Possible involvement of Na(+)-H+ exchange in the early phase of reperfusion in myocardial stunning

Effect of sodium bicarbonate infusion on hepatocyte Ca2+ overload during resuscitation from hemorrhagic shock

Ischemia/reperfusion events alter the cellular ion homeostasis by intracellular acidosis and a subsequent rise of sodium and calcium concentrations. Since disturbance of intracellular Ca2+ signaling pathways impairs cellular function, we investigated the effect of sodium bicarbonate infusion on hepatocellular Ca2+ dysregulation induced by resuscitation from hemorrhagic shock. Anesthetized Sprague-Dawley rats were bled to a mean arterial blood pressure of 40 mmHg for 60 min. Rats were resuscitated by retransfusion of shed blood (60%) in 20 min and three-fold the bleed out volume as lactated Ringers' during 60 min and received either a bolus infusion of sodium bicarbonate (2 mval/kg body weight) or an equal volume of sodium chloride (0.9%). After hepatocyte isolation by portal collagenase perfusion, the rate of Ca2+ influx (Ca2+in) in the absence and presence of epinephrine (100 nM), cellular Ca2+ uptake (Ca2+up) and membrane Ca2+ flux (Ca2+flux) were determined using 45Ca2+ incubation techniques. Hemorrhage/resuscitation substantially increased hepatocyte Ca2+up (3.44 +/- 0.2 nmol/mg protein) and Ca2+flux (32.8 +/- 5 pmol/mg protein x min) compared to sham-operated controls (2.57 +/- 0.1 and 15.2 +/- 3.5; P < 0.05). Resuscitation with sodium bicarbonate significantly prevented altered hepatocyte Ca2+ regulation (2.31 +/- 0.1 and 14.4 +/- 4.6; P < 0.05). These findings suggested that postischemic hepatocyte Ca2+ overload could partly be due to enhanced membrane Ca2+ movements to correct for altered intracellular pH homeostasis.

Protection against cellular damage in the perfused rat heart by lowered pH

In this comparative study, rat hearts were perfused at 37 degrees C with three clearly defined protocols: the Ca2+ paradox, the O2 paradox and with 20 mM caffeine. Each protocol involved an initial priming (Ca2+(o) depletion or anoxia; stage 1) and subsequent full activation (Ca2+(o) repletion or reoxygenation; stage 2) of the damage system of the sarcolemma. Creatine kinase release in stage 2 was completely inhibited (P < 0.001) in all three protocols when pH was reduced to 6.5 throughout the experiments, or only during stage 1, or only during stage 2. The inhibitor of the Na+/H+ antiporter, amiloride (1 mM), completely prevented creatine kinase release in the Ca2+ paradox (P < 0.001) and markedly reduced damage in the caffeine protocol. Amiloride had no significant effect on creatine kinase release in the O2 paradox. The possible role of Na+(i) was studied in the caffeine protocol: ouabain (5 x 10(-6) M) had little effect whereas substitution of choline for Na+ in the perfusion medium reduced creatine kinase release by about 50%. It is suggested that the same damage system is activated in stage 1 in all three protocols and that a key event is the intracellular production of H+ which are exported via Na+(o)/H(i) exchange. Prevention of H+ efflux by lowered pH(o), even during stage 2, protected against creatine kinase release. The possible role of Na+ movements in the genesis of sarcolemma damage is discussed.