Cardiac toxicity of resibufogenin: electrophysiological evidence

Resibufogenin (RBG) is a single compound isolated from Chansu, a traditional Chinese medicine obtained from the skin venom gland of the toad. Formulations of Chansu have been widely applied in China, Japan, and other Asian countries for a long time and are currently used as alternative medicines. However, there have been several reports about the toxicity of Chansu and its medical formulations in the United States recently. As digitalis, RBG possesses both pharmacologic and toxicologic effects. According to our study results, RBG, one of major ingredient of Chansu, induced delayed afterdepolarization and triggered arrhythmias both in cardiac fiber in vitro and in beating heart in vivo at the high concentrations. The electrophysiologic toxic effects of RBG, the possible mechanism of toxicity, and treatment possibilities are discussed in the present review

Extracellular detection of delayed afterdepolarization of cardiac fibers using signal averaging technique

AIM

To detect delayed after depolarizations (DAD) in extracellular electrograms using signal averaging technique.

METHODS

DAD were induced by acetylstrophanthidin (0.25 mumol.L-1, n = 9) and resibufogenin (0.52 mumol.L-1, n = 5) in sheep cardiac Purkinje fibers. Intracellular voltage was recorded with a conventional microelectrode, and simultaneous extracellular electrograms were recorded differentially from widely spaced electrodes placed in the tissue bath. Noise of electrograms was reduced using signal averaging technique.

RESULTS

Acetylstrophanthidin and resibufogenin both induced DAD in the intracellular recording and extracellular DAD (DAD-E) in the extracellular electrogram in sheep heart Purkinje fibers. Acetylstrophanthidin and resibufogenin induced typical changes in the action potential including decrease in action potential amplitude, resting potential, maximum diastolic potential, and action potential duration. Similar shortening occurred in the "Q-T interval" recorded by the extracellular electrogram. With either acetylstrophanthidin or resibufogenin, shortening of stimulation cycle length from 990 ms to 690 ms reduced the coupling interval between action potential upstroke and peak voltage of the DAD (P < 0.01), and the coupling interval between the "QRS" and DAD-E recorded extracellularly (P < 0.01).

CONCLUSION

DAD can be detected using the extracellular electrograms combined with the high resolution, signal averaging technique.

Panax quinquefolium L. inhibits thrombin-induced endothelin release in vitro

Endothelial cell damage is considered to be the initial step in the genesis of thrombosis and arteriosclerosis, the common precursors of cardiovascular disorders. In this study, we evaluated the protective effects of American ginseng or Panax quinquefolium L. extracts on endothelial cell injury, and investigated effects of ginseng extracts on thrombin-induced endothelin release using cultured human umbilical vein endothelial cells. We observed that when endothelial cells pretreated with 1, 10, and 100 micrograms/ml of Panax quinquefolium L. extracts were incubated for 4 and 24 hr with thrombin, the concentration of endothelin was significantly decreased in a concentration dependent, time related manner (at 4 hr, IC50 = 5.1 micrograms/ml; at 24 hr, IC50 = 6.2 micrograms/ml). We further evaluated the effects of NG-nitro-L-arginine (NLA), a nitric oxide (NO) synthetase inhibitor, on the activity of Panax quinquefolium L. extracts. Following pretreatment of cultured endothelial cells with NLA, the inhibition of thrombin-induced endothelin release by Panax quinquefolium L. was significantly reduced (P < 0.05). This result suggests that the pharmacological action of Panax quinquefolium L. is, at least partially, due to NO release. Our data demonstrate that American ginseng may play a therapeutic role in facilitating the hemodynamic balance of vascular endothelial cells.

Dose-related effects of oral acetaminophen on cold-induced pain: a double-blind, randomized, placebo-controlled trial

The cold-pressor test is a widely used pain-induction model in humans. This method has been shown to be a sensitive measure for detecting opioid analgesia. However, nonsteroidal anti-inflammatory drugs have not produced consistent analgesic effects with use of this model. The analgesic effect of acetaminophen (INN, paracetamol) on cold pressor-induced pain has not been reported by other investigators. In this study, a double-blind, randomized, placebo-controlled design was used to evaluate the dose-related effects of oral acetaminophen on cold pressor-induced pain in 18 normal healthy human subjects. We observed dose-related analgesic activity of oral acetaminophen using the cold pressor-induced pain model in these subjects. There were statistically significant main effects of both dose and time (pain and bothersomeness ratings decreased with increasing drug dose and increased over time). In pairwise comparisons only the contrast between the highest dose of acetaminophen (1000 mg) and placebo reached statistical significance. Results from our study suggest that the cold-pressor method may have clinical value in evaluating nonopioid analgesic agents.

Gastric and brain stem, effects of substance P on nucleus tractus solitarius unitary responses

Subdiaphragmatic vagally evoked unitary responses were recorded in the medial subnucleus of the nucleus tractus solitarius in an in vitro neonatal rat brain stem-gastric preparation. Substance P was applied to the gastric compartment and/or the brain stem compartment of the bath chamber to evaluate the peripheral gastric and central brain stem effects of the peptide on the nucleus tractus solitarius unitary activity. After substance P application to the gastric or brain stem compartment, a concentration-related change in the nucleus tractus solitarius unitary activity was observed. The gastric effects of substance P, at a concentration of 30 nM (minimum concentration for maximum effect), produced a 31 +/- 6.5% (mean +/- SD) increase in neuronal discharge frequency compared to the control recording. Both the proximal and the distal stomach were important in the gastric effect of the peptide on subdiaphragmatic vagally evoked nucleus tractus solitarius unitary responses. The brain stem effects of substance P. at a concentration of 10 nM (minimum concentration for maximum effect), induced a 52 +/- 11.3% increase in discharge frequency. Application of the peptide into both the gastric and brain stem compartments resulted in a subadditive response of 73 +/- 5.9%. This suggest that, peripherally and centrally, there are two different mechanisms of substance P activation. Our results suggest that substance P may play a role in regulating the ingestive process in neonates.