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Kiss D, Horváth B, Hézső T, Dienes C, Kovács Z, Topal L, Szentandrássy N, Almássy J, Prorok J, Virág L, Bányász T, Varró A, Nánási PP, Magyar J. Late Na + Current Is [Ca 2+] i-Dependent in Canine Ventricular Myocytes. Pharmaceuticals (Basel) 2021; 14:ph14111142. [PMID: 34832924 PMCID: PMC8623624 DOI: 10.3390/ph14111142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Enhancement of the late sodium current (INaL) increases arrhythmia propensity in the heart, whereas suppression of the current is antiarrhythmic. In the present study, we investigated INaL in canine ventricular cardiomyocytes under action potential voltage-clamp conditions using the selective Na+ channel inhibitors GS967 and tetrodotoxin. Both 1 µM GS967 and 10 µM tetrodotoxin dissected largely similar inward currents. The amplitude and integral of the GS967-sensitive current was significantly smaller after the reduction of intracellular Ca2+ concentration ([Ca2+]i) either by superfusion of the cells with 1 µM nisoldipine or by intracellular application of 10 mM BAPTA. Inhibiting calcium/calmodulin-dependent protein kinase II (CaMKII) by KN-93 or the autocamtide-2-related inhibitor peptide similarly reduced the amplitude and integral of INaL. Action potential duration was shortened in a reverse rate-dependent manner and the plateau potential was depressed by GS967. This GS967-induced depression of plateau was reduced by pretreatment of the cells with BAPTA-AM. We conclude that (1) INaL depends on the magnitude of [Ca2+]i in canine ventricular cells, (2) this [Ca2+]i-dependence of INaL is mediated by the Ca2+-dependent activation of CaMKII, and (3) INaL is augmented by the baseline CaMKII activity.
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Affiliation(s)
- Dénes Kiss
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
| | - Balázs Horváth
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
- Faculty of Pharmacy, University of Debrecen, 4032 Debrecen, Hungary
| | - Tamás Hézső
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
| | - Csaba Dienes
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
| | - Zsigmond Kovács
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
| | - Leila Topal
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary; (L.T.); (J.P.); (L.V.); (A.V.)
| | - Norbert Szentandrássy
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
- Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, 4032 Debrecen, Hungary
| | - János Almássy
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
| | - János Prorok
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary; (L.T.); (J.P.); (L.V.); (A.V.)
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, 6725 Szeged, Hungary
| | - László Virág
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary; (L.T.); (J.P.); (L.V.); (A.V.)
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, 6725 Szeged, Hungary
| | - Tamás Bányász
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary; (L.T.); (J.P.); (L.V.); (A.V.)
- ELKH-SZTE Research Group for Cardiovascular Pharmacology, Eötvös Loránd Research Network, 6725 Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, 6725 Szeged, Hungary
| | - Péter P. Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
- Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, 4032 Debrecen, Hungary
- Correspondence: ; Tel.: +36-52255575; Fax: +36-52255116
| | - János Magyar
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (D.K.); (B.H.); (T.H.); (C.D.); (Z.K.); (N.S.); (J.A.); (T.B.); (J.M.)
- Division of Sport Physiology, Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
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Dienes C, Hézső T, Kiss DZ, Baranyai D, Kovács ZM, Szabó L, Magyar J, Bányász T, Nánási PP, Horváth B, Gönczi M, Szentandrássy N. Electrophysiological Effects of the Transient Receptor Potential Melastatin 4 Channel Inhibitor (4-Chloro-2-(2-chlorophenoxy)acetamido) Benzoic Acid (CBA) in Canine Left Ventricular Cardiomyocytes. Int J Mol Sci 2021; 22:ijms22179499. [PMID: 34502410 PMCID: PMC8430982 DOI: 10.3390/ijms22179499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/23/2021] [Accepted: 08/27/2021] [Indexed: 01/16/2023] Open
Abstract
Transient receptor potential melastatin 4 (TRPM4) plays an important role in many tissues, including pacemaker and conductive tissues of the heart, but much less is known about its electrophysiological role in ventricular myocytes. Our earlier results showed the lack of selectivity of 9-phenanthrol, so CBA ((4-chloro-2-(2-chlorophenoxy)acetamido) benzoic acid) was chosen as a new, potentially selective inhibitor. Goal: Our aim was to elucidate the effect and selectivity of CBA in canine left ventricular cardiomyocytes and to study the expression of TRPM4 in the canine heart. Experiments were carried out in enzymatically isolated canine left ventricular cardiomyocytes. Ionic currents were recorded with an action potential (AP) voltage-clamp technique in whole-cell configuration at 37 °C. An amount of 10 mM BAPTA was used in the pipette solution to exclude the potential activation of TRPM4 channels. AP was recorded with conventional sharp microelectrodes. CBA was used in 10 µM concentrations. Expression of TRPM4 protein in the heart was studied by Western blot. TRPM4 protein was expressed in the wall of all four chambers of the canine heart as well as in samples prepared from isolated left ventricular cells. CBA induced an approximately 9% reduction in AP duration measured at 75% and 90% of repolarization and decreased the short-term variability of APD90. Moreover, AP amplitude was increased and the maximal rates of phase 0 and 1 were reduced by the drug. In AP clamp measurements, CBA-sensitive current contained a short, early outward and mainly a long, inward current. Transient outward potassium current (Ito) and late sodium current (INa,L) were reduced by approximately 20% and 47%, respectively, in the presence of CBA, while L-type calcium and inward rectifier potassium currents were not affected. These effects of CBA were largely reversible upon washout. Based on our results, the CBA induced reduction of phase-1 slope and the slight increase of AP amplitude could have been due to the inhibition of Ito. The tendency for AP shortening can be explained by the inhibition of inward currents seen in AP-clamp recordings during the plateau phase. This inward current reduced by CBA is possibly INa,L, therefore, CBA is not entirely selective for TRPM4 channels. As a consequence, similarly to 9-phenanthrol, it cannot be used to test the contribution of TRPM4 channels to cardiac electrophysiology in ventricular cells, or at least caution must be applied.
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Affiliation(s)
- Csaba Dienes
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Tamás Hézső
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Dénes Zsolt Kiss
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Dóra Baranyai
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Zsigmond Máté Kovács
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - László Szabó
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Doctoral School of Molecular Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - János Magyar
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Division of Sport Physiology, Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Tamás Bányász
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
| | - Péter P. Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, 4032 Debrecen, Hungary
| | - Balázs Horváth
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Faculty of Pharmacy, University of Debrecen, 4032 Debrecen, Hungary
| | - Mónika Gönczi
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
| | - Norbert Szentandrássy
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (C.D.); (T.H.); (D.Z.K.); (D.B.); (Z.M.K.); (L.S.); (J.M.); (T.B.); (P.P.N.); (B.H.); (M.G.)
- Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, 4032 Debrecen, Hungary
- Correspondence: ; Tel.: +36-52255575; Fax: +36-52255116
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Nánási PP, Horváth B, Tar F, Almássy J, Szentandrássy N, Jost N, Baczkó I, Bányász T, Varró A. Canine Myocytes Represent a Good Model for Human Ventricular Cells Regarding Their Electrophysiological Properties. Pharmaceuticals (Basel) 2021; 14:748. [PMID: 34451845 DOI: 10.3390/ph14080748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022] Open
Abstract
Due to the limited availability of healthy human ventricular tissues, the most suitable animal model has to be applied for electrophysiological and pharmacological studies. This can be best identified by studying the properties of ion currents shaping the action potential in the frequently used laboratory animals, such as dogs, rabbits, guinea pigs, or rats, and comparing them to those of human cardiomyocytes. The authors of this article with the experience of three decades of electrophysiological studies, performed in mammalian and human ventricular tissues and isolated cardiomyocytes, summarize their results obtained regarding the major canine and human cardiac ion currents. Accordingly, L-type Ca2+ current (ICa), late Na+ current (INa-late), rapid and slow components of the delayed rectifier K+ current (IKr and IKs, respectively), inward rectifier K+ current (IK1), transient outward K+ current (Ito1), and Na+/Ca2+ exchange current (INCX) were characterized and compared. Importantly, many of these measurements were performed using the action potential voltage clamp technique allowing for visualization of the actual current profiles flowing during the ventricular action potential. Densities and shapes of these ion currents, as well as the action potential configuration, were similar in human and canine ventricular cells, except for the density of IK1 and the recovery kinetics of Ito. IK1 displayed a largely four-fold larger density in canine than human myocytes, and Ito recovery from inactivation displayed a somewhat different time course in the two species. On the basis of these results, it is concluded that canine ventricular cells represent a reasonably good model for human myocytes for electrophysiological studies, however, it must be borne in mind that due to their stronger IK1, the repolarization reserve is more pronounced in canine cells, and moderate differences in the frequency-dependent repolarization patterns can also be anticipated.
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Veress R, Baranyai D, Hegyi B, Kistamás K, Dienes C, Magyar J, Bányász T, Nánási PP, Szentandrássy N, Horváth B. Transient receptor potential melastatin 4 channel inhibitor 9-phenanthrol inhibits K + but not Ca 2+ currents in canine ventricular myocytes. Can J Physiol Pharmacol 2018; 96:1022-1029. [PMID: 29806985 DOI: 10.1139/cjpp-2018-0049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The role of transient receptor potential melastatin 4 (TRPM4) channels has been frequently tested using their inhibitor 9-phenanthrol in various cardiac preparations; however, the selectivity of the compound is uncertain. Therefore, in the present study, the concentration-dependent effects of 9-phenanthrol on major ionic currents were studied in canine isolated ventricular cells using whole-cell configuration of the patch-clamp technique and 10 mM BAPTA-containing pipette solution to prevent the Ca2+-dependent activation of TRPM4 channels. Transient outward (Ito1), rapid delayed rectifier (IKr), and inward rectifier (IK1) K+ currents were suppressed by 10 and 30 μM 9-phenanthrol with the blocking potency for IK1 < IKr < Ito1 and partial reversibility. L-type Ca2+ current was not affected up to the concentration of 30 μM. In addition, a steady outward current was detected at voltages positive to -40 mV in 9-phenanthrol, which was larger at more positive voltages and larger 9-phenanthrol concentrations. Action potentials were recorded using microelectrodes. Maximal rate of depolarization, phase-1 repolarization, and terminal repolarization were decreased and the plateau potential was depressed by 9-phenanthrol (3-30 μM), congruently with the observed alterations of ionic currents. Significant action potential prolongation was observed by 9-phenanthrol in the majority of the studied cells, but only at 30 μM concentration. In conclusion, 9-phenanthrol is not selective to TRPM4 channels in canine ventricular myocardium; therefore, its application as a TRPM4 blocker can be appropriate only in expression systems but not in native cardiac cells.
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Affiliation(s)
- Roland Veress
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Baranyai
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Bence Hegyi
- b Department of Pharmacology, University of California at Davis, Davis, CA 95616, USA
| | - Kornél Kistamás
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csaba Dienes
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Magyar
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,c Division of Sport Physiology, Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Bányász
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,d Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Norbert Szentandrássy
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,d Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Balázs Horváth
- a Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,e Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
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Horváth B, Hegyi B, Kistamás K, Váczi K, Bányász T, Magyar J, Szentandrássy N, Nánási PP. Cytosolic calcium changes affect the incidence of early afterdepolarizations in canine ventricular myocytes. Can J Physiol Pharmacol 2015; 93:527-34. [PMID: 25928391 DOI: 10.1139/cjpp-2014-0511] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study was designed to investigate the influence of cytosolic Ca(2+) levels ([Ca(2+)]i) on action potential duration (APD) and on the incidence of early afterdepolarizations (EADs) in canine ventricular cardiomyocytes. Action potentials (AP) of isolated cells were recorded using conventional sharp microelectrodes, and the concomitant [Ca(2+)]i was monitored with the fluorescent dye Fura-2. EADs were evoked at a 0.2 Hz pacing rate by inhibiting the rapid delayed rectifier K(+) current with dofetilide, by activating the late sodium current with veratridine, or by activating the L-type calcium current with BAY K8644. These interventions progressively prolonged the AP and resulted in initiation of EADs. Reducing [Ca(2+)]i by application of the cell-permeant Ca(2+) chelator BAPTA-AM lengthened the AP at 1.0 Hz if it was applied alone, in the presence of veratridine, or in the presence of BAY K8644. However, BAPTA-AM shortened the AP if the cells were pretreated with dofetilide. The incidence of the evoked EADs was strongly reduced by BAPTA-AM in dofetilide, moderately reduced in veratridine, whereas EAD incidence was increased by BAPTA-AM in the presence of BAY K8644. Based on these experimental data, changes in [Ca(2+)]i have marked effects on APD as well as on the incidence of EADs; however, the underlying mechanisms may be different, depending on the mechanism of EAD generation. As a consequence, reduction of [Ca(2+)]i may eliminate EADs under some, but not all, experimental conditions.
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Affiliation(s)
- Balázs Horváth
- a Department of Physiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Nagyerdei krt 98, Hungary.,b Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Bence Hegyi
- a Department of Physiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Nagyerdei krt 98, Hungary
| | - Kornél Kistamás
- a Department of Physiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Nagyerdei krt 98, Hungary
| | - Krisztina Váczi
- a Department of Physiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Nagyerdei krt 98, Hungary
| | - Tamás Bányász
- a Department of Physiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Nagyerdei krt 98, Hungary
| | - János Magyar
- a Department of Physiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Nagyerdei krt 98, Hungary.,c Division of Sport Physiology, Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Norbert Szentandrássy
- a Department of Physiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Nagyerdei krt 98, Hungary.,d Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, Hungary
| | - Péter P Nánási
- a Department of Physiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Nagyerdei krt 98, Hungary.,d Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, Hungary
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