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Ma YL, Hu RM, Yang X, Wang T, Noble PJ, Wilkins R, Ellory C, Carr C, Noble D, Yang J, Lu W, Zhang J, Hu H, Guo X, Chen M, Wu Y, Wei M, Mao J, Ma X, Qin L, Wu H, Lu F, Cao Y, Gao S, Gu W. Investigation of the Cellular Pharmacological Mechanism and Clinical Evidence of the Multi-Herbal Antiarrhythmic Chinese Medicine Xin Su Ning. Front Pharmacol 2020; 11:600. [PMID: 32435196 PMCID: PMC7218142 DOI: 10.3389/fphar.2020.00600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/17/2020] [Indexed: 02/05/2023] Open
Abstract
Xin Su Ning (XSN), a China patented and certified multi-herbal medicine, has been available in China since 2005 for treating cardiac ventricular arrhythmia including arrhythmia induced by ischemic heart diseases and viral myocarditis, without adverse reactions being reported. It is vitally important to discover pharmacologically how XSN as a multicomponent medicine exerts its clinical efficacy, and whether the therapeutic effect of XSN can be verified by standard clinical trial studies. In this paper we report our discoveries in a cellular electrophysiological study and in a three-armed, randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. Conventional electrophysiological techniques were used to study the cellular antiarrhythmic mechanism of XSN. Data was then modeled with computational simulation of human action potential (AP) of the cardiac ventricular myocytes. The clinical trial was conducted with a total of 861 eligible participants randomly assigned in a ratio of 2:2:1 to receive XSN, mexiletine, or the placebo for 4 weeks. The primary and secondary endpoint was the change of premature ventricular contraction (PVC) counts and PVC-related symptoms, respectively. This trial was registered in the Chinese Clinical Trial Register Center (ChiCTR-TRC-14004180). We found that XSN prolonged AP duration of the ventricular myocytes in a dose-dependent, reversible manner and blocked potassium channels. Patients in XSN group exhibited significant total effective responses in the reduction of PVCs compared to those in the placebo group (65.85% vs. 27.27%, P < 0.0001). No severe adverse effects attributable to XSN were observed. In conclusion, XSN is an effective multicomponent antiarrhythmic medicine to treat PVC without adverse effect in patients, which is convincingly supported by its class I & III pharmacological antiarrhythmic mechanism of blocking hERG potassium channels and hNaV1.5 sodium channel reported in our earlier publication and prolongs AP duration both in ventricular myocytes and with computational simulation of human AP presented in this report.
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Affiliation(s)
- Yu-Ling Ma
- Oxford Chinese Medicine Research Centre & Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Rou-Mu Hu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinchun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Taiyi Wang
- Oxford Chinese Medicine Research Centre & Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Penelope J Noble
- Oxford Chinese Medicine Research Centre & Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Robert Wilkins
- Oxford Chinese Medicine Research Centre & Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Clive Ellory
- Oxford Chinese Medicine Research Centre & Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Carolyn Carr
- Oxford Chinese Medicine Research Centre & Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Denis Noble
- Oxford Chinese Medicine Research Centre & Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Weixing Lu
- Department of Cardiology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Junhua Zhang
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongde Hu
- Department of Cardiovascular Diseases, West China Hospital, School of Clinic Medicine, Sichuan University, Chengdu, China
| | - Xiaomei Guo
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Chen
- Geriatrics Department, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Yang Wu
- Clinical Departments of Cardiology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Meng Wei
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jingyuan Mao
- Department of Cardiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaochang Ma
- Department of Cardiology, Xiyuan Hospital CACMS, Beijing, China
| | - Ling Qin
- Department of Cardiology, the First Hospital of Jilin University, Changchun, China
| | - Huanlin Wu
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Feng Lu
- Department of Cardiology, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ying Cao
- Department of Cardiology, Hengyang Hospital of Traditional Chinese Medicine, Hengyang, China
| | - Sheng Gao
- Department of Cardiology, Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China
| | - Wanli Gu
- Department of Traditional Chinese Medicine, Liaocheng People's Hospital, Liaocheng, China
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Hamon D, Rajendran PS, Chui RW, Ajijola OA, Irie T, Talebi R, Salavatian S, Vaseghi M, Bradfield JS, Armour JA, Ardell JL, Shivkumar K. Premature Ventricular Contraction Coupling Interval Variability Destabilizes Cardiac Neuronal and Electrophysiological Control: Insights From Simultaneous Cardioneural Mapping. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004937. [PMID: 28408652 DOI: 10.1161/circep.116.004937] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Variability in premature ventricular contraction (PVC) coupling interval (CI) increases the risk of cardiomyopathy and sudden death. The autonomic nervous system regulates cardiac electrical and mechanical indices, and its dysregulation plays an important role in cardiac disease pathogenesis. The impact of PVCs on the intrinsic cardiac nervous system, a neural network on the heart, remains unknown. The objective was to determine the effect of PVCs and CI on intrinsic cardiac nervous system function in generating cardiac neuronal and electric instability using a novel cardioneural mapping approach. METHODS AND RESULTS In a porcine model (n=8), neuronal activity was recorded from a ventricular ganglion using a microelectrode array, and cardiac electrophysiological mapping was performed. Neurons were functionally classified based on their response to afferent and efferent cardiovascular stimuli, with neurons that responded to both defined as convergent (local reflex processors). Dynamic changes in neuronal activity were then evaluated in response to right ventricular outflow tract PVCs with fixed short, fixed long, and variable CI. PVC delivery elicited a greater neuronal response than all other stimuli (P<0.001). Compared with fixed short and long CI, PVCs with variable CI had a greater impact on neuronal response (P<0.05 versus short CI), particularly on convergent neurons (P<0.05), as well as neurons receiving sympathetic (P<0.05) and parasympathetic input (P<0.05). The greatest cardiac electric instability was also observed after variable (short) CI PVCs. CONCLUSIONS Variable CI PVCs affect critical populations of intrinsic cardiac nervous system neurons and alter cardiac repolarization. These changes may be critical for arrhythmogenesis and remodeling, leading to cardiomyopathy.
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Affiliation(s)
- David Hamon
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Pradeep S Rajendran
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Ray W Chui
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Olujimi A Ajijola
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Tadanobu Irie
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Ramin Talebi
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Siamak Salavatian
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Marmar Vaseghi
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Jason S Bradfield
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - J Andrew Armour
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Jeffrey L Ardell
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles
| | - Kalyanam Shivkumar
- From the Cardiac Arrhythmia Center (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.S.B., J.A.A., J.L.A., K.S.), Neurocardiology Research Center of Excellence (D.H., P.S.R., R.W.C., O.A.A., T.I., R.T., S.S., M.V., J.A.A., J.L.A., K.S.), and Molecular, Cellular & Integrative Physiology Program (P.S.R., R.W.C., M.V., J.L.A., K.S.), David Geffen School of Medicine, University of California-Los Angeles.
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