Severe arrhythmia disorder caused by cardiac L-type calcium channel mutations

Timothy syndrome (TS) is a multisystem disorder that causes syncope and sudden death from cardiac arrhythmias. Prominent features include congenital heart disease, immune deficiency, intermittent hypoglycemia, cognitive abnormalities, and autism. All TS individuals have syndactyly (webbing of fingers and toes). We discovered that TS resulted from a recurrent, de novo cardiac L-type calcium channel (CaV1.2) mutation, G406R. G406 is located in alternatively spliced exon 8A, encoding transmembrane segment S6 of domain I. Here, we describe two individuals with a severe variant of TS (TS2). Neither child had syndactyly. Both individuals had extreme prolongation of the QT interval on electrocardiogram, with a QT interval corrected for heart rate ranging from 620 to 730 ms, causing multiple arrhythmias and sudden death. One individual had severe mental retardation and nemaline rod skeletal myopathy. We identified de novo missense mutations in exon 8 of CaV1.2 in both individuals. One was an analogous mutation to that found in exon 8A in classic TS, G406R. The other mutation was G402S. Exon 8 encodes the same region as exon 8A, and the two are mutually exclusive. The spliced form of CaV1.2 containing exon 8 is highly expressed in heart and brain, accounting for approximately 80% of CaV1.2 mRNAs. G406R and G402S cause reduced channel inactivation, resulting in maintained depolarizing L-type calcium currents. Computer modeling showed prolongation of cardiomyocyte action potentials and delayed afterdepolarizations, factors that increase risk of arrhythmia. These data indicate that gain-of-function mutations of CaV1.2 exons 8 and 8A cause distinct forms of TS.     

伊贝沙坦对兔心室肌细胞L-型钙通道电流的影响

目的 研究伊贝沙坦(irbesartan)对正常家兔心室肌细胞L-型钙电流(ICa-L)、内向整流性钾电流(IK1)、快钠流(INa)以及跨膜动作电位的影响。方法 应用膜片钳全细胞记录方法记录各项离子流和跨膜动作电位。结果 (1)伊贝沙坦呈浓度依赖性阻断ICa-L；(2)伊贝沙坦可使ICa-L I—V曲线上移，但不改变其激活电位、峰值电位和反转电位；(3)伊贝沙坦呈使用依赖性阻滞ICa-L；(4)伊贝沙坦对ICa-L激活曲线无明显影响，但ICa-L失活后再激活的恢复时间常数(τ)明显延长；(6)伊贝沙坦对IKl和INa无明显影响；(7)伊贝沙坦(100nM)可使单个心室肌细胞动作电位时限缩短，对静息电位(RP)、动作电位幅度(APA)无影响。结论 伊贝沙坦作用于L-型钙通道的失活态从而阻断ICa-L。     

PFXYD序列参与phospholemman对L型钙通道的调节作用

目的探讨PFXYD序列在phospholemman（PLM）调节L型钙通道中的作用。方法用丙氨酸（Ala／,A）替换组成PFXYD序列的5个氨基酸,得到突变型PLM—ALL5。用磷酸钙沉淀法将编码L型钙通道的cDNA分别与编码载体质粒（empUvector,EV）、野生型PLM（wildtype,wT）、突变型PLM（ALL5）的cDNA转染到HEK293细胞中,待其表达相应蛋白后,用全细胞膜片钳方法记录L型钙电流（ICa（L））并分析其动力学特性。结果在除极化电位为一20mV和一10mV时,ALL5较wT更加明显地减慢了ICa（L）激活速度,而在相同电位下ALLJ5使ICa（L）失活速度也明显减慢;与WT相反,ALL5没有减慢ICa（L）灭活速度,反使其加快了;以上ALL5所致的ICa（L）改变与电流大小无关。结论PFXYD序列理化性质的改变可以引起PLM对L型钙通道调节作用的改变,提示PFXYD序列在PLM调节L型钙通道的过程中发挥重要作用。     

氧化苯胂对大鼠心室肌细胞L型Ca2+电流的影响

目的 :探讨氧化苯胂 （PAO） ,一种膜可通透的酪氨酸磷酸酶抑制剂 ,对大鼠心室肌细胞 L型 Ca2 +电流 （ICa,L）的影响。方法 :采用全细胞膜片钳技术记录大鼠心室肌细胞 ICa,L。结果 :1PAO对基础 ICa,L及β-肾上腺素受体激动剂异丙肾上腺素 （Iso）激发的 ICa,L有抑制作用 ;2 PAO对腺苷酸环化酶激动剂 forskolin激发的 ICa,L亦有抑制作用 ;3电极内液加入 1.5 mm ol/ L矾酸钠不能消除 PAO的作用 ;4PAO对 ICa,L的抑制作用可被二硫代苏糖醇反转。结论 :PAO抑制 ICa,L的作用与 c AMP- PKA-磷酸化途径和酪氨酸磷酸酶无关 ,可能与其使 L 型 Ca2 +通道蛋白上巯基氧化有关。     

渗透压对大鼠心室肌细胞L型Ca2+电流的影响

目的 :观察细胞胞外渗透压的改变对大鼠心室肌 L型 Ca2 +（ICa,L）电流的影响。方法 :采用全细胞膜片钳技术记录大鼠心室肌细胞 ICa,L。结果 :细胞外的渗透压由 3 10 m Osm / kg H2 O降低至 2 2 0 m Osm/ kg H2 O可使 ICa,L的 rundown明显变慢 ,电流大小无统计学意义上的差异 ;而当其中细胞外的渗透压由 3 10 m Osm/ kg H2 O升高至 410m Osm/ kg H2 O时可使 ICa,L减小 （5 1.4± 7.9） % （n=4,P<0 .0 1）。结论 :细胞外渗透压变化对大鼠心室肌基础 ICa,L有明显影响     

快速起搏大鼠心房肌细胞L-型钙通道及钾通道Kv4.3的表达变化

目的 利用原代培养的心房肌细胞建立快速起搏模型,研究L-型钙通道及钾通道Kv4.3在快速起搏早期的表达变化.方法 原代培养大鼠心房肌细胞,并建立快速起搏细胞模型,利用RT-PCR以及Western-blot方法检测L-型钙通道α1c及钾通道Kv4.3在快速起搏3、6、12、24 h后mRNA和蛋白的表达变化.结果 快速起搏6 h后L-型钙通道α1c的mRNA和蛋白表达较起搏前持续降低,并于24 h时达到最低值;而钾通道Kv4.3 mRNA和蛋白的表达在快速起搏12 h后降低,并且在其后保持相对稳定的水平.结论 快速起搏早期,原代培养心房肌细胞L-型钙通道α1c及钾通道Kv4.3的mRNA和蛋白表达均出现不同程度的降低,提示其发生了离子通道重构,并且可能是电重构的分子基础.     

Localised Ca channel phosphorylation modulates the distribution of L-type Ca current in cardiac myocytes

The t-tubule network is central to excitation-contraction coupling in mammalian cardiac ventricular myocytes, with recent studies showing that the majority of Ca influx via the L-type Ca current (I_Ca) occurs across the t-tubule membrane. The present study investigated whether tonic phosphorylation of the L-type Ca channel is different at the t-tubule and surface membranes, and if this could account for the high density of I_Ca at the t-tubules. Ventricular myocytes were isolated from male Wistar rats and detubulated using formamide. I_Ca was recorded using the whole cell patch clamp technique, and Ca transients were recorded using fluo-3 in conjunction with confocal microscopy. The protein kinase A (PKA) inhibitor H-89 (10 μmol/L) and the CaMKII inhibitor KN-93 (5 μmol/L) decreased the amplitude of I_Ca in intact cells but had no effect on I_Ca amplitude in detubulated cells. These inhibitors also decreased the amplitude of the Ca transient in intact cells but not in detubulated cells. Antibody staining for phosphorylated L-type Ca channel showed significantly higher phosphorylation at the t-tubules than at the surface membrane in intact cells. Thus it appears that tonic phosphorylation of the L-type Ca channel maintains the amplitude of I_Ca and occurs predominantly at the t-tubules. This may have important implications in heart disease, in which changes of phosphorylation and t-tubule density have been reported.     

Cellular electrophysiology of amlodipine: probing the cardiac L-type calcium channel

The electrophysiologic properties of amlodipine in single guinea-pig ventricular cells were investigated. The degree of ionization of the drug molecule was found to affect both the development of and the recovery from block of L-type calcium channels. Under alkaline conditions, when most of the drug is in a neutral form, the actions of amlodipine resemble previously described neutral dihydropyridine (DHP) compounds. Under these conditions, calcium channel block by amlodipine is reversibly regulated by cell membrane potential, i.e., block is more pronounced at voltages positive to -50 mV and completely relieved at voltages negative to -80 mV. When the drug molecule is ionized, block develops very slowly at positive membrane potentials and is very difficult to relieve on returning the membrane potential to more negative voltages. It is concluded that the degree of ionization of the drug molecule limits access to the DHP receptor and that the drug-bound receptor can be titrated by extracellular hydrogen ions. These results place limitations on the location of the DHP receptor within the cardiac sarcolemmal membrane.     

压力超负荷性慢性心力衰竭时心室肌L型钙通道重构的研究

目的观察慢性心力衰竭(CHF)大鼠心室肌L型钙通道重构的特征,探讨其在心律失常发生中的可能作用。方法 30只大鼠随机分为CHF组与假手术组。CHF组缩窄腹主动脉建立大鼠CHF模型,采用全细胞膜片钳技术记录L型钙电流(ICa,L),描述L型钙通道的稳态激活曲线、稳态失活曲线、失活后恢复曲线,免疫组化方法测定L型钙通道ɑ1c亚单位蛋白的表达,并与假手术组进行比较。结果 CHF组大鼠左室收缩末压、左室内压上升最大速率、左室内压下降最大速率、左室射血分数均显著低于假手术组,左室舒张末压显著高于假手术组(P均<0.01),提示CHF模型制作成功。CHF组ICa,L电流密度幅值较假手术组显著减小[-(5.03±0.51)pA/pF vs-(8.14±0.54)pA/pF,P<0.01],I-V曲线显著上移,V1/2,act幅值显著增大[-(3.9±0.11)mV vs-(2.8±0.10)mV,P<0.01],κact显著减小(6.1±1.3 mV vs 7.7±1.2 mV,P<0.01),激活曲线显著右移。两组的V1/2,inact、κinact值及稳态失活曲线均无差异。与假手术组比较,CHF组τ值增大(39.8±3.3 ms vs 26.3±2.9 ms,P<0.05),失活后恢复曲线右移,L型钙通道ɑ1c亚单位蛋白表达的阳性信号指数减小(37.3±8.7 vs 52.9±7.2,P<0.01)。结论CHF时L型钙通道出现激活减慢、失活后恢复减慢等通道动力学变化,且在心室肌表达降低,导致ICa,L电流密度下降,这可能是CHF时室性心律失常发生的重要原因。     

The role of L-type calcium current in the generation of repolarization-induced contraction in cardiac myocytes

OBJECTIVE: Early experiments into the arrhythmogenic transient inward current frequently showed apparent coupling of this current to repolarization from a depolarizing voltage clamp step. Calcium transients have subsequently been shown to couple to such repolarization and are the result of calcium release from the sarcoplasmic reticulum. We have investigated whether this phenomenon is due to calcium entry via non-inactivated calcium channels or to voltage-activated SR release. METHODS: Voltage clamp steps were imposed on isolated guinea pig and rabbit cardiac myocytes. Calcium release was monitored by tracking cell contraction. L-type calcium current at the moment of repolarization was manipulated by the rapid application of 2 mM cadmium or 10 mM calcium. RESULTS: Repolarization-induced contraction was abolished by the rapid application of 2 mM cadmium immediately prior to repolarization, and was augmented by the rapid change of extracellular calcium concentration from 2 mM to 10 mM immediately prior to repolarization. There is no evidence of coupling of drive train-induced aftercontractions to repolarization from the final action potential of the drive train and 2 mM cadmium does not alter the appearance or timing of these aftercontractions. Simulation of phase 1 repolarization in the mammalian cardiac action potential decreases rather than increases twitch amplitude. CONCLUSION: Repolarization-induced contraction results from calcium entry through non-inactivated calcium channels, not from voltage-activated release. It plays no physiological role in contributing to the stimulated twitch and no pathological role in generating drive train-induced aftercontractions.     

L-type calcium channel blockers and EGTA enhance superoxide production in cardiac fibroblasts

Since the recognition of the importance of calcium ions to cardiac contractility, the effects of alterations in calcium homeostasis on cardiac myocyte function have attracted immense attention. However, the possibility that changes in extracellular calcium concentration or the administration of calcium channel blockers may exert significant effects on cardiac fibroblasts has not hitherto been explored. This communication presents evidence, for the first time, that EGTA, calcium-free incubation and L-type calcium channel blockers increase endogenous superoxide production in adult rat cardiac fibroblasts. A combination of ryanodine and EGTA was found to have an even greater effect. The observations indicate that extracellular calcium levels influence endogenous superoxide production in cardiac fibroblasts and support the postulation that myocardial fibroblasts may contribute to the cardiac effects of calcium channel blockers and alterations in extracellular calcium concentration.     

Regulation of cardiac L-type calcium channels by protein kinase A and protein kinase C

Voltage-dependent L-type Ca(2+) channels are multisubunit transmembrane proteins, which allow the influx of Ca(2+) (I:(Ca)) essential for normal excitability and excitation-contraction coupling in cardiac myocytes. A variety of different receptors and signaling pathways provide dynamic regulation of I:(Ca) in the intact heart. The present review focuses on recent evidence describing the molecular details of regulation of L-type Ca(2+) channels by protein kinase A (PKA) and protein kinase C (PKC) pathways. Multiple G protein-coupled receptors act through cAMP/PKA pathways to regulate L-type channels. ss-Adrenergic receptor stimulation results in a marked increase in I:(Ca), which is mediated by a cAMP/PKA pathway. Growing evidence points to an important role of localized signaling complexes involved in the PKA-mediated regulation of I:(Ca), including A-kinase anchor proteins and binding of phosphatase PP2a to the carboxyl terminus of the alpha(1C) (Ca(v)1.2) subunit. Both alpha(1C) and ss(2a) subunits of the channel are substrates for PKA in vivo. The regulation of L-type Ca(2+) channels by Gq-linked receptors and associated PKC activation is complex, with both stimulation and inhibition of I:(Ca) being observed. The amino terminus of the alpha(1C) subunit is critically involved in PKC regulation. Crosstalk between PKA and PKC pathways occurs in the modulation of I:(Ca). Ultimately, precise regulation of I:(Ca) is needed for normal cardiac function, and alterations in these regulatory pathways may prove important in heart disease.     

血管紧张素-(1-7)对心肌细胞L-型钙通道的影响

目的 :研究血管紧张素 (1 7) [Ang (1 7) ]对正常豚鼠心室肌细胞L 型钙离子通道的影响 ,旨在探讨Ang (1 7)发挥降压作用的离子通道及分子基础。 方法 :应用膜片钳全细胞记录技术。结果 :Ang (1 7)可使ICa L呈浓度依赖性增加 ,选择性AngⅠ型 (AT1)受体拮抗剂缬沙坦或非选择性AT1受体拮抗剂Sarthran(Sar)均可消除Ang (1 7)增加ICa L的作用。结论 :Ang (1 7)通过AT1受体增加ICa L,其降压作用不是通过抑制钙离子内流而实现的。     

阿魏酸钠与胺碘酮对家兔心室肌细胞L型钙通道电流的影响

目的探讨阿魏酸钠对家兔心室肌细胞膜L型钙通道电流(ICa-L)的影响。方法酶解法急性分离兔单个心室肌细胞,以经典的Ⅲ类抗心律失常药物胺碘酮为对照,应用膜片钳全细胞记录技术观察3,10,30,100μmol/L的阿魏酸钠对心室肌细胞膜ICa-L的作用。结果阿魏酸钠及胺碘酮均呈浓度依赖性抑制L型钙电流。3,10,30,100μmol/L的阿魏酸钠对ICa-L的抑制率分别为11.1%±2.4%,26.9%±6.2%,40.5%±5.0%,61.9%±5.5%(P<0.05);1,3,10,30μmol/L的胺碘酮对ICa-L的抑制率分别为21.1%±3.8%,32.6%±2.6%,52.6%±4.6%,71.4%±7%(P<0.05);半数抑制浓度分别为32.6及9.5μmol/L,阿魏酸钠的抑制作用弱于胺碘酮(P<0.05)。阿魏酸钠及胺碘酮均能使ICa-L电流-电压曲线上移,稳态激活曲线右移,失活曲线左移,并可减慢钙通道灭活后的恢复过程。结论阿魏酸钠对ICa-L具有浓度依赖性阻滞作用,使ICa-L的激活减慢,失活加快,并且失活后的恢复时间延长,可能是其抗心律失常作用的电生理机制之一。     

Regulation of glutathione in cardiac myocytes

Reduced glutathione (GSH) is an essential, multifunctional tripepetide that controls redox-sensitive cellular processes, but its regulation in the heart is poorly understood. The present study used a pharmocological model of GSH depletion to examine cellular mechanisms controlling cardiac GSH. Inhibition of GSH metabolism was elicited in normal rats by daily injections of buthionine sulfoximine (BSO), a blocker of gamma-glutamylcysteine synthetase, plus 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU), an inhibitor of glutathione reductase. After 3 d of BSO/BCNU treatment, intracellular [GSH] was measured in isolated-ventricular myocytes by fluorescence microscopy using the probe monochlorobimane. Basal [GSH] in left-ventricular myocytes from BSO/BCNU-treated rats (2.0 +/- 0.05 amol/microm(3), n = 146) was 50% less than control (4.0 +/- 0.13 amol/microm(3), n = 116; P < 0.05). Incubation of myocytes from BSO/BCNU rats with 0.1 microM insulin normalized [GSH] after a delay of 3-4 h (3.6 +/- 0.29 amol/microm(3), n = 66). This effect of insulin was blocked by pre-treating myocytes with cycloheximide. A protein tyrosine phosphatase inhibitor, bis-peroxovanadium-1,10-phenanthroline (bpV(phen), 1 microM), elicited a similar effect as insulin, while neither agent altered [GSH] in myocytes from control rats. Moreover, the effect of insulin and bpV(phen) to up-regulate GSH was blocked by inhibitors of PI 3-kinase (wortmannin, LY294002), MEK (PD98059) and p38 MAP kinases (SB203580). These data suggest that the insulin-signaling cascade regulates [GSH] in ventricular myocytes by a coordinated activation of PI 3-kinase and MAP kinase pathways. These signaling mechanisms may play essential roles in controlling intracellular redox state and normal function of cardiac myocytes.     

The calcium channel blocker nitrendipine blocks sodium channels in neonatal rat cardiac myocytes

The dihydropyridine calcium channel blocker, nitrendipine, was studied for its effects on the sodium current of single cultured ventricular cells from neonatal rats. The patch-clamp method of recording whole cell currents was used, and sodium currents were isolated by suppressing potassium and calcium currents. Potassium currents were blocked by replacing potassium with cesium in the internal and external solutions and by adding tetraethylammonium chloride and 4-aminopyridine in the external solution; calcium current was blocked by replacing calcium with cobalt in the external solution. At low frequencies (0.1 Hz), nitrendipine reduced sodium currents without any significant change in the current-voltage relation. The block was dose dependent, and assuming a single occupancy model with complete block, had a half-maximum value of 3 X 10(-6) M at a holding potential of -80 mV where half the sodium channels are activatable. This value is within the range of the Kd's that have been reported for low-affinity dihydropyridine-binding sites found in cardiac sarcolemmal vesicles. In the presence of nitrendipine, the inactivation curve was shifted to hyperpolarized potentials. The block was greater with pulse intervals shorter than 1000 msec, and repriming was prolonged in the presence of the drug. These effects are similar to those of local anesthetics of the tertiary amine class, such as lidocaine. The block was relieved by the dihydropyridine agonist Bay K8644. The results are interpreted as indicating that dihydropyridines react with sodium channels.     

Evidence for regulation of mitochondrial function by the L-type Ca channel in ventricular myocytes

The L-type Ca²⁺ channel is responsible for initiating contraction in the heart. Mitochondria are responsible for meeting the cellular energy demands and calcium is required for the activity of metabolic intermediates. We examined whether activation of the L-type Ca²⁺ channel alone is sufficient to alter mitochondrial function. The channel was activated directly with the dihydropyridine agonist BayK(−) or voltage-clamp of the plasma membrane and indirectly by depolarization of the membrane with high KCl. Activation of the channel increased superoxide production (assessed as changes in dihydroethidium fluorescence), NADH production and metabolic activity (assessed as formation of formazan from tetrazolium) in a calcium-dependent manner. Activation of the channel also increased mitochondrial membrane potential assessed as changes in JC-1 fluorescence. The response was reversible upon inactivation of the channel during voltage-clamp of the plasma membrane and did not appear to require calcium. We examined whether the response may be mediated through movement of cytoskeletal proteins. Depolymerization of actin or exposing cells to a peptide directed against the alpha-interacting domain of the α_1C-subunit of the channel (thereby preventing movement of the β-subunit) attenuated the increase in mitochondrial membrane potential. We conclude that activation of the L-type Ca²⁺ channel can regulate mitochondrial function and the response appears to be modulated by movement through the cytoskeleton.