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Zhao T, Arbelet-Bonnin D, Tran D, Monetti E, Lehner A, Meimoun P, Kadono T, Dauphin A, Errakhi R, Reboutier D, Cangémi S, Kawano T, Mancuso S, El-Maarouf-Bouteau H, Laurenti P, Bouteau F. Biphasic activation of survival and death pathways in Arabidopsis thaliana cultured cells by sorbitol-induced hyperosmotic stress. PLANT SCIENCE : AN INTERNATIONAL JOURNAL OF EXPERIMENTAL PLANT BIOLOGY 2021; 305:110844. [PMID: 33691971 DOI: 10.1016/j.plantsci.2021.110844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
Hyperosmotic stresses represent some of the most serious abiotic factors that adversely affect plants growth, development and fitness. Despite their central role, the early cellular events that lead to plant adaptive responses remain largely unknown. In this study, using Arabidopsis thaliana cultured cells we analyzed early cellular responses to sorbitol-induced hyperosmotic stress. We observed biphasic and dual responses of A. thaliana cultured cells to sorbitol-induced hyperosmotic stress. A first set of events, namely singlet oxygen (1O2) production and cell hyperpolarization due to a decrease in anion channel activity could participate to signaling and osmotic adjustment allowing cell adaptation and survival. A second set of events, namely superoxide anion (O2-) production by RBOHD-NADPH-oxidases and SLAC1 anion channel activation could participate in programmed cell death (PCD) of a part of the cell population. This set of events raises the question of how a survival pathway and a death pathway could be induced by the same hyperosmotic condition and what could be the meaning of the induction of two different behaviors in response to hyperosmotic stress.
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Affiliation(s)
- Tingting Zhao
- Université de Paris, Laboratoire des Energies de Demain, Paris, France
| | | | - Daniel Tran
- former EA3514, Université Paris Diderot, Paris, France
| | - Emanuela Monetti
- former EA3514, Université Paris Diderot, Paris, France; LINV-DiSPAA, Department of Agri-Food and Environmental Science, University of Florence, Viale delle Idee 30, 50019, Sesto Fiorentino (FI), Italy
| | - Arnaud Lehner
- former EA3514, Université Paris Diderot, Paris, France
| | - Patrice Meimoun
- Université de Paris, Laboratoire des Energies de Demain, Paris, France; former EA3514, Université Paris Diderot, Paris, France; Université de Paris, Paris Interdisciplinary Energy Research Institute (PIERI), Paris, France
| | - Takashi Kadono
- former EA3514, Université Paris Diderot, Paris, France; Graduate School of Environmental Engineering, University of Kitakyushu, 1-1, Hibikino, Wakamatsu-ku, Kitakyushu 808-0135, Japan
| | | | - Rafik Errakhi
- former EA3514, Université Paris Diderot, Paris, France
| | | | - Sylvie Cangémi
- Université de Paris, Laboratoire des Energies de Demain, Paris, France
| | - Tomonori Kawano
- LINV-DiSPAA, Department of Agri-Food and Environmental Science, University of Florence, Viale delle Idee 30, 50019, Sesto Fiorentino (FI), Italy; Graduate School of Environmental Engineering, University of Kitakyushu, 1-1, Hibikino, Wakamatsu-ku, Kitakyushu 808-0135, Japan; University of Florence LINV Kitakyushu Research Center (LINV@Kitakyushu), Kitakyushu, Japan; Université de Paris, Paris Interdisciplinary Energy Research Institute (PIERI), Paris, France
| | - Stefano Mancuso
- LINV-DiSPAA, Department of Agri-Food and Environmental Science, University of Florence, Viale delle Idee 30, 50019, Sesto Fiorentino (FI), Italy; University of Florence LINV Kitakyushu Research Center (LINV@Kitakyushu), Kitakyushu, Japan; Université de Paris, Paris Interdisciplinary Energy Research Institute (PIERI), Paris, France
| | | | - Patrick Laurenti
- Université de Paris, Laboratoire des Energies de Demain, Paris, France
| | - François Bouteau
- Université de Paris, Laboratoire des Energies de Demain, Paris, France; former EA3514, Université Paris Diderot, Paris, France; LINV-DiSPAA, Department of Agri-Food and Environmental Science, University of Florence, Viale delle Idee 30, 50019, Sesto Fiorentino (FI), Italy; University of Florence LINV Kitakyushu Research Center (LINV@Kitakyushu), Kitakyushu, Japan.
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Han SS, Lee DE, Shim HE, Lee S, Jung T, Oh JH, Lee HA, Moon SH, Jeon J, Yoon S, Kim K, Kang SW. Physiological Effects of Ac4ManNAz and Optimization of Metabolic Labeling for Cell Tracking. Theranostics 2017; 7:1164-1176. [PMID: 28435456 PMCID: PMC5399584 DOI: 10.7150/thno.17711] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022] Open
Abstract
Metabolic labeling techniques are powerful tools for cell labeling, tracking and proteomic analysis. However, at present, the effects of the metabolic labeling agents on cell metabolism and physiology are not known. To address this question, in this study, we analyzed the effects of cells treated with Ac4ManNAz through microarray analysis and analyses of membrane channel activity, individual bio-physiological properties, and glycolytic flux. According to the results, treatment with 50 μM Ac4ManNAz led to the reduction of major cellular functions, including energy generation capacity, cellular infiltration ability and channel activity. Interestingly, 10 μM Ac4ManNAz showed the least effect on cellular systems and had a sufficient labeling efficiency for cell labeling, tracking and proteomic analysis. Based on our results, we suggest 10 μM as the optimum concentration of Ac4ManNAz for in vivo cell labeling and tracking. Additionally, we expect that our approach could be used for cell-based therapy for monitoring the efficacy of molecule delivery and the fate of recipient cells.
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Pérez-Verdaguer M, Capera J, Serrano-Novillo C, Estadella I, Sastre D, Felipe A. The voltage-gated potassium channel Kv1.3 is a promising multitherapeutic target against human pathologies. Expert Opin Ther Targets 2015; 20:577-91. [DOI: 10.1517/14728222.2016.1112792] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
The field of mitochondrial ion channels has recently seen substantial progress, including the molecular identification of some of the channels. An integrative approach using genetics, electrophysiology, pharmacology, and cell biology to clarify the roles of these channels has thus become possible. It is by now clear that many of these channels are important for energy supply by the mitochondria and have a major impact on the fate of the entire cell as well. The purpose of this review is to provide an up-to-date overview of the electrophysiological properties, molecular identity, and pathophysiological functions of the mitochondrial ion channels studied so far and to highlight possible therapeutic perspectives based on current information.
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Lui S, Jones RL, Robinson NJ, Greenwood SL, Aplin JD, Tower CL. Detrimental effects of ethanol and its metabolite acetaldehyde, on first trimester human placental cell turnover and function. PLoS One 2014; 9:e87328. [PMID: 24503565 PMCID: PMC3913587 DOI: 10.1371/journal.pone.0087328] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/20/2013] [Indexed: 01/08/2023] Open
Abstract
Fetal alcohol spectrum disorder (FASD) describes developmental issues from high maternal alcohol intake, which commonly results in fetal growth restriction and long term morbidity. We aimed to investigate the effect of alcohol and acetaldehyde, on the first trimester placenta, the period essential for normal fetal organogenesis. Normal invasion and establishment of the placenta during this time are essential for sustaining fetal viability to term. We hypothesise that alcohol (ethanol) and acetaldehyde have detrimental effects on cytotrophoblast invasion, turnover and placental function. Taurine is an important amino acid for neuronal and physiological development, and so, its uptake was assayed in cells and placental explants exposed to alcohol or acetaldehyde. First trimester villous explants and BeWo cells were treated with 0, 10, 20, 40 mM ethanol or 0, 10, 20, 40 µM acetaldehyde. The invasive capacity of SGHPL4, a first trimester extravillous cytotrophoblast cell line, was unaffected by ethanol or acetaldehyde (p>0.05; N = 6). The cells in-cycle were estimated using immunostaining for Ki67. Proliferating trophoblast cells treated with ethanol were decreased in both experiments (explants: 40% at 20 mM and 40 mM, p<0.05, N = 8–9) (cell line: 5% at 20 mM and 40 mM, p<0.05, N = 6). Acetaldehyde also reduced Ki67-positive cells in both experiments (explants at 40 µM p<0.05; N = 6) (cell line at 10 µM and 40 µM; p<0.05; N = 7). Only in the cell line at 20 µM acetaldehyde demonstrated increased apoptosis (p<0.05; N = 6). Alcohol inhibited taurine transport in BeWo cells at 10 mM and 40 mM (p<0.05; N = 6), and in placenta at 40 mM (p<0.05; N = 7). Acetaldehyde did not affect taurine transport in either model (P<0.05; N = 6). Interestingly, system A amino acid transport in placental explants was increased at 10 µM and 40 µM acetaldehyde exposure (p<0.05; N = 6). Our results demonstrate that exposure to both genotoxins may contribute to the pathogenesis of FASD by reducing placental growth. Alcohol also reduces the transport of taurine, which is vital for developmental neurogenesis.
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Affiliation(s)
- Sylvia Lui
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
- * E-mail:
| | - Rebecca L. Jones
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Nathalie J. Robinson
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Susan L. Greenwood
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - John D. Aplin
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Clare L. Tower
- Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, St. Mary’s Hospital, Manchester, United Kingdom
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Renaudo A, L'Hoste S, Guizouarn H, Borgèse F, Soriani O. Cancer cell cycle modulated by a functional coupling between sigma-1 receptors and Cl- channels. J Biol Chem 2007; 282:2259-67. [PMID: 17121836 DOI: 10.1074/jbc.m607915200] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The sigma-1 receptor is an intracellular protein characterized as a tumor biomarker whose function remains mysterious. We demonstrate herein for the first time that highly selective sigma ligands inhibit volume-regulated chloride channels (VRCC) in small cell lung cancer and T-leukemia cells. Sigma ligands and VRCC blockers provoked a cell cycle arrest underlined by p27 accumulation. In stably sigma-1 receptor-transfected HEK cells, the proliferation rate was significantly lowered by sigma ligands when compared with control cells. Sigma ligands produced a strong inhibition of VRCC in HEK-transfected cells but not in control HEK. Surprisingly, the activation rate of VRCC was dramatically delayed in HEK-transfected cells in the absence of ligands, indicating that sigma-1 receptors per se modulate cell regulating volume processes in physiological conditions. Volume measurements in hypotonic conditions revealed indeed that the regulatory volume decrease was delayed in HEK-transfected cells and virtually abolished in the presence of igmesine in both HEK-transfected and T-leukemic cells. Moreover, HEK-transfected cells showed a significant resistance to staurosporine-induced apoptosis volume decrease, indicating that sigma-1 receptors protect cancer cells from apoptosis. Altogether, our results show for the first time that sigma-1 receptors modulate "cell destiny" through VRCC and cell volume regulation.
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Affiliation(s)
- Adrien Renaudo
- UNSA CNRS UMR 6548, Laboratoire de Physiologie Cellulaire & Moléculaire des Systèmes Intégrés, Université de Nice Sophia-Antipolis, 06108 Nice Cedex 2, France
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Abstract
Diabetes mellitus is a devastating metabolic disease caused by either insulin deficiency or resistance and characterised by abnormal glucose, protein and lipid metabolism. It affects > 150 million people worldwide, 14 million in the US alone (90% Type II and 10% Type I) where it accounts for approximately 15% of healthcare expenditure. Insulin resistance is a cardinal feature of Type II diabetes. The molecular mechanisms that mediate insulin resistance are under intense scrutiny, and a major goal of this effort is to uncover potential therapeutic targets. Recent data indicate that the voltage-gated potassium channel, Kv1.3, is an important regulator of peripheral insulin sensitivity and glucose metabolism. Indeed, Kv1.3 channel inhibition increases insulin sensitivity by decreasing inflammatory cytokines and by facilitating the translocation of GLUT4 to the plasma membrane. In light of these novel findings, the author believes that Kv1.3 is a promising target for the development of drugs useful in the management of insulin resistance and diabetes.
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Affiliation(s)
- Gary V Desir
- Department of Medicine, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208029 New Haven, CT, USA.
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Abstract
Currently, the drug therapy of schizophrenia consists of blockade of central dopamine D2 receptors. There is, however, an urgent medical need for alternative, more effective treatments. Clinical and preclinical literature suggests that stimulation of AMPA-type glutamate receptors may be involved in positive symptoms of schizophrenia, whereas hypofunctionality of NMDA-type glutamate receptors may be involved in negative symptoms and cognitive deficits. Several pharmacological approaches are conceivable to prevent stimulation of AMPA receptors (AMPA receptor blockade, metabotropic glutamate receptors (mGlu(2) receptor) stimulation or lamotrigine-like Na(+)/Ca(2+) channel blockade). Similarly, several pharmacological principles are conceivable to enhance neurotransmission at NMDA receptors (catechol-o-methyl transferase inhibition, glycine uptake blockade, glutathione suppletion and others). In this review, the possible pharmacological approaches and their respective advantages and disadvantages are discussed.
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MESH Headings
- Amino Acid Transport System X-AG/antagonists & inhibitors
- Animals
- Antipsychotic Agents/classification
- Antipsychotic Agents/pharmacology
- Antipsychotic Agents/therapeutic use
- Brain Chemistry/drug effects
- Dopamine D2 Receptor Antagonists
- Drug Design
- Drug Evaluation, Preclinical
- Excitatory Amino Acid Agonists/pharmacology
- Excitatory Amino Acid Agonists/therapeutic use
- Excitatory Amino Acid Antagonists/pharmacology
- Excitatory Amino Acid Antagonists/therapeutic use
- Female
- Frontal Lobe/drug effects
- Frontal Lobe/metabolism
- Glutamate Plasma Membrane Transport Proteins
- Glutamic Acid/cerebrospinal fluid
- Glutamic Acid/physiology
- Humans
- Interneurons/drug effects
- Interneurons/metabolism
- Ketamine/adverse effects
- Ketamine/pharmacology
- Lamotrigine
- Pregnancy
- Prenatal Exposure Delayed Effects
- Rats
- Receptor, Metabotropic Glutamate 5
- Receptors, AMPA/antagonists & inhibitors
- Receptors, GABA/drug effects
- Receptors, GABA/physiology
- Receptors, Glutamate/drug effects
- Receptors, Glutamate/physiology
- Receptors, Metabotropic Glutamate/agonists
- Receptors, N-Methyl-D-Aspartate/agonists
- Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors
- Receptors, Neurotransmitter/drug effects
- Receptors, Neurotransmitter/physiology
- Schizophrenia/drug therapy
- Schizophrenia/etiology
- Schizophrenia/metabolism
- Schizophrenia/pathology
- Symporters/antagonists & inhibitors
- Triazines/pharmacology
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Affiliation(s)
- Hans O Kalkman
- Novartis Pharma AG, Research Nervous System, Building WSJ-360-405, CH-4002 Basel, Switzerland.
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9
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Vu CC, Bortner CD, Cidlowski JA. Differential involvement of initiator caspases in apoptotic volume decrease and potassium efflux during Fas- and UV-induced cell death. J Biol Chem 2001; 276:37602-11. [PMID: 11431480 DOI: 10.1074/jbc.m104810200] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Caspase activation and apoptotic volume decrease are fundamental features of programmed cell death; however, the relationship between these components is not well understood. Here we provide biochemical and genetic evidence for the differential involvement of initiator caspases in the apoptotic volume decrease during both intrinsic and extrinsic activation of apoptosis. Apoptosis induction in Jurkat T lymphocytes by Fas receptor engagement (intrinsic) or ultraviolet (UV)-C radiation (extrinsic) triggered the loss of cell volume, which was restricted to cells with diminished intracellular K(+) ions. These characteristics kinetically coincided with the proteolytic processing and activation of both initiator and effector caspases. Although the polycaspase inhibitor benzyloxycarbonyl-Val-Ala-Asp fluoromethyl ketone completely inhibited the Fas-mediated apoptotic volume decrease and K(+) efflux, it was much less effective in preventing these processes during UV-induced cell death under conditions whereby caspase activities and DNA degradation were blocked. To define the roles of specific initiator caspases, we utilized Jurkat cells genetically deficient in caspase-8 or stably transfected with a dominant-negative mutant of caspase-9. The results show that the activation of caspase-8, but not caspase-9, is necessary for Fas-induced apoptosis. Conversely, caspase-9, but not caspase-8, is important for UV-mediated shrunken morphology and apoptosis progression. Together, these findings indicate that cell shrinkage and K(+) efflux during apoptosis are tightly coupled, but are differentially regulated by either caspase-8 or caspase-9 depending on specific pathways of cell death.
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Affiliation(s)
- C C Vu
- Laboratory of Signal Transduction, NIEHS, National Institutes of Health, Research Triangle Park, North Carolina 27709, USA
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Lobo MV, Alonso FJ, Latorre A, del Río RM. Immunohistochemical localization of taurine in the rat ovary, oviduct, and uterus. J Histochem Cytochem 2001; 49:1133-42. [PMID: 11511682 DOI: 10.1177/002215540104900907] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The distribution of the amino acid taurine in the female reproductive organs has not been previously analyzed in detail. The aim of this study was to determine taurine localization in the rat ovary, oviduct, and uterus by immunohistochemical methods. Taurine was localized in the ovarian surface epithelium. The granulosa cells and oocytes of primordial follicles were immunonegative. In primary and antral follicles, taurine was found mainly in theca cells and oocytes, whereas the zona pellucida, antrum, and most granulosa cells were unstained. However, taurine immunoreactivity in theca cells and oocytes decreased during follicular atresia. During corpora lutea development, the number of immunopositive theca lutein cells increased as these cells invaded the granulosa-derived region. Therefore, most luteal cells from the mature corpora lutea were stained. In the regressing corpora lutea, however, taurine staining in luteal cells decreased. In the fimbriae, infundibulum, and uterotubal junction, taurine was localized in most epithelial cells. In the ampullar and isthmic segments, taurine was found in the cilia of most ciliated cells and in the apical cytoplasm of some non-ciliated cells. In the uterus, most epithelial cells were immunopositive during diestrus and metestrus, whereas most of them were immunonegative during estrus and proestrus. Moreover, taurine immunoreactivity in the oviduct and uterus decreased with pregnancy. (J Histochem Cytochem 49:1133-1142, 2001)
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Affiliation(s)
- M V Lobo
- Servicio de Neurobiología, Departamento de Investigación, Hospital Ramón y Cajal, Universidad de Alcalá, Alcalá de Henares, 28034 Madrid, Spain.
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Nishimura Y, Lemasters JJ. Glycine blocks opening of a death channel in cultured hepatic sinusoidal endothelial cells during chemical hypoxia. Cell Death Differ 2001; 8:850-8. [PMID: 11526438 DOI: 10.1038/sj.cdd.4400877] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2000] [Revised: 01/03/2001] [Accepted: 03/02/2001] [Indexed: 11/08/2022] Open
Abstract
Using confocal microscopy, we investigated mechanisms underlying loss of plasma membrane integrity during necrotic death of cultured hepatic sinusoidal endothelial cells exposed to 2.5 mM potassium cyanide (chemical hypoxia). After 2-3 h, the anionic fluorophore calcein abruptly began to enter the cytosol, and nuclei labeled with cationic propidium after another 2-5 min. As calcein permeated, growth of blebs on the plasma membrane accelerated. Lucifer yellow, another anionic fluorophore, entered identically to calcein, whereas high molecular weight dextrans (40-2000 kDa) entered like propidium. Glycine slowed, but did not prevent calcein entry, whereas permeation of propidium and high molecular weight dextrans was blocked completely by glycine. These findings suggest that opening of a glycine-sensitive organic anion channel, or death channel, precipitates a metastable state characterized by rapid cell swelling and bleb growth. This metastable state culminates in non-specific breakdown of the plasma membrane permeability barrier and irreversible cell death.
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Affiliation(s)
- Y Nishimura
- Department of Cell Biology & Anatomy, School of Medicine, University of North Carolina at Chapel Hill, 27599-7090, USA
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Zemgulis V, Wikström G, Henze A, Waldenström A, Thelin S, Ronquist G. Nucleoside transport inhibition in ischemic myocardium results in enhanced taurine efflux. Eur J Pharmacol 2001; 411:143-154. [PMID: 11137869 DOI: 10.1016/s0014-2999(00)00844-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We measured with the microdialysis technique energy-related metabolites in ischemic myocardium over time in an experimental pig model. Emphasis was put on the dipyridamole effect when administered in the microdialysis probe inserted in ischemic myocardium. Not only adenosine but also taurine and pyruvate concentrations were significantly higher in the microdialysate during the periods of ischemia and extracorporeal circulation with cardioplegia. The enhanced efflux of taurine in ischemic myocardium induced by dipyridamole is a new finding. A mechanistic role of taurine in the prevention of Ca(2+) overload in ischemic myocytes is discussed. Also, taurine may have stimulatory effects on glycolysis in ischemic heart.
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Affiliation(s)
- V Zemgulis
- Department of Cardiothoracic Surgery, University Hospital, S-751 85, Uppsala, Sweden.
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