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Schiffner E, Hilsmann F, Lakomek F, Beyersdorf C, Windolf J, Latz D. Degenerative changes of the wrist in mixed martial arts and boxing based on the three column theory. PHYSICIAN SPORTSMED 2024:1-5. [PMID: 38700558 DOI: 10.1080/00913847.2024.2351357] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Mixed Martial Arts (MMA) is a relatively young combat sport. In contrast to classic boxing, MMA combines techniques of grappling and striking. However, characteristic long-term effects of MMA on the wrist are discussed controversially. Aim of this study was to elucidate characteristic degenerative changes of the wrist from MMA fighters in comparison to classic boxers. METHODS In this study, eleven professional MMA fighters and ten professional boxers with chronic wrist pain were examined and compared. Age, weight, number of fights and weekly hours of training were recorded. Wrist and hand of each fighter were examined using a 3T-MR scanner. Degenerations of the radial, central and ulnar column were analyzed according to Navarro's three-column theory and degenerative changes were categorized based on the classification of Fredericson. RESULTS There was no significant difference of age, weight and number of fights between MMA fighters and boxers (p > 0.15). However, MMA fighters practiced significantly more hours per week (19.5 (MMA) vs. 8.5 (boxing) hours/week, p < 0.001). No significant associations were found between different training times per Week in terms of degenerative changes of the wrist in MMA and boxing based on the three column theory. The comparison of degenerative changes in the columns between MMA and boxing showed no significant differences. The MRI showed a significantly higher degeneration in the radial column compared to the central column among MMA fighters for ligaments (p = 0.01) and bones (p = 0.03). CONCLUSION Due to different fighting techniques, different physical traumas, including falls, pattern of degenerations of the wrist between MMA fighters and boxers are different. MMA fighters suffer of a highly degenerative radial column and boxers suffer of a homogeneous degeneration of all three columns.
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Affiliation(s)
- Erik Schiffner
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Falk Hilsmann
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Lakomek
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christoph Beyersdorf
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Joachim Windolf
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - David Latz
- Department for Orthopedics and Trauma Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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2
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Jaekel C, Windolf CD, Bieler D, Oezel L, Seiler LF, Lakomek FN, Beyersdorf C, Mertens J, Steuwe A, Windolf J, Grassmann JP. Efficacy of lysostaphin-coated titanium plates on implant-associated MRSA osteitis in minipigs. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02448-4. [PMID: 38265442 DOI: 10.1007/s00068-024-02448-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The growing incidence of implant-associated infections (IAIs) caused by biofilm-forming Staphylococcus aureus in combination with an increasing resistance to antibiotics requires new therapeutic strategies. Lysostaphin has been shown to eliminate this biofilm. Own studies confirm the effectiveness in a murine model. The current study characterizes the effects of lysostaphin-coated plates in an IAI minipig model. METHODS The femur of 30 minipigs was stabilized with a five-hole plate, a bone defect was created, and in 20 cases methicillin-resistant Staphylococcus aureus was applied. Ten animals served as control group. After 14 days, local debridement, lavage, and plate exchange (seven-hole plate) were performed. Ten of the infected minipigs received an uncoated plate and 10 a lysostaphin-coated plate. On day 84, the minipigs were again lavaged, followed by euthanasia. Bacterial load was quantified by colony-forming units (CFU). Immunological response was determined by neutrophils, as well as interleukins. Fracture healing was assessed radiologically. RESULTS CFU showed significant difference between infected minipigs with an uncoated plate and minipigs with a lysostaphin-coated plate (p = 0.0411). The infection-related excessive callus formation and calcification was significantly greater in the infected animals with an uncoated plate than in animals with a lysostaphin-coated plate (p = 0.0164/p = 0.0033). The analysis of polymorphonuclear neutrophils and interleukins did not reveal any pioneering findings. CONCLUSION This study confirms the minipig model for examining IAI. Furthermore, coating of plates using lysostaphin could be a promising tool in the therapeutic strategies of IAI. Future studies should focus on coating technology of implants and on translation into a clinical model.
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Affiliation(s)
- Carina Jaekel
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Ceylan D Windolf
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Department of Trauma Surgery and Orthopedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Lisa Oezel
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Lars F Seiler
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Felix N Lakomek
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christoph Beyersdorf
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jann Mertens
- Department of Trauma Surgery, Orthopaedics and Hand Surgery, Städtisches Klinikum Solingen, Solingen, Germany
| | - Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Joachim Windolf
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jan P Grassmann
- Department of Trauma, Hand and Reconstructive Surgery, Klinikum Osnabrück GmbH, Osnabrück, Germany
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3
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Wiedmann F, Beyersdorf C, Zhou XB, Kraft M, Paasche A, Jávorszky N, Rinné S, Sutanto H, Büscher A, Foerster KI, Blank A, El-Battrawy I, Li X, Lang S, Tochtermann U, Kremer J, Arif R, Karck M, Decher N, van Loon G, Akin I, Borggrefe M, Kallenberger S, Heijman J, Haefeli WE, Katus HA, Schmidt C. Treatment of atrial fibrillation with doxapram: TASK-1 potassium channel inhibition as a novel pharmacological strategy. Cardiovasc Res 2021; 118:1728-1741. [PMID: 34028533 DOI: 10.1093/cvr/cvab177] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS TASK-1 (K2P3.1) two-pore domain potassium channels are atrial-specific and significantly upregulated in atrial fibrillation (AF) patients, contributing to AF-related electrical remodelling. Inhibition of TASK-1 in cardiomyocytes of AF patients was shown to counteract AF-related action potential duration shortening. Doxapram was identified as a potent inhibitor of the TASK-1 channel. In the present study, we investigated the antiarrhythmic efficacy of doxapram in a porcine model of AF. METHODS AND RESULTS Doxapram successfully cardioverted pigs with artificially induced episodes of AF. We established a porcine model of persistent AF in domestic pigs via intermittent atrial burst stimulation using implanted pacemakers. All pigs underwent catheter-based electrophysiological investigations prior to and after 14 d of doxapram treatment. Pigs in the treatment group received intravenous administration of doxapram once per day. In doxapram-treated AF pigs, the AF burden was significantly reduced. After 14 d of treatment with doxapram, TASK-1 currents were still similar to values of sinus rhythm animals. Doxapram significantly suppressed AF episodes and normalized cellular electrophysiology by inhibition of the TASK-1 channel. Patch-clamp experiments on human atrial cardiomyocytes, isolated from patients with and without AF could reproduce the TASK-1 inhibitory effect of doxapram. CONCLUSIONS Repurposing doxapram might yield a promising new antiarrhythmic drug to treat AF in patients. TRANSLATIONAL PERSPECTIVE Pharmacological suppression of atrial TASK 1 potassium currents prolongs atrial refractoriness with no effects on ventricular repolarization, resulting in atrial-specific class III antiarrhythmic effects. In our preclinical pilot study the respiratory stimulant doxapram was successfully administered for cardioversion of acute AF as well as rhythm control of persistent AF in a clinically relevant porcine animal model.
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Affiliation(s)
- Felix Wiedmann
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Christoph Beyersdorf
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Xiao-Bo Zhou
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Manuel Kraft
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Amelie Paasche
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Natasa Jávorszky
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Susanne Rinné
- Institute for Physiology and Pathophysiology, Vegetative Physiology and Marburg Center for Mind, Brain and Behavior MCMBB, University of Marburg, Marburg, Germany
| | - Henry Sutanto
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Antonius Büscher
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Kathrin I Foerster
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ibrahim El-Battrawy
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Xin Li
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Siegfried Lang
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Ursula Tochtermann
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jamila Kremer
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Niels Decher
- Institute for Physiology and Pathophysiology, Vegetative Physiology and Marburg Center for Mind, Brain and Behavior MCMBB, University of Marburg, Marburg, Germany
| | - Gunther van Loon
- Department of Large Animal Internal Medicine, Equine Cardioteam, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Ibrahim Akin
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Stefan Kallenberger
- Digital Health Center, Berlin Institute of Health (BIH) and Charité, Berlin, Germany and Health Data Science Unit, University Hospital Heidelberg, Heidelberg, Germany
| | - Jordi Heijman
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
| | - Constanze Schmidt
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, University of Heidelberg, Heidelberg, Germany
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Wiedmann F, Beyersdorf C, Zhou XB, Kraft M, Foerster KI, El-Battrawy I, Lang S, Borggrefe M, Haefeli WE, Frey N, Schmidt C. The Experimental TASK-1 Potassium Channel Inhibitor A293 Can Be Employed for Rhythm Control of Persistent Atrial Fibrillation in a Translational Large Animal Model. Front Physiol 2021; 11:629421. [PMID: 33551849 PMCID: PMC7858671 DOI: 10.3389/fphys.2020.629421] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/14/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background Upregulation of the two-pore-domain potassium channel TASK-1 (hK2P3.1) was recently described in patients suffering from atrial fibrillation (AF) and resulted in shortening of the atrial action potential. In the human heart, TASK-1 channels facilitate repolarization and are specifically expressed in the atria. In the present study, we tested the antiarrhythmic effects of the experimental ion channel inhibitor A293 that is highly affine for TASK-1 in a porcine large animal model of persistent AF. Methods Persistent AF was induced in German landrace pigs by right atrial burst stimulation via implanted pacemakers using a biofeedback algorithm over 14 days. Electrophysiological and echocardiographic investigations were performed before and after the pharmacological treatment period. A293 was intravenously administered once per day. After a treatment period of 14 days, atrial cardiomyocytes were isolated for patch clamp measurements of currents and atrial action potentials. Hemodynamic consequences of TASK-1 inhibition were measured upon acute A293 treatment. Results In animals with persistent AF, the A293 treatment significantly reduced the AF burden (6.5% vs. 95%; P < 0.001). Intracardiac electrophysiological investigations showed that the atrial effective refractory period was prolonged in A293 treated study animals, whereas, the QRS width, QT interval, and ventricular effective refractory periods remained unchanged. A293 treatment reduced the upregulation of the TASK-1 current as well as the shortening of the action potential duration caused by AF. No central nervous side effects were observed. A mild but significant increase in pulmonary artery pressure was observed upon acute TASK-1 inhibition. Conclusion Pharmacological inhibition of atrial TASK-1 currents exerts in vivo antiarrhythmic effects that can be employed for rhythm control in a porcine model of persistent AF. Care has to be taken as TASK-1 inhibition may increase pulmonary artery pressure levels.
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Affiliation(s)
- Felix Wiedmann
- Department of Cardiology, Heidelberg University, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, Heidelberg University, Heidelberg, Germany
| | - Christoph Beyersdorf
- Department of Cardiology, Heidelberg University, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, Heidelberg University, Heidelberg, Germany
| | - Xiao-Bo Zhou
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany.,First Department of Medicine, University Medical Center, Mannheim University, Mannheim, Germany
| | - Manuel Kraft
- Department of Cardiology, Heidelberg University, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, Heidelberg University, Heidelberg, Germany
| | - Kathrin I Foerster
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany
| | - Ibrahim El-Battrawy
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany.,First Department of Medicine, University Medical Center, Mannheim University, Mannheim, Germany
| | - Siegfried Lang
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany.,First Department of Medicine, University Medical Center, Mannheim University, Mannheim, Germany
| | - Martin Borggrefe
- DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany.,First Department of Medicine, University Medical Center, Mannheim University, Mannheim, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Heidelberg University, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, Heidelberg University, Heidelberg, Germany
| | - Constanze Schmidt
- Department of Cardiology, Heidelberg University, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany.,HCR, Heidelberg Center for Heart Rhythm Disorders, Heidelberg University, Heidelberg, Germany
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5
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Wiedmann F, Beyersdorf C, Zhou X, Büscher A, Kraft M, Nietfeld J, Walz TP, Unger LA, Loewe A, Schmack B, Ruhparwar A, Karck M, Thomas D, Borggrefe M, Seemann G, Katus HA, Schmidt C. Pharmacologic TWIK-Related Acid-Sensitive K+ Channel (TASK-1) Potassium Channel Inhibitor A293 Facilitates Acute Cardioversion of Paroxysmal Atrial Fibrillation in a Porcine Large Animal Model. J Am Heart Assoc 2020; 9:e015751. [PMID: 32390491 PMCID: PMC7660874 DOI: 10.1161/jaha.119.015751] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The tandem of P domains in a weak inward rectifying K+ channel (TWIK)-related acid-sensitive K+ channel (TASK-1; hK2P3.1) two-pore-domain potassium channel was recently shown to regulate the atrial action potential duration. In the human heart, TASK-1 channels are specifically expressed in the atria. Furthermore, upregulation of atrial TASK-1 currents was described in patients suffering from atrial fibrillation (AF). We therefore hypothesized that TASK-1 channels represent an ideal target for antiarrhythmic therapy of AF. In the present study, we tested the antiarrhythmic effects of the high-affinity TASK-1 inhibitor A293 on cardioversion in a porcine model of paroxysmal AF. Methods and Results Heterologously expressed human and porcine TASK-1 channels are blocked by A293 to a similar extent. Patch clamp measurements from isolated human and porcine atrial cardiomyocytes showed comparable TASK-1 currents. Computational modeling was used to investigate the conditions under which A293 would be antiarrhythmic. German landrace pigs underwent electrophysiological studies under general anesthesia. Paroxysmal AF was induced by right atrial burst stimulation. After induction of AF episodes, intravenous administration of A293 restored sinus rhythm within cardioversion times of 177±63 seconds. Intravenous administration of A293 resulted in significant prolongation of the atrial effective refractory period, measured at cycle lengths of 300, 400 and 500 ms, whereas the surface ECG parameters and the ventricular effective refractory period lengths remained unchanged. Conclusions Pharmacological inhibition of atrial TASK-1 currents exerts antiarrhythmic effects in vivo as well as in silico, resulting in acute cardioversion of paroxysmal AF. Taken together, these experiments indicate the therapeutic potential of A293 for AF treatment.
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Affiliation(s)
- Felix Wiedmann
- Department of Cardiology University of Heidelberg Germany.,DZHK (German Center for Cardiovascular Research) partner site Heidelberg /Mannheim University of Heidelberg Germany.,HCR Heidelberg Center for Heart Rhythm Disorders University of Heidelberg Germany
| | - Christoph Beyersdorf
- Department of Cardiology University of Heidelberg Germany.,HCR Heidelberg Center for Heart Rhythm Disorders University of Heidelberg Germany
| | - Xiaobo Zhou
- DZHK (German Center for Cardiovascular Research) partner site Heidelberg /Mannheim University of Heidelberg Germany.,First Department of Medicine University Medical Center Mannheim Germany
| | - Antonius Büscher
- Department of Cardiology University of Heidelberg Germany.,HCR Heidelberg Center for Heart Rhythm Disorders University of Heidelberg Germany
| | - Manuel Kraft
- Department of Cardiology University of Heidelberg Germany.,DZHK (German Center for Cardiovascular Research) partner site Heidelberg /Mannheim University of Heidelberg Germany.,HCR Heidelberg Center for Heart Rhythm Disorders University of Heidelberg Germany
| | - Jendrik Nietfeld
- Department of Cardiology University of Heidelberg Germany.,HCR Heidelberg Center for Heart Rhythm Disorders University of Heidelberg Germany
| | - Teo Puig Walz
- Institute for Experimental Cardiovascular Medicine University Heart Center Freiburg Bad Krozingen Germany.,Medical Center University of Freiburg, and Faculty of Medicine University of Freiburg Germany
| | - Laura A Unger
- Institute of Biomedical Engineering Karlsruhe Institute of Technology (KIT) Karlsruhe Germany
| | - Axel Loewe
- Institute of Biomedical Engineering Karlsruhe Institute of Technology (KIT) Karlsruhe Germany
| | - Bastian Schmack
- Department of Cardiac Surgery University Hospital Heidelberg Germany
| | | | - Matthias Karck
- Department of Cardiac Surgery University Hospital Heidelberg Germany
| | - Dierk Thomas
- Department of Cardiology University of Heidelberg Germany.,DZHK (German Center for Cardiovascular Research) partner site Heidelberg /Mannheim University of Heidelberg Germany.,HCR Heidelberg Center for Heart Rhythm Disorders University of Heidelberg Germany
| | - Martin Borggrefe
- DZHK (German Center for Cardiovascular Research) partner site Heidelberg /Mannheim University of Heidelberg Germany.,First Department of Medicine University Medical Center Mannheim Germany
| | - Gunnar Seemann
- Institute for Experimental Cardiovascular Medicine University Heart Center Freiburg Bad Krozingen Germany.,Medical Center University of Freiburg, and Faculty of Medicine University of Freiburg Germany
| | - Hugo A Katus
- Department of Cardiology University of Heidelberg Germany.,DZHK (German Center for Cardiovascular Research) partner site Heidelberg /Mannheim University of Heidelberg Germany.,HCR Heidelberg Center for Heart Rhythm Disorders University of Heidelberg Germany
| | - Constanze Schmidt
- Department of Cardiology University of Heidelberg Germany.,DZHK (German Center for Cardiovascular Research) partner site Heidelberg /Mannheim University of Heidelberg Germany.,HCR Heidelberg Center for Heart Rhythm Disorders University of Heidelberg Germany
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Schmidt C, Wiedmann F, Beyersdorf C, Zhao Z, El-Battrawy I, Kraft M, Lang S, Szabo G, Karck M, Zhou X, Borggrefe M, Thomas D, Haefeli WE, Decher N, Katus H. 1206Doxapram is a promising new antiarrhythmic drug for an atrial-specific therapy of atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
TASK-1 (K2P3.1) is an atrial-specific two-pore domain potassium channel that is significantly upregulated in atrial fibrillation (AF) patients resulting in shortened atrial action potential duration (APD). Inhibition of TASK-1 in human atrial cardiomyocytes reverses AF-related APD shortening to values observed in patients with sinus rhythm (SR). By in silico-modelling and experimental characterization of drug binding sites, doxapram was identified as specific inhibitor of TASK-1.
Purpose
In this study, we investigated the antiarrhythmic efficacy of doxapram in a porcine model of AF to convert and suppress AF.
Methods
We established a new porcine model of persistent AF without induced tachymyopathy. AF was induced in domestic pigs by intermittent atrial burst stimulation using implanted pacemakers. During AF episodes, burst stimulation was inhibited by an integrated pacemaker biofeedback algorithm. AV-node ablation was performed to prevent AF-associated heart failure. All pigs underwent catheter-based electrophysiological investigations prior to and after 14 days doxapram treatment. Pigs in the treatment group received intravenous applications of doxapram twice per day. Rhythm status was continuously recorded by intracardiac long-term ECG monitors. The application of doxapram for cardioversion and long term suppression of AF in pigs with persistent AF was evaluated. Subsequent to the doxapram treatment, porcine cardiomyocytes were isolated from right and left atria and electrophysiologically investigated by patch-clamp and multi-electrode experiments. Atrial electrical remodeling was characterized by analyses of ion channel expression at mRNA and protein levels.
Results
TASK-1 mRNA, protein and transmembrane current were significantly increased in AF pigs compared to SR controls, resulting in shortened atrial APDs. In doxapram-treated AF pigs the AF burden was significantly reduced. After 14 days treatment with doxapram, TASK-1 currents and atrial APDs recorded in porcine cardiomyocytes were reduced and similar to values of SR animals. Doxapram could be successfully applied for cardioversion in pigs with persistent AF. On average, cardioversion was observed 3 minutes after doxapram application.
Conclusion
Doxapram significantly suppressed AF episodes and normalized cellular electrophysiological characteristics in a porcine model of AF through inhibition of the TASK-1 ion channel. Furthermore, doxapram rapidly converted AF into SR in pigs. Therefore, doxapram might serve as a new antiarrhythmic drug to treat AF in patients.
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Affiliation(s)
- C Schmidt
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - F Wiedmann
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - C Beyersdorf
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - Z Zhao
- University Medical Centre of Mannheim, Mannheim, Germany
| | - I El-Battrawy
- University Medical Centre of Mannheim, Mannheim, Germany
| | - M Kraft
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - S Lang
- University Medical Centre of Mannheim, Mannheim, Germany
| | - G Szabo
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - M Karck
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - X Zhou
- University Medical Centre of Mannheim, Mannheim, Germany
| | - M Borggrefe
- University Medical Centre of Mannheim, Mannheim, Germany
| | - D Thomas
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - W E Haefeli
- University Hospital of Heidelberg, Pharmacology, Heidelberg, Germany
| | - N Decher
- Philipps University of Marburg, Physiology, Marburg, Germany
| | - H Katus
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
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Schmidt C, Wiedmann F, Beyersdorf C, Zhao Z, El-Battrawy I, Lan H, Szabo G, Li X, Lang S, Korkmaz-Icöz S, Rapti K, Jungmann A, Ratte A, Müller OJ, Karck M, Seemann G, Akin I, Borggrefe M, Zhou XB, Katus HA, Thomas D. Genetic Ablation of TASK-1 (Tandem of P Domains in a Weak Inward Rectifying K + Channel-Related Acid-Sensitive K + Channel-1) (K 2P3.1) K + Channels Suppresses Atrial Fibrillation and Prevents Electrical Remodeling. Circ Arrhythm Electrophysiol 2019; 12:e007465. [PMID: 31514528 DOI: 10.1161/circep.119.007465] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite an increasing understanding of atrial fibrillation (AF) pathophysiology, translation into mechanism-based treatment options is lacking. In atrial cardiomyocytes of patients with chronic AF, expression, and function of tandem of P domains in a weak inward rectifying TASK-1 (K+ channel-related acid-sensitive K+ channel-1) (K2P3.1) atrial-specific 2-pore domain potassium channels is enhanced, resulting in action potential duration shortening. TASK-1 channel inhibition prevents action potential duration shortening to maintain values observed among sinus rhythm subjects. The present preclinical study used a porcine AF model to evaluate the antiarrhythmic efficacy of TASK-1 inhibition by adeno-associated viral anti-TASK-1-siRNA (small interfering RNA) gene transfer. METHODS AF was induced in domestic pigs by atrial burst stimulation via implanted pacemakers. Adeno-associated viral vectors carrying anti-TASK-1-siRNA were injected into both atria to suppress TASK-1 channel expression. After the 14-day follow-up period, porcine cardiomyocytes were isolated from right and left atrium, followed by electrophysiological and molecular characterization. RESULTS AF was associated with increased TASK-1 transcript, protein and ion current levels leading to shortened action potential duration in atrial cardiomyocytes compared to sinus rhythm controls, similar to previous findings in humans. Anti-TASK-1 adeno-associated viral application significantly reduced AF burden in comparison to untreated AF pigs. Antiarrhythmic effects of anti-TASK-1-siRNA were associated with reduction of TASK-1 currents and prolongation of action potential durations in atrial cardiomyocytes to sinus rhythm values. Conclusions Adeno-associated viral-based anti-TASK-1 gene therapy suppressed AF and corrected cellular electrophysiological remodeling in a porcine model of AF. Suppression of AF through selective reduction of TASK-1 currents represents a new option for antiarrhythmic therapy.
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Affiliation(s)
- Constanze Schmidt
- Department of Cardiology (C.S., F.W., C.B., K.R., A.J., A.R., H.A.K., D.T.), University of Heidelberg.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,HCR (Heidelberg Center for Heart Rhythm Disorders) (C.S., F.W., C.B., A.R., H.A.K., D.T.), University Hospital Heidelberg
| | - Felix Wiedmann
- Department of Cardiology (C.S., F.W., C.B., K.R., A.J., A.R., H.A.K., D.T.), University of Heidelberg.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,HCR (Heidelberg Center for Heart Rhythm Disorders) (C.S., F.W., C.B., A.R., H.A.K., D.T.), University Hospital Heidelberg
| | - Christoph Beyersdorf
- Department of Cardiology (C.S., F.W., C.B., K.R., A.J., A.R., H.A.K., D.T.), University of Heidelberg.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,HCR (Heidelberg Center for Heart Rhythm Disorders) (C.S., F.W., C.B., A.R., H.A.K., D.T.), University Hospital Heidelberg
| | - Zhihan Zhao
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,First Department of Medicine, University Medical Center Mannheim (Z.Z., I.E.-B., H.L., X.L., S.L., I.A., M.B., X.-B.Z.)
| | - Ibrahim El-Battrawy
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,First Department of Medicine, University Medical Center Mannheim (Z.Z., I.E.-B., H.L., X.L., S.L., I.A., M.B., X.-B.Z.)
| | - Huan Lan
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,First Department of Medicine, University Medical Center Mannheim (Z.Z., I.E.-B., H.L., X.L., S.L., I.A., M.B., X.-B.Z.)
| | - Gabor Szabo
- Department of Cardiac Surgery (G. Szabo, S.K.-I., M.K.), University Hospital Heidelberg
| | - Xin Li
- First Department of Medicine, University Medical Center Mannheim (Z.Z., I.E.-B., H.L., X.L., S.L., I.A., M.B., X.-B.Z.)
| | - Siegfried Lang
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,First Department of Medicine, University Medical Center Mannheim (Z.Z., I.E.-B., H.L., X.L., S.L., I.A., M.B., X.-B.Z.)
| | - Sevil Korkmaz-Icöz
- Department of Cardiac Surgery (G. Szabo, S.K.-I., M.K.), University Hospital Heidelberg
| | - Kleopatra Rapti
- Department of Cardiology (C.S., F.W., C.B., K.R., A.J., A.R., H.A.K., D.T.), University of Heidelberg.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg
| | - Andreas Jungmann
- Department of Cardiology (C.S., F.W., C.B., K.R., A.J., A.R., H.A.K., D.T.), University of Heidelberg.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg
| | - Antonius Ratte
- Department of Cardiology (C.S., F.W., C.B., K.R., A.J., A.R., H.A.K., D.T.), University of Heidelberg.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,HCR (Heidelberg Center for Heart Rhythm Disorders) (C.S., F.W., C.B., A.R., H.A.K., D.T.), University Hospital Heidelberg
| | - Oliver J Müller
- Department of Internal Medicine III (O.J.M.), University of Kiel.,DZHK, partner site Hamburg/Kiel/Lübeck (O.J.M.), University of Kiel
| | - Matthias Karck
- Department of Cardiac Surgery (G. Szabo, S.K.-I., M.K.), University Hospital Heidelberg
| | - Gunnar Seemann
- Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen (G. Seemann).,Faculty of Medicine, Albert-Ludwigs University of Freiburg, Germany (G. Seemann)
| | - Ibrahim Akin
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,First Department of Medicine, University Medical Center Mannheim (Z.Z., I.E.-B., H.L., X.L., S.L., I.A., M.B., X.-B.Z.)
| | - Martin Borggrefe
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,First Department of Medicine, University Medical Center Mannheim (Z.Z., I.E.-B., H.L., X.L., S.L., I.A., M.B., X.-B.Z.)
| | - Xiao-Bo Zhou
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,First Department of Medicine, University Medical Center Mannheim (Z.Z., I.E.-B., H.L., X.L., S.L., I.A., M.B., X.-B.Z.)
| | - Hugo A Katus
- Department of Cardiology (C.S., F.W., C.B., K.R., A.J., A.R., H.A.K., D.T.), University of Heidelberg.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg.,HCR (Heidelberg Center for Heart Rhythm Disorders) (C.S., F.W., C.B., A.R., H.A.K., D.T.), University Hospital Heidelberg
| | - Dierk Thomas
- Department of Cardiology (C.S., F.W., C.B., K.R., A.J., A.R., H.A.K., D.T.), University of Heidelberg.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim (C.S., F.W., C.B., Z.Z., I.E.-B., H.L., S.L., K.R., A.J., A.R., I.A., M.B., X.-B.Z., H.A.K., D.T.), University of Heidelberg
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Schmidt C, Wiedmann F, Beyersdorf C, Zhao Z, El-Battrawy I, Li X, Lang S, Rapti K, Jungmann A, Mueller O, Zhou X, Borggrefe M, Katus H, Thomas D. 197Inhibition of TASK-1 by gene therapy and pharmacological compounds suppresses atrial fibrillation in a large animal model. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Schmidt
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - F Wiedmann
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - C Beyersdorf
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - Z Zhao
- University Medical Centre of Mannheim, Mannheim, Germany
| | - I El-Battrawy
- University Medical Centre of Mannheim, Mannheim, Germany
| | - X Li
- University Medical Centre of Mannheim, Mannheim, Germany
| | - S Lang
- University Medical Centre of Mannheim, Mannheim, Germany
| | - K Rapti
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - A Jungmann
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - O Mueller
- University Medical Center of Schleswig-Holstein, Cardiology, Kiel, Germany
| | - X Zhou
- University Medical Centre of Mannheim, Mannheim, Germany
| | - M Borggrefe
- University Medical Centre of Mannheim, Mannheim, Germany
| | - H Katus
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - D Thomas
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
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