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(Circulation. 1995;92:1612-1618.)
© 1995 American Heart Association, Inc.

Articles

Response of Failing Canine and Human Heart Cells to ß₂-Adrenergic Stimulation

Ruth A. Altschuld, PhD; Randall C. Starling, MD; Robert L. Hamlin, DVM; George E. Billman, PhD; James Hensley, BS; Lourdes Castillo, BS; Richard H. Fertel, PhD; Charlene M. Hohl, PhD; Pierre-Marie L. Robitaille, PhD; Larry R. Jones, MD, PhD; Rui-Ping Xiao, MD, PhD; Edward G. Lakatta, MD

From the Departments of Medical Biochemistry (R.A.A., J.H., L.C., C.M.H.), Physiology (G.E.B.), Pharmacology (R.H.F.), Radiology (P.-M.L.R.), Internal Medicine (Division of Cardiology) (R.C.S.), and Veterinary Physiology and Pharmacology (R.L.H.), Ohio State University, Columbus; Krannert Institute of Cardiology, University of Indiana, Indianapolis (L.R.J.); and the Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, Baltimore, Md (R.-P.X., E.G.L.).

Correspondence to Dr Ruth A. Altschuld, Ohio State University, Department of Medical Biochemistry, 333 Hamilton Hall, 1645 Neil Ave, Columbus OH 43210-1218. E-mail raltschu@magnus.acs.ohio-state.edu.

	Abstract

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Background Failing human hearts lose ß₁- but not ß₂-adrenergic receptors. In canine hearts with tachypacing failure, the ratio of ß₂- to ß₁-adrenergic receptors is increased. The present study was designed to determine whether heart failure increases sensitivity to ß₂-adrenergic stimulation in isolated canine ventricular cardiomyocytes and to verify that myocytes from failing human ventricles contain functional ß₂-adrenergic receptors.

Methods and Results Myocytes from healthy dogs, dogs with tachypacing failure, and human transplant recipients were loaded with fura 2-AM and subjected to electric field stimulation in the presence of zinterol, a highly selective ß₂-adrenergic agonist. Zinterol significantly increased [Ca²⁺]_i transient amplitudes in all three groups. The failing canine myocytes were significantly more responsive than normal to ß₂-adrenergic stimulation. We also measured isotonic twitches, indo-1 fluorescence transients, and L-type Ca²⁺ currents in healthy canine myocytes. Zinterol (10^-5 mol/L) elicited large increases in the amplitudes of simultaneously recorded twitches and [Ca²⁺]_i transients. Zinterol also increased L-type Ca²⁺ currents in the normal canine myocytes; this augmentation was abolished by 10^-7 mol/L ICI 118,551. cAMP production by suspensions of healthy and failing canine myocytes was not increased by zinterol (10^-9 to 10^-5 mol/L), nor did 10^-5 mol/L zinterol elicit phospholamban phosphorylation.

Conclusions Failing human ventricular cardiomyocytes contain functional ß₂-adrenergic receptors. Canine myocytes also contain functional ß₂-adrenergic receptors. The canine ventricular response to ß₂-agonists is increased in tachypacing failure. Positive inotropic responses to ß₂-stimulation are not mediated by increases in cAMP or cAMP-dependent phosphorylation of phospholamban.

Key Words: calcium channels • cells • heart failure • myocardial contraction • receptors, adrenergic, beta • sarcoplasmic reticulum

	Introduction

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ß-Adrenergic stimulation increases the rate and force of myocardial contraction and enables the heart to respond appropriately to increased peripheral demands. Although there are several different types of ß-adrenergic receptors (ßAR), it had been thought that those in the myocardium are primarily the ß₁ subtype (ß₁AR). However, strong evidence is now available that ventricular muscle cells (myocytes) also contain functional ß₂-adrenergic receptors (ß₂AR).^{1 2 3 4 5} Because the reduced contractile function characteristic of chronic heart failure in humans is accompanied by a substantial loss of ß₁AR with little or no loss of ß₂AR,^{1 6 7} the potential role of ß₂AR for improving cardiac performance has received considerable attention.⁸

To better characterize myocardial ß₂AR receptor responses, we examined the effects of zinterol, a highly selective ß₂AR partial agonist, on healthy and failing canine cells. We chose to investigate the canine model of heart failure because of the many similarities between canine and human myocytes, both of which are from large, slow-heart-rate mammals. We also examined the effects of zinterol on failing human myocytes.

	Methods

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Canine Heart Failure
Rapid pacing heart failure was induced in six mongrel dogs. Under general anesthesia with ketamine-diazepam-halothane, a bipolar pacing catheter was advanced percutaneously through the left jugular vein so that the electrode tip could be screwed into the endocardium of the right ventricle near its apex. The catheter was attached to a Medtronic 8320 pacemaker carried by the dog in a protective cervical collar. The ventricle was paced with a pulse of 0.5 ms at 2.5 V and 240 beats per minute. Each week, the pacemaker was turned off briefly, and ventricular function during sinus rhythm was assessed by left ventricular shortening fraction and the presence of an S₃ gallop. The degree of cardiomegaly and pulmonary congestion and/or edema was assessed radiographically. All dogs had slightly reduced ventricular function by week 1, and all dogs were in moderately severe to severe heart failure by week 5. This heart failure was manifested by tachycardia, an S₃ gallop, ascites, exercise intolerance, a shortening fraction of approximately 10% (normal, >25%), and severe cardiomegaly and pulmonary congestion, usually with pulmonary edema. After 5 weeks of rapid pacing, dogs were killed with an overdose of sodium pentobarbital, and their hearts were removed for isolation of ventricular cardiomyocytes. Seven healthy dogs served as controls. Myocytes were prepared from four additional healthy dogs for studies not involving a comparison between healthy and failing cells. All procedures conformed to the guiding principles of the American Physiological Society and were approved by the Institutional Laboratory Animal Care and Use Committee.

Explanted Human Ventricles
Five failing human hearts were obtained at the time of cardiac transplant. Two hearts were from patients with dilated cardiomyopathy and three were from patients with coronary artery disease. The Table describes each individual patient.

View this table: [in this window] [in a new window]   Table 1. Patient Characteristics

Myocyte Isolation
Canine and human myocytes were isolated in Columbus, Ohio, by use of segmental collagenase perfusion as described previously.^{9 10} Healthy canine cells were sent by overnight mail to Baltimore, Md, where measurements of L-type Ca²⁺ currents, indo-1 fluorescence transients, and unloaded shortening were made.

[Ca²⁺]_i-Dependent Fura 2 Fluorescence Ratio Transients
Canine and human cells in Columbus were loaded with 5 µmol/L fura 2-AM for 5 minutes, postincubated for 1 hour at room temperature, superfused with bicarbonate-buffered Krebs-Henseleit, pH 7.4, at 37°C, and field stimulated at 0.2 Hz with parallel platinum electrodes.¹¹ Fluorescence measurements, with excitation alternating between 340 and 380 nm, were obtained with a PTI filterscan. Because cells loaded with fura 2-AM accumulate Ca²⁺-sensitive dye in the mitochondria,¹² accurate calibration of the cytosolic dye signal is problematic. Data are therefore presented as the ratios of fluorescence intensity at 340- and 380-nm excitation. The amplitude and configuration of the fura 2 ratio transients are thought to reflect accurately the magnitude and time course of changes in cytosolic free [Ca²⁺].

Unloaded Shortening and Indo-1 Transients
Myocytes were loaded with the fluorescent Ca²⁺ probe indo-1 as described by Xiao and Lakatta.¹³ Cells were placed on the stage of a modified inverted Zeiss microscope equipped for simultaneous recording of indo-1 fluorescence and cell length and were superfused with HEPES-buffered Krebs-Henseleit at 23°C.

L-Type Ca²⁺ Currents
Canine myocytes were placed on the stage of an inverted microscope and superfused with HEPES buffer consisting of (mmol/L) CaCl₂ 1.0, NaCl 137, CsCl 5, dextrose 15, MgCl₂ 1.3, and HEPES 20; pH was adjusted to 7.4 with NaOH. Low-resistance (1.8 to 2 M) patch pipette electrodes were filled with a solution containing (mmol/L) CsCl 120, HEPES 20, MgCl₂ 5, NaCl 10, EGTA 5, and MgATP 3; pH was adjusted to 7.2 with CsOH. All experiments were performed at room temperature. Membrane current was recorded in the whole-cell configuration with a discontinuous switch clamp on an Axoclamp amplifier (Axon Instruments) and controlled by a Vax 11/730 computer with an LPA-1 Lab Interface. The computer was also used to acquire (2 kHz), store, and analyze the cell length and the membrane current. The membrane current was measured as the difference between the peak of inward current and the current at the end of the 200-ms pulse. To inactivate sodium current, cells were voltage clamped at -40 mV, and 200-ms depolarizing test pulses to +20 mV were applied at 0.5 Hz.

Measurement of cAMP in Suspensions of Intact Canine Myocytes
Suspensions of canine myocytes (0.4 mg protein/mL) were incubated for 5 minutes at 37°C with the indicated concentration of zinterol or isoproterenol. Cells were then separated from their suspending medium and simultaneously extracted by rapid centrifugation through a layer of bromododecane into 2N perchloric acid. The acid extracts were neutralized with Freon-trioctylamine, and cAMP content was analyzed by radioimmunoassay as described by Hohl and Li.⁹

Phospholamban Immunoblotting
The degree of phospholamban phosphorylation was detected by its characteristic mobility shift on SDS-PAGE.¹⁴ Cells were incubated 5 minutes with the indicated drug, dissolved in SDS (10% final concentration), and shipped on dry ice to Indianapolis, Ind. Samples (80 µg myocyte protein per lane) were electrophoresed on a 7% to 18% polyacrylamide gradient and transferred to nitrocellulose in 50 mmol/L phosphate, pH 7.4, at 3 A for 90 minutes. The nitrocellulose sheet was blotted with BSA and then incubated with phospholamban monoclonal antibody 2D12 at a 1:500 dilution. Antibody binding was detected colorimetrically with alkaline phosphatase–coupled protein A (Sigma Chemical Co) and bromochloroindolyl–nitro blue tetrazolium (Promega).

Data Analysis
All dose response curves were fitted by use of GRAPHPAD INPLOT. Tests for statistically significant differences between groups used Microsoft EXCEL and a two-tailed Student's t test. A value of P<.05 was considered statistically significant.

	Results

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Zinterol Effects on Normal Canine Cells
In healthy canine myocytes superfused at 23°C, 10^-5 mol/L zinterol increased the amplitude of the isotonic twitch and ([Ca²⁺]_i)-dependent indo-1 ratio transient (Fig 1). These effects were due, at least in part, to activation of L-type Ca²⁺ currents. Zinterol produced a substantial rise in nifedipine-sensitive Ca²⁺ currents in patch-clamped myocytes (Fig 2) that was fully reversed by the highly selective ß₂-antagonist ICI 118,551.

View larger version (21K): [in this window] [in a new window]   Figure 1. Representative traces showing a representative example of the effects of the ß2-adrenergic receptor agonist zinterol (ZINT) on the simultaneously recorded indo-1 fluorescence ratio and cell length of a healthy canine myocyte. The cell was loaded with indo-1/AM and field stimulated at 0.5 Hz, 23°C, in 1 mmol/L [Ca2+]o. Seven normal canine myocytes gave similar results.

View larger version (16K): [in this window] [in a new window]   Figure 2. Traces showing effects of zinterol (ZINT) on L-type Ca2+ channel current in a normal canine myocyte. The increase in L-type Ca2+ current was abolished by ICI 118,551 (ICI), and the current itself was abolished by nifedipine (NIPHED). Traces are representative of those from 5 cells.

Failing Canine Myocytes
To ascertain the effects of heart failure on canine myocytes, we compared fura 2 [Ca²⁺]_i transients in 15 healthy cells and 17 cells from dogs with tachypacing heart failure. The mean baseline fluorescence ratio for the healthy cells was 1.68±0.09 compared with 1.45±0.09 for those from failing hearts. This difference was not statistically significant. The mean increase in the fluorescence ratio during electric field stimulation without added drugs was 0.54±0.02 for cells from healthy hearts and 0.56±0.03 for cells from dogs with rapid pacing failure. The [Ca²⁺]_i transient duration tended to be longer in the failing myocytes (compare Figs 3 and 4), but the difference was not statistically significant when the data from all cells were analyzed.

View larger version (15K): [in this window] [in a new window]   Figure 3. Traces showing typical effects of increasing concentrations of zinterol on [Ca2+]i-dependent fura 2 ratio transients in a single healthy canine myocyte. Each [Ca2+]i transient resulted from the signal averaging of 16 consecutive unsmoothed steady-state transients at 0.2 Hz. Signal-averaged [Ca2+]i transients for each treatment have been placed side by side along an arbitrary time dependent x axis for comparison. The time scale was held constant, with the distance between the ticks along the x axis equivalent to 5 seconds.

View larger version (15K): [in this window] [in a new window]   Figure 4. Traces showing typical effects of increasing concentrations of zinterol on [Ca2+]i-dependent fura 2 ratio transients in a single failing canine myocyte. Signal averaging and data presentation are as described in Fig 3.

ß₂AR activation with zinterol caused a dose-dependent abbreviation of the [Ca²⁺]_i transients and an augmentation of transient amplitude in both healthy (Fig 3) and failing myocytes (Fig 4). The failing cells were significantly more responsive to zinterol, especially at low concentrations of the drug (Fig 5).

View larger version (18K): [in this window] [in a new window]   Figure 5. Line graph summarizing [Ca2+]i transient amplitudes in healthy and failing canine myocytes treated with various concentrations of zinterol. Complete cumulative zinterol dose-response curves were obtained for each cell. There were 15 cells from 7 healthy dogs () and 17 cells from 6 failing dogs (). Data are mean±SEM. Differences between control and failing cells were statistically significant (P<.05) at 10-6 through 10-9 mol/L zinterol.

Because zinterol is a partial ß₂AR agonist, we investigated the effects of isoproterenol, a full but nonselective ßAR agonist, on [Ca²⁺]_i transients in 7 myocytes from two healthy dogs. Both ICI 118,551, a selective ß₂AR antagonist, and CGP-20712A, a selective ß₁AR antagonist, attenuated the effects of 100 nmol/L isoproterenol (Fig 6).

View larger version (27K): [in this window] [in a new window]   Figure 6. Bar graph showing effects of 100 nmol/L isoproterenol (Iso, open bar), 100 nmol/L isoproterenol plus 100 nmol/L ICI 118,551 (Iso+ICI, crosshatched bar), 100 nmol/L isoproterenol plus 300 nmol/L CGP-20712A (Iso+CGP, solid bar), and 100 nmol/L isoproterenol plus 100 nmol/L ICI 118,551 plus 300 nmol/L CGP-20712A (Iso+ICI+CGP, stippled bar) on [Ca2+]i transients in fura 2-AM–loaded canine myocytes. The data were from 7 myocytes from two healthy dogs.

cAMP Production
To characterize further the effects of ß₂AR stimulation, we examined the effects of zinterol on cAMP production by suspensions of healthy and failing canine myocytes. Intracellular cAMP did not increase significantly with any concentration of zinterol tested up to 10^-5 mol/L, despite a pronounced rise in cAMP when portions of the same cell suspensions were titrated with isoproterenol (Fig 7). In addition, 100 nmol/L ICI 118,551 did not significantly affect cAMP production in cells incubated with 100 nmol/L isoproterenol (Fig 8), whereas 300 nmol/L CGP-20712A reduced cAMP to a value only 25% greater than the control value.

View larger version (18K): [in this window] [in a new window]   Figure 7. Line graph showing effects of zinterol and isoproterenol on cAMP content of healthy and failing canine myocytes. All data are mean±SEM for 7 myocyte preparations in each group. All myocyte preparations were examined in parallel for their responses to isoproterenol and zinterol. None of the cAMP values for zinterol-treated cells were significantly different from their respective control values. cAMP production in the presence of isoproterenol was significantly greater (P<.05) in healthy vs failing cells at 10-7 through 10-5 mol/L. indicates healthy cells plus isoproterenol; , failing cells plus isoproterenol; , normal cells plus zinterol; and , failing cells plus zinterol.

View larger version (22K): [in this window] [in a new window]   Figure 8. Bar graph showing effects of 100 nmol/L isoproterenol (Iso, left bar), 100 nmol/L ICI 118,551 (Iso+ICI, middle bar), and 300 nmol/L CGP-20712A (Iso+CGP, right bar) on cAMP production by 4 preparations of healthy canine myocytes. Data are normalized to each respective control (mean, 8.73±1.03 pmol/mg myocyte protein) and are expressed as mean±SEM. *P<.05 vs Iso+ICI; **P<.01 vs Iso.

Phospholamban Phosphorylation
Phosphorylation of phospholamban decreases electrophoretic mobility, giving rise to multiple bands on SDS-PAGE.¹⁴ Our previous study of rat myocytes demonstrated that isoproterenol and norepinephrine but not zinterol produce multiple immunoreactive phospholamban bands.¹⁵ Similar results were obtained in the present study with canine myocytes: zinterol had no discernible effect on phospholamban phosphorylation, whereas isoproterenol-treated myocytes exhibited multiple phospholamban bands (Fig 9).

View larger version (23K): [in this window] [in a new window]   Figure 9. Blot showing phospholamban mobility shifts in canine myocytes incubated with 10-6 mol/L isoproterenol or 10-5 mol/L zinterol.

Despite the absence of increased cAMP or altered phospholamban mobility in the zinterol-treated canine myocytes, it is clear from Figs 3 and 4 that zinterol abbreviated the [Ca²⁺]_i-dependent fura 2 fluorescence transients. Such abbreviation of [Ca²⁺]_i transients is commonly associated with cAMP-dependent phosphorylation of phospholamban. However, as Fig 10 shows, [Ca²⁺]_i transients in healthy canine myocytes also were abbreviated by increases in extracellular [Ca²⁺].

View larger version (14K): [in this window] [in a new window]   Figure 10. Traces showing effects of varied [Ca2+]o on signal-averaged (n=8) steady-state (0.2 Hz) [Ca2+]i-dependent fura 2 ratio transients in a typical healthy canine myocyte. Note the abbreviation of time course as [Ca2+]o is increased. This experiment was conducted with a different light source and photomultiplier from those described in Figs 3 and 4, and the different baseline and peak fluorescence ratios are system-dependent. Signal averaging and data presentation are the same as described in Fig 3.

Human Myocytes
Although the canine myocyte is a useful model, direct studies in human myocytes are necessary to determine whether failing human ventricular muscle cells contain functional ß₂AR, which might prove clinically relevant. Accordingly, we measured [Ca²⁺]_i transients in myocytes isolated from the excised ventricles of five human transplant recipients. In right ventricular myocytes from patient 1, [Ca²⁺]_i transient amplitude was increased 50±3% with 10^-9 mol/L zinterol (n=4, mean±SEM) and 77±14% with 10^-8 mol/L zinterol (Fig 11). Note the biphasic [Ca²⁺]_i transient for the cell treated with 10^-8 mol/L zinterol (Fig 11C). This waveform is very common when failing human myocytes are stimulated at low frequency in the presence of catecholamines. Zinterol effects were completely abolished by 10^-7 mol/L ICI 118,551 (Fig 11D), confirming that the effects were mediated by the ß₂AR. In other cells from the same heart (n=3), where cumulative dose-response curves were obtained, the responses to 10^-9, 10^-8, and 10^-7 mol/L zinterol were nearly identical (ie, 148±8%, 145±8%, and 144±4% of control values, respectively). It was therefore impractical to obtain full dose-response curves such as those described for the canine cells.

View larger version (10K): [in this window] [in a new window]   Figure 11. Traces showing effects of zinterol and ICI 118,551 on [Ca2+]i transients in failing human myocytes. A, Control transient; B, 10-9 mol/L zinterol; C, 10-8 mol/L zinterol; D, 10-8 mol/L zinterol+10-7 mol/L ICI 118,551. Plots are representative signal-averaged steady-state transients (n=16) for a single cell challenged first with 10-8 mol/L zinterol (C) and then with 10-8 mol/L zinterol plus 10-7 mol/L ICI 118,551 (D) and a second cell treated only with 10-9 mol/L zinterol (B). The two cells were chosen because of their nearly superimposable baseline [Ca2+]i transients. Signal averaging and data presentation are as described in Fig 3.

In 7 myocytes from two other explanted hearts, we tested the effects of both ICI 118,551 and CGP-20712A on the response to zinterol. First, the cells were challenged with zinterol followed by washout of the drug. Next, the cells were exposed to zinterol plus either ICI 118,551 or CGP-20712A. This was again followed by drug washout and a subsequent superfusion with zinterol plus the second antagonist. We alternated the order in which cells were exposed to ICI 118,551 or CGP-20712A. Fig 12 shows results for a typical cell from patient 4. CGP-20712A had no effect on [Ca²⁺]_i transient amplitude, whereas ICI 118,551 again abolished the stimulatory effect of 10 nmol/L zinterol.

View larger version (13K): [in this window] [in a new window]   Figure 12. Traces showing effects of 10 nmol/L zinterol (ZIN), 300 nmol/L CGP-20712A (CGP), and 100 nmol/L ICI 118,551 (ICI) on signal-averaged [Ca2+]i transients from a typical failing human myocyte.

The Table summarizes the effects of 10^-8 mol/L zinterol on [Ca²⁺]_i transient amplitudes for all cells studied from each explanted heart. The number of cells examined from each heart is given in parentheses.

	Discussion

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The recent overexpression of the human ß₂AR gene in transgenic mouse hearts has been hailed as the first step toward a gene therapy approach to heart failure,⁸ but difficulties could arise from our incomplete understanding of ventricular ß₂AR signal transduction, especially in the hearts of larger mammals. There are substantial differences between large and small mammals with respect to the ability of ß₂AR to regulate myocardial contractility. Possible disease-related alterations in this pathway must also be explored.

Early studies with rat ventricular cardiomyocytes suggested that ß₂AR arising from nonmuscle cells accounted for nearly all ß₂AR in rat heart homogenates.¹⁶ More recently, however, Xiao and Lakatta¹³ demonstrated that isolated rat ventricular cardiomyocytes are responsive to ß₂AR stimulation, albeit in a manner different from that commonly associated with ß₁AR stimulation.¹⁵ The threshold concentration for ß₂AR stimulation of myocyte contractility in rat ventricular myocytes is relatively high (ie, >10^-7 mol/L zinterol).

By contrast, in canine myocytes, the threshold zinterol concentration for stimulation of [Ca²⁺]_i transient amplitudes was <10^-9 mol/L (Figs 3 and 4). Another novel and important finding of the present study was that failing canine myocytes were significantly more responsive than healthy cells to the stimulatory effects of zinterol. This enhanced sensitivity of failing versus healthy myocytes to ß₂AR stimulation agrees with the observation of Kiuchi et al¹⁷ that ß₂AR-ß₁AR ratios are increased in ventricular membrane preparations from dogs with rapid pacing heart failure. It remains to be established whether ß₂AR sensitivity is enhanced in other forms of heart failure.

ß₂AR Effects in Human Myocytes
Human myocytes, like canine cells, appeared to be quite responsive to ß₂AR stimulation. A number of investigators demonstrated positive inotropic effects of ß₂AR stimulation at relatively low agonist concentrations in multicellular^{1 2 3} and single-cell preparations¹⁸ from explanted human hearts. The results of the present study confirm and extend those observations by showing that the highly selective ß₂AR agonist zinterol can elicit significant increases in [Ca²⁺]_i transient amplitude in isolated failing human ventricular cardiomyocytes. In isolated cells, potential complications attributable to catecholamine release from endogenous stores are eliminated, whereas the use of a selective ß₂AR agonist should eliminate any residual concerns relative to the specificity of selective antagonists. The inability of the highly selective ß₁AR antagonist CGP-20712A to inhibit the effects of zinterol lends further support to the argument that failing human ventricular myocytes contain functional ß₂ARs.

Signal transduction for both ß₁AR and ß₂AR is generally thought to occur primarily through cAMP. But although ß₂AR stimulation clearly activates adenylyl cyclase in some systems, Brodde et al¹⁹ noted that zinterol does not stimulate cAMP production by membrane fragments from human cardiac muscle. This observation initially raised the possibility that inotropic effects of ß₂AR might be cAMP-independent.

Effects of ßAR Stimulation on [Ca²⁺]_i Transient Duration
In rat myocytes, ß₂AR stimulation increases the [Ca²⁺]_i transient amplitude but, unlike isoproterenol, does not abbreviate its time course¹³ or increase phospholamban phosphorylation.¹⁵ While zinterol causes some accumulation of cAMP in rat myocytes, the maximum elevation of the membrane-bound pool of cAMP by ß₂AR is only half that induced by ß₁AR stimulation. Therefore, in rat myocytes, there is good evidence for a dissociation between activation of adenylyl cyclase and the positive inotropic response to ß₂AR stimulation.

The failure of zinterol to increase cAMP or phospholamban phosphorylation in canine myocytes further supports the hypothesis that positive inotropic effects of ß₂AR agonists in adult ventricular myocytes are largely cAMP-independent.¹³ Data showing direct G-protein effects on cardiac ion channels have accumulated recently^{20 21 22} and could account for the positive inotropic effects of ß₂AR stimulation in ventricular cardiomyocytes.

Unlike in rat myocytes, however, zinterol significantly abbreviated the [Ca²⁺]_i transients measured in both normal and failing canine cells (Figs 3 and 4). In rat myocytes, the cAMP-dependent phosphorylation of phospholamban accelerates Ca²⁺ accumulation by the sarcoplasmic reticulum and is largely responsible for shortening the [Ca²⁺]_i transient duration. Accordingly, in rat myocytes, when [Ca²⁺]_i transient amplitudes are increased by increased [Ca²⁺]_o from 1 to 3.5 mmol, the time course is unchanged. In canine cells, on the other hand, increasing [Ca²⁺]_o caused significant abbreviation of the [Ca²⁺]_i transient (Fig 10). Thus, cAMP-dependent phosphorylation of phospholamban clearly is not responsible for shortening the [Ca²⁺]_i transient duration in zinterol-treated canine myocytes. Alternative possibilities would be phospholamban phosphorylation in beating cells by a calcium-calmodulin–dependent protein kinase²³ or direct phosphorylation of the sarcoplasmic reticular Ca²⁺ATPase by a calcium-calmodulin–dependent protein kinase.²⁴

Isoproterenol Effects on cAMP Production in Normal and Failing Canine Myocytes
While the failing canine myocytes exhibited an increased [Ca²⁺]_i transient response to zinterol, these same cell preparations produced significantly less cAMP than normal when challenged with isoproterenol. This depressed cAMP response to the nonselective ß-agonist is consistent with both downregulation of the ß₁AR and depressed adenylyl cyclase activity in failing myocardium.²⁵

Study Limitations
The major limitation of the present study was the small number of observations in human myocytes and the lack of healthy human control cells. Another difficulty was the lack of human myocyte preparations with the yields needed for careful titrations of drug effects on cAMP production in suspensions of intact, viable cells. Thus, it is impossible to state whether failing human ventricular cardiomyocytes, like failing canine cells, exhibit a heightened response to ß₂AR agonists and whether such responses are cAMP-independent.

Preparations of healthy and failing human ventricular cardiomyocytes with high yields and excellent viability have been obtained in our laboratory,¹⁰ but preparations with 0% to 10% intact rod-shaped cells are more common. Therefore, in our hands, data from human ventricular cardiomyocytes tend to be anecdotal. Nevertheless, such data are useful for evaluating the clinical relevance of myocyte data from experimental animal models. That failing canine myocytes exhibit responses to ß₂AR stimulation similar to those observed in five consecutive preparations of failing human myocytes supports the use of canine models for studies of ßAR alterations in heart failure.

With respect to the studies of canine myocytes, although cAMP did not increase in zinterol-treated cells, there could have been localized increases in cAMP that were not detected by measurement of whole-cell values. Additional studies are required to address this issue.

Study Implications
The robust response of failing myocytes from human and canine hearts to ß₂AR stimulation indicates that these receptors may take on added importance in at least some forms of heart failure. The question is whether enhanced contractile responses to ß₂AR stimulation are beneficial or detrimental over the long term. Positive inotropes that inhibit cAMP phosphodiesterase (ie, milrinone) shorten survival in patients with heart failure.²⁶ In this regard, ß₁AR but not ß₂AR stimulation evokes spontaneous [Ca²⁺]_i oscillations, increases the diastolic indo-1 fluorescence ratio, and causes a decline in resting cell length in rat myocytes.¹³ In sheep Purkinje fibers treated with isoproterenol, triggered activity resulting from oscillatory afterpotentials appears to result primarily from the stimulation of ß₁AR, with little or no contribution from the ß₂ARs.²⁷ Therefore, selective activation of ß₂AR or its overexpression through gene therapy might provide safe inotropic support without increasing the likelihood of arrhythmias.

	Acknowledgments

 
These studies were supported by Grant-in-Aid 91013490 (Dr Altschuld) from the American Heart Association, funds contributed by the Ohio Affiliate of the American Heart Association and Parke Davis, and NIH grants HL-36240 and HL-48835 (Dr Altschuld), PO1-HL-06308 and HL-49428 (Dr Jones), and HL-45120 (Dr Robitaille). Zinterol was a generous gift from Bristol-Myers, Evansville, Ind. We wish to thank Dr Pal Vaghy and Ron Phillips for their invaluable assistance.

Received January 9, 1995; revision received March 3, 1995; accepted March 10, 1995.

	References

Top Abstract Introduction Methods Results Discussion References

 
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