Abstract
Cardiac glycosides exert a positive inotropic effect by inhibiting sodium pump (Na,K-ATPase) activity, decreasing the driving force for Na+-Ca++ exchange, and increasing cellular content and release of Ca++ during depolarization. Since the inotropic response will be a function of the level of expression of sodium pumps, which are alpha(beta) heterodimers, and of Na+-Ca++ exchangers, this study aimed to determine the regional pattern of expression of these transporters in the heart. Immunoblot assays of homogenate from atria, ventricles, and septa of 14 nonfailing human hearts established expression of Na,K-ATPase alpha1, alpha2, alpha3, beta1, and Na+-Ca++ exchangers in all regions. Na,K-ATPase beta2 expression is negligible, indicating that the human cardiac glycoside receptors are alpha1beta1, alpha2beta1, and alpha3beta1. alpha3, beta1, sodium pump activity, and Na+-Ca++ exchanger levels were 30-50% lower in atria compared to ventricles and/or septum; differences between ventricles and septum were insignificant. Functionally, the EC50 of the sodium channel activator BDF 9148 to increase force of contraction was lower in atria than ventricle muscle strips (0.36 vs. 1.54 microM). These results define the distribution of the cardiac glycoside receptor isoforms in the human heart and they demonstrate that atria have fewer sodium pumps, fewer Na+-Ca++ exchangers, and enhanced sensitivity to inotropic stimulation compared to ventricles.
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- Azuma K. K., Hensley C. B., Tang M. J., McDonough A. A. Thyroid hormone specifically regulates skeletal muscle Na(+)-K(+)-ATPase alpha 2- and beta 2-isoforms. Am J Physiol. 1993 Sep;265(3 Pt 1):C680–C687. doi: 10.1152/ajpcell.1993.265.3.C680. [DOI] [PubMed] [Google Scholar]
- Blaustein M. P. Physiological effects of endogenous ouabain: control of intracellular Ca2+ stores and cell responsiveness. Am J Physiol. 1993 Jun;264(6 Pt 1):C1367–C1387. doi: 10.1152/ajpcell.1993.264.6.C1367. [DOI] [PubMed] [Google Scholar]
- Bossen E. H., Sommer J. R., Waugh R. A. Comparative stereology of mouse atria. Tissue Cell. 1981;13(1):71–77. doi: 10.1016/0040-8166(81)90039-2. [DOI] [PubMed] [Google Scholar]
- Eakle K. A., Kim K. S., Kabalin M. A., Farley R. A. High-affinity ouabain binding by yeast cells expressing Na+, K(+)-ATPase alpha subunits and the gastric H+, K(+)-ATPase beta subunit. Proc Natl Acad Sci U S A. 1992 Apr 1;89(7):2834–2838. doi: 10.1073/pnas.89.7.2834. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Erdmann E., Schoner W. Ouabain-receptor interactions in (Na + +K + )-ATPase preparations from different tissues and species. Determination of kinetic constants and dissociation constants. Biochim Biophys Acta. 1973 May 11;307(2):386–398. doi: 10.1016/0005-2736(73)90104-1. [DOI] [PubMed] [Google Scholar]
- Frank J. S., Mottino G., Reid D., Molday R. S., Philipson K. D. Distribution of the Na(+)-Ca2+ exchange protein in mammalian cardiac myocytes: an immunofluorescence and immunocolloidal gold-labeling study. J Cell Biol. 1992 Apr;117(2):337–345. doi: 10.1083/jcb.117.2.337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Frank J. S., Philipson K. D., Beydler S. Ultrastructure of isolated sarcolemma from dog and rabbit myocardium. Comparison to intact tissue. Circ Res. 1984 Apr;54(4):414–423. doi: 10.1161/01.res.54.4.414. [DOI] [PubMed] [Google Scholar]
- Gheorghiade M., Ferguson D. Digoxin. A neurohormonal modulator in heart failure? Circulation. 1991 Nov;84(5):2181–2186. doi: 10.1161/01.cir.84.5.2181. [DOI] [PubMed] [Google Scholar]
- González-Martínez L. M., Avila J., Martí E., Lecuona E., Martín-Vasallo P. Expression of the beta-subunit isoforms of the Na,K-ATPase in rat embryo tissues, inner ear and choroid plexus. Biol Cell. 1994;81(3):215–222. doi: 10.1016/0248-4900(94)90003-5. [DOI] [PubMed] [Google Scholar]
- Grupp I., Im W. B., Lee C. O., Lee S. W., Pecker M. S., Schwartz A. Relation of sodium pump inhibition to positive inotropy at low concentrations of ouabain in rat heart muscle. J Physiol. 1985 Mar;360:149–160. doi: 10.1113/jphysiol.1985.sp015609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Herzig S., Lilienthal E., Mohr K. The positive inotropic drugs DPI 201-106, BDF 9148, and veratridine increase ouabain toxicity and [3H]ouabain binding in guinea pig heart. J Cardiovasc Pharmacol. 1991 Aug;18(2):182–189. doi: 10.1097/00005344-199108000-00002. [DOI] [PubMed] [Google Scholar]
- Hundal H. S., Marette A., Mitsumoto Y., Ramlal T., Blostein R., Klip A. Insulin induces translocation of the alpha 2 and beta 1 subunits of the Na+/K(+)-ATPase from intracellular compartments to the plasma membrane in mammalian skeletal muscle. J Biol Chem. 1992 Mar 15;267(8):5040–5043. [PubMed] [Google Scholar]
- Jorgensen P. L. Purification and characterization of (Na+ plus K+ )-ATPase. 3. Purification from the outer medulla of mammalian kidney after selective removal of membrane components by sodium dodecylsulphate. Biochim Biophys Acta. 1974 Jul 12;356(1):36–52. doi: 10.1016/0005-2736(74)90292-2. [DOI] [PubMed] [Google Scholar]
- Kashgarian M., Biemesderfer D., Caplan M., Forbush B., 3rd Monoclonal antibody to Na,K-ATPase: immunocytochemical localization along nephron segments. Kidney Int. 1985 Dec;28(6):899–913. doi: 10.1038/ki.1985.216. [DOI] [PubMed] [Google Scholar]
- Kim D., Cragoe E. J., Jr, Smith T. W. Relations among sodium pump inhibition, Na-Ca and Na-H exchange activities, and Ca-H interaction in cultured chick heart cells. Circ Res. 1987 Feb;60(2):185–193. doi: 10.1161/01.res.60.2.185. [DOI] [PubMed] [Google Scholar]
- LOWRY O. H., ROSEBROUGH N. J., FARR A. L., RANDALL R. J. Protein measurement with the Folin phenol reagent. J Biol Chem. 1951 Nov;193(1):265–275. [PubMed] [Google Scholar]
- Lee C. O. 200 years of digitalis: the emerging central role of the sodium ion in the control of cardiac force. Am J Physiol. 1985 Nov;249(5 Pt 1):C367–C378. doi: 10.1152/ajpcell.1985.249.5.C367. [DOI] [PubMed] [Google Scholar]
- Lingrel J. B., Orlowski J., Shull M. M., Price E. M. Molecular genetics of Na,K-ATPase. Prog Nucleic Acid Res Mol Biol. 1990;38:37–89. doi: 10.1016/s0079-6603(08)60708-4. [DOI] [PubMed] [Google Scholar]
- Magyar C. E., Wang J., Azuma K. K., McDonough A. A. Reciprocal regulation of cardiac Na-K-ATPase and Na/Ca exchanger: hypertension, thyroid hormone, development. Am J Physiol. 1995 Sep;269(3 Pt 1):C675–C682. doi: 10.1152/ajpcell.1995.269.3.C675. [DOI] [PubMed] [Google Scholar]
- McDonough A. A., Wang J., Farley R. A. Significance of sodium pump isoforms in digitalis therapy. J Mol Cell Cardiol. 1995 Apr;27(4):1001–1009. doi: 10.1016/0022-2828(95)90069-1. [DOI] [PubMed] [Google Scholar]
- McDonough A. A., Zhang Y., Shin V., Frank J. S. Subcellular distribution of sodium pump isoform subunits in mammalian cardiac myocytes. Am J Physiol. 1996 Apr;270(4 Pt 1):C1221–C1227. doi: 10.1152/ajpcell.1996.270.4.C1221. [DOI] [PubMed] [Google Scholar]
- Packer M., Gheorghiade M., Young J. B., Costantini P. J., Adams K. F., Cody R. J., Smith L. K., Van Voorhees L., Gourley L. A., Jolly M. K. Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. RADIANCE Study. N Engl J Med. 1993 Jul 1;329(1):1–7. doi: 10.1056/NEJM199307013290101. [DOI] [PubMed] [Google Scholar]
- Philipson K. D., Longoni S., Ward R. Purification of the cardiac Na+-Ca2+ exchange protein. Biochim Biophys Acta. 1988 Nov 22;945(2):298–306. doi: 10.1016/0005-2736(88)90492-0. [DOI] [PubMed] [Google Scholar]
- Porzig H., Li Z., Nicoll D. A., Philipson K. D. Mapping of the cardiac sodium-calcium exchanger with monoclonal antibodies. Am J Physiol. 1993 Sep;265(3 Pt 1):C748–C756. doi: 10.1152/ajpcell.1993.265.3.C748. [DOI] [PubMed] [Google Scholar]
- Pressley T. A. Phylogenetic conservation of isoform-specific regions within alpha-subunit of Na(+)-K(+)-ATPase. Am J Physiol. 1992 Mar;262(3 Pt 1):C743–C751. doi: 10.1152/ajpcell.1992.262.3.C743. [DOI] [PubMed] [Google Scholar]
- Reinecke H., Studer R., Vetter R., Holtz J., Drexler H. Cardiac Na+/Ca2+ exchange activity in patients with end-stage heart failure. Cardiovasc Res. 1996 Jan;31(1):48–54. [PubMed] [Google Scholar]
- Schmidt T. A., Svendsen J. H., Haunsø S., Kjeldsen K. Quantification of the total Na,K-ATPase concentration in atria and ventricles from mammalian species by measuring 3H-ouabain binding to intact myocardial samples. Stability to short term ischemia reperfusion. Basic Res Cardiol. 1990 Jul-Aug;85(4):411–427. doi: 10.1007/BF01907133. [DOI] [PubMed] [Google Scholar]
- Schoner W., von Ilberg C., Kramer R., Seubert W. On the mechanism of Na+- and K+-stimulated hydrolysis of adenosine triphosphate. 1. Purification and properties of a Na+-and K+-activated ATPase from ox brain. Eur J Biochem. 1967 May;1(3):334–343. doi: 10.1007/978-3-662-25813-2_45. [DOI] [PubMed] [Google Scholar]
- Schwinger R. H., Böhm M., La Rosée K., Schmidt U., Schulz C., Erdmann E. Na(+)-channel activators increase cardiac glycoside sensitivity in failing human myocardium. J Cardiovasc Pharmacol. 1992 Apr;19(4):554–561. doi: 10.1097/00005344-199204000-00012. [DOI] [PubMed] [Google Scholar]
- Schwinger R. H., Böhm M., Mittmann C., La Rosée K., Erdmann E. Evidence for a sustained effectiveness of sodium-channel activators in failing human myocardium. J Mol Cell Cardiol. 1991 Apr;23(4):461–471. doi: 10.1016/0022-2828(91)90170-q. [DOI] [PubMed] [Google Scholar]
- Schwinger R. H., Böhm M., Müller-Ehmsen J., Uhlmann R., Schmidt U., Stäblein A., Uberfuhr P., Kreuzer E., Reichart B., Eissner H. J. Effect of inotropic stimulation on the negative force-frequency relationship in the failing human heart. Circulation. 1993 Nov;88(5 Pt 1):2267–2276. doi: 10.1161/01.cir.88.5.2267. [DOI] [PubMed] [Google Scholar]
- Schwinger R. H., Böhm M., Schmidt U., Karczewski P., Bavendiek U., Flesch M., Krause E. G., Erdmann E. Unchanged protein levels of SERCA II and phospholamban but reduced Ca2+ uptake and Ca(2+)-ATPase activity of cardiac sarcoplasmic reticulum from dilated cardiomyopathy patients compared with patients with nonfailing hearts. Circulation. 1995 Dec 1;92(11):3220–3228. doi: 10.1161/01.cir.92.11.3220. [DOI] [PubMed] [Google Scholar]
- Schwinger R. H., Böhm M., Uhlmann R., La Rosée K., Koch A., Erdmann E. Increase of the extracellular magnesium concentration reduces cardiac glycoside toxicity in the human myocardium. J Pharmacol Exp Ther. 1992 Dec;263(3):1352–1359. [PubMed] [Google Scholar]
- Schwinger R. H., Müller-Ehmsen J., Frank K., Koch A., Erdmann E. Enhanced sensitivity of the failing human myocardium to cardiac glycosides and Na(+)-channel activators. Am Heart J. 1996 May;131(5):988–993. doi: 10.1016/s0002-8703(96)90184-2. [DOI] [PubMed] [Google Scholar]
- Shamraj O. I., Grupp I. L., Grupp G., Melvin D., Gradoux N., Kremers W., Lingrel J. B., De Pover A. Characterisation of Na/K-ATPase, its isoforms, and the inotropic response to ouabain in isolated failing human hearts. Cardiovasc Res. 1993 Dec;27(12):2229–2237. doi: 10.1093/cvr/27.12.2229. [DOI] [PubMed] [Google Scholar]
- Smith T. W. Digitalis. Mechanisms of action and clinical use. N Engl J Med. 1988 Feb 11;318(6):358–365. doi: 10.1056/NEJM198802113180606. [DOI] [PubMed] [Google Scholar]
- Studer R., Reinecke H., Bilger J., Eschenhagen T., Böhm M., Hasenfuss G., Just H., Holtz J., Drexler H. Gene expression of the cardiac Na(+)-Ca2+ exchanger in end-stage human heart failure. Circ Res. 1994 Sep;75(3):443–453. doi: 10.1161/01.res.75.3.443. [DOI] [PubMed] [Google Scholar]
- Sweadner K. J., Gilkeson R. C. Two isozymes of the Na,K-ATPase have distinct antigenic determinants. J Biol Chem. 1985 Jul 25;260(15):9016–9022. [PubMed] [Google Scholar]
- Sweadner K. J., Herrera V. L., Amato S., Moellmann A., Gibbons D. K., Repke K. R. Immunologic identification of Na+,K(+)-ATPase isoforms in myocardium. Isoform change in deoxycorticosterone acetate-salt hypertension. Circ Res. 1994 Apr;74(4):669–678. doi: 10.1161/01.res.74.4.669. [DOI] [PubMed] [Google Scholar]
- Wang G. X., Schmied R., Ebner F., Korth M. Intracellular sodium activity and its regulation in guinea-pig atrial myocardium. J Physiol. 1993 Jun;465:73–84. doi: 10.1113/jphysiol.1993.sp019667. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zahler R., Brines M., Kashgarian M., Benz E. J., Jr, Gilmore-Hebert M. The cardiac conduction system in the rat expresses the alpha 2 and alpha 3 isoforms of the Na+,K(+)-ATPase. Proc Natl Acad Sci U S A. 1992 Jan 1;89(1):99–103. doi: 10.1073/pnas.89.1.99. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zahler R., Gilmore-Hebert M., Baldwin J. C., Franco K., Benz E. J., Jr Expression of alpha isoforms of the Na,K-ATPase in human heart. Biochim Biophys Acta. 1993 Jul 4;1149(2):189–194. doi: 10.1016/0005-2736(93)90200-j. [DOI] [PubMed] [Google Scholar]
- Zahler R., Sun W., Ardito T., Kashgarian M. Na-K-ATPase alpha-isoform expression in heart and vascular endothelia: cellular and developmental regulation. Am J Physiol. 1996 Jan;270(1 Pt 1):C361–C371. doi: 10.1152/ajpcell.1996.270.1.C361. [DOI] [PubMed] [Google Scholar]