Effects of L-propionylcarnitine on electrical and mechanical alterations induced by amphiphilic lipids in isolated guinea pig ventricular muscle

Long-chain acylcarnitine 18:1 acutely increases human atrial myocardial contractility and arrhythmia susceptibility

Long-chain acylcarnitines (LCACs) are known to directly alter cardiac contractility and electrophysiology. However, the acute effect of LCACs on human cardiac function is unknown. We aimed to determine the effect of LCAC 18:1, which has been associated with cardiovascular disease, on the contractility and arrhythmia susceptibility of human atrial myocardium. Additionally, we aimed to assess how LCAC 18:1 alters Ca²⁺ influx and spontaneous Ca²⁺ release in vitro. Human right atrial trabeculae (n = 32) stimulated at 1 Hz were treated with LCAC 18:1 at a range of concentrations (1-25 µM) for a 45-min period. Exposure to the LCAC induced a dose-dependent positive inotropic effect on myocardial contractility (maximal 1.5-fold increase vs. control). At the 25 µM dose (n = 8), this was paralleled by an enhanced propensity for spontaneous contractions (50% increase). Furthermore, all LCAC 18:1 effects on myocardial function were reversed following LCAC 18:1 washout. In fluo-4-AM-loaded HEK293 cells, LCAC 18:1 dose dependently increased cytosolic Ca²⁺ influx relative to vehicle controls and the short-chain acylcarnitine C3. In HEK293 cells expressing ryanodine receptor (RyR2), this increased Ca²⁺ influx was linked to an increased propensity for RyR2-mediated spontaneous Ca²⁺ release events. Our study is the first to show that LCAC 18:1 directly and acutely alters human myocardial function and in vitro Ca²⁺ handling. The metabolite promotes proarrhythmic muscle contractions and increases contractility. The exploratory findings in vitro suggest that LCAC 18:1 increases proarrhythmic RyR2-mediated spontaneous Ca²⁺ release propensity. The direct effects of metabolites on human myocardial function are essential to understand cardiometabolic dysfunction.NEW & NOTEWORTHY For the first time, the fatty acid metabolite, long-chain acylcarnitine 18:1, is shown to acutely increase the arrhythmia susceptibility and contractility of human atrial myocardium. In vitro, this was linked to an influx of Ca²⁺ and an enhanced propensity for spontaneous RyR2-mediated Ca²⁺ release.

Long-Chain Acylcarnitines and Cardiac Excitation-Contraction Coupling: Links to Arrhythmias

A growing number of metabolomic studies have associated high circulating levels of the amphiphilic fatty acid metabolites, long-chain acylcarnitines (LCACs), with cardiovascular disease (CVD) risk. These studies show that plasma LCAC levels can be correlated with the stage and severity of CVD and with indices of cardiac hypertrophy and ventricular function. Complementing these recent clinical associations is an extensive body of basic research that stems mostly from the twentieth century. These works, performed in cardiomyocyte and multicellular preparations from animal and cell models, highlight stereotypical derangements in cardiac electrophysiology induced by exogenous LCAC treatment that promote arrhythmic muscle behavior. In many cases, this is coupled with acute inotropic modulation; however, whether LCACs increase or decrease contractility is inconclusive. Linked to the electromechanical alterations induced by LCAC exposure is an array of effects on cardiac excitation-contraction coupling mechanisms that overload the cardiomyocyte cytosol with Na⁺ and Ca²⁺ ions. The aim of this review is to revisit this age-old literature and collate it with recent findings to provide a pathophysiological context for the growing body of metabolomic association studies that link circulating LCACs with CVD.

Alterations in Ca2+ cycling by lysoplasmenylcholine in adult rabbit ventricular myocytes

We previously reported that lysoplasmenylcholine (LPlasC) altered the action potential (AP) and induced afterdepolarizations in rabbit ventricular myocytes. In this study, we investigated how LPlasC alters excitation-contraction coupling using edge-motion detection, fura-PE3 fluorescent indicator, and perforated and whole cell patch-clamp techniques. LPlasC increased contraction, myofilament Ca(2+) sensitivity, systolic and diastolic free Ca(2+) levels, and the magnitude of Ca(2+) transients concomitant with increases in the maximum rates of shortening and relaxation of contraction and the rising and declining phases of Ca(2+) transients. In some cells, LPlasC induced arrhythmias in a pattern consistent with early and delayed aftercontractions. LPlasC also augmented the caffeine-induced Ca(2+) transient with a reduction in the decay rate. Furthermore, LPlasC enhanced L-type Ca(2+) channel current (I(Ca,L)) and outward currents. LPlasC-induced alterations in contraction and I(Ca,L) were paralleled by its effect on the AP. Thus these results suggest that LPlasC elicits distinct, potent positive inotropic, lusitropic, and arrhythmogenic effects, resulting from increases in Ca(2+) influx, Ca(2+) sensitivity, sarcoplasmic reticular (SR) Ca(2+) release and uptake, SR Ca(2+) content, and probably reduction in sarcolemmal Na(+)/Ca(2+) exchange.

Carnitine palmitoyl transferase-I activity in the aging mouse heart

We investigated the influence of age on carnitine palmitoyl transferase-I (CPT-I, EC 2.3.1.21) activity in the mouse heart. There was an age-associated decrease in CPT-I activity from 2 to 26 months (P = 0.006). We studied the effect of oxygen-derived radicals on CPT-I activity. Mitochondria from 2-month-old mouse hearts exposed to different concentrations of hydrogen peroxide (H2O2) showed a dose-related decrease in CPT-I activity (P < 0.002). To determine the possible reversibility of the age change in CPT-I activity, we studied the effect of oral administration of propionyl-L-carnitine (PLC). Oral pretreatment of middle-aged (18-month-old) mice with PLC resulted in a 37% increase of basal CPT-I activity (P < 0.05) compared to age-matched untreated animals, and restored it to a level similar to that of 2-month-old mice. Pretreatment of senescent (26-month-old) mice with PLC, however, showed no significant change in basal CPT-I activity. It is possible that the age-related decrease in CPT-I activity may result from an in vivo accumulation of oxygen-derived radical damage. It appears that the age change in CPT-I activity in 18- but not in the 26-month-old mice is reversible with PLC.

Differential mechanism of block of palmitoyl lysophosphatidylcholine and of palmitoylcarnitine on inward rectifier K+ channels of guinea-pig ventricular myocytes

We investigated the effect of lysophosphatidylcholine (lysoPtdCho) and palmitoylcarnitine (PamCar), ischemia-induced amphipathic lipid metabolites, on the inward rectifier K+ channel in guinea-pig ventricular cells, under whole-cell and cell-attached configurations with patch-clamp techniques. (a) Both lysoPtdCho (10-50 microM) and PamCar (10-50 microM) depolarized the resting membrane potential (RP), retarded the repolarization of action potential, provoked spontaneous action potential discharges from oscillatory afterpotentials, and eventually caused a sudden rise of the RP to plateau levels. (b) These lysoPtdCho- or PamCar-induced depolarizations of RP were due to a decrease in the inward rectifier K+ current (IK1), and the sudden rise of the RP could be accounted for by a crossover of N-shaped current-voltage relationship on the voltage axis (zero current line) more than once. (c) Single-channel studies in the cell-attached mode revealed that lysoPtdCho (5-100 microM) decreased the conductance of the single IK1 channel with little change in its open probability, whereas PamCar (10-50 microM) did so by decreasing the open probability, with the channel conductance unaltered. (d) A short-chain acylcarnitine, l-propionylcarnitine (PpCar, 100 microM), prevented the depressant effect of lysoPtdCho (50 microM), but not of PamCar (50 microM), on the IK1. (e) Both lysoPtdCho and PamCar produced identical electrophysiological alterations on the membrane potential and IK1 in whole-cell recordings. However, molecular mechanisms involved in the effects of these toxic metabolites on single IK1 channels differ.

Effects of elastase on contractility and morphology of elastic tissue in isolated guinea pig papillary muscles

Elastase (ELA) is an enzyme catalyzing the digestion of elastin, an essential constituent of elastic fibers. Using isolated guinea pig papillary muscles, we examined the effect of ELA (3 x 10(-7) -3 x 10(-4) g/ml) on resting tension (RT) and twitch tension (TT). The effects of ELA on elastic fibers located in the subendocardium were examined histologically. A relatively high concentration of ELA (3 x 10(-4) g/ml) increased TT transiently, with progressive decreases in RT. In contrast, a relatively low concentration (3 x 10(-5) g/ml) decreased both TT and RT straightforwardly. Much lower concentrations (3 x 10(-6) -3 x 10(-7) g/ml) did not reveal significant effects. The ELA-induced increases in TT were unaffected in the presence of atenolol (10(-5) g/ml), ouabain (10(-7) M) or ryanodine (10(-6)M). ELA did not increase the maximum rate of rise of slow action potentials recorded using standard microelectrodes. ELA (3 x 10(-5) g/ml) decreased the maximum TT obtained at optimal RT or Lmax, and decreased the slope of the ascending and descending limbs of the TT-RT relation curve (Frank-Starling's). Electron-microscopic findings revealed that subendocardial elastin was mostly digested at ELA concentrations of 3 x 10(-5) -3 x 10(-4) g/ml. These findings suggest that the decrease of RT by ELA may be, at least in part, caused by a decomposition of the elastic fibers. On the other hand, the increase of TT by ELA could not be attributed to a release of endogenous catecholamine, an inhibition of Na+, K(+)-pump, a release of Ca2+ from sarcoplasmic reticulum, or an increase of slow inward current.

Recent insights pertaining to sarcolemmal phospholipid alterations underlying arrhythmogenesis in the ischemic heart

Myocardial ischemia in vivo is associated with dramatic electrophysiologic alterations that occur within minutes of cessation of coronary flow and are rapidly reversible with reperfusion. This suggests that subtle and reversible biochemical alterations within or near the sarcolemma may contribute to the electrophysiologic derangements. Our studies have concentrated on two amphipathic metabolites, long-chain acylcarnitines and lysophosphatidylcholine (LPC), which have been shown to increase rapidly in ischemic tissue in vivo and to elicit electrophysiologic derangements in normoxic tissue in vitro. Incorporation of these amphiphiles into the sarcolemma at concentrations of 1 to 2 mole%, elicits profound electrophysiologic derangements analogous to those observed in ischemic myocardium in vivo. The pathophysiological effects of the accumulation of these amphiphiles are thought to be mediated by alterations in the biophysical properties of the sarcolemmal membrane, although there is a possibility of a direct effect upon ion channels. Inhibition of carnitine acyltransferase I (CAT-I) in the ischemic cat heart was found to prevent the increase in long-chain acylcarnitines and LPC and to significantly reduce the incidence of malignant arrhythmias including ventricular tachycardia and fibrillation. This review focuses on the electrophysiologic derangements that are observed during early ischemia and presents data supporting the concept that accumulation of these amphiphiles within the sarcolemma contributes to these changes. The potential contribution of these amphiphiles to the increases in extracellular potassium and intracellular calcium are examined. Finally, recent data pertaining to the accumulation of long-chain acylcarnitines on cell-to-cell uncoupling are presented. In addition to the events reviewed here, there are many other alterations that occur during early myocardial ischemia, but the results from multiple studies over the past two decades indicate that the accumulation of these amphiphiles contributes importantly to arrhythmogenesis and that development of specific inhibitors of CAT-I or phospholipase A2 may be a promising therapeutic strategy to attenuate the incidence of lethal arrhythmias associated with ischemic heart disease in man.

Protection of the ischemic diabetic heart by L-propionylcarnitine therapy

Diabetics suffer from an increased incidence of myocardial infarction and are less likely to survive an ischemic insult. Since L-propionylcarnitine (LPC) has been shown to protect against ischemic/reperfusion injury, we hypothesized that LPC may be of even greater benefit to the diabetic heart. Diabetes was induced by i.v. streptozotocin, 60 mg/kg; duration: 12 wks. The chronic effect of LPC was determined by daily i.p. injections (100 mg/kg) for 8 wks. The acute effects of LPC were determined by adding it to the perfusion medium (5 mM) of control and diabetic hearts. Initial cardiac contractile performance of isolated perfused working hearts was assessed by varying left atrial filling pressure. Hearts were then subjected to 90 min of low flow global ischemia followed by 30 min reperfusion. Chronic LPC treatment had no effect on initial cardiac performance in either control or diabetic hearts. Acute addition of LPC to the perfusion medium enhanced pump performance of control hearts, but had no effect in diabetic hearts. Both acute and chronic LPC significantly improved the ability of control and diabetic hearts to recover cardiac contractile performance after ischemia and reperfusion, however, chronic treatment was more effective in diabetic hearts.

Electrophysiologic evaluation of intravenous L-propionylcarnitine in man

L-propionylcarnitine, a short-chain acylcarnitine, has been shown in experimental studies to induce, during acidic and hypoxic conditions, some electrophysiological changes such as an increase of duration of the action potential and of the effective refractory period. In this study, the acute electrophysiological effects of intravenous L-propionylcarnitine (30 mg/kg in 3 min) were studied in 12 subjects with estimated normal function of the sinus node and normal parameters for atrioventricular conduction. Statistically significant changes were observed 2 min after infusion. The sinus cycle length shortened (866 +/- 138 vs 818 +/- 124 msec, P less than 0.05) while refractory periods of the atrioventricular node increased (effective by 30-50 msec in four cases; functional from 425 +/- 52 to 436 +/- 55 msec, P less than 0.05). Sinuatrial conduction time, atrial refractory periods, infranodal conduction, bundle branch, His-Purkinje system and ventricular refractoriness were unchanged. Systolic and diastolic blood pressure were also unchanged. Because of the limited effects on electrophysiological parameters, L-propionylcarnitine should be used as a metabolic drug even in patients with mild disturbances of conduction.

Lack of correlation between the antiarrhythmic effect of L-propionylcarnitine on reoxygenation-induced arrhythmias and its electrophysiological properties

1. The antiarrhythmic effect of L-propionylcarnitine (L-PC) was evaluated in the guinea-pig isolated heart; arrhythmias were induced with hypoxia followed by reoxygenation and by digitalis intoxication. 2. L-PC 1 microM, was found to be the minimal but effective antiarrhythmic concentration against reoxygenation-induced ventricular fibrillation. No antiarrhythmic effect was observed against digitalis-induced arrhythmias. D-Propionylcarnitine, L-carnitine and propionic acid did not exert antiarrhythmic effects. 3. During hypoxia and reoxygenation L-PC consistently prevented the rise of the diastolic left ventricular pressure, and significantly reduced the release of the cardiac enzymes creatine kinase (CK) and lactic dehydrogenase (LDH). 4. The electrophysiological effects of L-PC were then studied on either normal sheep cardiac Purkinje fibres or those manifesting oscillatory after potentials induced by barium or strophanthidin. 5. L-PC (1 and 10 microM) did not significantly modify action potential characteristics and contractility of normal Purkinje fibres, or the amplitude of OAP induced by strophanthidin or barium. 6. It is concluded that the antiarrhythmic action of L-PC on reoxygenation-induced arrhythmias is not correlated with its direct electrophysiological effects studied on normoxic preparations.