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Fan Y, Huang S, Li S, Wu B, Zhao Q, Huang L, Zheng Z, Xie X, Liu J, Huang W, Sun J, Zhu X, Zhu J, Xiang AP, Li W. The adipose-neural axis is involved in epicardial adipose tissue-related cardiac arrhythmias. Cell Rep Med 2024; 5:101559. [PMID: 38744275 PMCID: PMC11148799 DOI: 10.1016/j.xcrm.2024.101559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/18/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
Dysfunction of the sympathetic nervous system and increased epicardial adipose tissue (EAT) have been independently associated with the occurrence of cardiac arrhythmia. However, their exact roles in triggering arrhythmia remain elusive. Here, using an in vitro coculture system with sympathetic neurons, cardiomyocytes, and adipocytes, we show that adipocyte-derived leptin activates sympathetic neurons and increases the release of neuropeptide Y (NPY), which in turn triggers arrhythmia in cardiomyocytes by interacting with the Y1 receptor (Y1R) and subsequently enhancing the activity of the Na+/Ca2+ exchanger (NCX) and calcium/calmodulin-dependent protein kinase II (CaMKII). The arrhythmic phenotype can be partially blocked by a leptin neutralizing antibody or an inhibitor of Y1R, NCX, or CaMKII. Moreover, increased EAT thickness and leptin/NPY blood levels are detected in atrial fibrillation patients compared with the control group. Our study provides robust evidence that the adipose-neural axis contributes to arrhythmogenesis and represents a potential target for treating arrhythmia.
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Affiliation(s)
- Yubao Fan
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Local Joint Engineering Research Center for Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shanshan Huang
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Local Joint Engineering Research Center for Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Suhua Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bingyuan Wu
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Local Joint Engineering Research Center for Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qi Zhao
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Local Joint Engineering Research Center for Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Li Huang
- Center of Stem Cell and Regenerative Medicine, Gaozhou People's Hospital, Maoming, Guangdong, China
| | - Zhenda Zheng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xujing Xie
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jia Liu
- VIP Medical Service Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weijun Huang
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Local Joint Engineering Research Center for Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiaqi Sun
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Local Joint Engineering Research Center for Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiulong Zhu
- The Cardiovascular Center, Gaozhou People's Hospital, Maoming, Guangdong, China.
| | - Jieming Zhu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Andy Peng Xiang
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Local Joint Engineering Research Center for Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Histoembryology and Cell Biology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, Guangdong, China.
| | - Weiqiang Li
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; National-Local Joint Engineering Research Center for Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Histoembryology and Cell Biology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China.
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2
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Amoni M, Ingelaere S, Moeyersons J, Wets D, Tanushi A, Van Huffel S, Varon C, Sipido K, Claus P, Willems R. Regional beat-to-beat variability of repolarization increases during ischemia and predicts imminent arrhythmias in a pig model of myocardial infarction. Am J Physiol Heart Circ Physiol 2023; 325:H54-H65. [PMID: 37145956 PMCID: PMC10511165 DOI: 10.1152/ajpheart.00732.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/07/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
Ventricular arrhythmia (VT/VF) can complicate acute myocardial ischemia (AMI). Regional instability of repolarization during AMI contributes to the substrate for VT/VF. Beat-to-beat variability of repolarization (BVR), a measure of repolarization lability increases during AMI. We hypothesized that its surge precedes VT/VF. We studied the spatial and temporal changes in BVR in relation to VT/VF during AMI. In 24 pigs, BVR was quantified on 12-lead electrocardiogram recorded at a sampling rate of 1 kHz. AMI was induced in 16 pigs by percutaneous coronary artery occlusion (MI), whereas 8 underwent sham operation (sham). Changes in BVR were assessed at 5 min after occlusion, 5 and 1 min pre-VF in animals that developed VF, and matched time points in pigs without VF. Serum troponin and ST deviation were measured. After 1 mo, magnetic resonance imaging and VT induction by programmed electrical stimulation were performed. During AMI, BVR increased significantly in inferior-lateral leads correlating with ST deviation and troponin increase. BVR was maximal 1 min pre-VF (3.78 ± 1.36 vs. 5 min pre-VF, 1.67 ± 1.56, P < 0.0001). After 1 mo, BVR was higher in MI than in sham and correlated with the infarct size (1.43 ± 0.50 vs. 0.57 ± 0.30, P = 0.009). VT was inducible in all MI animals and the ease of induction correlated with BVR. BVR increased during AMI and temporal BVR changes predicted imminent VT/VF, supporting a possible role in monitoring and early warning systems. BVR correlated to arrhythmia vulnerability suggesting utility in risk stratification post-AMI.NEW & NOTEWORTHY The key finding of this study is that BVR increases during AMI and surges before ventricular arrhythmia onset. This suggests that monitoring BVR may be useful for monitoring the risk of VF during and after AMI in the coronary care unit settings. Beyond this, monitoring BVR may have value in cardiac implantable devices or wearables.
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Affiliation(s)
- Matthew Amoni
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
| | - Sebastian Ingelaere
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
| | - Jonathan Moeyersons
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Dries Wets
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Aldo Tanushi
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Carolina Varon
- Department of Electrical Engineering, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
- Microgravity Research Center, Université Libre de Bruxelles, Brussels, Belgium
| | - Karin Sipido
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Piet Claus
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Rik Willems
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals, Leuven, Belgium
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O'Brien F, Staunton CA, Barrett-Jolley R. Systemic application of the transient receptor potential vanilloid-type 4 antagonist GSK2193874 induces tail vasodilation in a mouse model of thermoregulation. Biol Lett 2022; 18:20220129. [PMID: 35702981 PMCID: PMC9198786 DOI: 10.1098/rsbl.2022.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In humans, skin is a primary thermoregulatory organ, with vasodilation leading to rapid body cooling, whereas in Rodentia the tail performs an analogous function. Many thermodetection mechanisms are likely to be involved including transient receptor potential vanilloid-type 4 (TRPV4), an ion channel with thermosensitive properties. Previous studies have shown that TRPV4 is a vasodilator by local action in blood vessels, so here, we investigated whether constitutive TRPV4 activity affects Mus muscularis tail vascular tone and thermoregulation. We measured tail blood flow by pressure plethysmography in lightly sedated M. muscularis (CD1 strain) at a range of ambient temperatures, with and without intraperitoneal administration of the blood-brain barrier crossing TRPV4 antagonist GSK2193874. We also measured heart rate (HR) and blood pressure. As expected for a thermoregulatory organ, we found that tail blood flow increased with temperature. However, unexpectedly, we found that GSK2193874 increased tail blood flow at all temperatures, and we observed changes in HR variability. Since local TRPV4 activation causes vasodilation that would increase tail blood flow, these data suggest that increases in tail blood flow resulting from the TRPV4 antagonist may arise from a site other than the blood vessels themselves, perhaps in central cardiovascular control centres.
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Affiliation(s)
- Fiona O'Brien
- Department of Musculoskeletal Ageing, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Caroline A. Staunton
- Department of Musculoskeletal Ageing, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Richard Barrett-Jolley
- Department of Musculoskeletal Ageing, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
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Wang H, Wu Y, Zou Q, Yang W, Xu Z, Dong H, Zhu Z, Wang D, Wang T, Hu N, Zhang D. A biosensing system using a multiparameter nonlinear dynamic analysis of cardiomyocyte beating for drug-induced arrhythmia recognition. MICROSYSTEMS & NANOENGINEERING 2022; 8:49. [PMID: 35547605 PMCID: PMC9081091 DOI: 10.1038/s41378-022-00383-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/14/2022] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Abstract
Cardiovascular disease is the number one cause of death in humans. Therefore, cardiotoxicity is one of the most important adverse effects assessed by arrhythmia recognition in drug development. Recently, cell-based techniques developed for arrhythmia recognition primarily employ linear methods such as time-domain analysis that detect and compare individual waveforms and thus fall short in some applications that require automated and efficient arrhythmia recognition from large datasets. We carried out the first report to develop a biosensing system that integrated impedance measurement and multiparameter nonlinear dynamic algorithm (MNDA) analysis for drug-induced arrhythmia recognition and classification. The biosensing system cultured cardiomyocytes as physiologically relevant models, used interdigitated electrodes to detect the mechanical beating of the cardiomyocytes, and employed MNDA analysis to recognize drug-induced arrhythmia from the cardiomyocyte beating recording. The best performing MNDA parameter, approximate entropy, enabled the system to recognize the appearance of sertindole- and norepinephrine-induced arrhythmia in the recording. The MNDA reconstruction in phase space enabled the system to classify the different arrhythmias and quantify the severity of arrhythmia. This new biosensing system utilizing MNDA provides a promising and alternative method for drug-induced arrhythmia recognition and classification in cardiological and pharmaceutical applications.
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Affiliation(s)
- Hao Wang
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou, 510006 China
| | - Yue Wu
- Research Center for Intelligent Sensing Systems, Zhejiang Lab, Hangzhou, 311121 China
| | - Quchao Zou
- ZJU-Hangzhou Global Scientific and Technological Innovation Center, Department of Chemistry, The Second Affiliated Hospital Zhejiang University School of Medicine, Department of Clinical Medical Engineering, Zhejiang University, Hangzhou, 310058 China
| | - Wenjian Yang
- Research Center for Intelligent Sensing Systems, Zhejiang Lab, Hangzhou, 311121 China
| | - Zhongyuan Xu
- Research Center for Intelligent Sensing Systems, Zhejiang Lab, Hangzhou, 311121 China
| | - Hao Dong
- Research Center for Intelligent Sensing Systems, Zhejiang Lab, Hangzhou, 311121 China
| | - Zhijing Zhu
- Key Laboratory of Novel Target and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, School of Computer & Computing Science, Zhejiang University City College, Hangzhou, 310015 China
- School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, 310058 China
| | - Depeng Wang
- College of Energy and Power Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016 China
| | - Tianxing Wang
- E-LinkCare Meditech Co., Ltd., Hangzhou, 310011 China
| | - Ning Hu
- State Key Laboratory of Optoelectronic Materials and Technologies, Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou, 510006 China
- ZJU-Hangzhou Global Scientific and Technological Innovation Center, Department of Chemistry, The Second Affiliated Hospital Zhejiang University School of Medicine, Department of Clinical Medical Engineering, Zhejiang University, Hangzhou, 310058 China
- State Key Laboratory of Transducer Technology, Chinese Academy of Sciences, Shanghai, 200050 China
| | - Diming Zhang
- Research Center for Intelligent Sensing Systems, Zhejiang Lab, Hangzhou, 311121 China
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5
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Site-directed deuteration of dronedarone preserves cytochrome P4502J2 activity and mitigates its cardiac adverse effects in canine arrhythmic hearts. Acta Pharm Sin B 2022; 12:3905-3923. [PMID: 36213535 PMCID: PMC9532722 DOI: 10.1016/j.apsb.2022.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/13/2022] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Cytochrome P4502J2 (CYP2J2) metabolizes arachidonic acid (AA) to cardioprotective epoxyeicosatrienoic acids (EETs). Dronedarone, an antiarrhythmic drug prescribed for treatment of atrial fibrillation (AF) induces cardiac adverse effects (AEs) with poorly understood mechanisms. We previously demonstrated that dronedarone inactivates CYP2J2 potently and irreversibly, disrupts AA-EET pathway leading to cardiac mitochondrial toxicity rescuable via EET enrichment. In this study, we investigated if mitigation of CYP2J2 inhibition prevents dronedarone-induced cardiac AEs. We first synthesized a deuterated analogue of dronedarone (termed poyendarone) and demonstrated that it neither inactivates CYP2J2, disrupts AA-EETs metabolism nor causes cardiac mitochondrial toxicity in vitro. Our patch-clamp experiments demonstrated that pharmacoelectrophysiology of dronedarone is unaffected by deuteration. Next, we show that dronedarone treatment or CYP2J2 knockdown in spontaneously beating cardiomyocytes indicative of depleted CYP2J2 activity exacerbates beat-to-beat (BTB) variability reflective of proarrhythmic phenotype. In contrast, poyendarone treatment yields significantly lower BTB variability compared to dronedarone in cardiomyocytes indicative of preserved CYP2J2 activity. Importantly, poyendarone and dronedarone display similar antiarrhythmic properties in the canine model of persistent AF, while poyendarone substantially reduces beat-to-beat variability of repolarization duration suggestive of diminished proarrhythmic risk. Our findings prove that deuteration of dronedarone prevents CYP2J2 inactivation and mitigates dronedarone-induced cardiac AEs.
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6
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Smoczyńska A, Aarnink EW, Dunnink A, Bossu A, van Weperen VYH, Meijborg VMF, Beekman HDM, Coronel R, Vos MA. Interplay between temporal and spatial dispersion of repolarization in the initiation and perpetuation of torsades de pointes in the chronic atrioventricular block dog. Am J Physiol Heart Circ Physiol 2021; 321:H569-H576. [PMID: 34355987 DOI: 10.1152/ajpheart.00945.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ventricular arrhythmias, consisting of single ectopic beats (sEB), multiple EB (mEB), and torsades de pointes (TdP, defined as ≥5 beats with QRS vector twisting around isoelectric line) can be induced in the anesthetized chronic atrioventricular block (CAVB) dog by dofetilide (IKr blocker). The interplay between temporal dispersion of repolarization, quantified as short-term variability (STV), and spatial dispersion of repolarization (SDR) in the initiation and perpetuation of these arrhythmias remains unclear. Five inducible (≥3 TdPs/10 min) CAVB dogs underwent one mapping experiment and were observed for 10 min from the start of dofetilide infusion (0.025 mg/kg, 5 min). An intracardiac decapolar electrogram (EGM) catheter and 30 intramural cardiac needles in the left ventricle (LV) were introduced. STVARI was derived from 31 consecutive activation recovery intervals (ARIs) on the intracardiac EGM, using the formula: [Formula: see text]. The mean SDR3D in the LV was determined as the three-dimensional repolarization time differences between the intramural cardiac needles. Moments of measurement included baseline (BL) and after dofetilide infusion before first 1) sEB (occurrence at 100 ± 35 s), 2) mEB (224 ± 96 s), and 3) non-self-terminating TdP (454 ± 298 s). STVARI increased from 2.15 ± 0.32 ms at BL to 3.73 ± 0.99 ms* before the first sEB and remained increased without further significant progression to mEB (4.41 ± 0.45 ms*) and TdP (5.07 ± 0.84 ms*) (*P < 0.05 compared with BL). SDR3D did not change from 31 ± 11 ms at BL to 43 ± 13 ms before sEB but increased significantly before mEB (68 ± 7 ms*) and to TdP (86 ± 9 ms*+) (+P < 0.05 compared with sEB). An increase in STV contributes to the initiation of sEB, whereas an increase in SDR is important for the perpetuation of non-self-terminating TdPs.NEW & NOTEWORTHY This study compared two well-established electrophysiological parameters, being temporal and spatial dispersion of repolarization, and provided new insights into their interplay in the arrhythmogenesis of torsades de pointes arrhythmias. Although it confirmed that an increase in temporal dispersion of repolarization contributes to the initiation of single ectopic beats, it showed that an increase in spatial dispersion of repolarization is important for the perpetuation of non-self-terminating torsades de pointes arrhythmias.
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Affiliation(s)
- Agnieszka Smoczyńska
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Errol W Aarnink
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Albert Dunnink
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexandre Bossu
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Valerie Y H van Weperen
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Veronique M F Meijborg
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Heart Institute, Holland Heart House, Utrecht, The Netherlands
| | - Henriëtte D M Beekman
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Coronel
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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Taggart P, Pueyo E, Duijvenboden SV, Porter B, Bishop M, Sampedro-Puente DA, Orini M, Hanson B, Rinaldi CA, Gill JS, Lambiase P. Emerging evidence for a mechanistic link between low-frequency oscillation of ventricular repolarization measured from the electrocardiogram T-wave vector and arrhythmia. Europace 2021; 23:1350-1358. [PMID: 33880542 PMCID: PMC8427352 DOI: 10.1093/europace/euab009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
Strong recent clinical evidence links the presence of prominent oscillations of ventricular repolarization in the low-frequency range (0.04–0.15 Hz) to the incidence of ventricular arrhythmia and sudden death in post-MI patients and patients with ischaemic and non-ischaemic cardiomyopathy. It has been proposed that these oscillations reflect oscillations of ventricular action potential duration at the sympathetic nerve frequency. Here we review emerging evidence to support that contention and provide insight into possible underlying mechanisms for this association.
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Affiliation(s)
- Peter Taggart
- Department of Cardiovascular Sciences, University College London, London, UK
| | - Esther Pueyo
- BSICOS Group, 13A, 11S, Aragon, University of Zaragoza, Spain.,CIBER-BBN, Zaragoza, Spain
| | | | - Bradley Porter
- Department of Imaging Sciences and Biomedical Engineering, KCL, London, UK
| | - Martin Bishop
- Department of Imaging Sciences and Biomedical Engineering, KCL, London, UK
| | | | - M Orini
- Department of Cardiovascular Sciences, University College London, London, UK
| | - B Hanson
- UCL Mechanical Engineering, University College London, London, UK
| | | | | | - Pier Lambiase
- Department of Cardiovascular Sciences, University College London, London, UK
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8
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Loen V, Vos MA, van der Heyden MAG. The canine chronic atrioventricular block model in cardiovascular preclinical drug research. Br J Pharmacol 2021; 179:859-881. [PMID: 33684961 PMCID: PMC9291585 DOI: 10.1111/bph.15436] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/29/2022] Open
Abstract
Ventricular cardiac arrhythmia is a life threating condition arising from abnormal functioning of many factors in concert. Animal models mirroring human electrophysiology are essential to predict and understand the rare pro- and anti-arrhythmic effects of drugs. This is very well accomplished by the canine chronic atrioventricular block (CAVB) model. Here we summarize canine models for cardiovascular research, and describe the development of the CAVB model from its beginning. Understanding of the structural, contractile and electrical remodelling processes following atrioventricular (AV) block provides insight in the many factors contributing to drug-induced arrhythmia. We also review all safety pharmacology studies, efficacy and mechanistic studies on anti-arrhythmic drugs in CAVB dogs. Finally, we compare pros and cons with other in vivo preclinical animal models. In view of the tremendous amount of data obtained over the last 100 years from the CAVB dog model, it can be considered as man's best friend in preclinical drug research.
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Affiliation(s)
- Vera Loen
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Shi B, Motin MA, Wang X, Karmakar C, Li P. Bivariate Entropy Analysis of Electrocardiographic RR-QT Time Series. ENTROPY 2020; 22:e22121439. [PMID: 33419293 PMCID: PMC7766536 DOI: 10.3390/e22121439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
QT interval variability (QTV) and heart rate variability (HRV) are both accepted biomarkers for cardiovascular events. QTV characterizes the variations in ventricular depolarization and repolarization. It is a predominant element of HRV. However, QTV is also believed to accept direct inputs from upstream control system. How QTV varies along with HRV is yet to be elucidated. We studied the dynamic relationship of QTV and HRV during different physiological conditions from resting, to cycling, and to recovering. We applied several entropy-based measures to examine their bivariate relationships, including cross sample entropy (XSampEn), cross fuzzy entropy (XFuzzyEn), cross conditional entropy (XCE), and joint distribution entropy (JDistEn). Results showed no statistically significant differences in XSampEn, XFuzzyEn, and XCE across different physiological states. Interestingly, JDistEn demonstrated significant decreases during cycling as compared with that during the resting state. Besides, JDistEn also showed a progressively recovering trend from cycling to the first 3 min during recovering, and further to the second 3 min during recovering. It appeared to be fully recovered to its level in the resting state during the second 3 min during the recovering phase. The results suggest that there is certain nonlinear temporal relationship between QTV and HRV, and that the JDistEn could help unravel this nuanced property.
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Affiliation(s)
- Bo Shi
- School of Medical Imaging, Bengbu Medical College, Bengbu 233030, China;
| | - Mohammod Abdul Motin
- Department of Electrical and Electronic Engineering, University of Melbourne, Melbourne, VIC 3110, Australia;
| | - Xinpei Wang
- School of Control Science and Engineering, Shandong University, Jinan 250061, China;
| | - Chandan Karmakar
- School of Information Technology, Deakin University, Geelong, VIC 3225, Australia
- Correspondence: (C.K.); (P.L.)
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Correspondence: (C.K.); (P.L.)
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10
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DeProspero DJ, Adin DB. Visual representations of canine cardiac arrhythmias with Lorenz (Poincaré) plots. Am J Vet Res 2020; 81:720-731. [PMID: 33112172 DOI: 10.2460/ajvr.81.9.720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the patterns associated with Lorenz plots (LPs) or Poincaré plots derived from the Holter recordings of dogs with various cardiac rhythms. ANIMALS 77 dogs with 24-hour Holter recordings. PROCEDURES A 1-hour period from the Holter recordings from each of 20 dogs without arrhythmias and from each of 57 dogs with arrhythmias (10 each with supraventricular premature complexes, complex supraventricular ectopy, ventricular premature complexes, complex ventricular ectopy, and atrial fibrillation, and 7 with high-grade second-degree atrioventricular block) were used to generate the LPs. Patterns depicted in the LPs were described. RESULTS Arrhythmia-free Holter recordings yielded LPs with a Y-shaped pattern and variable silent zones. Recordings with single premature complexes yielded LPs with double side and triple side lobes. Complex ectopy was denoted by dots clustered in the lower left corner of the LPs. The LPs of recordings with atrial fibrillation had fan patterns consistent with a nonlinear relationship between atrial electrical impulses and atrioventricular nodal conduction. The recordings with atrioventricular block yielded LPs with island patterns consistent with variable atrioventricular nodal conduction. CONCLUSIONS AND CLINICAL RELEVANCE Distinct LP patterns were identified for common cardiac rhythms of dogs, supportive of nonrandom mechanisms as the cause of most rhythms. Visual interpretation of an LP generated from a Holter recording may aid in determining the arrhythmia type and understanding the arrhythmia's mechanism in dogs and other species.
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11
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Smoczyńska A, Sprenkeler DJ, Aranda A, Beekman JDM, Bossu A, Dunnink A, Wijers SC, Stegemann B, Meine M, Vos MA. Evaluation of a Fully Automatic Measurement of Short-Term Variability of Repolarization on Intracardiac Electrograms in the Chronic Atrioventricular Block Dog. Front Physiol 2020; 11:1005. [PMID: 32973549 PMCID: PMC7472439 DOI: 10.3389/fphys.2020.01005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Short-term variability (STV) of repolarization of the monophasic action potential duration (MAPD) or activation recovery interval (ARI) on the intracardiac electrogram (EGM) increases abruptly prior to the occurrence of ventricular arrhythmias in the chronic AV-block (CAVB) dog model. Therefore, this parameter might be suitable for continuous monitoring of imminent arrhythmias using the EGM stored on an implanted device. However, 24/7 monitoring would require automatic STVARI measurement by the device. Objective: To evaluate a newly developed automatic measurement of STVARI for prediction of dofetilide-induced torsade de pointes (TdP) arrhythmias in the CAVB-dog. Methods: Two retrospective analyses were done on data from recently performed dog experiments. (1) In seven anesthetized CAVB-dogs, the new automatic STVARI method was compared with the gold standard STVMAPD at baseline and after dofetilide administration (0.025 mg/kg in 5 min). (2) The predictive value of the automatic method was compared to currently used STVARI methods, i.e., slope method and fiducial segment averaging (FSA) method, in 11 inducible (≥3 TdP arrhythmias) and 10 non-inducible CAVB-dogs. Results: (1) The automatic measurement of STVARI had good correlation with STVMAPD (r2 = 0.89; p < 0.001). Bland-Altman analysis showed a small bias of 0.06 ms with limits of agreement between −0.63 and 0.76 ms. (2) STVARI of all three methods was significantly different between inducible and non-inducible dogs after dofetilide. The automatic method showed the highest predictive performance with an area under the ROC-curve of 0.93, compared to 0.85 and 0.87 of the slope and FSA methods, respectively. With a threshold of STV set at 1.69 ms, STVARI measured with the automatic method had a sensitivity of 0.91 and specificity of 0.90 in differentiating inducible from non-inducible subjects. Conclusion: We developed a fully-automatic method for measurement of STVARI on the intracardiac EGM that can accurately predict the occurrence of ventricular arrhythmias in the CAVB-dog. Future integration of this method into implantable devices could provide the opportunity for 24/7 monitoring of arrhythmic risk.
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Affiliation(s)
- Agnieszka Smoczyńska
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - David J Sprenkeler
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alfonso Aranda
- Medtronic Bakken Research Center, Maastricht, Netherlands
| | - Jet D M Beekman
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alexandre Bossu
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Albert Dunnink
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sofieke C Wijers
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
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12
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Vargas HM, Rolf MG, Wisialowski TA, Achanzar W, Bahinski A, Bass A, Benson CT, Chaudhary KW, Couvreur N, Dota C, Engwall MJ, Michael Foley C, Gallacher D, Greiter-Wilke A, Guillon JM, Guth B, Himmel HM, Hegele-Hartung C, Ito M, Jenkinson S, Chiba K, Lagrutta A, Levesque P, Martel E, Okai Y, Peri R, Pointon A, Qu Y, Teisman A, Traebert M, Yoshinaga T, Gintant GA, Leishman DJ, Valentin JP. Time for a Fully Integrated Nonclinical-Clinical Risk Assessment to Streamline QT Prolongation Liability Determinations: A Pharma Industry Perspective. Clin Pharmacol Ther 2020; 109:310-318. [PMID: 32866317 PMCID: PMC7891594 DOI: 10.1002/cpt.2029] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/13/2020] [Indexed: 02/03/2023]
Abstract
Defining an appropriate and efficient assessment of drug‐induced corrected QT interval (QTc) prolongation (a surrogate marker of torsades de pointes arrhythmia) remains a concern of drug developers and regulators worldwide. In use for over 15 years, the nonclinical International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) S7B and clinical ICH E14 guidances describe three core assays (S7B: in vitro hERG current & in vivo QTc studies; E14: thorough QT study) that are used to assess the potential of drugs to cause delayed ventricular repolarization. Incorporating these assays during nonclinical or human testing of novel compounds has led to a low prevalence of QTc‐prolonging drugs in clinical trials and no new drugs having been removed from the marketplace due to unexpected QTc prolongation. Despite this success, nonclinical evaluations of delayed repolarization still minimally influence ICH E14‐based strategies for assessing clinical QTc prolongation and defining proarrhythmic risk. In particular, the value of ICH S7B‐based “double‐negative” nonclinical findings (low risk for hERG block and in vivo QTc prolongation at relevant clinical exposures) is underappreciated. These nonclinical data have additional value in assessing the risk of clinical QTc prolongation when clinical evaluations are limited by heart rate changes, low drug exposures, or high‐dose safety considerations. The time has come to meaningfully merge nonclinical and clinical data to enable a more comprehensive, but flexible, clinical risk assessment strategy for QTc monitoring discussed in updated ICH E14 Questions and Answers. Implementing a fully integrated nonclinical/clinical risk assessment for compounds with double‐negative nonclinical findings in the context of a low prevalence of clinical QTc prolongation would relieve the burden of unnecessary clinical QTc studies and streamline drug development.
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Affiliation(s)
- Hugo M Vargas
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - Michael G Rolf
- Research & Development, Clinical Pharmacology & Safety Sciences, AstraZeneca, Gothenburg, Sweden
| | - Todd A Wisialowski
- Global Safety Pharmacology, Pfizer Global Research and Development, Groton, Connecticut, USA
| | | | | | - Alan Bass
- Merck & Co., Inc., Boston, Massachusetts, USA
| | | | | | - Nicolas Couvreur
- Safety Pharmacology, Institute de Recherches Servier, Suresnes, France
| | - Corina Dota
- Research & Development, Chief Medical Officer Organization, AstraZeneca, Gothenburg, Sweden
| | - Michael J Engwall
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - C Michael Foley
- Integrative Pharmacology, Abbvie, Inc, North Chicago, Illinois, USA
| | - David Gallacher
- Global Safety Pharmacology, Janssen Research & Development, Beerse, Belgium
| | | | | | - Brian Guth
- Department of Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | | | | | - Maki Ito
- Japan Pharmaceutical Manufacturers Association, Tokyo, Japan
| | - Stephen Jenkinson
- Global Safety Pharmacology, Pfizer Global Research and Development, San Diego, California, USA
| | - Katsuyoshi Chiba
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | | | - Paul Levesque
- BMS Bristol-Myers Squibb Company, Princeton, New Jersey, USA
| | - Eric Martel
- Department of Drug Discovery Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Yoshiko Okai
- Takeda Pharmaceutical Company Ltd., Fujisawa, Kanagawa, Japan
| | - Ravikumar Peri
- Takeda Pharmaceutical Company Ltd., Cambridge, Massachusetts, USA
| | - Amy Pointon
- Research & Development, Clinical Pharmacology & Safety Sciences, AstraZeneca, Cambridge, UK
| | - Yusheng Qu
- Translational Safety & Bioanalytical Sciences, Amgen Research, Thousand Oaks, California, USA
| | - Ard Teisman
- Global Safety Pharmacology, Janssen Research & Development, Beerse, Belgium
| | - Martin Traebert
- Safety Pharmacology, Novartis Institute of Biomedical Research, Basel, Switzerland
| | | | - Gary A Gintant
- Integrative Pharmacology, Abbvie, Inc, North Chicago, Illinois, USA
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13
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Baczkó I, Hornyik T, Brunner M, Koren G, Odening KE. Transgenic Rabbit Models in Proarrhythmia Research. Front Pharmacol 2020; 11:853. [PMID: 32581808 PMCID: PMC7291951 DOI: 10.3389/fphar.2020.00853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/22/2020] [Indexed: 12/23/2022] Open
Abstract
Drug-induced proarrhythmia constitutes a potentially lethal side effect of various drugs. Most often, this proarrhythmia is mechanistically linked to the drug's potential to interact with repolarizing cardiac ion channels causing a prolongation of the QT interval in the ECG. Despite sophisticated screening approaches during drug development, reliable prediction of proarrhythmia remains very challenging. Although drug-induced long-QT-related proarrhythmia is often favored by conditions or diseases that impair the individual's repolarization reserve, most cellular, tissue, and whole animal model systems used for drug safety screening are based on normal, healthy models. In recent years, several transgenic rabbit models for different types of long QT syndromes (LQTS) with differences in the extent of impairment in repolarization reserve have been generated. These might be useful for screening/prediction of a drug's potential for long-QT-related proarrhythmia, particularly as different repolarizing cardiac ion channels are impaired in the different models. In this review, we summarize the electrophysiological characteristics of the available transgenic LQTS rabbit models, and the pharmacological proof-of-principle studies that have been performed with these models—highlighting the advantages and disadvantages of LQTS models for proarrhythmia research. In the end, we give an outlook on potential future directions and novel models.
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Affiliation(s)
- István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Tibor Hornyik
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary.,Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Brunner
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Medical Intensive Care, St. Josefskrankenhaus, Freiburg, Germany
| | - Gideon Koren
- Cardiovascular Research Center, Division of Cardiology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, United States
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Translational Cardiology, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.,Institute of Physiology, University of Bern, Bern, Switzerland
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14
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Shah D, Prajapati C, Penttinen K, Cherian RM, Koivumäki JT, Alexanova A, Hyttinen J, Aalto-Setälä K. hiPSC-Derived Cardiomyocyte Model of LQT2 Syndrome Derived from Asymptomatic and Symptomatic Mutation Carriers Reproduces Clinical Differences in Aggregates but Not in Single Cells. Cells 2020; 9:cells9051153. [PMID: 32392813 PMCID: PMC7290503 DOI: 10.3390/cells9051153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/13/2022] Open
Abstract
Mutations in the HERG gene encoding the potassium ion channel HERG, represent one of the most frequent causes of long QT syndrome type-2 (LQT2). The same genetic mutation frequently presents different clinical phenotypes in the family. Our study aimed to model LQT2 and study functional differences between the mutation carriers of variable clinical phenotypes. We derived human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) from asymptomatic and symptomatic HERG mutation carriers from the same family. When comparing asymptomatic and symptomatic single LQT2 hiPSC-CMs, results from allelic imbalance, potassium current density, and arrhythmicity on adrenaline exposure were similar, but a difference in Ca2+ transients was observed. The major differences were, however, observed at aggregate level with increased susceptibility to arrhythmias on exposure to adrenaline or potassium channel blockers on CM aggregates derived from the symptomatic individual. The effect of this mutation was modeled in-silico which indicated the reactivation of an inward calcium current as one of the main causes of arrhythmia. Our in-vitro hiPSC-CM model recapitulated major phenotype characteristics observed in LQT2 mutation carriers and strong phenotype differences between LQT2 asymptomatic vs. symptomatic were revealed at CM-aggregate level.
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Affiliation(s)
- Disheet Shah
- Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University, 33520 Tampere, Finland; (C.P.); (K.P.); (R.M.C.); (J.T.K.); (A.A.); (J.H.); (K.A.-S.)
- Correspondence:
| | - Chandra Prajapati
- Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University, 33520 Tampere, Finland; (C.P.); (K.P.); (R.M.C.); (J.T.K.); (A.A.); (J.H.); (K.A.-S.)
| | - Kirsi Penttinen
- Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University, 33520 Tampere, Finland; (C.P.); (K.P.); (R.M.C.); (J.T.K.); (A.A.); (J.H.); (K.A.-S.)
| | - Reeja Maria Cherian
- Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University, 33520 Tampere, Finland; (C.P.); (K.P.); (R.M.C.); (J.T.K.); (A.A.); (J.H.); (K.A.-S.)
| | - Jussi T. Koivumäki
- Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University, 33520 Tampere, Finland; (C.P.); (K.P.); (R.M.C.); (J.T.K.); (A.A.); (J.H.); (K.A.-S.)
| | - Anna Alexanova
- Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University, 33520 Tampere, Finland; (C.P.); (K.P.); (R.M.C.); (J.T.K.); (A.A.); (J.H.); (K.A.-S.)
| | - Jari Hyttinen
- Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University, 33520 Tampere, Finland; (C.P.); (K.P.); (R.M.C.); (J.T.K.); (A.A.); (J.H.); (K.A.-S.)
| | - Katriina Aalto-Setälä
- Faculty of Medicine and Health Technology and BioMediTech Institute, Tampere University, 33520 Tampere, Finland; (C.P.); (K.P.); (R.M.C.); (J.T.K.); (A.A.); (J.H.); (K.A.-S.)
- Heart Hospital, Tampere University Hospital, 33520 Tampere, Finland
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15
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Sattler SM, Lubberding AF, Kristensen CB, Møgelvang R, Blanche P, Fink-Jensen A, Engstrøm T, Kääb S, Jespersen T, Tfelt-Hansen J. Effect of the antipsychotic drug haloperidol on arrhythmias during acute myocardial infarction in a porcine model. IJC HEART & VASCULATURE 2020; 26:100455. [PMID: 32140549 PMCID: PMC7046512 DOI: 10.1016/j.ijcha.2019.100455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022]
Abstract
Patients receiving psychiatric medication, like the antipsychotic drug haloperidol, are at an increased risk of sudden cardiac death (SCD). Haloperidol blocks the cardiac rapidly-activating delayed rectifier potassium current, thereby increasing electrical dispersion of repolarization which can potentially lead to arrhythmias. Whether these patients are also at a higher risk to develop SCD during an acute myocardial infarction (AMI) is unknown. AMI locally shortens action potential duration, which might further increase repolarization dispersion and increase the risk of arrhythmia in the presence of haloperidol compared to without. Our aim was to test whether treatment with haloperidol implies an increased risk of SCD when eventually experiencing AMI. Twenty-eight female Danish Landrace pigs were randomized into three groups: low dose haloperidol (0.1 mg/kg), high dose (1.0 mg/kg) or vehicle-control group. One hour after haloperidol/vehicle infusion, AMI was induced by balloon-occlusion of the mid-left anterior descending coronary artery and maintained for 120 min, followed by 60 min of reperfusion. VF occurred during occlusion in 7/11 pigs in the control group, 3/11 in the low dose (p = 0.198) and 2/6 in the high dose group (p = 0.335). High dose haloperidol significantly prolonged QT, and reduced heart rate, vascular resistance and blood pressure before and during AMI. Premature ventricular contractions in phase 1b during AMI were reduced with high dose haloperidol. AMI-induced arrhythmia was not aggravated in pigs with haloperidol treatment. Our results do not suggest that AMI is contributing to the excess mortality in patients treated with antipsychotic drugs seen in epidemiological studies.
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Affiliation(s)
- Stefan M Sattler
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig-Maximilians University Munich (LMU), Munich, Germany
| | - Anniek F Lubberding
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte B Kristensen
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Paul Blanche
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Anders Fink-Jensen
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig-Maximilians University Munich (LMU), Munich, Germany
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
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16
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17
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Liu X, Qu C, Shi S, Ye T, Wang L, Liu S, Zhang C, Liang J, Hu D, Yang B. The Reversal Effect of Sigma-1 Receptor (S1R) Agonist, SA4503, on Atrial Fibrillation After Depression and Its Underlying Mechanism. Front Physiol 2019; 10:1346. [PMID: 31803058 PMCID: PMC6870537 DOI: 10.3389/fphys.2019.01346] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/10/2019] [Indexed: 12/26/2022] Open
Abstract
Aim Sigma-1 receptors have been investigated and shown to play a protective role in both depression and cardiovascular disease. SA4503, known as a σ1 receptor agonist, regulates cardiac calcium and potassium channels in rat models of depression. However, it remains unknown whether SA4503 can alleviate myocardial inflammation or conduction junctions in the atrium after exposure to chronic mild stress. Methods and Results Sprague-Dawley male rats received 28-day treatment with SA4503, simultaneously with chronic mild stress. Behavior measurements were assessed after the daily doses. Additionally, a multielectrode array assessment, electrophysiological study, immunohistochemistry analysis, histological analysis, and Western blot analysis were performed. Depression rats’ hearts showed abnormal electrical activity, including disordered excitation propagation and prolonged total activation time (TAT). In addition, atrial arrhythmias (AAs), induced by burst stimulation, showed higher incidence and longer duration in the depression group compared to the control group. These changes were related to reduced conduction junctions and enhanced spatial heterogeneity. Importantly, depressed rat hearts showed greater expression of inflammatory factors (TGF-α, IL-6, and TGF-β), more collagen distribution in the extracellular matrix, and lower expression of gap junction proteins (CX40 and CX43). Furthermore, SA4503 partially mitigated the above indices in the depression group (P < 0.01 for all groups). Conclusion These findings show the effects of the σ1R agonist SA4503; it alleviates atrial myocardial inflammation and conduction junctions after chronic mild stress. SA4503 may be the promising pharmacological agent to treat depression-related AAs by increasing conduction function, improving the expression of connexin 40 and 43, and reducing cardiac myocardial inflammation.
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Affiliation(s)
- Xin Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Chuan Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Shaobo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Tianxin Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Linglin Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Steven Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Cui Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Jinjun Liang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Dan Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
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18
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Nánási PP, Szabó Z, Kistamás K, Horváth B, Virág L, Jost N, Bányász T, Almássy J, Varró A. Implication of frequency-dependent protocols in antiarrhythmic and proarrhythmic drug testing. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2019; 157:76-83. [PMID: 31726065 DOI: 10.1016/j.pbiomolbio.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 01/20/2023]
Abstract
It has long been known that the electrophysiological effects of many cardioactive drugs strongly depend on the rate dependent frequency. This was recognized first for class I antiarrhythmic agents: their Vmax suppressive effect was attenuated at long cycle lengths. Later many Ca2+ channel blockers were also found to follow such kinetics. The explanation was provided by the modulated and the guarded receptor theories. Regarding the duration of cardiac action potentials (APD) an opposite frequency-dependence was observed, i.e. the drug-induced changes in APD were proportional with the cycle length of stimulation, therefore it was referred as "reverse rate-dependency". The beat-to-beat, or short term variability of APD (SV) has been recognized as an important proarrhythmic mechanism, its magnitude can be used as an arrhythmia predictor. SV is modulated by several cardioactive agents, however, these drugs modify also APD itself. In order to clear the drug-specific effects on SV from the concomitant unspecific APD-change related ones, the term of "relative variability" was introduced. Relative variability is increased by ion channel blockers that decrease the negative feedback control of APD (i.e. blockers of ICa, IKr and IKs) and also by elevation of cytosolic Ca2+. Cardiac arrhythmias are also often categorized according to the characteristic heart rate (tachy- and bradyarrhythmias). Tachycardia is proarrhythmic primarily due to the concomitant Ca2+ overload causing delayed afterdepolarizations. Early afterdepolarizations (EADs) are complications of the bradycardic heart. What is common in the reverse rate-dependent nature of drug action on APD, increased SV and EAD incidence associated with bradycardia.
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Affiliation(s)
- Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Department of Dental Physiology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kornél Kistamás
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Balázs Horváth
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Virág
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary; Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Norbert Jost
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary; Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary; MTA-SZTE Research Group for Cardiovascular Pharmacology, Szeged, Hungary
| | - Tamás Bányász
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Almássy
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary; Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary; MTA-SZTE Research Group for Cardiovascular Pharmacology, Szeged, Hungary.
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19
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Smoczynska A, Beekman HD, Vos MA. The Increment of Short-term Variability of Repolarisation Determines the Severity of the Imminent Arrhythmic Outcome. Arrhythm Electrophysiol Rev 2019; 8:166-172. [PMID: 31576205 PMCID: PMC6766692 DOI: 10.15420/aer.2019.16.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Ventricular remodelling can make the heart more susceptible to ventricular arrhythmias like torsades de pointes. Understanding the underlying mechanisms of initiation of ventricular arrhythmias and the determining factors for its severity has the potential to uncover new interventions. Beat-to-beat variation of repolarisation, quantified as short-term variability of repolarisation (STV), has been identified as an important factor contributing to arrhythmogenesis. This article provides an overview of experimental data about STV in relation to the initiation of torsades de pointes in a canine model of complete chronic atrioventricular block susceptible to torsades de pointes arrhythmias. Furthermore, it explores STV in relation to the severity of the arrhythmic outcome.
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Affiliation(s)
- Agnieszka Smoczynska
- Department of Medical Physiology, University Medical Center Utrecht Utrecht, the Netherlands
| | - Henriëtte Dm Beekman
- Department of Medical Physiology, University Medical Center Utrecht Utrecht, the Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht Utrecht, the Netherlands
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20
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Sampedro-Puente DA, Fernandez-Bes J, Porter B, van Duijvenboden S, Taggart P, Pueyo E. Mechanisms Underlying Interactions Between Low-Frequency Oscillations and Beat-to-Beat Variability of Celullar Ventricular Repolarization in Response to Sympathetic Stimulation: Implications for Arrhythmogenesis. Front Physiol 2019; 10:916. [PMID: 31427979 PMCID: PMC6687852 DOI: 10.3389/fphys.2019.00916] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: Enhanced beat-to-beat variability of ventricular repolarization (BVR) has been linked to arrhythmias and sudden cardiac death. Recent experimental studies on human left ventricular epicardial electrograms have shown that BVR closely interacts with low-frequency (LF) oscillations of activation recovery interval during sympathetic provocation. In this work human ventricular computational cell models are developed to reproduce the experimentally observed interactions between BVR and its LF oscillations, to assess underlying mechanisms and to establish a relationship with arrhythmic risk. Materials and Methods: A set of human ventricular action potential (AP) models covering a range of experimental electrophysiological characteristics was constructed. These models incorporated stochasticity in major ionic currents as well as descriptions of β-adrenergic stimulation and mechanical effects to investigate the AP response to enhanced sympathetic activity. Statistical methods based on Automatic Relevance Determination and Canonical Correlation Analysis were developed to unravel individual and common factors contributing to BVR and LF patterning of APD in response to sympathetic provocation. Results: Simulated results reproduced experimental evidences on the interactions between BVR and LF oscillations of AP duration (APD), with replication of the high inter-individual variability observed in both phenomena. ICaL, IKr and IK1 currents were identified as common ionic modulators of the inter-individual differences in BVR and LF oscillatory behavior and were shown to be crucial in determining susceptibility to arrhythmogenic events. Conclusions: The calibrated family of human ventricular cell models proposed in this study allows reproducing experimentally reported interactions between BVR and LF oscillations of APD. Ionic factors involving ICaL, IKr and IK1 currents are found to underlie correlated increments in both phenomena in response to sympathetic provocation. A link to arrhythmogenesis is established for concomitantly elevated levels of BVR and its LF oscillations.
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Affiliation(s)
| | | | - Bradley Porter
- Department of Imaging Sciences and Biomedical Engineering, Kings College London, London, United Kingdom
| | | | - Peter Taggart
- Department of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Esther Pueyo
- BSICOS Group, I3A, IIS Aragón, University of Zaragoza, Zaragoza, Spain.,CIBER-BBN, Madrid, Spain
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21
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Modeling of LMNA-Related Dilated Cardiomyopathy Using Human Induced Pluripotent Stem Cells. Cells 2019; 8:cells8060594. [PMID: 31208058 PMCID: PMC6627421 DOI: 10.3390/cells8060594] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/31/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is one of the leading causes of heart failure and heart transplantation. A portion of familial DCM is due to mutations in the LMNA gene encoding the nuclear lamina proteins lamin A and C and without adequate treatment these patients have a poor prognosis. To get better insights into pathobiology behind this disease, we focused on modeling LMNA-related DCM using human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CM). Primary skin fibroblasts from DCM patients carrying the most prevalent Finnish founder mutation (p.S143P) in LMNA were reprogrammed into hiPSCs and further differentiated into cardiomyocytes (CMs). The cellular structure, functionality as well as gene and protein expression were assessed in detail. While mutant hiPSC-CMs presented virtually normal sarcomere structure under normoxia, dramatic sarcomere damage and an increased sensitivity to cellular stress was observed after hypoxia. A detailed electrophysiological evaluation revealed bradyarrhythmia and increased occurrence of arrhythmias in mutant hiPSC-CMs on β-adrenergic stimulation. Mutant hiPSC-CMs also showed increased sensitivity to hypoxia on microelectrode array and altered Ca2+ dynamics. Taken together, p.S143P hiPSC-CM model mimics hallmarks of LMNA-related DCM and provides a useful tool to study the underlying cellular mechanisms of accelerated cardiac degeneration in this disease.
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22
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Tisdale JE, Jaynes HA, Overholser BR, Sowinski KM, Kovacs RJ. Progesterone pretreatment reduces the incidence of drug-induced torsades de pointes in atrioventricular node-ablated isolated perfused rabbit hearts. J Cardiovasc Electrophysiol 2019; 30:941-949. [PMID: 31006943 PMCID: PMC6591050 DOI: 10.1111/jce.13942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Higher progesterone concentrations are protective against drug-induced prolongation of ventricular repolarization. We tested the hypothesis that pretreatment with progesterone reduces the incidence of drug-induced torsades de pointes (TdP). METHODS AND RESULTS Female New Zealand white rabbits (2.5-3.2 kg) underwent ovariectomy and were randomized to undergo implantation with subcutaneous 21-day sustained release pellets containing progesterone 50 mg (n = 22) or placebo (n = 23). After 20 days, hearts were excised, mounted, and perfused with modified Krebs-Henseleit solution. The atrioventricular (AV) node was destroyed manually. Following a 15-minute equilibration period, hearts were perfused with dofetilide 100 nM for 30 minutes, during which the electrocardiogram was recorded continuously. Incidences of spontaneous TdP, other ventricular arrhythmias and mean QTc intervals were compared. Median serum progesterone concentrations were higher in progesterone vs placebo-treated rabbits (3.8 [range, 2.8-5.1] vs 0.7 [0.4-1.7] ng/mL, P < 0.0001). Median serum estradiol concentrations were similar (58 [22-72] vs 53 [34-62] pg/mL), P = 0.79). The incidence of TdP was lower in hearts from progesterone-treated rabbits (27% vs 61%, P = 0.049). The incidences of bigeminy (36% vs 74%, P = 0.03) and trigeminy (18% vs 57%, P = 0.01) were also lower in hearts from progesterone-treated rabbits. There was no significant difference between groups in incidence of couplets (59% vs 74%, P = 0.54) or monomorphic ventricular tachycardia (14% vs 30%, P = 0.28). Maximum QT c interval and short-term beat-to-beat QT interval variability during dofetilide perfusion were significantly shorter in hearts from progesterone-treated rabbits. CONCLUSIONS Pretreatment with progesterone reduces the incidence of drug-induced TdP, bigeminy, and trigeminy in isolated perfused AV node-ablated rabbit hearts.
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Affiliation(s)
- James E. Tisdale
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Indiana
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN
| | - Heather A. Jaynes
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Indiana
| | - Brian R. Overholser
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Indiana
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN
| | - Kevin M. Sowinski
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Indiana
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN
| | - Richard J. Kovacs
- Krannert Institute of Cardiology, School of Medicine, Indiana University
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23
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Sprenkeler DJ, Bossu A, Beekman JDM, Schoenmakers M, Vos MA. An Augmented Negative Force-Frequency Relationship and Slowed Mechanical Restitution Are Associated With Increased Susceptibility to Drug-Induced Torsade de Pointes Arrhythmias in the Chronic Atrioventricular Block Dog. Front Physiol 2018; 9:1086. [PMID: 30135660 PMCID: PMC6092493 DOI: 10.3389/fphys.2018.01086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction: In the chronic AV-block (CAVB) dog model, structural, contractile, and electrical remodeling occur, which predispose the heart to dofetilide-induced Torsade de Pointes (TdP) arrhythmias. Previous studies found a relation between electrical remodeling and inducibility of TdP, while structural remodeling is not a prerequisite for arrhythmogenesis. In this study, we prospectively assessed the relation between in vivo markers of contractile remodeling and TdP inducibility. Methods: In 18 anesthetized dogs, the maximal first derivative of left ventricular pressure (LV dP/dtmax) was assessed at acute AV-block (AAVB) and after 2 weeks of chronic AV-block (CAVB2). Using pacing protocols, three markers of contractile remodeling, i.e., force-frequency relationship (FFR), mechanical restitution (MR), and post-extrasystolic potentiation (PESP) were determined. Infusion of dofetilide (0.025 mg/kg in 5 min) was used to test for TdP inducibility. Results: After infusion of dofetilide, 1/18 dogs and 12/18 were susceptible to TdP-arrhythmias at AAVB and CAVB2, respectively (p = 0.001). The inducible dogs at CAVB2 showed augmented contractility at a CL of 1200 ms (2354 ± 168 mmHg/s in inducible dogs versus 1091 ± 59 mmHg/s in non-inducible dogs, p < 0.001) with a negative FFR, while the non-inducible dogs retained their positive FFR. The time constant (TC) of the MR curve was significantly higher in the inducible dogs (158 ± 7 ms versus 97 ± 8 ms, p < 0.0001). Furthermore, a linear correlation was found between a weighted score of the number and severity of arrhythmias and contractile parameters, i.e., contractility at CL of 1200 ms (r = 0.73, p = 0.002), the slope of the FFR (r = -0.58, p = 0.01) and the TC of MR (r = 0.66, p = 0.003). Thus, more severe arrhythmias were seen in dogs with the most pronounced contractile remodeling. Conclusion: Contractile remodeling is concomitantly observed with susceptibility to dofetilide-induced TdP-arrhythmias. The inducible dogs show augmented contractile remodeling compared to non-inducible dogs, as seen by a negative FFR, higher maximal response of MR and PESP and slowed MR kinetics. These altered contractility parameters could reflect disrupted Ca2+ handling and Ca2+-overload, which predispose the heart to delayed- and early afterdepolarizations that could trigger TdP-arrhythmias.
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Affiliation(s)
- David J Sprenkeler
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alexandre Bossu
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jet D M Beekman
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marieke Schoenmakers
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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24
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Limprasutr V, Pirintr P, Kijtawornrat A, Hamlin RL. An increasing electromechanical window is a predictive marker of ventricular fibrillation in anesthetized rabbit with ischemic heart. Exp Anim 2017; 67:175-183. [PMID: 29162767 PMCID: PMC5955749 DOI: 10.1538/expanim.17-0100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The QTc interval is widely used in Safety Pharmacological studies to predict arrhythmia
risk, and the electromechanical window (EMW) and short-term variability of QT intervals
(STVQT) have been studied as new biomarkers for drug-induced Torsades de
Pointes (TdP). However, the use of EMW and STVQT to predict ventricular
fibrillation (VF) has not been elucidated. This study aimed to evaluate EMW and
STVQT to predict VF in anesthetized rabbit model of VF. VF was induced by
ligation of the left anterior descending and a descending branch of the left circumflex
coronary arteries in a sample population of rabbits (n=18). VF was developed 55.6%
(10/18). In rabbit with VF, the EMW was significantly higher than in rabbits without VF
(96.3 ± 15.6 ms and 49.5 ± 5.6 ms, respectively, P<0.05).
STVQT had significantly increased before the onset of VF in rabbits that
experienced VF, but not in rabbits that did not experience VF (11.7 ± 1.8 ms and 3.7 ± 0.4
ms, respectively, P<0.05). The EMW and STVQT had better
predictive power for VF with higher sensitivity and specificity than the QTc measure. The
result suggested that the increasing of EMW, as well as the elevation of STVQT,
can potentially be used as biomarkers for predicting of VF.
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Affiliation(s)
- Vudhiporn Limprasutr
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Wang Mai, Pathumwan, Bangkok 10330, Thailand
| | - Prapawadee Pirintr
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Wang Mai, Pathumwan, Bangkok 10330, Thailand.,Department of Veterinary Biosciences and Veterinary Public Health, Faculty of Veterinary Medicine, Chiang Mai University, 155 Tumbon Mae Hiae, Muang, Chiang Mai 50100, Thailand
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Wang Mai, Pathumwan, Bangkok 10330, Thailand.,Research clusters: research study and testing of drug's effect related to cardiovascular system in laboratory animals, Chulalongkorn University, 39 Henri Dunant Road, Wang Mai, Pathumwan, Bangkok 10330, Thailand
| | - Robert L Hamlin
- QTest Labs, LLC. 6456 Fiesta Drive, Columbus, Ohio 43235, USA
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25
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Mechano-electrical feedback in the clinical setting: Current perspectives. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 130:365-375. [DOI: 10.1016/j.pbiomolbio.2017.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/13/2022]
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26
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Orini M, Pueyo E, Laguna P, Bailon R. A Time-Varying Nonparametric Methodology for Assessing Changes in QT Variability Unrelated to Heart Rate Variability. IEEE Trans Biomed Eng 2017; 65:1443-1451. [PMID: 28991727 DOI: 10.1109/tbme.2017.2758925] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To propose and test a novel methodology to measure changes in QT interval variability (QTV) unrelated to RR interval variability (RRV) in nonstationary conditions. METHODS Time-frequency coherent and residual spectra representing QTV related (QTVrRRV) and unrelated (QTVuRRV) to RRV, respectively, are estimated using time-frequency Cohen's class distributions. The proposed approach decomposes the nonstationary output spectrum of any two-input one-output model with uncorrelated inputs into two spectra representing the information related and unrelated to one of the two inputs, respectively. An algorithm to correct for the bias of the time-frequency coherence function between QTV and RRV is proposed to provide accurate estimates of both QTVuRRV and QTVrRRV. Two simulation studies were conducted to assess the methodology in challenging nonstationary conditions and data recorded during head-up tilt in 16 healthy volunteers were analyzed. RESULTS In the simulation studies, QTVuRRV changes were tracked with only a minor delay due to the filtering necessary to estimate the nonstationary spectra. The correlation coefficient between theoretical and estimated patterns was even for extremely noisy recordings (signal to noise ratio (SNR) in QTV dB). During head-up tilt, QTVrRRV explained the largest proportion of QTV, whereas QTVuRRV showed higher relative increase than QTV or QTVrRRV in all spectral bands ( for most pairwise comparisons). CONCLUSION The proposed approach accurately tracks changes in QTVuRRV. Head-up tilt induced a slightly greater increase in QTVuRRV than in QTVrRRV. SIGNIFICANCE The proposed index QTVuRRV may represent an indirect measure of intrinsic ventricular repolarization variability, a marker of cardiac instability associated with sympathetic ventricular modulation and sudden cardiac death.
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27
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Piccini I, Fehrmann E, Frank S, Müller FU, Greber B, Seebohm G. Adrenergic Stress Protection of Human iPS Cell-Derived Cardiomyocytes by Fast K v7.1 Recycling. Front Physiol 2017; 8:705. [PMID: 28959214 PMCID: PMC5603700 DOI: 10.3389/fphys.2017.00705] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/31/2017] [Indexed: 01/09/2023] Open
Abstract
The fight-or-flight response (FFR), a physiological acute stress reaction, involves positive chronotropic and inotropic effects on heart muscle cells mediated through β-adrenoceptor activation. Increased systolic calcium is required to enable stronger heart contractions whereas elevated potassium currents are to limit the duration of the action potentials and prevent arrhythmia. The latter effect is accomplished by an increased functional activity of the Kv7.1 channel encoded by KCNQ1. Current knowledge, however, does not sufficiently explain the full extent of rapid Kv7.1 activation and may hence be incomplete. Using inducible genetic KCNQ1 complementation in KCNQ1-deficient human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), we here reinvestigate the functional role of Kv7.1 in adapting human CMs to adrenergic stress. Under baseline conditions, Kv7.1 was barely detectable at the plasma membrane of hiPSC-CMs, yet it fully protected these from adrenergic stress-induced beat-to-beat variability of repolarization and torsade des pointes-like arrhythmia. Furthermore, isoprenaline treatment increased field potential durations specifically in KCNQ1-deficient CMs to cause these adverse macroscopic effects. Mechanistically, we find that the protective action by Kv7.1 resides in a rapid translocation of channel proteins from intracellular stores to the plasma membrane, induced by adrenergic signaling. Gene silencing experiments targeting RAB GTPases, mediators of intracellular vesicle trafficking, showed that fast Kv7.1 recycling under acute stress conditions is RAB4A-dependent.Our data reveal a key mechanism underlying the rapid adaptation of human cardiomyocytes to adrenergic stress. These findings moreover aid to the understanding of disease pathology in long QT syndrome and bear important implications for safety pharmacological screening.
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Affiliation(s)
- Ilaria Piccini
- Department of Cardiovascular Medicine, Institute of Genetics of Heart Diseases, University of Münster Medical SchoolMünster, Germany.,Human Stem Cell Pluripotency Laboratory, Max Planck Institute for Molecular BiomedicineMünster, Germany
| | - Edda Fehrmann
- Institute of Pharmacology and Toxicology, University of MünsterMünster, Germany
| | - Stefan Frank
- Human Stem Cell Pluripotency Laboratory, Max Planck Institute for Molecular BiomedicineMünster, Germany.,Chemical Genomics Centre of the Max Planck SocietyDortmund, Germany
| | - Frank U Müller
- Institute of Pharmacology and Toxicology, University of MünsterMünster, Germany
| | - Boris Greber
- Human Stem Cell Pluripotency Laboratory, Max Planck Institute for Molecular BiomedicineMünster, Germany.,Chemical Genomics Centre of the Max Planck SocietyDortmund, Germany
| | - Guiscard Seebohm
- Department of Cardiovascular Medicine, Institute of Genetics of Heart Diseases, University of Münster Medical SchoolMünster, Germany
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28
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Nánási PP, Magyar J, Varró A, Ördög B. Beat-to-beat variability of cardiac action potential duration: underlying mechanism and clinical implications. Can J Physiol Pharmacol 2017; 95:1230-1235. [PMID: 28746810 DOI: 10.1139/cjpp-2016-0597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Beat-to-beat variability of cardiac action potential duration (short-term variability, SV) is a common feature of various cardiac preparations, including the human heart. Although it is believed to be one of the best arrhythmia predictors, the underlying mechanisms are not fully understood at present. The magnitude of SV is basically determined by the intensity of cell-to-cell coupling in multicellular preparations and by the duration of the action potential (APD). To compensate for the APD-dependent nature of SV, the concept of relative SV (RSV) has been introduced by normalizing the changes of SV to the concomitant changes in APD. RSV is reduced by ICa, IKr, and IKs while increased by INa, suggesting that ion currents involved in the negative feedback regulation of APD tend to keep RSV at a low level. RSV is also influenced by intracellular calcium concentration and tissue redox potential. The clinical implications of APD variability is discussed in detail.
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Affiliation(s)
- Péter P Nánási
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,b Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - János Magyar
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - András Varró
- c Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Balázs Ördög
- c Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
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29
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Cao X, Wada T, Nakamura Y, Matsukura S, Izumi-Nakaseko H, Ando K, Naito AT, Sugiyama A. Sensitivity and Reliability of Halothane-anaesthetizedMicrominipigsto Assess Risk of Drug-induced Long QT Syndrome. Basic Clin Pharmacol Toxicol 2017; 121:465-470. [DOI: 10.1111/bcpt.12838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Xin Cao
- Department of Pharmacology; Toho University Graduate School of Medicine; Ota-ku, Tokyo Japan
| | - Takeshi Wada
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Yuji Nakamura
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Suchitra Matsukura
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Hiroko Izumi-Nakaseko
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Kentaro Ando
- Department of Pharmacology; Toho University Graduate School of Medicine; Ota-ku, Tokyo Japan
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Atsuhiko T. Naito
- Department of Pharmacology; Toho University Graduate School of Medicine; Ota-ku, Tokyo Japan
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
| | - Atsushi Sugiyama
- Department of Pharmacology; Toho University Graduate School of Medicine; Ota-ku, Tokyo Japan
- Department of Pharmacology; Faculty of Medicine; Toho University; Ota-ku, Tokyo Japan
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30
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Osadchii OE. Role of abnormal repolarization in the mechanism of cardiac arrhythmia. Acta Physiol (Oxf) 2017; 220 Suppl 712:1-71. [PMID: 28707396 DOI: 10.1111/apha.12902] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In cardiac patients, life-threatening tachyarrhythmia is often precipitated by abnormal changes in ventricular repolarization and refractoriness. Repolarization abnormalities typically evolve as a consequence of impaired function of outward K+ currents in cardiac myocytes, which may be caused by genetic defects or result from various acquired pathophysiological conditions, including electrical remodelling in cardiac disease, ion channel modulation by clinically used pharmacological agents, and systemic electrolyte disorders seen in heart failure, such as hypokalaemia. Cardiac electrical instability attributed to abnormal repolarization relies on the complex interplay between a provocative arrhythmic trigger and vulnerable arrhythmic substrate, with a central role played by the excessive prolongation of ventricular action potential duration, impaired intracellular Ca2+ handling, and slowed impulse conduction. This review outlines the electrical activity of ventricular myocytes in normal conditions and cardiac disease, describes classical electrophysiological mechanisms of cardiac arrhythmia, and provides an update on repolarization-related surrogates currently used to assess arrhythmic propensity, including spatial dispersion of repolarization, activation-repolarization coupling, electrical restitution, TRIaD (triangulation, reverse use dependence, instability, and dispersion), and the electromechanical window. This is followed by a discussion of the mechanisms that account for the dependence of arrhythmic vulnerability on the location of the ventricular pacing site. Finally, the review clarifies the electrophysiological basis for cardiac arrhythmia produced by hypokalaemia, and gives insight into the clinical importance and pathophysiology of drug-induced arrhythmia, with particular focus on class Ia (quinidine, procainamide) and Ic (flecainide) Na+ channel blockers, and class III antiarrhythmic agents that block the delayed rectifier K+ channel (dofetilide).
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Affiliation(s)
- O. E. Osadchii
- Department of Health Science and Technology; University of Aalborg; Aalborg Denmark
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31
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Ji Y, Varkevisser R, Opacic D, Bossu A, Kuiper M, Beekman JDM, Yang S, Khan AP, Dobrev D, Voigt N, Wang MZ, Verheule S, Vos MA, van der Heyden MAG. The inward rectifier current inhibitor PA-6 terminates atrial fibrillation and does not cause ventricular arrhythmias in goat and dog models. Br J Pharmacol 2017; 174:2576-2590. [PMID: 28542844 PMCID: PMC5513871 DOI: 10.1111/bph.13869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 01/24/2023] Open
Abstract
Background and Purpose The density of the inward rectifier current (IK1) increases in atrial fibrillation (AF), shortening effective refractory period and thus promoting atrial re‐entry. The synthetic compound pentamidine analogue 6 (PA‐6) is a selective and potent IK1 inhibitor. We tested PA‐6 for anti‐AF efficacy and potential proarrhythmia, using established models in large animals. Experimental Approach PA‐6 was applied i.v. in anaesthetized goats with rapid pacing‐induced AF and anaesthetized dogs with chronic atrio‐ventricular (AV) block. Electrophysiological and pharmacological parameters were determined. Key Results PA‐6 (2.5 mg·kg−1·10 min−1) induced cardioversion to sinus rhythm (SR) in 5/6 goats and prolonged AF cycle length. AF complexity decreased significantly before cardioversion. PA‐6 accumulated in cardiac tissue with ratios between skeletal muscle : atrial muscle : ventricular muscle of approximately 1:8:21. In SR dogs, PA‐6 peak plasma levels 10 min post infusion were 5.5 ± 0.9 μM, PA‐6 did not induce significant prolongation of QTc and did not affect heart rate, PQ or QRS duration. In dogs with chronic AV block, PA‐6 did not affect QRS but lengthened QTc during the experiment, but not chronically. PA‐6 did not induce TdP arrhythmias in nine animals (0/9) in contrast to dofetilide (5/9). PA‐6 (200 nM) inhibited IK1, but not IK,ACh, in human isolated atrial cardiomyocytes. Conclusion and Implications PA‐6 restored SR in goats with persistent AF and, in dogs with chronic AV block, prolonged QT intervals, without inducing TdP arrhythmias. Our results demonstrate cardiac safety and good anti‐AF properties for PA‐6.
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Affiliation(s)
- Yuan Ji
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosanne Varkevisser
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dragan Opacic
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Alexandre Bossu
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marion Kuiper
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Jet D M Beekman
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sihyung Yang
- Department of Pharmaceutical Chemistry, School of Pharmacy, The University of Kansas, Lawrence, KS, USA
| | - Azinwi Phina Khan
- Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Niels Voigt
- Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.,Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), Göttingen, Germany
| | - Michael Zhuo Wang
- Department of Pharmaceutical Chemistry, School of Pharmacy, The University of Kansas, Lawrence, KS, USA
| | - Sander Verheule
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Bossu A, Varkevisser R, Beekman HDM, Houtman MJC, van der Heyden MAG, Vos MA. Short-term Variability of Repolarization Is Superior to Other Repolarization Parameters in the Evaluation of Diverse Antiarrhythmic Interventions in the Chronic Atrioventricular Block Dog. J Cardiovasc Pharmacol 2017; 69:398-407. [PMID: 28574954 PMCID: PMC5464753 DOI: 10.1097/fjc.0000000000000488] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Short-term variability (STV), to quantify beat-to-beat variability of repolarization, is a surrogate parameter that reliably identifies proarrhythmic risk in preclinical models. Examples include not only the use in the chronic atrioventricular block (CAVB) dog model whereby it was developed but also in vulnerable patients with heart failure or drug-induced long QT syndrome. In the CAVB dog model, STV can specifically distinguish between safe and unsafe drugs in proarrhythmic screening. Conversely, this dog model also offers the possibility to evaluate antiarrhythmic strategies in a setting of Torsades de Pointes (TdP) induction with a standard IKr inhibitor. The different antiarrhythmic interventions studied in suppression and prevention of drug-induced TdP in vivo in the CAVB dog model and in vitro in canine ventricular cardiomyocytes are described in this overview. We provide evidence that STV predicts the magnitude of antiarrhythmic effect against TdP better than other repolarization parameters in both suppression and prevention conditions. Moreover, suppression and prevention experiments revealed the same level of antiarrhythmic efficacy, whereas cellular experiments seem more sensitive in comparison with drug testing in vivo. Together, these observations suggest that STV could be used as a consistent indicator to rank efficacy of antiarrhythmic interventions in a number of conditions.
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Affiliation(s)
- Alexandre Bossu
- Department of Medical Physiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
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Yokoyama H, Nakamura Y, Saito H, Nagayama Y, Hoshiai K, Wada T, Izumi-Nakaseko H, Ando K, Akie Y, Sugiyama A. Pharmacological characterization of microminipig as a model to assess the drug-induced cardiovascular responses for non-clinical toxicity and/or safety pharmacology studies. J Toxicol Sci 2017; 42:93-101. [PMID: 28070113 DOI: 10.2131/jts.42.93] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We tried to establish the halothane-anesthetized microminipigs as an alternative animal model for non-clinical toxicity and/or safety pharmacology studies. In order to characterize the halothane-anesthetized microminipigs, we firstly clarified the effects of halothane anesthesia on their cardiovascular system (n = 5). Then, we examined the cardiovascular effects of dl-sotalol in doses of 0.1, 0.3 and 1 mg/kg, i.v. on the halothane-anesthetized microminipigs (n = 6). Induction of the halothane anesthesia by itself prolonged the QT interval as well as QTcF, suggesting that the halothane anesthesia can reduce the cardiac repolarization reserve in microminipigs like in dogs. dl-Sotalol showed more potent negative chronotropic, dromotropic and hypotensive effects together with repolarization delay in microminipigs than in dogs, although each cardiovascular response to dl-sotalol was directionally similar between them, suggesting greater basal sympathetic tone and/or smaller volume of distribution of the drug in microminipigs than in dogs. Analyses of proarrhythmic surrogate markers indicate that Tpeak-Tend and short-term variability of QT interval may be more sensitive to detect the dl-sotalol-induced direct electrophysiological changes in microminipigs than in dogs, but its reverse will be true for J-Tpeakc. Thus, these results may help better understand the drug-induced cardiovascular responses in microminipigs.
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Sugrue A, Noseworthy PA, Kremen V, Bos JM, Qiang B, Rohatgi RK, Sapir Y, Attia ZI, Brady P, Caraballo PJ, Asirvatham SJ, Friedman PA, Ackerman MJ. Automated T-wave analysis can differentiate acquired QT prolongation from congenital long QT syndrome. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28429460 DOI: 10.1111/anec.12455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/18/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Prolongation of the QT on the surface electrocardiogram can be due to either genetic or acquired causes. Distinguishing congenital long QT syndrome (LQTS) from acquired QT prolongation has important prognostic and management implications. We aimed to investigate if quantitative T-wave analysis could provide a tool for the physician to differentiate between congenital and acquired QT prolongation. METHODS Patients were identified through an institution-wide computer-based QT screening system which alerts the physician if the QTc ≥ 500 ms. ECGs were retrospectively analyzed with an automated T-wave analysis program. Congenital LQTS was compared in a 1:3 ratio to those with an identified acquired etiology for QT prolongation (electrolyte abnormality and/or prescription of known QT prolongation medications). Linear discriminant analysis was performed using 10-fold cross-validation to statistically test the selected features. RESULTS The 12-lead ECG of 38 patients with congenital LQTS and 114 patients with drug-induced and/or electrolyte-mediated QT prolongation were analyzed. In lead V5 , patients with acquired QT prolongation had a shallower T wave right slope (-2,322 vs. -3,593 mV/s), greater T-peak-Tend interval (109 vs. 92 ms), and smaller T wave center of gravity on the x axis (290 ms vs. 310 ms; p < .001). These features could distinguish congenital from acquired causes in 77% of cases (sensitivity 90%, specificity 58%). CONCLUSION T-wave morphological analysis on lead V5 of the surface ECG could successfully differentiate congenital from acquired causes of QT prolongation.
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Affiliation(s)
- Alan Sugrue
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Vaclav Kremen
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA.,Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - J Martijn Bos
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology & Experimental Therapeutics Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Bo Qiang
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Ram K Rohatgi
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Yehu Sapir
- Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Zachi I Attia
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA.,Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Peter Brady
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | | | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology & Experimental Therapeutics Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
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Hortigon-Vinagre MP, Zamora V, Burton FL, Green J, Gintant GA, Smith GL. The Use of Ratiometric Fluorescence Measurements of the Voltage Sensitive Dye Di-4-ANEPPS to Examine Action Potential Characteristics and Drug Effects on Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes. Toxicol Sci 2016; 154:320-331. [PMID: 27621282 PMCID: PMC5139069 DOI: 10.1093/toxsci/kfw171] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) and higher throughput platforms have emerged as potential tools to advance cardiac drug safety screening. This study evaluated the use of high bandwidth photometry applied to voltage-sensitive fluorescent dyes (VSDs) to assess drug-induced changes in action potential characteristics of spontaneously active hiPSC-CM. Human iPSC-CM from 2 commercial sources (Cor.4U and iCell Cardiomyocytes) were stained with the VSD di-4-ANEPPS and placed in a specialized photometry system that simultaneously monitors 2 wavebands of emitted fluorescence, allowing ratiometric measurement of membrane voltage. Signals were acquired at 10 kHz and analyzed using custom software. Action potential duration (APD) values were normally distributed in cardiomyocytes (CMC) from both sources though the mean and variance differed significantly (APD90: 229 ± 15 ms vs 427 ± 49 ms [mean ± SD, P < 0.01]; average spontaneous cycle length: 0.99 ± 0.02 s vs 1.47 ± 0.35 s [mean ± SD, P < 0.01], Cor.4U vs iCell CMC, respectively). The 10-90% rise time of the AP (Trise) was ∼6 ms and was normally distributed when expressed as 1/[Formula: see text] in both cell preparations. Both cell types showed a rate dependence analogous to that of adult human cardiac cells. Furthermore, nifedipine, ranolazine, and E4031 had similar effects on cardiomyocyte electrophysiology in both cell types. However, ranolazine and E4031 induced early after depolarization-like events and high intrinsic firing rates at lower concentrations in iCell CMC. These data show that VSDs provide a minimally invasive, quantitative, and accurate method to assess hiPSC-CM electrophysiology and detect subtle drug-induced effects for drug safety screening while highlighting a need to standardize experimental protocols across preparations.
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Affiliation(s)
- M P Hortigon-Vinagre
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Science, University of Glasgow 126 University Place, Glasgow G12 8TA, United Kingdom
- Clyde Biosciences Ltd, BioCity Scotland, Bo'Ness Road, Newhouse, Lanarkshire, Scotland ML1 5UH, United Kingdom
| | - V Zamora
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Science, University of Glasgow 126 University Place, Glasgow G12 8TA, United Kingdom
- Clyde Biosciences Ltd, BioCity Scotland, Bo'Ness Road, Newhouse, Lanarkshire, Scotland ML1 5UH, United Kingdom
| | - F L Burton
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Science, University of Glasgow 126 University Place, Glasgow G12 8TA, United Kingdom
- Clyde Biosciences Ltd, BioCity Scotland, Bo'Ness Road, Newhouse, Lanarkshire, Scotland ML1 5UH, United Kingdom
| | - J Green
- AbbVie, 1 North Waukegan Road, Department ZR-13, Building AP-9A, North Chicago, Illinois 60064-6119
| | - G A Gintant
- AbbVie, 1 North Waukegan Road, Department ZR-13, Building AP-9A, North Chicago, Illinois 60064-6119
| | - G L Smith
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Science, University of Glasgow 126 University Place, Glasgow G12 8TA, United Kingdom
- Clyde Biosciences Ltd, BioCity Scotland, Bo'Ness Road, Newhouse, Lanarkshire, Scotland ML1 5UH, United Kingdom
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36
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Electrocardiographic Predictors of Torsadogenic Risk During Dofetilide or Sotalol Initiation: Utility of a Novel T Wave Analysis Program. Cardiovasc Drugs Ther 2016; 29:433-41. [PMID: 26411977 DOI: 10.1007/s10557-015-6619-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Initiation of class III anti-arrhythmic medications requires telemetric monitoring for ventricular arrhythmias and QT prolongation to reduce the risk of torsades de pointes (TdP). Heart rate-corrected QT interval (QTc) is an indicator of risk, however it is imperfect, and subtle abnormalities of repolarization have been linked with arrhythmogenesis. PURPOSE Identification of electrocardiographic predictors of torsadogenic risk through the application of a novel T wave analysis tool. METHODS Among all patients admitted to Mayo Clinic for initiation of dofetilide or sotalol, we identified 13 cases who developed drug-induced TdP and 26 age and sex matched controls that did not develop TdP. The immediate pre-TdP ECG of those with TdP was compared to the last ECG performed prior to hospital discharge in controls using a novel T wave program that quantified subtle changes in T wave morphology. RESULTS The QTc and 12 T wave parameters successfully distinguished TdP cases from controls. The top performing parameters were the QTc in lead V3 (mean case vs control 480 vs 420 msec, p < 0.001, r = 0.72) and T wave right slope in lead I (mean case vs control -840.29 vs -1668.71 mV/s, p = 0.002, r = 0.45). The addition of T wave right slope to QTc improved prediction accuracy from 79 to 88 %. CONCLUSION Our data demonstrate that, in addition to QTc, the T wave right slope is correlated strongly with TdP risk. This suggests that a computer-based repolarization measurement tool that integrates additional data beyond the QTc may identify patients with the greatest torsadogenic potential.
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Sala L, Yu Z, Ward-van Oostwaard D, van Veldhoven JP, Moretti A, Laugwitz KL, Mummery CL, IJzerman AP, Bellin M. A new hERG allosteric modulator rescues genetic and drug-induced long-QT syndrome phenotypes in cardiomyocytes from isogenic pairs of patient induced pluripotent stem cells. EMBO Mol Med 2016; 8:1065-81. [PMID: 27470144 PMCID: PMC5009811 DOI: 10.15252/emmm.201606260] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Long-QT syndrome (LQTS) is an arrhythmogenic disorder characterised by prolongation of the QT interval in the electrocardiogram, which can lead to sudden cardiac death. Pharmacological treatments are far from optimal for congenital forms of LQTS, while the acquired form, often triggered by drugs that (sometimes inadvertently) target the cardiac hERG channel, is still a challenge in drug development because of cardiotoxicity. Current experimental models in vitro fall short in predicting proarrhythmic properties of new drugs in humans. Here, we leveraged a series of isogenically matched, diseased and genetically engineered, human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) from patients to test a novel hERG allosteric modulator for treating congenital LQTS, drug-induced LQTS or a combination of the two. By slowing IK r deactivation and positively shifting IK r inactivation, the small molecule LUF7346 effectively rescued all of these conditions, demonstrating in a human system that allosteric modulation of hERG may be useful as an approach to treat inherited and drug-induced LQTS Furthermore, our study provides experimental support of the value of isogenic pairs of patient hiPSC-CMs as platforms for testing drug sensitivities and performing safety pharmacology.
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Affiliation(s)
- Luca Sala
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Zhiyi Yu
- Gorlaeus Laboratories, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | | | - Jacobus Pd van Veldhoven
- Gorlaeus Laboratories, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Alessandra Moretti
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- I. Department of Medicine (Cardiology), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christine L Mummery
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriaan P IJzerman
- Gorlaeus Laboratories, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Milena Bellin
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Frommeyer G, Brücher B, von der Ahe H, Kaese S, Dechering DG, Kochhäuser S, Bogossian H, Milberg P, Eckardt L. Low proarrhythmic potential of citalopram and escitalopram in contrast to haloperidol in an experimental whole-heart model. Eur J Pharmacol 2016; 788:192-199. [PMID: 27328775 DOI: 10.1016/j.ejphar.2016.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 11/28/2022]
Abstract
In several case reports proarrhythmic effects of citalopram and escitalopram have been reported. Systematic analyses on prorarrhythmic effects of these drugs are not yet available. The aim of the present study was to investigate if application of citalopram, escitalopram or haloperidol provokes polymorphic ventricular tachycardia in a sensitive model of proarrhythmia. In isolated rabbit hearts monophasic action potentials and ECG showed a significant QT-prolongation after application of citalopram (2µM: +47ms, 4µM: +56ms, P<0.05) accompanied by an increase of action potential duration (APD) but not dispersion of repolarization. Reduced potassium concentration in bradycardic AV-blocked hearts provoked early afterdepolarizations (EAD) in 2 of 12 hearts but no polymorphic ventricular tachycardia (pVT). Application of escitalopram also increased QT-interval (2µM: +3ms, 4µM: +30ms, P<0.05) and APD without effects on dispersion. 3 of 10 hearts showed EAD and pVT in 2 of 10 hearts (32 episodes). The results were compared to 12 rabbits treated with haloperidol which led to an increase in QT-interval (1µM:+62ms; 2µM:+96ms; P<0.01), APD and dispersion (1µM:+15ms, 2µM:+40ms; P<0.01) and induced EAD in all 12 and pVT in 10 of 12 hearts (152 episodes). Citalopram and escitalopram demonstrated a rather safe electrophysiologic profile despite significant QT prolongation. In contrast, haloperidol led to significant increase of dispersion of repolarization while this parameter remained stable under the influence of citalopram or escitalopram. These results imply that application of citalopram or escitalopram is not as proarrhythmic as some case reports might suggest while haloperidol is torsadogenic.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
| | - Benedict Brücher
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Henning von der Ahe
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Sven Kaese
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Harilaos Bogossian
- Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, University of Witten-Herdecke, Germany
| | - Peter Milberg
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
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Bonilla IM, Nishijima Y, Vargas-Pinto P, Baine SH, Sridhar A, Li C, Billman GE, Carnes CA. Chronic Omega-3 Polyunsaturated Fatty Acid Treatment Variably Affects Cellular Repolarization in a Healed Post-MI Arrhythmia Model. Front Physiol 2016; 7:225. [PMID: 27378936 PMCID: PMC4906012 DOI: 10.3389/fphys.2016.00225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/30/2016] [Indexed: 01/22/2023] Open
Abstract
Introduction: Over the last 40 years omega-3 polyunsaturated fatty acids (PUFAs) have been shown to be anti-arrhythmic or pro-arrhythmic depending on the method and duration of administration and model studied. We previously reported that omega-3 PUFAs do not confer anti-arrhythmic properties and are pro-arrhythmic in canine model of sudden cardiac death (SCD). Here, we evaluated the effects of chronic omega-3 PUFA treatment in post-MI animals susceptible (VF+) or resistant (VF−) to ventricular tachyarrhythmias. Methods: Perforated patch clamp techniques were used to measure cardiomyocyte action potential durations (APD) at 50 and 90% repolarization and short term variability of repolarization. The early repolarizing transient outward potassium current Ito was also studied. Results: Omega-3 PUFAs prolonged the action potential in VF− myocytes at both 50 and 90% repolarization. Short term variability of repolarization was increased in both untreated and treated VF− myocytes vs. controls. Ito was unaffected by omega-3 PUFA treatment. Omega-3 PUFA treatment attenuated the action potential prolongation in VF+ myocytes, but did not return repolarization to control values. Conclusions: Omega-3 PUFAs do not confer anti-arrhythmic properties in the setting of healed myocardial infarction in a canine model of SCD. In canines previously resistant to ventricular fibrillation (VF−), omega-3 PUFA treatment prolonged the action potential in VF− myocytes, and may contribute to pro-arrhythmic responses.
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Affiliation(s)
- Ingrid M Bonilla
- College of Pharmacy, The Ohio State UniversityColumbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State UniversityColumbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State UniversityColumbus, OH, USA
| | | | - Pedro Vargas-Pinto
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University Columbus, OH, USA
| | - Stephen H Baine
- College of Pharmacy, The Ohio State University Columbus, OH, USA
| | - Arun Sridhar
- College of Pharmacy, The Ohio State University Columbus, OH, USA
| | - Chun Li
- Division of Cardiology, Peking University People's Hospital Beijing, China
| | - George E Billman
- Department of Physiology and Cell Biology, The Ohio State UniversityColumbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State UniversityColumbus, OH, USA
| | - Cynthia A Carnes
- College of Pharmacy, The Ohio State UniversityColumbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State UniversityColumbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State UniversityColumbus, OH, USA
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40
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Stams TR, Oosterhoff P, Heijdel A, Dunnink A, Beekman JD, van der Nagel R, van Rijen HV, van der Heyden MA, Vos MA. Beat-to-Beat Variability in Preload Unmasks Latent Risk of Torsade de Pointes in Anesthetized Chronic Atrioventricular Block Dogs. Circ J 2016; 80:1336-45. [PMID: 27151565 DOI: 10.1253/circj.cj-15-1335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Beat-to-beat variability in ventricular repolarization (BVR) associates with increased arrhythmic risk. Proarrhythmic remodeling in the dog with chronic AV-block (CAVB) compromises repolarization reserve and associates with increased BVR, which further increases upon dofetilide infusion and correlates with Torsade de Pointes (TdP) arrhythmias. It was hypothesized that these pro-arrhythmia-associated increases in BVR are induced by beat-to-beat variability in preload. METHODS AND RESULTS Left ventricular monophasic action potential duration (LVMAPD) was recorded in acute (AAVB) and CAVB dogs, before and after dofetilide infusion. BVR was quantified as short-term variability of LVMAPD. The PQ-interval was controlled by pacing: either a constant or an alternating preload pattern was established, verified by PV-loop. The effect of the stretch-activated channel blocker, streptomycin, on BVR was evaluated in a second CAVB group. At alternating preload only, BVR was increased after proarrhythmic remodeling (0.45±0.14 ms AAVB vs. 2.2±1.1 ms CAVB, P<0.01). At CAVB, but not at AAVB, dofetilide induced significant proarrhythmia. Preload variability augmented the dofetilide-induced BVR increase at CAVB (+1.5±0.8 ms vs. +0.9±0.9 ms, P=0.058). In the second group, the increase in baseline BVR by alternating preload (0.3±0.03 ms to 1.0±0.8 ms, P<0.01) was abolished by streptomycin (0.5±0.2 ms, P<0.05). CONCLUSIONS In CAVB dogs, the inverse relation between BVR and repolarization reserve originates from an augmented sensitivity of ventricular repolarization to beat-to-beat preload changes. Stretch-activated channels appear to be involved in the mechanism of BVR. (Circ J 2016; 80: 1336-1345).
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Affiliation(s)
- Thom Rg Stams
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center
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Ohara H, Nakamura Y, Watanabe Y, Cao X, Yamazaki Y, Izumi-Nakaseko H, Ando K, Yamazaki H, Yamazaki J, Ikeda T, Sugiyama A. Azithromycin Can Prolong QT Interval and Suppress Ventricular Contraction, but Will Not Induce Torsade de Pointes. Cardiovasc Toxicol 2016; 15:232-40. [PMID: 25367413 DOI: 10.1007/s12012-014-9289-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Azithromycin has been reported to increase the risk of death from cardiovascular causes among patients with high baseline risk. Since the information is still limited to bridge the gap between electrophysiological properties of azithromycin in vitro and cardiac death in patients, we initially assessed its electropharmacological effects in doses of 3 and 30 mg/kg, i.v., with the halothane-anesthetized dogs (n = 4). The low dose provided 5.2 times higher than the therapeutic concentration, whereas the high dose attained 17.0 times higher. The high dose delayed the ventricular repolarization in a reverse use-dependent manner, reflecting blockade of the rapid component of delayed rectifier K(+) current, and the potency was relatively weak; namely, maximum change in QTc was +20 ms (+5.6%). The high dose also induced the negative inotropic effect possibly through Ca(2+) channel-independent pathway. In order to clarify proarrhythmic risk, 30 mg/kg, i.v., of azithromycin was examined with the chronic atrioventricular block dogs (n = 4). Azithromycin neither induced torsade de pointes nor affected beat-to-beat variability of repolarization. Thus, azithromycin can be considered to lack proarrhythmic potential, but caution has to be paid on its use for patients with left ventricular dysfunction.
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Affiliation(s)
- Hiroshi Ohara
- Department of Pharmacology, Faculty of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
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Seethala S, Singh P, Shusterman V, Ribe M, Haugaa KH, Němec J. QT Adaptation and Intrinsic QT Variability in Congenital Long QT Syndrome. J Am Heart Assoc 2015; 4:e002395. [PMID: 26675252 PMCID: PMC4845278 DOI: 10.1161/jaha.115.002395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/03/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Increased variability of QT interval (QTV) has been linked to arrhythmias in animal experiments and multiple clinical situations. Congenital long QT syndrome (LQTS), a pure repolarization disease, may provide important information on the relationship between delayed repolarization and QTV. METHODS AND RESULTS Twenty-four-hour Holter monitor tracings from 78 genotyped congenital LQTS patients (52 females; 51 LQT1, 23 LQT2, 2 LQT5, 2 JLN, 27 symptomatic; age, 35.2±12.3 years) were evaluated with computer-assisted annotation of RR and QT intervals. Several models of RR-QT relationship were tested in all patients. A model assuming exponential decrease of past RR interval contributions to QT duration with 60-second time constant provided the best data fit. This model was used to calculate QTc and residual "intrinsic" QTV, which cannot be explained by heart rate change. The intrinsic QTV was higher in patients with long QTc (r=0.68; P<10(-4)), and in LQT2 than in LQT1/5 patients (5.65±1.28 vs 4.46±0.82; P<0.0002). Both QTc and intrinsic QTV were similar in symptomatic and asymptomatic patients (467±52 vs 459±53 ms and 5.10±1.19 vs 4.74±1.09, respectively). CONCLUSIONS In LQTS patients, QT interval adaptation to heart rate changes occurs with time constant ≈60 seconds, similar to results reported in control subjects. Intrinsic QTV correlates with the degree of repolarization delay and might reflect action potential instability observed in animal models of LQTS.
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Affiliation(s)
- Srikanth Seethala
- Scripps ClinicSan DiegoCA
- Present address: University of TennesseeCollege of MedicineChattanoogaTN
| | | | | | - Margareth Ribe
- Department of CardiologyCenter for Cardiological Innovation and Institute for Surgical ResearchOslo University Hospital, RikshospitaletOsloNorway
| | - Kristina H. Haugaa
- Department of CardiologyCenter for Cardiological Innovation and Institute for Surgical ResearchOslo University Hospital, RikshospitaletOsloNorway
- University of OsloNorway
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Němec J, Kim JJ, Salama G. The link between abnormal calcium handling and electrical instability in acquired long QT syndrome--Does calcium precipitate arrhythmic storms? PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2015; 120:210-21. [PMID: 26631594 DOI: 10.1016/j.pbiomolbio.2015.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 12/19/2022]
Abstract
Release of Ca(2+) ions from sarcoplasmic reticulum (SR) into myocyte cytoplasm and their binding to troponin C is the final signal form myocardial contraction. Synchronous contraction of ventricular myocytes is necessary for efficient cardiac pumping function. This requires both shuttling of Ca(2+) between SR and cytoplasm in individual myocytes, and organ-level synchronization of this process by means of electrical coupling among ventricular myocytes. Abnormal Ca(2+) release from SR causes arrhythmias in the setting of CPVT (catecholaminergic polymorphic ventricular tachycardia) and digoxin toxicity. Recent optical mapping data indicate that abnormal Ca(2+) handling causes arrhythmias in models of both repolarization impairment and profound bradycardia. The mechanisms involve dynamic spatial heterogeneity of myocardial Ca(2+) handling preceding arrhythmia onset, cell-synchronous systolic secondary Ca(2+) elevation (SSCE), as well as more complex abnormalities of intracellular Ca(2+) handling detected by subcellular optical mapping in Langendorff-perfused hearts. The regional heterogeneities in Ca(2+) handling cause action potential (AP) heterogeneities through sodium-calcium exchange (NCX) activation and eventually overwhelm electrical coupling of the tissue. Divergent Ca(2+) dynamics among different myocardial regions leads to temporal instability of AP duration and - on the patient level - in T wave lability. Although T-wave alternans has been linked to cardiac arrhythmias, non-alternans lability is observed in pre-clinical models of the long QT syndrome (LQTS) and CPVT, and in LQTS patients. Analysis of T wave lability may provide a real-time window on the abnormal Ca(2+) dynamics causing specific arrhythmias such as Torsade de Pointes (TdP).
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Affiliation(s)
- Jan Němec
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Jong J Kim
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Guy Salama
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Antoons G, Johnson DM, Dries E, Santiago DJ, Ozdemir S, Lenaerts I, Beekman JDM, Houtman MJC, Sipido KR, Vos MA. Calcium release near L-type calcium channels promotes beat-to-beat variability in ventricular myocytes from the chronic AV block dog. J Mol Cell Cardiol 2015; 89:326-34. [PMID: 26454162 DOI: 10.1016/j.yjmcc.2015.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 09/08/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022]
Abstract
Beat-to-beat variability of ventricular repolarization (BVR) has been proposed as a strong predictor of Torsades de Pointes (TdP). BVR is also observed at the myocyte level, and a number of studies have shown the importance of calcium handling in influencing this parameter. The chronic AV block (CAVB) dog is a model of TdP arrhythmia in cardiac hypertrophy, and myocytes from these animals show extensive remodeling, including of Ca(2+) handling. This remodeling process also leads to increased BVR. We aimed to determine the role that (local) Ca(2+) handling plays in BVR. In isolated LV myocytes an exponential relationship was observed between BVR magnitude and action potential duration (APD) at baseline. Inhibition of Ca(2+) release from sarcoplasmic reticulum (SR) with thapsigargin resulted in a reduction of [Ca(2+)]i, and of both BVR and APD. Increasing ICaL in the presence of thapsigargin restored APD but BVR remained low. In contrast, increasing ICaL with preserved Ca(2+) release increased both APD and BVR. Inhibition of Ca(2+) release with caffeine, as with thapsigargin, reduced BVR despite maintained APD. Simultaneous inhibition of Na(+)/Ca(2+) exchange and ICaL decreased APD and BVR to similar degrees, whilst increasing diastolic Ca(2+). Buffering of Ca(2+) transients with BAPTA reduced BVR for a given APD to a greater extent than buffering with EGTA, suggesting subsarcolemmal Ca(2+) transients modulated BVR to a larger extent than the cytosolic Ca(2+) transient. In conclusion, BVR in hypertrophied dog myocytes, at any APD, is strongly dependent on SR Ca(2+) release, which may act through modulation of the l-type Ca(2+) current in a subsarcolemmal microdomain.
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Affiliation(s)
- Gudrun Antoons
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven (University of Leuven), Leuven, Belgium; Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands; Department of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Daniel M Johnson
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven (University of Leuven), Leuven, Belgium
| | - Eef Dries
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven (University of Leuven), Leuven, Belgium
| | - Demetrio J Santiago
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven (University of Leuven), Leuven, Belgium
| | - Semir Ozdemir
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven (University of Leuven), Leuven, Belgium; Department of Biophysics, Akdeniz University, Antalya, Turkey
| | - Ilse Lenaerts
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven (University of Leuven), Leuven, Belgium
| | - Jet D M Beekman
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Marien J C Houtman
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Karin R Sipido
- Experimental Cardiology, Department of Cardiovascular Sciences, KU Leuven (University of Leuven), Leuven, Belgium.
| | - Marc A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
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Frommeyer G, Eckardt L. Drug-induced proarrhythmia: risk factors and electrophysiological mechanisms. Nat Rev Cardiol 2015; 13:36-47. [PMID: 26194552 DOI: 10.1038/nrcardio.2015.110] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Drug-induced ventricular tachyarrhythmias can be caused by cardiovascular drugs, noncardiovascular drugs, and even nonprescription agents. They can result in arrhythmic emergencies and sudden cardiac death. If a new arrhythmia or aggravation of an existing arrhythmia develops during therapy with a drug at a concentration usually considered not to be toxic, the situation can be defined as proarrhythmia. Various cardiovascular and noncardiovascular drugs can increase the occurrence of polymorphic ventricular tachycardia of the 'torsade de pointes' type. Antiarrhythmic drugs, antimicrobial agents, and antipsychotic and antidepressant drugs are the most important groups. Age, female sex, and structural heart disease are important risk factors for the occurrence of torsade de pointes. Genetic predisposition and individual pharmacodynamic and pharmacokinetic sensitivity also have important roles in the generation of arrhythmias. An increase in spatial or temporal dispersion of repolarization and a triangular action-potential configuration have been identified as crucial predictors of proarrhythmia in experimental models. These studies emphasized that sole consideration of the QT interval is not sufficient to assess the proarrhythmic risk. In this Review, we focus on important triggers of proarrhythmia and the underlying electrophysiological mechanisms that can enhance or prevent the development of torsade de pointes.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Strasse 33, D-48149 Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Albert-Schweitzer Strasse 33, D-48149 Münster, Germany
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Long VP, Bonilla IM, Vargas-Pinto P, Nishijima Y, Sridhar A, Li C, Mowrey K, Wright P, Velayutham M, Kumar S, Lee NY, Zweier JL, Mohler PJ, Györke S, Carnes CA. Heart failure duration progressively modulates the arrhythmia substrate through structural and electrical remodeling. Life Sci 2015; 123:61-71. [PMID: 25596015 PMCID: PMC4763601 DOI: 10.1016/j.lfs.2014.12.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 01/10/2023]
Abstract
AIMS Ventricular arrhythmias are a common cause of death in patients with heart failure (HF). Structural and electrical abnormalities in the heart provide a substrate for such arrhythmias. Canine tachypacing-induced HF models of 4-6 weeks duration are often used to study pathophysiology and therapies for HF. We hypothesized that a chronic canine model of HF would result in greater electrical and structural remodeling than a short term model, leading to a more arrhythmogenic substrate. MAIN METHODS HF was induced by ventricular tachypacing for one (short-term) or four (chronic) months to study remodeling. KEY FINDINGS Left ventricular contractility was progressively reduced, while ventricular hypertrophy and interstitial fibrosis were evident at 4 month but not 1 month of HF. Left ventricular myocyte action potentials were prolonged after 4 (p<0.05) but not 1 month of HF. Repolarization instability and early afterdepolarizations were evident only after 4 months of HF (p<0.05), coinciding with a prolonged QTc interval (p<0.05). The transient outward potassium current was reduced in both HF groups (p<0.05). The outward component of the inward rectifier potassium current was reduced only in the 4 month HF group (p<0.05). The delayed rectifier potassium currents were reduced in 4 (p<0.05) but not 1 month of HF. Reactive oxygen species were increased at both 1 and 4 months of HF (p<0.05). SIGNIFICANCE Reduced Ito, outward IK1, IKs, and IKr in HF contribute to EAD formation. Chronic, but not short term canine HF, results in the altered electrophysiology and repolarization instability characteristic of end-stage human HF.
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Affiliation(s)
- Victor P Long
- College of Pharmacy, The Ohio State University, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Ingrid M Bonilla
- College of Pharmacy, The Ohio State University, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Pedro Vargas-Pinto
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Arun Sridhar
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Chun Li
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | | | - Patrick Wright
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA
| | - Murugesan Velayutham
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Sanjay Kumar
- College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Nam Y Lee
- College of Pharmacy, The Ohio State University, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Jay L Zweier
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA
| | - Peter J Mohler
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA
| | - Sandor Györke
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA
| | - Cynthia A Carnes
- College of Pharmacy, The Ohio State University, Columbus, OH, USA; Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA.
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Assessment of anti-arrhythmic activity of antipsychotic drugs in an animal model: Influence of non-cardiac α1-adrenergic receptors. Eur J Pharmacol 2015; 748:10-7. [DOI: 10.1016/j.ejphar.2014.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/28/2014] [Accepted: 12/10/2014] [Indexed: 01/09/2023]
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48
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Bonilla IM, Long VP, Vargas-Pinto P, Wright P, Belevych A, Lou Q, Mowrey K, Yoo J, Binkley PF, Fedorov VV, Györke S, Janssen PML, Kilic A, Mohler PJ, Carnes CA. Calcium-activated potassium current modulates ventricular repolarization in chronic heart failure. PLoS One 2014; 9:e108824. [PMID: 25271970 PMCID: PMC4182742 DOI: 10.1371/journal.pone.0108824] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/26/2014] [Indexed: 01/19/2023] Open
Abstract
The role of IKCa in cardiac repolarization remains controversial and varies across species. The relevance of the current as a therapeutic target is therefore undefined. We examined the cellular electrophysiologic effects of IKCa blockade in controls, chronic heart failure (HF) and HF with sustained atrial fibrillation. We used perforated patch action potential recordings to maintain intrinsic calcium cycling. The IKCa blocker (apamin 100 nM) was used to examine the role of the current in atrial and ventricular myocytes. A canine tachypacing induced model of HF (1 and 4 months, n = 5 per group) was used, and compared to a group of 4 month HF with 6 weeks of superimposed atrial fibrillation (n = 7). A group of age-matched canine controls were used (n = 8). Human atrial and ventricular myocytes were isolated from explanted end-stage failing hearts which were obtained from transplant recipients, and studied in parallel. Atrial myocyte action potentials were unchanged by IKCa blockade in all of the groups studied. IKCa blockade did not affect ventricular myocyte repolarization in controls. HF caused prolongation of ventricular myocyte action potential repolarization. IKCa blockade caused further prolongation of ventricular repolarization in HF and also caused repolarization instability and early afterdepolarizations. SK2 and SK3 expression in the atria and SK3 in the ventricle were increased in canine heart failure. We conclude that during HF, IKCa blockade in ventricular myocytes results in cellular arrhythmias. Furthermore, our data suggest an important role for IKCa in the maintenance of ventricular repolarization stability during chronic heart failure. Our findings suggest that novel antiarrhythmic therapies should have safety and efficacy evaluated in both atria and ventricles.
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Affiliation(s)
- Ingrid M. Bonilla
- College of Pharmacy, The Ohio State University, Columbus, Ohio, United States of America
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Victor P. Long
- College of Pharmacy, The Ohio State University, Columbus, Ohio, United States of America
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Pedro Vargas-Pinto
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Patrick Wright
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Andriy Belevych
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Qing Lou
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Kent Mowrey
- St Jude Medical, Sylmar, California, United States of America
| | - Jae Yoo
- College of Pharmacy, The Ohio State University, Columbus, Ohio, United States of America
| | - Philip F. Binkley
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Vadim V. Fedorov
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Sandor Györke
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Paulus M. L. Janssen
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Ahmet Kilic
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Peter J. Mohler
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Cynthia A. Carnes
- College of Pharmacy, The Ohio State University, Columbus, Ohio, United States of America
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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Analysis of Unipolar Electrograms in Rabbit Heart Demonstrated the Key Role of Ventricular Apicobasal Dispersion in Arrhythmogenicity. Cardiovasc Toxicol 2014; 14:316-28. [DOI: 10.1007/s12012-014-9254-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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50
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Frommeyer G, Milberg P, Clauss C, Schmidt M, Ramtin S, Kaese S, Grundmann F, Grotthoff JS, Pott C, Eckardt L. Electrophysiological profile of vernakalant in an experimental whole-heart model: the absence of proarrhythmia despite significant effect on myocardial repolarization. Europace 2014; 16:1240-8. [PMID: 24696223 DOI: 10.1093/europace/euu014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM The most recent European Society of Cardiology (ESC) update on atrial fibrillation has introduced vernakalant (VER) for pharmacological cardioversion of atrial fibrillation. The aim of the present study was to investigate the safety profile of VER in a sensitive model of proarrhythmia. METHODS AND RESULTS In 36 Langendorff-perfused rabbit hearts, VER (10, 30 µM, n = 12); ranolazine (RAN, 10, 30 µM, n = 12), or sotalol (SOT, 50; 100 µM, n = 12) were infused after obtaining baseline data. Monophasic action potentials and a 12-lead electrocardiogram showed a significant QT prolongation after application of VER as compared with baseline (10 µM: +25 ms, 30 µM: +50 ms, P < 0.05) accompanied by an increase of action potential duration (APD). The increase in APD90 was accompanied by a more marked increase in effective refractory period (ERP) leading to a significant increase in post-repolarization refractoriness (PRR, 10 µM: +30 ms, 30 µM: +36 ms, P < 0.05). Vernakalant did not affect the dispersion of repolarization. Lowered potassium concentration in bradycardic hearts did not provoke early afterdepolarizations (EADs) or polymorphic ventricular tachycardia (pVT). Comparable results were obtained with RAN. Hundred micromolars of SOT led to an increase in QT interval (+49 ms) and APD90 combined with an increased ERP and PRR (+23 ms). In contrast to VER, 100 µM SOT led to a significant increase in dispersion of repolarization and to the occurrence of EAD in 10 of 12 and pVT in 8 of 12 hearts. CONCLUSION In the present study, application of VER and SOT led to a comparable prolongation of myocardial repolarization. Both drugs increased the PRR. However, VER neither affect the dispersion of repolarization nor induce EAD and therefore did not cause proarrhythmia.
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Affiliation(s)
- Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Peter Milberg
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Catharina Clauss
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Marco Schmidt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Shahram Ramtin
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Sven Kaese
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Fabian Grundmann
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Jochen Schulze Grotthoff
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Christian Pott
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
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