Effects of ryanodine on inotropic and arrhythmogenic actions of cardiotonic steroids

Ryanodine receptors and ventricular arrhythmias: emerging trends in mutations, mechanisms and therapies

It has been six years since the first reported link between mutations in the cardiac ryanodine receptor Ca(2+) release channel (RyR2) and catecholaminergic polymorphic ventricular tachycardia (CPVT), a malignant stress-induced arrhythmia. In this time, rapid advances have been made in identifying new mutations, and in understanding how these mutations disrupt normal channel function to cause VT that frequently degenerates into ventricular fibrillation (VF) and sudden death. Functional characterisation of these RyR2 Ca(2+) channelopathies suggests that mutations alter the ability of RyR2 to sense its intracellular environment, and that channel modulation via covalent modification, Ca(2+)- and Mg(2+)-dependent regulation and structural feedback mechanisms are catastrophically disturbed. This review reconciles the current status of RyR2 mutation-linked etiopathology, the significance of mutational clustering within the RyR2 polypeptide and the mechanisms underlying channel dysfunction. We will also review new data that explores the link between abnormal Ca(2+) release and the resultant cardiac electrical instability in VT and VF, and how these recent developments impact on novel anti-arrhythmic therapies. Finally, we evaluate the concept that mechanistic differences between CPVT and other arrhythmogenic disorders may preclude a common therapeutic strategy to normalise RyR2 function in cardiac disease.

Cardiotoxicity of digitalis glycosides: roles of autonomic pathways, autacoids and ion channels

1 Cardiac glycosides have been used for centuries as therapeutic agents for the treatment of heart diseases. In patients with heart failure, digoxin and the other glycosides exert their positive inotropic effect by inhibiting Na(+)-K(+)-ATPase, thereby increasing intracellular sodium, which, in turn, inhibits the Na(+)/Ca(2+) exchanger and increases intracellular calcium levels. As the therapeutic index of digitalis is narrow, arrhythmias are common problems in clinical practice. The mechanisms and mediators of these arrhythmias, however, are not completely understood. 2 The involvement of the sympathetic and parasympathetic nervous system in digitalis cardiac toxicity is reviewed. 3 Receptors, channels, exchange systems or other cellular components involved in digitalis-induced cardiotoxicity are also reviewed. 4 Possible mediators of digitalis-induced cardiac toxicity are discussed. 5 Management of digitalis toxicity in patients is summarized. 6 The determination of the possible mediators of digitalis-induced cardiac toxicity will enhance our knowledge and lead to the development of new therapeutic strategies to treat these lethal arrhythmias.

Electrophysiological actions of ryanodine on single rabbit sinoatrial nodal cells

1. Effects of ryanodine on the action potentials and the ionic currents in spontaneously beating single rabbit sinoatrial (SA) nodal cells were examined using current-clamp and whole-cell voltage-clamp techniques. 2. Cumulative administrations of ryanodine (10(-8) to 10(-4) M) caused a negative chronotropic effect in a concentration-dependent manner; the effect was not modified by atropine (10(-7) M). At 10(-6) M, ryanodine increased the action potential amplitude and the maximum rate of depolarization, and prolonged the duration of action potentials, significantly. The maximum diastolic potential was unaffected. 3. No arrhythmia occurred in the presence of ryanodine (10(-6) M) alone, but addition of either caffeine (10 mM) or high Ca2+ (10.8 mM) elicited arrhythmias. The incidence increased with an increase in extracellular Ca2+ concentration. 4. Ryanodine, at 10(-6) M, enhanced the Ca2+ current but, at 10(-5) M, inhibited it. Ryanodine inhibited the delayed rectifier K+ current and the hyperpolarization-activated inward current in a concentration-dependent manner. 5. In addition, ryanodine actually elevated the cytosolic Ca2+ level in the SA nodal cells loaded with Ca(2+)-sensitive fluorescent dye (fura-2). 6. These results indicate that ryanodine modulates the ionic currents (presumably dependent on cellular Ca2+ concentration), suggesting similar pharmacological properties to caffeine.

Digitalis sensitivity of Na+,K(+)-ATPase, myocytes and the heart

Cardiac Na+,K(+)-ATPase, the receptor molecule for digitalis glycosides, have isoforms with different intrinsic affinities for the glycosides. Expression of these isoforms are under developmental and hormonal regulation. Switching in isoforms to those with lower intrinsic affinity may decrease digitalis sensitivity of the heart. In addition to the intrinsic affinity of the cardiac Na+,K(+)-ATPase for the glycoside, increases in the rate of Na+ influx and decreases in extracellular K+ concentrations increase glycoside sensitivity of the heart and also reduces the margin of safety by reducing reserve capacity of the sodium pump. Reserve capacity of the sodium pump is also reduced by pathological conditions or aging, resulting in reduced margin of safety for the glycoside. Events that follow sodium pump inhibition also affect sensitivity of the heart to digitalis toxicity. These are hypercalcemia and magnesium depletion. It is now feasible to predict digitalis sensitivity of the heart, not empirically but based on the understanding of the mechanisms responsible for the positive inotropic and toxic actions of the glycoside.

Comparative effects of ouabain on isolated papillary muscle from tree shrews, guinea-pigs and rats

Inotropic effects of ouabain were investigated in the isolated papillary muscle preparations of the tree shrew (Tupaia glis), guinea-pigs and rats. In the guinea-pig and shrew papillary muscles, ouabain at concentrations of 10(-8) to 3 x 10(-7) M caused a concentration-dependent positive inotropic response in a similar magnitude, while in the rat, ouabain at concentrations of 10(-7) to 3 x 10(-6) M elicited negative inotropic one. Either phentolamine or pindolol in a concentration sufficient to block the alpha- and beta-adrenoceptors did not antagonize the positive inotropic effect of ouabain in the papillary muscle preparation of the shrews.

Influence of BAY K-8644 on positive inotropic agents in guinea pig atrial muscle

This study examined the influence of BAY K-8644, a dihydropyridine Ca2+ agonist, on the positive inotropic effects of strophanthidin, isoproterenol, methoxamine and extracellular Ca2+ (Ca2+0) in atrial muscle isolated from guinea pig heart. BAY K-8644 enhanced both the maximum developed tension observed in the presence of strophanthidin and the sensitivity to its toxic effects. The maximum contractile force observed in the presence of methoxamine was also elevated by BAY K-8644 pretreatment; however, the ED50 value for methoxamine was not affected. The maximum contractile force elicited by BAY K-8644 alone or by strophanthidin or methoxamine in combination with BAY K-8644 was approximately the same as that produced by isoproterenol alone. The Ca2+ agonist did not alter the maximum developed tension elicited by increasing concentrations of isoproterenol or Ca2+0; however, it reduce both the ED50 for Ca2+0 and the concentration of isoproterenol necessary to produce maximum contractility. These results suggest that combinations of BAY K-8644 and cardiac glycosides can elevate contractile force to a level greater than that produced by cardiac glycosides alone.