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(Hypertension. 2005;45:288.)
© 2005 American Heart Association, Inc.
Scientific Contributions |
From the Centro de Investigaciones Cardiovasculares, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Argentina.
Correspondence to Dr Ernesto A. Aiello, Centro de Investigaciones Cardiovasculares, Facultad de Ciencias Médicas, UNLP, 60 y 120 (1900) La Plata, Argentina. E-mail aaiello{at}atlas.med.unlp.edu.ar
| Abstract |
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Key Words: contraction ion channels endothelin
| Introduction |
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20%, the positive inotropic effect (PIE) is entirely attributable to activation of the reverse mode of the Na+/Ca2+ exchanger (NCX).5 This increase in contractility is similar in magnitude to that detected during the slow force response of myocardial stretch.68 A sustained increase in intracellular Ca2+ through the NCX reverse mode induced by an increase in intracellular Na+ (Na+i) produced by the activation of the Na+/H+ exchanger (NHE) may represent the signaling link between this transporter and cardiac hypertrophy.911 In fact, we demonstrated recently that this mechanism is responsible for the increase in contractility induced by ET-1.5 We proposed that ET-1 activates the NHE, which increases Na+i and shifts the NCX reversal potential (ENCX) to a more negative voltage. These changes give more time for NCX to operate in reverse mode during the action potential and promote Ca2+ influx to the cell, determining the increase in force.5 It is well known that activation of protein kinase C (PKC) is a downstream pathway of ET-1 receptor binding.4 Consistently, it has been shown that PKC phosphorylates the NCX protein after ET-1 stimulation.12 Moreover, a direct PKC-dependent increase in the NCX current (INCX) induced by ET-1 in guinea pig myocytes was reported previously.13 Thus, the possibility exists that a direct effect of ET-1 on NCX could also contribute to the PIE of this peptide after NCX is driven to the reverse mode by the mandatory increase in Na+i produced by activation of the NHE. In other words, the increase in Na+i could be a necessary but not exclusive condition to mediate the ET-1induced Ca2+ influx through the NCX reverse mode. The investigation of this hypothesis constitutes the main purpose of the present study.
The overall results obtained herein allow us to suggest that the cardiac NCX reverse mode is modulated by ET-1 through 2 different pathways: (1) an Na+i-dependent one, consistent with a negative shift of ENCX after a rise in Na+i attributable to the NHE activation; and (2) an Na+i-independent and PKC-dependent NCX stimulation. Both pathways appear to contribute to the ET-1induced PIE. However, the latter seems to contribute to this effect only after primary participation of the former, which appears to be a mandatory step.
| Materials and Methods |
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Cat papillary muscles were used for registering developed force, intracellular pH (pHi), and Na+i measurements, and isolated cat ventricular myocytes were used for patch-clamp experiments. Na+i and pHi were determined by epifluorescence. A detailed description of these techniques is presented in an expanded Materials and Methods section, available online at http://www.hypertensionaha.org.
Experimental Protocols
To analyze the above-mentioned hypothesis, 3 different experimental approaches were assayed in the present work. (1) We compared the increase in Na+i and force promoted by ET-1 to those induced by partial inhibition of the Na+/K+ATPase; (2) We tested the ability of ET-1 to induce a PIE after driving the NCX in reverse mode by increasing Na+i through the partial inhibition of the Na+/K+ ATPase in the presence of NHE blockade; and (3) We evaluated the effects of ET-1 on outward INCX in the presence and absence of NHE inhibition.
Pharmacological Interventions
HOE642 (1 µmol/L) was used to inhibit the NHE, KB-R7943 (5 µmol/L), to inhibit the NCX reverse mode, and chelerythrine (1 µmol/L), to block PKC activation.
Statistics
Data are expressed as mean±SEM. To detect significant differences, paired or unpaired t test or repeated-measures 1-way ANOVA followed by Student NewmanKeuls as post hoc test were used as appropriate. A P<0.05 was considered to indicate significant differences.
| Results |
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Although these experiments are suggesting that the PIE of this ET-1 dose is entirely attributable to stimulation of the NCX reverse mode, the possibility exists that the compound used for blocking this NCX operation mode would be acting on other mechanisms. However, as shown in Figure 2, this was not the case. We were unable to show any effect of KB-R7943 (5 µmol/L) on contractility under our control conditions (Figure 2A). These results also indicate that the NCX reverse mode does not contribute to basal contractility. KB-R7943 even failed to affect contractility after increasing it by enhancing extracellular Ca2+ concentration in a magnitude enough to increase developed force by
20% (Figure 2B), which is the effect produced by the dose of ET-1 used in the present work.
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To test the possibility that in addition to the Na+i-dependent mechanism, there is also a direct stimulatory effect of ET-1 on NCX, pilot experiments in which an increase in Na+i promoted by partial inhibition of the Na+/K+ ATPase with ouabain were performed. Although no systematic studies were done to establish the relationship between the increase in Na+i and developed force in our preparations, no consistent relationship between both parameters was found after 1, 2, or 5 µmol/L ouabain (data not shown). These results might be explained by nonspecific effects of this compound15,16 or failure to select the right dose. Then we decided to increase Na+i by partial inhibition of the Na+/K+ ATPase by lowering extracellular K+ (K+o). Figure 3 shows that when Na+i was increased by this maneuver, the increase in developed force showed a linear relationship with Na+i. This increase in developed force was blunted by KB-R7943 (5 µmol/L; Figure 3, inset), indicating that it was attributable to activation of the NCX reverse mode. However, when the Na+i levels were augmented by ET-1induced activation of NHE, the increase in force lies above this relationship. Therefore, for a given Na+i, the increase in developed force was greater when the increase in Na+i was attributable to ET-1 than when it was induced by low K+o. This finding suggests that ET-1 is driving the NCX in reverse mode by increasing Na+i by NHE activation, but it also has additional effects favoring the Ca2+ influx through NCX.
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If ET-1 is directly stimulating NCX through a PKC pathway,12,13 and this mechanism is inducing additional effects to NHE activation, we should detect a further increase in developed force at higher-than-normal Na+i and under NHE blockade. Figure 4 shows that this was the case. After the low K+o-induced PIE and despite the NHE inhibition, an additional increase in force was now evident when ET-1 was added to the extracellular solution (Figure 4A). KB-R7943 reversed both PIEs, that of low K+o and that of ET-1, indicating that they were attributable to activation of the NCX reverse mode. On average, ET-1 induced an increase of developed force of 10.8±0.4% with respect to the steady-state value obtained with low K+o (Figure 4B). To confirm that this ET-1induced PIE is Na+i independent, we performed additional experiments in which we simultaneously recorded force and Na+i (Figure 5). A similar pharmacological protocol of Figure 4 was followed, but in this case, instead of KB-R7943, the PKC inhibitor chelerythrine (1 µmol/L) was added after the ET-1induced PIE reached a steady-state level. Figure 5 clearly shows that under these experimental conditions, ET-1 produces a PIE in the absence of changes in Na+i and that this increase in contractility is completely reversed by PKC inhibition. These overall results indicate that ET-1 is able to induce a PKC-dependent PIE in the presence of NHE inhibition only after the increase in Na+i produced by low K+o, which drives the NCX to the reverse mode. These experiments also indicate that part of the PIE of ET-1 is Na+i independent and thus unrelated to the change in ENCX produced by the increase in Na+i.
If there are changes induced by ET-1 occurring through the NCX in reverse independent of the alterations in the ENCX, we should detect changes in the INCX insensitive to NHE blockade. Thus, we next recorded whole-cell currents evoked by depolarizing steps between 80 and +80 mV in 10-mV increments from a holding potential of 40 mV. Figure 6A shows the average current-voltage (I-V) relationship for INCX before and after addition of ET-1 to the bath solution. A statistically significant ET-1induced enhancement in outward INCX was observed at potentials higher than 10 mV with 1 nmol/L ET-1 and at potentials higher than 40 mV with 10 nmol/L ET-1. A significant increase in inward INCX was also observed at 70 and 80 mV with 10 nmol/L ET-1. A linear fitting of the individual data points of the I-V for each cell was performed to detect the 0 current level of INCX, representing ENCX, in the absence and presence of ET-1. ET-1 dose-dependently produced a significant ENCX negative shift (Figure 6B).
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To evaluate whether the ET-1induced ENCX negative shift was attributable to an increase in Na+i secondary to the activation of the NHE, experiments in the presence of HOE642 were performed. Figure 6C shows the effect of HOE642 on the average I-V for INCX before and after the addition of ET-1 to the bath solution. A statistically significant ET-1induced enhancement in outward INCX was observed at potentials >+40 mV with 1 nmol/L ET-1 and at potentials higher than 30 mV with 10 nmol/L ET-1. A significant increase in inward INCX was also observed at 70 and 80 mV with 10 nmol/L ET-1. HOE642 did not affect basal INCX (Figure 6A and 6C). No shift in ENCX was observed in the presence of HOE642 (Figure 6D), indicating that the ET-1induced negative shift observed in the absence of this inhibitor was attributable to the increase in Na+i generated by activation of NHE. No significant changes in basal ENCX were observed with the NHE inhibitor (39.2±5.4 and 49.5±5.1 in the absence [n=8] and presence of HOE642 [n=9], respectively).
To further analyze the net effect of ET-1 on NCX, we compared the relative increase in INCX induced by ET-1 in the absence and presence of the NHE inhibitor. ET-1 induced a greater augmentation of INCX in the absence of HOE642 than in the presence of this NHE inhibitor (at 0 mV with 10 nmol/L ET-1; 3.5±0.8- and 1.9±0.5-fold increase in the absence [n=8] and presence of HOE642 [n=9], respectively; P<0.05). The most likely interpretation of these results is that when the ENCX negative shift was prevented by HOE642, stimulation of the NCX reverse mode was limited to the direct effect of ET-1 on NCX. On the other hand, when Na+i was allowed to rise in the absence of NHE inhibition, both effects of ET-1 on the NCX were evident: the increase in the driving force for the reverse mode induced by the ENCX negative shift and direct stimulation of NCX.
| Discussion |
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These results strongly suggest that factors affecting the NCX reverse mode other than the increase in Na+i and the consequent ENCX negative shift are participating when the increase in force is mediated by ET-1. In this regard, our electrophysiological experiments are indicating that ET-1 is also producing a direct stimulation of NCX. A phosphorylation of NCX by a PKC-dependent mechanism has been proposed12,13 and might represent the subcellular pathway leading to direct stimulation of this transporter. Consistently, we showed in the present work that PKC mediates the Na+i-independent PIE detected in the experiments in which ET-1 was applied after low K+o in the presence of NHE inhibition. The possibility that ET-1induced activation of different PKC isoforms may represent a common pathway for both, Na+i-dependent and -independent effects on NCX, constitutes an interesting hypothesis that deserves further research.
Taking into account the values of the ET-1induced ENCX negative shift detected in the present study and considering that Ca2+o, Ca2+i, and Na+o were 2 mmol/L, 200 nmol/L, and 140 mmol/L, respectively, the change in Na+i can be calculated with the equation: ENCX=3ENa2ECa, where ENa and ECa are the equilibrium potentials for Na+ and Ca2+, respectively. Thus, the values of the estimated increase in Na+i were 1.57±0.51 and 5.22±1.32 mmol/L for 1 and 10 nmol/L ET-1 (n=8), respectively. These values are of the same order of magnitude to those measured in the bulk of the cytosol by epifluorescence in papillary muscles after addition of 5 nmol/L ET-1 (Figure 1C). However, it is important to note that the increase in Na+i in the isolated myocytes might reflect changes of this ion in a space in which intracellular dialysis with the solution of the patch pipette cannot maintain the Na+ concentration at a constant level.
Although it is difficult to imagine how the increase in Na+i can only enhance the NCX reverse mode without slowing the forward mode, we would like to call attention to the fact that the selective inhibitor of the NCX reverse mode blunted the contractile response. However, we cannot completely rule out a contribution of a reduced forward mode of the NCX to the increase in Ca2+i.
Together, the results presented herein indicate that the cardiac NCX reverse mode is modulated by ET-1 through 2 different pathways: (1) a negative shift of ENCX after a rise in Na+i because of NHE activation, and (2) an increase in the turnover rate of the NCX units induced by a PKC-dependent pathway. Both pathways appear to contribute to the ET-1induced PIE. However, the increased turnover rate seems to contribute to this effect only after the change in ENCX produced by NHE activation, which appears to be a necessary step. The fact that basal levels of Na+i are increased in some myocardial diseases such as hypertrophy17,18 or heart failure18,19 permit the speculation that it would not be mandatory that the aforementioned mechanisms should take place in series. Thus, the relative contribution of these 2 pathways to the ET-1induced increase in contractility in pathological states is an interesting forthcoming perspective that deserves future attention.
Study Limitations
The main limitations of our study rely on the comparison of the contractile response with an increase in Na+i levels by 2 different interventions, namely ET-1 and low K+o. Although we demonstrated that both interventions increase contractility by NCX in reverse, and that for a given increase in Na+i, ET-1 induced a greater increase in contractility than inhibition of the Na+/K+ ATPase, the following possibilities should be analyzed: (1) Despite an equal Na+i in the bulk of the cytosol, the increase of Na+i induced by ET-1 would be higher in a fuzzy space close to NCX. However, a colocalization of NCX and NHE,20,21 and also of NCX and the Na+/K+ ATPase,22 have been reported; (2) ET-1 could induce a greater prolongation of the action potential duration (APD) than low K+o, then the influx of Ca2+ through the NCX reverse mode would be greater than that induced by Na+/K+ ATPase inhibition. Although the increase in APD by ET-1 has been reported,23,24 low K+o can also induce a prolongation of APD,25 and the differences between both interventions are difficult to evaluate; (3) The way selected by us to increase Na+i (low K+o), by hyperpolarizing the cell, may promote Ca2+ efflux through the forward mode of NCX, thus reducing PIE. However, no negative inotropic effect was observed after complete block with KB-R7943 of the low K+o-induced PIE (Figure 3, inset); and (4) The increase in Na+i produced by either ET-1 or inhibition of the Na+/K+ ATPase may affect regulation of ion channels (ie, Na+-activated K+ channels26) and alter membrane potential. However, in our experiments, these potential effects of increased Na+i unlikely influence the contractile behavior because the PIE induced by ET-1 or Na+/K+ ATPase inhibition was completely cancelled by selective inhibition of the NCX reverse mode.
| Acknowledgments |
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Received September 17, 2004; first decision October 4, 2004; accepted November 29, 2004.
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