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(Circulation. 2004;110:776-783.)
© 2004 American Heart Association, Inc.
Original Articles |
From INSERM U637-EA3759 (E.P., B.-G.K., P.B., S.R., A.M.G., J.-P.B.), IFR3, Montpellier, France, and the Division of Endocrinology and Diabetology and Laboratory of Clinical Chemistry (N.L., M.F.R.), University Hospital, Geneva, Switzerland.
Correspondence to Jean-Pierre Benitah, INSERM U637EA3759, CHU A. de Villeneuve, 34295 Montpellier, France. E-mail benitah{at}montp.inserm.fr
Received October 28, 2003; de novo received January 29, 2004; revision received April 15, 2004; accepted April 16, 2004.
| Abstract |
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Methods and Results Using whole-cell, patch-clamp and quantitative reverse transcriptionpolymerase chain reaction techniques on right ventricular myocytes of a myocardial infarction (MI) rat model, we examined the cellular response over time. One week after MI, no sign of cellular hypertrophy was found, but action potential duration (APD) was lengthened. Both an increase in Ca2+ current (ICa) and a decrease in K+ transient outward current (Ito) underlay this effect. Consistently, the relative expression of mRNA coding for the Ca2+ channel
1C subunit (Cav1.2) increased, and that of the K+ channel Kv4.2 subunit decreased. Three weeks after MI, AP prolongation endured, whereas cellular hypertrophy developed. ICa density, Cav1.2, and Kv4.2 mRNA levels regained control levels, but Ito density remained reduced. Long-term treatment with RU28318, an MR antagonist, prevented this electrical remodeling. In a different etiologic model of abdominal aortic constriction, we confirmed that APD prolongation and modifications of ionic currents precede cellular hypertrophy.
Conclusions Electrical remodeling, which is triggered at least in part by MR activation, is an initial, early cellular response to hypertrophic insults.
Key Words: hypertrophy action potentials ion channels remodeling hormones
| Introduction |
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Irrespective of etiology, the common electrophysiological feature of the hypertrophied cardiomyocyte is action potential duration (APD) prolongation, which is involved in a higher propensity to arrhythmias.12 The change in cardiac repolarization stems from an imbalance of repolarizing and depolarizing ionic currents. However, the downregulation of the outward K+ current, especially the transient one (Ito), and/or the upregulation of the L-type Ca2+ current (ICa) are still controversial.13 Changes may arise not only from the specific etiology and animal models used but also from the stage of the disease.14 Moreover, alteration of ion channels is thought to be an end-organ response that accompanies structural hypertrophy, resulting from global protein synthesis stimulation or fetal gene reprogramming.1 However, temporal dissociation of electrical remodeling and structural hypertrophy has been reported.15,16 Moreover, ionic remodeling might be a primary factor in triggering cardiac hypertrophy.17 Accordingly, electrical remodeling could be independent of mechanical overload, and a specific signal must initiate the remodeling.
In the present study, we analyzed the electrical characteristics of rat myocytes at different stages after myocardial infarction (MI). We show that electrical remodeling precedes cellular hypertrophy. APD lengthened significantly, ICa was upregulated, and Ito was downregulated already at 1 week after MI. Changes in current were matched by changes in mRNA levels. Cellular hypertrophy was evident only 3 weeks after surgery. Moreover, we observed that treatment of post-MI rats with RU28318 prevented early electrical remodeling. In a different model, left ventricular (LV) compensated hypertrophy induced by abdominal constriction, we confirmed that AP prolongation and modifications of ionic currents precede cellular hypertrophy.
| Methods |
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Abdominal Aortic Constriction
LV hypertrophy was induced in 150- to 180-g male Wistar rats by abdominal aorta constriction (AC).19 Age-matched, sham-operated animals were used as controls.
RU28318 Treatment
An osmotic minipump (Alzet 2ML4) was implanted subcutaneously at the time of surgery to deliver 50 µg/h RU28318, provided by Aventis (France).
Cell Isolation and Recording Techniques
Animals were euthanized 1 and 3 weeks after surgery with intraperitoneal injection of sodium pentobarbital (50 mg · kg1). No apparent signs of failure (pulmonary congestion or chamber dilatation) were observed. Ventricular myocytes were isolated enzymatically.11 This investigation conformed to the European Community guide for the care and use of laboratory animals (French decree no. 87/848 of October 19, 1987).
Cellular hypertrophy was monitored by 2-photon microscopy (Zeiss LSM 510 NLO) to calculate cell volume (VC), and the whole-cell patch-clamp technique was used to measure membrane capacitance (Cm),19 an electrical index of membrane surface area. To measure VC, the voltage-sensitive dye 1-(3-sulfonatopropyl)-8-[b-[2-(di-n-butylamino)-6-naphthyl]vinyl]pyridium betaine (di-4-ANEPPS)loaded cells were illuminated at 840 nm with a mode-locked Ti:sapphire laser (Mira 900, Coherent) and recorded in 3D. Images of spherical beads (Molecular Probes) were recorded under the same conditions to calculate the point spread function. Deconvolution was performed with Huygens (Bitplane AG). VC was estimated by the myocyte cross-sectional area at the center multiplied by the deconvoluted image thickness.
AP and whole-cell current were monitored at 0.1 Hz with an Axopatch 1D amplifier and recorded with pCLAMP-7 (Axon Instruments) at 23°C to 25°C. Series resistance was electronically compensated (40% to 60%). AP, Ito, and ICa were measured with protocols and solutions previously described.11,20
RT-PCR and Real-Time PCR
Total RNA was extracted from isolated cardiomyocytes by a Trizol method (InVitrogen), and its integrity was analyzed by electrophoresis with a chip-based RNA analysis system (Agilent Technologies). To obtain cDNA, 200 ng total RNA was reverse-transcribed with use of the Taqman Gold reverse transcriptionpolymerase chain reaction (RT-PCR) kit (Applied Biosystems). Real-time PCR analysis was done with an iCycler iQ detection system (Bio-Rad) in a master mix that contained specific primers, as described elsewhere (400 nmol/L for Cav1.221 and cyclophilin22; 500 nmol/L for Kv4.223), AmpliTaq Gold DNA polymerase, and Taqman probes (100 nmol/L) tagged at the 5' end with the fluorescent molecule 6-carboxyfluorescein (5'-FAM) containing the fluorescent quencher moiety 6-carboxytetramethylrhodamine (3'-TAMRA) in 3'. Each measurement was performed in triplicate.
Statistics
Data are presented as mean±SEM and were analyzed with either an unpaired t test or ANOVA. P<0.05 was considered significant.
| Results |
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One week after surgery, VC (Figure 1A) and Cm (see below) were similar in myocytes isolated from post-MI and sham-operated rats, indicating that cellular hypertrophy had not occurred at this stage. Three weeks after MI, myocytes were hypertrophied: VC (Figure 1D) and Cm (see below) were increased significantly. In contrast, the AP was prolonged already after 1 week (Figure 1B), and this lengthening was maintained with hypertrophy development (Figure 1E). APDs were consistently lengthened from 20% of repolarization 1 and 3 weeks after MI (Figure 1C and 1F, respectively). The zero-current potential (ER) and AP amplitude were similar among all groups (data not shown).
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To determine the ionic basis involved in this APD prolongation, we examined ICa and Ito. After 1 week, ICa amplitudes were substantially larger in post-MI than in sham myocytes (inserts in Figure 2A). Normalized to Cm, the increase of ICa densities was statistically significant in the 10- to +20-mV voltage range (Figure 2A). No changes in voltage-dependent availability were observed (Figure 2B). Neither the potential of half-inactivation (V0.5: 25.4±1.7 versus 24.8±1.4 mV for 5 post-MI versus 5 sham, respectively) nor the slope factor (k: 7.8±1.4 versus 8.5±1.6 for post-MI versus sham, respectively) was changed. However, a significant acceleration of activation rates was observed in 1-week post-MI myocytes (Figure 2C). Over the 10- to +20-mV range, the time to peak values (tpeak), determined as the time from onset of depolarization to the time of maximal current amplitude, were significantly reduced. The inactivation kinetics were determined by fitting the decay phase of the current traces to a biexponential function. The fast time constants were significantly smaller in post-MI myocytes (in the 10- to +20-mV voltage range), whereas the slow ones were not affected (Figure 2D). The faster rates of activation and inactivation could be correlated to the increase in ICa.29 In 3-week post-MI myocytes, ICa density and kinetic properties had returned to control values (Figure 2E through 2H). Neither parameter of the availability curves was altered (in mV: 24.0±1.2 and 6.5±0.7 in 7 post-MI myocytes versus 25.5±0.8 and 8.9±1.1 in 7 sham myocytes for V0.5 and k, respectively; Figure 2F). The time courses of activation or inactivation were not affected 3 weeks after MI (Figure 2G and 2H).
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One week after MI, Ito amplitudes were reduced (inserts in Figure 3A) and then returned to normal 3 weeks after MI (inserts in Figure 3E). Ito densities were significantly decreased from 0 mV in post-MI myocytes (Figure 4A and 4E). There was no change in the voltage- and time-dependent properties of Ito. The availability curves of Ito were not altered (Figure 4B and 4F); V0.5 (in mV) and k values were increased: at week 1, they were 7.9±0.8 versus 9.0±0.6, and 7.3±0.7 versus 6.4±0.5, 17 post-MI versus 14 sham, respectively, and at week 3, they were 9.1±0.8 versus 9.6±0.6 mV, and 8.3±0.7 versus 7.5±0.6, 20 post-MI versus 21 sham, respectively. Furthermore, activation and inactivation rates were unchanged. The tpeak values were not different in any group (Figure 3C and 3G). The time constants of inactivation, best fitted by a monoexponential function, were not altered (Figure 3D and 3H).
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To investigate the molecular mechanisms of the changes in ICa and Ito densities after MI, the expression level of mRNA corresponding to the
-subunits of Cav1.2 and Kv4.2, respectively, were quantitatively assessed by real-time RT-PCR. Data were normalized to the amount of mRNA coding for cyclophilin present in the same cell extracts. When expressed as a percentage of the mean amount of mRNA found in sham-operated cells in each experiment, we observed after 1 week a 24% increase in Cav1.2 mRNA (Figure 4A) and a 39% decrease in Kv4.2 mRNA (Figure 4B). By 3 weeks, molecular levels of both channels returned to their respective control levels (Figure 4C and 4D).
MR Activation Contributes to Electrical Remodeling in Post-MI Myocytes
To examine whether inappropriate activation of the MR plays a role during the early response to hypertrophy, we investigated the effect of the MR antagonist RU28318 on animals subjected to MI or sham operation (in 6 versus 5 animals at 1 week and in 4 versus 4 animals at 3 weeks, MI versus sham, respectively). Although it interacts in vitro with the glucocorticoid receptor, RU28318 has been used as a selective MR antagonist because it is rapidly converted in vivo into its
-lactone form, which is highly selective for MR.30 Infarct size was similar in the post-MI treated groups compared with untreated groups. RU28318 treatment did not have any effect on Cm after 1 week (Figure 2A), whereas it blunted the increase in Cm in post-MI myocytes 3 weeks after surgery. RU28318 also prevented lengthening of the APD (Figure 5B). AP area, evaluated by integration of voltage variation over time, increased significantly, reflecting APD lengthening in post-MI myocytes, because neither AP amplitude nor ER was modified. At both weeks 1 and 3, RU28318 treatment blunted the AP prolongation. The ICa density-voltage relations were fitted with a function to estimate the maximal conductance (GmaxICa).10 The significant increase of GmaxICa in the 1-week post-MI group was blunted by RU28318 treatment, which did not have any effect on GmaxICa in the sham group or in the myocytes 3 weeks after MI (Figure 5C). The effect of RU28318 treatment on Ito was determined on slope conductances (GsIto) estimated by linear fitting of the current densityvoltage relations from +10 to +60 mV. Compared with sham-operated groups, mean GsIto was decreased significantly after MI at 1 and 3 weeks (Figure 2D). This effect was prevented by treatment with RU28318, which also blunted Cav1.2 and Kv4.2 mRNA alterations (data not shown).
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AC Alters Ionic Currents Before Cellular Hypertrophy Develops
To investigate whether early electrical remodeling is specific to the post-MI model, we examined the well-established AC model19 by using approaches similar to those in the post-MI model. To minimize electrophysiological heterogeneity, we selected cells from the LV apex.19 Hypertrophy was not evident until 3 weeks after surgery (heart weighttobody weight ratios [in mg/g] of AC versus sham-operated rats, respectively, were 4.67±0.1 [n=8] versus 4.61±0.1 [n=10] at week 1 and 5.10±0.1 [n=12] versus 4.51±0.1 [n=11] at week 3; P<0.005). Whereas there was no change in Cm or VC at week 1 (Figure 6A), significant increases were observed 3 weeks after AC (Figure 6D). As in the post-MI model, AC myocytes also showed AP prolongation after 1 week, whereas no change in ER or AP amplitude was detected. At week 1, an increase in ICa and a decrease in Ito (Figure 6A through 6C) might explain the AP prolongation. No changes in ICa or Ito activation or inactivation were observed (data not shown). This could indicate an increase in the number of Ca2+ channels and a decrease in the number of Ito channels. Consistently, the increase in ICa induced by ß-adrenergic stimulation was similar in sham and AC animals. At 0 mV, 1 µmol/L isoproterenol increased ICa by 175±20% (n=5) versus 174±10% (n=11) in AC versus sham myocytes, respectively. Three weeks after AC, cellular hypertrophy had normalized the elevated ICa values to control levels, whereas Ito density remained reduced.
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| Discussion |
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Our results are consistent with published work on electrical remodeling studied at different periods during the development of hypertrophy.12,13,19,24 Most importantly, our data show that electrical remodeling occurs before cellular hypertrophy development. AP prolongation at the early stages of cardiac hypertrophy may be linked to the upregulation of ICa and the downregulation of Ito. Later, once cellular hypertrophy is established, only reduced Ito persists, whereas ICa values regain control levels. After 3 weeks, the decrease in repolarizing Ito would result in AP prolongation. This repolarization rate slowing would enhance ICa activation, which in turn modulates APD.31 This hypothesis does not exclude that concomitant changes in other currents may also be involved in AP prolongation.13 The reported changes in ICa and Ito are rather controversial. A downregulation in Ito is generally reported, whereas an increased, a decreased, or an unchanged ICa have been described.13,14,32 These discrepancies may reflect differences in etiology, species, nature of analyses, experimental conditions, and even more important, the stage of disease.14 Our data support the last hypothesis, because they show that ICa increases at early stages and returns to control values once cellular hypertrophy becomes established. Whereas we observed a downregulation of Kv4.2 genes and currents before manifest hypertrophy occurred, only the Ito density decrease persisted with cellular hypertrophy. We suggest that this might reflect a Ca2+ dependence on Ito regulation, as has been noted for aldosterone regulation.11 After 3 weeks, when ICa regained control levels, the absence of a net regulation of the Kv4.2 gene and current magnitude rendered a decrease in density related to the increase in cell size. However, we cannot exclude the possibility that other processes, such as alterations of protein trafficking, come into play.
Taken together, our results show that electrical remodeling precedes cellular hypertrophy, independently of the so-called mechanoconversion,1 and might be one of the primary factors.14,17,32 In this regard, calcineurin, which triggers the hypertrophic response,33 is a Ca2+-dependent phosphatase. Hence, an increase in Ca2+ signaling must precede calcineurin activation to initiate hypertrophy. In the present work, using 2 different models of cardiac hypertrophy, we have shown that AP prolongation, which enhances Ca2+ influx, precedes cardiac hypertrophy. This early enhancement may be responsible for initiating the hypertrophic response. For example, cardiac-specific overexpression of L-type Ca2+ channels resulted in an increased Ca2+ influx and enhanced basal contractility in mice at 8 weeks of age34 and progressed to cardiomyopathy by 8 months of age.17 The signal that induces the increase in L-type Ca2+ channel gene transcription might be at the origin of hypertrophy. We thus suggest that early after an insult, there are neurohormonal signals that induce the Ca2+ influx increase and activate gene transcription, thereby triggering cardiac hypertrophy.
The role of inappropriate MR activation, as an independent contributor to cardiovascular injury, has been suggested by numerous studies. Collectively, different animal35 and clinical4 studies have emphasized the pathophysiological cardiac role of MRs. One of the more striking results of the resurgent use of the aldosterone-blocking agent spironolactone or its analogue eplerenone to treat patients with systolic LV dysfunction has been a reduction in the incidence of arrhythmias, which have been mainly related to fibrosis.4,8,9,35 However, other protective mechanisms have been underscored. Aldosterone is the major regulator of body ion homeostasis. In this regard, we recently established in vitro that aldosterone decreases Ito secondary to enhanced Ca2+ signaling,11 which probably arises from the aldosterone-induced upregulation of ICa.10 In the present study, the MR antagonist RU28318 blunted early electrical remodeling. Moreover, spironolactone is also a powerful blocker of ICa on vascular smooth muscle cells.36 We suggest that, besides fibrinogenesis, MR activation has a crucial role in electrical remodeling early after myocardial insult and before morphological remodeling. These early changes in ionic currents might open new therapeutic perspectives.
| Acknowledgments |
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| Footnotes |
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