Dystrophic calcification of myocardium as conditioning factor in genesis of congestive heart failure. An experimental study

Quantification of the calcification phenotype of Abcc6-deficient mice with microcomputed tomography

Pseudoxanthoma elasticum in humans and dystrophic cardiac calcification in mice are heritable disorders characterized by dystrophic calcification of soft connective tissues related to the defective function of the ABCC6 (human)/Abcc6 (mouse) transporter. Of particular interest is the finding of calcified vibrissae in Abcc6(-/-) mice, which facilitates the study of dystrophic calcification by histological techniques. We aimed to determine whether mice prone to dystrophic cardiac calcification (C3H/HeOuJ and DBA/2J strains) presented similar vibrissae changes and to evaluate the value of microcomputed tomography to quantify the extent of mystacial vibrissae calcifications. These calcifications were absent in DBA/2J and C57BL/6J control mice. In both Abcc6(-/-) and C3H/HeOuJ mice, calcifications progressed in a caudal-rostral direction with aging. However, the calcification process was delayed in C3H/HeOuJ mice, indicating an incomplete expression of the calcification phenotype. We also found that the calcification process in the cephalic region was not limited to mystacial vibrissae but was also present in other periorbital sensorial vibrissae. The vibrissae calcification was circular and encompassed the medial region of the vibrissae capsule, adjacent to the ring and cavernous sinuses (the areas adjacent to blood and lymphatic vessels). Collectively, our findings confirm that Abcc6 acts as an inhibitor of spontaneous chronic mineralization and that microcomputed tomography is a valuable noninvasive tool for the assessment of the calcification phenotype in Abcc6-deficient mice.

Cell coupling and impulse propagation in the failing heart

Cell coupling and impulse propagation were investigated in the ventricle of cardiomyopathic hamsters at an advanced stage of heart failure. An appreciable decline in junctional conductance was found, a phenomenon in part related to activation of the plasma and cardiac renin-angiotensin systems. Decreased expression of connexin43 or an alteration of junctional proteins also might be implicated in the decreased cell coupling. Morphologic abnormalities such as fibrosis, necrosis, and rupture of cell contacts contribute to the decline of conduction velocity or to the blockade of impulse propagation in some areas of the ventricle, creating the conditions for anisotropic conduction and cardiac arrhythmias. The decrease in membrane potential found in myopathic cells is related in part to depression of Na-KATPase activity, and the lack of action of beta-adrenergic agonists on junctional conductance is explained by down-regulation of beta receptors and an abnormality of adenyl cyclase.

Correlation between changes in morphology, electrical properties, and angiotensin-converting enzyme activity in the failing heart

Evidence is available that morphologic and electrophysiologic abnormalities are present in the failing heart. In the present work, the progressive changes in electrical properties and morphology of the failing heart of Syrian cardiomyopathic hamsters (TO2) were investigated at different stages of the pathological process, and the possible role of the renin-angiotensin system was studied. Cardiomyopathic hamsters 2 and 11 months of age were used. Age-matched normal hamsters (F1B) were utilized as controls. Measurements of membrane potential, conduction velocity and refractoriness were made with conventional intracellular electrodes connected to a high impedance DC amplifier. Serum and cardiac angiotensin-converting enzyme (ACE) activities were measured in controls and cardiomyopathic animals. The results indicated that interstitial fibrosis and calcification were present in the heart of 2-month old Syrian cardiomyopathic hamsters. Measurements of the resting potential performed in the isolated right ventricle of 2-month old Syrian cardiomyopathic hamsters indicated an average value of -66.7 +/- 0.96 mV (n = 25); in the controls of the same age was -78.5 +/- 1 mV (n = 25, P < 0.05); and in 11-month old cardiomyopathic hamsters was -67.8 +/- 0.83 mV (n = 10). The duration of the action potential measured at 50 and 90% of repolarization in 2-month old hamsters was well above the controls. The conduction velocity measured in the isolated right ventricle of 2-month old Syrian cardiomyopathic hamsters (44.2 +/- 1.6 cm/s, n = 12) was not different from the control (43.7 +/- 1.1 cm/s, n = 7, P > 0.05) but was significantly larger than that recorded from the ventricle of 11-month old animals (37.8 +/- 2.9 cm/s, n = 11, P < 0.05). ACE activity was 0.26 +/- 0.01 nmol/mg x min in the heart of controls at 2 months of age and did not change with age. Although in the 2-month old cardiomyopathic hamsters the enzyme activity (0.28 +/- 0.04 nmol/mg x min) was not different from the controls (P > 0.05), in myopathic animals at 11 months of age, the enzyme activity (0.56 +/- 0.027 nmol/mg x min) was greater than controls (P < 0.05). The ACE activity in plasma followed the same pattern. The conclusion from these experiments is, that some parameters like resting potential, action potential duration, and morphological abnormalities appeared quite early in the failing process. The decline in conduction velocity, however, appeared later on, concurrently with the activation of plasma and cardiac renin-angiotensin systems.

Electrophysiologic and morphologic abnormalities in the failing heart: effect of enalapril on the electrical properties

BACKGROUND

Knowledge of the electrophysiologic abnormalities in the failing heart is meager. In this work morphologic and electrophysiologic changes were investigated in the cardiomyopathic hamster (BIO TO-2) at 11 months of age. The results were compared with control hamsters (F1B) of the same age.

METHODS AND RESULTS

Conventional KCl microelectrodes were used to measure membrane potential, conduction velocity, and refractoriness. Histologic studies consisted of Harris' hematoxylin and eosin, Masson trichrome, and von Kossa's calcium stain. The resting potential of myopathic fibers (-67.8 mV; SEM 1 0.83) in the cardiomyopathic hamsters was less negative than the control subjects' potential (-78.5 V; SEM + 1), and the action potential duration measured at 50% of repolarization was increased by 213%. The conduction velocity (36.9 cm/s) was 15.7% lower than that of the control subjects. Enalapril (50 micrograms/mL) caused a hyperpolarization of 6.8 mV, it increased the action potential duration at 90% of repolarization by 110%, and the conduction velocity of the myopathic fibers was appreciably increased compared to the control hamsters'. The refractoriness of myopathic and normal ventricular fibers was also increased by enalapril. Histologic studies performed on the right and left ventricular wall indicated interstitial fibrosis, necrotic foci, and extensive calcification.

CONCLUSIONS

The results indicate severe morphologic and electrophysiologic abnormalities in the failing ventricular muscle. The effect of enalapril on membrane potential and conduction velocity might indicate that the activation of the cardiac renin-angiotensin system during the process of heart failure is, in part, responsible for the abnormalities described here. The improvement of impulse propagation and the increase in refractoriness seem to represent important factors involved in the antiarrhythmic action of enalapril.

Renin-angiotensin system and cell communication in the failing heart

The influence of heart failure on the process of cell communication was investigated in cell pairs isolated from the ventricle of cardiomyopathic hamsters (11 months old) and the results compared with age-matched normal hamsters. The gap junctional conductance (gj) was measured with two voltage-clamp amplifiers. The results showed two major populations of cell pairs with respect to gj values: one with very low values (0.8 to 2.5 nS) and the other with higher values (7 to 35 nS). In normal hamsters, the most frequent gj values were in the range of 40 to 100 nS. Angiotensin II (Ang 11, 1 microg/mL) caused cell uncoupling in myopathic myocytes with low gj but reduced gj by 53 +/- 6.6 percent (+/- SE) in cell pairs with higher gj values (7 to 35 nS). The effect of Ang II on gj of myopathic cell pairs was suppressed by losartan (10(-7) mol/L). In cardiomyopathic cell pairs with low gj (0.8 to 2.5 nS), enalapril (1 microg/mL) caused an appreciable increase in gj (219 +/- 20.3 percent), whereas in cell pairs with higher gj (7 to 35 nS), the gj increment was smaller (80 +/- 10.8 percent) but still larger than that seen in controls (33 +/- 5.4 percent). Intracellular dialysis of Ang I (10(-8) mol/L) abolished cell communication in myopathic cell pairs with low gj (0.8 to 2.5 nS) and reduced gj by 66 +/- 1.7 percent in the other pairs (7 to 35 nS). The effect of Ang I on gj was greatly reduced by enalaprilat (10(-9) mol/L) added to the cytosol. Dialysis of Ang II (10(-8) mol/L) into the myopathic cell reduced gj by 48 +/- 4.2 percent, an effect abolished by losartan (10(-8) mol/L). The results indicate that the decline in gj seen in the ventricle of cardiomyopathic hamsters is in part due to activation of the cardiac renin-angiotensin system.

Impaired regulation of cell communication by beta-adrenergic receptor activation in the failing heart

We investigated the influence of beta-adrenergic receptor activation on the control of gap junctional conductance (gj) in the heart of cardiomyopathic hamsters (11 months old). We measured gj in isolated ventricular cell pairs using two voltage-clamp circuits. Administration of isoproterenol (10(-6) mol/L) to the bath had no effect on gj in myopathic cell pairs but increased gj by 45 +/- 3% (+/- SE) in normal hamsters. Moreover, forskolin (10(-7) mol/L), an activator of adenyl cyclase, did not change gj in myopathic cells but enhanced gj by 23 +/- 2.8% in controls. Similar results were obtained with isobutylmethylxanthine (10(-6) mol/L), a phosphodiesterase inhibitor. Dibutyryl-cAMP (10(-6) mol/L), however, increased gj of cardiomyopathic cell pairs by 58 +/- 2.1% within 2 minutes and enhanced gj in controls by 50 +/- 3.6%. The effect of dibutyryl-cAMP on gj of myopathic cells was suppressed by intracellular dialysis of an inhibitor of protein kinase A. These observations indicate that the regulation of gj by the beta-adrenergic receptor-G protein-adenyl cyclase signaling system is greatly impaired in the failing heart but the ability of cAMP to increase gj is still preserved.

Monoamines in the parabrachial nucleus of the cardiomyopathic hamster

The development of dystrophic cardiac muscle is related to increases in sympathetic nervous system activity but little is known regarding possible central neural mechanisms that may be involved in cardiomyopathy. The inbred cardiomyopathic hamster is an animal model for studying the development and mechanisms of necrosis in cardiac muscle which resemble non-vascular myocardial diseases of man. Because monoamines are known to play a major role in central regulation of the cardiovascular system, we compared the distribution and density of tyrosine hydroxylase (TH) and 5-hydroxytryptamine (5-HT) immunostaining in the brains of cardiomyopathic hamsters (strain CHF-146), a related strain (CHF-148) of non-cardiomyopathic albino hamsters, and golden Syrian hamsters for possible differences in neurochemical organization. At the time of sacrifice, the cardiomyopathic hamsters exhibit small, calcified lesions on the surface of the ventricular cardiac muscle (early necrotic phase). Brain sections from each group were processed identically and simultaneously. The results show that there were significant differences among strains in the parabrachial nucleus with respect to the two neurochemicals examined. In golden Syrian and albino hamsters, TH and 5-HT immunoreactive axons were lightly-to-moderately stained in the lateral parabrachial nucleus. In the cardiomyopathic hamster, there were significantly more densely stained TH and 5-HT immunoreactive axons in the lateral parabrachial nucleus, in particular the inner part of the external lateral subnucleus. Because the lateral parabrachial nucleus, including the external lateral subnucleus, is known to be involved in regulation of the cardiovascular system, the differential distribution of TH and 5-HT in the parabrachial nucleus of cardiomyopathic hamsters in comparison to normal hamsters suggests that the parabrachial nucleus could be involved in sympathetic mechanisms related to the development of necrosis in cardiac muscle of the cardiomyopathic hamster.

Altered lipid metabolism in the failing heart of cardiomyopathic hamsters (UM-X7.1)

The lipid composition of different anatomic regions of 150 day-old UM-X7.1 cardiomyopathic hamster and age-matched controls (Syrian golden hamsters) was examined. Cardiomyopathic hamsters exhibit a phospholipid to protein ratio higher than healthy animals in atria, whereas the contrary is true in the other anatomic regions examined. In all tissues the cholesterol to phospholipid ratio is higher in cardiomyopathic hamster than in controls. Healthy and UM-X7.1 hamsters differ substantially as far as the percent distribution of fatty acids in total lipids is concerned, the lipids from cardiomyopathic animals accumulating fatty acids of the omega-6 series and being relatively poor in monoenoic fatty acids. The different fatty acid composition of heart lipids appears to be a consequence of a generalized disturbance of the lipid metabolism in cardiomyopathic hamsters during congestive heart failure.

Improvement in myocardial performance without a decrease in high-energy phosphate metabolites after isoproterenol in Syrian cardiomyopathic hamsters

To determine the effect of isoproterenol on cardiac energetics and function in an animal preparation of cardiomyopathy, we studied Langendorff perfused hearts from Syrian cardiomyopathic hamsters. High-energy phosphate metabolites (phosphocreatine [PCr], ATP, inorganic phosphate [Pi]) and intracellular pH (pHi) were measured by 31P nuclear magnetic resonance spectroscopy and correlated with left ventricular developed pressure, coronary flow, and O2 consumption before and during a 10(-6)M infusion of isoproterenol. Total intracellular calcium was also determined by atomic absorption spectroscopy with the use of potassium ethylenediamine tetra-acetate cobaltate as a marker for extracellular space. In cardiomyopathic hamsters, isoproterenol infusion increased mean developed pressure by 300% (p less than .005 compared with control; n = 5), O2 consumption eightfold (p less than .0005), and PCr by 40% (p less than .05). PCr/Pi ratio, which is analogous to phosphorylation potential, improved 100% (p = .05). In normal hamsters, isoproterenol infusion resulted in an 83% increase in developed pressure (p less than .001) and a 25% increase in O2 consumption (NS). However, mean PCr and PCr/Pi decreased by 30% and 50%, respectively (p less than .05 for both), during isoproterenol infusion. pHi decreased in normal animals (p less than .01), but tended to improve in diseased animals (NS) during isoproterenol infusion. Freeze-clamp measurements of phosphate metabolites correlated well with the nuclear magnetic resonance data. Intracellular calcium increased from 0.0102 +/- 0.002 to 0.144 +/- 0.030 mumol/ml heart water in normal hamsters during isoproterenol infusion. Cardiomyopathic hamsters had a markedly elevated baseline calcium content of 60.82 +/- 5.85 mumol/ml heart water due to the presence of dystrophic calcification.(ABSTRACT TRUNCATED AT 250 WORDS)

Intracellular elemental content of cardiac and skeletal muscle of normal and dystrophic hamsters

To test the hypothesis that the genetic lesion causing muscular dystrophy might be reflected in an abnormal intracellular elemental content, the elemental content of individual cardiac and skeletal muscle fibers in 50-day-old male control and cardiomyopathic BIO 53.58 hamsters was determined. The technique of electron probe x-ray microanalysis of freeze-dried tissue was employed. No electrolyte content differences were found between control and diseased animals for nuclei, myofibrillar cytoplasm, or mitochondrially-enriched cytoplasm of cardiac myocytes. Sulfur was elevated in dystrophic cardiac myocytes and was the only element significantly different in heart tissue of control and cardiomyopathic animals. Sulfur was also elevated in dystrophic soleus muscle fibers. The pattern of electrolyte content of these cells reflected a mixture of normal cells and damaged cells with altered electrolyte content. In this hamster model, alteration of electrolyte content of myocytes appears to be a result of the disease process and not an inherent characteristic of muscular dystrophy. The elevated sulfur in dystrophic hamster myocytes reflects a biochemical lesion which deserves further study.

Verapamil preserves myocardial contractility in the hereditary cardiomyopathy of the Syrian hamster

We attempted to alter the inherited myocardial damage and loss of contractility of the cardiomyopathic Syrian hamster (strain U-MX7-1) by giving cardiac drugs that altered intracellular calcium and myocardial workload. Thirty-seven 21-day-old cardiomyopathic and thirty-seven 21-day-old normal hamsters were divided into five groups each: verapamil-, propranolol-, digoxin-, hydralazine-, and saline-injected. On their 90th day of life, the hamsters were killed. Of the five cardiomyopathic groups, only verapamil reduced myocardial damage. When both "control" and cardiomyopathic hamsters were treated with saline, digoxin, or propranolol, the cardiomyopathic hamsters had significantly less contractile force, maximal rate of force development, and maximum velocity of unloaded shortening. When both groups were treated with verapamil or hydralazine, there were no significant group differences in the indices of contractility. However, when saline-treated cardiomyopathic hamsters were compared with drug-treated cardiomyopathic hamsters, only verapamil preserved myocardial contractility. There was also a weak correlation between the Vmax and the actin-activated ATPase activity of the cardiomyopathic hamsters (r = 0.63, P less than 0.001). We conclude that verapamil helped protect the myocardium of genetically cardiomyopathic hamsters against structural damage, and helped preserve myocardial contractility.

Hereditary polymyopathy and cardiomyopathy in the Syrian hamster. II. Development of heart necrotic changes in relation to defective mitochondrial function

The mitochondrial oxidative phosphorylation, calcium and magnesium contents, and swelling-contraction activity were investigated in relation to the progression of the hereditary hamster cardiomyopathy. The assessment was made in animals between 22 and 232 days of age, which were divided into 7 groups according to stage of disease. In 24-day-old hamsters prior to development of heart necrotic changes, the membrane permeability of isolated mitochondria was altered. In 50-day-old animals, at a stage of disease when myocardial cells undergo degeneration, a defect of oxidative phosphorylation resulting from an increase in mitochondrial calcium was demonstrated. With culmination of the heart necrotic changes, at close to 100 days of age, mitochondrial dysfunction and calcium overload were maximal. There was a transient improvement during the healing stage, but the situation deteriorated with the occurrence of circulatory failure. Since the mitochondrial respiratory pattern and calcium overload parallel the cardiac degeneration, it is inferred that the cell energy depletion is a functional consequence of an abnormal calcium influx.

Development of necrosis and its sequelae in the myocardium of polymyopathic hamsters (BIO 8262). An electron microscopic study

Beginning about 30 days after birth, polymyopathic Syrian hamsters of the strain BIO 8262 develop calcifying myocardial necrosis. In the final stage the resorptive granulation tissue is followed by scars with multi-nucleated giant cells containing huge amorphous calcium plaques. The ultrastructural findings reveal the importance of myocardial mitochondria as starting points for calcification. The pattern of cell damage shows marked similarity to the changes observed in the myocardiocytes of magnesium-deficient rats. However, it is different from the alterations described in degenerating myocardiocytes of dehydrotachysterol-treated animals. Spicular electron-dense inclusions are the first and only kind of intramitochondrial calcification. Granular and annular-granular inclusions, as observed in ischaemic and infarcted canine myocardium, could not be detected, indicating that different pathogenetic mechanisms operate. The increased intracellular calcium level triggering myocardial necrosis is regarded as a secondary phenomenon, based on a genetic abnormality.

Excitation-contraction coupling in heart. VII. Calcium accumulation in subcellular particles in congestive heart failure

The ability of heavy microsomes and mitochondria, isolated from the control and failing hearts of genetically dystrophic hamsters (BIO 14.6 strain), to accumulate calcium was examined. The rate and extent of energy-linked calcium binding (in the absence of oxalate) by the heavy microsomes of the failing heart were markedly depressed. The calcium uptake (in the presence of 5 mM oxalate) by the heavy microsomes of the failing heart was similar to that of the control heart. On the other hand, both the rate and extent of energy-linked calcium binding (in the absence of Pi and succinate) and calcium uptake (in the presence of 4 mM Pi and 5 mM succinate) by mitochondria were greatly reduced in the failing heart in comparison to the control. No difference in the total adenosine triphosphatase activities (Ca(++)-Mg(++) stimulated) of heavy microsomes or mitochondria was observed between the control and failing hearts. These results indicate an abnormality of subcellular membranes of the failing heart to bind calcium and support the growing conviction concerning the defective "calcium pump" as a molecular abnormality associated with a moderate degree of congestive heart failure.