Changes in the interstitial pH of dog myocardium in response to local ischemia, hypoxia, hyper- and hypocapnia, measured continuously by means of glass microelectrodes

Hypothesis-generating analysis of the impact of non-damaging metabolic acidosis on the transcriptome of different cell types: Integrated stress response (ISR) modulation as general transcriptomic reaction to non-respiratory acidic stress?

Extracellular pH is an important parameter influencing cell function and fate. Microenvironmental acidosis accompanies different pathological situations, including inflammation, hypoxia and ischemia. Research focussed mainly on acidification of the tumour micromilieu and the possible consequences on proliferation, migration and drug resistance. Much less is known regarding the impact of microenvironmental acidosis on the transcriptome of non-tumour cells, which are exposed to local acidosis during inflammation, hypoxia, ischemia or metabolic derailment. In the present hypothesis-generating study, we investigated the transcriptional impact of extracellular acidosis on five non-tumour cell types of human and rat origin, combining RNA-Sequencing and extensive bioinformatics analyses. For this purpose, cell type-dependent acidosis resiliences and acidosis-induced transcriptional changes within these resilience ranges were determined, using 56 biological samples. The RNA-Sequencing results were used for dual differential-expression analysis (DESeq and edgeR) and, after appropriate homology mapping, Gene Ontology enrichment analysis (g:Profiler), Ingenuity Pathway Analysis (IPA®), as well as functional enrichment analysis for predicted upstream regulators, were performed. Extracellular acidosis led to substantial, yet different, quantitative transcriptional alterations in all five cell types. Our results identify the regulator of the transcriptional activity NCOA5 as the only general acidosis-responsive gene. Although we observed a species- and cell type-dominated response regarding gene expression regulation, Gene Ontology enrichment analysis and upstream regulator analysis predicted a general acidosis response pattern. Indeed, they suggested the regulation of four general acidosis-responsive cellular networks, which comprised the integrated stress response (ISR), TGF-β signalling, NFE2L2 and TP53. Future studies will have to extend the results of our bioinformatics analyses to cell biological and cell physiological validation experiments, in order to test the refined working hypothesis here.

Structural Conformation and Activity of Spider-Derived Inhibitory Cystine Knot Peptide Pn3a Are Modulated by pH

Numerous spider venom-derived gating modifier toxins exhibit conformational heterogeneity during purification by reversed-phase high-performance liquid chromatography (RP-HPLC). This conformational exchange is especially peculiar for peptides containing an inhibitor cystine knot motif, which confers excellent structural stability under conditions that are not conducive to disulfide shuffling. This phenomenon is often attributed to proline cis/trans isomerization but has also been observed in peptides that do not contain a proline residue. Pn3a is one such peptide forming two chromatographically distinguishable peaks that readily interconvert following the purification of either conformer. The nature of this exchange was previously uncharacterized due to the fast rate of conversion in solution, making isolation of the conformers impossible. In the present study, an N-terminal modification of Pn3a enabled the isolation of the individual conformers, allowing activity assays to be conducted on the individual conformers using electrophysiology. The conformers were analyzed separately by nuclear magnetic resonance spectroscopy (NMR) to study their structural differences. RP-HPLC and NMR were used to study the mechanism of exchange. The later-eluting conformer was the active conformer with a rigid structure that corresponds to the published structure of Pn3a, while NMR analysis revealed the earlier-eluting conformer to be inactive and disordered. The exchange was found to be pH-dependent, arising in acidic solutions, possibly due to reversible disruption and formation of intramolecular salt bridges. This study reveals the nature of non-proline conformational exchange observed in Pn3a and possibly other disulfide-rich peptides, highlighting that the structure and activity of some disulfide-stabilized peptides can be dramatically susceptible to disruption.

The conundrum of the complex relationship between acute kidney injury and cardiac arrhythmias

Acute kidney injury (AKI) is defined by a rapid increase in serum creatinine levels, reduced urine output, or both. Death may occur in 16%-49% of patients admitted to an intensive care unit with severe AKI. Complex arrhythmias are a potentially serious complication in AKI patients with pre-existing or AKI-induced heart damage and myocardial dysfunction, fluid overload, and especially electrolyte and acid-base disorders representing the pathogenetic mechanisms of arrhythmogenesis. Cardiac arrhythmias, in turn, increase the risk of poor renal outcomes, including AKI. Arrhythmic risk in AKI patients receiving kidney replacement treatment may be reduced by modifying dialysis/replacement fluid composition. The most common arrhythmia observed in AKI patients is atrial fibrillation. Severe hyperkalemia, sometimes combined with hypocalcemia, causes severe bradyarrhythmias in this clinical setting. Although the likelihood of life-threatening ventricular arrhythmias is reportedly low, the combination of cardiac ischemia and specific electrolyte or acid-base abnormalities may increase this risk, particularly in AKI patients who require kidney replacement treatment. The purpose of this review is to summarize the available epidemiological, pathophysiological, and prognostic evidence aiming to clarify the complex relationships between AKI and cardiac arrhythmias.

Metabolic and electrolyte abnormalities as risk factors in drug-induced long QT syndrome

Drug-induced long QT syndrome (diLQTS) is the phenomenon by which the administration of drugs causes prolongation of cardiac repolarisation and leads to an increased risk of the ventricular tachycardia known as torsades de pointes (TdP). In most cases of diLQTS, the primary molecular target is the human ether-à-go-go-related gene protein (hERG) potassium channel, which carries the rapid delayed rectifier current (IKr) in the heart. However, the proarrhythmic risk associated with drugs that block hERG can be modified in patients by a range of environmental- and disease-related factors, such as febrile temperatures, alterations in pH, dyselectrolytaemias such as hypokalaemia and hypomagnesemia and coadministration with other drugs. In this review, we will discuss the clinical occurrence of drug-induced LQTS in the context of these modifying factors as well as the mechanisms by which they contribute to altered hERG potency and proarrhythmic risk.

The death-inducing activity of RIPK1 is regulated by the pH environment

Receptor-interacting protein kinase 1 (RIPK1) is a serine/threonine kinase that dictates whether cells survive or die in response to the cytokine tumor necrosis factor (TNF) and other inflammatory stimuli. The activity of RIPK1 is tightly controlled by multiple posttranslational modification mechanisms, including ubiquitination and phosphorylation. Here, we report that sensitivity to TNF-induced, RIPK1-dependent cell death was tunable by the pH environment. We found that an acidic extracellular pH, which led to a concomitant decrease in intracellular pH, impaired the kinase activation of RIPK1 and autophosphorylation at Ser¹⁶⁶ Consequently, formation of the cytosolic death-inducing complex II and subsequent RIPK1-dependent necroptosis and apoptosis were inhibited. By contrast, low pH did not affect the formation of membrane-anchored TNFR1-containing signaling complex (complex I), RIPK1 ubiquitination, and NF-κB activation. TNF-induced cell death in Ripk1 ^-/- cells was not sensitive to pH changes. Furthermore, mutation of the conserved His¹⁵¹ abolished the pH dependence of RIPK1 activation, suggesting that this histidine residue functions as a proton acceptor to modulate RIPK1 activity in response to pH changes. These results revealed an unexpected environmental factor that controls the death-inducing activity of RIPK1.

Effects of Verapamil and Pinacidil on Extracellular K+, pH, and the Incidence of Ventricular Fibrillation during 60 Minutes of Ischemia

Ca⁺⁺-channel antagonist verapamil and ATP-sensitive K⁺-channel opener pinacidil are known to decrease the rise in extracellular K⁺ ([K⁺]_e) level and pH (pH_e) that occurs during reversible acute myocardial ischemia and to lessen the accompanying activation delay. Verapamil is also known to decrease the incidence of ventricular tachycardia (VT)/fibrillation (VF) during acute myocardial ischemia; however, the effects of ATP-sensitive K⁺-channel opener on the incidence of VT/VF are controversial. We studied, in an in vivo pig model, the effects of verapamil and pinacidil on the changes in [K⁺]_e level and pH_e, local activation, and the incidence of VT/VF during 60 minutes of ischemia. Thirty-one pigs were divided into 2 groups: a verapamil group (9 control pigs and 8 verapamil-treated pigs) and pinacidil group (5 control pigs and 9 pinacidil-treated pigs). In the verapamil group, VF developed in 1 of the 9 control pigs, whereas no VF developed in 8 verapamil-treated pigs. In the pinacidil group, VF developed in 3 of the 5 control pigs and all 9 pinacidil-treated pigs. Under verapamil treatment (versus the control condition), onset of the second rise in [K⁺]_e level was delayed, and the maximum rise in [K⁺]_e level was decreased. Under pinacidil treatment (versus the control condition), time to the onset of VT/VF was shorter than that under the control condition, and VT/VF developed at lower [K⁺]_e level and higher pH_e. In conclusion, VF may develop at a lesser [K⁺]_e rise and pH_e fall in the presence of pinacidil during acute myocardial ischemia.

Multifaceted anti-amyloidogenic and pro-amyloidogenic effects of C-reactive protein and serum amyloid P component in vitro

C-reactive protein (CRP) and serum amyloid P component (SAP), two major classical pentraxins in humans, are soluble pattern recognition molecules that regulate the innate immune system, but their chaperone activities remain poorly understood. Here, we examined their effects on the amyloid fibril formation from Alzheimer’s amyloid β (Aβ) (1-40) and on that from D76N β₂-microglobulin (β2-m) which is related to hereditary systemic amyloidosis. CRP and SAP dose-dependently and substoichiometrically inhibited both Aβ(1-40) and D76N β2-m fibril formation in a Ca²⁺-independent manner. CRP and SAP interacted with fresh and aggregated Aβ(1-40) and D76N β2-m on the fibril-forming pathway. Interestingly, in the presence of Ca²⁺, SAP first inhibited, then significantly accelerated D76N β2-m fibril formation. Electron microscopically, the surface of the D76N β2-m fibril was coated with pentameric SAP. These data suggest that SAP first exhibits anti-amyloidogenic activity possibly via A face, followed by pro-amyloidogenic activity via B face, proposing a model that the pro- and anti-amyloidogenic activities of SAP are not mutually exclusive, but reflect two sides of the same coin, i.e., the B and A faces, respectively. Finally, SAP inhibits the heat-induced amorphous aggregation of human glutathione S-transferase. A possible role of pentraxins to maintain extracellular proteostasis is discussed.

Danger signaling in atherosclerosis

All aspects of the pathogenesis of atherosclerosis are critically influenced by the inflammatory response in vascular plaques. Research in the field of innate immunity from the past 2 decades has uncovered many novel mechanisms elucidating how immune cells sense microbes, tissue damage, and metabolic derangements. Here, we summarize which triggers of innate immunity appear during atherogenesis and by which pathways they can contribute to inflammation in atherosclerotic plaques. The increased understanding gained from studies assessing how immune activation is associated with the pathogenesis of atherosclerosis has provided many novel targets for potential therapeutic intervention. Excitingly, the concept that inflammation may be the core of cardiovascular disease is currently being clinically evaluated and will probably encourage further studies in this area.

Proton modulation of cardiac I Na: a potential arrhythmogenic trigger

Voltage-gated sodium (NaV) channels generate the upstroke and mediate duration of the ventricular action potential, thus they play a critical role in mediating cardiac excitability. Cardiac ischemia triggers extracellular pH to drop as low as pH 6.0, within just 10 min of its onset. Heightened proton concentrations reduce sodium conductance and alter the gating parameters of the cardiac-specific voltage-gated sodium channel, NaV1.5. Most notably, acidosis destabilizes fast inactivation, which plays a critical role in regulating action potential duration. The changes in NaV1.5 channel gating contribute to cardiac dysfunction during ischemia that can cause syncope, cardiac arrhythmia, and even sudden cardiac death. Understanding NaV channel modulation by protons is paramount to treatment and prevention of the deleterious effects of cardiac ischemia and other triggers of cardiac acidosis.

Extracellular acidosis is a novel danger signal alerting innate immunity via the NLRP3 inflammasome

BACKGROUND

Local acidosis has been demonstrated in ischemic tissues and at inflammatory sites.

RESULTS

Acidic extracellular pH triggers NLRP3 inflammasome activation and interleukin-1β secretion in human macrophages.

CONCLUSION

Acidic pH represents a novel danger signal alerting the innate immunity.

SIGNIFICANCE

Local acidosis may promote inflammation at ischemic and inflammatory sites. Local extracellular acidification has been demonstrated at sites of ischemia and inflammation. IL-1β is one of the key proinflammatory cytokines, and thus, its synthesis and secretion are tightly regulated. The NLRP3 (nucleotide-binding domain leucine-rich repeat containing family, pyrin domain containing 3) inflammasome complex, assembled in response to microbial components or endogenous danger signals, triggers caspase-1-mediated maturation and secretion of IL-1β. In this study, we explored whether acidic environment is sensed by immune cells as an inflammasome-activating danger signal. Human macrophages were exposed to custom cell culture media at pH 7.5-6.0. Acidic medium triggered pH-dependent secretion of IL-1β and activation of caspase-1 via a mechanism involving potassium efflux from the cells. Acidic extracellular pH caused rapid intracellular acidification, and the IL-1β-inducing effect of acidic medium could be mimicked by acidifying the cytosol with bafilomycin A1, a proton pump inhibitor. Knocking down the mRNA expression of NLRP3 receptor abolished IL-1β secretion at acidic pH. Remarkably, alkaline extracellular pH strongly inhibited the IL-1β response to several known NLRP3 activators, demonstrating bipartite regulatory potential of pH on the activity of this inflammasome. The data suggest that acidic environment represents a novel endogenous danger signal alerting the innate immunity. Low pH may thus contribute to inflammation in acidosis-associated pathologies such as atherosclerosis and post-ischemic inflammatory responses.

Differences in protective profiles of diltiazem isomers in ischemic and reperfused guinea pig hearts

The effects of L-cis and D-cis diltiazem on the extracellular potassium concentration ([K(+)]e), pH and cardiac function were compared in ischemic guinea pig hearts. Before inducing ischemia, L-cis diltiazem (10 and 30 microM) reduced the left ventricular developed pressure (LVDP) with a marginal inhibition of heart rate (HR), whereas lower doses of the D-cis isomer decreased both LVDP and HR. L-cis Diltiazem only slightly inhibited the increase in [K(+)]e and the decrease in pH but significantly inhibited ischemic contractures in contrast to the marked inhibition of these parameters produced by even low doses of the D-cis isomer. Notably, at equipotent doses for the ischemic parameters, L-cis diltiazem restored the left ventricular end-diastolic pressure (LVEDP) and HR after reperfusion to a greater extent than the D-cis isomer. These results suggest that the L-cis isomer may specifically improve postischemic function, in addition to the modest action on [K(+)]e and pH, in guinea pig hearts.

Effect of efonidipine, a novel dihydropyridine derivative, on myocardial metabolic changes induced by coronary artery ligation in dogs: comparison with nifedipine

Efonidipine is a dihydropyridine derivative having a vasodilating action, which is slower in onset and longer in duration than that of nifedipine. In the present study, we compared the effects of efonidipine with those of nifedipine on the ischemic myocardial metabolism in anesthetized dogs. The heart was made ischemic by ligating the left anterior descending coronary artery (LAD) completely for 3 or 30 min. Efonidipine or nifedipine was injected intravenously, 10 or 3 min, respectively, before the start of LAD occlusion. Efonidipine (0.01 or 0.03 mg/kg) decreased both blood pressure and heart rate, whereas nifedipine (0.003 mg/kg) decreased blood pressure and increased heart rate. The magnitude of decrease in mean blood pressure induced by 0.03 mg/kg efonidipine was similar to that induced by 0.003 mg/kg nifedipine. Although efonidipine did not modify the changes in myocardial carbohydrate metabolism induced by ischemia, it attenuated the ischemia-induced decrease in the myocardial level of adenosine triphosphate and energy charge potential. Nifedipine, however, did not modify the changes in both myocardial energy and carbohydrate metabolism induced by ischemia. The results suggest that efonidipine has a cardioprotective effect in the dog, probably because of its negative chronotropic effect.

Pain due to experimental acidosis in human skin: evidence for non-adapting nociceptor excitation

The mechanisms of acid pain induction by superfusion of a human blister base and by intradermal infusion of acid phosphate buffer are compared in this study. Superfusion of a freshly opened blister base with CO2-saturated 'synthetic interstitial fluid' (pH 6.1) led to pain that linearly faded away during 15 min. In contrast, the protein content of the blister effluate approached a very low basal level within the first 5 min of superfusion, irrespective of the pH applied, which suggests a progressive sealing of the blister base impeding macromolecular permeation first, and invasion of protons and CO2 later. In contrast, pressure infusion of an acidic buffer into the skin induced constant pain for as long as a flow rate was maintained. The time course and distribution of the intracutaneous pH changes induced were monitored at different distances to the infusion point using a pH-sensitive needle electrode. The continuous infusion produced a restricted area of cutaneous tissue acidosis where pH values were sufficiently low presumably to excite nociceptors. This area had relatively sharp borders, and in the border zone a steady-state of the local pH was reached within about 20 min (at an infusion rate of 40 ml/h) suggesting a balance between acidifying and neutralizing forces. The acid pain increased during the first minutes of infusion closely in parallel to the pH near the infusion point, remained constant at constant pH and flow rate and declined more rapidly than the pH was able to recover after discontinuation of the infusion. In conclusion, the results suggest that the pain from the experimental tissue acidosis is due to non-adapting excitation of a relatively constant population of nociceptors terminating in a spatially restricted volume of tissue.

Simulated ischemia does not protect against efferent sympathetic denervation following acute myocardial infarction in canine hearts

INTRODUCTION

Preconditioning the myocardium with brief episodes of ischemia preserves efferent autonomic responsiveness of noninfarcted myocardium apical to a site of acute transmural ischemia by mechanism(s) still unknown. We hypothesized that repeated brief exposure of the myocardium to a simulated ischemic milieu including hypoxia, high K+, low pH, and adenosine would be as effective as brief coronary occlusions in creating this protection.

METHODS AND RESULTS

Open chest anesthetized dogs received an extracorporeal bypass between the left carotid artery and a diagonal branch of the left anterior descending coronary artery. We analyzed the effects of simulated ischemia on the time course and extent of efferent sympathetic denervation during a subsequent 3-hour sustained ischemia in three groups of dogs: two groups of dogs underwent four cycles of 5-minute intracoronary perfusion with either hypoxic altered Tyrode's solution (12 mM K+, 6.8 pH, and 10 microM adenosine; n = 11) or normal Tyrode's solution (n = 11). Each Tyrode's perfusion was separated by 5 minutes of blood perfusion prior to permanent coronary occlusion by latex embolization of the cannulated coronary artery. A third group received a continuous 3-hour blood perfusion before the final ischemic episode (n = 5). Shortening of effective refractory periods (ERPs) induced by bilateral ansae subclaviae stimulation (2 to 4 Hz) basal and apical to the intervention site was determined before and after perfusions and 20, 60, 120, and 180 minutes after sustained occlusion. In all groups, sympathetically-induced ERP shortening was unchanged at basal sites throughout the experiment. ERP shortening at apical sites was unchanged after perfusions with either the altered or normal Tyrode's solution or after a continuous 3-hour blood perfusion. However, ERP shortening became significantly attenuated at apical sites after coronary occlusion in all groups. Neither the size in reduction of sympathetically-induced ERP shortening at apical test sites nor the cumulative percentage of denervated apical test sites (< or = 2-msec shortening) during a 3-hour period of permanent ischemia differed significantly among groups (P = 0.052 and P = 0.752, respectively). The degree of subepicardial involvement in the myocardial infarction was comparable among groups.

CONCLUSION

Thus, brief exposure of the left ventricular myocardium to ischemic metabolites prior to a subsequent permanent coronary occlusion does not trigger mechanism(s) that are responsible for protection against efferent sympathetic denervation apical to an area of transmural myocardial infarction/ischemia.

Effects of MCI-176, a new quinazolinone calcium antagonist, on myocardial energy and carbohydrate metabolism in ischemic dog hearts

The effect of 2-(2,5-dimethoxyphenylmethyl)-3-(2-dimethylaminoethyl)- 6-isopropoxy-4(3H)-quinazolinone hydrochloride (MCI-176), a calcium antagonist, on ischemic myocardial metabolism was studied in dog hearts subjected to an occlusion of the left anterior descending coronary artery (LAD) for 3 or 30 min. MCI-176 (0.03 or 0.1 mg/kg), when injected i.v. 5 min before occlusion, increased coronary blood flow and decreased systemic aortic pressure. When the LAD was ligated, the levels of creatine phosphate, ATP, total adenine nucleotides and energy change potential decreased in the ischemic myocardium. Three minutes after ischemia, MCI-176 (0.1 mg/kg) significantly (P less than 0.05) diminished these impairments of energy metabolism. Even 30 min after ischemia, pretreatment with MCI-176 tended to lessen the depletion of ATP and total adenine nucleotides, although these effects were not statistically significant. Myocardial ischemia produced a breakdown of glycogen, an accumulation of lactate, and an inhibition of glycolytic flux through phosphofructokinase reaction. MCI-176 (0.1 mg/kg) significantly (P less than 0.05) reduced these alterations of carbohydrate metabolism after 3 min of ischemia. These results suggest that pretreatment with MCI-176 reduces the impairments of myocardial energy and carbohydrate metabolism in ischemic dog hearts, suggesting that the drug is capable of improving the imbalance between oxygen supply and oxygen demand in the ischemic myocardium.

Betaxolol, a cardioselective beta-adrenoceptor antagonist, attenuates ischemic myocardial acidosis in dogs

The effects of betaxolol, a cardioselective beta-adrenoceptor antagonist, on ischemic myocardial acidosis were studied in dog hearts, in which the left anterior descending coronary artery was partially occluded for 90 min, and were compared with those of atenolol and propranolol. Myocardial ischemia produced a decrease in myocardial pH (measured by a micro glass pH electrode) and an elevation of the ST segment of epicardial ECG (assessed by a surface electrode). Betaxolol (0.01, 0.03 or 0.1 mg/kg), atenolol (0.03 or 0.1 mg/kg) or propranolol (0.03 or 0.1 mg/kg), when injected i.v. 30 min after ischemia, restored myocardial pH and the ST segment of ECG that had been altered by partial occlusion. However, the effect of betaxolol on myocardial acidosis was more potent than that of atenolol or propranolol. The decrease in (+)dp/dt by betaxolol (0.03 mg/kg) was less potent than that by atenolol (0.1 mg/kg) and equivalent to that by propranolol (0.1 mg/kg), although the restorations of myocardial acidosis by the drugs were almost equivalent. These results have confirmed that beta-adrenoceptor antagonists attenuate the ischemia-induced myocardial acidosis and have shown that among three beta-adrenoceptor antagonists, betaxolol is the most effective in improving myocardial acidosis with a relatively weak effect on myocardial contractile function.

Presynaptic modulation of efferent sympathetic and vagal neurotransmission in the canine heart by hypoxia, high K+, low pH, and adenosine. Possible relevance to ischemia-induced denervation

Ischemia in the dog produces denervation of myocardium apical to the ischemic area. To investigate the mechanism(s) of the denervation, we tested the effects of hypoxia and some components of ischemia including high K+, low pH, and adenosine on efferent cardiac autonomic responses. In anesthetized, open-chest dogs, we occluded a diagonal branch of the left anterior descending coronary artery and perfused it with hypoxic Tyrode's solutions (PO2 less than 50 mm Hg). We found that effective refractory period (ERP) shortening induced by bilateral ansae subclaviae stimulation at myocardium basal and apical to the perfusing area did not change during a 20-25 minute period of perfusion with hypoxic normal Tyrode's solution. During perfusion with hypoxic combined Tyrode's solution containing 12 mM K+, pH 6.8, and 10 microM adenosine, ERP shortening at basal sites induced by bilateral ansae subclaviae stimulation remained unchanged but was attenuated at apical sites (16 +/- 1 to 8 +/- 1 msec, mean +/- SEM, n = 35, p less than 0.001), and seven apical sites exhibited denervation (less than or equal to 2-msec shortening). The maximum extracellular K+ concentration of the perfusing area, measured with a K(+)-sensitive electrode, was 5.1 +/- 0.9 mM (N = 3 dogs) during perfusion with normal Tyrode's solution and was 11.8 +/- 0.1 mM (N = 3 dogs) during perfusion with hypoxic combined solution (p = 0.017). In a separate group of dogs, the effects of high K+, low pH, and adenosine in the absence of ischemia were examined. Oxygenated Tyrode's solutions were instilled into the pericardial cavity to superfuse epicardial nerves. The Tyrode's solutions containing high K+ (12 mM), low pH (6.4), or adenosine (10 microM), individually or combined, reduced ERP shortening induced by bilateral ansae subclaviae stimulation in the ventricular intramyocardium to 46%, 55%, 56%, and 33% of each control value obtained during superfusion with normal Tyrode's solution and reduced the magnitude of ERP lengthening induced by bilateral cervical vagal stimulation to 57%, 71%, 61%, and 39%, respectively. ERP responses of the test sites to infused norepinephrine and methacholine, however, remained unaffected by superfusion with combined Tyrode's solution. Thus, high K+, low pH, and adenosine each inhibit efferent sympathetic and vagal neurotransmission presynaptically in the canine heart and may contribute to the development of denervation during early ischemia.

Inhibition of postischemic reperfusion arrhythmias by an SOD derivative that circulates bound to albumin with prolonged in vivo half-life

Intravenously administered superoxide dismutase (SOD) rapidly disappeared from the circulation and often failed to prevent oxidative tissue injury. Thus, although superoxide radicals have been postulated to play an important role in the pathogenesis of postischemic reflow-induced tissue injury, conclusive evidence supporting this concept is lacking. We have synthesized an SOD derivative (SM-SOD) that circulated bound to albumin and accumulated in injured tissues whose local pH was decreased. Transient occlusion followed by reperfusion of the coronary artery elicited severe ventricular arrhythmias in rats. Intravenous administration of SM-SOD markedly inhibited the reflow-induced arrhythmias. SOD did not show such inhibitory effect. Kinetic analysis revealed that SM-SOD accumulated in the acidic lesion of the injured heart soon after reflow and returned to the circulation thereafter. These and other results suggest that superoxide radical and/or its metabolites would play a critical role in the pathogenesis of reperfusion arrhythmias and that SM-SOD may be useful for protecting acute myocardial injury induced by such hazardous oxygen metabolites.

Regulation of intracellular pH in the myocardium; relevance to pathology

Intracellular pH affects the contractile function of the heart, metabolic reactions, ion exchange and calcium homoeostasis. Numerous studies have concluded that a fall of extracellular pH, by whatever mechanism, causes a fall of contractility by alteration of intracellular pH. Measurement of cytosolic intracellular pH using microelectrodes has confirmed that earlier deduction. Acidosis reduces the slow calcium current and the release of calcium from the sarcoplasmic reticumul but, because the cytosolic calcium does not fall, the major site of action of hydrogen ions appears to be on the calcium sensitivity of the contractile proteins. In man acidosis can be detected 15 s after the occlusion of a coronary artery and is a major mechanism for the simultaneous loss of contractility in ischaemia. A transient alkalosis is not detected in man but has been reported in isolated heart preparations where ATP consumption is low. An imposed mild respiratory acidosis during hypoxia increases the subsequent recovery of mechanical function on reoxygenation whereas a severe acidosis can be harmful. Acidosis in ischaemic may be advantageous due to a cardioplegic effect, inhibition of transsarcolemmal calcium fluxes or a reduction of mitochondrial calcium overload. Calcium uptake on reperfusion or reoxygenation has been linked to an inward movement of sodium in exchange for hydrogen ions on reperfusion and subsequent sodium-calcium exchange. Such a mechanism in its simplest form cannot account for the similar uptake of calcium on reoxygenation and reperfusion. Acidosis is a cause of early contractile failure in ischaemia but the role of acidosis in causing cell necrosis is not established.

Simulated ischemia and intracellular pH in isolated ventricular muscle

Isolated guinea pig papillary muscles were subjected to an in vitro model of ischemia, consisting of superfusion arrest and immersion in paraffin oil, which results in restriction of substrate supply and metabolite washout. Intracellular pH (pHi) and surface pH (pHs) were measured with glass microelectrodes. Contractile force declined to 82% of the pre-"ischemic" value after 2 min and to 37% of the control value after 10 min. In addition, a shortening of the time to peak and duration of contraction was noted. The rate of force development decreased later than the rate of relaxation. After 10 min, pHi was acidified on average 0.08 pH unit, which is about one-third of the measured pHs change. Tripling the ischemic pHi change by reduction of the intracellular buffering power only slightly increased the rate of tension decline. Experimental pHi changes of similar magnitude, induced during normal superfusion, had a smaller effect on contractile force and failed to reproduce the characteristic changes in time course of the contraction. It is concluded that, in our condition of simulated ischemia, the intracellular acidification cannot account fully for the rapid decline in contractility.

Significance of the transmural diminution in regional hydrogen ion production after repeated coronary artery occlusions

Previous studies have revealed that the regional accumulation of ischemic metabolites including hydrogen ion (H+) and PCO2 diminish after repeated occlusions. We postulated that this diminution reflects a blunted metabolic response that is related to the severity of ischemic injury and, hence, may be most pronounced in subendocardial (ENDO) regions. To investigate this hypothesis, the left anterior descending coronary artery was serially occluded three times in 51 dogs for a period of either 3 minutes (n = 15), 5 minutes (n = 18), or 15 minutes (n = 18). Each occlusion was separated by 45 minutes of reperfusion. Myocardial [H+] was measured in the endomyocardium and in the epimyocardium of the ischemic anterior wall by use of miniature pH glass electrodes. Accumulation of H+ during occlusion (delta [H+]) in the ENDO region was significantly less during the second occlusion when compared with the first occlusion (3-minute occlusions: 28.2 +/- 3.7 nM/l vs. 39.4 +/- 5.4 nM/l, p less than 0.002; 5-minute occlusions: 49.8 +/- 5.0 nM/l vs. 72.1 +/- 6.5 nM/l, p less than 0.0002; 15-minute occlusions: 132.3 +/- 14.6 nM/l vs. 225.6 +/- 27.7 nM/l, p less than 0.0003). A similar trend was noted for delta [H+] in the subepicardial (EPI) regions. During occlusion, the rise in [H+] occurred sooner, and delta [H+] was consistently greater in the ENDO when compared with the EPI regions (p less than 0.05). Regional myocardial blood flow did not change during the three occlusions, indicating that the diminution in H+ accumulation stemmed from a decrease in H+ production and not from an increase in collateral flow. The decrement in H+ accumulation between the first and second occlusions (delta [H+]1-delta [H+]2) 1) was greater in the ENDO than in the EPI regions (p less than 0.05); 2) correlated with the duration of occlusion (ENDO: r = 0.66, p less than 0.001; EPI: r = 0.82, p less than 0.0001); and 3) was related to the impairment of anterior wall systolic shortening after the first reperfusion period. These findings suggest that the diminution in H+ production that follows serial coronary occlusions reflects a blunted metabolic response that is related to both the duration of ischemia and the degree of systolic dysfunction. Moreover, though attenuation of ischemic metabolite production occurs transmurally, it is most pronounced in the deep ENDO regions.

Coronary sinus pH during percutaneous transluminal coronary angioplasty: early development of acidosis during myocardial ischaemia in man

Coronary sinus pH was measured continuously in eight patients undergoing angioplasty to the left anterior descending coronary artery. A catheter tip pH sensitive electrode with a response time of less than 300 ms and an output of greater than or equal to 57 mV/pH unit was placed high in the coronary sinus. Recordings were obtained during a total of 24 balloon occlusions of the left anterior descending coronary artery varying in duration from 5 to 45 s. Continuous 12 lead surface electrocardiograms were recorded. During or after balloon inflation of greater than or equal to 12 s (n = 4) there was no change in coronary sinus pH or the electrocardiogram. During balloon inflation of greater than or equal to 15 s (n = 20) coronary sinus pH was unaltered but between 4 and 6 s after balloon deflation coronary sinus pH fell transiently by between 0.010 and 0.120 pH units before returning to the control value within 65 s. Ischaemic changes were seen on the electrocardiogram during 15 balloon occlusions. In individual patients the peak fall in coronary sinus pH was related to the duration of occlusion of the left anterior descending coronary artery. A rise in coronary sinus pH (alkalosis) was never seen. In man acidosis occurs in the myocardium after short periods (greater than or equal to 12 s) of ischaemia. The fall of pH precedes ischaemic changes on the surface electrocardiogram and occurs concurrently with the earliest reported changes in contractile function.

Evaluation of a needle pH electrode for continuous tissue-pH monitoring during labor. Characteristics during acidosis in the rat

A prototype of a needle tissue-pH (t-pH) electrode designed for continuous t-pH monitoring of the human fetus during labor is described and evaluated in vitro and in vivo in the rat. Respiratory acidosis was induced by ventilation with 5% carbon dioxide, and t-pH measured by the needle electrode compared to simultaneous t-pH measured by the Kontron-Roche electrode and to arterial blood pH. A close correlation between the two t-pH electrodes was demonstrated (r = 0.80, P < 0.001). Furthermore, a close correlation was found between t-pH and arterial blood pH during the first 15 min of acidosis (r = 0.82, P< 0.001). It is concluded that the needle electrode fulfils nearly all theoretical demands to a t-pH electrode for clinical use.

The significance of the late fall in myocardial PCO2 and its relationship to myocardial pH after regional coronary occlusion in the dog

After acute regional coronary occlusion, myocardial tissue PCO2, as measured by mass spectrometry, rises, reaches a peak, and then gradually falls. This late fall in myocardial tissue PCO2 could be due to (1) a gradual increase in tissue blood flow (and hence improved carbon dioxide washout), (2) a gradual consumption of tissue bicarbonate, (3) a gradual reduction in the production of carbon dioxide due to progressive cellular damage, or (4) an artifact caused by the continued presence of the mass spectrometer probe in the ischemic tissue. To determine which of these four mechanisms is responsible for the late fall in myocardial tissue PCO2, we subjected 27 anesthetized open-chest dogs to 3-hour occlusion of the left anterior descending coronary artery. Both myocardial tissue PCO2 and intramyocardial hydrogen ion concentration were measured in the myocardial segment supplied by the left anterior descending coronary artery. Ten dogs (group 1) were killed after the occlusion (occlusion I), and 11 dogs (group 2) underwent reocclusion (occlusion II) at the same site after a 45-minute period of reflow. Regional myocardial blood flow was measured periodically by the intramural injection of 127Xe. Changes in myocardial tissue PCO2 and hydrogen ion concentration were related to ultrastructural changes in the tissues adjacent to the myocardial tissue PCO2 probe. Regional myocardial blood flow remained unchanged throughout the 3-hour occlusion, ruling out increased carbon dioxide washout as a cause for its late fall. Tissue hydrogen ion concentration, as measured by a new lead glass electrode, correlated well with myocardial tissue PCO2, with the reduction in regional myocardial blood flow, and with ischemic damage assessed histologically. Myocardial hydrogen ion concentration also exhibited a late fall after the occlusion, from a peak of 199.8 +/- 27.8 nmol/liter to 91.9 +/- 12.1 nmol/liter (mean +/- SEM). This ruled out consumption of tissue bicarbonate as the cause for the late fall in myocardial tissue PCO2. Peak rise in myocardial tissue PCO2 after occlusion II (71.2 +/- 7.9 mm Hg) was significantly lower than peak myocardial tissue PCO2 after occlusion I (116.7 +/- 13.9 mm Hg, P less than 0.001). The difference between these latter two values, as well as the magnitude of fall in myocardial tissue PCO2 during occlusion I, related directly to the degree of histological damage observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Nicorandil attenuates myocardial acidosis during coronary occlusion in dogs

In dogs anaesthetized with pentobarbitone, the left anterior descending coronary artery (LAD) was partially occluded. Before and 30 min after partial occlusion, the myocardial pH was 7.52-7.54 and 6.89-6.91, respectively. Nicorandil (50 micrograms kg-1, i.v.) increased the pH that had been reduced by partial occlusion and this effect lasted at least 60 min. Thus nicorandil attenuates ischaemic myocardial acidosis.

Comparative studies on the role of calcium in triggering subcellular damage in cardiac muscle

Isolated cardiac muscle strips from amphibians and mammals, together with isolated frog hearts, have been used as model systems for studying the action of elevated [Ca2+]i in promoting severe damage. A23187 and caffeine are believed to cause a rise in [Ca2+]i. Elevated [Ca2+]i causes characteristic damage which has been categorized and includes hypercontraction, Z-line damage and myofilament dissolution. The damage closely resembles that described in the isolated mammalian heart and in skeletal muscle preparations when [Ca2+]i is raised dramatically. Damage can therefore be triggered by releasing Ca2+ from intracellular sites, as distinct from increasing Ca2+ entry (as in the Ca2+-paradox). DNP and ruthenium red also cause identical damage and the results suggest that whilst the fall in pHi associated with ischaemia is probably the consequence of Ca2+/2H+ exchange at the mitochondria, coupled with ATP hydrolysis, lowered pHi by mitochondrial action is probably not the only cause of myofilament dissolution. Damage is not prevented by pretreatment with leupeptin, an inhibitor of Ca2+-activated neutral proteases, and it is concluded that the latter are probably not implicated in rapid and dramatic damage. The possible involvement of lysosomal enzymes in damage triggered by high [Ca2+]i is discussed.

The influence of molecular form of local anesthetic-type antiarrhythmic agents on reduction of the maximum upstroke velocity of canine cardiac Purkinje fibers

We studied the local anesthetic effects of the quaternary lidocaine analogues QX-314, QX-572, and QX-222, the tertiary amine lidocaine, its analogues tocainide, 6603, 6211, and the neutral local anesthetic benzocaine to determine if molecular charge of antiarrhythmic agents influences their local anesthetic effects on heart fibers. We used standard microelectrode techniques and canine cardiac Purkinje fibers to compare the effects of stimulation rate, drug concentration, and K+-induced changes in resting membrane potential on the reduction of fast inward sodium current using the maximum rate of rise of the action potential upstroke, Vmax, as an index of changes in peak sodium current. Use-dependent block, defined as a modulation of the reduction in Vmax by local anesthetics due to changes in the stimulation rate, was observed with the permanently charged analogues and was most prominent for agents existing predominantly in the charged form, but was absent for the neutral local anesthetic benzocaine. The development of use-dependent block during rapid stimulation preceded by prolonged periods of quiescence was an exponential process which became more rapid with increasing drug concentration. Recovery from use-dependent block during quiescence was an exponential process that was not influenced by similar drug concentration changes. All local anesthetics caused tonic block, defined as a drug-induced reduction of Vmax from control that attained a constant value at slow stimulation rates (cycle length range 15 seconds to 2 minutes) and was not changed by prolonged (up to 8 minutes) periods of quiescence. These findings suggest that the charged form of lidocaine and its analogues is responsible for use-dependent block of cardiac sodium channels.

Perspectives and future trends in cellular electrophysiology: implications for the clinician

As a result of single fiber electrophysiologic studies, the clinical approach to the electrical behavior of the heart has improved. Three areas are examined: 1) the electrocardiographic waveform, 2) normal and abnormal cardiac rhythms, and 3) the mechanism of action of antiarrhythmic drugs. In each area, the results of single fiber studies have provided a conceptual framework for diagnostic and therapeutic decisions. These studies have also enabled investigators to test hypotheses formulated from clinical observations. It may be only a slight exaggeration to attribute many of our recent advances in each of the three areas to the development and use of the microelectrode.

Interaction of acidosis and increased extracellular potassium on action potential characteristics and conduction in guinea pig ventricular muscle

We studied the individual and combined effects of extracellular acidosis and increases in extracellular potassium on action potential characteristics and conduction in order to gain a better understanding of the effects of acute ischemia. At each level of potassium between 2.7 and 17 mm, acidosis induced by increasing Pco2 (respiratory acidosis) and by decreasing HCO3- (metabolic acidosis) decreased resting membrane potential, the maximum rate of rise of the action potential upstroke (Vmax), and slowed conduction. Metabolic acidosis consistently and significantly lengthened the steady state action potential duration whereas respiratory acidosis did not. Respiratory acidosis caused changes in resting membrane potential, Vmax, and conduction velocity; which occurred more rapidly and were of greater magnitude than the changes induced by metabolic acidosis. The changes in Vmax induced both types of acidosis were due to a change in the resting membrane potential-Vmax relationship as well as to the changes in the resting membrane potential. The conduction slowing induced by acidosis was greater when potassium was 9 and 13 mM than when potassium was 5.4 mm. Our results suggest that acidosis causes important changes in the electrophysiological properties of ventricular fibers and that many of the known electrophysiological effects of acute ischemia can be mimicked by the combined effects of extracellular acidosis and an increase in extracellular potassium.

Interstitial pH value in the myocardium as indicator of ischemic stress of cardioplegically arrested hearts

The influence of different cardioplegic methods (Bretschneider, Cardiac Surgery in Hamburg, Kirklin, St. Thomas' Hospital in London) on the progressive myocardial acidosis during global ischemia of up to 24 hours' duration was investigated in arrested, nonperfused canine hearts (n = 36). The increasing acidosis of the ischemic heart muscle was continuously measured and registered with the aid of interstitial pH measurement (pHi) using glass implant electrodes. With various buffered and unbuffered cardioplegic solutions there were relatively wide fluctuations of the pHi courses in the myocardial extracellular space. The "critical" interstitial pH values ("pHcrit") relative to a defined myocardial ATP concentration (4 mumol/g ww) vary between 6.10 (Bretschneider) and 5.6 (Kirklin) (p less than 0.001). These striking results cannot be attributed solely to different total myocardial lactate concentrations, but variations in a "cellular" and an "extracellular factor" must also be taken into account. Measurement of interstitial pH for intraoperative monitoring of myocardial ischemic stress can therefore be used only within limits and with knowledge of the specific protective procedure applied. The method continues an important tool in basic investigations of partial or global ischemia of organs, particularly as regards the spectrum of metabolic, morphological and functional parameters.

Effect of sotalol on ischemic myocardial pH in the dog heart

In dogs anesthetized with pentobarbital, the left anterior descending coronary artery (LAD) was occluded partially so that the LAD flow could be reduced to 1/2 to 1/3 the original flow (partial occlusion). Myocardial pH was recorded continuously by the use of a micro glass pH electrode inserted in the area to become ischemic by partial occlusion. Before partial occlusion, myocardial pH was 7.51--7.66. Partial occlusion reduced the pH by 0.63--0.72. Sotalol (5 mg . kg-1, i.v.) increased the pH (by 0.45) that had been reduced by partial occlusion, with a marked decrease in heart rate (about 70 beats . min-1) and a slight decrease in blood pressure (about 10 mm Hg in systolic pressure). Even when the sotalol-induced decrease in heart rate was prevented by pacing the heart, sotalol (5 mg . kg-1, i.v.) increased the pH (by 0.43) of myocardium in which LAD was partially occluded. The pH of the non-ischemic normal heart, however, was not influenced by the injection of sotalol (5 mg . kg-1, i.v.). It is concluded that the effect of sotalol to increase the pH of the ischemic heart is not related to the decrease in heart rate produced by the drug injection.

Changes of extracellular Na+, K+, Ca2+ and H+ of the ischemic myocardium in pigs

In open-chest pigs during severe myocardial ischemia [K+]e, [Ca2+]e and [H+]e increase, [Na+]e increases transiently reaching control values after 30 min. Extracellular osmolality of the ischemic area increases due to an H2O-shift from the ECS to the ICS. The increase of [Na+]e and [Ca2+]e must b explained by the shrinkage of the ECS due to the H2O-shift. The increase of [Ca2+]e is additionally caused by the decrease of pHe. The increase of [K+]e is mainly caused by the release of K+ from the ICS. The changes of [K+]e and [K+]i cause a decrease of the membrane potential to a range in which slow response potentials and re-entry excitations can occur. The increase of [K+]e therefore seems to be a major factor to cause early post-ischemic arrhythmias.

Increase of myocardial pH by 1- and d-propranolol during ischemia of the heart in dogs

Myocardial pH was measured continuously with a micro pH electrode inserted into the left ventricular wall in dogs. Anterior descending coronary flow was reduced to about 1/3 of the original flow by partial occlusion of the coronary artery. Myocardial pH decreased from 7.50--7.60 to 7.06--7.24 after partial occlusion. Drugs were injected intravenously during ischemia of the heart caused by partial occlusion. l-Propranolol (1 mg/kg) reduced heart rate and increased the pH from 7.06 +/- 0.04 to 7.48 +/- 0.04 (P less than 0.01). d-Propranolol (1 mg/kg) reduced heart non-significantly and increased the pH from 7.24 +/- 0.05 TO 7.56 +/- 0.05 significantly (P less than 0.05). In other studies, the effect of l- and d-propranolol on both heart rate and metabolic responses to isoproterenol (500 micrograms/kg i.p.) was studied. Isoproterenol increased heart rate and also elevated the blood levels of glucose and lactate. l-Propranolol inhibited these responses to isoproterenol. d-Propranolol did not inhibit the heart rate response but inhibited the blood lactate response to isoproterenol significantly. The blood glucose response to isoproterenol was inhibited by d-propranolol non-significantly. The action of both l- and d-propranolol on ischemic myocardial pH may be related to their action on cardiac metabolism as well as to their local anesthetic action.

Tissue pH electrodes for clinical applications

The reduction of peripheral blood flow, which occurs during shock or in patients with occlusive arterial disease of the lower limb is accompanied by an increase in hydrogen ion activity in tissue cells. If this change could be measured, it could possibly be used as an indicator of tissue perfusion in such patients. Investigations have been carried out into various pH microelectrode designs in order to construct one which could be used clinically to measure extracellular pH changes in skin. Experiments with antimony and externally insulated glass micro-electrodes demonstrated that these were unsatisfactory for the purpose. The successful design was insulated internally by means of a glass to glass fuse. It was robust, stable, sensitive and had a fast response time. Use of the electrode in normal volunteers produced reproducible skin pH values and demonstrated the feasibility of the system. Preliminary results using the micro-electrodes in patients indicate their possible application to the assessment of peripheral vascular disease, and to the monitoring of patients under intensive care.

2,4-dinitrophenol, lysosomal breakdown and rapid myofilament degradation in vertebrate skeletal muscle

1. The possibility that rapid Ca2+-uptake by skeletal muscle mitochondria may cause local reductions in pHi (by H+/Ca2+ exchange) and so promote lysosomal breakdown has been explored using amphibian and mammalian preparations. Recent studies suggested that such a sequence of events is possible in cardiac muscle. 2. However, extensive muscle damage can still be initiated in skeletal muscle when the mitochondria are uncoupled so that Ca2+-uptake is prevented. 3. DNP alone induces extensive myofilament degradation which is similar to that produced by A23187 and caffeine and described previously. 4. It is suggested that (a) the known action of DNP in promoting lysosomal labilization in living cells is produced by mitochondrial uncoupling and the release of stored Ca2+, (b) raised [Ca2+]i promotes lysosomal breakdown in skeletal muscle, so that the hydrolases released effect myofilament dissolution rapidly. 5. DNP also rapidly causes septation and division of the mitochondria in mammalian skeletal muscle.

Changes in extracellular potassium activity in response to decreased pH in rabbit atrial muscle

The extracellular and intracellular potassium (K+) activities of isolated superfused rabbit atrial muscle were measured using K+-sensitive liquid ion exchanger microelectrodes. When the pH of the bathing medium was decreased from 7.5 to 6.8, intracellular K+ activity fell and extracellular K+ activity rose from a mean control level of 3.6 mM to a new steady state level of 3.9 mM after 1 hour. When the pH was further decreased to 6.1, extracellular K+ activity increased to a mean of 4.9 mM. Following the change in pH, the increase in extracellular K+ activity occurred over a period of 30-40 minutes at which time a stable value was reached and maintained for the next hour. On return to normal pH the extracellular K+ activity returned to control with a time constant of 20 minutes or less. Measurements of intracellular K+ activity over 1 hour showed a mean loss of 3 mM at pH 6.8 and a mean loss of 8 mM at pH 6.1. The loss was reversible within 20 minutes of return to control pH. The increase in extracellular K+ activity was accompanied by a decrease in resting membrane potential as well as decreases in maximum dv/dt and overshoot of the action potential. The action potential contour underwent complex changes consisting of decrease in the plateau and a prolongation of the time to full repolarization.

Is early decline of cardiac function in ischaemia due to carbon-dioxide retention?

There is no satisfactory explanation for the early and rapid decline of cardiac muscle function in ischaemia. Reduction of the energy source for contraction, A.T.P., is insufficient in magnitude and too slow in onset to be the prime cause. It is proposed that a large part of the loss of function is directly attributable to an immediate fall of intracellular pH and results from the accumulation of carbon dioxide and lactic acid; the intracellular acidosis reduces myocardial function by inhibition of that part of the calcium-ion influx associated with contraction.

Mechanisms of activation of cardiac glycogen phosphorylase in ischemia and anoxia

The effects of ischemia and anoxia on cardiac adenosine 3', 5'-monophosphate (cyclic AMP) concentration, glycogen phosphorylase activity ratio (-5'-AMP: +5'-AMP), phosphorylase kinase activity ratio (pH 6.8:8.2), and myocardial contractility (left ventricular dP/dt) were studied in an open-chest rat heart preparation. Ischemia produced by termination of coronary blood flow increased cyclic AMP from 0.55 to 0.77 µmoles/kg in 5 seconds and phosphorylase from 0.14 to 0.57 in 20 seconds. Anoxia induced by breathing N 2 increased cyclic AMP from 0.50 to 0.62 µmoles/kg in 10 seconds and phosphorylase from 0.14 to 0.65 in 30 seconds. Phosphorylase kinase increased with ischemia but did not change with anoxia. Beta-receptor blockade with practolol prevented the rise in cyclic AMP and phosphorylase kinase but blocked the increase in phosphorylase only in ischemia. Myocardial contractility declined precipitously during the first 20 seconds of anoxia. Epinephrine (0.1 µg/kg) caused an increase in cyclic AMP comparable to that elicited by anoxia, and it produced an increase in dP/dt during N 2 breathing. These results suggest that in the intact working heart ischemia induces phosphorylase a formation through a cyclic AMP-dependent transformation of phosphorylase kinase; however, in anoxia phosphorylase a formation depends only on the regulation of the catalytic activity of phosphorylase kinase without conversion of this enzyme to its activated form. An increase in cyclic AMP during anoxia is not associated with a positive inotropic response even though such a response is obtained with epinephrine. Factors other than the elevation of myocardial cyclic AMP may be limiting in the control of both cardiac glycogenolysis and inotropic state.