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Seo K, Yamamoto Y, Kirillova A, Kawana M, Yadav S, Huang Y, Wang Q, Lane KV, Pruitt BL, Perez MV, Bernstein D, Wu JC, Wheeler MT, Parikh VN, Ashley EA. Improved Cardiac Performance and Decreased Arrhythmia in Hypertrophic Cardiomyopathy With Non-β-Blocking R-Enantiomer Carvedilol. Circulation 2023; 148:1691-1704. [PMID: 37850394 DOI: 10.1161/circulationaha.123.065017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/05/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Hypercontractility and arrhythmia are key pathophysiologic features of hypertrophic cardiomyopathy (HCM), the most common inherited heart disease. β-Adrenergic receptor antagonists (β-blockers) are the first-line therapy for HCM. However, β-blockers commonly selected for this disease are often poorly tolerated in patients, where heart-rate reduction and noncardiac effects can lead to reduced cardiac output and fatigue. Mavacamten, myosin ATPase inhibitor recently approved by the US Food and Drug Administration, has demonstrated the ability to ameliorate hypercontractility without lowering heart rate, but its benefits are so far limited to patients with left ventricular (LV) outflow tract obstruction, and its effect on arrhythmia is unknown. METHODS We screened 21 β-blockers for their impact on myocyte contractility and evaluated the antiarrhythmic properties of the most promising drug in a ventricular myocyte arrhythmia model. We then examined its in vivo effect on LV function by hemodynamic pressure-volume loop analysis. The efficacy of the drug was tested in vitro and in vivo compared with current therapeutic options (metoprolol, verapamil, and mavacamten) for HCM in an established mouse model of HCM (Myh6R403Q/+ and induced pluripotent stem cell (iPSC)-derived cardiomyocytes from patients with HCM (MYH7R403Q/+). RESULTS We identified that carvedilol, a β-blocker not commonly used in HCM, suppresses contractile function and arrhythmia by inhibiting RyR2 (ryanodine receptor type 2). Unlike metoprolol (a β1-blocker), carvedilol markedly reduced LV contractility through RyR2 inhibition, while maintaining stroke volume through α1-adrenergic receptor inhibition in vivo. Clinically available carvedilol is a racemic mixture, and the R-enantiomer, devoid of β-blocking effect, retains the ability to inhibit both α1-receptor and RyR2, thereby suppressing contractile function and arrhythmias without lowering heart rate and cardiac output. In Myh6R403Q/+ mice, R-carvedilol normalized hyperdynamic contraction, suppressed arrhythmia, and increased cardiac output better than metoprolol, verapamil, and mavacamten. The ability of R-carvedilol to suppress contractile function was well retained in MYH7R403Q/+ iPSC-derived cardiomyocytes. CONCLUSIONS R-enantiomer carvedilol attenuates hyperdynamic contraction, suppresses arrhythmia, and at the same time, improves cardiac output without lowering heart rate by dual blockade of α1-adrenergic receptor and RyR2 in mouse and human models of HCM. This combination of therapeutic effects is unique among current therapeutic options for HCM and may particularly benefit patients without LV outflow tract obstruction.
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Affiliation(s)
- Kinya Seo
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Yuta Yamamoto
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Anna Kirillova
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Masataka Kawana
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Sunil Yadav
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Yong Huang
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Qianru Wang
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Kerry V Lane
- Departments of Mechanical Engineering (K.V.L., B.L.P.), University of California, Santa Barbara, CA
| | - Beth L Pruitt
- Departments of Mechanical Engineering (K.V.L., B.L.P.), University of California, Santa Barbara, CA
- BioMolecular Science and Engineering (B.L.P.), University of California, Santa Barbara, CA
| | - Marco V Perez
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | | | - Joseph C Wu
- Cardiovascular Research Institute (J.C.W.), Stanford University School of Medicine, CA
| | - Matthew T Wheeler
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Victoria N Parikh
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
| | - Euan A Ashley
- From the Departments of Medicine (K.S., Y.Y., A.K., M.K., S.Y., Y.H., Q.W., M.V.P., M.T.W., V.N.P., E.A.A.), Stanford University School of Medicine, CA
- Genetics (E.A.A.), Stanford University School of Medicine, CA
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Mokrov GV. Multitargeting in cardioprotection: An example of biaromatic compounds. Arch Pharm (Weinheim) 2023; 356:e2300196. [PMID: 37345968 DOI: 10.1002/ardp.202300196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023]
Abstract
A multitarget drug design approach is actively developing in modern medicinal chemistry and pharmacology, especially with regard to multifactorial diseases such as cardiovascular diseases, cancer, and neurodegenerative diseases. A detailed study of many well-known drugs developed within the single-target approach also often reveals additional mechanisms of their real pharmacological action. One of the multitarget drug design approaches can be the identification of the basic pharmacophore models corresponding to a wide range of the required target ligands. Among such models in the group of cardioprotectors is the linked biaromatic system. This review develops the concept of a "basic pharmacophore" using the biaromatic pharmacophore of cardioprotectors as an example. It presents an analysis of possible biological targets for compounds corresponding to the biaromatic pharmacophore and an analysis of the spectrum of biological targets for the five most known and most studied cardioprotective drugs corresponding to this model, and their involvement in the biological effects of these drugs.
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Martinez-Hernandez E, Kanaporis G, Blatter LA. Mechanism of carvedilol induced action potential and calcium alternans. Channels (Austin) 2022; 16:97-112. [PMID: 35501948 PMCID: PMC9067505 DOI: 10.1080/19336950.2022.2055521] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Carvedilol is a nonspecific β-blocker clinically used for the treatment of cardiovascular diseases but has also been shown to have profound effects on excitation-contraction coupling and Ca signaling at the cellular level. We investigate the mechanism by which carvedilol facilitates Ca transient (CaT) and action potential duration (APD) alternans in rabbit atrial myocytes. Carvedilol lowered the frequency threshold for pacing-induced CaT alternans and facilitated alternans in a concentration-dependent manner. Carvedilol prolonged the sarcoplasmic reticulum (SR) Ca release refractoriness by significantly increasing the time constant τ of recovery of SR Ca release; however, no changes in L-type calcium current recovery from inactivation or SR Ca load were found after carvedilol treatment. Carvedilol enhanced the degree of APD alternans nearly two-fold. Carvedilol slowed the APD restitution kinetics and steepened the APD restitution curve at the pacing frequency (2 Hz) where alternans were elicited. No effect on the CaT or APD alternans ratios was observed in experiments with a different β-blocker (metoprolol), excluding the possibility that the carvedilol effect on CaT and APD alternans was determined by its β-blocking properties. These data suggest that carvedilol contributes to the generation of CaT and APD alternans in atrial myocytes by modulating the restitution of CaT and APD.
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Affiliation(s)
| | - Giedrius Kanaporis
- Department of Physiology & Biophysics, Rush University Medical Center, Chicago, Illinois, USA
| | - Lothar A. Blatter
- Department of Physiology & Biophysics, Rush University Medical Center, Chicago, Illinois, USA,CONTACT Lothar A. Blatter Department of Physiology & Biophysics, Rush University Medical Center, 1750 W. Harrison Street, Chicago, IL60612, USA
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Li XT. Beneficial effects of carvedilol modulating potassium channels on the control of glucose. Biomed Pharmacother 2022; 150:113057. [PMID: 35658228 DOI: 10.1016/j.biopha.2022.113057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
The increased prevalence of hypertensive patients with type 2 diabetes mellitus (T2DM) is evident worldwide, leading to a higher risk of cardiovascular disease onset, which is substantially associated with disabilities and mortality in the clinic. In order to achieve the satisfyingly clinical outcomes and prognosis, the comprehensive therapies have been conducted with a beneficial effect on both blood pressure and glucose homeostasis, and clinical trials reveal that some kind of antihypertensive drugs such as angiotensin converting enzyme inhibitors (ACE-I) may, at least in part, meet the dual requirement during the disease management. As a nonselective β-blocker, carvedilol is employed for treating many cardiovascular diseases in clinical practice, including hypertension, angina pectoris and heart failure, and also exhibit the effectiveness for glycemic control and insulin resistance. Apart from alleviating sympathetic nervous system activity, several causes, such as lowering oxygen reactive species, may contribute to the effects of carvedilol on controlling plasma glucose levels, suggesting a feature of this drug having multiple targets. Interestingly, numerous distinct K+ channels expressed in pancreatic β-cells and peripheral insulin-sensitive tissues, which play a sentential role in glucose metabolism, are subjected to extensive modulation of carvdilol, establishing a linkage between K+ channels and drug's effects on the control of glucose. A variety of evidence shows that the impact of carvedilol on different K+ channels, including Kv, KAch, KATP and K2 P, can lead to positive influences for glucose homeostasis, contributing to its clinical beneficial effectiveness in treatment of hypertensive patients with T2DM. This review focus on the control of plasma glucose conferred by carvedilol modulation on K+ channels, providing the novel mechanistic explanation for drug's actions.
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Affiliation(s)
- Xian-Tao Li
- Department of Neuroscience, South-Central University for Nationalities, Wuhan 430074, China; School of Medicine, Guizhou University, Guiyang 550025, China.
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Reilly L, Eckhardt LL. Cardiac potassium inward rectifier Kir2: Review of structure, regulation, pharmacology, and arrhythmogenesis. Heart Rhythm 2021; 18:1423-1434. [PMID: 33857643 PMCID: PMC8328935 DOI: 10.1016/j.hrthm.2021.04.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022]
Abstract
Potassium inward rectifier channel Kir2 is an important component of terminal cardiac repolarization and resting membrane stability. This functionality is part of balanced cardiac excitability and is a defining feature of excitable cardiac membranes. “Gain-of-function” or “loss-of-function” mutations in KCNJ2, the gene encoding Kir2.1, cause genetic sudden cardiac death syndromes, and loss of the Kir2 current IK1 is a major contributing factor to arrhythmogenesis in failing human hearts. Here we provide a contemporary review of the functional structure, physiology, and pharmacology of Kir2 channels. Beyond the structure and functional relationships, we will focus on the elements of clinically used drugs that block the channel and the implications for treatment of atrial fibrillation with IK1-blocking agents. We will also review the clinical disease entities associated with KCNJ2 mutations and the growing area of research into associated arrhythmia mechanisms. Lastly, the presence of Kir2 channels has become a tipping point for electrical maturity in induced pluripotent stem cell-derived cardiomyocytes (iPS-CMs) and highlights the significance of understanding why Kir2 in iPS-CMs is important to consider for Comprehensive In Vitro Proarrhythmia Assay and drug safety testing.
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Affiliation(s)
- Louise Reilly
- Cellular and Molecular Arrhythmia Research Program, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lee L Eckhardt
- Cellular and Molecular Arrhythmia Research Program, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
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Martinez-Hernandez E, Blatter LA. Effect of carvedilol on atrial excitation-contraction coupling, Ca 2+ release, and arrhythmogenicity. Am J Physiol Heart Circ Physiol 2020; 318:H1245-H1255. [PMID: 32275472 DOI: 10.1152/ajpheart.00650.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Carvedilol is an FDA-approved β-blocker commonly used for treatment of high blood pressure, congestive heart failure, and cardiac tachyarrhythmias, including atrial fibrillation. We investigated at the cellular level the mechanisms through which carvedilol interferes with sarcoplasmic reticulum (SR) Ca2+ release during excitation-contraction coupling (ECC) in single rabbit atrial myocytes. Carvedilol caused concentration-dependent (1-10 µM) failure of SR Ca2+ release. Failure of ECC and Ca2+ release was the result of dose-dependent inhibition of voltage-gated Na+ (INa) and L-type Ca2+ (ICa) currents that are responsible for the rapid depolarization phase of the cardiac action potential (AP) and the initiation of Ca2+-induced Ca2+ release from the SR, respectively. Carvedilol (1 µM) led to AP duration shortening, AP failures, and peak INa inhibition by ~80%, whereas ICa was not markedly affected. Carvedilol (10 µM) blocked INa almost completely and reduced ICa by ~40%. No effect on Ca2+-transient amplitude, ICa, and INa was observed in control experiments with the β-blocker metoprolol, suggesting that the carvedilol effect on ECC is unlikely the result of its β-blocking property. The effects of carvedilol (1 µM) on subcellular SR Ca2+ release was spatially inhomogeneous, where a selective inhibition of peripheral subsarcolemmal Ca2+ release from the junctional SR accounted for the cell-averaged reduction in Ca2+-transient amplitude. Furthermore, carvedilol significantly reduced the probability of spontaneous arrhythmogenic Ca2+ waves without changes of SR Ca2+ load. The data suggest a profound antiarrhythmic action of carvedilol in atrial myocytes resulting from an inhibitory effect on the SR Ca2+ release channel.NEW & NOTEWORTHY Here we show that the clinically widely used β-blocker carvedilol has profound effects on Ca2+ signaling and ion currents, but also antiarrhythmic effects in adult atrial myocytes. Carvedilol inhibits sodium and calcium currents and leads to failure of ECC but also prevents spontaneous Ca2+ release from cellular sarcoplasmic reticulum (SR) Ca2+ stores in form of arrhythmogenic Ca2+ waves. The antiarrhythmic effect occurs by carvedilol acting directly on the SR ryanodine receptor Ca2+ release channel.
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Affiliation(s)
- E Martinez-Hernandez
- Department of Physiology and Biophysics, Rush University Medical Center, Chicago, Illinois
| | - L A Blatter
- Department of Physiology and Biophysics, Rush University Medical Center, Chicago, Illinois
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Cheng N, Ren S, Yang JF, Liu XM, Li XT. Carvedilol blockage of delayed rectifier Kv2.1 channels and its molecular basis. Eur J Pharmacol 2019; 855:50-55. [PMID: 31063774 DOI: 10.1016/j.ejphar.2019.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 11/19/2022]
Abstract
Previous studies indicated that one of the action targets of carvedilol is the voltage-gated potassium (Kv) channel, which has a fundamental role in the control of electrical properties in excitable cells. It is not clear whether this compound exerts any actions specifically on delayed rectifier Kv2.1 channels. The present study is conducted on Kv2.1 currents heterologously expressed in HEK293 cells to characterize the block by carvedilol in detail, identifying molecular determinants and providing biophysical insights of the block. Macroscopic Kv2.1 currents obtained by whole-cell recording were substantially inhibited after addition of carvedilol with an IC50 value of 5.1 μM. This drug also led to a largely hyperpolarizing shift (30 mV) of the inactivation curve, which may contribute to the blocking action due to more inactivation of Kv2.1 currents occurred in depolarization potentials. Mutations at Y380 (a putative TEA binding site) and K356 (a K+ binding site) in the outer vestibule of Kv2.1 channels significantly eliminated the inhibitory effects of carvedilol and prevented the leftward shift of inactivation. Moreover, mutations at above positions modulated the effects of carvedilol on the deactivation but not activation kinetics of Kv2.1 channels. Collected data indicate that carvedilol can exert a blocking effect on the closed-state of Kv2.1 channels, and specific residues within the S5-P and P-S6 linkers in the outer vestibule may play crucial roles in carvedilol-induced blocking for Kv2.1 channels.
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Affiliation(s)
- Neng Cheng
- College of Life Science, South-Central University for Nationalities, Wuhan, 430074, China
| | - Sheng Ren
- College of Life Science, South-Central University for Nationalities, Wuhan, 430074, China
| | - Jin-Feng Yang
- College of Life Science, South-Central University for Nationalities, Wuhan, 430074, China
| | - Xiang-Ming Liu
- GongQing Institute of Science and Technology, Gongqing City, 332020, China
| | - Xian-Tao Li
- College of Life Science, South-Central University for Nationalities, Wuhan, 430074, China.
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Zhang R, Jie LJ, Wu WY, Wang ZQ, Sun HY, Xiao GS, Wang Y, Li YG, Li GR. Comparative study of carvedilol and quinidine for inhibiting hKv4.3 channel stably expressed in HEK 293 cells. Eur J Pharmacol 2019; 853:74-83. [PMID: 30880181 DOI: 10.1016/j.ejphar.2019.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 02/03/2023]
Abstract
The inhibition of transient outward potassium current (Ito) is the major ionic mechanism for quinidine to treat Brugada syndrome; however, quinidine is inaccessible in many countries. The present study compared the inhibitory effect of the nonselective β-adrenergic blocker carvedilol with quinidine on human Kv4.3 (hKv4.3, encoding for Ito) channel and action potential notch using a whole-cell patch technique in HEK 293 cell line expressing KCND3 as well as in ventricular epicardial myocytes of rabbit hearts. It was found that carvedilol and quinidine inhibited hKv4.3 current in a concentration-dependent manner. The IC50 of carvedilol was 1.2 μM for inhibiting hKv4.3 charge area, while the IC50 of quinidine was 2.9 μM (0.2 Hz). Both carvedilol and quinidine showed typical open channel blocking properties (i.e. decreasing the time to peak of activation and increasing the inactivation of hKv4.3), negatively shifted the V1/2 of activation and inactivation, and slowed the recovery from inactivation of the channel. Although carvedilol had weaker in use- and rate-dependent inhibition of hKv4.3 peak current than quinidine, its reduction of the charge area was more than quinidine at all frequencies (0.2-3.3 Hz). Moreover, the inhibitory effect of carvedilol on action potential notch was greater than quinidine. These results provide the novel information that carvedilol, like quinidine, significantly inhibits hKv4.3 and action potential notch, suggesting that carvedilol is likely an alternative drug for preventing malignant ventricular arrhythmias in patients with Brugada syndrome in countries where quinidine is unavailable.
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Affiliation(s)
- Rui Zhang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China; Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Ling-Jun Jie
- Xiamen Cardiovascular Hospital, Medical School of Xiamen University, Xiamen, Fujian 361004, China
| | - Wei-Yin Wu
- Xiamen Cardiovascular Hospital, Medical School of Xiamen University, Xiamen, Fujian 361004, China
| | - Zhi-Quan Wang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Hai-Ying Sun
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Guo-Sheng Xiao
- Xiamen Cardiovascular Hospital, Medical School of Xiamen University, Xiamen, Fujian 361004, China
| | - Yan Wang
- Xiamen Cardiovascular Hospital, Medical School of Xiamen University, Xiamen, Fujian 361004, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
| | - Gui-Rong Li
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China; Xiamen Cardiovascular Hospital, Medical School of Xiamen University, Xiamen, Fujian 361004, China.
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Yang JF, Cheng N, Ren S, Liu XM, Li XT. Characterization and molecular basis for the block of Kv1.3 channels induced by carvedilol in HEK293 cells. Eur J Pharmacol 2018; 834:206-212. [PMID: 30016664 DOI: 10.1016/j.ejphar.2018.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/04/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
Carvedilol is a non-selective β-adrenoreceptor antagonist and exhibits a wide range of biological activities. The voltage-gated K+ (Kv) channel is one of the target ion channels of this compound. The rapidly activating Kv1.3 channel is expressed in several different tissues and plays an important role in the regulation of physiological functions, including cell proliferation and apoptosis. However, little is known about the possible action of carvedilol on Kv1.3 currents. Using the whole-cell configuration of the patch-clamp technique, we have revealed that exposure to carvedilol produced a concentration-dependent blocking of Kv1.3 channels heterologously expressed in HEK293 cells, with an IC50 value of 9.7 μM. This chemical decelerated the deactivation tail current of Kv1.3 currents, resulting in a tail crossover phenomenon. In addition, carvedilol generated a markedly hyperpolarizing shift (20 mV) of the inactivation curve, but failed to affect the activation curve. Mutagenesis experiments of Kv1.3 channels identified G427 and H451, two related sites of TEA block, as important residues for carvedilol-mediated blocking. The present results suggest that carvedilol acts directly on Kv1.3 currents by inducing closed- and open-channel block and helps to elucidate the mechanisms of action of this compound on Kv channels.
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Affiliation(s)
- Jin-Feng Yang
- College of Life Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Neng Cheng
- College of Life Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Sheng Ren
- College of Life Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Xiang-Ming Liu
- GongQing Institute of Science and Technology, Gongqing City 332020, China
| | - Xian-Tao Li
- College of Life Science, South-Central University for Nationalities, Wuhan 430074, China.
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Cao F, Wang T, Ding W, Li Z, Shi S, Wang X. Effects of diacetyl-liensinine on electrophysiology in rabbit ventricular myocytes. BMC Pharmacol Toxicol 2017; 18:33. [PMID: 28476169 PMCID: PMC5420095 DOI: 10.1186/s40360-017-0137-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diacetyl-liensinine is a chemosynthetic derivative of liensinine, extracted from the seed embryo of Nelumbo nucifera Gaertn, in China. It has been found to have extensive anti- arrhythmic actions. The present study was designed to investigate the effects of diacetyl-liensinine on electro- physiology of myocytes. METHODS We exposed rabbit ventricular myocytes to diacetyl-liensinine using standard whole-cell patch-clamp technique and measured the action potential, L-type calcium current (I Ca-L), delayed rectifier potassium current (I K), transient outward potassium current (I to) and inward rectifier potassium current (I K1). RESULTS Our results showed that diacetyl-liensinine significantly prolonged action potential duration at 50 and 90% repolarization (APD50, APD90), at 10 and 30 μM, while shortened APD50 and APD90 at 100 μM. In addition, diacetyl-liensinine inhibited the ICa-L, IK, I to and IK1 in a concentration-dependent manner. CONCLUSIONS The results suggest that diacetyl-liensinine might be a potential anti-arrhythmic agent.
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Affiliation(s)
- Feng Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China.
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China.
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China.
| | - Teng Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Wenmao Ding
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Zhe Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Shaobo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
| | - Xiaozhan Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People's Republic of China
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Sube R, Ertel EA. Cardiomyocytes Derived from Human Induced Pluripotent Stem Cells: An In-Vitro Model to Predict Cardiac Effects of Drugs. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/jbise.2017.1011040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Abstract
This is a brief review of properties of cardiovascular function that should be considered for interrogation in studies of toxicology and/or safety pharmacology for non-cardiologists and non-physiologists. Since concern over the rarely occurring, unusual, and drug-induced tachycardia, Torsade de pointes, is a leading cause for cessation of development of potential drugs and for removal of drugs from the market, therefore, the toxic manifestation of drugs will be emphasized. The putative origin of torsade de pointes, and the origin of the electrocardiogram and electrocardiographic features of ventricular arrhythmias will be discussed.
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Affiliation(s)
- Robert L Hamlin
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio 43210, USA.
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Gasparova I, Kubatka P, Opatrilova R, Caprnda M, Filipova S, Rodrigo L, Malan L, Mozos I, Rabajdova M, Nosal V, Kobyliak N, Valentova V, Petrovic D, Adamek M, Kruzliak P. Perspectives and challenges of antioxidant therapy for atrial fibrillation. Naunyn Schmiedebergs Arch Pharmacol 2016; 390:1-14. [PMID: 27900409 DOI: 10.1007/s00210-016-1320-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/18/2016] [Indexed: 12/26/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia associated with significant morbidity and mortality. The mechanisms underlying the pathogenesis of AF are poorly understood, although electrophysiological remodeling has been described as an important initiating step. There is growing evidence that oxidative stress is involved in the pathogenesis of AF. Many known triggers of oxidative stress, such as age, diabetes, smoking, and inflammation, are linked with an increased risk of arrhythmia. Numerous preclinical studies and clinical trials reported the importance of antioxidant therapy in the prevention of AF, using vitamins C and E, polyunsaturated fatty acids, statins, or nitric oxide donors. The aim of our work is to give a current overview and analysis of opportunities, challenges, and benefits of antioxidant therapy in AF.
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Affiliation(s)
- Iveta Gasparova
- Institute of Biology, Genetics and Medical Genetics, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic, Slovakia
| | - Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovak Republic, Slovakia
| | - Radka Opatrilova
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Martin Caprnda
- 2nd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Slavomira Filipova
- Department of Cardiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Luis Rodrigo
- Faculty of Medicine, University of Oviedo, Central University of Asturias (HUCA), Oviedo, Spain
| | - Leone Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, Potchefstroom, South Africa
| | - Ioana Mozos
- Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Miroslava Rabajdova
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Vladimir Nosal
- Clinic of Neurology, Jessenius Faculty of Medicine, Comenius University and University Hospital in Martin, Martin, Slovak Republic
| | - Nazarii Kobyliak
- Department of Endocrinology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Vanda Valentova
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovak Republic, Slovakia
| | - Daniel Petrovic
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljublana, Ljublana, Slovenia
| | - Mariusz Adamek
- Department of Thoracic Surgery, Medical University of Silesia, Zabrze, Poland
| | - Peter Kruzliak
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic. .,2nd Department of Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Bednarski M, Otto M, Dudek M, Kołaczkowski M, Bucki A, Siwek A, Groszek G, Maziarz E, Wilk P, Sapa J. Synthesis and Pharmacological Activity of a New Series of 1-(1H-Indol-4-yloxy)-3-(2-(2-methoxyphenoxy)ethylamino)propan-2-ol Analogs. Arch Pharm (Weinheim) 2016; 349:211-23. [PMID: 26853441 DOI: 10.1002/ardp.201500234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 12/18/2022]
Abstract
β-Adrenergic receptor antagonists are important therapeutics for the treatment of cardiovascular disorders. In the group of β-blockers, much attention is being paid to the third-generation drugs that possess important ancillary properties besides inhibiting β-adrenoceptors. Vasodilating activity of these drugs is produced through different mechanisms, such as nitric oxide (NO) release, β2 -agonistic action, α1 -blockade, antioxidant action, and Ca(2+) entry blockade. Here, a study on evaluation of the cardiovascular activity of five new compounds is presented. Compound 3a is a methyl and four of the tested compounds (3b-e) are dimethoxy derivatives of 1-(1H-indol-4-yloxy)-3-(2-(2-methoxyphenoxy)ethylamino)propan-2-ol. The obtained results confirmed that the methyl and dimethoxy derivatives of 1-(1H-indol-4-yloxy)-3-(2-(2-methoxyphenoxy)ethylamino)propan-2-ol and their enantiomers possess α1 - and β1 -adrenolytic activities and that the antiarrhythmic and hypotensive effects of the tested compounds are related to their adrenolytic properties.
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Affiliation(s)
- Marek Bednarski
- Faculty of Pharmacy, Department of Pharmacological Screening, Medical College, Jagiellonian University, Krakow, Poland
| | - Monika Otto
- Faculty of Pharmacy, Department of Pharmacological Screening, Medical College, Jagiellonian University, Krakow, Poland
| | - Magdalena Dudek
- Faculty of Pharmacy, Department of Pharmacological Screening, Medical College, Jagiellonian University, Krakow, Poland
| | - Marcin Kołaczkowski
- Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Medical College, Jagiellonian University, Krakow, Poland
| | - Adam Bucki
- Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Medical College, Jagiellonian University, Krakow, Poland
| | - Agata Siwek
- Faculty of Pharmacy, Department of Pharmacobiology, Medical College, Jagiellonian University, Krakow, Poland
| | - Grażyna Groszek
- Faculty of Chemistry, Rzeszów University of Technology, Rzeszów, Poland
| | | | - Piotr Wilk
- Nencki Institute of Experimental Biology, Warszawa, Poland
| | - Jacek Sapa
- Faculty of Pharmacy, Department of Pharmacological Screening, Medical College, Jagiellonian University, Krakow, Poland
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Kisselbach J, Seyler C, Schweizer PA, Gerstberger R, Becker R, Katus HA, Thomas D. Modulation of K2P 2.1 and K2P 10.1 K(+) channel sensitivity to carvedilol by alternative mRNA translation initiation. Br J Pharmacol 2014; 171:5182-94. [PMID: 25168769 DOI: 10.1111/bph.12596] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/20/2013] [Accepted: 01/16/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE The β-receptor antagonist carvedilol blocks a range of ion channels. K2P 2.1 (TREK1) and K2P 10.1 (TREK2) channels are expressed in the heart and regulated by alternative translation initiation (ATI) of their mRNA, producing functionally distinct channel variants. The first objective was to investigate acute effects of carvedilol on human K2P 2.1 and K2P 10.1 channels. Second, we sought to study ATI-dependent modulation of K2P K(+) current sensitivity to carvedilol. EXPERIMENTAL APPROACH Using standard electrophysiological techniques, we recorded currents from wild-type and mutant K2P 2.1 and K2P 10.1 channels in Xenopus oocytes and HEK 293 cells. KEY RESULTS Carvedilol concentration-dependently inhibited K2P 2.1 channels (IC50 ,oocytes = 20.3 μM; IC50 , HEK = 1.6 μM) and this inhibition was frequency-independent. When K2P 2.1 isoforms generated by ATI were studied separately in oocytes, the IC50 value for carvedilol inhibition of full-length channels (16.5 μM) was almost 5-fold less than that for the truncated channel variant (IC50 = 79.0 μM). Similarly, the related K2P 10.1 channels were blocked by carvedilol (IC50 ,oocytes = 24.0 μM; IC50 , HEK = 7.6 μM) and subject to ATI-dependent modulation of drug sensitivity. CONCLUSIONS AND IMPLICATIONS Carvedilol targets K2P 2.1 and K2P 10.1 K(+) channels. This previously unrecognized mechanism supports a general role of cardiac K2P channels as antiarrhythmic drug targets. Furthermore, the work reveals that the sensitivity of the cardiac ion channels K2P 2.1 and K2P 10.1 to block was modulated by alternative mRNA translation initiation.
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Affiliation(s)
- J Kisselbach
- Department of Cardiology, Medical University Hospital, Heidelberg, Germany
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The hypotensive agent dodoneine inhibits L-type Ca2+ current with negative inotropic effect on rat heart. Eur J Pharmacol 2014; 728:119-27. [DOI: 10.1016/j.ejphar.2014.01.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/23/2014] [Accepted: 01/29/2014] [Indexed: 12/29/2022]
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Choi EK, Shen MJ, Lin SF, Chen PS, Oh S. Effects of carvedilol on cardiac autonomic nerve activities during sinus rhythm and atrial fibrillation in ambulatory dogs. Europace 2014; 16:1083-91. [PMID: 24469435 DOI: 10.1093/europace/eut364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIMS We hypothesized that carvedilol can effectively suppress autonomic nerve activity (ANA) in ambulatory dogs during sinus rhythm and atrial fibrillation (AF), and that carvedilol withdrawal can lead to rebound elevation of ANA. Carvedilol is known to block pre-junctional β2-adrenoceptor responsible for norepinephrine release. METHODS AND RESULTS We implanted radiotransmitters to record stellate ganglion nerve activity (SGNA), vagal nerve activity (VNA), and superior left ganglionated plexi nerve activity (SLGPNA) in 12 ambulatory dogs. Carvedilol (12.5 mg orally twice a day) was given for 7 days during sinus rhythm (n = 8). Four of the eight dogs and an additional four dogs were paced into persistent AF. Carvedilol reduced heart rate [from 103 b.p.m. (95% confidence interval (CI), 100-105) to 100 b.p.m. (95% CI, 98-102), P = 0.044], suppressed integrated nerve activities (Int-NAs, SGNA by 17%, VNA by 19%, and SLGPNA by 12%; all P < 0.05 vs. the baseline), and significantly reduced the incidence (from 8 ± 6 to 3 ± 3 episodes/day, P < 0.05) and total duration (from 68 ± 64 to 16 ± 21 s/day, P < 0.05) of paroxysmal atrial tachycardia (PAT). Following the development of persistent AF, carvedilol loading was associated with AF termination in three dogs. In the remaining five dogs, Int-NAs were not significantly suppressed by carvedilol, but SGNA significantly increased by 16% after carvedilol withdrawal (P < 0.001). CONCLUSION Carvedilol suppresses ANA and PAT in ambulatory dogs during sinus rhythm.
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Affiliation(s)
- Eue-Keun Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Mark J Shen
- Krannert Institute of Cardiology and the Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Shien-Fong Lin
- Krannert Institute of Cardiology and the Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology and the Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
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Inada S, Ono T, Shibata N, Iwata M, Haraguchi R, Ashihara T, Mitsui K, Boyett MR, Dobrzynski H, Nakazawa K. Simulation study of complex action potential conduction in atrioventricular node. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:6850-3. [PMID: 24111318 DOI: 10.1109/embc.2013.6611131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The atrioventricular (AV) node, which is located between the atria and ventricles of the heart, acts as important roles in cardiac excitation conduction between the two chambers. Although there are multiple conduction pathways in the AV node, the structure of the AV node has not been clarified. In this study, we constructed a one-dimensional model of the AV node and simulated excitation conduction between the right atrium and the bundle of His via the AV node. We also investigated several characteristics of the AV node: (1) responses of the AV node to high-rate excitation in the right atrium, (2) the AV nodal reentrant beat induced by premature stimulus, and (3) ventricular rate control during atrial fibrillation with various methods. Our simulation results suggest that multiple conduction pathways act as important roles in controlling the ventricular rate. The one-dimensional model constructed in this study may be useful to analyze complex conduction patterns in the AV node.
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Bodi I, Franke G, Pantulu ND, Wu K, Perez-Feliz S, Bode C, Zehender M, zur Hausen A, Brunner M, Odening KE. Differential effects of the β-adrenoceptor blockers carvedilol and metoprolol on SQT1- and SQT2-mutant channels. J Cardiovasc Electrophysiol 2013; 24:1163-71. [PMID: 23718892 DOI: 10.1111/jce.12178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/23/2013] [Accepted: 04/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND N588K-KCNH2 and V307L-KCNQ1 mutations lead to a gain-of-function of IKr and IKs thus causing short-QT syndromes (SQT1, SQT2). Combined pharmacotherapies using K(+) -channel-blockers and β-blockers are effective in SQTS. Since β-blockers can block IKr and IKs , we aimed at determining carvedilol's and metoprolol's electrophysiological effects on N588K-KCNH2 and V307L-KCNQ1 channels. METHODS Wild-type (WT)-KCNH2, WT-KCNQ1 and mutant N588K-KCNH2 and V307L-KCNQ1 channels were expressed in CHO-K1 or HEK-293T cells and IKs and IKr were recorded at baseline and during β-blocker exposure. RESULTS Carvedilol (10 μM) reduced IKs tail in WT- and V307L-KCNQ1 by 36.5 ± 5% and 18.6 ± 9% (P < 0.05). IC50 values were 16.3 μM (WT) and 46.1 μM (V307L), indicating a 2.8-fold decrease in carvedilol's IKs -blocking potency in V307L-KCNQ1. Carvedilol's (1 μM) inhibition of the IKr tail was attenuated in N588K-KCNH2 (4.5 ± 3% vs 50.3 ± 4%, WT, P < 0.001) with IC50 values of 2.8 μM (WT) and 25.4 μM (N588K). Carvedilol's IKr end-pulse inhibition, however, was increased in N588K-KCNH2 (10 μM, 60.7 ± 6% vs 36.5 ± 5%, WT, P < 0.01). Metoprolol (100 μM) reduced IKr end-pulse by 0.23 ± 3% (WT) and 74.1 ± 7% (N588K, P < 0.05), IKr tail by 32.9 ± 10% (WT) and 68.8 ± 7% (N588K, P < 0.05), and reduced IKs end-pulse by 18.3 ± 5% (WT) and 57.1 ± 11% (V307L, P < 0.05) and IKs tail by 3.3 ± 1% (WT) and 45.1 ± 13 % (V307L, P < 0.05), indicating an increased sensitivity to metoprolol in SQT mutated channels. CONCLUSIONS N588K-KCNH2 and V307L-KCNQ1 mutations decrease carvedilol's inhibition of the IKs or IKr tail but increase carvedilol's IKr end-pulse inhibition and metoprolol's inhibition of tail and end-pulse currents. These different effects on SQT1 and SQT2 mutated channels should be considered when using β-blocker therapy in SQTS patients.
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Affiliation(s)
- Ilona Bodi
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany
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Kharin S, Krandycheva V, Tsvetkova A, Strelkova M, Shmakov D. Remodeling of ventricular repolarization in a chronic doxorubicin cardiotoxicity rat model. Fundam Clin Pharmacol 2012; 27:364-72. [DOI: 10.1111/j.1472-8206.2012.01037.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Jeong I, Choi BH, Yoon SH, Hahn SJ. Carvedilol blocks the cloned cardiac Kv1.5 channels in a β-adrenergic receptor-independent manner. Biochem Pharmacol 2012; 83:497-505. [PMID: 22146582 DOI: 10.1016/j.bcp.2011.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/21/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022]
Abstract
Carvedilol, a non-selective β-adrenergic blocker, is widely used for the treatment of angina pectoris and hypertension. We examined the action of carvedilol on cloned Kv1.5 expressed in CHO cells, using the whole-cell patch clamp technique. Carvedilol reduced the peak amplitude of Kv1.5 and accelerated the inactivation rate in a concentration-dependent manner with an IC50 of 2.56 μM. Using a first-order kinetics analysis, we calculated k(+1) = 19.68 μM(-1)s(-1) for the association rate constant, and k(-1) = 44.89 s(-1) for the dissociation rate constant. The apparent K(D) (k(-1)/k(+1)) was 2.28 μM, which is similar to the IC50 value. Other β-adrenergic blockers (alprenolol, oxprenolol and carteolol) had little or no effect on Kv1.5 currents. Carvedilol slowed the deactivation time course, resulting in a tail crossover phenomenon. Carvedilol-induced block was voltage-dependent in the voltage range for channel activation, but voltage-independent in the voltage range for full activation. The voltage dependences for both steady-state activation and inactivation were unchanged by carvedilol. Carvedilol affected Kv1.5 in a use-dependent manner. When stimulation frequencies were increased to quantify a use-dependent block, however, the block by carvedilol was slightly increased with IC50 values of 2.56 μM at 0.1 Hz, 2.38 μM at 1 Hz and 2.03 μM at 2 Hz. Carvedilol also slowed the time course of recovery from inactivation of Kv1.5. These results indicate that carvedilol blocks Kv1.5 in a reversible, concentration-, voltage-, time-, and use-dependent manner, but only at concentrations slightly higher than therapeutic plasma concentrations in humans. These effects are probably relevant to an understanding of the ionic mechanism underlying the antiarrhythmic property of carvedilol.
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Affiliation(s)
- Imju Jeong
- Department of Physiology, Medical Research Center, College of Medicine, The Catholic University of Korea, Seoul 137-701, Republic of Korea
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Polak S, Wiśniowska B, Glinka A, Fijorek K, Mendyk A. Slow delayed rectifying potassium current (IKs ) - analysis of the in vitro inhibition data and predictive model development. J Appl Toxicol 2012; 33:723-39. [PMID: 22334483 DOI: 10.1002/jat.2719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/21/2011] [Accepted: 12/21/2011] [Indexed: 01/16/2023]
Abstract
The excitable cell membranes contain ion channels that allow the ions passage through the specific pores via a passive process. Assessment of the inhibition of the IKr (hERG) current is considered to be the main target during the drug development process, although there are other ionic currents for which drug-triggered modification can either potentiate or mask hERG channel blockade. Information describing the results of in vitro studies investigating the chemical-IKs current interactions has been developed in the current study. Based on the publicly available data sources, 145 records were collected. The final list of publications consists of 64 positions and refers to 106 different molecules connected with IKs current inhibition, with at least one IC50 value measured. Ultimately, 98 of the IC50 values expressed as absolute values were gathered. For 36 records the IC50 was expressed as a relative value. For the 11 remaining records, the inhibition was not clearly expressed. Based on the collected data the predictive models for the IC50 estimation were developed with the use of various algorithms. The extended Quantitative Structure-Activity Relationships (QSAR) methodology was applied and the in vitro research settings were included as independent variables, apart from the physico-chemical descriptors calculated with the use of the Marvin Calculator Plugins. The root mean squared error and normalized root mean squared error values for the best model (an expert system based on two independent artificial neural networks) were 0.86 and 14.04%, respectively. The model was further built into the ToxComp system, the ToxIVIVE tool specialized for cardiotoxicity assessment of drugs.
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Affiliation(s)
- Sebastian Polak
- Department of Toxicology, Faculty of Pharmacy, Medical College, Jagiellonian University, Cracow, Poland.
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24
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Staudacher K, Staudacher I, Ficker E, Seyler C, Gierten J, Kisselbach J, Rahm AK, Trappe K, Schweizer PA, Becker R, Katus HA, Thomas D. Carvedilol targets human K2P 3.1 (TASK1) K+ leak channels. Br J Pharmacol 2011; 163:1099-110. [PMID: 21410455 PMCID: PMC3130955 DOI: 10.1111/j.1476-5381.2011.01319.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 01/20/2011] [Accepted: 02/05/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Human K(2P) 3.1 (TASK1) channels represent potential targets for pharmacological management of atrial fibrillation. K(2P) channels control excitability by stabilizing membrane potential and by expediting repolarization. In the heart, inhibition of K(2P) currents by class III antiarrhythmic drugs results in action potential prolongation and suppression of electrical automaticity. Carvedilol exerts antiarrhythmic activity and suppresses atrial fibrillation following cardiac surgery or cardioversion. The objective of this study was to investigate acute effects of carvedilol on human K(2P) 3.1 (hK(2P) 3.1) channels. EXPERIMENTAL APPROACH Two-electrode voltage clamp and whole-cell patch clamp electrophysiology was used to record hK(2P) 3.1 currents from Xenopus oocytes, Chinese hamster ovary (CHO) cells and human pulmonary artery smooth muscle cells (hPASMC). KEY RESULTS Carvedilol concentration-dependently inhibited hK(2P) 3.1 currents in Xenopus oocytes (IC(50) = 3.8 µM) and in mammalian CHO cells (IC(50) = 0.83 µM). In addition, carvedilol sensitivity of native I(K2P3.1) was demonstrated in hPASMC. Channels were blocked in open and closed states in frequency-dependent fashion, resulting in resting membrane potential depolarization by 7.7 mV. Carvedilol shifted the current-voltage (I-V) relationship by -6.9 mV towards hyperpolarized potentials. Open rectification, characteristic of K(2P) currents, was not affected. CONCLUSIONS AND IMPLICATIONS The antiarrhythmic drug carvedilol targets hK(2P) 3.1 background channels. We propose that cardiac hK(2P) 3.1 current blockade may suppress electrical automaticity, prolong atrial refractoriness and contribute to the class III antiarrhythmic action in patients treated with the drug.
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Affiliation(s)
- K Staudacher
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - I Staudacher
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - E Ficker
- Rammelkamp Center, MetroHealth Campus, Case Western Reserve UniversityCleveland, OH, USA
| | - C Seyler
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - J Gierten
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - J Kisselbach
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - A-K Rahm
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - K Trappe
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - PA Schweizer
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - R Becker
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - HA Katus
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
| | - D Thomas
- Department of Cardiology, Medical University Hospital HeidelbergHeidelberg, Germany
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Abstract
Sudden cardiac death (SCD) accounts for approximately one-third of all deaths in patients with heart failure, and is generally the result of ventricular tachycardia (VT) and/or ventricular fibrillation (VF). The mechanisms of VT/VF associated with heart failure are complex and heterogeneous; they include functional and structural remodeling, as well as neurohormonal activation. The implantable cardioverter-defibrillator is very useful for preventing SCD, but the improvement of outcome is limited in patients with cardiac dysfunction and advanced heart failure. This article reviews the current status of drug therapy for the treatment of VT/VF in patients with heart failure. Chronic beta-blocker therapy reduces SCD and improves survival. Angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers and aldosterone antagonists are thought to reduce SCD by preventing ventricular remodeling. Amiodarone is potentially effective for preventing VT/VF in patients at high risk, especially those with nonischemic heart failure. This may be a result of the complex pharmacodynamics of amiodarone, which affects many kinds of ion channels/transporters, as well as thyroid function. The pure class III antiarrhythmic drug, nifekalant, is useful in the emergency treatment of VT/VF.
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Affiliation(s)
- Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo 162-8666, Japan.
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Ferrer T, Ponce-Balbuena D, López-Izquierdo A, Aréchiga-Figueroa IA, de Boer TP, van der Heyden MAG, Sánchez-Chapula JA. Carvedilol inhibits Kir2.3 channels by interference with PIP₂-channel interaction. Eur J Pharmacol 2011; 668:72-7. [PMID: 21663737 DOI: 10.1016/j.ejphar.2011.05.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 05/05/2011] [Accepted: 05/22/2011] [Indexed: 11/28/2022]
Abstract
Carvedilol, a β- and α-adrenoceptor blocker, is used to treat congestive heart failure, mild to moderate hypertension, and myocardial infarction. It has been proposed to block K(ATP) channels by binding to the bundle crossing region at a domain including cysteine at position 166, and thereby plugging the pore region. However, carvedilol was reported not to affect Kir2.1 channels, which lack 166 Cys. Here, we demonstrate that carvedilol inhibits Kir2.3 carried current by an alternative mechanism. Carvedilol inhibited Kir2.3 channels with at least 100 fold higher potency (IC(50)=0.49 μM) compared to that for Kir2.1 (IC(50)>50 μM). Kir2.3 channel inhibition was concentration-dependent and voltage-independent. Increasing Kir2.3 channel affinity for PIP(2), by a I213L point mutation, decreased the inhibitory effect of carvedilol more than twentyfold (IC(50)=11.1 μM). In the presence of exogenous PIP(2), Kir2.3 channel inhibition by carvedilol was strongly reduced (80 vs. 2% current inhibition). These results suggest that carvedilol, as other cationic amphiphilic drugs, inhibits Kir2.3 channels by interfering with the PIP(2)-channel interaction.
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Affiliation(s)
- Tania Ferrer
- Unidad de Investigación Carlos Méndez del Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Mexico.
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Hsieh YD, Chi CC, Chou CT, Cheng JS, Kuo CC, Liang WZ, Lin KL, Tseng LL, Jan CR. Investigation of carvedilol-evoked Ca²+ movement and death in human oral cancer cells. J Recept Signal Transduct Res 2011; 31:220-8. [PMID: 21619449 DOI: 10.3109/10799893.2011.577785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The effect of carvedilol on cytosolic free Ca²⁺ concentrations ([Ca²⁺](i)) in OC2 human oral cancer cells is unknown. This study examined if carvedilol altered basal [Ca²⁺](i) levels in suspended OC2 cells by using fura-2 as a Ca²⁺-sensitive fluorescent probe. Carvedilol at concentrations between 10 and 40 µM increased [Ca²⁺](i) in a concentration-dependent fashion. The Ca²⁺ signal was decreased by 50% by removing extracellular Ca²⁺. Carvedilol-induced Ca²⁺ entry was not affected by the store-operated Ca²⁺ channel blockers nifedipine, econazole, and SK&F96365, but was enhanced by activation or inhibition of protein kinase C. In Ca²⁺-free medium, incubation with the endoplasmic reticulum Ca²⁺ pump inhibitor thapsigargin did not change carvedilol-induced [Ca²⁺](i) rise; conversely, incubation with carvedilol did not reduce thapsigargin-induced Ca²⁺ release. Pretreatment with the mitochondrial uncoupler carbonylcyanide m-chlorophenylhydrazone (CCCP) inhibited carvedilol-induced [Ca²⁺](i) release. Inhibition of phospholipase C with U73122 did not alter carvedilol-induced [Ca²⁺](i) rise. Carvedilol at 5-50 µM induced cell death in a concentration-dependent manner. The death was not reversed when cytosolic Ca²⁺ was chelated with 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid acetoxymethyl ester (BAPTA/AM). Annexin V/propidium iodide staining assay suggests that apoptosis played a role in the death. Collectively, in OC2 cells, carvedilol induced [Ca²⁺](i) rise by causing phospholipase C-independent Ca²⁺ release from mitochondria and non-endoplasmic reticulum stores, and Ca²⁺ influx via protein kinase C-regulated channels. Carvedilol (up to 50 μM) induced cell death in a Ca²⁺-independent manner that involved apoptosis.
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Affiliation(s)
- Yao-Dung Hsieh
- Department of Dentistry, Kaohsiung Veterans General Hospital, Taiwan
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Sozmen NN, Tuncay E, Bilginoglu A, Turan B. Profound cardioprotection with timolol in a female rat model of aging-related altered left ventricular function. Can J Physiol Pharmacol 2011; 89:277-88. [DOI: 10.1139/y11-018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Increasing evidence shows a marked beneficial effect with β-blockers in heart dysfunction via scavenging reactive oxygen species. Previously we showed that chronic treatment with either timolol or propranolol possessed similar beneficial effects for heart function in male rats as age increased, whereas only timolol exerted similar benefits in female rats. Therefore, in this study, we aimed first to examine the cellular bases for age-related alterations in excitation–contraction coupling in ventricular myocytes from female rats and, second, to investigate the hypothesis that age-related changes in [Ca2+]ihomeostasis and receptor-mediated system can be prevented with chronic timolol treatment. Chronic timolol treatment of 3-month-old female rats abolished age-related decrease in left ventricular developed pressure and the attenuated responses to β-adrenoreceptor stimulation. It also normalized the altered parameters of [Ca2+]itransients, decreased Ca2+loading of sarcoplasmic reticulum and increased basal [Ca2+]i, and decreased L-type Ca2+currents in 12-month-old female rats compared with the 3-month-old group. Adenylyl cyclase activity, β-adrenoreceptor affinity to its agonist, and β-adrenoreceptor density of the 12-month-old group are normalized to those of the 3-month-old group. Moreover, timolol treatment prevented dysfunction of the antioxidant system, including increased lipid peroxidation, decreased ratio of reduced glutathione to oxidized glutathione, and decreased activities of thioredoxin reductase and glucose-6-phosphate dehydrogenase, in the left ventricle of hearts from the 12-month-old group. Our data confirmed that aging-related early myocardial impairment is primarily related to a dysfunctional antioxidant system and impairment of Ca2+homeostasis, which can be prevented with chronic timolol treatment.
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Affiliation(s)
- Nazli N. Sozmen
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Erkan Tuncay
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ayca Bilginoglu
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Belma Turan
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
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Shieh P, Lee CH, Yi NL, Jan CR. Carvedilol-induced elevation in cytosolic free Ca(2+) level and apoptosis in SIRC corneal epithelial cells. Hum Exp Toxicol 2009; 29:477-87. [PMID: 20028701 DOI: 10.1177/0960327109357775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of the cardiovascular drug carvedilol on cytosolic free Ca(2+) concentrations ([Ca( 2+)](i)) and viability was examined in Statens Seruminstitut rabbit cornea (SIRC) corneal epithelial cells. [Ca(2+)](i) and cell viability were measured using the fluorescent dyes fura-2 and 4-[3-[4-lodophenyl]-2-4(4-nitrophenyl)-2H-5-tetrazolio-1,3-benzene disulfonate] (WST-1), respectively. Carvedilol at concentrations between 1 and 30 microM increased [Ca( 2+)](i) in a concentration-dependent manner. The Ca(2+) signal was reduced partly by removing extracellular Ca(2+). Carvedilol induced Mn(2+) quench of fura-2 fluorescence implicating Ca(2+) influx. The Ca(2+) influx was inhibited by suppression of protein kinase C activity. In Ca(2+)-free medium, after pretreatment with 1 microM thapsigargin (an endoplasmic reticulum Ca( 2+) pump inhibitor), carvedilol-induced [Ca(2+)](i) rise was reduced; and conversely, carvedilol pretreatment inhibited a major part of thapsigargin-induced [Ca( 2+)](i) rise. Addition of the phospholipase C inhibitor 1-[6-[[17 beta-3-methoxyestra-1,3,5(10)-trien-17-yl]amino] hexyl]-1H-pyrrole-2,5-dione (U73122; 2 microM) did not change carvedilol-induced [Ca(2+)](i) rise. At concentrations between 5 and 70 microM, carvedilol killed cells in a concentration-dependent manner. The cytotoxic effect of 20 microM carvedilol was not reversed by prechelating cytosolic Ca(2+) with BAPTA/AM. Apoptosis was induced by 5-70 microM carvedilol. Collectively, in SIRC corneal epithelial cells, carvedilol-induced [Ca(2+)](i) rises by causing Ca(2+) release from the endoplasmic reticulum in a phospholipase C-independent manner, and Ca( 2+) influx via protein kinase C-regulated Ca(2+) channels. Carvedilol-caused cytotoxicity was mediated by Ca(2+)-independent apoptosis in a concentration-dependent manner.
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Affiliation(s)
- Pochuen Shieh
- Department of Pharmacy, Tajen University, Pingtung, Taiwan.
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Groszek G, Nowak-Król A, Wdowik T, Świerczyński D, Bednarski M, Otto M, Walczak M, Filipek B. Synthesis and adrenolytic activity of 1-(1H-indol-4-yloxy)-3-(2-(2-methoxy phenoxy)ethylamino)propan-2-ol analogs and its enantiomers. Part 2. Eur J Med Chem 2009; 44:5103-11. [DOI: 10.1016/j.ejmech.2009.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 07/12/2009] [Accepted: 07/16/2009] [Indexed: 11/29/2022]
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Deng C, Rao F, Wu S, Kuang S, Liu X, Zhou Z, Shan Z, Lin Q, Qian W, Yang M, Geng Q, Zhang Y, Yu X, Lin S. Pharmacological effects of carvedilol on T-type calcium current in murine HL-1 cells. Eur J Pharmacol 2009; 621:19-25. [PMID: 19744474 DOI: 10.1016/j.ejphar.2009.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 08/21/2009] [Accepted: 08/25/2009] [Indexed: 11/29/2022]
Abstract
Carvedilol is widely used in the treatment of cardiovascular diseases including atrial fibrillation. T-type Ca(2+) channels have been recognized recently in the mechanisms underlying atrial arrhythmias. However, it is unclear whether carvedilol may affect the T-type Ca(2+) channel. The present study evaluated the pharmacological effects of carvedilol on T-type calcium current (I(Ca,T)) in the murine HL-1 cell line. I(Ca)(,T) was recorded by the whole-cell patch-clamp technique. Calcium transient was monitored by the fluorescent dye Fluo-4/AM and confocal laser scanning microscopy. Carvedilol reversibly inhibited I(Ca)(,T) in a concentration-dependent manner, with an IC50 of 2.1 microM. 3 microM carvedilol was found to decrease the peak I(Ca)(,T) amplitude at -20 mV from 20.1+/-1.8pA/pF to 10.9+/-2.1pA/pF. Carvedilol significantly shifted the steady-state inactivation curve of I(Ca)(,T) towards more negative potential by 12.8 mV, while the activation curve was not significantly altered. Carvedilol delayed recovery from inactivation of I(Ca)(,T), time constant (tau) was 112.4+/-3.5 ms in control and 270.1+/-4.7 ms in carvedilol. Carvedilol-induced inhibition rate in I(Ca)(,T) was enhanced with the increase in stimuli frequency, the inhibitory rate was 23.2+/-4.1% at 0.2 Hz and 47.2+/-0.6% at 2 Hz. Carvedilol still produced the significant decrease in the amplitude of I(Ca)(,T) in the presence of H-89, PKA inhibitor. Carvedilol significantly inhibited the amplitude of the calcium transient in a concentration-dependent manner. These findings indicate that carvedilol inhibits I(Ca)(,T) in atrial cells by mechanisms involving preferential interaction with the inactivated state of T-type Ca(2+) channel.
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Affiliation(s)
- Chunyu Deng
- Medical Research Center of Guangdong General Hospital, Guangzhou, PR China
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Groszek G, Bednarski M, Dybała M, Filipek B. Synthesis and adrenolytic activity of 1-(1H-indol-4-yloxy)-3-{[2-(2-methoxyphenoxy)ethyl]amino}propan-2-ol and its enantiomers. Part 1. Eur J Med Chem 2009; 44:809-17. [DOI: 10.1016/j.ejmech.2008.05.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 05/21/2008] [Accepted: 05/22/2008] [Indexed: 11/28/2022]
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Wen H, Jiang H, Lu Z, He B, Hu X, Chen J, Zhao D. Carvedilol Ameliorates the Decreases in Connexin 43 and Ventricular Fibrillation Threshold in Rats with Myocardial Infarction. TOHOKU J EXP MED 2009; 218:121-7. [DOI: 10.1620/tjem.218.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Huazhi Wen
- Department of Cardiology, Renmin Hospital of Wuhan University
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University
| | - Zhibing Lu
- Department of Cardiology, Renmin Hospital of Wuhan University
| | - Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University
| | - Xiaorong Hu
- Department of Cardiology, Renmin Hospital of Wuhan University
| | - Jing Chen
- Department of Cardiology, Renmin Hospital of Wuhan University
| | - Dongdong Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University
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Betablockers: Is the Reduction of Sudden Death Related to Pure Electrophysiologic Effects? Cardiovasc Drugs Ther 2008; 22:163-4. [DOI: 10.1007/s10557-008-6104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kanoupakis EM, Manios EG, Mavrakis HE, Kallergis EM, Lyrarakis GM, Koutalas EP, Vardas PE. Electrophysiological effects of carvedilol administration in patients with dilated cardiomyopathy. Cardiovasc Drugs Ther 2008; 22:169-76. [PMID: 18205033 DOI: 10.1007/s10557-008-6081-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Accepted: 01/02/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Several studies suggest the clinical efficacy of carvedilol in reducing atrial and ventricular arrhythmias in patients with left ventricular dysfunction (LVD) due to congestive heart failure (CHF) or following myocardial infarction. However, the mechanisms supporting its antiarrhythmic efficacy have been derived from experimental studies. In this prospective, placebo-controlled trial we examined the electrophysiological effects of a high oral dose of carvedilol in patients with CHF and LVD due to non-ischemic dilated cardiomyopathy. METHODS Thirty-one patients with stable CHF underwent electrophysiological study and were randomly assigned to treatment with carvedilol or placebo. After 2 months of treatment the study was repeated. RESULTS Carvedilol prolonged almost all conduction times. In the same group atrial and ventricular effective refractory periods were significantly prolonged, while the parameters of repolarization remained virtually unchanged. The prolongation of refractoriness was most pronounced in the atrium. The change in ventricular refractoriness was correlated with ejection fraction (r = 0.94, p < 0.01) suggesting that patients with more preserved left ventricular function responded to treatment with greater prolongation. CONCLUSION Even after a short period of administration carvedilol has marked and diffused electrophysiological effects that would be beneficial for patients with CHF and may contribute to the positive outcome of clinical trials.
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Yokoyama A, Sato N, Kawamura Y, Hasebe N, Kikuchi K. Electrophysiological effects of carvedilol on rabbit heart pacemaker cells. Int Heart J 2007; 48:347-58. [PMID: 17592199 DOI: 10.1536/ihj.48.347] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The electrophysiological effects of carvedilol, a beta-blocking agent with vasodilating actions, have been studied on rabbit pacemaker cells using the whole-cell patch clamp technique. Nystatin-perforated patch recordings from the sinoatrial (SA) and atrioventricular (AV) nodes demonstrated that 1-3 microM of carvedilol caused a decrease in the spontaneous firing frequency, depolarization of the maximal diastolic potential, and prolongation of the action potential duration in both species. Voltage clamp experiments were performed using SA and AV node myocytes to identify and define the carvedilol-induced changes in the Ca(2+) current, I(Ca), delayed rectifier K(+) current, I(K), and hyperpolarization-activated inward current, I(f). In the SA node cells, 1 microM of carvedilol blocked I(K), I(Ca), and I(f) by 72%, 47%, and 22%, respectively. In the AV node cells, the corresponding reductions were 64% (I(K)) and 46% (I(Ca)), respectively. In both the SA and AV nodes the decrease in I(K) appeared to be mainly due to the rapidly activating component of the delayed rectifier, I(Kr), since the high dose of carvedilol blocked I(K) in the SA and AV nodes to a submaximal degree. In conclusion, effective doses of carvedilol have classical class III antiarrhythmic actions and a negative chronotropic effect resulting from the inhibition of I(K) and I(Ca). Both actions may be efficacious for treating supraventricular tachyarrhythmias.
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Affiliation(s)
- Ayumi Yokoyama
- First Department of Internal Medicine, Asahikawa Medical College, Hokkaido
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Mechanisms of carvedilol-induced [Ca2+] i rises and death in human hepatoma cells. Naunyn Schmiedebergs Arch Pharmacol 2007; 376:185-94. [PMID: 17917717 DOI: 10.1007/s00210-007-0191-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 09/07/2007] [Indexed: 02/08/2023]
Abstract
The effect of the cardiovascular drug carvedilol on cytosolic free Ca2+ concentrations ([Ca2+]i) and viability has not been explored in human hepatoma cells. This study examined whether carvedilol altered [Ca2+]i and caused cell death in HA59T cells. [Ca2+]i and cell viability were measured using the fluorescent dyes fura-2 and WST-1, respectively. Carvedilol at concentrations >or=1 microM increased [Ca2+]i in a concentration-dependent manner with an EC50 value of 20 microM. The Ca2+ signal was reduced partly by removing extracellular Ca2+. Carvedilol induced Mn2+ quench of fura-2 fluorescence, implicating Ca2+ influx. The Ca2+ influx was sensitive to La3+, econazole, nifedipine, and SKF96365. In Ca2+-free medium, after pretreatment with 1 muM thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor), carvedilol-induced [Ca2+]i rises were abolished; and conversely, carvedilol pretreatment inhibited a major part of thapsigargin-induced [Ca2+]i rises. Inhibition of phospholipase C with 2 microM U73122 did not change carvedilol-induced [Ca2+]i rises. At concentrations between 1 and 50 microM, carvedilol killed cells in a concentration-dependent manner. The cytotoxic effect of 1 microM (but not 30 microM) carvedilol was fully reversed by prechelating cytosolic Ca2+ with 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid-acetoxymethyl ester (BAPTA/AM). Apoptosis was induced by 30 (but not 1) microM carvedilol. Collectively, in HA59T hepatoma cells, carvedilol induced [Ca2+]i rises by causing Ca2+ release from the endoplasmic reticulum in a phospholipase-C-independent manner and Ca2+ influx via store-operated Ca2+ channels. Carvedilol-caused cytotoxicity was mediated by Ca2+ and apoptosis in a concentration-dependent manner.
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Adamson PB, Gilbert EM. Reducing the Risk of Sudden Death in Heart Failure With β-Blockers. J Card Fail 2006; 12:734-46. [PMID: 17174236 DOI: 10.1016/j.cardfail.2006.08.213] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 08/15/2006] [Accepted: 08/28/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Heart failure (HF) is a serious cardiovascular syndrome that affects nearly 5 million people in the United States. A review of clinical data demonstrates that sudden cardiac death (SCD) accounts for approximately one-third of all HF deaths. This fatal outcome typically involves an unexpected electrical event leading to sustained cardiac arrhythmias resulting in cardiovascular collapse. METHODS AND RESULTS A systematic review of the literature was performed to serve as the basis for this review. Factors contributing directly to incidence of SCD in the HF population may include significant remodeling of the left ventricle (hypertrophy, dilation, and fibrosis) in addition to increased sympathetic activation. Using specific therapies to limit these mechanisms are beneficial in the HF patient by preventing SCD. Beta-blockers play a key role in the prevention of SCD for patients with HF by limiting the effects of circulating norepinephrine and by reducing left ventricular remodeling. CONCLUSIONS This review outlines the potential mechanisms and contributing factors of SCD in patients with HF and the impact of beta-blocker usage in the prevention of this fatal outcome for this growing patient population.
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Affiliation(s)
- Philip B Adamson
- Heart Failure Institute at the Oklahoma Heart Hospital, Oklahoma City, Oklahoma 73120, USA
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Deng C, Yu X, Kuang S, Zhang W, Zhou Z, Zhang K, Qian W, Shan Z, Yang M, Wu S, Lin S. Effects of carvedilol on transient outward and ultra-rapid delayed rectifier potassium currents in human atrial myocytes. Life Sci 2006; 80:665-71. [PMID: 17118405 DOI: 10.1016/j.lfs.2006.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 10/22/2006] [Accepted: 10/23/2006] [Indexed: 11/26/2022]
Abstract
Carvedilol is a beta- and alpha(1)-adrenoceptor antagonist. It is widely used in the treatment of cardiovascular diseases including atrial arrhythmias. However, it is unclear whether carvedilol may affect the repolarization currents, transient outward K(+) current (I(to)) and ultra-rapid delayed rectifier K(+) current (I(Kur)) in the human atrium. The present study evaluated effects of carvedilol on I(to) and I(Kur) in isolated human atrial myocytes by whole-cell patch-clamp recording technique. We found that carvedilol reversibly inhibited I(to) and I(Kur) in a concentration-dependent manner. Carvedilol (0.3 microM) suppressed I(to) from 9.2+/-0.5 pA/pF to 4.8+/-0.5 pA/pF (P<0.01) and I(Kur) from 3.6+/-0.5 pA/pF to 1.9+/-0.3 pA/pF (P<0.01) at +50 mV. I(to) was inhibited in a voltage-dependent manner, being significantly attenuated at test potentials from +10 to +50 mV, whereas the inhibition of I(Kur) was independent. The concentration giving a 50% inhibition was 0.50 microM for I(to) and 0.39 microM for I(Kur). Voltage-dependence of activation, inactivation and time-dependent recovery from inactivation of I(to) were not altered by carvedilol. However, time to peak and time-dependent inactivation of I(to) were significantly accelerated, indicating an open channel blocking action. The findings indicate that carvedilol significantly inhibits the major repolarization K(+) currents I(to) and I(Kur) in human atrial myocytes.
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Affiliation(s)
- Chunyu Deng
- Research Center of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou 510080, PR China
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Kopecky SL. Effect of beta blockers, particularly carvedilol, on reducing the risk of events after acute myocardial infarction. Am J Cardiol 2006; 98:1115-9. [PMID: 17027583 DOI: 10.1016/j.amjcard.2006.05.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 05/11/2006] [Accepted: 05/11/2006] [Indexed: 11/19/2022]
Abstract
The morbidity and mortality rates of patients who have had acute myocardial infarctions (AMIs) are high. Clinical guidelines recommend that most survivors of AMIs without contraindications should receive long-term treatment with beta blockade. Beta blockers have been shown to reduce mortality and reinfarction after AMI, but the pharmacologic differences among beta blockers may affect their ability to reduce these adverse events. The beta blocker carvedilol has adjunctive pharmacologic properties, including alpha1-blocking, antioxidant, anti-inflammatory, and antiarrhythmic activities that appear to underlie the outcomes demonstrated in experimental models and clinical trials. In conclusion, this review explores the experimental and clinical evidence supporting the preferential use of carvedilol in post-AMI patients with left ventricular dysfunction.
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Kawakami K, Nagatomo T, Abe H, Kikuchi K, Takemasa H, Anson BD, Delisle BP, January CT, Nakashima Y. Comparison of HERG channel blocking effects of various beta-blockers-- implication for clinical strategy. Br J Pharmacol 2006; 147:642-52. [PMID: 16314852 PMCID: PMC1751343 DOI: 10.1038/sj.bjp.0706508] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
beta-Blockers are widely used in the treatment of cardiovascular diseases. However, their effects on HERG channels at comparable conditions remain to be defined. We investigated the direct acute effects of beta-blockers on HERG current and the molecular basis of drug binding to HERG channels with mutations of putative common binding site (Y652A and F656C). beta-Blockers were selected based on the receptor subtype. Wild-type, Y652A and F656C mutants of HERG channel were stably expressed in HEK293 cells, and the current was recorded by using whole-cell patch-clamp technique (23 degrees C). Carvedilol (nonselective), propranolol (nonselective) and ICI 118551 (beta(2)-selective) inhibited HERG current in a concentration-dependent manner (IC(50) 0.51, 3.9 and 9.2 microM, respectively). The IC(50) value for carvedilol was a clinically relevant concentration. High metoprolol (beta(1)-selective) concentrations were required for blockade (IC(50) 145 microM), and atenolol (beta(1)-selective) did not inhibit the HERG current. Inhibition of HERG current by carvedilol, propranolol and ICI 118551 was partially but significantly attenuated in Y652A and F656C mutant channels. Affinities of metoprolol to Y652A and F656C mutant channels were not different compared with the wild-type. HERG current block by all beta-blockers was not frequency-dependent. Drug affinities to HERG channels were different in beta-blockers. Our results provide additional strategies for clinical usage of beta-blockers. Atenolol and metoprolol may be preferable for patients with type 1 and 2 long QT syndrome. Carvedilol has a class III antiarrhythmic effect, which may provide the rationale for a favourable clinical outcome compared with other beta-blockers as suggested in the recent COMET (Carvedilol Or Metoprolol European Trial) substudy.
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Affiliation(s)
- Kazunobu Kawakami
- Second Department of Internal Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Toshihisa Nagatomo
- Second Department of Internal Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
- Author for correspondence:
| | - Haruhiko Abe
- Second Department of Internal Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Kan Kikuchi
- Second Department of Internal Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Hiroko Takemasa
- Second Department of Internal Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
| | - Blake D Anson
- Department of Medicine, Section of Cardiovascular Medicine, University of Wisconsin, Madison, WI 53792, U.S.A
| | - Brian P Delisle
- Department of Medicine, Section of Cardiovascular Medicine, University of Wisconsin, Madison, WI 53792, U.S.A
| | - Craig T January
- Department of Medicine, Section of Cardiovascular Medicine, University of Wisconsin, Madison, WI 53792, U.S.A
| | - Yasuhide Nakashima
- Second Department of Internal Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan
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Kikuta JI, Ishii M, Kishimoto K, Kurachi Y. Carvedilol blocks cardiac KATP and KG but not IK1 channels by acting at the bundle-crossing regions. Eur J Pharmacol 2005; 529:47-54. [PMID: 16325804 DOI: 10.1016/j.ejphar.2005.10.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 10/26/2005] [Indexed: 11/15/2022]
Abstract
We examined the effects of carvedilol on cardiac inwardly rectifying K(+) (Kir) channels, i.e., ATP-sensitive (K(ATP)), G-protein-activated (K(G)) and background (I(K1)) Kir channels. We found that carvedilol effectively inhibits K(ATP) and K(G), but not I(K1) channels. Carvedilol inhibits K(ATP) channels reconstituted in HEK293 cells with Kir6.2 lacking the C-terminal 26 amino acids (Kir6.2DeltaC26), suggesting that carvedilol acts in the channel pore. A sequence comparison of the three channels revealed that a cysteine residue, C166, in the inner helix of Kir6.2 is conserved in both Kir6.xs (K(ATP)) and Kir3.xs (K(G)), but not in Kir2.xs (I(K1)). The mutation of this residue (C166A) made Kir6.2DeltaC26 resistant to the drug. Homology modeling and docking simulation suggested that interaction between carvedilol and the pore could be located at the cytosolic portion of the inner helix (bundle-crossing region) containing C166. This study shows that carvedilol blocks specific groups of Kir channels by interacting with the bundle-crossing region.
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Affiliation(s)
- Jun-ichi Kikuta
- Department of Pharmacology, Osaka University of Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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43
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Shah RR, Hondeghem LM. Refining detection of drug-induced proarrhythmia: QT interval and TRIaD. Heart Rhythm 2005; 2:758-72. [PMID: 15992736 DOI: 10.1016/j.hrthm.2005.03.023] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2005] [Accepted: 03/27/2005] [Indexed: 01/10/2023]
Abstract
QT interval prolongation is so frequently associated with torsades de pointes (TdP) that it has come to be recognized as a surrogate marker of this unique tachyarrhythmia. However, not only does TdP not always follow QT interval prolongation, but TdP can occur even in the absence of a prolonged QT interval. Worse still, even shortening of the QT interval may be associated with serious arrhythmias (particularly ventricular tachycardia [VT] and ventricular fibrillation [VF]). It appears increasingly probable that the distinction between various ventricular tachyarrhythmias may be arbitrary, and drug-induced TdP, polymorphic VT, VT, catecholaminergic polymorphic VT, and VF may represent discrete entities within a spectrum of drug-induced proarrhythmia. Although they are differentiated by the coupling interval and the duration of QT interval, they appear to share a common substrate: a set of disturbances of repolarization characterized by Triangulation, Reverse use dependency, electrical Instability of the action potential, and Dispersion (TRIaD). It is becoming increasingly evident that augmentation of TRIaD, rather than changes in the duration of QT interval, provides the proarrhythmic substrate. In contrast, when not associated with an increase of TRIaD, QT interval prolongation can be an antiarrhythmic property. Electrophysiologically, augmentation of TRIaD can be explained by inhibition of hERG (human ether-a-go-go related gene) channel. Because drug-induced disturbances in repolarization commonly result from inhibition of hERG channels or I(Kr), hERG blockade and the resulting prolongation of QT interval are important properties of a drug to be studied. However, these need only be a concern if associated with TRIaD. More significantly, TRIaD so often precedes prolongation of action potential duration or QT interval and ventricular tachyarrhythmias that it should be considered a marker of proarrhythmia until proven otherwise, even in the absence of QT interval prolongation. Detecting drug-induced augmentation of TRIaD may offer an additional, more sensitive, and accurate indicator of the broader proarrhythmic potential of a drug than may QT interval prolongation alone.
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Affiliation(s)
- Rashmi R Shah
- Medicines and Healthcare Products Regulatory Agency, London, UK.
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44
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El-Sherif N, Turitto G. Electrophysiologic Effects of Carvedilol: Is Carvedilol an Antiarrhythmic Agent? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:985-90. [PMID: 16176541 DOI: 10.1111/j.1540-8159.2005.00200.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The cardiovascular drug carvedilol is characterized by multiple pharmacological actions, which translate into a wide-spectrum therapeutic potential. Its major molecular targets are membrane adrenoceptors, ion channels, and reactive oxygen species. Carvedilol's favorable hemodynamic effects are due to the fact that the drug competitively blocks beta(1)-, beta(2)-, and alpha(1)- adrenoceptors. Several additional properties have been documented and may be clinically important, including antioxidant, antiproliferative/antiatherogenic, anti-ischemic, and antihypertrophic effects. The antiarrhythmic action of carvedilol may be related to a combination of its beta-blocking effects with its modulating effects on a variety of ion channels and currents. Several studies suggest that the drug may be useful in reducing cardiac death in high-risk patients with prior myocardial infarction and/or heart failure, as well as for primary and secondary prevention of atrial fibrillation. This article will review experimental data available on the electrophysiologic properties of carvedilol, with a focus on their clinical relevance.
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Affiliation(s)
- Nabil El-Sherif
- SUNY Downstate Medical Center 450 Clarkson Avenue, Box 1199, Brooklyn, NY 11203, USA.
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45
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Naccarelli GV, Lukas MA. Carvedilol's antiarrhythmic properties: therapeutic implications in patients with left ventricular dysfunction. Clin Cardiol 2005; 28:165-73. [PMID: 15869048 PMCID: PMC6653935 DOI: 10.1002/clc.4960280403] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Carvedilol is a beta- and alpha-adrenergic-blocking drug with clinically important antiarrhythmic properties. It possesses anti-ischemic and antioxidant activity and inhibits a number of cationic channels in the cardiomyocyte, including the HERG-associated potassium channel, the L-type calcium channel, and the rapid-depolarizing sodium channel. The electrophysiologic properties of carvedilol include moderate prolongation of action potential duration and effective refractory period; slowing of atrioventricular conduction; and reducing the dispersion of refractoriness. Experimentally, carvedilol reduces complex and repetitive ventricular ectopy induced by ischemia and reperfusion. In patients, carvedilol is effective in controlling the ventricular rate response in atrial fibrillation (AF), with and without digitalis, and is useful in maintaining sinus rhythm after cardioversion, with and without amiodarone. In patients with AF and heart failure (HF), carvedilol reduces mortality risk and improves left ventricular (LV) function. Large-scale clinical trials have demonstrated that combined carvedilol and angiotensin-converting enzyme inhibitor therapy significantly reduces sudden cardiac death, mortality, and ventricular arrhythmia in patients with LV dysfunction (LVD) due to chronic HF or following myocardial infarction (MI). Despite intensive neurohormonal blockade, mortality rates remain relatively high in patients with post-MI and nonischemic LVD. Recent trials of implantable cardioverter-defibrillators added to pharmacologic therapy, especially beta blockers, have shown a further reduction in arrhythmic deaths in these patients.
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Affiliation(s)
- Gerald V Naccarelli
- Division of Cardiology, Cardiovascular Center, Penn State University College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
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46
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Abstract
Atrial fibrillation (AF) in heart failure develops commonly in older individuals and its prevalence increases as heart failure severity progresses. Because of deteriorating hemodynamics, patients with heart failure are at increased risk for developing AF and, conversely, AF in heart failure patients is associated with adverse hemodynamic changes. AF is believed to increase the mortality risk in heart failure, which may be minimized by treatment that includes the control of ventricular rate, prevention of thrombotic events, and conversion to normal sinus rhythm. Clinical guidelines recommend amiodarone or dofetilide in heart failure patients, but these drugs have certain drawbacks, such as an increased risk for bradyarrhythmias with amiodarone and proarrhythmic reaction with dofetilide. Some but not all clinical trials have suggested that rate control should be the primary therapeutic goal in high-risk heart failure patients with AF and, if unsuccessful, followed by rhythm control. The former is effectively achieved with rate-lowering beta-blockers alone or in combination with digoxin. Recent studies evaluating the effects of combination carvedilol/digoxin therapy demonstrate synergistic effects between the two drugs. This combination therapy decreased heart failure symptoms, effectively reduced ventricular rate, and improved ventricular function to a greater extent compared with that produced by either drug alone. Although digoxin alone is an effective heart failure treatment, its use as a single rate-control therapy is often ineffective in heart failure patients with AF associated with rapid ventricular response. Carvedilol is effective, alone or in combination, with digoxin in such heart failure patients with AF, and has been shown to reduce mortality risk in patients with chronic heart failure during prolonged therapy.
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Affiliation(s)
- Gerald V Naccarelli
- Division of Cardiology, Penn State University, College of Medicine, The Milton S. Hershey Medical Center, Hershey, PA.
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47
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Liu CP, Jan CR. Effect of carvedilol on Ca2+ movement and cytotoxicity in human MG63 osteosarcoma cells. Basic Clin Pharmacol Toxicol 2005; 95:59-65. [PMID: 15379781 DOI: 10.1111/j.1742-7843.2004.950203.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Carvedilol is a useful cardiovascular drug for treating heart failure, however, the in vitro effect on many cell types is unclear. In human MG63 osteosarcoma cells, the effect of carvedilol on intracellular Ca2+ concentrations ([Ca2+]i) and cytotoxicity was explored by using fura-2 and tetrazolium, respectively. Carvedilol at concentrations greater than 1 microM caused a rapid rise in [Ca2+]i in a concentration-dependent manner (EC50=15 microM). Carvedilol-induced [Ca2+]i rise was reduced by 60% by removal of extracellular Ca2+. Carvedilol-induced Mn2+-associated quench of intracellular fura-2 fluorescence also suggests that carvedilol induced extracellular Ca2+ influx. In Ca2+-free medium, thapsigargin, an inhibitor of the endoplasmic reticulum Ca2+-ATPase, caused a monophasic [Ca2+]i rise, after which the increasing effect of carvedilol on [Ca2+]i was inhibited by 50%. Conversely, pretreatment with carvedilol to deplete intracellular Ca2+ stores totally prevented thapsigargin from releasing more Ca2+. U73122, an inhibitor of phospholipase C, abolished histamine (an inositol 1,4,5-trisphosphate-dependent Ca2+ mobilizer)-induced, but not carvedilol-induced, [Ca2+]i rise. Pretreatment with phorbol 12-myristate 13-acetate and forskolin to activate protein kinase C and adenylate cyclase, respectively, did not alter carvedilol-induced [Ca2+]i rise. Separately, overnight treatment with 0.1-30 microM carvedilol inhibited cell proliferation in a concentration-dependent manner. These findings suggest that in human MG63 osteosarcoma cells, carvedilol increases [Ca2+]i by stimulating extracellular Ca2+ influx and also by causing intracellular Ca2+ release from the endoplasmic reticulum and other stores via a phospholipase C-independent manner. Carvedilol may be cytotoxic to osteoblasts.
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Affiliation(s)
- Chun Peng Liu
- Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 813.
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48
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McBride BF, White CM. Critical differences among beta-adrenoreceptor antagonists in myocardial failure: debating the MERIT of COMET. J Clin Pharmacol 2005; 45:6-24. [PMID: 15601801 DOI: 10.1177/0091270004269841] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In the United States, carvedilol and metoprolol (tartrate or succinate) are the most commonly employed beta-adrenoreceptor antagonists for the treatment of heart failure. However, use of these agents in patients with heart failure remains extremely low despite overwhelming evidence of their beneficial short- and long-term effects. Because the myocardial pathophysiology associated with heart failure involves not only beta-1 adrenoreceptors but also beta-2 and alpha-1 adrenoreceptors, this indicates a more complex disease process that may require pan-receptor antagonism to provide optimal clinical benefit. Relative to metoprolol (tartrate or succinate), carvedilol represents an extremely complex molecular entity that not only possesses the ability to antagonize all of the principle adrenoreceptors involved in heart failure but also reduces oxidative stress and provides an antiarrhythmic benefit independent of beta-adrenoreceptor antagonism. Taken together, an interesting pharmacologic premise for the superiority of carvedilol relative to metoprolol (tartrate) may exist, but the lack of clinical trials comparing an optimal dose of either extended-release metoprolol (ie, succinate) or immediate-release metoprolol (ie, tartrate) to carvedilol limits the clinical application of the pharmacologic differences between the agents.
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Affiliation(s)
- Brian F McBride
- Division of Clinical Pharmacology, College of Medicine, Vanderbilt University, Nashville, Tennessee, USA
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49
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Du LP, Tsai KC, Li MY, You QD, Xia L. The pharmacophore hypotheses of IKr potassium channel blockers: novel class III antiarrhythmic agents. Bioorg Med Chem Lett 2004; 14:4771-7. [PMID: 15324906 DOI: 10.1016/j.bmcl.2004.06.070] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2004] [Accepted: 06/17/2004] [Indexed: 11/24/2022]
Abstract
Predictive pharmacophore models were developed for a large series of I(Kr) potassium channel blockers as class III antiarrhythmic agents using HypoGen in Catalyst software. The pharmacophore hypotheses were generated using a training set consisting of 34 compounds carefully selected from documents. Their biological data, expressed as IC(50), spanned from 1.5 nM to 2.8 mM with 7 orders difference. The most predictive hypothesis (Hypo1), consisting of four features (one positive ionizable feature, two aromatic rings and one hydrophobic group), had a best correlation coefficient of 0.825, a lowest rms deviation of 1.612, and a highest cost difference (null cost-total cost) of 77.552, which represents a true correlation and a good predictivity. The hypothesis Hypo1 was then validated by a test set consisting of 21 compounds and by a cross-validation of 95% confidence level with randomizing the data using CatScramble program. Accordingly, our model has strong predictivity to identify structural diverse I(Kr) potassium channel blockers with desired biological activity by virtual screening
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Affiliation(s)
- Lü-Pei Du
- Department of Medicinal Chemistry, China Pharmaceutical University, Nanjing 210009, China
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50
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Kanoupakis EM, Manios EG, Mavrakis HE, Tzerakis PG, Mouloudi HK, Vardas PE. Comparative effects of carvedilol and amiodarone on conversion and recurrence rates of persistent atrial fibrillation. Am J Cardiol 2004; 94:659-62. [PMID: 15342304 DOI: 10.1016/j.amjcard.2004.05.037] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Revised: 05/14/2004] [Accepted: 05/14/2004] [Indexed: 11/30/2022]
Abstract
Pretreatment with antiarrhythmic agents could improve cardioversion and recurrence rates in patients with persistent atrial fibrillation. In a prospective controlled trial, 145 patients were randomly assigned to treatment with carvedilol, amiodarone, or placebo for 4 weeks before electrical cardioversion. Although the 2 drugs had similar effects on cardioversion rates, amiodarone was superior in terms of sinus rhythm maintenance after conversion.
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