ca2+ channel block shortened FPD at all heart rates. Optogenetic pacing also allowed analysis of the maximum downstroke velocity of the FP to detect drug effects on Na+ channel availability. In principle, the presented method is well scalable for high content cardiac toxicity screening or personalized medicine for inherited cardiac channelopathies.
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Affiliation(s)
- Hendrik Lapp
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Tobias Bruegmann
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
- Research Training Group 1873, University of Bonn, 53127, Bonn, Germany
| | - Daniela Malan
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Stephanie Friedrichs
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Carsten Kilgus
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Alexandra Heidsieck
- Zentralinstitut für Medizintechnik, Technische Universität München, München, Germany
| | - Philipp Sasse
- Institute of Physiology I, Life and Brain Center, Medical Faculty, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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70
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Wit AL. Editorial Commentary: Important contributions of basic electrophysiology to the prevention and therapy of drug induced cardiac arrhythmias. Trends Cardiovasc Med 2017; 27:460-462. [PMID: 28709808 DOI: 10.1016/j.tcm.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Andrew L Wit
- Department of Pharmacology, College of Physicians and Surgeons of Columbia University, New York, NY.
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71
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Onohara T, Hisatome I, Kurata Y, Li P, Notsu T, Morikawa K, Otani N, Yoshida A, Iitsuka K, Kato M, Miake J, Ninomiya H, Higaki K, Shirayoshi Y, Nishihara T, Itoh T, Nakamura Y, Nishimura M. Molecular mechanisms underlying the pilsicainide-induced stabilization of hERG proteins in transfected mammalian cells. J Arrhythm 2017; 33:226-233. [PMID: 28607619 PMCID: PMC5459418 DOI: 10.1016/j.joa.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022] Open
Abstract
Background Pilsicainide, classified as a relatively selective Na+ channel blocker, also has an inhibitory action on the rapidly-activating delayed-rectifier K+ current (IKr) through human ether-a-go-go-related gene (hERG) channels. We studied the effects of chronic exposure to pilsicainide on the expression of wild-type (WT) hERG proteins and WT-hERG channel currents, as well as on the expression of mutant hERG proteins, in a heterologous expression system. Methods HEK293 cells stably expressing WT or mutant hERG proteins were subjected to Western blotting, immunofluorescence microscopy and patch-clamp experiments. Results Acute exposure to pilsicainide at 0.03–10 μM influenced neither the expression of WT-hERG proteins nor WT-hERG channel currents. Chronic treatment with 0.03–10 μM pilsicainide for 48 h, however, increased the expression of WT-hERG proteins and channel currents in a concentration-dependent manner. Chronic treatment with 3 μM pilsicainide for 48 h delayed degradation of WT-hERG proteins and increased the channels expressed on the plasma membrane. A cell membrane-impermeant pilsicainide derivative did not influence the expression of WT-hERG, indicating that pilsicainide stabilized the protein inside the cell. Pilsicainide did not influence phosphorylation of Akt (protein kinase B) or expression of heat shock protein families such as HSF-1, hsp70 and hsp90. E4031, a chemical chaperone for hERG, abolished the pilsicainide effect on hERG. Chronic treatment with pilsicainide could also increase the protein expression of trafficking-defective mutant hERG, G601S and R752W. Conclusions Pilsicainide penetrates the plasma membrane, stabilizes WT-hERG proteins by acting as a chemical chaperone, and enhances WT-hERG channel currents. This mechanism could also be applicable to modulations of certain mutant-hERG proteins.
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Affiliation(s)
- Takeshi Onohara
- Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Ichiro Hisatome
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, Nishichou 36-1, Yonago, Japan
| | - Yasutaka Kurata
- Department of Physiology II, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, Japan
| | - Peili Li
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, Nishichou 36-1, Yonago, Japan
| | - Tomomi Notsu
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, Nishichou 36-1, Yonago, Japan
| | - Kumi Morikawa
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, Nishichou 36-1, Yonago, Japan
| | - Naoyuki Otani
- Department of Pharmacology, Dokkyo Medical College, Tochigi, Japan
| | - Akio Yoshida
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, Nishichou 36-1, Yonago, Japan
| | - Kazuhiko Iitsuka
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Nishichou 36-1, Yonago, Japan
| | - Masaru Kato
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Nishichou 36-1, Yonago, Japan
| | - Junichiro Miake
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Nishichou 36-1, Yonago, Japan
| | - Haruaki Ninomiya
- Department of Biological Regulation, Tottori University Faculty of Medicine, Nishichou 36-1, Yonago, Japan
| | - Katsumi Higaki
- Division of Functional Genomics, Research Center for Bioscience and Technology, Tottori University, Nishichou 36-1, Yonago, Japan
| | - Yasuaki Shirayoshi
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, Nishichou 36-1, Yonago, Japan
| | - Takashi Nishihara
- Department of Chemistry and Biotechnology, Graduate School of Engineering, Tottori University, 4-101 Koyama-minami, Tottori 680-8552, Japan.,Center for Research on Green Sustainable Chemistry, Tottori University, 4-101 Koyama-minami, Tottori 680-8552, Japan
| | - Toshiyuki Itoh
- Department of Chemistry and Biotechnology, Graduate School of Engineering, Tottori University, 4-101 Koyama-minami, Tottori 680-8552, Japan.,Center for Research on Green Sustainable Chemistry, Tottori University, 4-101 Koyama-minami, Tottori 680-8552, Japan
| | - Yoshinobu Nakamura
- Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Motonobu Nishimura
- Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Yonago, Japan
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Predicting the Unpredictable: Drug-Induced QT Prolongation and Torsades de Pointes. J Am Coll Cardiol 2017; 67:1639-1650. [PMID: 27150690 DOI: 10.1016/j.jacc.2015.12.063] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/20/2015] [Accepted: 12/14/2015] [Indexed: 01/09/2023]
Abstract
Drug-induced long QT syndrome (diLQTS) and congenital LQTS (cLQTS) share many features, and both syndromes can result in life-threatening torsades de pointes (TdP). Our understanding of their mechanistic and genetic similarities has led to their improved clinical management. However, our inability to prevent diLQTS has resulted in removal of many medicines from the market and from development. Genetic and clinical risk factors for diLQTS and TdP are well known and raise the possibility of TdP prevention. Clinical decision support systems (CDSS) can scan the patient's electronic health records for clinical risk factors predictive of diLQTS and warn when a drug that can cause TdP is prescribed. CDSS have reduced prescriptions of QT-prolonging drugs, but these relatively small changes lack the power to reduce TdP. The growing genetic evidence linking diLQTS to cLQTS suggests that prevention of TdP in the future may require inclusion of both genetic and clinical predictors into CDSS.
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73
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Cohen IS, Lin RZ, Ballou LM. Acquired long QT syndrome and phosphoinositide 3-kinase. Trends Cardiovasc Med 2017; 27:451-459. [PMID: 28687226 DOI: 10.1016/j.tcm.2017.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/08/2023]
Abstract
While it is well known that mutation of several different ion channels can cause congenital long QT syndrome, block of IKr is widely thought to be responsible for most cases of drug-induced acquired long QT syndrome (aLQTS). In this article, we review evidence supporting another cause of aLQTS due to inhibition of phosphoinositide 3-kinase (PI3K) signaling. Inhibition of PI3K affects multiple plateau currents, reducing IKr, IKs, and ICaL while increasing the persistent sodium current (INaP). The effects of PI3K inhibitors develop slowly, requiring hours to days to reach steady state. Dofetilide and terfenadine, an antihistamine on which much of the original IKr hypothesis was based, are among the many drugs that inhibit the PI3K pathway. Reduced PI3K signaling may also play a role in aLQTS associated with diabetes. Drug safety testing to identify aLQTS risk may be improved by examining PI3K-dependent effects that develop over time.
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Affiliation(s)
- Ira S Cohen
- Department of Physiology and Biophysics, The Institute for Molecular Cardiology, Stony Brook University, Stony Brook, NY.
| | - Richard Z Lin
- Department of Physiology and Biophysics, The Institute for Molecular Cardiology, Stony Brook University, Stony Brook, NY; Medical Service, Northport VA Medical Center, Northport, NY
| | - Lisa M Ballou
- Department of Physiology and Biophysics, The Institute for Molecular Cardiology, Stony Brook University, Stony Brook, NY
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74
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Yang Z, Prinsen JK, Bersell KR, Shen W, Yermalitskaya L, Sidorova T, Luis PB, Hall L, Zhang W, Du L, Milne G, Tucker P, George AL, Campbell CM, Pickett RA, Shaffer CM, Chopra N, Yang T, Knollmann BC, Roden DM, Murray KT. Azithromycin Causes a Novel Proarrhythmic Syndrome. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.115.003560. [PMID: 28408648 DOI: 10.1161/circep.115.003560] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/26/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The widely used macrolide antibiotic azithromycin increases risk of cardiovascular and sudden cardiac death, although the underlying mechanisms are unclear. Case reports, including the one we document here, demonstrate that azithromycin can cause rapid, polymorphic ventricular tachycardia in the absence of QT prolongation, indicating a novel proarrhythmic syndrome. We investigated the electrophysiological effects of azithromycin in vivo and in vitro using mice, cardiomyocytes, and human ion channels heterologously expressed in human embryonic kidney (HEK 293) and Chinese hamster ovary (CHO) cells. METHODS AND RESULTS In conscious telemetered mice, acute intraperitoneal and oral administration of azithromycin caused effects consistent with multi-ion channel block, with significant sinus slowing and increased PR, QRS, QT, and QTc intervals, as seen with azithromycin overdose. Similarly, in HL-1 cardiomyocytes, the drug slowed sinus automaticity, reduced phase 0 upstroke slope, and prolonged action potential duration. Acute exposure to azithromycin reduced peak SCN5A currents in HEK cells (IC50=110±3 μmol/L) and Na+ current in mouse ventricular myocytes. However, with chronic (24 hour) exposure, azithromycin caused a ≈2-fold increase in both peak and late SCN5A currents, with findings confirmed for INa in cardiomyocytes. Mild block occurred for K+ currents representing IKr (CHO cells expressing hERG; IC50=219±21 μmol/L) and IKs (CHO cells expressing KCNQ1+KCNE1; IC50=184±12 μmol/L), whereas azithromycin suppressed L-type Ca++ currents (rabbit ventricular myocytes, IC50=66.5±4 μmol/L) and IK1 (HEK cells expressing Kir2.1, IC50=44±3 μmol/L). CONCLUSIONS Chronic exposure to azithromycin increases cardiac Na+ current to promote intracellular Na+ loading, providing a potential mechanistic basis for the novel form of proarrhythmia seen with this macrolide antibiotic.
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Affiliation(s)
- Zhenjiang Yang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Joseph K Prinsen
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Kevin R Bersell
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Wangzhen Shen
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Liudmila Yermalitskaya
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Tatiana Sidorova
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Paula B Luis
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Lynn Hall
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Wei Zhang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Liping Du
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Ginger Milne
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Patrick Tucker
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Alfred L George
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Courtney M Campbell
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Robert A Pickett
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Christian M Shaffer
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Nagesh Chopra
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Tao Yang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Bjorn C Knollmann
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Dan M Roden
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Katherine T Murray
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN.
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75
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Damrongwatanasuk R, Fradley MG. Cardiovascular Complications of Targeted Therapies for Chronic Myeloid Leukemia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:24. [PMID: 28316033 DOI: 10.1007/s11936-017-0524-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OPINION STATEMENT The development of tyrosine kinase inhibitors (TKIs) dramatically changed the treatment landscape for many different cancers including chronic myeloid leukemia (CML). With the introduction of imatinib, the first TKI developed and approved to effectively treat CML, patient survival has increased dramatically and, in some cases, this fatal cancer can be managed as a chronic disease. Since the approval of imatinib in 2002, four additional TKIs have been developed to treat this disease including the second-generation TKIs nilotinib, dasatinib, and bosutinib and the third-generation TKI ponatinib. Despite their significant impact on the progression of CML, there is increasing recognition of cardiovascular toxicities which can limit their long-term use and impact patient morbidity and mortality. The majority of the cardiotoxicities are associated with the second- and third-generation TKIs, the most concerning of which are vascular events including myocardial infarction, stroke and peripheral arterial disease. In addition, QT prolongation, pleural effusions, and both systemic and pulmonary hypertension are also observed. It is essential for both cardiologists and oncologists to possess knowledge of these issues in order to develop appropriate monitoring and risk mitigation strategies to prevent these toxicities and avoid premature cessation of the drug.
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Affiliation(s)
- Rongras Damrongwatanasuk
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida and H. Lee Moffitt Cancer Center & Research Institute, 2 Tampa General Circle, Tampa, FL, 33606, USA
| | - Michael G Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida and H. Lee Moffitt Cancer Center & Research Institute, 2 Tampa General Circle, Tampa, FL, 33606, USA.
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76
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Abstract
The QT interval on surface electrocardiograms provides a model of a multicomponent integrated readout of many biological systems, including ion channels, modulatory subunits, signaling systems that modulate their activity, and mechanisms that regulate the expression of their responsible genes. The problem of drug exposure causing exaggerated QT interval prolongation and torsades de pointes highlights the multicomponent nature of cardiac repolarization and the way in which simple perturbations can yield exaggerated responses. Future directions will involve cellular approaches coupled to evolving technologies that can interrogate multicellular systems and provide a sophisticated view of mechanisms in this previously idiosyncratic drug reaction.
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Affiliation(s)
- Dan M Roden
- Oates Institute for Experimental Therapeutics, Vanderbilt University School of Medicine, 1285 MRB IV, Nashville, TN 37232-0575, USA.
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77
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Chiamvimonvat N, Chen-Izu Y, Clancy CE, Deschenes I, Dobrev D, Heijman J, Izu L, Qu Z, Ripplinger CM, Vandenberg JI, Weiss JN, Koren G, Banyasz T, Grandi E, Sanguinetti MC, Bers DM, Nerbonne JM. Potassium currents in the heart: functional roles in repolarization, arrhythmia and therapeutics. J Physiol 2017; 595:2229-2252. [PMID: 27808412 DOI: 10.1113/jp272883] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/11/2016] [Indexed: 12/19/2022] Open
Abstract
This is the second of the two White Papers from the fourth UC Davis Cardiovascular Symposium Systems Approach to Understanding Cardiac Excitation-Contraction Coupling and Arrhythmias (3-4 March 2016), a biennial event that brings together leading experts in different fields of cardiovascular research. The theme of the 2016 symposium was 'K+ channels and regulation', and the objectives of the conference were severalfold: (1) to identify current knowledge gaps; (2) to understand what may go wrong in the diseased heart and why; (3) to identify possible novel therapeutic targets; and (4) to further the development of systems biology approaches to decipher the molecular mechanisms and treatment of cardiac arrhythmias. The sessions of the Symposium focusing on the functional roles of the cardiac K+ channel in health and disease, as well as K+ channels as therapeutic targets, were contributed by Ye Chen-Izu, Gideon Koren, James Weiss, David Paterson, David Christini, Dobromir Dobrev, Jordi Heijman, Thomas O'Hara, Crystal Ripplinger, Zhilin Qu, Jamie Vandenberg, Colleen Clancy, Isabelle Deschenes, Leighton Izu, Tamas Banyasz, Andras Varro, Heike Wulff, Eleonora Grandi, Michael Sanguinetti, Donald Bers, Jeanne Nerbonne and Nipavan Chiamvimonvat as speakers and panel discussants. This article summarizes state-of-the-art knowledge and controversies on the functional roles of cardiac K+ channels in normal and diseased heart. We endeavour to integrate current knowledge at multiple scales, from the single cell to the whole organ levels, and from both experimental and computational studies.
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Affiliation(s)
- Nipavan Chiamvimonvat
- Department of Internal Medicine, University of California, Davis, Genome and Biomedical Science Facility, Rm 6315, Davis, CA, 95616, USA.,Department of Veterans Affairs, Northern California Health Care System, Mather, CA, 95655, USA
| | - Ye Chen-Izu
- Department of Internal Medicine, University of California, Davis, Genome and Biomedical Science Facility, Rm 6315, Davis, CA, 95616, USA.,Department of Pharmacology, University of California, Davis, Genome and Biomedical Science Facility, Rm 3503, Davis, CA, 95616, USA.,Department of Biomedical Engineering, University of California, Davis, Genome and Biomedical Science Facility, Rm 2303, Davis, CA, 95616, USA
| | - Colleen E Clancy
- Department of Pharmacology, University of California, Davis, Genome and Biomedical Science Facility, Rm 3503, Davis, CA, 95616, USA
| | - Isabelle Deschenes
- Department of Physiology and Biophysics, and Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44109, USA.,Heart and Vascular Research Center, MetroHealth Medical Center, Cleveland, OH, 44109, USA
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Leighton Izu
- Department of Pharmacology, University of California, Davis, Genome and Biomedical Science Facility, Rm 3503, Davis, CA, 95616, USA
| | - Zhilin Qu
- Division of Cardiology, Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA, 3645 MRL, Los Angeles, CA, 90095, USA
| | - Crystal M Ripplinger
- Department of Pharmacology, University of California, Davis, Genome and Biomedical Science Facility, Rm 3503, Davis, CA, 95616, USA
| | - Jamie I Vandenberg
- Victor Chang Cardiac Research Institute, 405 Liverpool Street, Darlinghurst, NSW, 2010, Australia
| | - James N Weiss
- Division of Cardiology, Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA, 3645 MRL, Los Angeles, CA, 90095, USA
| | - Gideon Koren
- Cardiovascular Research Center, Rhode Island Hospital and the Cardiovascular Institute, The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Tamas Banyasz
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eleonora Grandi
- Department of Pharmacology, University of California, Davis, Genome and Biomedical Science Facility, Rm 3503, Davis, CA, 95616, USA
| | - Michael C Sanguinetti
- Department of Internal Medicine, University of Utah, Nora Eccles Harrison Cardiovascular Research & Training Institute, Salt Lake City, UT, 84112, USA
| | - Donald M Bers
- Department of Pharmacology, University of California, Davis, Genome and Biomedical Science Facility, Rm 3503, Davis, CA, 95616, USA
| | - Jeanne M Nerbonne
- Departments of Developmental Biology and Internal Medicine, Cardiovascular Division, Washington University Medical School, St Louis, MO, 63110, USA
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Bohnen MS, Peng G, Robey SH, Terrenoire C, Iyer V, Sampson KJ, Kass RS. Molecular Pathophysiology of Congenital Long QT Syndrome. Physiol Rev 2017; 97:89-134. [PMID: 27807201 PMCID: PMC5539372 DOI: 10.1152/physrev.00008.2016] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Ion channels represent the molecular entities that give rise to the cardiac action potential, the fundamental cellular electrical event in the heart. The concerted function of these channels leads to normal cyclical excitation and resultant contraction of cardiac muscle. Research into cardiac ion channel regulation and mutations that underlie disease pathogenesis has greatly enhanced our knowledge of the causes and clinical management of cardiac arrhythmia. Here we review the molecular determinants, pathogenesis, and pharmacology of congenital Long QT Syndrome. We examine mechanisms of dysfunction associated with three critical cardiac currents that comprise the majority of congenital Long QT Syndrome cases: 1) IKs, the slow delayed rectifier current; 2) IKr, the rapid delayed rectifier current; and 3) INa, the voltage-dependent sodium current. Less common subtypes of congenital Long QT Syndrome affect other cardiac ionic currents that contribute to the dynamic nature of cardiac electrophysiology. Through the study of mutations that cause congenital Long QT Syndrome, the scientific community has advanced understanding of ion channel structure-function relationships, physiology, and pharmacological response to clinically employed and experimental pharmacological agents. Our understanding of congenital Long QT Syndrome continues to evolve rapidly and with great benefits: genotype-driven clinical management of the disease has improved patient care as precision medicine becomes even more a reality.
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Affiliation(s)
- M S Bohnen
- Department of Pharmacology, Columbia University Medical Center, New York, New York; and The New York Stem Cell Foundation Research Institute, New York, New York
| | - G Peng
- Department of Pharmacology, Columbia University Medical Center, New York, New York; and The New York Stem Cell Foundation Research Institute, New York, New York
| | - S H Robey
- Department of Pharmacology, Columbia University Medical Center, New York, New York; and The New York Stem Cell Foundation Research Institute, New York, New York
| | - C Terrenoire
- Department of Pharmacology, Columbia University Medical Center, New York, New York; and The New York Stem Cell Foundation Research Institute, New York, New York
| | - V Iyer
- Department of Pharmacology, Columbia University Medical Center, New York, New York; and The New York Stem Cell Foundation Research Institute, New York, New York
| | - K J Sampson
- Department of Pharmacology, Columbia University Medical Center, New York, New York; and The New York Stem Cell Foundation Research Institute, New York, New York
| | - R S Kass
- Department of Pharmacology, Columbia University Medical Center, New York, New York; and The New York Stem Cell Foundation Research Institute, New York, New York
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79
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MicroRNA-mediated maturation of human pluripotent stem cell-derived cardiomyocytes: Towards a better model for cardiotoxicity? Food Chem Toxicol 2016; 98:17-24. [DOI: 10.1016/j.fct.2016.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 01/20/2023]
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80
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Lester RM, Olbertz J. Early drug development: assessment of proarrhythmic risk and cardiovascular safety. Expert Rev Clin Pharmacol 2016; 9:1611-1618. [PMID: 27718759 DOI: 10.1080/17512433.2016.1245142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION hERG assays and thorough ECG trials have been mandated since 2005 to evaluate the QT interval and potential proarrhythmic risk of new chemical entities. The high cost of these studies and the shortcomings inherent in these binary and limited approaches to drug evaluation have prompted regulators to search for more cost effective and mechanistic paradigms to assess drug liability as exemplified by the CiPA initiative and the exposure response ICH E14(R3) guidance document. Areas covered: This review profiles the changing regulatory landscape as it pertains to early drug development and outlines the analyses that can be performed to characterize preclinical and early clinical cardiovascular risk. Expert commentary: It is further acknowledged that the narrow focus on the QT interval needs to be expanded to include a more comprehensive evaluation of cardiovascular risk since unanticipated off target effects have led to the withdrawal of multiple drugs after they had been approved and marketed.
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Affiliation(s)
- Robert M Lester
- a Cardiovascular Safety Services , Celerion Inc. , Tempe , AZ , USA
| | - Joy Olbertz
- a Cardiovascular Safety Services , Celerion Inc. , Tempe , AZ , USA
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81
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Antiarrhythmic effect of the Ca 2+-activated K + (SK) channel inhibitor ICA combined with either amiodarone or dofetilide in an isolated heart model of atrial fibrillation. Pflugers Arch 2016; 468:1853-1863. [PMID: 27722784 PMCID: PMC6763419 DOI: 10.1007/s00424-016-1883-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 08/13/2016] [Accepted: 08/27/2016] [Indexed: 12/22/2022]
Abstract
Dose is an important parameter in terms of both efficacy and adverse effects in pharmacological treatment of atrial fibrillation (AF). Both of the class III antiarrhythmics dofetilide and amiodarone have documented anti-AF effects. While dofetilide has dose-related ventricular side effects, amiodarone primarily has adverse non-cardiac effects. Pharmacological inhibition of small conductance Ca2+-activated K+ (SK) channels has recently been reported to be antiarrhythmic in a number of animal AF models. In a Langendorff model of acutely induced AF on guinea pig hearts, it was investigated whether a combination of the SK channel blocker N-(pyridin-2-yl)-4-(pyridin-2-yl)thiazol-2-amine (ICA) together with either dofetilide or amiodarone provided a synergistic effect. The duration of AF was reduced with otherwise subefficacious concentrations of either dofetilide or amiodarone when combined with ICA, also at a subefficacious concentration. At a concentration level effective as monotherapy, dofetilide produced a marked increase in the QT interval. This QT prolonging effect was absent when combined with ICA at non-efficacious monotherapy concentrations. The results thereby reveal that combination of subefficacious concentrations of an SK channel blocker and either dofetilide or amiodarone can maintain anti-AF properties, while the risk of ventricular arrhythmias is reduced.
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82
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Blinova K, Stohlman J, Vicente J, Chan D, Johannesen L, Hortigon-Vinagre MP, Zamora V, Smith G, Crumb WJ, Pang L, Lyn-Cook B, Ross J, Brock M, Chvatal S, Millard D, Galeotti L, Stockbridge N, Strauss DG. Comprehensive Translational Assessment of Human-Induced Pluripotent Stem Cell Derived Cardiomyocytes for Evaluating Drug-Induced Arrhythmias. Toxicol Sci 2016; 155:234-247. [PMID: 27701120 DOI: 10.1093/toxsci/kfw200] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM) hold promise for assessment of drug-induced arrhythmias and are being considered for use under the comprehensive in vitro proarrhythmia assay (CiPA). We studied the effects of 26 drugs and 3 drug combinations on 2 commercially available iPSC-CM types using high-throughput voltage-sensitive dye and microelectrode-array assays being studied for the CiPA initiative and compared the results with clinical QT prolongation and torsade de pointes (TdP) risk. Concentration-dependent analysis comparing iPSC-CMs to clinical trial results demonstrated good correlation between drug-induced rate-corrected action potential duration and field potential duration (APDc and FPDc) prolongation and clinical trial QTc prolongation. Of 20 drugs studied that exhibit clinical QTc prolongation, 17 caused APDc prolongation (16 in Cor.4U and 13 in iCell cardiomyocytes) and 16 caused FPDc prolongation (16 in Cor.4U and 10 in iCell cardiomyocytes). Of 14 drugs that cause TdP, arrhythmias occurred with 10 drugs. Lack of arrhythmic beating in iPSC-CMs for the four remaining drugs could be due to differences in relative levels of expression of individual ion channels. iPSC-CMs responded consistently to human ether-a-go-go potassium channel blocking drugs (APD prolongation and arrhythmias) and calcium channel blocking drugs (APD shortening and prevention of arrhythmias), with a more variable response to late sodium current blocking drugs. Current results confirm the potential of iPSC-CMs for proarrhythmia prediction under CiPA, where iPSC-CM results would serve as a check to ion channel and in silico modeling prediction of proarrhythmic risk. A multi-site validation study is warranted.
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Affiliation(s)
- Ksenia Blinova
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland;
| | - Jayna Stohlman
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland
| | - Jose Vicente
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland.,US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, Maryland.,BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Dulciana Chan
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland
| | - Lars Johannesen
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland
| | | | - Victor Zamora
- University of Glasgow, Glasgow, UK.,Clyde Biosciences, Glasgow, UK
| | - Godfrey Smith
- University of Glasgow, Glasgow, UK.,Clyde Biosciences, Glasgow, UK
| | | | - Li Pang
- Division of Biochemical Toxicology, US Food and Drug Administration, National Center for Toxicological Research, Jefferson, Arkansas
| | - Beverly Lyn-Cook
- Division of Biochemical Toxicology, US Food and Drug Administration, National Center for Toxicological Research, Jefferson, Arkansas
| | | | | | | | | | - Loriano Galeotti
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland
| | - Norman Stockbridge
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Silver Spring, Maryland
| | - David G Strauss
- US Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Silver Spring, Maryland; .,US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Clinical Pharmacology, Silver Spring, Maryland
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83
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Qiu XS, Chauveau S, Anyukhovsky EP, Rahim T, Jiang YP, Harleton E, Feinmark SJ, Lin RZ, Coronel R, Janse MJ, Opthof T, Rosen TS, Cohen IS, Rosen MR. Increased Late Sodium Current Contributes to the Electrophysiological Effects of Chronic, but Not Acute, Dofetilide Administration. Circ Arrhythm Electrophysiol 2016; 9:e003655. [PMID: 27071826 DOI: 10.1161/circep.115.003655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/01/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Drugs are screened for delayed rectifier potassium current (IKr) blockade to predict long QT syndrome prolongation and arrhythmogenesis. However, single-cell studies have shown that chronic (hours) exposure to some IKr blockers (eg, dofetilide) prolongs repolarization additionally by increasing late sodium current (INa-L) via inhibition of phosphoinositide 3-kinase. We hypothesized that chronic dofetilide administration to intact dogs prolongs repolarization by blocking IKr and increasing INa-L. METHODS AND RESULTS We continuously infused dofetilide (6-9 μg/kg bolus+6-9 μg/kg per hour IV infusion) into anesthetized dogs for 7 hours, maintaining plasma levels within the therapeutic range. In separate experiments, myocardial biopsies were taken before and during 6-hour intravenous dofetide infusion, and the level of phospho-Akt was determined. Acute and chronic dofetilide effects on action potential duration (APD) were studied in canine left ventricular subendocardial slabs using microelectrode techniques. Dofetilide monotonically increased QTc and APD throughout 6.5-hour exposure. Dofetilide infusion during ≥210 minutes inhibited Akt phosphorylation. INa-L block with lidocaine shortened QTc and APD more at 6.5 hours than at 50 minutes (QTc) or 30 minutes (APD) dofetilide administration. In comparison, moxifloxacin, an IKr blocker with no effects on phosphoinositide 3-kinase and INa-L prolonged APD acutely but no additional prolongation occurred on chronic superfusion. Lidocaine shortened APD equally during acute and chronic moxifloxacin superfusion. CONCLUSIONS Increased INa-L contributes to chronic dofetilide effects in vivo. These data emphasize the need to include time and INa-L in evaluating the phosphoinositide 3-kinase inhibition-derived proarrhythmic potential of drugs and provide a mechanism for benefit from lidocaine administration in clinical acquired long QT syndrome.
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Affiliation(s)
- Xiaoliang S Qiu
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Samuel Chauveau
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Evgeny P Anyukhovsky
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Tania Rahim
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Ya-Ping Jiang
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Erin Harleton
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Steven J Feinmark
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Richard Z Lin
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Ruben Coronel
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Michiel J Janse
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Tobias Opthof
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Tove S Rosen
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
| | - Ira S Cohen
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.).
| | - Michael R Rosen
- From the Department of Physiology and Biophysics, Stony Brook University, NY (X.S.Q., S.C., E.P.A., T.R., Y.-P.J., R.Z.L., I.S.C.); Departments of Pharmacology (E.H., S.J.F., M.R.R.) and Pediatrics (T.S.R., M.R.R.), College of Physician and Surgeons of Columbia University, New York, NY; Medical Service, Northport VA Medical Center, NY (R.Z.L.); Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (R.C., M.J.J., T.O.); L'Institut de RYthmologie et de modélisation Cardiaque (LIRYC), Université Bordeaux Segalen, Bordeaux, France (R.C.); and Department of Medical Physiology, University Medical Center Utrecht, The Netherlands (T.O.)
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84
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McCauley MD, Darbar D. A new paradigm for predicting risk of Torsades de Pointes during drug development: Commentary on: "Improved prediction of drug-induced Torsades de Pointes through simulations of dynamics and machine learning algorithms". Clin Pharmacol Ther 2016; 100:324-6. [PMID: 27301674 DOI: 10.1002/cpt.408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 01/10/2023]
Abstract
Drug-induced long QT syndrome (diLQTS) is a clinical entity in which administration of a drug produces marked prolongation of the QT interval on the ECG. DiLQTS places a patient at risk of developing Torsades de Pointes (TdP), a malignant polymorphic ventricular tachycardia associated with arrhythmic sudden cardiac death (SCD). In addition to diLQTS, other clinical risk factors for TdP include female gender, bradycardia, electrolyte disturbances, recent conversion to normal (sinus) rhythm, and congenital LQTS.
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Affiliation(s)
- M D McCauley
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - D Darbar
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA.
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85
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Human Organotypic Cultured Cardiac Slices: New Platform For High Throughput Preclinical Human Trials. Sci Rep 2016; 6:28798. [PMID: 27356882 PMCID: PMC4928074 DOI: 10.1038/srep28798] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/10/2016] [Indexed: 12/11/2022] Open
Abstract
Translation of novel therapies from bench to bedside is hampered by profound disparities between animal and human genetics and physiology. The ability to test for efficacy and cardiotoxicity in a clinically relevant human model system would enable more rapid therapy development. We have developed a preclinical platform for validation of new therapies in human heart tissue using organotypic slices isolated from donor and end-stage failing hearts. A major advantage of the slices when compared with human iPS-derived cardiomyocytes is that native tissue architecture and extracellular matrix are preserved, thereby allowing investigation of multi-cellular physiology in normal or diseased myocardium. To validate this model, we used optical mapping of transmembrane potential and calcium transients. We found that normal human electrophysiology is preserved in slice preparations when compared with intact hearts, including slices obtained from the region of the sinus node. Physiology is maintained in slices during culture, enabling testing the acute and chronic effects of pharmacological, gene, cell, optogenetic, device, and other therapies. This methodology offers a powerful high-throughput platform for assessing the physiological response of the human heart to disease and novel putative therapies.
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86
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Abstract
Sotalol is effective for treating atrial fibrillation (AF), ventricular tachycardia, premature ventricular contractions, and supraventricular tachycardia. Racemic (DL) sotalol inhibits the rapid component of the delayed rectifier potassium current. There is a near linear relationship between sotalol dosage and QT interval prolongation. However, in dose ranging trials in patients with AF, low-dose sotalol was not more effective than placebo. Orally administered sotalol has a bioavailability of nearly 100%. The only significant drug interactions are the need to avoid or limit use of concomitant drugs that cause QT prolongation, bradycardia, and/or hypotension.
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Affiliation(s)
- John Alvin Kpaeyeh
- Division of Cardiology, Department of Medicine, Tourville Arrhythmia Center, Medical University of South Carolina, 114 Doughty Street, MSC 592, Charleston, SC 29425-5920, USA
| | - John Marcus Wharton
- Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Tourville Arrhythmia Center, Medical University of South Carolina, 114 Doughty Street, BM 216, MSC 592, Charleston, SC 29425-5920, USA.
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87
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Lancaster MC, Sobie EA. Improved Prediction of Drug-Induced Torsades de Pointes Through Simulations of Dynamics and Machine Learning Algorithms. Clin Pharmacol Ther 2016; 100:371-9. [PMID: 26950176 DOI: 10.1002/cpt.367] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/15/2016] [Accepted: 03/03/2016] [Indexed: 12/21/2022]
Abstract
The ventricular arrhythmia Torsades de Pointes (TdP) is a common form of drug-induced cardiotoxicity, but prediction of this arrhythmia remains an unresolved issue in drug development. Current assays to evaluate arrhythmia risk are limited by poor specificity and a lack of mechanistic insight. We addressed this important unresolved issue through a novel computational approach that combined simulations of drug effects on dynamics with statistical analysis and machine-learning. Drugs that blocked multiple ion channels were simulated in ventricular myocyte models, and metrics computed from the action potential and intracellular (Ca(2+) ) waveform were used to construct classifiers that distinguished between arrhythmogenic and nonarrhythmogenic drugs. We found that: (1) these classifiers provide superior risk prediction; (2) drug-induced changes to both the action potential and intracellular (Ca(2+) ) influence risk; and (3) cardiac ion channels not typically assessed may significantly affect risk. Our algorithm demonstrates the value of systematic simulations in predicting pharmacological toxicity.
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Affiliation(s)
- M Cummins Lancaster
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - E A Sobie
- Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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88
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Baczkó I, Jost N, Virág L, Bősze Z, Varró A. Rabbit models as tools for preclinical cardiac electrophysiological safety testing: Importance of repolarization reserve. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 121:157-68. [PMID: 27208697 DOI: 10.1016/j.pbiomolbio.2016.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/01/2016] [Indexed: 01/26/2023]
Abstract
It is essential to more reliably assess the pro-arrhythmic liability of compounds in development. Current guidelines for pre-clinical and clinical testing of drug candidates advocate the use of healthy animals/tissues and healthy individuals and focus on the test compound's ability to block the hERG current and prolong cardiac ventricular repolarization. Also, pre-clinical safety tests utilize several species commonly used in cardiac electrophysiological studies. In this review, important species differences in cardiac ventricular repolarizing ion currents are considered, followed by the discussion on electrical remodeling associated with chronic cardiovascular diseases that leads to altered ion channel and transporter expression and densities in pathological settings. We argue that the choice of species strongly influences experimental outcome and extrapolation of results to human clinical settings. We suggest that based on cardiac cellular electrophysiology, the rabbit is a useful species for pharmacological pro-arrhythmic investigations. In addition to healthy animals and tissues, the use of animal models (e.g. those with impaired repolarization reserve) is suggested that more closely resemble subsets of patients exhibiting increased vulnerability towards the development of ventricular arrhythmias and sudden cardiac death.
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Affiliation(s)
- István Baczkó
- Department of Pharmacology & Pharmacotherapy, University of Szeged, Dóm tér 12., 6720 Szeged, Hungary.
| | - Norbert Jost
- Department of Pharmacology & Pharmacotherapy, University of Szeged, Dóm tér 12., 6720 Szeged, Hungary; MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Dóm tér 12., 6720 Szeged, Hungary
| | - László Virág
- Department of Pharmacology & Pharmacotherapy, University of Szeged, Dóm tér 12., 6720 Szeged, Hungary
| | - Zsuzsanna Bősze
- Rabbit Genome and Biomodel Group, NARIC-Agricultural Biotechnology Institute, 2100 Gödöllő, Hungary
| | - András Varró
- Department of Pharmacology & Pharmacotherapy, University of Szeged, Dóm tér 12., 6720 Szeged, Hungary; MTA-SZTE Research Group of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Dóm tér 12., 6720 Szeged, Hungary
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89
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Windley MJ, Mann SA, Vandenberg JI, Hill AP. Temperature Effects on Kinetics of KV11.1 Drug Block Have Important Consequences for In Silico Proarrhythmic Risk Prediction. Mol Pharmacol 2016; 90:1-11. [PMID: 27190211 DOI: 10.1124/mol.115.103127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/11/2016] [Indexed: 01/08/2023] Open
Abstract
Drug block of voltage-gated potassium channel subtype 11.1 human ether-a-go-go related gene (Kv11.1) (hERG) channels, encoded by the KCNH2 gene, is associated with reduced repolarization of the cardiac action potential and is the predominant cause of acquired long QT syndrome that can lead to fatal cardiac arrhythmias. Current safety guidelines require that potency of KV11.1 block is assessed in the preclinical phase of drug development. However, not all drugs that block KV11.1 are proarrhythmic, meaning that screening on the basis of equilibrium measures of block can result in high attrition of potentially low-risk drugs. The basis of the next generation of drug-screening approaches is set to be in silico risk prediction, informed by in vitro mechanistic descriptions of drug binding, including measures of the kinetics of block. A critical issue in this regard is characterizing the temperature dependence of drug binding. Specifically, it is important to address whether kinetics relevant to physiologic temperatures can be inferred or extrapolated from in vitro data gathered at room temperature in high-throughout systems. Here we present the first complete study of the temperature-dependent kinetics of block and unblock of a proarrhythmic drug, cisapride, to KV11.1. Our data highlight a complexity to binding that manifests at higher temperatures and can be explained by accumulation of an intermediate, non-blocking encounter-complex. These results suggest that for cisapride, physiologically relevant kinetic parameters cannot be simply extrapolated from those measured at lower temperatures; rather, data gathered at physiologic temperatures should be used to constrain in silico models that may be used for proarrhythmic risk prediction.
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Affiliation(s)
- Monique J Windley
- Computational Cardiology, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.J.W., S.A.M., J.I.V., A.P.H.); and St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia (S.A.M., J.I.V., A.P.H.)
| | - Stefan A Mann
- Computational Cardiology, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.J.W., S.A.M., J.I.V., A.P.H.); and St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia (S.A.M., J.I.V., A.P.H.)
| | - Jamie I Vandenberg
- Computational Cardiology, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.J.W., S.A.M., J.I.V., A.P.H.); and St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia (S.A.M., J.I.V., A.P.H.)
| | - Adam P Hill
- Computational Cardiology, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.J.W., S.A.M., J.I.V., A.P.H.); and St. Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia (S.A.M., J.I.V., A.P.H.)
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90
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Klimas A, Ambrosi CM, Yu J, Williams JC, Bien H, Entcheva E. OptoDyCE as an automated system for high-throughput all-optical dynamic cardiac electrophysiology. Nat Commun 2016; 7:11542. [PMID: 27161419 PMCID: PMC4866323 DOI: 10.1038/ncomms11542] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/05/2016] [Indexed: 01/11/2023] Open
Abstract
The improvement of preclinical cardiotoxicity testing, discovery of new ion-channel-targeted drugs, and phenotyping and use of stem cell-derived cardiomyocytes and other biologics all necessitate high-throughput (HT), cellular-level electrophysiological interrogation tools. Optical techniques for actuation and sensing provide instant parallelism, enabling contactless dynamic HT testing of cells and small-tissue constructs, not affordable by other means. Here we show, computationally and experimentally, the limits of all-optical electrophysiology when applied to drug testing, then implement and validate OptoDyCE, a fully automated system for all-optical cardiac electrophysiology. We validate optical actuation by virally introducing optogenetic drivers in rat and human cardiomyocytes or through the modular use of dedicated light-sensitive somatic ‘spark' cells. We show that this automated all-optical approach provides HT means of cellular interrogation, that is, allows for dynamic testing of >600 multicellular samples or compounds per hour, and yields high-content information about the action of a drug over time, space and doses. The efficiency of preclinical drug testing and characterization of cellular function can be improved through the use of optogenetic tools. Here Klimas et al. present and validate OptoDyCE, a fully automated system for all-optical high-throughput cardiac electrophysiology.
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Affiliation(s)
- Aleksandra Klimas
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Christina M Ambrosi
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Jinzhu Yu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - John C Williams
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Harold Bien
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Emilia Entcheva
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
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91
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Hou JW, Li W, Guo K, Chen XM, Chen YH, Li CY, Zhao BC, Zhao J, Wang H, Wang YP, Li YG. Antiarrhythmic effects and potential mechanism of WenXin KeLi in cardiac Purkinje cells. Heart Rhythm 2016; 13:973-82. [DOI: 10.1016/j.hrthm.2015.12.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 10/22/2022]
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92
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α1-Syntrophin Variant Identified in Drug-Induced Long QT Syndrome Increases Late Sodium Current. PLoS One 2016; 11:e0152355. [PMID: 27028743 PMCID: PMC4814026 DOI: 10.1371/journal.pone.0152355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/14/2016] [Indexed: 12/19/2022] Open
Abstract
Drug-induced long-QT syndrome (diLQTS) is often due to drug block of IKr, especially in genetically susceptible patients with subclinical mutations in the IKr-encoding KCHN2. Few variants in the cardiac NaV1.5 Na+ channel complex have been associated with diLQTS. We tested whether a novel SNTA1 (α1-syntrophin) variant (p.E409Q) found in a patient with diLQTS increases late sodium current (INa-L), thereby providing a disease mechanism. Electrophysiological studies were performed in HEK293T cells co-expressing human NaV1.5/nNOS/PMCA4b with either wild type (WT) or SNTA1 variants (A390V-previously reported in congenital LQTS; and E409Q); and in adult rat ventricular cardiomyocytes infected with SNTA1 expressing adenoviruses (WT or one of the two SNTA1 variants). In HEK293T cells and in cardiomyocytes, there was no significant difference in the peak INa densities among the SNTA1 WT and variants. However, both variants increased INa-L (% of peak current) in HEK293T cells (0.58±0.10 in WT vs. 0.90±0.11 in A390V, p = 0.048; vs. 0.88±0.07 in E409Q, p = 0.023). In cardiomyocytes, INa-L was significantly increased by E409Q, but not by A390V compared to WT (0.49±0.14 in WT vs.0.94±0.23 in A390V, p = 0.099; vs. 1.12±0.24 in E409Q, p = 0.019). We demonstrated that a novel SNTA1 variant is likely causative for diLQTS by augmenting INa-L. These data suggest that variants within the NaV1.5-interacting α1-syntrophin are a potential mechanism for diLQTS, thereby expanding the concept that variants within congenital LQTS loci can cause diLQTS.
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93
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McCauley M, Vallabhajosyula S, Darbar D. Proarrhythmic and Torsadogenic Effects of Potassium Channel Blockers in Patients. Card Electrophysiol Clin 2016; 8:481-93. [PMID: 27261836 DOI: 10.1016/j.ccep.2016.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The most common arrhythmia requiring drug treatment is atrial fibrillation (AF), which affects 2 to 5 million Americans and continues to be a major cause of morbidity and increased mortality. Despite recent advances in catheter-based and surgical therapies, antiarrhythmic drugs continue to be the mainstay of therapy for most patients with symptomatic AF. However, many antiarrhythmics block the rapid component of the cardiac delayed rectifier potassium current (IKr) as a major mechanism of action, and marked QT prolongation and pause-dependent polymorphic ventricular tachycardia (torsades de pointes) are major class toxicities.
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Affiliation(s)
- Mark McCauley
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood Street, Suite 920 (MC715), Chicago, IL 60612, USA
| | - Sharath Vallabhajosyula
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood Street, Suite 920 (MC715), Chicago, IL 60612, USA
| | - Dawood Darbar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood Street, Suite 920 (MC715), Chicago, IL 60612, USA.
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94
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Kim JG, Sung DJ, Kim HJ, Park SW, Won KJ, Kim B, Shin HC, Kim KS, Leem CH, Zhang YH, Cho H, Bae YM. Impaired Inactivation of L-Type Ca2+ Current as a Potential Mechanism for Variable Arrhythmogenic Liability of HERG K+ Channel Blocking Drugs. PLoS One 2016; 11:e0149198. [PMID: 26930604 PMCID: PMC4772914 DOI: 10.1371/journal.pone.0149198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/28/2016] [Indexed: 01/06/2023] Open
Abstract
The proarrhythmic effects of new drugs have been assessed by measuring rapidly activating delayed-rectifier K+ current (IKr) antagonist potency. However, recent data suggest that even drugs thought to be highly specific IKr blockers can be arrhythmogenic via a separate, time-dependent pathway such as late Na+ current augmentation. Here, we report a mechanism for a quinolone antibiotic, sparfloxacin-induced action potential duration (APD) prolongation that involves increase in late L-type Ca2+ current (ICaL) caused by a decrease in Ca2+-dependent inactivation (CDI). Acute exposure to sparfloxacin, an IKr blocker with prolongation of QT interval and torsades de pointes (TdP) produced a significant APD prolongation in rat ventricular myocytes, which lack IKr due to E4031 pretreatment. Sparfloxacin reduced peak ICaL but increased late ICaL by slowing its inactivation. In contrast, ketoconazole, an IKr blocker without prolongation of QT interval and TdP produced reduction of both peak and late ICaL, suggesting the role of increased late ICaL in arrhythmogenic effect. Further analysis showed that sparfloxacin reduced CDI. Consistently, replacement of extracellular Ca2+ with Ba2+ abolished the sparfloxacin effects on ICaL. In addition, sparfloxacin modulated ICaL in a use-dependent manner. Cardiomyocytes from adult mouse, which is lack of native IKr, demonstrated similar increase in late ICaL and afterdepolarizations. The present findings show that sparfloxacin can prolong APD by augmenting late ICaL. Thus, drugs that cause delayed ICaL inactivation and IKr blockage may have more adverse effects than those that selectively block IKr. This mechanism may explain the reason for discrepancies between clinically reported proarrhythmic effects and IKr antagonist potencies.
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Affiliation(s)
- Jae Gon Kim
- Department of Physiology and the Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, South Korea
- Next-Generation Pharmaceutical Research Center, Korea Institute of Toxicology, Korea Research Institute of Chemical Technology, Daejeon, South Korea
| | - Dong Jun Sung
- Division of Sport Science, College of Science and Technology, Konkuk University, Choongju, South Korea
| | - Hyun-ji Kim
- Department of Physiology and the Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Sang Woong Park
- Department of Physiology, KU Open Innovation Center, Research Institute of Medical Science, Konkuk University School of Medicine, Chungju, South Korea
| | - Kyung Jong Won
- Department of Physiology, KU Open Innovation Center, Research Institute of Medical Science, Konkuk University School of Medicine, Chungju, South Korea
| | - Bokyung Kim
- Department of Physiology, KU Open Innovation Center, Research Institute of Medical Science, Konkuk University School of Medicine, Chungju, South Korea
| | - Ho Chul Shin
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Ki-Suk Kim
- Next-Generation Pharmaceutical Research Center, Korea Institute of Toxicology, Korea Research Institute of Chemical Technology, Daejeon, South Korea
- Human and Environmental Toxicology Program, University of Science and Technology, Daejeon, South Korea
| | - Chae Hun Leem
- Department of Physiology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yin Hua Zhang
- Department of Physiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hana Cho
- Department of Physiology and the Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, South Korea
- * E-mail: ;
| | - Young Min Bae
- Department of Physiology, KU Open Innovation Center, Research Institute of Medical Science, Konkuk University School of Medicine, Chungju, South Korea
- * E-mail: ;
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96
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Johannesen L, Vicente J, Mason JW, Erato C, Sanabria C, Waite-Labott K, Hong M, Lin J, Guo P, Mutlib A, Wang J, Crumb WJ, Blinova K, Chan D, Stohlman J, Florian J, Ugander M, Stockbridge N, Strauss DG. Late sodium current block for drug-induced long QT syndrome: Results from a prospective clinical trial. Clin Pharmacol Ther 2016; 99:214-23. [PMID: 26259627 PMCID: PMC5421403 DOI: 10.1002/cpt.205] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/05/2015] [Indexed: 12/19/2022]
Abstract
Drug-induced long QT syndrome has resulted in many drugs being withdrawn from the market. At the same time, the current regulatory paradigm for screening new drugs causing long QT syndrome is preventing drugs from reaching the market, sometimes inappropriately. In this study, we report the results of a first-of-a-kind clinical trial studying late sodium (mexiletine and lidocaine) and calcium (diltiazem) current blocking drugs to counteract the effects of hERG potassium channel blocking drugs (dofetilide and moxifloxacin). We demonstrate that both mexiletine and lidocaine substantially reduce heart-rate corrected QT (QTc) prolongation from dofetilide by 20 ms. Furthermore, all QTc shortening occurs in the heart-rate corrected J-Tpeak (J-Tpeak c) interval, the biomarker we identified as a sign of late sodium current block. This clinical trial demonstrates that late sodium blocking drugs can substantially reduce QTc prolongation from hERG potassium channel block and assessment of J-Tpeak c may add value beyond only assessing QTc.
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Affiliation(s)
- L Johannesen
- Center for Devices and Radiological Health, US Food and Drug Administration,
Silver Spring, Maryland, USA
- Department of Clinical Physiology, Karolinska Institutet and Karolinska
University Hospital, Stockholm, Sweden
| | - J Vicente
- Center for Devices and Radiological Health, US Food and Drug Administration,
Silver Spring, Maryland, USA
- Center for Drug Evaluation and Research, US Food and Drug Administration,
Silver Spring, Maryland, USA
- BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS
Aragón, University of Zaragoza, Zaragoza, Spain
| | - JW Mason
- Spaulding Clinical, West Bend, Wisconsin, USA
- University of Utah, Salt Lake City, Utah, USA
| | - C Erato
- Spaulding Clinical, West Bend, Wisconsin, USA
| | - C Sanabria
- Spaulding Clinical, West Bend, Wisconsin, USA
| | | | - M Hong
- Frontage Laboratories, Exton, Pennsylvania, USA
| | - J Lin
- Frontage Laboratories, Exton, Pennsylvania, USA
| | - P Guo
- Frontage Laboratories, Exton, Pennsylvania, USA
| | - A Mutlib
- Frontage Laboratories, Exton, Pennsylvania, USA
| | - J Wang
- Frontage Laboratories, Exton, Pennsylvania, USA
| | - WJ Crumb
- Zenas Technologies, Metairie, Louisiana, USA
| | - K Blinova
- Center for Devices and Radiological Health, US Food and Drug Administration,
Silver Spring, Maryland, USA
| | - D Chan
- Center for Devices and Radiological Health, US Food and Drug Administration,
Silver Spring, Maryland, USA
| | - J Stohlman
- Center for Devices and Radiological Health, US Food and Drug Administration,
Silver Spring, Maryland, USA
| | - J Florian
- Center for Drug Evaluation and Research, US Food and Drug Administration,
Silver Spring, Maryland, USA
| | - M Ugander
- Center for Devices and Radiological Health, US Food and Drug Administration,
Silver Spring, Maryland, USA
- Department of Clinical Physiology, Karolinska Institutet and Karolinska
University Hospital, Stockholm, Sweden
| | - N Stockbridge
- Center for Drug Evaluation and Research, US Food and Drug Administration,
Silver Spring, Maryland, USA
| | - DG Strauss
- Center for Devices and Radiological Health, US Food and Drug Administration,
Silver Spring, Maryland, USA
- Department of Clinical Physiology, Karolinska Institutet and Karolinska
University Hospital, Stockholm, Sweden
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97
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Roden DM. Predicting drug-induced QT prolongation and torsades de pointes. J Physiol 2016; 594:2459-68. [PMID: 26660066 DOI: 10.1113/jp270526] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/03/2015] [Indexed: 12/16/2022] Open
Abstract
Drugs used to treat cardiovascular disease as well as those used in the treatment of multiple other conditions can occasionally produce exaggerated prolongation of the QT interval on the electrocardiogram and the morphologically distinctive polymorphic ventricular tachycardia ('torsades de pointes'). This syndrome of drug-induced long QT syndrome has moved from an interesting academic exercise to become a key element in the development of any new drug entity. The prevailing view, which has driven both clinical care and drug regulation, holds that cardiac repolarization represents a balance between inward currents (primarily through calcium and sodium channels) and outward currents (primarily through rapid and slowed delayed rectifier potassium channels) and that block of the rapid delayed rectifier (IKr ) is the primary mechanism whereby drugs prolong individual action potentials, manifest on the surface electrocardiogram as QT interval prolongation. Such marked action potential prolongation in individual cardiac cells, in turn, is accompanied by arrhythmogenic afterdepolarizations thought to trigger torsades de pointes. This review describes the evidence in support of this construct, and describes the way in which clinical and whole heart experiments have informed molecular mechanisms and vice versa. New data that challenge these views and that may, as a result, lead to new clinical care and drug screening paradigms, are discussed.
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Affiliation(s)
- Dan M Roden
- Vanderbilt University, Nashville, TN, 37232, USA
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98
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Liu J, Laksman Z, Backx PH. The electrophysiological development of cardiomyocytes. Adv Drug Deliv Rev 2016; 96:253-73. [PMID: 26788696 DOI: 10.1016/j.addr.2015.12.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/23/2015] [Accepted: 12/31/2015] [Indexed: 02/07/2023]
Abstract
The generation of human cardiomyocytes (CMs) from human pluripotent stem cells (hPSCs) has become an important resource for modeling human cardiac disease and for drug screening, and also holds significant potential for cardiac regeneration. Many challenges remain to be overcome however, before innovation in this field can translate into a change in the morbidity and mortality associated with heart disease. Of particular importance for the future application of this technology is an improved understanding of the electrophysiologic characteristics of CMs, so that better protocols can be developed and optimized for generating hPSC-CMs. Many different cell culture protocols are currently utilized to generate CMs from hPSCs and all appear to yield relatively “developmentally” immature CMs with highly heterogeneous electrical properties. These hPSC-CMs are characterized by spontaneous beating at highly variable rates with a broad range of depolarization-repolarization patterns, suggestive of mixed populations containing atrial, ventricular and nodal cells. Many recent studies have attempted to introduce approaches to promote maturation and to create cells with specific functional properties. In this review, we summarize the studies in which the electrical properties of CMs derived from stem cells have been examined. In order to place this information in a useful context, we also review the electrical properties of CMs as they transition from the developing embryo to the adult human heart. The signal pathways involved in the regulation of ion channel expression during development are also briefly considered.
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99
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Champeroux P, Le Guennec JY, Jude S, Laigot C, Maurin A, Sola ML, Fowler JSL, Richard S, Thireau J. The high frequency relationship: implications for torsadogenic hERG blockers. Br J Pharmacol 2016; 173:601-12. [PMID: 26589499 DOI: 10.1111/bph.13391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 11/11/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Ventricular arrhythmias induced by human ether-a-go-go related gene (hERG; Kv 11.1 channel) blockers are a consequence of alterations in ventricular repolarisation in association with high-frequency (HF) oscillations, which act as a primary trigger; the autonomic nervous system plays a modulatory role. In the present study, we investigated the role of β1 -adrenoceptors in the HF relationship between magnitude of heart rate and QT interval changes within discrete 10 s intervals (sorted into 5 bpm heart rate increments) and its implications for torsadogenic hERG blockers. EXPERIMENTAL APPROACH The HF relationship was studied under conditions of autonomic blockade with atenolol (β1 -adrenoceptor blocker) in the absence or presence of five hERG blockers in beagle dogs. In total, the effects of 14 hERG blockers on the HF relationship were investigated. KEY RESULTS All the torsadogenic hERG blockers tested caused a vertical shift in the HF relationship, while hERG blockers associated with a low risk of Torsades de Pointes did not cause any vertical shift. Atenolol completely prevented the effects four torsadogenic agents (quinidine, thioridazine, risperidone and terfenadine) on the HF relationship, but only partially reduced those of dofetilide, leading to the characterization of two types of torsadogenic agent. CONCLUSIONS AND IMPLICATIONS Analysis of the vertical shift in the HF relationship demonstrated that signs of transient sympathetic activation during HF oscillations in the presence of torsadogenic hERG blockers are mediated by β1 -adrenoceptors. We suggest the HF relationship as a new biomarker for assessing Torsades de pointes liability, with potential implications in both preclinical studies and the clinic.
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Affiliation(s)
- P Champeroux
- Centre de Recherches Biologiques, CERB, Chemin de Montifault, 18800, Baugy, France
| | - J Y Le Guennec
- Laboratoire PHYMEDEXP, Physiologie et Médecine Expérimentale, Cœur et Muscles, INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, 371 Avenue du doyen G. Giraud, 34295, Montpellier cedex 05, France
| | - S Jude
- Centre de Recherches Biologiques, CERB, Chemin de Montifault, 18800, Baugy, France
| | - C Laigot
- Centre de Recherches Biologiques, CERB, Chemin de Montifault, 18800, Baugy, France
| | - A Maurin
- Centre de Recherches Biologiques, CERB, Chemin de Montifault, 18800, Baugy, France
| | - M L Sola
- Centre de Recherches Biologiques, CERB, Chemin de Montifault, 18800, Baugy, France
| | - J S L Fowler
- Centre de Recherches Biologiques, CERB, Chemin de Montifault, 18800, Baugy, France
| | - S Richard
- Centre de Recherches Biologiques, CERB, Chemin de Montifault, 18800, Baugy, France
| | - J Thireau
- Laboratoire PHYMEDEXP, Physiologie et Médecine Expérimentale, Cœur et Muscles, INSERM U1046, CNRS UMR 9214, Université de Montpellier, CHU Arnaud de Villeneuve, 371 Avenue du doyen G. Giraud, 34295, Montpellier cedex 05, France
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100
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Barth AS, Kumordzie A, Tomaselli GF. Orchestrated regulation of energy supply and energy expenditure: Transcriptional coexpression of metabolism, ion homeostasis, and sarcomeric genes in mammalian myocardium. Heart Rhythm 2016; 13:1131-1139. [PMID: 26776558 DOI: 10.1016/j.hrthm.2016.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND During the development of heart failure, the myocardium undergoes profound electrical remodeling, characterized by prolongation of action potential duration, changes in Ca(2+) homeostasis, and slowing of conduction. OBJECTIVE We tested the hypothesis that the electrical remodeling, indexed by the expression of ion channel and transporter genes, occurs in the context of a coordinated regulation of metabolism and signaling processes observed in heart failure. METHODS A meta-analysis of myocardial murine and human microarray data sets was performed. RESULTS We identified transcripts that were coordinately expressed with 132 myocardial ion channel and transporter genes in 18 murine and human myocardial microarray data sets. The genes coexpressed with ion channels were subsequently grouped into Gene Ontology (GO) categories, revealing 4 major, mutually exclusive GO clusters: 55 ion channel and transporter genes were coexpressed with major bioenergetic pathways (oxidative phosphorylation, citric acid cycle, glycolysis, and fatty acid metabolism) and contractile processes (muscle contraction, sarcomere, and Z disc), while 36, 16, and 25 ion channel transcripts were associated with the GO clusters of signal transduction, transcription/translation, and a nonspecified cluster, respectively. Myocardial expression of ion channel genes coexpressed with metabolic processes was >10-fold higher than that of ion channels associated with the other 3 clusters. In addition to transcriptional coexpression, major myocardial ion channels were found to physically interact with metabolic pathways based on protein-protein interaction data. CONCLUSION Electromechanical and metabolic remodeling processes are intricately linked at the transcriptional level, suggesting an orchestrated regulation of energy supply (metabolism) and energy expenditure (muscle contraction and ion homeostasis) in mammalian myocardium.
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Affiliation(s)
- Andreas S Barth
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Ami Kumordzie
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Gordon F Tomaselli
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
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