Influence of thyroid hormone on the positive inotropic effects mediated by alpha- and beta-adrenoceptors in isolated guinea pig atria and rabbit papillary muscles

Acute right ventricular failure evoked by trauma induced thyroid storm supported by extracorporeal membrane oxygenation: A case report

RATIONALE

Cardiac arrest due to thyroid storm is a very rare clinical feature with high mortality that presents as multiorgan dysfunction. The mortality rate under this condition is close to 30%, even with appropriate treatment. Most thyroid storms occur in patients with long-standing untreated hyperthyroidism.

PATIENT CONCERNS

A 67-year-old woman, who had no specific medical history, was admitted with stupor mentality after a pedestrian traffic accident.

DIAGNOSIS

The patient had a Burch and Wartofsky score of 80, well beyond the criteria for diagnosis of a thyroid storm (>45 points).

INTERVENTIONS

Venoarterial extracorporeal membrane oxygenation (ECMO) was performed due to persistent unstable vital signs and findings of right ventricular dysfunction after return of spontaneous circulation after cardiopulmonary resuscitation. Circulatory assist with ECMO was performed for 8 days using a beta blocker, steroids, thionamide, and Lugol iodine solution.

OUTCOMES

Myocardial function and thyroid hormone levels were rapidly normalized. The patient's mental state recovered, and patient was discharged on day 36 maintaining medication.

LESSONS

Diagnosis of a thyroid storm in patients with multiple trauma is very difficult, because most trauma patients have symptoms of tachycardia, altered mental status, and abdominal pain that appear in thyrotoxic events. However, when unexplained shock without bleeding evidence occurs in patients with multiple trauma, a thyroid function test should be performed to rule out thyroid storm. Moreover, if hyperthyroidism is observed in a trauma patient, even if there is no history of hyperthyroidism, the possibility of a thyroid storm must be considered along with medical support treatment such as ECMO in patient with cardiogenic shock.

Case report: a patient with thyroid storm, refractory cardiogenic shock, and cardiac arrest treated with Lugol's iodine solution and veno-arterial extra corporal membrane oxygenation support

Background

Thyroid storm is a life-threatening condition. Refractory cardiogenic shock and cardiac arrest are rare complications of thyroid storm and the treatment options are limited.

Case summary

A 35-year- old woman treated for Grave’s disease was admitted with thyrotoxicosis complicated by infection and neutropenia caused by thionamide treatment. After treatment including beta-blockers, steroids, and Lugol’s iodine solution, she went into cardiac arrest. Echocardiography after resuscitation demonstrated severe biventricular heart failure. The patient was in refractory cardiogenic shock with recurrent cardiac arrest and mechanical circulatory support with a veno-arterial extra corporal membrane oxygenation (V-A ECMO) circuit was established. After 2 days on V-A ECMO and supportive treatment with iodine solution, glucocorticosteroids, and levosimendan, her myocardial function recovered and thyroid hormone levels were normalized. Veno-arterial extra corporal membrane oxygenation was discontinued, and the patient was treated with early total thyroidectomy. The patient made a full recovery with no neurological/cognitive impairment, as assessed after 4 weeks.

Discussion

Adverse reactions to standard treatment of hyperthyroidism contributed to this patient’s development of thyroid storm and the following refractory cardiogenic shock. When she was critically unstable, levosimendan improved myocardial function while inotropic support with dobutamine was ineffective, likely due to prolonged beta-antagonist administration. Temporary support with V-A ECMO, until effective lowering of thyroid hormone levels and improvement in myocardial function were obtained, was life-saving in this young patient and may be considered in refractory cardiogenic shock caused by thyroid storm.

Updates on Thyroid Disease in Rabbits and Guinea Pigs

Hyperthyroidism seems to be a rare, but likely underdiagnosed disease of guinea pigs (Cavia porcellus) and rabbits (Oryctolagus cuniculus). Diagnosis is confounded by nonspecific clinical signs, lack of validated assays, and species-specific reference intervals. With increasing English-language publications on the topic, naturally occurring thyroid disease is likely to be increasingly diagnosed in exotic small mammals. The most consistently observed clinical signs include weight loss with or without a change in appetite and a palpable cervical mass. Diagnosis is supported by elevated blood thyroxine concentrations. Treatment may include thyreostatic agents, radioactive iodine, or surgical thyroidectomy.

Myocardial Rac1 exhibits partial involvement in thyroxin-induced cardiomyocyte hypertrophy and its inhibition is not sufficient to improve cardiac dysfunction or contractile abnormalities in mouse papillary muscles

: Development of cardiac hypertrophy after thyroxin (T4) treatment is well recognized. Recently, we observed that T4-induced cardiac hypertrophy is associated with increased cardiac Rac1 expression and activity. Whether this Rac1 increase has a role in inducing this cardiac phenotype is, however, still unknown. Here, we showed that T4 treatment (500 µg/kg/d) for 2 weeks resulted in increased myocardial Rac1 activity with subsequent hypertension, cardiac hypertrophy, and left ventricular systolic dysfunction in vivo. Isolated right ventricular papillary muscles of T4-treated mice maintained their peak isometric active developed tension but exhibited significant decreases in their corresponding time to peak and in relaxation times. Positive inotropic responses to increasing pacing rate and β-adrenergic stimulation were also depressed in these muscles. Pravastatin (10 mg/kg/d), a Rac1 inhibitor, significantly decreased myocardial Rac1 activity, hypertension, and cardiomyocyte size in T4-treated mice but could not attenuate gross heart weight or functional cardiac changes in these mice. Our data showed that T4 could activate different signaling pathways with distinct cardiovascular outcomes. We also provide the first mechanistic evidence for the partial involvement of Rac1 activation in T4-induced cardiomyocyte hypertrophy and reveal a putative role for Rac1 in the development of T4-induced hypertension.

Thyroid hormone modulates inotropic responses, alpha-adrenoceptor density and catecholamine concentrations in the rat heart

We investigated the influence of hyper- and hypothyroidism on basal parameters of isolated perfused hearts of rats. In addition the effects of different extracellular calcium concentrations ([Ca2+]o), the calcium entry promoter Bay K8644 and the alpha 1-adrenoceptor agonist methoxamine were investigated. Since alterations in alpha-adrenoceptor density could explain the increased sensitivity to methoxamine in hearts from hypothyroid rats, alpha 1-adrenoceptor density in the left ventricle was also established. Different time-schedules of exposure to hyper- and hypothyroidism were used to investigate whether the influence of chronic dysthyroid states on alpha 1-adrenoceptor density is transient and time-dependent. Simultaneously myocardial noradrenaline and adrenaline tissue concentrations were determined, since they might correlate with the observed changes. Hyperthyroidism was induced by feeding rats for 1, 4 and 8 weeks with 5 mg/kg L-thyroxine (T4)-containing rat chow. Hypothyroid rats were obtained by adding 0.05% propylthiouracil (PTU) to the drinking water during 1, 4 and 8 weeks. For the functional experiments animals were treated during 4 weeks, to mimic the clinical situation of a chronic endocrine disease. Langendorff hearts from hyperthyroid hearts showed an increased maximally developed relaxation velocity, whereas Langendorff hearts from hypothyroid rats showed an increased left ventricular pressure (LVP). We observed an increased maximal inotropic response to [Ca2+]o in hearts from both hyperthyroid and hypothyroid rats, indicating that both dysthyroid states interfere with the handling of calcium ions by the contractile apparatus. Unchanged responses to Bay K8644 in hearts from hyperthyroid and depressed responses in hearts from hypothyroid rats suggest that the involvement of L-type calcium channels is rather unlikely. Furthermore, the reflex increase in coronary flow in response to enhanced contractile force appeared to fail in hearts from hypothyroid rats. Sensitivity of the response to methoxamine was increased in hearts from hypothyroid rats, which was accompanied by a decrease in the number of myocardial alpha 1-adrenoceptors. Both T4 and PTU treatment resulted in a non-transient decrease of alpha 1-adrenoceptor density in left ventricular tissue. Furthermore, hypothyroidism increased the percentage of alpha 1A-binding sites, whereas in hyperthyroidism the distribution of the alpha 1-adrenoceptor subtypes was not affected. Myocardial tissue concentrations of noradrenaline and adrenaline were unchanged in hyperthyroid rats and decreased in hypothyroid rats. The present study indicates that thyroid hormones have a direct rather than a sympathetically mediated effect on alpha 1-adrenoceptor mediated myocardial functions.

Mechanism of hyperthyroidism-induced modulation of the L-type Ca2+ current in guinea pig ventricular myocytes

The positive inotropic effects of thyroid hormone in the heart, increased force and velocity of contraction have been mostly attributed to modulation of myosin ATPase isoenzymes (V1, V2 and V3), and sarcoplasmic reticulum Ca2+ pumping activity. In addition, we have suggested that the effects on ventricular contraction result from a thyroid hormone-induced increase in L-type Ca2+ current (ICa,L). Due to the central role of ICa,L in excitation-contraction coupling, we studied mechanisms whereby thyroid hormone augments this current. Since thyroid hormone modulates adenylate cyclase activity in various tissues, we tested the hypothesis that the hormone activates adenylate cyclase, leading to increased cyclic adenosine monophosphate (cAMP) levels, protein kinase A activation, Ca2+ channel phosphorylation and increased ICa,L. We therefore stimulated or inhibited different sites along the "adenylate cyclase cascade", and measured ICa,L and isometric twitch in ventricular myocytes and papillary muscles from euthyroid and hyperthyroid guinea pigs. Our major findings were as follows. In euthyroid myocytes, 0.1 microM isoproterenol (Iso) increased ICa,L (at VM = 0 mV) from -7.04 +/- 0.72 to -22.26 +/- 1.88 pA/pF, P < 0.05, while in hyperthyroid myocytes (ICa,L = -21.48 +/- 2.94 pA/pF), Iso was ineffective. In euthyroid myocytes, intracellular application of cAMP (50 microM) was as potent as Iso, but ineffective in hyperthyroid myocytes. In hyperthyroid myocytes, a protein kinase A inhibitor (2 microM) lowered ICa,L from -26.82 +/- 1.54 to -10.17 +/- 1.70 pApF (P < 0.05), but had no effect in euthyroid myocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Alterations of responsiveness to adrenoceptor agonists and calcium of non-infarcted hypertrophied muscles from rats with chronic myocardial infarction

1. The responsiveness of hypertrophied right ventricular muscle from rats with chronic myocardial infarction (MI) was examined. Myocardial infarction was produced by ligating the left coronary artery. The positive inotropic effects of alpha- and beta-adrenoceptor agonists and calcium on the isolated non-ischaemic muscles were determined at one and four weeks after ligation, and were compared with those in sham-operated (SO) rats. 2. The contractile force of electrically-driven right ventricular papillary muscles was measured isometrically. We also determined the change of beating rate of the right atrium in response to a beta-adrenoceptor agonist. 3. Basal contractile force increased at four weeks after ligation. 4. The pEC50 values of the alpha 1-adrenoceptor agonist, methoxamine, and calcium increased at four weeks after ligation, but the pEC50 values of the beta-adrenoceptor agonist, dobutamine did not change. 5. Maximal contractile force did not change with these agonists at either one and four weeks after ligation. 6. Tissues from rats four weeks after MI exhibited slight increases in the Bmax of alpha- but not beta-receptors, without any changes of affinity. 7. The increases in the sensitivity to an alpha 1-adrenoceptor agonist and calcium may be compensatory mechanisms of non-infarcted ventricular tissue which has undergone hypertrophy in chronic MI.

Whether phenylephrine exerts inotropic effects through alpha- or beta-adrenoceptors depends upon the relative receptor populations

Phenylephrine produced concentration-related positive inotropic responses in isolated left atria and papillary muscles of guinea-pigs and rats. In rat tissues, these responses were unaffected by propranolol but antagonized by prazosin and therefore mediated via alpha 1-adrenoceptors. The alpha 1-adrenoceptor agonist methoxamine also exerted positive inotropic effects in these rat tissues. The maximum alpha-adrenoceptor-mediated effect of methoxamine (relative to the isoprenaline maximum) was greater than that of phenylephrine in left atria (in the presence of propranolol), whereas in papillary muscles phenylephrine exerted the greater maximum. In guinea-pig papillary muscles, the response to phenylephrine was unaffected by prazosin but was antagonized by propranolol and therefore caused by stimulation of beta-adrenoceptors. Methoxamine had no effect in guinea-pig papillary muscles. Guinea-pig left atria produced biphasic concentration-response curves for phenylephrine, the lower portion being antagonized by phentolamine and was therefore alpha-adrenoceptor-mediated, while the upper portion was antagonized by propranolol and therefore beta-adrenoceptor-mediated. Methoxamine exerted a small inotropic response, the maximum of which was similar to that of the first component of the phenylephrine response. Phenylephrine was a partial agonist for the cardiac beta-adrenoceptor. The density of rat ventricular alpha-adrenoceptors was 4 times greater than beta-adrenoceptor density, as measured by [3H]-prazosin and [3H]-dihydroalprenolol binding. This explains why the responses of rat papillary muscles were alpha-adrenoceptor-mediated. In contrast, the density of beta-adrenoceptor binding sites in guinea-pig ventricles was 6 times greater than the alpha-adrenoceptor density. This explains why the phenylephrine responses were beta-adrenoceptor-mediated in guinea-pig papillary muscles. In the left atria of guinea-pigs, which displayed both alpha- and beta-adrenoceptor-mediated responses, the densities of alpha- and beta-adrenoceptor binding sites were similar. Thus, phenylephrine exerts positive inotropic effects through alpha- or beta-adrenoceptors depending upon their relative densities.

Electrophysiological abnormalities and enhanced reperfusion arrhythmias in the isolated hearts of hyperthyroid rats

1. The influence of hyperthyroidism on electrophysiological characteristics and on reperfusion arrhythmias was examined in rat hearts. 2. Electrophysiological studies were performed with glass microelectrodes, and the experiments on reperfusion arrhythmias were done in isolated perfused hearts. 3. Ventricular muscle from hyperthyroid rats was more prone than that from euthyroid rats to develop triggered activity under conditions believed to cause myoplasmic Ca2+ overload. 4. The severity of reperfusion arrhythmias was significantly enhanced in hyperthyroid preparations as compared with euthyroid ones. 5. The enhanced reperfusion arrhythmias in hyperthyroid rats were significantly reduced by propranolol (3 x 10(-7) M), lignocaine (1 x 10(-5) M) and verapamil (3 x 10(-8) M), but not by nadolol (3 x 10(-7) M) or prazosin (3 x 10(-7) M). 6. These results suggest that increased heart rate due to hyperthyroidism and responses mediated via either alpha- or beta-adrenoceptors were not dominant causes of enhanced reperfusion arrhythmias in hyperthyroid hearts. 7. The increased tendency to develop triggered activity which was observed in the electrophysiological study, may be one possible explanation of enhanced reperfusion arrhythmias in hyperthyroid hearts.

Adrenaline increases the rate of cycling of crossbridges in rat cardiac muscle as measured by pseudo-random binary noise-modulated perturbation analysis

The mechanism of action of adrenaline on cardiac contractility in rat papillary muscles containing V1 and V3 isomyosins was analyzed during barium-activated contractures at 25 degrees C by frequency domain analysis using pseudo-random binary noise-modulated perturbations. The analysis characterizes a frequency (fmin) at which dynamic stiffness of a muscle is a minimum, a parameter that reflects the rate of cycling of crossbridges. We have previously shown that fmin for V1- and V3-containing papillary muscles were 2.1 +/- 0.2 Hz (mean +/- SD) (n = 10) and 1.1 +/- 0.2 Hz (n = 8), respectively, and that these values were independent of the level of activation. The present study's goal was to determine whether the inotropic action of adrenaline was associated with an increased rate of crossbridge cycling. The results show that a saturating dose of adrenaline increased fmin in V1 hearts by 49 +/- 2% (n = 11). The action on V3 hearts was significantly less; the increase in fmin was 26 +/- 2% (n = 6). The increase in fmin for V1 hearts was shown to be sensitive to the beta-blocking agent propranolol. These results suggest that adrenaline significantly increases the rate of crossbridge cycling by a beta-receptor-mediated mechanism. We conclude that the increased contractility of the heart in the presence of adrenaline arises not only from more complete activation of the contractile proteins but also from the increased rate at which each crossbridge can transduce energy.

Relation between renal and hepatic excretion in drugs. VIII. Influence of triiodothyronine on maturation of phenol red excretion in rats

Experiments were performed on 10-, 20-, and 55-day-old female rats. Administration of triiodothyronine (T3; 10 or 20 micrograms/100 g b.wt. for 3 days, once daily) was followed by a significant increase in renal phenol red excretion in 20-day-old and older rats. In 10-day-old rats there was no stimulatory effect of T3 on renal excretion of the dye. On the other hand, biliary excretion of phenol red was significantly diminished in all age groups. Surprisingly, in nephrectomized rats there was a significant increase in hepatic dye excretion in 20- and 55-day-old rats after T3. This increase in transport capacity via liver was connected with a distinct rise of bile flow. In experiments on tissue slices phenol red accumulation was investigated at different medium concentrations. In renal cortical slices there was no significant influence of T3 on specific accumulation of phenol red per 1 g organ wet weight, whereas aerobic accumulation of the dye seems to be diminished in liver tissue after T3 treatment. But in all age groups kidney weight increased significantly. Calculation of total accumulation (= specific accumulation x organ wet weight) resulted in a significantly enhanced renal transport capacity for phenol red in all age groups. In contrast, total hepatic accumulation was reduced independently of age.

Examination of cardiac alpha-adrenoceptors from pharmacological responses and radioligand binding. Comparison of rat and guinea pig tissues

The object of this study was to determine suitable experimental conditions for the pharmacological evaluation of cardiac alpha-adrenoceptors. Atrial and ventricular preparations of the guinea pig and rat were employed, and the alpha-adrenoceptor responsiveness was compared with the binding of the alpha-adrenoceptor radioligand [3H]prazosin in membranes prepared from these cardiac regions. The experimental variables examined were the pacing frequency, bath temperature, choice of agonist, and cardiac region. In guinea pig atria the optimum alpha-adrenoceptor-mediated positive inotropic response to phenylephrine was at 32 degrees C and a pacing frequency of 1 Hz. A comparison of phenylephrine with methoxamine showed that the former yielded biphasic concentration-response curves in guinea pig left atria; the lower portion was alpha-adrenoceptor mediated and the upper, more substantial portion, was beta mediated. Methoxamine produced monophasic curves due entirely to alpha-adrenoceptor stimulation and was therefore used for comparisons between rat and guinea pig tissues. Of the guinea pig tissues, only the left atrium produced positive inotropic responses. Negative chronotropy was obtained with right atria and negative inotropy with ventricular strips and papillary muscles. The rat tissues all responded with positive responses, the largest maximum being in the left atrium. Binding data showed a larger number of alpha-adrenoceptors in the rat tissues, of which the ventricles had the greatest number. The lack of response of guinea pig ventricular tissues was therefore reflected in the low binding. From this study, the most appropriate model for characterizing cardiac alpha-adrenoceptors is therefore the rat left atria at 32 degrees C and paced at 1 Hz with methoxamine as the agonist.

Circulating prostacyclin and thromboxane in patients with Graves' disease

We measured plasma levels of PGI2 as 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) and thromboxane A2 (TXA2) as thromboxane B2 (TXB2) in patients with Graves' disease and in normal subjects. The levels of plasma 6-keto-PGF1 alpha were significantly elevated and correlated with those of serum T4 and T3, respectively, in hyperthyroid patients with Graves' disease. Significant reduction of 6-keto-PGF1 alpha levels was observed after antithyroid drug therapy. In contrast, the levels of plasma TXB2 were significantly lower in untreated patients with Graves' disease than in normal subjects. These data suggest that an elevation of plasma 6-keto-PGF1 alpha may play some additional role in pathophysiology of Graves' disease.

A unique pressor response to isoprenaline in the pithed rat during triiodo-L-thyronine(T3)-induced hyperthyroidism

Thyroid hormone appears to be involved in the regulation of beta-adrenoceptors affecting cardiovascular performance. In the present study, the influence of hyperthyroidism on beta-adrenoceptor-mediated response of the cardiovascular system was investigated in vivo using the pithed rat preparation. Hyperthyroidism was induced by triiodothyronine injections (500 micrograms/kg, i.p.) for 6 days. A markedly accelerated basal heart rate and a wider pulse pressure with a significantly elevated systolic blood pressure were observed in hyperthyroid pithed rats. Although the basal and the maximal heart rates were increased in hyperthyroid rats, EC50 of the heart rate response to isoprenaline did not significantly differ between euthyroid and hyperthyroid pithed animals. Markedly different responses of blood pressure to isoprenaline were obtained in the two groups; isoprenaline caused a dose-dependent decrease in diastolic pressure in euthyroid pithed rats, whereas it produced pressor response in hyperthyroid pithed rats. This unique pressor response to isoprenaline observed in hyperthyroid pithed rats was abolished by the beta 1-adrenoceptor selective antagonist metoprolol but not by the alpha-adrenoceptor antagonist phenoxybenzamine. The density of myocardial binding sites of the beta-type was markedly increased after T3 treatment (65%), whereas that of the mesenteric artery was not altered. The results indicate that thyroid hormone exerts different effects on cardiac and vascular beta-adrenoceptors, and this different susceptibility to thyroid hormone may in part be responsible for the altered response of blood pressure to isoprenaline seen in hyperthyroid pithed rats.

[Alpha-adrenoceptors in the myocardium: incidence and functional significance]

Alpha-adrenoceptors mediating positive inotropic effects are well established in the heart of various species including human heart. The mechanism by which alpha-adrenoceptor stimulation increases force of contraction is not known. cAMP is unlikely to be involved as a mediator. Evidence has been presented that an increase in magnitude and duration of the slow Ca++ inward current may be partly responsible for the positive inotropic effect. In addition, stimulation of alpha-adrenoceptors may increase Ca++ sensitivity of the contractile proteins. Stimulation of alpha-adrenoceptors by endogenous catecholamines may serve as a reserve mechanism under various conditions of impaired beta-adrenergic influence, e.g. hypothyroidism, bradycardia or ischemia. Furthermore, alpha-adrenoceptors may be involved in the genesis of reperfusion arrhythmias in ischemic heart.

Catecholamine, vasoactive intestinal peptide and thyrotrophin-dependent cAMP levels display a different sensitivity to iodothyronines in both normal and pathological human thyroid cells in culture

As the interactions of iodothyronines on adrenergic and vipergic receptors are not clear, the effect of exogenous T3 and T4 on catecholamine- and VIP-induced cAMP accumulation in human normal thyroid cells after eight days of primary culture has been investigated. To evaluate the effect of endogenous iodothyronines, the response of the adenylate cyclase system to isoprenaline, adrenaline, VIP, and TSH was studied during a 10 d period. T3 and T4 were unable to modify the catecholamine- and VIP-induced cAMP accumulation in human normal thyroid cells after 6-8 days of culture, while the response to TSH was significantly inhibited. In cells cultured from thyrotoxic tissue, the response of the adenylate cyclase system to catecholamines and VIP, during a 10 d primary culture, showed a behaviour similar to controls. TSH responsiveness was negligible up to the fourth day of culture, while in normal cells a response to all the agonists was present from the beginning. In view of the lack of effect of iodothyronines on catecholamine- and VIP-induced cAMP accumulation, and of the superimposable behaviour of the response to catecholamines and VIP in normal and hyperthyroid cells during the first days of culture, we can conclude that iodothyronines do not directly modify the response of the adenylate cyclase system to adrenergic and vipergic stimulation in human thyroid follicular cells. The lack of responsiveness to TSH of cells obtained from hyperthyroid tissue during the first 4 d of culture, associated with normal responsiveness to catecholamines and VIP, points to a possible involvement of biogenic amines and neuropeptides in sustaining such hyperthyroid states.

Catecholamine-induced cardiac hypertrophy in a denervated, hemodynamically non-stressed heart transplant

Studies of stress-induced cardiac hypertrophy suggest that myocardial mass is regulated by the circulating level of epinephrine. The trophic effect is mediated by cardiac beta-adrenergic receptors, and in the murine, rat, and dog heart, specifically by beta 2-adrenergic receptors. The well-characterized functional effects of catecholamines on heart have obscured their role as myocardial trophic hormones. Therefore, we compared the effect of beta-adrenergic receptor stimulation on the myocardial mass of both a working innervated heart and an essentially nonworking denervated heterotopically transplanted heart in the same rat; in this model, the neural and stretch parameters are nonoperational in the transplanted heart. Ornithine decarboxylase (ODC), an enzyme elevated in a dose-dependent manner in heart by isoproterenol, was assayed in both hearts to determine the relationship between ODC activity and myocardial mass in response to isoproterenol administration in working, innervated heart compared to denervated, nonworking heart. In both recipient and donor heart, the myocardial mass paralleled the ability of an isoproterenol bolus to stimulate ODC in the respective heart. However, beta-adrenergic receptor activity in the donor heart was decreased 5 days after transplantation as assessed by the differential ability of a single dose of isoproterenol to stimulate ODC activity. Beta-receptor coupling to ODC activity in the donor heart exceeded that of the recipient heart at 10 days posttransplantation suggesting a time-dependent elevation of beta-adrenergic receptor activity in donor heart. At all times, alterations in myocardial mass paralleled beta-adrenoceptor activity as assessed by the ability of isoproterenol administration to elevate ODC activity. The results support the concept that myocardial mass is regulated by the level of circulating hormones, particularly epinephrine.

Age-dependent differences in the positive inotropic effect of phenylephrine on rat isolated atria

The age-dependent differences in the involvement of alpha-adrenoceptors in the positive inotropic effect of phenylephrine (Phe) were examined in isolated atria of male Wistar rats 6 weeks (6W), 10 weeks and 7 months (7M) of age. The maximal increase in tension development induced by Phe increased with age, whereas the EC50 values for the positive inotropic effect of Phe did not change with age. The inhibitory effect of phentolamine on the response to Phe increased with age. Propranolol caused only slight inhibition of the effect of Phe in both 6W and 7M rats, and the EC50 values for Phe in the presence of propranolol did not change significantly with age. The EC50 values for isoprenaline and 5-hydroxytryptamine in 7M rats were higher than those in 6W rats. In 7M rats, the duration of the tension development was only slightly affected by Phe in the presence or absence of propranolol, but it was markedly decreased by Phe in the presence of phentolamine. The dose-response curve for Phe was markedly shifted to the left by papaverine in 6W rats, but slightly in 7M rats. The dose-response curve for isoprenaline was markedly shifted to the left by papaverine in both groups. These results are consistent with effects of Phe being mediated by both alpha- and beta-adrenoceptors in both 6W and 7M rats, but there is a shift in the balance from rather more beta-receptors in the young animals to more alpha-receptors in the adults.

Cyclic AMP regulation of myosin isozymes in mammalian cardiac muscle

Hyperpermeable cells from rat heart contain a cAMP-dependent system that can increase the maximum Ca-activated force (contractility) of the contractile proteins. In two different conditions where the relative concentration of the myosin isozymes changes, i.e., hypothyroidism and aging, the size of the increase in contractility from activation of the cAMP-regulated system varies closely with the relative concentration of V1, the isozyme of myosin with the greatest Ca- and actin-activated ATPase activity. The existence of another system for the regulation of the slow isozyme V3 has been demonstrated, and it may be inhibited by beta-adrenergic activity. The possibility of cAMP-dependent myosin regulation of contraction in addition to Ca regulation of troponin is considered. Phosphorylation of the contractile proteins themselves is not required for the increased contractility.

Additional evidence against universal modulation of beta-adrenoceptor responses by excessive thyroxine

1 The effect of prolonged, excessive thyroxine on beta-adrenoceptor-mediated relaxation of guinea-pig trachea was studied. 2 Thyroxine did not significantly affect the potency of the beta 1-adrenoceptor agonist, noradrenaline, or the beta 2-adrenoceptor agonist, terbutaline. 3 Thyroxine did not significantly affect the apparent KB values of the selective beta 1-adrenoceptor antagonist, practolol, or the selective beta 2-adrenoceptor antagonist, butoxamine. 4 Thyroxine did not significantly affect the maximum response to noradrenaline. The maximum response to terbutaline in tissues from the thyroxine-treated animals was only slightly lower than the maximum response in tissues from paired control animals. 5 These results suggest that excessive thyroxine does not significantly affect the beta-adrenoceptor-mediated relaxation of guinea-pig trachea and that the reported modulation of beta-adrenoceptor-mediated responses in other tissues is specific for the given tissue rather than common to all beta-adrenoceptor systems.

Catecholamine-thyroid hormone interaction on myocardial ornithine decarboxylase

Myocardial phosphorylase alpha activity responds to stimulation by catecholamines and thyroid hormone. In hyperthyroidism this enzyme is supersensitive to beta-adrenergic stimulation and blockade, indicating that its increased activity is an indirect effect of thyroid hormone. Myocardial ornithine decarboxylase (ODC) activity also responds to catecholamine and thyroid hormone stimulation. In the present studies, we sought to determine whether ODC shares the responses of phosphorylase alpha in hyperthyroidism. As opposed to euthyroid rats, isoproterenol acutely inhibited myocardial OCD activity in hyperthyroid rats. Timolol (60 mg/kg) injected immediately before the isoproterenol blocked this paradoxical inhibitory effect, defining it as beta-adrenergic. When timolol (100 mg/kg), distributed over a 24-h period, was administered during the 3 days of triiodothyronine (T3) administration, it blocked the T3 stimulation of myocardial OCD activity by 35%. However, timolol affected weight gain of the hyperthyroid rats. When fasted rats were used, timolol was without effect on T3-induced myocardial ODC stimulation. Timolol was also without effect on T3-induced stimulation of hepatic ODC or on T3-induced cardiomegaly. Timolol did decrease the T3-induced tachycardia. In summary, in the hyperthyroid heart, 1) isoproterenol paradoxically inhibits myocardial ODC activity and 2) timolol, when food intake is not a variable, is without effect. We conclude that the effect of thyroid hormone on myocardial ODC is not mediated by change in catecholamine sensitivity. Thus the behavior of phosphorylase alpha does not represent a general enzymatic phenomenon.

Quantitative changes in beta-adrenergic responses of isolated atria from hyper- and hypothyroid rats

Concentration-response curves for the chronotropic and inotropic effects of isoprenaline, in the absence and presence of propranolol, were obtained on heart atria isolated from normo- or dysthyroid rats. Hyperthyroidism increased the chronotropic potency and efficacy of the beta-adrenergic agonist. The results are compatible with the view that thyroid hormone increases the density of functional beta-adrenoceptors in cardiac pacemaker tissue.

The influence of hormonal and neuronal factors on rat heart adrenoceptors

1 The influence of hormonal and neuronal factors on adrenoceptors mediating increased cardiac force and rate of contraction were studied in rat isolated atria. The pharmacological properties of these receptors were deduced from the relative potencies of agonists and from the effects of selective alpha- and beta-adrenoceptor antagonists. The numbers and affinities of alpha- and beta-adrenoceptors were also determined by radioligand binding to ventricular membrane fragments.2 Hypophysectomy reduced the inotropic potency of isoprenaline and increased the potency of phenylephrine and methoxamine in left atria. The effect of phenylephrine was inhibited by propranolol less effectively and by phentolamine or phenoxybenzamine more effectively in hypophysectomized than in control rats. The difference in block was smaller at low than at high antagonist concentrations. Similar but smaller changes were observed for chronotropic responses of right atria.3 The decreased beta- and increased alpha-receptor response after hypophysectomy was similar to that observed earlier in thyroidectomized rats (Kunos, 1977). These changes developed slowly after hypophysectomy (>2 weeks), they were both reversed within 2 days of thyroxine treatment (0.2 mg/kg daily), but were not affected by cortisone treatment (50 mg/kg every 12 h for 4 days).4 Treatment of hypophysectomized rats for 2 days with thyroxine increased the density of [(3)H]-dihydroalprenolol ([(3)H]-DHA) binding sites from 27.5 +/- 2.7 to 45.5 +/- 5.7 fmol/mg protein and decreased the density of [(3)H]-WB-4101 binding sites from 38.7 +/- 3.1 to 18.7 +/- 2.5 fmol/mg protein. The affinity of either type of binding site for agonists or antagonist was not significantly altered by thyroxine treatment and the sum total of alpha(1)- and beta-receptors remained the same.5 Sympathetic denervation of thyroidectomized rats by 6-hydroxydopamine increased the inotropic potency of isoprenaline and noradrenaline and the blocking effect of propranolol, and decreased the potency of phenylephrine and the blocking effect of phenoxybenzamine to or beyond values observed in euthyroid controls. The density of [(3)H]-DHA binding sites was higher and that of [(3)H]-WB-4101 binding sites was lower in the denervated than in the innervated hypothyroid myocardium. Depletion of endogenous noradrenaline stores by reserpine did not significantly alter the adrenoceptor response pattern of the hypothyroid preparations and did not influence the density or affinity of [(3)H]-DHA and [(3)H]-WB-4101 binding sites.6 These results indicate that thyrotropin or steroids do not contribute to the reciprocal changes in the sensitivity of cardiac alpha(1)- and beta-adrenoceptors in altered thyroid states. These thyroid hormone-dependent changes are probably due to a parallel, reciprocal change in the numbers but not the affinities of alpha(1)- and beta-adrenoceptors. Reciprocal regulation of cardiac alpha(1)- and beta-adrenoceptors by thyroid hormones requires intact sympathetic innervation but not the presence of normal stores of the neurotransmitter.

Influence of temperature on the sensitivity of the adrenoceptors in the isolated atria of guinea pigs and rats

The influence of the bath temperature on the responsiveness to sympathomimetic amines was studied with isolated guinea pig and rat atria. In electrically driven guinea pig left atria, the dose-response curve for the positive inotropic effect of isoproterenol (ISO) was shifted to the left by lowering the temperature from 36 to 24 degrees C. The positive inotropic effect of phenylephrine (PHE) in lower concentrations was attenuated by lowering the temperature. Phentolamine markedly inhibited the PHE response at 36 and 32 degrees C, whereas it produced no inhibition at 24 degrees C. Similar changes were observed with rat left atria. In guinea pig left atria, propranolol inhibited the response to PHE more effectively at 24 degrees C than 32 degrees C. With guinea pig and rat atria the dose--response curve for the positive inotropic effect of PHE in the presence of phentolamine was shifted to the left by lowering the temperature. The results suggest that lowering the temperature of the bath solution diminished the positive inotropic effect of PHE mediated by alpha-adrenoceptors and potentiated that mediated by beta-adrenoceptors.