The mode of action of 4-aminopyridine on the chronotropic and inotropic responses in the isolated, blood-perfused dog heart

Multiple effects of 4-aminopyridine on feline and rabbit sinoatrial node myocytes and multicellular preparations

4-aminopyridine (4-AP) is commonly used to block the transient outward potassium current, I(to), in cardiac and noncardiac tissues. In the present work, we found that 4-AP inhibited the rapid component of the delayed rectifier potassium current, I(Kr), in rabbit-isolated sinoatrial node myocytes by 25% (1 mM) and 51% (5 mM) and inhibited the slow component of the delayed rectifier potassium current, I(Ks), in cat- isolated sinoatrial node myocytes by 39% (1 mM) and 62% (5 mM). In cat- and rabbit-isolated sinoatrial node myocytes, 4-AP activated muscarinic receptors in a voltage-dependent manner to increase the acetylcholine-activated potassium current, I(KACh). In multicellular preparations of the central region of the sinoatrial node from nonreserpinized rabbits, 4-AP produced an increase in action potential overshoot, frequency, and rate of diastolic depolarization. In the presence of the beta-adrenergic antagonist propranolol, 4-AP produced a marked increase in duration and a marked decrease in maximum diastolic potential and eventually, cessation of the spontaneous activity in preparations from the sinoatrial central region. In multicellular preparations from reserpinized rabbits, 4-AP produced similar effects to those observed in the presence of propranolol. We conclude that 4-AP inhibits multiple cardiac K(+) currents, including I(to), I(Kr), and I(Ks), and that these activities mask I(KACh) activation. In addition, in multicellular preparations, 4-AP produces neurotransmitter release from the autonomic nerve terminals. These multiple effects need to be considered when using 4-AP as a "specific" I(to) blocker.

Mobilization of calcium from intracellular stores, potentiation of neurotransmitter-induced calcium transients, and capacitative calcium entry by 4-aminopyridine

In this study we analyzed the effect of 4-aminopyridine (4-AP) on free cytosolic calcium concentration ([Ca(2+)](i)) in basal conditions, after stimulation with neurotransmitters, and during capacitative calcium entry. Using fura-2 ratiometric calcium imaging, we found that 4-AP increased [Ca(2+)](i) in type I astrocytes, neurons, and in skeletal muscle cells. The [Ca(2+)](i) elevation induced by 4-AP was concentration-dependent and consisted of two phases: the first was dependent on intracellular calcium mobilization, and the second was dependent on extracellular calcium influx. 4-AP also increased the second messenger inositol trisphosphate in both neurons and astrocytes. In astrocytes, 4-AP treatment potentiated the sustained phase of the [Ca(2+)](i) elevation induced by ATP and bradykinin. In addition, capacitative calcium entry was potentiated severalfold by 4-AP, in astrocytes and muscle cells but not in neurons. These effects of 4-AP were completely and promptly reversible. 4-AP blocked voltage-sensitive K(+) currents in astrocytes. However, voltage-sensitive K(+) channel blockers inhibiting these currents did not affect agonist-induced calcium transients or capacitative calcium entry, indicating that 4-AP effects on [Ca(2+)](i) were not caused by the blockade of voltage-gated K(+) channels. We conclude that 4-AP is able to affect calcium homeostasis at multiple levels, from increasing basal [Ca(2+)](i) to potentiating capacitative calcium entry. The potentiation of capacitative calcium entry in astrocytes or muscle cells may explain some of the therapeutic activities of 4-AP as a neurotransmission enhancer.

Dose-dependence of 4-aminopyridine plasma concentrations and electrophysiological effects in dogs : potential relevance to ionic mechanisms in vivo

BACKGROUND

Previous investigators have administered 4-aminopyridine (4AP) to dogs to evaluate the role of transient outward current (I(to)) in vivo; however, plasma concentrations of 4AP were not measured, and it is therefore uncertain which cardiac ion channels were blocked at the concentrations achieved.

METHODS AND RESULTS

We applied high-performance liquid chromatography to measure 4AP concentrations produced by intravenous 4AP administration to dogs. A previously described dose regimen produced plasma concentrations that increased during the maintenance infusion but never exceeded 250 micromol/L and caused significant mortality. Whole-cell patch-clamp experiments on isolated canine myocytes showed that even the maximum 4AP concentrations achieved in vivo failed to alter ventricular I(to) and had very small effects on atrial I(to); however, concentrations achieved in vivo had a strong inhibitory effect on the dog ultrarapid delayed rectifier (I(Kur.d)), present only in atrial cells. We designed a loading and maintenance infusion regimen to produce stable 4AP plasma concentrations. At concentrations in the range of 25 and 50 micromol/L, 4AP had no effect on ventricular refractory period but increased atrial refractoriness significantly, consistent with the results of voltage clamp studies.

CONCLUSIONS

The interpretation of previous studies using intravenous 4AP administration to inhibit I(to) in dogs in vivo needs to be reevaluated in light of the fact that the infusion regimens used produce plasma concentrations that are inadequate to affect ventricular I(to). Our findings also support the concept that selective inhibition of ultrarapid delayed rectifier current can prolong atrial refractory periods without affecting ventricular refractoriness.

Resistance to antagonism of atrial P(1) purinoceptor responses in the presence of K(+) channel blockade

The rate of onset of the negative inotropic responses of guinea-pig isolated paced atria to the adenosine receptor agonist, N(6)-cyclopentyladenosine, was significantly slowed by the K(+) channel inhibitor, 4-aminopyridine (10 mM). The concentration-dependent inhibition of developed tension by N(6)-cyclopentyladenosine, however, was unaffected by 4-aminopyridine (10 mM). Thus, K(+) efflux only governs the speed of onset of the negative inotropic response and does not appear to be a major component in the negative inotropy produced by the adenosine A(1) receptor agonist. The P(1) purinoceptor antagonist, 8(p-sulfophenyl) theophylline (1 x 10(-5) M) significantly shifted the concentration-response curve for N(6)-cyclopentyladenosine to the right (concentration-ratio, 7.1+/-1.5). In the presence of 4-aminopyridine (10 mM), 8(p-sulfophenyl) theophylline caused a non-parallel rightwards shift of the curve. At the IC(35) there was no significant shift, whereas at the IC(75) there was a small significant displacement of the curve. The adenosine A(1)/A(3) receptor agonist, N(6)-2-(4-aminophenyl) ethyladenosine (APNEA) yielded a biphasic concentration-response curve which was significantly shifted to the right by 8(p-sulfophenyl) theophylline (1 x 10(-5 ) M). In the presence 4-aminopyridine, however, there was no shift of the APNEA concentration-response curve by 8(p-sulfophenyl)theophylline. These results show that when K(+) channels are blocked by 4-aminopyridine, the residual response is resistant to antagonism by the P(1) purinoceptor antagonist, 8(p-sulfophenyl)theophylline. This residual component may involve L-type Ca(2+) channels, the adenosine A(1) receptor being possibly coupled to the two transduction pathways for negative inotropism via the different components of the G protein (receptor-transducer promiscuity).

Inhibition by bertosamil of cardiac responses to pinacidil or Bay k 8644 in isolated dog atria and ventricles

We investigated the effects of a novel bradycardiac agent, bertosamil (3-isobutyl-7-isopropyl-9,9-pentamethylene-3,7-diazabicyclo[3.3.1] nonane sesquihydrogenfumarate), on the sinus rate and atrial contractile force and the left ventricular contractile force in isolated, blood-perfused dog hearts and the blocking effects of bertosamil on the chronotropic and inotropic responses to pinacidil and Bay k 8644 (methyl-1,4-dihydro-2,6-dimethyl-3-nitro-4-(2-trifluoromethylphenyl)- piridine-5-carboxylate). Bertosamil (0.1-100 nmol) caused transient positive, followed by continuous negative, chronotropic responses and positive inotropic responses in atria, and increased the left ventricular contractile force. Neither propranolol nor atropine affected the cardiac responses to bertosamil. Bertosamil (3-100 nmol) dose dependently attenuated the negative chronotropic and inotropic responses to pinacidil but not to acetylcholine. Bertosamil at a high dose attenuated the positive cardiac responses to Bay k 8644, norepinephrine and isoproterenol. These results suggest that bertosamil inhibits negative cardiac responses mediated by an ATP-sensitive K+ channel but not an acetylcholine muscarinic receptor and, at a high dose, attenuates the L-type Ca2+ channel-mediated positive cardiac responses in isolated dog hearts.

T wave changes persisting after ventricular pacing in canine heart are altered by 4-aminopyridine but not by lidocaine. Implications with respect to phenomenon of cardiac 'memory'

BACKGROUND

Cardiac "memory" refers to changes in T wave polarity induced by ventricular pacing that persist long after resumption of normal atrioventricular conduction.

METHODS AND RESULTS

We studied the occurrence and mechanism of T wave changes in the open-chest anesthetized dog subjected to three discontinuous 20-minute periods of right ventricular pacing. ECG changes were recorded in the standard limb leads during normal conduction (prepacing) and three trains (T1, T2, and T3) of right ventricular pacing at a rate 50% higher than normal (pacing), each followed by a period of normal conduction (postpacing) lasting as long as necessary for T wave changes to return to control values. During each of these phases, heart rate, QRS, corrected QT (QTc) duration, and T wave amplitude were measured. In the first group (control), T wave inversions occurred during normal atrioventricular conduction after a period of right ventricular pacing. These T wave anomalies appeared in the absence of any change in heart rate, QRS, or QTc duration. The magnitude of the T wave amplitude change was significantly greater after each successive pacing period. Furthermore, the changes in T wave morphology persisted for a longer period after each successive pacing train. In a second experimental group, lidocaine, which depresses the sodium window current, was administered to six dogs that were subjected to the same pacing protocol. Lidocaine decreased the QTc interval and prolonged QRS duration but did not alter the magnitude of changes in T wave amplitude and time to recovery described in control animals during the three postpacing intervals. In contrast, in the third group, 4-aminopyridine, a drug that blocks the transient outward current (ito), abolished the changes in T wave morphology that occurred during any postpacing interval.

CONCLUSIONS

These results demonstrate that the manifestation of cardiac memory in the in situ dog heart is not altered by lidocaine but is abolished by 4-aminopyridine. Thus, cardiac memory may be based on a physiological property of the myocardium that is related to specific K+ channels.

Blockade by 4-aminopyridine of the muscarinic-receptor-mediated responses of guinea-pig atria and trachea

The potassium channel blocker 4-aminopyridine (4-AP) has been shown to antagonize the negative inotropic effects of muscarinic receptor agonists on atrial preparations. This is consistent with muscarinic agonists mediating their negative inotropy through the opening of potassium channels. In the present study, the possibility of a direct antagonism of the muscarinic receptor was examined by comparing the effects of 4-AP upon the responses to carbachol of isolated left atria (negative inotropy) and tracheal spirals (contraction) from reserpine pretreated guinea-pigs. The latter response is K+ channel-independent. The concentration-response curve for carbachol on the paced left atria was displaced 520-fold to the right by 4-AP (10 mM). 4-AP alone caused dose-related contractions of the tracheal spirals. Carbachol-induced contractions were, however, superimposed upon the raised tone and there were substantial rightwards shifts of the concentration-response curves of 4.7- and 31.4-fold by 1 and 10 mM of 4-AP, respectively. Thus 4-AP appears to have muscarinic receptor antagonistic blocking properties. The blockade of the atrial responses was, however, substantially greater and could be attributed to an additional blockade of muscarinic receptor-linked potassium channels. The negative inotropic responses of the A1-adenosine receptor agonist L-phenylisopropyladenosine (L-PIA) were also antagonized by 4-AP, but to a lesser extent than for carbachol. After allowing for the muscarinic receptor blocking activity of 4-AP, carbachol was still antagonized more effectively than L-PIA. This could be due to the presence of a K+ channel-independent component in the response to L-PIA which is not susceptible to 4-AP.

The inotropic effect of 4-aminopyridine and pH changes in rabbit papillary muscle

The effects of 4-aminopyridine (4AP), and pH changes have been examined on tension responses and cyclic nucleotide levels in rabbit isolated right ventricular papillary muscles. 4AP augmented papillary muscle contractions in a concentration-dependent manner. However, this positive inotropic action was largely due to an increase in extracellular pH produced by 4AP, rather than an intrinsic activity of the drug. Increases in extracellular pH (from 5 to 9) produced graded and reproducible increases in contractile force which were not blocked by propranolol (1 x 10(-7) M) but were inhibited by verapamil in a concentration-dependent manner. The positive inotropic effects of Ca2+ were enhanced and depressed by alkaline and acidic pH, respectively. Neither 4AP nor alkaline pH significantly changed cyclic AMP concentration in rabbit papillary muscles. The cyclic GMP content, however, was increased by 4AP only and this effect was blocked by atropine. The results suggest that the positive inotropic effect associated with a rise in pH from neutrality may be due to facilitation of translocation of membrane Ca2+ and/or to increase the release of Ca2+ from sources within the cell. They also illustrate that a major component of the inotropic effect of 4AP is a result of an increase in extracellular pH.