Strophanthidin and force regulation by intracellular sodium activity in cardiac Purkinje fibers

On the mechanisms underlying diastolic voltage oscillations in the sinoatrial node

AIM

The study of the mechanisms underlying the oscillatory afterpotential (V(os)) and prepotential (ThV(os)).

BACKGROUND

It has been recently shown that V(os) and ThV(os) play an obligatory role in the dominant sinoatrial node (SAN) discharge.

METHODS

Guinea pig isolated SAN was studied in vitro by means of a microelectrode technique.

RESULTS

High [K(+)](o) and premature stimuli unmask V(os) superimposed on early diastolic depolarization and ThV(os) within a less negative voltage range ("oscillatory zone"). Subthreshold stimuli elicit ThV(os) in the oscillatory zone, but not at more negative values. Drive and caffeine shift the oscillatory zone in a negative direction. Low caffeine concentrations increase the size of V(os) and of ThV(os), rate, and force. High caffeine concentrations suppress V(os) but increase the size of ThV(os) and shift them to more negative values until they eventually miss the threshold. In quiescent SAN in high caffeine, a fast drive enhances ThV(os) size, thereby initiating a transient spontaneous rhythm ("overdrive excitation"). Adrenergic agonists potentiate caffeine-induced overdrive excitation through an increase in ThV(os). In high caffeine, the first twitch after quiescence is not larger, twitch relaxation is slower, V(os) is abolished, and the prolonged nonoscillatory afterdepolarization V(ex) is induced, consistent with an impairment of Ca2+ handling by the sarcoplasmic reticulum. The effects of caffeine in Tyrode's solution are accounted for by the caffeine-induced changes in the oscillatory potentials. Tetrodotoxin decreases force and size of both V(os) and ThV(os).

CONCLUSIONS

The mechanism underlying V(os) is related to a diastolic release of Ca2+ from a Ca2+-overloaded sarcoplasmic reticulum, whereas that of ThV(os) appears to be related to ionic currents in the resting potential range that can initiate and sustain spontaneous discharge.

Mechanisms underlying overdrive suppression and overdrive excitation in guinea pig sino-atrial node

The hypothesis that the pause that follows overdrive of the sino-atrial node (SAN) might be the net result of overdrive excitation and overdrive suppression was tested by studying rate and force patterns induced by overdrive in isolated guinea pig SAN superfused in vitro. In Tyrode solution, the pause is short and changes but little with longer or faster drives. In high [K(+)](o) solution, longer overdrives increase force percent-wise more than in Tyrode solution, shorten the pause and are followed by greater rate and force. When the SAN (quiescent in high [K(+)](o)) is driven at 6/min, faster overdrives are followed by stronger, slowly decreasing contractions. Alternating 10 s drives with 10 s pauses have little effect on force and rate in Tyrode solution, but progressively increase force and rate in high [K(+)](o). Cesium has effects similar to high [K(+)](o). High [Ca(2+)](o) increases force and in high [K(+)](o) increases the rate as well as it shortens the pause, whereas Ni(2+) decreases force as well as rate and lengthens the pause. Barium dissociates the effects on force and rate. Lidocaine and tetrodotoxin decrease rate and force, and increase the pause duration. In overdrive excitation, the increase in rate is associated with an enhancement of diastolic voltage oscillations. It is concluded that in SAN the prevalence of Ca(2+) load leads to overdrive excitation whereas the prevalence of Na(+) load leads to overdrive suppression. In Tyrode solution, the pause after drive appears to be the net result of these two different mechanisms.

Molecular Control of Cardiac Sodium Homeostasis in Health and Disease

INTRODUCTION

Cardiac myocytes utilize three high-capacity Na transport processes whose precise function can determine myocyte fate and the triggering of arrhythmias in pathological settings. We present recent results on the regulation of all three transporters that may be important for an understanding of cardiac function during ischemia/reperfusion episodes.

METHODS AND RESULTS

Refined ion selective electrode (ISE) techniques and giant patch methods were used to analyze the function of cardiac Na/K pumps, Na/Ca exchange (NCX1), and Na/H exchange (NHE1) in excised cardiac patches and intact myocytes. To consider results cohesively, simulations were developed that account for electroneutrality of the cytoplasm, ion homeostasis, water homeostasis (i.e., cell volume), and cytoplasmic pH. The Na/K pump determines the average life-time of Na ions (3-10 minutes) as well as K ions (>30 minutes) in the cytoplasm. The long time course of K homeostasis can determine the time course of myocyte volume changes after ion homeostasis is perturbed. In excised patches, cardiac Na/K pumps turn on slowly (-30 seconds) with millimolar ATP dependence, when activated for the first time. In steady state, however, pumps are fully active with <0.2 mM ATP and are nearly unaffected by high ADP (2 mM) and Pi (10 mM) concentrations as may occur in ischemia. NCX1s appear to operate with slippage that contributes to background Na influx and inward current in heart. Thus, myocyte Na levels may be regulated by the inactivation reactions of the exchanger which are both Na- and proton-dependent. NHE1 also undergo strong Na-dependent inactivation, whereby a brief rise of cytoplasmic Na can cause inactivation that persists for many minutes after cytoplasmic Na is removed. This mechanism is blocked by pertussis toxin, suggesting involvement of a Na-dependent G-protein. Given that maximal NCX1- and NHE1-mediated ion fluxes are much greater than maximal Na/K pump-mediated Na extrusion in myocytes, the Na-dependent inactivation mechanisms of NCX1 and NHE1 may be important determinants of cardiac Na homeostasis.

CONCLUSIONS

Na/K pumps appear to be optimized to continue operation when energy reserves are compromised. Both NCX1 and NHE1 activities are regulated by accumulation of cytoplasmic Na. These principles may importantly control cardiac cytoplasmic Na and promote myocyte survival during ischemia/reperfusion episodes by preventing Ca overload.

Calcium overload and cardiac function

The changes in cardiac function caused by calcium overload are reviewed. Intracellular Ca(2+) may increase in different structures [e.g. sarcoplasmic reticulum (SR), cytoplasm and mitochondria] to an excessive level which induces electrical and mechanical abnormalities in cardiac tissues. The electrical manifestations of Ca(2+) overload include arrhythmias caused by oscillatory (V(os)) and non-oscillatory (V(ex)) potentials. The mechanical manifestations include a decrease in force of contraction, contracture and aftercontractions. The underlying mechanisms involve a role of Na(+) in electrical abnormalities as a charge carrier in the Na(+)-Ca(2+) exchange and a role of Ca(2+) in mechanical toxicity. Ca(2+) overload may be induced by an increase in [Na(+)](i) through the inhibition of the Na(+)-K(+) pump (e.g. toxic concentrations of digitalis) or by an increase in Ca(2+) load (e.g. catecholamines). The Ca(2+) overload is enhanced by fast rates. Purkinje fibers are more susceptible to Ca(2+) overload than myocardial fibers, possibly because of their greater Na(+) load. If the SR is predominantly Ca(2+) overloaded, V(os) and fast discharge are induced through an oscillatory release of Ca(2+) in diastole from the SR; if the cytoplasm is Ca(2+) overloaded, the non-oscillatory V(ex) tail is induced at negative potentials. The decrease in contractile force by Ca(2+) overload appears to be associated with a decrease in high energy phosphates, since it is enhanced by metabolic inhibitors and reduced by metabolic substrates. The ionic currents I(os) and I(ex) underlie V(os) and V(ex), respectively, both being due to an electrogenic extrusion of Ca(2+) through the Na(+)-Ca(2+) exchange. I(os) is an oscillatory current due to an oscillatory release of Ca(2+) in early diastole from the Ca(2+)-overloaded SR, and I(ex) is a non-oscillatory current due to the extrusion of Ca(2+) from the Ca(2+)-overloaded cytoplasm. I(os) and I(ex) can be present singly or simultaneously. An increase in [Ca(2+)](i) appears to be involved in the short- and long-term compensatory mechanisms that tend to maintain cardiac output in physiological and pathological conditions. Eventually, [Ca(2+)](i) may increase to overload levels and contribute to cardiac failure. Experimental evidence suggests that clinical concentrations of digitalis increase force in Ca(2+)-overloaded cardiac cells by decreasing the inhibition of the Na(+)-K(+) pump by Ca(2+), thereby leading to a reduction in Ca(2+) overload and to an increase in force of contraction.

Action-potential duration and contractility in canine cardiac tissues: action of inotropic drugs

1. Inotropic and electrophysiologic effects of veratrine, vesnarinone, d-sotalol and tetraethylammonium (TEA) were compared. Action-potential duration (APD) and contractility were measured in isolated canine Purkinje fiber and ventricular trabecular muscle preparations by using standard microelectrode techniques. Each drug significantly increased APD and force development in either tissue. 2. Drug-induced increases in force development were normalized to increases in APD. The order of efficacy was found to be vesnarinone>veratrine>TEA in ventricular myocardium, whereas it was veratrine>>vesnarinone=d-sotalol=TEA in Purkinje fibers. 3. The force-APD relation was linear for all drugs in the concentrations used. 4. Simultaneous measurements of APD, force development and intracellular sodium ion activity (a(i)Na) in the presence of either veratrine or lidocaine indicated a linear relation between force development and changes in a(i)Na. 5. The relation between APD and force development was different in ventricular and Purkinje fiber preparations. Differences in the veratrine sensitivity of the force-APD relation observed between Purkinje and ventricular preparations suggest that a(i)Na-dependent changes in Na+/Ca2+ exchange may play a more important role in regulation of force generation in Purkinje fibers than in ventricular myocardium.

Role of Intracellular Sodium Activity in the Control of Contraction in Cardiac Purkinje Fibers

The role of intracellular sodium activity (a(i)(Na)) in the control of force was studied in sheep cardiac Purkinje fibers exposed to norepinephrine (NE) and high [Ca](o) in the absence and presence of overdrive or of a low concentration of strophanthidin. Both NE and high [Ca](o) decrease a(i)(Na) and increae force, while overdrive increases and low strophanthidin decreases both parameters. In the presence of NE, overdrive increases a(i)(Na) less than force and is followed by a more pronounced undershoot in a(i)(Na) and force. In contrast, in high [Ca](o) overdrive increases a(i)(Na) more than force and is followed by a less pronounced undershoot in a(i)(Na) and force than in NE. High [Ca](o) increases force to a peak, but then the decreasing a(i)(Na) reduces force. In all these conditions, a(i)(Na) determines force changes during recovery from overdrive. NE and high [Ca](o) decrease a(i)(Na) less and increase force more in low strophanthidin. Thus, changes in a(i)(Na) modulate the increase in force due to increased Ca influx and control force development when Ca influx is either unchanged (low strophanthidin) or has reached a steady state (high [Ca](o), recovery from overdrive). Copyright 1994 S. Karger AG, Basel

Effects of caffeine on intracellular sodium activity in cardiac Purkinje fibres: relation to force

1. An increase in cytoplasmic calcium by caffeine would lead to Ca extrusion via the Na/Ca exchange. The hypotheses were investigated that, as a consequence, caffeine might increase intracellular sodium activity (aiNa) and that the relation between aiNa and force might be conditioned by the Ca load. 2. Action potential, aiNa and contractile force were recorded in sheep Purkinje fibres during exposure to caffeine under conditions that decrease or increase the Ca load by different mechanisms. 3. In Tyrode solution, caffeine (8 mM) increased aiNa from 8.05 +/- 0.20 to 10.52 +/- 0.40 mM (+30.5%) and had a triphasic effect on force: an initial transient increase (+93.6%), a subsequent decrease (-37.1%) (negative inotropy) and slow partial recovery (+8.9%). 4. Decreasing the Ca load by means of manganese (1 mM) decreased aiNa and force. Adding caffeine re-increased aiNa and no longer caused a negative inotropic action. Cadmium (0.2 mM) also decreased aiNa, and caffeine reincreased it although far less than in Tyrode solution. 5. High [K]o (10 mM) and tetrodotoxin (5 microM) decreased aiNa as well as force. In their presence, caffeine re-increased aiNa and no longer had a negative inotropic action. 6. Increasing the Ca load by means of high [Ca]o (8.1 mM) increased force (+195%) and decreased aiNa, (-20.3%). Adding caffeine re-increased aiNa (+28.1%), but immediately decreased force (-32.3%). 7. Addition of pyruvate (10 mM) to caffeine increased force, as it does in the presence of Ca overload. 8. Noradrenaline (0.1-1 microM) decreased aiNa and increased contractile force. In its presence, caffeine decreased aiNa further and increased force. 9. It is concluded that caffeine increases aiNa, even during the negative inotropic effect. The decrease in force appears to depend on Ca load. Thus, caffeine no longer decreases force under conditions that decrease Ca load (Mn, high [K]0, TTX) and immediately decreases force when the Ca load is increased(high [Ca]0). However, in the presence of noradrenaline, caffeine decreases aiNa and markedly increases force, as the Ca load is increased, but Ca can be removed from the cytoplasm into the SR.

The relationship between contraction and intracellular sodium in rat and guinea-pig ventricular myocytes

1. The contraction, measured optically, and the intracellular Na+ activity (aNai), measured with the Na(+)-sensitive fluorescent dye SBFI, have been recorded simultaneously in rat and guinea-pig ventricular myocytes. 2. In rat and guinea-pig ventricular myocytes at rest, aNai was 7.8 +/- 0.3 mM (n = 4) and 5.1 +/- 0.3 mM (n = 16), respectively. 3. When both rat and guinea-pig ventricular myocytes were stimulated at 1 Hz after a rest there was usually a gradual increase in twitch shortening (referred to as a 'staircase') over several minutes accompanied by an increase in aNai over a similar time course. Twitch shortening increased by 21 +/- 3% (n = 6) and 20 +/- 4% (n = 16) (of steady-state twitch shortening during 1 Hz stimulation) per millimolar rise in aNai in rat and guinea-pig ventricular myocytes, respectively. 4. When rat and guinea-pig ventricular myocytes were exposed to strophanthidin to block the Na(+)-K+ pump, there were increases in twitch shortening and aNai over similar time courses. Twitch shortening increased by 24 +/- 4% (n = 5) and 20 +/- 3% (n = 10) (of control twitch shortening) per millimolar rise in aNai in rat and guinea-pig ventricular myocytes respectively. 5. The inotropic effect of cardiac glycosides, such as strophanthidin, is widely regarded to be principally the result of the rise in aNai. The similarity of the relation between twitch shortening and aNai during the staircase and on application of strophanthidin suggests that the progressive increase in the strength of contraction during the staircase was also linked to the rise in aNai. 6. In guinea-pig, but not rat, ventricular myocytes there was hysteresis in the relation between twitch shortening and aNai on application and wash-off of strophanthidin. This indicates that strophanthidin has another inotropic action in guinea-pig ventricular myocytes. 7. A computer model of excitation-contraction coupling has been developed to simulate the staircase and the action of cardiac glycoside and to account for the relation between contraction and intracellular Na+.

Role of intracellular Na+ activity in the negative inotropy of strophanthidin in cardiac Purkinje fibers

The relation between intracellular sodium activity (aNai) and different phases of strophanthidin inotropy was studied in sheep cardiac Purkinje fibers superfused in vitro. Strophanthidin (1 microM) progressively increases aNai whereas increases and then decreases contractile force, induces contracture ('mechanical toxicity') and arrhythmias ('electrical toxicity'). Contractile force begins to decrease at approximately 11 mM aNai. Force and aNai show a positive correlation during the increasing and a negative correlation during the decreasing phase of strophanthidin inotropy. In high [K]o (8, 12 and 16 mM), strophanthidin increases aNai and force to a smaller peak and fails to induce toxicity. In high [Na]o (+18.5%), strophanthidin increases aNai and force to a larger peak and induces electrical toxicity below and mechanical toxicity above a higher aNai value (approximately 15 mM). In higher [K]o, high [Na]o restores the ability of strophanthidin to induce mechanical toxicity. Thus, mechanical toxicity begins when aNai increases past a critical value and the continuing aNai increase correlates with decrease in contractile force and contracture. The critical value of aNai is modified by Ca load related to changes in membrane potential or to Na electrochemical gradient.

Effects of strophanthidin on the slow inward current in guinea-pig isolated ventricular myocytes

1. The effect of strophanthidin on the slow inward current (Isi) and on contractile force were studied in guinea-pig isolated ventricular myocytes and intact papillary muscles, respectively. In myocytes, both low (10 nmol/L) and high (1-10 mumols/L) concentrations had small or no effects in either direction on Isi whereas norepinephrine (10-100 nmol/L) increased it. To determine whether the same results are obtained after decreasing or increasing intracellular calcium or sodium, the same concentrations of strophanthidin were tested in different procedures that are known to (i) increase [Ca]i and decrease [Na]i (high [Ca]o, 3.6-5.4 mmol/L; low [Na]o, 112 mmol/L; (ii) decrease [Ca]i and increase [Na]i (low [Ca]o, 0.45-1 mmol/L; Sr, 1 mmol/L; (iii) decrease [Ca]i and [Na]i (Cd, 0.1-0.2 mmol/L); and (iv) increase [Ca]i and [Na]i (veratridine, 0.2 mumol/L). High [Ca]o and veratridine increased whereas low [Ca]o and Cd decreased Isi. In contrast, during these various procedures, strophanthidin had small and inconsistent effects at a low or high concentration. In intact papillary muscles, low strophanthidin decreased whereas high strophanthidin increased contractile force. It is concluded that strophanthidin has little direct or indirect effect on Isi and that the decrease in force by low and increase in force by high concentrations in intact muscle are probably related to demonstrated decrease and increase, respectively, in intracellular sodium activity.