Effects of acetylcholine on time-dependent currents in sheep cardiac Purkinje fibers

Acetylcholine Reduces L-Type Calcium Current without Major Changes in Repolarization of Canine and Human Purkinje and Ventricular Tissue

Vagal nerve stimulation (VNS) holds a strong basis as a potentially effective treatment modality for chronic heart failure, which explains why a multicenter VNS study in heart failure with reduced ejection fraction is ongoing. However, more detailed information is required on the effect of acetylcholine (ACh) on repolarization in Purkinje and ventricular cardiac preparations to identify the advantages, risks, and underlying cellular mechanisms of VNS. Here, we studied the effect of ACh on the action potential (AP) of canine Purkinje fibers (PFs) and several human ventricular preparations. In addition, we characterized the effects of ACh on the L-type Ca²⁺ current (I_CaL) and AP of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and performed computer simulations to explain the observed effects. Using microelectrode recordings, we found a small but significant AP prolongation in canine PFs. In the human myocardium, ACh slightly prolonged the AP in the midmyocardium but resulted in minor AP shortening in subepicardial tissue. Perforated patch-clamp experiments on hiPSC-CMs demonstrated that 5 µM ACh caused an ≈15% decrease in I_CaL density without changes in gating properties. Using dynamic clamp, we found that under blocked K⁺ currents, 5 µM ACh resulted in an ≈23% decrease in AP duration at 90% of repolarization in hiPSC-CMs. Computer simulations using the O'Hara-Rudy human ventricular cell model revealed that the overall effect of ACh on AP duration is a tight interplay between the ACh-induced reduction in I_CaL and ACh-induced changes in K⁺ currents. In conclusion, ACh results in minor changes in AP repolarization and duration of canine PFs and human ventricular myocardium due to the concomitant inhibition of inward I_CaL and outward K⁺ currents, which limits changes in net repolarizing current and thus prevents major changes in AP repolarization.

Isolation and characterization of embryonic stem cell-derived cardiac Purkinje cells

The cardiac Purkinje fiber network is composed of highly specialized cardiomyocytes responsible for the synchronous excitation and contraction of the ventricles. Computational modeling, experimental animal studies, and intracardiac electrical recordings from patients with heritable and acquired forms of heart disease suggest that Purkinje cells (PCs) may also serve as critical triggers of life-threatening arrhythmias. Nonetheless, owing to the difficulty in isolating and studying this rare population of cells, the precise role of PC in arrhythmogenesis and the underlying molecular mechanisms responsible for their proarrhythmic behavior are not fully characterized. Conceptually, a stem cell-based model system might facilitate studies of PC-dependent arrhythmia mechanisms and serve as a platform to test novel therapeutics. Here, we describe the generation of murine embryonic stem cells (ESC) harboring pan-cardiomyocyte and PC-specific reporter genes. We demonstrate that the dual reporter gene strategy may be used to identify and isolate the rare ESC-derived PC (ESC-PC) from a mixed population of cardiogenic cells. ESC-PC display transcriptional signatures and functional properties, including action potentials, intracellular calcium cycling, and chronotropic behavior comparable to endogenous PC. Our results suggest that stem-cell derived PC are a feasible new platform for studies of developmental biology, disease pathogenesis, and screening for novel antiarrhythmic therapies.

Tissue-specific effects of acetylcholine in the canine heart

Acetylcholine (ACh) release from the vagus nerve slows heart rate and atrioventricular conduction. ACh stimulates a variety of receptors and channels, including an inward rectifying current [ACh-dependent K⁺ current (IK,ACh)]. The effect of ACh in the ventricle is still debated. We compared the effect of ACh on action potentials in canine atria, Purkinje, and ventricular tissue as well as on ionic currents in isolated cells. Action potentials were recorded from ventricular slices, Purkinje fibers, and arterially perfused atrial preparations. Whole cell currents were recorded under voltage-clamp conditions, and unloaded cell shortening was determined on isolated cells. The effect of ACh (1-10 μM) as well as ACh plus tertiapin, an IK,ACh-specific toxin, was tested. In atrial tissue, ACh hyperpolarized the membrane potential and shortened the action potential duration (APD). In Purkinje and ventricular tissues, no significant effect of ACh was observed. Addition of ACh to atrial cells activated a large inward rectifying current (from -3.5 ± 0.7 to -23.7 ± 4.7 pA/pF) that was abolished by tertiapin. This current was not observed in other cell types. A small inhibition of Ca²⁺ current (ICa) was observed in the atria, endocardium, and epicardium after ACh. ICa inhibition increased at faster pacing rates. At a basic cycle length of 400 ms, ACh (1 μM) reduced ICa to 68% of control. In conclusion, IK,ACh is highly expressed in atria and is negligible/absent in Purkinje, endocardial, and epicardial cells. In all cardiac tissues, ACh caused rate-dependent inhibition of ICa.

Muscarinic receptors in the mammalian heart

In the mammalian heart, cardiac function is under the control of the sympathetic and parasympathetic nervous system. All regions of the mammalian heart are innervated by parasympathetic (vagal) nerves, although the supraventricular tissues are more densely innervated than the ventricles. Vagal activation causes stimulation of cardiac muscarinic acetylcholine receptors (M-ChR) that modulate pacemaker activity via I(f) and I(K.ACh), atrioventricular conduction, and directly (in atrium) or indirectly (in ventricles) force of contraction. However, the functional response elicited by M-ChR-activation depends on species, age, anatomic structure investigated, and M-ChR-agonist concentration used. Among the five M-ChR-subtypes M(2)-ChR is the predominant isoform present in the mammalian heart, while in the coronary circulation M(3)-ChR have been identified. In addition, evidence for a possible existence of an additional, not M(2)-ChR in the heart has been presented. M-ChR are subject to regulation by G-protein-coupled-receptor kinase. Alterations of cardiac M(2)-ChR in age and various kinds of disease are discussed.

Hyperpolarization-activated inward current in ventricular myocytes from normal and failing human hearts

BACKGROUND

The hyperpolarization-activated inward current (I[f]) was found to be overexpressed in hypertrophied rat ventricular myocytes, indicating that I(f) might favor arrhythmias in hypertrophied or failing ventricular myocardium. In the present study, we evaluated whether I(f) is expressed in human ventricular myocardium, if it may be increased in human heart failure, and if its autonomic modulation may be altered.

METHODS AND RESULTS

The whole-cell patch-clamp technique was used to record I(f) in isolated ventricular myocytes from 34 failing (dilated [DCM] or ischemic [ICM] cardiomyopathy) and 13 donor hearts (NF). I(f) was observed in all myocytes showing typical current properties, ie, time and voltage dependence, block by [Cs+]o, permeability for K+ and Na+, and current increase with raising [K+]o. There was a trend toward larger current densities in myopathic (at -130 mV in [K+]o 25 mmol/L; DCM: -1.37 +/- 0.12 pA/pF, n = 50; ICM: -1.39 +/- 0.24 pA/pF, n = 30) than in nonfailing cells (-1.18 +/- 0.21 pA/pF, n = 24), although this difference did not reach statistical significance (P=.23). Boltzmann distributions yielded an activation threshold of -80 mV and half-maximal activation at -110.96 +/- 0.06 mV in myopathic and normal myocytes. Isoproterenol (10(-5) mol/L) shifted the current activation by 10 mV (31 myopathic, 5 NF). Carbachol and adenosine had no direct effect on I(f) (6 and 12 myopathic, 3 and 3 NF, respectively) but reversibly antagonized beta-adrenergic stimulation (5 and 7 myopathic, 2 and 2 NF, respectively). Autonomic modulation was similar in failing and nonfailing cells.

CONCLUSIONS

In end-stage heart failure, no significant change of I(f) could be found, although there was a trend toward increased I(f). Together with an elevated plasma norepinephrine concentration and a previously reported reduction in I(K1) in human heart failure, I(f) might favor diastolic depolarization in individual myopathic cells.

Mechanism of acetylcholine action on pacemaker current (i(f)) in canine Purkinje fibers

We have recently reported in canine Purkinje fibers that acetylcholine (ACh) can reverse the positive voltage shift of the pacemaker current (i(f)) induced by beta-adrenergic stimulation while having no direct action of its own. We have now investigated this effect of ACh on the cyclic adenosine monophosphate (cAMP) cascade in more detail. We find that addition of a membrane permeable analogue of cAMP (8-chlorophenylthio cAMP), 0.5-1 mM, increased the amplitude of i(f). This action was not reversed by 1 microM ACh, implying that ACh acts at a step prior to cAMP action. We then looked at the steps controlling intracellular concentration of cAMP. Inhibiting the phosphodiesterase with 100 microM isobutyl-1-methylxanthine (IBMX) increased i(f). This action, however, was reversed by ACh. Finally we investigated whether the action of forskolin, a direct activator of adenylyl cyclase, could be reversed by ACh. Forskolin (10-20 microM) increased i(f), and ACh at 1 microM partially reversed this action of forskolin. These results suggest that, in canine Purkinje fibers, ACh reverses the positive action of beta-adrenergic agents on i(f) via a decrease in cAMP production.

Acetylcholine reverses effects of beta-agonists on pacemaker current in canine cardiac Purkinje fibers but has no direct action. A difference between primary and secondary pacemakers

We have investigated the actions of acetylcholine in the absence and presence of the beta-agonist isoproterenol in cardiac Purkinje fibers. beta-Agonists, like isoproterenol, increase the magnitude of the pacemaker current (If) in cardiac myocytes by shifting its activation voltage more positive on the voltage axis. We find that acetylcholine has no effect on If in the absence of isoproterenol. However, if If is first increased by beta-agonist stimulation, acetylcholine can then return If to control levels. This effect on If is exerted through muscarinic receptors since atropine prevents this action of acetylcholine. Functionally, this action of acetylcholine can guarantee the maintenance of ventricular pacemakers when there is high parasympathetic tone but can also prevent extra ventricular beats when sympathetic and parasympathetic tone are both high.

Muscarinic control of the hyperpolarization-activated current (if) in rabbit sino-atrial node myocytes

1. The mechanism by which acetylcholine (ACh), by stimulation of muscarinic receptors, acts to inhibit activation of the hyperpolarization-activated 'pacemaker' current, if was investigated in isolated rabbit sino-atrial (SA) node myocytes. 2. Intracellular loading with GTP gamma S, a non-hydrolysable analogue of GTP, did not impair the ACh action on if, but made it irreversible. On the other hand, the ACh action on if disappeared after a few minutes of cell loading with GDP beta S, a GDP analogue known to bind to G-proteins and prevent their receptor-stimulated action. Furthermore, incubation of cells in a solution containing pertussis toxin (PTX) led to abolition of the if response to ACh. These results indicate that the inhibitory effect of ACh on if is mediated by G-proteins activated by muscarinic receptors. 3. Intracellular loading with phosphodiesterase (PDE) increased the rate of if current run-down, but did not abolish the inhibitory action of ACh on if. 4. Extracellular perfusion with isobutylmethylxanthine (IBMX), a PDE inhibitor, increased if activation by shifting the current activation range to more positive voltages, as inferred by a three-pulse protocol analysis; in the presence of IBMX, the inhibition of if by ACh was not abolished. 5. The ACh-induced if depression persisted also in cells loaded with cyclic GMP. In these cells, as in those loaded with PDE, the if run-down was fast. 6. Oxotremorine, a muscarinic agonist coupled to adenylate cyclase but not to phosphoinositide turnover in cardiac cells, simulated ACh in its inhibitory action on if. The above results rule against the ACh action being mediated by PDE or by phosphoinositide turnover. 7. To investigate the possible involvement of cyclic AMP as a second messenger in the ACh action on if, we loaded cells with cyclic AMP and IBMX; under these conditions the action of ACh disappeared within a few minutes of whole-cell recording. 8. In cells where the slow inward Ca2+ current (isi) was measured together with if, ACh was seen to depress both currents. 9. In cells superfused with forskolin, the if amplitude on stepping to the half-activation voltage range was enhanced as a consequence of a depolarizing shift of the activation curve; ACh was not effective on if following stimulation by forskolin, but strongly depressed in the same cell the if current stimulated to a similar degree by isoprenaline.(ABSTRACT TRUNCATED AT 400 WORDS)

Inhibition of the hyperpolarization-activated current (if) induced by acetylcholine in rabbit sino-atrial node myocytes

1. The action of acetylcholine (ACh) on the hyperpolarization-activated ('pacemaker') current if was studied in single myocytes from the sino-atrial (SA) node region of the rabbit heart, where low doses of ACh slow spontaneous activity by prolonging the diastolic depolarization phase. 2. Besides activating an outward component at voltages positive to the K+ equilibrium potential (iK,ACh), ACh depressed the current if activated on hyperpolarization at concentrations in the range 0.03-1 microM. 3. The ACh-dependent if depression was dissected from modifications of iK,ACh by blocking iK,ACh with barium and was studied under conditions that minimized the interference of other current changes caused by ACh. 4. The study of if modification by ACh with three-pulse protocols and the measurement of fully activated I-V relations of if with and without ACh revealed that ACh acted on if by shifting the current activation range to more negative voltages, with no obvious alteration of the fully activated current amplitude. 5. The action of ACh on if was opposite to that caused by catecholamines. The presence of isoprenaline (IP) did not prevent ACh inhibition of if, nor did the presence of ACh prevent the if stimulation caused by IP. The effects of IP and ACh on if were additive. 6. The ACh-induced inhibition of if was reversed by addition of atropine and could be mimicked by muscarine, indicating that muscarinic receptors mediate it. The implications of these findings on the regulation of pacemaker activity by ACh is discussed.

Channel-mediated calcium current in the heart

Calcium ions play an important role in the regulation of heart functions. Calcium ions may enter or leave the myocardial cell through various mechanisms, including several exchange mechanisms and pumps. This review concentrates on the influx of calcium ions through channels in the sarcolemma, resulting in an electric current flow. The calcium current plays an important role in the maintenance of the action potential duration, in the generation of pacemaker activity, and in the initiation of contraction. The calcium current displays both activation and a subsequent inactivation when the membrane potential is changed in a stepwise fashion. Previously, the activation was thought to occur rather slowly, hence the name "slow inward current." Recent evidence suggests that the calcium current occurs much faster and that two types of calcium currents might exist, differing in their selectivity to other ions and in their sensitivity to membrane potential and to drugs. The calcium current is modulated by several factors. Beta-adrenergic stimulation increases the calcium current by increasing the opening probability of the calcium channel. The effects of acetylcholine are less well described. There also exists a class of drugs, called calcium channel blockers (or calcium antagonists) that decrease the flow of calcium ions through calcium channels. It is not quite clear how the calcium current is changed during myocardial ischemia. Factors that may reduce the calcium current during ischemia are the increased extracellular potassium concentration, metabolic inhibition and a decreased ATP level, and acidosis. Raised levels of intracellular cAMP, however, should lead to an increased calcium current.

Currents through ionic channels in multicellular cardiac tissue and single heart cells

Ionic channels are elementary excitable elements in the cell membranes of heart and other tissues. They produce and transduce electrical signals. After decades of trouble with quantitative interpretation of voltage-clamp data from multicellular heart tissue, due to its morphological complexness and methodological limitations, cardiac electrophysiologists have developed new techniques for better control of membrane potential and of the ionic and metabolic environment on both sides of the plasma membrane, by the use of single heart cells. Direct recordings of the behavior of single ionic channels have become possible by using the patch-clamp technique, which was developed simultaneously. Biochemists have made excellent progress in purifying and characterizing ionic channel proteins, and there has been initial success in reconstituting some partially purified channels into lipid bilayers, where their function can be studied.

Changes by acetylcholine of membrane currents in rabbit cardiac Purkinje fibres

The ionic mechanisms underlying the effects of acetylcholine (ACh) on electrophysiological properties of rabbit cardiac Purkinje fibres have been analysed using the two-micro-electrode voltage-clamp technique on short preparations. In normal Tyrode solution, ACh shifted the membrane currents in the outward direction at potentials positive to the K+ equilibrium potential, EK, and in the inward direction at potentials negative to EK. When ACh effects were studied in various [K+]o the reversal potential for the ACh-induced current was changed in a way expected for a pure K+ electrode. The results indicate an increase of an inward-rectifying K+ conductance by ACh. ACh also decreased the magnitude of the late outward current (ix). The activation curve for this current was not modified, but the fully activated current was decreased. The effect of ACh on ix was more pronounced in the presence of catecholamines. The slow inward current (isi) was not changed by ACh in control conditions. However, the increase produced by beta-adrenergic stimulation in this current was suppressed by ACh in a concentration-dependent way.

Parasympathetic effects on electrophysiologic properties of cardiac ventricular tissue

The physiologic importance of parasympathetic influence on the sinoatrial and atrioventricular nodes is well established, but the importance of parasympathetic modulation of ventricular function remains controversial. Recognized effects of muscarinic cholinergic stimulation on ventricular automaticity and ventricular repolarization, the ability of muscarinic cholinergic agonists to antagonize catecholamine effects in the ventricle and proposed mechanisms for these effects are described. Anatomic studies have demonstrated a great abundance of cholinergic nerve endings in association with the ventricular conducting system. Stimulation of the vagus nerve or addition of muscarinic cholinergic agonists suppresses ventricular automaticity in most species and antagonizes isoproterenol-induced action potential shortening and isoproterenol-restored slow response action potentials. In vivo, interactions between the parasympathetic and sympathetic nervous systems occur at multiple levels. Muscarinic cholinergic agonists inhibit release of norepinephrine from sympathetic nerve terminals, inhibit catecholamine-stimulated adenylate cyclase activity and alter cyclic guanosine monophosphate (GMP) and possibly cyclic adenosine monophosphate (AMP) levels. Evidence is also presented that, in vivo, parasympathetic effects on ventricular electrical function might influence the pathophysiologic milieu responsible for initiation or termination of certain ventricular arrhythmias. Vagal influences appear to be protective against certain digitalis-induced arrhythmias and protective in certain experimental acute myocardial infarctions. In human beings, there appears to be tonic vagal tone in the ventricle and vagal stimulation terminates certain types of ventricular tachycardia. The evidence presented supports a physiologic role of parasympathetic stimulation in altering ventricular electrical function.

Effect of rate-dependent changes in the transient outward current on the action potential in sheep Purkinje fibres

1. The rate of membrane potential change during the initial phase of rapid repolarization of the action potential in sheep Purkinje fibres has been measured by electronic differentiation. 2. Phase-plane analysis has revealed that the potential dependence of rapid repolarization corresponds to the potential range over which the transient outward current , Ito, is recorded in voltage clamp experiments. 3. The initial rate of repolarization is strongly rate-dependent and it is markedly reduced at high rates. 4. The effect of high rates of stimulation on the phase-plane diagram is consistent with a reduction in I. 5. After an increase or decrease in rate there is an abrupt change in the initial rate of repolarization in the first response followed by slower changes over several hundred responses. 6. Recovery of the initial rate of repolarization occurs in two distinct phases after repetitive to activity: there is a rapid, approximately exponential phase of recovery in the first 10 s which is followed by a slower phase of recovery lasting several hundred seconds. 7. The rate-dependent changes in the initial rate of repolarization are abolished by 4-aminopyridine, 0.5-1.0 mmol/l. 8. It is concluded that the rate-dependent changes in the initial phase of repolarization are due to the similar changes in Ito described in a companion paper (Boyett, 1981). 9. Rate-dependent changes in peak tension have been measured and they bear no relationship to the changes in the initial rate of repolarization. It is concluded that the major component of the transient outward current in sheep Purkinje fibers is unlikely to be a Ca-activated current