Cardiac impairment in adrenal insufficiency in the cat. Reduced adenosinetriphosphatase activity of myocardial contractile proteins

Reversible cardiomyopathy in paediatric Addison's disease--a cautionary tale

A 13 year-old girl with clinical features of Addison's disease developed acute cardiac failure after initiation of treatment and after initial clinical improvement. Large doses of i.v. hydrocortisone and oral fludrocortisone, in addition to inotropic and ventilatory support, were required to achieve cardiovascular stability. The cardiomyopathy improved over one week and her condition then remained stable on oral glucocorticoid and mineralocorticoid replacement therapy. Reversible cardiomyopathy is a rare and potentially life-threatening complication of Addison's disease. The second reported paediatric patient is presented, the only one reported to require ventilatory support.

Hemodynamic changes in acute adrenal insufficiency

OBJECTIVE

Acute adrenocortical insufficiency is an unusual cause of isolated shock. The purpose of this study is to describe the cardiovascular changes in 6 patients with acute adrenal insufficiency presenting with hemodynamic instability.

DESIGN

Retrospective and prospective study.

SETTING

Medical intensive care unit in a university hospital.

PATIENTS

6 patients studied by right cardiac catheterization.

MEASUREMENTS AND RESULTS

Results before glucocorticoid treatment show two possible hemodynamic states: 1) myocardial depression with hypovolemia in 3 patients, and 2) hyperdynamic shock with high cardiac output and diminished systemic arterial resistance in 3 other patients. The 3 patients presenting hyperdynamic shock were all given intravenous fluid therapy of over 20 ml/kg before the first hemodynamic measurement. For 2 other patients with low cardiac index and high systemic arterial resistance studied prospectively, 20 ml/kg intravenous fluid therapy transformed the hemodynamic state to hyperdynamic shock. The cardiovascular effect of glucocorticoid treatment studied in 4 patients was resulted in an improvement in the left ventricular systolic work index.

CONCLUSIONS

Diagnosis of acute adrenocortical insufficiency must be considered if clinical manifestations are present suggesting septic shock without any obvious infectious cause in patients having undergone considerable intravenous fluid therapy as an initial course of treatment.

Myocardial contractile protein ATPase activities in adrenalectomized and thyroidectomized rats

This report compares the effects of adrenalectomy and thyroidectomy, with and without hormone replacement, on loss of contractile protein ATPase activities. The rationale for this study was derived from the similarities in their intracellular receptors, mechanisms of action, and the large number of proteins regulated by both hormones. Rats were adrenalectomized, thyroidectomized, or both, and were subsequently treated for 6 weeks with hydrocortisone, triiodothyronine, or saline. Sham-operated rats were given saline for the same period of time. Six weeks of adrenal insufficiency resulted in diminished enzymatic activity of myofibrillar, Ca(2+)-activated myosin ATPase, and actin-activated myosin ATPase fractions. Treatment with hydrocortisone prevented the decline in enzymatic activity due to adrenalectomy. Likewise, thyroidectomy caused a loss of enzymatic activity which was prevented by treatment with triiodothyronine. The full deleterious effect of combined ablation could be partially prevented by treatment with either hydrocortisone or triiodothyronine, but the latter was most effective. The results suggest that hydrocortisone and triiodothyronine each had significant positive effects in the presence of the other, but not in its absence, on the activity of myofibrillar Ca(2+)-dependent Mg-ATPase and Ca(2+)-activated myosin ATPase. The effects of these two hormones on actin-activated myosin ATPase activity were more independent of each other. We conclude that the actions of thyroid and glucocorticoid hormones on the heart are interrelated and that optimum myocardial function results from their combined action.

Effects of riboflavin analogues and diuretics on the spontaneously hypertensive rat heart

The chronic treatment of spontaneously hypertensive rats (SHR) with 7,8-dimethyl-10-(3-chlorobenzyl) isoalloxazine [CBI], 7,8-diethyl-10-aminol isoalloxazine [DEAI], enduron (methyclothiazide) and amiloride were studied for their effects on blood pressure and cardiac contractile protein ATPase activities. After 35 weeks of treatment all the above antihypertensive agents showed a decrease in blood pressure in the SHR (p less than 0.01). Chronic treatment with CBI, DEAI, enduron, and amiloride significantly improved the myofibrillar ATPase activity at all pCa2+ concentrations (p less than 0.01). Furthermore, CBI, DEAI, enduron, and amiloride drug treatments enhanced actin-activated myosin ATPase activity (p less than 0.01). The Ca2(+)-activated myosin ATPase activity was significantly elevated after treating with CBI and DEAI (p less than 0.01). These results suggest that the antihypertensive agents used in this study helped in reducing the blood pressure with a subsequent increase in myocardial contractile protein ATPase activity.

Changes in myocardial contractile protein ATPases in chronically adrenalectomized rats with and without glucocorticoid replacement

Studies were conducted to examine the effects of chronic adrenalectomy (Adx) and adrenalectomy plus glucocorticoid replacement therapy on rat cardiac contractile protein ATPase activities. The Ca2+-dependent Mg-ATPase activity of myofibrils isolated from rat ventricles 3 weeks postadrenalectomy (Adx) was significantly decreased at all pCa2+ concentrations (P less than 0.01), compared to sham-operated (SO) rats. Similarly, Ca2+-, K+-EDTA, and actin-activated myosin ATPase activities of Adx rat hearts were markedly decreased below that of SO rats (P less than 0.01). Dexamethasone administration to Adx rats prevented the decrease of Ca2+- and K+-ATPase activities of myosin, but not of myofibrillar Ca2+-dependent Mg-ATPase or actin-activated myosin Mg-ATPase activities. These studies suggest that glucocorticoid insufficiency induced by adrenalectomy results in altered myocardial contractile protein ATPase activity which may underlie impaired cardiac performance.

Hormonal influences on cardiac myosin ATPase activity and myosin isoenzyme distribution

It has been recognized for a long time that changes in hormone secretion can influence cardiac function; however, the biochemical basis for these changes has only recently been clarified. In this review the influences of hormonal status on the contractile protein myosin is discussed. Myosin has a rod-like portion and a globular head and consists of two myosin heavy chains (MHC) and four light chains (LC), two of which are identical. The globular head is the site of an ATP-splitting enzyme, the myosin ATPase, and increases in myosin ATPase activity are closely related to an increased velocity of contraction of the heart. Myosin ATPase activity shows marked response to alterations in thyroid hormone, insulin, glucocorticoid, testosterone and catecholamine levels, but marked animal species differences in this response occur. Thyroid hormone administration to normal rabbits, for example, increases myosin ATPase activity markedly, but the myosin ATPase activity of hyperthyroid rats remains unchanged. In contrast, in hypothyroid rats myosin ATPase activity is markedly decreased but the hypothyroid rabbit shows no such response. These species-related differences in the hormonal response of myosin ATPase activity result from the predominance pattern of specific myosin isoenzymes. In the normal rat heart three myosin isoenzymes, V1, V2 and V3, can be separated electrophoretically. Myosin V1 predominates (70% of total myosin), and has the highest myosin ATPase activity, whereas in rabbits myosin V3, which has a lower myosin ATPase activity, is the predominant isomyosin. Thyroid hormone administration to rabbits induces myosin V1 predominance and therefore increases myosin ATPase activity, whereas in hyperthyroid rats only a small further increase in V1 predominance can occur. The alterations in myosin isoenzyme predominance and myosin ATPase activity are closely correlated to changes in cardiac contractility. Hormone-induced alterations in myosin isoenzyme predominance are mediated through changes in the formation of two isoforms of myosin heavy chain. Changes in the expression of different myosin heavy chain genes are most likely responsible for the thyroid hormone and insulin-induced alterations in myosin isoenzyme predominance. Investigation of the control of myosin heavy chain formation can provide further insights into the hormonal control of a multigene family as well as broaden our understanding of the molecular events which result in altered cardiac contractility.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of thyroid deficiency and sympathectomy on cardiac enzymes

The effects of thyroid deficiency (Td) and of chemical sympathectomy (Sx) were studied on marker enzymes of energy metabolism in cardiac muscle of neonatal and of adult rats. Td prevented the normal development of neonatal body weight, relative heart mass, and cardiac levels of cytochrome c (-22%), citrate synthase (-27%), phosphofructokinase (-20%) and Mg2+- and Ca2+-ATPase activity of purified myofibrils (-33%, -44%). Exogenous thyroxin replacement restored those parameters studied to normal with the exception that it persistently elevated citrate synthase activity significantly above normal control levels. Responses similar to those of Td neonates occurred when adult rats were similarly treated. Sx produced no consistent effects on respiratory and glycogenolytic marker enzymes, but caused a 20% reduction in Ca2+-ATPase activity of both neonatal and adult cardiac myofibrils. These findings suggest that cardiac muscle cells require thyroxin for normal growth and enzyme development. Also, Sx may impair cardiac functional capacity by altering Ca2+ activity of actomyosin ATPase.

Heart contractile proteins

That several proteins of the sarcomere differ from one muscle to the next is well documented, and it is becoming evident that homogeneous muscles, like the heart, are also species specific. 1) Clear-cut evidence is available concerning myosin, and, to date, several types of molecules have been described. a) The myosins of white skeletal, heart, and smooth muscle differ in the activity of their Ca2+ and K+ATPases, as also in the structure of their light subunits. b) The Ca2+ATPases of the various cardiac myosins have been shown to exhibit species differences and correlate with the speed of shortening of the muscle. 2) The structures of tropomyosin, some troponin components, and alpha actinin (but not actin) appear to be unlike in the different types of muscle. 3) These phylogenic modifications may be related to the changes characteristic of the particular muscles under pathological conditions, which are accompanied by substantial increase in protein synthesis.

Rate of uptake of endogenous cortisol by the left ventricle of the anaesthetized dog during ventilation with ambient air and during hypoxia

1. The rate of uptake of endogenous cortisol by the left ventricle was determined in eight dogs as the product of the left ventricular myocardial plasma flow and the coronary arteriovenous difference in plasma cortisol concentration. The arteriovenous difference in hormone concentration in resting skeletal muscle (M. gracilis) was also measured. The values given are means +/- S.E.2. During ventilation with ambient air (arterial P(O2): 85 +/- 2 mm Hg), the rate of cortisol uptake by the left ventricle averaged 382 +/- 92 ng/100 g.min. The arteriovenous difference in hormone concentration in the vessels of the M. gracilis was more than twice that in the coronary vessels. Assuming a value of 3-4 ml./100 g.min for the blood flow in this muscle, the corresponding rate of cortisol uptake would be in the range of 25-33 ng/100 g.min.3. During hypoxia (arterial P(O2): 35 +/- 1 mm Hg), the rate of cortisol uptake by the left ventricle was not significant, averaging 26 +/- 113 ng/100 g.min. By contrast, the skeletal muscle still extracted significant amounts of cortisol from the plasma. It is inferred that the suppression of a significant uptake of the hormone by the left ventricle was related, at least in part, to the changes in the mechanical and associated metabolic activity of the heart muscle elicited by the lowering of the arterial P(O2).4. Hypoxia depressed the net uptake of cortisol by the left ventricle rather than the uptake mechanism itself. Indeed, bi-directional movements of cortisol between the plasma and the heart muscle, with rates of release up to 1150 ng/100 g.min, were observed.

Hormonal control of cardiac myosin adenosine triphosphatase in the rat

Cardiac function was impaired in hearts from hypophysectomized rats. Corresponding to the decrease in performance, myosin from the hearts of these rats exhibited a decreased Ca 2+ -activated ATPase activity. Myosin ATPase activated by K + or NH 4 + was not different in any of the preparations studied. The decreased Ca 2+ -activated ATPase was observed in cardiac myosin but not in red or white skeletal muscle myosin. Treatment with thyroxine, but not with growth hormone, restored cardiac myosin ATPase and performance to normal. Hypothyroidism produced a decrease in cardiac myosin ATPase activity comparable to that seen after hypophysectomy, suggesting that the absence of thyroid hormone was responsible for the alterations. However, hyperthyroidism did not increase ATPase activity above normal values. Adrenalectomy failed to alter myosin ATPase. Anion exchange chromatography of the myosins and addition of various concentrations of Na + , Ca 2+ , and Mg 2+ did not abolish the differences in myosin ATPase. The results strongly suggest that the lower myosin ATPase activity in the absence of thyroid hormone was the result of a change in the myosin molecule per se and that the lower enzymatic activity was involved in the lower cardiac performance in these rats.