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Beuthner BE, Elkenani M, Evert K, Mustroph J, Jacob CF, Paul NB, Beißbarth T, Zeisberg EM, Schnelle M, Puls M, Hasenfuß G, Toischer K. Histological assessment of cardiac amyloidosis in patients undergoing transcatheter aortic valve replacement. ESC Heart Fail 2024. [PMID: 38407567 DOI: 10.1002/ehf2.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/28/2023] [Accepted: 01/19/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS Studies have reported a strongly varying co-prevalence of aortic stenosis (AS) and cardiac amyloidosis (CA). We sought to histologically determine the co-prevalence of AS and CA in patients undergoing transcatheter aortic valve replacement (TAVR). Consequently, we aimed to derive an algorithm to identify cases in which to suspect the co-prevalence of AS and CA. METHODS AND RESULTS In this prospective, monocentric study, endomyocardial biopsies of 162 patients undergoing TAVR between January 2017 and March 2021 at the University Medical Centre Göttingen were analysed by one pathologist blinded to clinical data using haematoxylin-eosin staining, Elastica van Gieson staining, and Congo red staining of endomyocardial biopsies. CA was identified in only eight patients (4.9%). CA patients had significantly higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (4356.20 vs. 1938.00 ng/L, P = 0.034), a lower voltage-to-mass ratio (0.73 vs. 1.46 × 10-2 mVm2 /g, P = 0.022), and lower transaortic gradients (Pmean 17.5 vs. 38.0 mmHg, P = 0.004) than AS patients. Concomitant CA was associated with a higher prevalence of post-procedural acute kidney injury (50.0% vs. 13.1%, P = 0.018) and sudden cardiac death [SCD; P (log-rank test) = 0.017]. Following propensity score matching, 184 proteins were analysed to identify serum biomarkers of concomitant CA. CA patients expressed lower levels of chymotrypsin (P = 0.018) and carboxypeptidase 1 (P = 0.027). We propose an algorithm using commonly documented parameters-stroke volume index, ejection fraction, NT-proBNP levels, posterior wall thickness, and QRS voltage-to-mass ratio-to screen for CA in AS patients, reaching a sensitivity of 66.6% with a specificity of 98.1%. CONCLUSIONS The co-prevalence of AS and CA was lower than expected, at 4.9%. Despite excellent 1 year mortality, AS + CA patients died significantly more often from SCD. We propose a multimodal algorithm to facilitate more effective screening for CA containing parameters commonly documented during clinical routine. Proteomic biomarkers may yield additional information in the future.
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Affiliation(s)
- Bo Eric Beuthner
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Manar Elkenani
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
| | - Christoph Friedemann Jacob
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Niels Benjamin Paul
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- Department of Medical Bioinformatics, University Medical Centre Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Tim Beißbarth
- Department of Medical Bioinformatics, University Medical Centre Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Elisabeth Maria Zeisberg
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Moritz Schnelle
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Clinical Chemistry, University Medical Centre Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Miriam Puls
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg August University of Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
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Leininger SB, Staudner ST, Vogel MJ, Mustroph J, Hubauer U, Wallner S, Lehn P, Burkhardt R, Meindl C, Hanses F, Zimmermann M, Maier LS, Hupf J, Jungbauer CG. Bioactive adrenomedullin and interleukin-6 in COVID-19: potential biomarkers of acute kidney injury and critical illness. BMC Nephrol 2024; 25:52. [PMID: 38336628 PMCID: PMC10858491 DOI: 10.1186/s12882-024-03486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate whether bioactive adrenomedullin (bio-ADM) and interleukin-6 (IL-6) are related to acute kidney injury (AKI) and severe illness in COVID-19 patients. METHODS 153 patients with COVID-19 admitted to the emergency department (ED) were included. Blood samples were collected from each patient at admission. Bio-ADM and IL-6, as well as DPP3 and routinely measured markers were evaluated regarding the endpoints AKI (22/128 hospitalized patients) and a composite endpoint of admission to intensive care unit and/or in-hospital death (n = 26/153 patients). RESULTS Bio-ADM and IL-6 were significantly elevated in COVID-19 patients with AKI compared to COVID-19 patients without AKI (each p < 0.001). According to ROC analyses IL-6 and bio-ADM had the largest AUC (0.84 and 0.81) regarding the detection of AKI. Furthermore, bio-ADM and IL-6 were significantly elevated in COVID-19 patients reaching the composite endpoint (each p < 0.001). Regarding the composite endpoint ROC analysis showed an AUC of 0.89 for IL-6 and 0.83 for bio-ADM in COVID-19 patients. In the multivariable logistic model bio-ADM and IL-6 presented as independent significant predictors regarding both endpoints AKI and the composite endpoint in COVID-19 patients (as well as creatinine regarding the composite endpoint; each p < 0.05), opposite to leukocytes, C-reactive protein (CRP) and dipeptidyl peptidase 3 (DPP3; each p = n.s.). CONCLUSION Elevated levels of bio-ADM and IL-6 are associated with AKI and critical illness in patients with COVID-19. Therefore, both biomarkers may be potential tools in risk stratification in COVID-19 patients at presentation in the ED.
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Affiliation(s)
- Simon B Leininger
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Stephan T Staudner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Manuel J Vogel
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Petra Lehn
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Ralph Burkhardt
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Staudner ST, Leininger SB, Vogel MJ, Mustroph J, Hubauer U, Meindl C, Wallner S, Lehn P, Burkhardt R, Hanses F, Zimmermann M, Scharf G, Hamer OW, Maier LS, Hupf J, Jungbauer CG. Dipeptidyl-peptidase 3 and IL-6: potential biomarkers for diagnostics in COVID-19 and association with pulmonary infiltrates. Clin Exp Med 2023; 23:4919-4935. [PMID: 37733154 PMCID: PMC10725357 DOI: 10.1007/s10238-023-01193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
Coronavirus SARS-CoV-2 spread worldwide, causing a respiratory disease known as COVID-19. The aim of the present study was to examine whether Dipeptidyl-peptidase 3 (DPP3) and the inflammatory biomarkers IL-6, CRP, and leucocytes are associated with COVID-19 and able to predict the severity of pulmonary infiltrates in COVID-19 patients versus non-COVID-19 patients. 114 COVID-19 patients and 35 patients with respiratory infections other than SARS-CoV-2 were included in our prospective observational study. Blood samples were collected at presentation to the emergency department. 102 COVID-19 patients and 28 non-COVID-19 patients received CT imaging (19 outpatients did not receive CT imaging). If CT imaging was available, artificial intelligence software (CT Pneumonia Analysis) was used to quantify pulmonary infiltrates. According to the median of infiltrate (14.45%), patients who obtained quantitative CT analysis were divided into two groups (> median: 55 COVID-19 and nine non-COVID-19, ≤ median: 47 COVID-19 and 19 non-COVID-19). DPP3 was significantly elevated in COVID-19 patients (median 20.85 ng/ml, 95% CI 18.34-24.40 ng/ml), as opposed to those without SARS-CoV-2 (median 13.80 ng/ml, 95% CI 11.30-17.65 ng/ml; p < 0.001, AUC = 0.72), opposite to IL-6, CRP (each p = n.s.) and leucocytes (p < 0.05, but lower levels in COVID-19 patients). Regarding binary logistic regression analysis, higher DPP3 concentrations (OR = 1.12, p < 0.001) and lower leucocytes counts (OR = 0.76, p < 0.001) were identified as significant and independent predictors of SARS-CoV-2 infection, as opposed to IL-6 and CRP (each p = n.s.). IL-6 was significantly increased in patients with infiltrate above the median compared to infiltrate below the median both in COVID-19 (p < 0.001, AUC = 0.78) and in non-COVID-19 (p < 0.05, AUC = 0.81). CRP, DPP3, and leucocytes were increased in COVID-19 patients with infiltrate above median (each p < 0.05, AUC: CRP 0.82, DPP3 0.70, leucocytes 0.67) compared to infiltrate below median, opposite to non-COVID-19 (each p = n.s.). Regarding multiple linear regression analysis in COVID-19, CRP, IL-6, and leucocytes (each p < 0.05) were associated with the degree of pulmonary infiltrates, as opposed to DPP3 (p = n.s.). DPP3 showed the potential to be a COVID-19-specific biomarker. IL-6 might serve as a prognostic marker to assess the extent of pulmonary infiltrates in respiratory patients.
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Affiliation(s)
- Stephan T Staudner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Simon B Leininger
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Manuel J Vogel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Petra Lehn
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Gregor Scharf
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Okka W Hamer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Mustroph J, Baier MJ, Unsin D, Provaznik Z, Kozakov K, Lebek S, Tarnowski D, Schildt S, Voigt N, Wagner S, Maier LS, Neef S. Ethanol-Induced Atrial Fibrillation Results From Late INa and Can Be Prevented by Ranolazine. Circulation 2023; 148:698-700. [PMID: 37603603 PMCID: PMC10437457 DOI: 10.1161/circulationaha.123.064561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Julian Mustroph
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Maria J. Baier
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Denise Unsin
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Zdenek Provaznik
- Cardiothoracic Surgery (Z.P., K.K.), University Medical Center Regensburg, Germany
| | - Kostiantyn Kozakov
- Cardiothoracic Surgery (Z.P., K.K.), University Medical Center Regensburg, Germany
| | - Simon Lebek
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Daniel Tarnowski
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Sönke Schildt
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg August University Göttingen, Germany (N.V.)
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany (N.V.)
- Cluster of Excellence “Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Germany (N.V.)
| | - Stefan Wagner
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Lars S. Maier
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
| | - Stefan Neef
- Departments of Internal Medicine II (J.M., M.J.B., D.U., S.L., D.T., S.S., S.W., L.S.M., S.N.), University Medical Center Regensburg, Germany
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Vogel MJ, Leininger SB, Staudner ST, Hubauer U, Wallner S, Mustroph J, Hanses F, Zimmermann M, Lehn P, Burkhardt R, Maier LS, Hupf J, Jungbauer CG. Urinary N-Terminal Pro-Brain Natriuretic Peptide Predicts Acute Kidney Injury and Severe Disease in COVID-19. Kidney Blood Press Res 2023; 48:424-435. [PMID: 37364545 PMCID: PMC10308530 DOI: 10.1159/000529690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/01/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION The ongoing COVID-19 pandemic is placing an extraordinary burden on our health care system with its limited resources. Accurate triage of patients is necessary to ensure medical care for those most severely affected. In this regard, biomarkers could contribute to risk evaluation. The aim of this prospective observational clinical study was to assess the relationship between urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) and acute kidney injury (AKI) as well as severe disease in patients with COVID-19. METHODS 125 patients treated with an acute respiratory infection in the emergency department of the University Hospital Regensburg were analyzed. These patients were divided into a COVID-19 cohort (n = 91) and a cohort with infections not caused by severe acute respiratory syndrome-coronavirus-2 (n = 34). NT-proBNP was determined from serum and fresh urine samples collected in the emergency department. Clinical endpoints were the development of AKI and a composite one consisting of AKI, intensive care unit admission, and in-hospital death. RESULTS 11 (12.1%) COVID-19 patients developed AKI during hospitalization, whereas 15 (16.5%) reached the composite endpoint. Urinary NT-proBNP was significantly elevated in COVID-19 patients who suffered AKI or reached the composite endpoint (each p < 0.005). In a multivariate regression analysis adjusted for age, chronic kidney disease, chronic heart failure, and arterial hypertension, urinary NT-proBNP was identified as independent predictor of AKI (p = 0.017, OR = 3.91 [CI: 1.28-11.97] per standard deviation [SD]), as well as of the composite endpoint (p = 0.026, OR 2.66 [CI: 1.13-6.28] per SD). CONCLUSION Urinary NT-proBNP might help identify patients at risk for AKI and severe disease progression in COVID-19.
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Affiliation(s)
- Manuel Julian Vogel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Simon B Leininger
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stephan T Staudner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Petra Lehn
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Mustroph J, Baier MJ, Pabel S, Stehle T, Trum M, Provaznik Z, Mohler PJ, Musa H, Hund TJ, Sossalla S, Maier LS, Wagner S. Empagliflozin Inhibits Cardiac Late Sodium Current by Ca/Calmodulin-Dependent Kinase II. Circulation 2022; 146:1259-1261. [PMID: 36251785 PMCID: PMC9586469 DOI: 10.1161/circulationaha.122.057364] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II (J.M., M.J.B., S.P., T.S., M.T., S.S., L.S.M., S.W.), University Medical Center Regensburg, Germany
| | - Maria J. Baier
- Department of Internal Medicine II (J.M., M.J.B., S.P., T.S., M.T., S.S., L.S.M., S.W.), University Medical Center Regensburg, Germany
| | - Steffen Pabel
- Department of Internal Medicine II (J.M., M.J.B., S.P., T.S., M.T., S.S., L.S.M., S.W.), University Medical Center Regensburg, Germany
| | - Thea Stehle
- Department of Internal Medicine II (J.M., M.J.B., S.P., T.S., M.T., S.S., L.S.M., S.W.), University Medical Center Regensburg, Germany
| | - Maximilian Trum
- Department of Internal Medicine II (J.M., M.J.B., S.P., T.S., M.T., S.S., L.S.M., S.W.), University Medical Center Regensburg, Germany
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery (Z.P.), University Medical Center Regensburg, Germany
| | - Peter J. Mohler
- Davis Heart and Lung Research Institute, Ohio State University, Columbus (P.J.M., H.M., T.J.H.)
| | - Hassan Musa
- Davis Heart and Lung Research Institute, Ohio State University, Columbus (P.J.M., H.M., T.J.H.)
| | - Thomas J. Hund
- Davis Heart and Lung Research Institute, Ohio State University, Columbus (P.J.M., H.M., T.J.H.)
| | - Samuel Sossalla
- Department of Internal Medicine II (J.M., M.J.B., S.P., T.S., M.T., S.S., L.S.M., S.W.), University Medical Center Regensburg, Germany
| | - Lars S. Maier
- Department of Internal Medicine II (J.M., M.J.B., S.P., T.S., M.T., S.S., L.S.M., S.W.), University Medical Center Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II (J.M., M.J.B., S.P., T.S., M.T., S.S., L.S.M., S.W.), University Medical Center Regensburg, Germany
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Tangos M, Budde H, Kolijn D, Sieme M, Zhazykbayeva S, Lódi M, Herwig M, Gömöri K, Hassoun R, Robinson EL, Meister TL, Jaquet K, Kovács Á, Mustroph J, Evert K, Babel N, Fagyas M, Lindner D, Püschel K, Westermann D, Mannherz HG, Paneni F, Pfaender S, Tóth A, Mügge A, Sossalla S, Hamdani N. SARS-CoV-2 infects human cardiomyocytes promoted by inflammation and oxidative stress. Int J Cardiol 2022; 362:196-205. [PMID: 35643215 PMCID: PMC9132721 DOI: 10.1016/j.ijcard.2022.05.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
Introduction The respiratory illness triggered by severe acute respiratory syndrome virus-2 (SARS-CoV-2) is often particularly serious or fatal amongst patients with pre-existing heart conditions. Although the mechanisms underlying SARS-CoV-2-related cardiac damage remain elusive, inflammation (i.e. ‘cytokine storm’) and oxidative stress are likely involved. Methods and results Here we sought to determine: 1) if cardiomyocytes are targeted by SARS-CoV-2 and 2) how inflammation and oxidative stress promote the viral entry into cardiac cells. We analysed pro-inflammatory and oxidative stress and its impact on virus entry and virus-associated cardiac damage from SARS-CoV-2 infected patients and compared it to left ventricular myocardial tissues obtained from non-infected transplanted hearts either from end stage heart failure or non-failing hearts (donor group). We found that neuropilin-1 potentiates SARS-CoV-2 entry into human cardiomyocytes, a phenomenon driven by inflammatory and oxidant signals. These changes accounted for increased proteases activity and apoptotic markers thus leading to cell damage and apoptosis. Conclusion This study provides new insights into the mechanisms of SARS-CoV-2 entry into the heart and defines promising targets for antiviral interventions for COVID-19 patients with pre-existing heart conditions or patients with co-morbidities.
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Affiliation(s)
- Melina Tangos
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Heidi Budde
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Detmar Kolijn
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Marcel Sieme
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Saltanat Zhazykbayeva
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Mária Lódi
- Department of Neuroanatomy and Molecular Brain Research, Ruhr University Bochum, Medical Faculty, Bochum, Germany
| | - Melissa Herwig
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Kamilla Gömöri
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Roua Hassoun
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Emma Louise Robinson
- School of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, United States of America
| | - Toni Luise Meister
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Kornelia Jaquet
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Árpád Kovács
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University Hospital Regensburg, Regensburg, Germany
| | - Nina Babel
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Miklós Fagyas
- Center for Molecular Cardiology, University of Zürich, University Heart Center, Cardiology, University Hospital Zurich, Zürich, Switzerland
| | - Diana Lindner
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Hans Georg Mannherz
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Anatomy and Molecular Embryology, Ruhr University Bochum, Bochum, Germany
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, University Heart Center, Cardiology, University Hospital Zurich, Zürich, Switzerland; University Heart Center, Cardiology, Department of Research and Education, University Hospital Zurich, Zürich, Switzerland
| | - Stephanie Pfaender
- Department of Molecular and Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Attila Tóth
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, Debrecen, Hungary
| | - Andreas Mügge
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany; Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany; Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany; Institute of Physiology, Ruhr University Bochum, Bochum, Germany.
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Mustroph J, Hupf J, Baier MJ, Evert K, Brochhausen C, Broeker K, Meindl C, Seither B, Jungbauer C, Evert M, Maier LS, Wagner S. Cardiac Fibrosis Is a Risk Factor for Severe COVID-19. Front Immunol 2021; 12:740260. [PMID: 34745111 PMCID: PMC8569622 DOI: 10.3389/fimmu.2021.740260] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022] Open
Abstract
Increased left ventricular fibrosis has been reported in patients hospitalized with coronavirus disease 2019 (COVID-19). It is unclear whether this fibrosis is a consequence of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection or a risk factor for severe disease progression. We observed increased fibrosis in the left ventricular myocardium of deceased COVID-19 patients, compared with matched controls. We also detected increased mRNA levels of soluble interleukin-1 receptor-like 1 (sIL1-RL1) and transforming growth factor β1 (TGF-β1) in the left ventricular myocardium of deceased COVID-19 patients. Biochemical analysis of blood sampled from patients admitted to the emergency department (ED) with COVID-19 revealed highly elevated levels of TGF-β1 mRNA in these patients compared to controls. Left ventricular strain measured by echocardiography as a marker of pre-existing cardiac fibrosis correlated strongly with blood TGF-β1 mRNA levels and predicted disease severity in COVID-19 patients. In the left ventricular myocardium and lungs of COVID-19 patients, we found increased neuropilin-1 (NRP-1) RNA levels, which correlated strongly with the prevalence of pulmonary SARS-CoV-2 nucleocapsid. Cardiac and pulmonary fibrosis may therefore predispose these patients to increased cellular viral entry in the lung, which may explain the worse clinical outcome observed in our cohort. Our study demonstrates that patients at risk of clinical deterioration can be identified early by echocardiographic strain analysis and quantification of blood TGF-β1 mRNA performed at the time of first medical contact.
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Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Maria J Baier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | | | - Katharina Broeker
- Department of Physiology, University of Regensburg, Regensburg, Germany
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Benedikt Seither
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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9
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Baier MJ, Wagner S, Hupf J, Evert K, Evert M, Sossalla S, Jungbauer C, Maier LS, Neef S, Mustroph J. Cardiac iron overload promotes cardiac injury in patients with severe COVID-19. Infection 2021; 50:547-552. [PMID: 34669163 PMCID: PMC8527292 DOI: 10.1007/s15010-021-01722-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/13/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Maria J Baier
- Department of Internal Medicine II (Cardiology), University Heart Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II (Cardiology), University Heart Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II (Cardiology), University Heart Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II (Cardiology), University Heart Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II (Cardiology), University Heart Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stefan Neef
- Department of Internal Medicine II (Cardiology), University Heart Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Julian Mustroph
- Department of Internal Medicine II (Cardiology), University Heart Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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10
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Islam MMT, Tarnowski D, Zhang M, Trum M, Lebek S, Mustroph J, Daniel H, Moellencamp J, Pabel S, Sossalla S, El‐Armouche A, Nikolaev VO, Shah AM, Eaton P, Maier LS, Sag CM, Wagner S. Enhanced Heart Failure in Redox-Dead Cys17Ser PKARIα Knock-In Mice. J Am Heart Assoc 2021; 10:e021985. [PMID: 34583520 PMCID: PMC8649132 DOI: 10.1161/jaha.121.021985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background PKARIα (protein kinase A type I-α regulatory subunit) is redox-active independent of its physiologic agonist cAMP. However, it is unknown whether this alternative mechanism of PKARIα activation may be of relevance to cardiac excitation-contraction coupling. Methods and Results We used a redox-dead transgenic mouse model with homozygous knock-in replacement of redox-sensitive cysteine 17 with serine within the regulatory subunits of PKARIα (KI). Reactive oxygen species were acutely evoked by exposure of isolated cardiac myocytes to AngII (angiotensin II, 1 µmol/L). The long-term relevance of oxidized PKARIα was investigated in KI mice and their wild-type (WT) littermates following transverse aortic constriction (TAC). AngII increased reactive oxygen species in both groups but with RIα dimer formation in WT only. AngII induced translocation of PKARI to the cell membrane and resulted in protein kinase A-dependent stimulation of ICa (L-type Ca current) in WT with no effect in KI myocytes. Consequently, Ca transients were reduced in KI myocytes as compared with WT cells following acute AngII exposure. Transverse aortic constriction-related reactive oxygen species formation resulted in RIα oxidation in WT but not in KI mice. Within 6 weeks after TAC, KI mice showed an enhanced deterioration of contractile function and impaired survival compared with WT. In accordance, compared with WT, ventricular myocytes from failing KI mice displayed significantly reduced Ca transient amplitudes and lack of ICa stimulation. Conversely, direct pharmacological stimulation of ICa using Bay K8644 rescued Ca transients in AngII-treated KI myocytes and contractile function in failing KI mice in vivo. Conclusions Oxidative activation of PKARIα with subsequent stimulation of ICa preserves cardiac function in the setting of acute and chronic oxidative stress.
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Affiliation(s)
- M. M. Towhidul Islam
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
- Department of Biochemistry and Molecular BiologyUniversity of DhakaBangladesh
| | - Daniel Tarnowski
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Min Zhang
- School of Cardiovascular Medicine & SciencesKings College London British Heart Foundation Centre of ExcellenceLondonUnited Kingdom
| | - Maximilian Trum
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Simon Lebek
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Julian Mustroph
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Henriette Daniel
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Johanna Moellencamp
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Steffen Pabel
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Samuel Sossalla
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Ali El‐Armouche
- Department of Pharmacology and ToxicologyTechnical University DresdenDresdenGermany
| | - Viacheslav O. Nikolaev
- Institute of Experimental Cardiovascular ResearchUniversity Medical Center Hamburg‐EppendorfEppendorfGermany
| | - Ajay M. Shah
- School of Cardiovascular Medicine & SciencesKings College London British Heart Foundation Centre of ExcellenceLondonUnited Kingdom
| | - Philip Eaton
- The William Harvey Research InstituteBarts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUnited Kingdom
| | - Lars S. Maier
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Can Martin Sag
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
| | - Stefan Wagner
- Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
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11
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Vogel MJ, Mustroph J, Staudner ST, Leininger SB, Hubauer U, Wallner S, Meindl C, Hanses F, Zimmermann M, Maier LS, Jungbauer CG, Hupf J. Kidney injury molecule-1: potential biomarker of acute kidney injury and disease severity in patients with COVID-19. J Nephrol 2021; 34:1007-1018. [PMID: 34110585 PMCID: PMC8190170 DOI: 10.1007/s40620-021-01079-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023]
Abstract
AIMS The aim of the current study was to evaluate whether tubular markers kidney injury molecule-1 (KIM-1) and N-acetyl-ß-glucosaminidase (NAG) are related to acute kidney injury (AKI) and severe disease in patients with COVID-19. METHODS AND RESULTS In this prospective observational clinical trial we examined a cohort of 80 patients with proof of acute respiratory infection and divided them into a COVID-19 cohort (n = 54) and a control cohort (n = 26). KIM-1 and NAG were measured from urine samples collected in the emergency department. We assessed the development of AKI, admission to the intensive care unit (ICU) and intrahospital death as clinical endpoints. Urinary KIM-1 and NAG were not significantly different between patients with SARS-CoV-2 and those with other respiratory infections (each p = n.s.). Eight patients from the COVID-19 cohort and five of the non-COVID-19-patients suffered from acute kidney injury during their stay. Nine COVID-19 patients and two non-COVID-19 patients were admitted to the ICU. KIM-1 was significantly elevated in COVID-19 patients with, compared to those without AKI (p = 0.005), as opposed to NAG and creatinine (each p = n.s.). Furthermore, KIM-1 was significantly elevated in the patients with COVID-19 that had to be transferred to the ICU (p = 0.015), in contrast to NAG and creatinine (each p = n.s.). CONCLUSION Assessing KIM-1 in patients with COVID-19 might provide additional value in recognizing AKI at an early stage of disease. Further, KIM-1 might indicate higher risk for clinical deterioration as displayed by admission to the ICU.
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Affiliation(s)
- Manuel J Vogel
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Julian Mustroph
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Stephan T Staudner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Simon B Leininger
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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12
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Pabel S, Mustroph J, Stehle T, Lebek S, Dybkova N, Keyser A, Rupprecht L, Wagner S, Neef S, Maier LS, Sossalla S. Dantrolene reduces CaMKIIδC-mediated atrial arrhythmias. Europace 2021; 22:1111-1118. [PMID: 32413138 DOI: 10.1093/europace/euaa079] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/10/2020] [Accepted: 03/17/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS In atrial fibrillation (AF), an increased diastolic Ca2+ leak from the sarcoplasmic reticulum (SR) mediated by calcium/calmodulin-dependent-protein-kinaseIIδC (CaMKII) can serve as a substrate for arrhythmia induction and persistence. Dantrolene has been shown to stabilize the cardiac ryanodine-receptor. This study investigated the effects of dantrolene on arrhythmogenesis in human and mouse atria with enhanced CaMKII activity. METHODS AND RESULTS Human atrial cardiomyocytes (CMs) were isolated from patients with AF. To investigate CaMKII-mediated arrhythmogenesis, atrial CMs from mice overexpressing CaMKIIδC (TG) and the respective wildtype (WT) were studied using confocal microscopy (Fluo-4), patch-clamp technique, and in vivo atrial catheter-based burst stimulations. Dantrolene potently reduced Ca2+ spark frequency (CaSpF) and diastolic SR Ca2+ leak in AF CMs. Additional CaMKII inhibition did not further reduce CaSpF or leak compared to dantrolene alone. While the increased SR CaSpF and leak in TG mice were reduced by dantrolene, no effects could be detected in WT. Dantrolene also potently reduced the pathologically enhanced frequency of diastolic SR Ca2+ waves in TG without having effects in WT. As an increased diastolic SR Ca2+ release can induce a depolarizing transient inward current, we could demonstrate that the incidence of afterdepolarizations in TG, but not in WT, mice was significantly diminished in the presence of dantrolene. To translate these findings into an in vivo situation we could show that dantrolene strongly suppressed the inducibility of AF in vivo in TG mice. CONCLUSION Dantrolene reduces CaMKII-mediated atrial arrhythmogenesis and may therefore constitute an interesting antiarrhythmic drug for treating patients with atrial arrhythmias driven by an enhanced CaMKII activity, such as AF.
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Affiliation(s)
- Steffen Pabel
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Thea Stehle
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Simon Lebek
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Nataliya Dybkova
- Clinic for Cardiology & Pneumology, Georg-August University Göttingen, DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany
| | - Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Leopold Rupprecht
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Stefan Neef
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.,Clinic for Cardiology & Pneumology, Georg-August University Göttingen, DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany
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13
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Hammer KP, Mustroph J, Stauber T, Birchmeier W, Wagner S, Maier LS. Beneficial effect of voluntary physical exercise in Plakophilin2 transgenic mice. PLoS One 2021; 16:e0252649. [PMID: 34086773 PMCID: PMC8177441 DOI: 10.1371/journal.pone.0252649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/19/2021] [Indexed: 12/31/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy is a hereditary, rare disease with an increased risk for sudden cardiac death. The disease-causing mutations are located within the desmosomal complex and the highest incidence is found in plakophilin2. However, there are other factors playing a role for the disease progression unrelated to the genotype such as inflammation or exercise. Competitive sports have been identified as risk factor, but the type and extend of physical activity as cofactor for arrhythmogenesis remains under debate. We thus studied the effect of light voluntary exercise on cardiac health in a mouse model. Mice with a heterozygous PKP2 loss-of-function mutation were given the option to exercise in a running wheel which was monitored 24 h/d. We analyzed structural and functional development in vivo by echocardiography which revealed that neither the genotype nor the exercise caused any significant structural changes. Ejection fraction and fractional shortening were not influenced by the genotype itself, but exercise did cause a drop in both parameters after 8 weeks, which returned to normal after 16 weeks of training. The electrophysiological analysis revealed that the arrhythmogenic potential was slightly higher in heterozygous animals (50% vs 18% in wt littermates) and that an additional stressor (isoprenaline) did not lead to an increase of arrhythmogenic events pre run or after 8 weeks of running but the vulnerability was increased after 16 weeks. Exercise-induced alterations in Ca handling and contractility of isolated myocytes were mostly abolished in heterozygous animals. No fibrofatty replacements or rearrangement of gap junctions could be observed. Taken together we could show that light voluntary exercise can cause a transient aggravation of the mutation-induced phenotype which is abolished after long term exercise indicating a beneficial effect of long term light exercise.
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Affiliation(s)
- Karin P. Hammer
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
- * E-mail:
| | - Julian Mustroph
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - Teresa Stauber
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | | | - Stefan Wagner
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - Lars S. Maier
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
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14
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Mustroph J, Sag CM, Bähr F, Schmidtmann AL, Gupta SN, Dietz A, Islam MMT, Lücht C, Beuthner BE, Pabel S, Baier MJ, El-Armouche A, Sossalla S, Anderson ME, Möllmann J, Lehrke M, Marx N, Mohler PJ, Bers DM, Unsöld B, He T, Dewenter M, Backs J, Maier LS, Wagner S. Loss of CASK Accelerates Heart Failure Development. Circ Res 2021; 128:1139-1155. [PMID: 33593074 DOI: 10.1161/circresaha.120.318170] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.)
| | - Can M Sag
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.)
| | - Felix Bähr
- Cardiology & Pneumology, University Medical Center Göttingen, Germany (F.B., A.-L.S., S.N.G., A.D., M.M.T.I., B.E.B., S.S.)
| | - Anna-Lena Schmidtmann
- Cardiology & Pneumology, University Medical Center Göttingen, Germany (F.B., A.-L.S., S.N.G., A.D., M.M.T.I., B.E.B., S.S.)
| | - Shamindra N Gupta
- Cardiology & Pneumology, University Medical Center Göttingen, Germany (F.B., A.-L.S., S.N.G., A.D., M.M.T.I., B.E.B., S.S.)
| | - Alexander Dietz
- Cardiology & Pneumology, University Medical Center Göttingen, Germany (F.B., A.-L.S., S.N.G., A.D., M.M.T.I., B.E.B., S.S.)
| | - M M Towhidul Islam
- Cardiology & Pneumology, University Medical Center Göttingen, Germany (F.B., A.-L.S., S.N.G., A.D., M.M.T.I., B.E.B., S.S.)
| | - Charlotte Lücht
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.)
| | - Bo Eric Beuthner
- Cardiology & Pneumology, University Medical Center Göttingen, Germany (F.B., A.-L.S., S.N.G., A.D., M.M.T.I., B.E.B., S.S.)
| | - Steffen Pabel
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.)
| | - Maria J Baier
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.)
| | - Ali El-Armouche
- Department of Pharmacology and Toxicology, Technical University Dresden, Germany (A.E.-A.)
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.).,Cardiology & Pneumology, University Medical Center Göttingen, Germany (F.B., A.-L.S., S.N.G., A.D., M.M.T.I., B.E.B., S.S.)
| | | | - Julia Möllmann
- Clinic for Cardiology, Angiology, and Internal Intensive Care, University Clinic Aachen, Germany (J. Möllmann, M.L., N.M.)
| | - Michael Lehrke
- Clinic for Cardiology, Angiology, and Internal Intensive Care, University Clinic Aachen, Germany (J. Möllmann, M.L., N.M.)
| | - Nikolaus Marx
- Clinic for Cardiology, Angiology, and Internal Intensive Care, University Clinic Aachen, Germany (J. Möllmann, M.L., N.M.)
| | - Peter J Mohler
- College of Medicine, the Ohio State University Wexner Medical Center, Columbus (P.J.M.)
| | - Donald M Bers
- College of Biological Sciences, University of California at Davis (D.M.B.)
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.)
| | - Tao He
- Department of Molecular Cardiology and Epigenetics, University Clinic Heidelberg, Germany (T.H., M.D., J.B.)
| | - Matthias Dewenter
- Department of Molecular Cardiology and Epigenetics, University Clinic Heidelberg, Germany (T.H., M.D., J.B.)
| | - Johannes Backs
- Department of Molecular Cardiology and Epigenetics, University Clinic Heidelberg, Germany (T.H., M.D., J.B.)
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.)
| | - Stefan Wagner
- Department of Internal Medicine II, University Medical Center Regensburg, Germany (J. Mustroph, C.M.S., C.L., S.P., M.J.B., S.S., B.U., L.S.M., S.W.)
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15
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Mustroph J, Hupf J, Hanses F, Evert K, Baier MJ, Evert M, Meindl C, Wagner S, Hubauer U, Pietrzyk G, Leininger S, Staudner S, Vogel M, Wallner S, Zimmermann M, Sossalla S, Maier LS, Jungbauer C. Decreased GLUT1/NHE1 RNA expression in whole blood predicts disease severity in patients with COVID-19. ESC Heart Fail 2021; 8:309-316. [PMID: 33215884 PMCID: PMC7835506 DOI: 10.1002/ehf2.13063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS We aimed to assess whether expression of whole-blood RNA of sodium proton exchanger 1 (NHE1) and glucose transporter 1 (GLUT1) is associated with COVID-19 infection and outcome in patients presenting to the emergency department with respiratory infections. Furthermore, we investigated NHE1 and GLUT1 expression in the myocardium of deceased COVID-19 patients. METHODS AND RESULTS Whole-blood quantitative assessment of NHE1 and GLUT1 RNA was performed using quantitative PCR in patients with respiratory infection upon first contact in the emergency department and subsequently stratified by SARS-CoV-2 infection status. Assessment of NHE1 and GLUT1 RNA using PCR was also performed in left ventricular myocardium of deceased COVID-19 patients. NHE1 expression is up-regulated in whole blood of patients with COVID-19 compared with other respiratory infections at first medical contact in the emergency department (control: 0.0021 ± 0.0002, COVID-19: 0.0031 ± 0.0003, P = 0.01). The ratio of GLUT1 to NHE1 is significantly decreased in the blood of COVID-19 patients who are subsequently intubated and/or die (severe disease) compared with patients with moderate disease (moderate disease: 0.497 ± 0.083 vs. severe disease: 0.294 ± 0.0336, P = 0.036). This ratio is even further decreased in the myocardium of patients who deceased from COVID-19 in comparison with the myocardium of non-infected donors. CONCLUSIONS NHE1 and GLUT1 may be critically involved in the disease progression of SARS-CoV-2 infection. We show here that SARS-CoV-2 infection critically disturbs ion channel expression in the heart. A decreased ratio of GLUT1/NHE1 could potentially serve as a biomarker for disease severity in patients with COVID-19.
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Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Julian Hupf
- Emergency DepartmentUniversity Hospital RegensburgRegensburgGermany
| | - Frank Hanses
- Emergency DepartmentUniversity Hospital RegensburgRegensburgGermany
- Department of Infection Prevention and Infectious DiseasesUniversity Hospital RegensburgRegensburgGermany
| | - Katja Evert
- Institute of PathologyUniversity Hospital RegensburgRegensburgGermany
| | - Maria J. Baier
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Matthias Evert
- Institute of PathologyUniversity Hospital RegensburgRegensburgGermany
| | - Christine Meindl
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Stefan Wagner
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Ute Hubauer
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Gabriela Pietrzyk
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Simon Leininger
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Stephan Staudner
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Manuel Vogel
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory MedicineUniversity Hospital RegensburgRegensburgGermany
| | | | - Samuel Sossalla
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Lars S. Maier
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II (Cardiology)University Hospital RegensburgFranz‐Josef‐Strauß‐Allee 11Regensburg93053Germany
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16
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Pabel S, Reetz F, Dybkova N, Shomroni O, Salinas G, Mustroph J, Hammer KP, Hasenfuss G, Hamdani N, Maier LS, Streckfuss-Bömeke K, Sossalla S. Long-term effects of empagliflozin on excitation-contraction-coupling in human induced pluripotent stem cell cardiomyocytes. J Mol Med (Berl) 2020; 98:1689-1700. [PMID: 33034709 PMCID: PMC7679329 DOI: 10.1007/s00109-020-01989-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/11/2020] [Accepted: 10/01/2020] [Indexed: 12/18/2022]
Abstract
Abstract The SGLT2 inhibitor empagliflozin improved cardiovascular outcomes in patients with diabetes. As the cardiac mechanisms remain elusive, we investigated the long-term effects (up to 2 months) of empagliflozin on excitation-contraction (EC)-coupling in human cardiomyocytes derived from induced pluripotent stem cells (iPSC-CM) in a blinded manner. IPSC from 3 donors, differentiated into pure iPSC-CM (4 differentiations), were treated with a clinically relevant concentration of empagliflozin (0.5 μmol/l) or vehicle control. Treatment, data acquisition, and analysis were conducted externally blinded. Epifluorescence microscopy measurements in iPSC-CM showed that empagliflozin has neutral effects on Ca2+ transient amplitude, diastolic Ca2+ levels, Ca2+ transient kinetics, or sarcoplasmic Ca2+ load after 2 weeks or 8 weeks of treatment. Confocal microscopy determining possible effects on proarrhythmogenic diastolic Ca2+ release events showed that in iPSC-CM, Ca2+ spark frequency and leak was not altered after chronic treatment with empagliflozin. Finally, in patch-clamp experiments, empagliflozin did not change action potential duration, amplitude, or resting membrane potential compared with vehicle control after long-term treatment. Next-generation RNA sequencing (NGS) and mapped transcriptome profiles of iPSC-CMs untreated and treated with empagliflozin for 8 weeks showed no differentially expressed EC-coupling genes. In line with NGS data, Western blots indicate that empagliflozin has negligible effects on key EC-coupling proteins. In this blinded study, direct treatment of iPSC-CM with empagliflozin for a clinically relevant duration of 2 months did not influence cardiomyocyte EC-coupling and electrophysiology. Therefore, it is likely that other mechanisms independent of cardiomyocyte EC-coupling are responsible for the beneficial treatment effect of empagliflozin. Key messages This blinded study investigated the clinically relevant long-term effects (up to 2 months) of empagliflozin on cardiomyocyte excitation-contraction (EC)-coupling. Human cardiomyocytes derived from induced pluripotent stem cells (iPSC-CM) were used to study a human model including a high repetition number of experiments. Empagliflozin has neutral effects on cardiomyocyte Ca2+ transients, sarcoplasmic Ca2+ load, and diastolic sarcoplasmic Ca2+ leak. In patch-clamp experiments, empagliflozin did not change the action potential. Next-generation RNA sequencing, mapped transcriptome profiles, and Western blots of iPSC-CM untreated and treated with empagliflozin showed no differentially expressed EC-coupling candidates.
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Affiliation(s)
- Steffen Pabel
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Florian Reetz
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Nataliya Dybkova
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and DZHK (German Center for Cardiovascular Research), Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Orr Shomroni
- NGS-Integrative Genomics (NIG) Institute Human Genetics (O.S., G.S.), University Medical Center Goettingen, Georg-August University, Goettingen, Germany
| | - Gabriela Salinas
- NGS-Integrative Genomics (NIG) Institute Human Genetics (O.S., G.S.), University Medical Center Goettingen, Georg-August University, Goettingen, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Karin P Hammer
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Gerd Hasenfuss
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and DZHK (German Center for Cardiovascular Research), Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Nazha Hamdani
- Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Katrin Streckfuss-Bömeke
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and DZHK (German Center for Cardiovascular Research), Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and DZHK (German Center for Cardiovascular Research), Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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17
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Hupf J, Mustroph J, Hanses F, Evert K, Maier LS, Jungbauer CG. RNA-expression of adrenomedullin is increased in patients with severe COVID-19. Crit Care 2020; 24:527. [PMID: 32859259 PMCID: PMC7453369 DOI: 10.1186/s13054-020-03246-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Julian Hupf
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Julian Mustroph
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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18
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Mustroph J, Drzymalski M, Baier M, Pabel S, Biedermann A, Memmel B, Durczok M, Neef S, Sag CM, Floerchinger B, Rupprecht L, Schmid C, Zausig Y, Bégis G, Briand V, Ozoux ML, Tamarelle D, Ballet V, Janiak P, Beauverger P, Maier LS, Wagner S. The oral Ca/calmodulin-dependent kinase II inhibitor RA608 improves contractile function and prevents arrhythmias in heart failure. ESC Heart Fail 2020; 7:2871-2883. [PMID: 32691522 PMCID: PMC7524064 DOI: 10.1002/ehf2.12895] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/29/2020] [Accepted: 06/24/2020] [Indexed: 01/15/2023] Open
Abstract
Aims Excessive activation of Ca/calmodulin‐dependent kinase II (CaMKII) is of critical importance in heart failure (HF) and atrial fibrillation. Unfortunately, lack of selectivity, specificity, and bioavailability have slowed down development of inhibitors for clinical use. We investigated a novel CaMKIIδ/CaMKIIɣ‐selective, ATP‐competitive, orally available CaMKII inhibitor (RA608) on right atrial biopsies of 119 patients undergoing heart surgery. Furthermore, we evaluated its oral efficacy to prevent deterioration of HF in mice after transverse aortic constriction (TAC). Methods and results In human atrial cardiomyocytes and trabeculae, respectively, RA608 significantly reduced sarcoplasmic reticulum Ca leak, reduced diastolic tension, and increased sarcoplasmic reticulum Ca content. Patch‐clamp recordings confirmed the safety of RA608 in human cardiomyocytes. C57BL6/J mice were subjected to TAC, and left ventricular function was monitored by echocardiography. Two weeks after TAC, RA608 was administered by oral gavage for 7 days. Oral RA608 treatment prevented deterioration of ejection fraction. At 3 weeks after TAC, ejection fraction was 46.1 ± 3.7% (RA608) vs. 34.9 ± 2.6% (vehicle), n = 9 vs. n = 12, P < 0.05, ANOVA, which correlated with significantly less CaMKII autophosphorylation at threonine 287. Moreover, a single oral dose significantly reduced inducibility of atrial and ventricular arrhythmias in CaMKIIδ transgenic mice 4 h after administration. Atrial fibrillation was induced in 6/6 mice for vehicle vs. 1/7 for RA608, P < 0.05, 'n − 1' χ2 test. Ventricular tachycardia was induced in 6/7 for vehicle vs. 2/7 for RA608, P < 0.05, 'n − 1' χ2 test. Conclusions RA608 is the first orally administrable CaMKII inhibitor with potent efficacy in human myocytes. Moreover, oral administration potently inhibits arrhythmogenesis and attenuates HF development in mice in vivo.
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Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Marzena Drzymalski
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Maria Baier
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Steffen Pabel
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Alexander Biedermann
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Bernadette Memmel
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Melanie Durczok
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Stefan Neef
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Can Martin Sag
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Bernhard Floerchinger
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Leopold Rupprecht
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - York Zausig
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | | | | | | | | | | | - Philip Janiak
- Sanofi Research & Development (R&D), Chilly-Mazarin, France
| | | | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
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19
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Lebek S, Pichler K, Reuthner K, Trum M, Tafelmeier M, Mustroph J, Camboni D, Rupprecht L, Schmid C, Maier LS, Arzt M, Wagner S. Enhanced CaMKII-Dependent Late I
Na
Induces Atrial Proarrhythmic Activity in Patients With Sleep-Disordered Breathing. Circ Res 2020; 126:603-615. [DOI: 10.1161/circresaha.119.315755] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rationale:
Sleep-disordered breathing (SDB) is frequently associated with atrial arrhythmias. Increased CaMKII (Ca/calmodulin-dependent protein kinase II) activity has been previously implicated in atrial arrhythmogenesis.
Objective:
We hypothesized that CaMKII-dependent dysregulation of Na current (I
Na
) may contribute to atrial proarrhythmic activity in patients with SDB.
Methods and Results:
We prospectively enrolled 113 patients undergoing elective coronary artery bypass grafting for cross-sectional study and collected right atrial appendage biopsies. The presence of SDB (defined as apnea-hypopnea index ≥15/h) was assessed with a portable SDB monitor the night before surgery. Compared with 56 patients without SDB, patients with SDB (57) showed a significantly increased level of activated CaMKII. Patch clamp was used to measure I
Na
. There was a significantly enhanced late I
Na
, but reduced peak I
Na
due to enhanced steady-state inactivation in atrial myocytes of patients with SDB consistent with significantly increased CaMKII-dependent cardiac Na channel phosphorylation (Na
V
1.5, at serine 571, Western blotting). These gating changes could be fully reversed by acute CaMKII inhibition (AIP [autocamtide-2 related inhibitory peptide]). As a consequence, we observed significantly more cellular afterdepolarizations and more severe premature atrial contractions in atrial trabeculae of patients with SDB, which could be blocked by either AIP or KN93 (N-[2-[[[(E)-3-(4-chlorophenyl)prop-2-enyl]-methylamino]methyl]phenyl]-N-(2-hydroxyethyl)-4-methoxybenzenesulfonamide). In multivariable linear regression models incorporating age, sex, body mass index, existing atrial fibrillation, existing heart failure, diabetes mellitus, and creatinine levels, apnea-hypopnea index was independently associated with increased CaMKII activity, enhanced late I
Na
and correlated with premature atrial contraction severity.
Conclusions:
In atrial myocardium of patients with SDB, increased CaMKII-dependent phosphorylation of Na
V
1.5 results in dysregulation of I
Na
with proarrhythmic activity that was independent from preexisting comorbidities. Inhibition of CaMKII may be useful for prevention or treatment of arrhythmias in SDB.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02877745.
Visual Overview:
An online visual overview is available for this article.
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Affiliation(s)
- Simon Lebek
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
| | - Konstantin Pichler
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
| | - Kathrin Reuthner
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
| | - Maximillian Trum
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
| | - Maria Tafelmeier
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
| | - Julian Mustroph
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
| | - Daniele Camboni
- Department of Cardiothoracic Surgery (D.C., L.R., C.S.), University Hospital Regensburg, Germany
| | - Leopold Rupprecht
- Department of Cardiothoracic Surgery (D.C., L.R., C.S.), University Hospital Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery (D.C., L.R., C.S.), University Hospital Regensburg, Germany
| | - Lars S. Maier
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
| | - Michael Arzt
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
| | - Stefan Wagner
- From the Department of Internal Medicine II (S.L., K.P., K.R., M. Trum, M. Tafelmeier, J.M., L.S.M., M.A., S.W.), University Hospital Regensburg, Germany
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20
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Pabel S, Ahmad S, Tirilomis P, Stehle T, Mustroph J, Knierim M, Dybkova N, Bengel P, Holzamer A, Hilker M, Streckfuss-Bömeke K, Hasenfuss G, Maier LS, Sossalla S. Inhibition of Na V1.8 prevents atrial arrhythmogenesis in human and mice. Basic Res Cardiol 2020; 115:20. [PMID: 32078054 PMCID: PMC7033079 DOI: 10.1007/s00395-020-0780-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
Abstract
Pharmacologic approaches for the treatment of atrial arrhythmias are limited due to side effects and low efficacy. Thus, the identification of new antiarrhythmic targets is of clinical interest. Recent genome studies suggested an involvement of SCN10A sodium channels (NaV1.8) in atrial electrophysiology. This study investigated the role and involvement of NaV1.8 (SCN10A) in arrhythmia generation in the human atria and in mice lacking NaV1.8. NaV1.8 mRNA and protein were detected in human atrial myocardium at a significant higher level compared to ventricular myocardium. Expression of NaV1.8 and NaV1.5 did not differ between myocardium from patients with atrial fibrillation and sinus rhythm. To determine the electrophysiological role of NaV1.8, we investigated isolated human atrial cardiomyocytes from patients with sinus rhythm stimulated with isoproterenol. Inhibition of NaV1.8 by A-803467 or PF-01247324 showed no effects on the human atrial action potential. However, we found that NaV1.8 significantly contributes to late Na+ current and consequently to an increased proarrhythmogenic diastolic sarcoplasmic reticulum Ca2+ leak in human atrial cardiomyocytes. Selective pharmacological inhibition of NaV1.8 potently reduced late Na+ current, proarrhythmic diastolic Ca2+ release, delayed afterdepolarizations as well as spontaneous action potentials. These findings could be confirmed in murine atrial cardiomyocytes from wild-type mice and also compared to SCN10A-/- mice (genetic ablation of NaV1.8). Pharmacological NaV1.8 inhibition showed no effects in SCN10A-/- mice. Importantly, in vivo experiments in SCN10A-/- mice showed that genetic ablation of NaV1.8 protects against atrial fibrillation induction. This study demonstrates that NaV1.8 is expressed in the murine and human atria and contributes to late Na+ current generation and cellular arrhythmogenesis. Blocking NaV1.8 selectively counteracts this pathomechanism and protects against atrial arrhythmias. Thus, our translational study reveals a new selective therapeutic target for treating atrial arrhythmias.
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Affiliation(s)
- Steffen Pabel
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Shakil Ahmad
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
| | - Petros Tirilomis
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
| | - Thea Stehle
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maria Knierim
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
| | - Nataliya Dybkova
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
| | - Philipp Bengel
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Katrin Streckfuss-Bömeke
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
| | - Gerd Hasenfuss
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
- Clinic for Cardiology and Pneumology, Georg-August University Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Robert Koch Str. 40, 37075, Göttingen, Germany.
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Trum M, Wagner S, Maier LS, Mustroph J. CaMKII and GLUT1 in heart failure and the role of gliflozins. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165729. [PMID: 32068116 DOI: 10.1016/j.bbadis.2020.165729] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
Empagliflozin, a selective sodium-glucose co-transporter 2 (SGLT2) inhibitor, has been shown to reduce mortality and hospitalization for heart failure in diabetic patients in the EMPA-REG-OUTCOME trial (Zinman et al., 2015). Surprisingly, dapagliflozin, another SGLT2 inhibitor, exerted comparable effects on clinical endpoints even in the absence of diabetes mellitus (DAPA-HF trial) (McMurray et al., 2019). There is a myriad of suggested underlying mechanisms ranging from improved glycemic control and hemodynamic effects to altered myocardial metabolism, inflammation, neurohumoral activation and intracellular ion homeostasis. Here, we review the effects of gliflozins on cardiac electro-mechanical coupling with an emphasis on novel CaMKII-mediated pathways and on cardiac glucose and ketone metabolism in the failing heart. We focus on empagliflozin as it is the gliflozin with the most abundant experimental evidence for direct effects on the heart. Where useful, we aim to compare empagliflozin to other gliflozins. To facilitate understanding of empagliflozin-induced alterations, we first give a short summary of the pathophysiological role of CaMKII in heart failure, as well as cardiac changes of glucose and ketone body metabolism in the failing heart.
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Affiliation(s)
- M Trum
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - S Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - L S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - J Mustroph
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
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22
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Mustroph J, Pabel S, Stehle T, Lebek S, Neef S, Maier LS, Sossalla S. P3832Dantrolene reduces CaMKII-mediated arrhythmogenesis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Rationale
In atrial and ventricular rhythm disorders, an increased diastolic sarcoplasmatic reticulum (SR) calcium leak can induce a depolarizing transient inward current, serving as a trigger for cellular arrhythmias. Dantrolene has been shown to also stabilize the cardiac ryanodine receptor. However, the detailed mechanism of the mode of action remains unknown. This study aims to investigate the effects of dantrolene on calcium/calmodulin-dependent kinase II (CaMKII) mediated arrhythmogenesis.
Methods and results
Right atrial cardiomyocytes (CM) were isolated from patients with atrial fibrillation. To investigate SR Ca2+ leak, measurements of diastolic SR Ca2+ sparks were performed by confocal microscopy using Fluo-4 AM. Dantrolene (10 μmol/l) potently reduced Ca2+-spark-frequency (CaSpF) by 90±26% (p<0.05, n=21 cells dantrolene vs. 19 cells control) leading to a reduction of the calculated diastolic SR-Ca2+-leak by 91±31% (p<0.05, n=21 vs. 19). Interestingly, CaMKII-inhibition using Autocamtide-2-Related Inhibitory Peptide (AIP) did not further reduced SR Ca2+ leak compared to dantrolene alone in human cardiomyocytes. This observation may suggest (secondary) inhibitory effects of dantrolene on CaMKII. To elucidate the role of CaMKII in dantrolene-mediated antiarrhythmic effects, we investigated atrial CM from mice overexpressing CaMKII (TG) and respective wildtype controls (WT). CaSpF and SR Ca2+ leak were reduced by dantrolene in both TG and WT mice (p<0.005, TG: dantrolene vs. vehicle n=132 vs 127 cells (9 mice); WT: dantrolene vs. vehicle n=61 vs 61 cells (5 mice)). However, proarrhythmogenic Ca2+ waves were only significantly reduced by dantrolene in TG mice (p<0.05, TG: dantrolene vs. vehicle 10.8% vs. 26.2%, n=154 vs 164 cells). Correspondingly, the incidence of delayed afterdepolarizations (DADs) in TG cells was significantly diminished by dantrolene (p<0.05, TG: dantrolene vs. vehicle 1/14 vs. 9/15 cells, n=5 mice). In contrast, DADs were not reduced by dantrolene in WT cells without increased CaMKII activity (p=n.s., WT: dantrolene vs vehicle 3/16 vs 2/13 cells, n=5 mice). In preliminary in vivo experiments, intraperitoneal injection of 40 mg/kg body weight dantrolene reduced the inducibility of arrhythmias by ventricular burst stimulation in CaMKII TG mice compared to vehicle (dantrolene 0/2 mice vs. vehicle 2/2 mice, p<0.05 Chi-Square).
Conclusion
Dantrolene beneficially altered Ca2+ homeostasis in human AF CM and murine CM. Dantrolene seems to exert its antiarrhythmic potential in a CaMKII-dependent manner. Thus, dantrolene as an already clinically approved compound might be a potential antiarrhythmic drug that merits clinical investigation.
Acknowledgement/Funding
Deutsche Forschungsgemeinschaft (MA 1981/5-1 and 7-1 to LSM). Marga und Walter Boll-Stiftung (SS).
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Affiliation(s)
- J Mustroph
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Pabel
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - T Stehle
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Lebek
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Neef
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - L S Maier
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Sossalla
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
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Mustroph J, Lücht CM, Wagemann O, Sowa T, Hammer KP, Sag CM, Tarnowski D, Holzamer A, Pabel S, Beuthner BE, Sossalla S, Maier LS, Wagner S. Empagliflozin enhances human and murine cardiomyocyte glucose uptake by increased expression of GLUT1. Diabetologia 2019; 62:726-729. [PMID: 30694352 DOI: 10.1007/s00125-019-4819-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Charlotte M Lücht
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Olivia Wagemann
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Thomas Sowa
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Karin P Hammer
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Can M Sag
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Daniel Tarnowski
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Holzamer
- Department of Cardio-thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Steffen Pabel
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Bo Eric Beuthner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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24
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Abstract
Ethanol can acutely and chronically alter cardiomyocyte and whole-organ function in the heart. Importantly, ethanol acutely and chronically predisposes to arrhythmias, while chronic abuse can induce heart failure. However, the molecular mechanisms of ethanol toxicity in the heart are incompletely understood. In this review, we summarize the current mechanistic knowledge on cardiac ethanol toxicity, with a focus on druggable pathways. Ethanol effects on excitation-contraction coupling, oxidative stress, apoptosis, and cardiac metabolism, as well as effects of ethanol metabolites will be discussed. Important recent findings have been gained by investigation of acute ethanol effects. These include a renewed focus on reactive oxygen species (ROS) and induction of SR Ca2+ leak by CaMKII-mediated pathways downstream of ROS. Furthermore, a clinical outlook into potential novel treatment options is provided.
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Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Simon Lebek
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Stefan Neef
- Department of Internal Medicine II, University Medical Center Regensburg, Germany.
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25
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Pabel S, Wagner S, Bollenberg H, Bengel P, Kovács Á, Schach C, Tirilomis P, Mustroph J, Renner A, Gummert J, Fischer T, Van Linthout S, Tschöpe C, Streckfuss-Bömeke K, Hasenfuss G, Maier LS, Hamdani N, Sossalla S. Empagliflozin directly improves diastolic function in human heart failure. Eur J Heart Fail 2018; 20:1690-1700. [PMID: 30328645 DOI: 10.1002/ejhf.1328] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 12/19/2022] Open
Abstract
AIMS Empagliflozin, a clinically used oral antidiabetic drug that inhibits the sodium-dependent glucose co-transporter 2, has recently been evaluated for its cardiovascular safety. Surprisingly, empagliflozin reduced mortality and hospitalization for heart failure (HF) compared to placebo. However, the underlying mechanisms remain unclear. Therefore, our study aims to investigate whether empagliflozin may cause direct pleiotropic effects on the myocardium. METHODS AND RESULTS In order to assess possible direct myocardial effects of empagliflozin, we performed contractility experiments with in toto-isolated human systolic end-stage HF ventricular trabeculae. Empagliflozin significantly reduced diastolic tension, whereas systolic force was not changed. These results were confirmed in murine myocardium from diabetic and non-diabetic mice, suggesting independent effects from diabetic conditions. In human HF cardiomyocytes, empagliflozin did not influence calcium transient amplitude or diastolic calcium level. The mechanisms underlying the improved diastolic function were further elucidated by studying myocardial fibres from patients and rats with diastolic HF (HF with preserved ejection fraction, HFpEF). Empagliflozin beneficially reduced myofilament passive stiffness by enhancing phosphorylation levels of myofilament regulatory proteins. Intravenous injection of empagliflozin in anaesthetized HFpEF rats significantly improved diastolic function measured by echocardiography, while systolic contractility was unaffected. CONCLUSION Empagliflozin causes direct pleiotropic effects on the myocardium by improving diastolic stiffness and hence diastolic function. These effects were independent of diabetic conditions. Since pharmacological therapy of diastolic dysfunction and HF is an unmet need, our results provide a rationale for new translational studies and might also contribute to the understanding of the EMPA-REG OUTCOME trial.
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Affiliation(s)
- Steffen Pabel
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.,Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Hannah Bollenberg
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Philipp Bengel
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Árpád Kovács
- Department of Systems Physiology, Ruhr University Bochum, Bochum, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Petros Tirilomis
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - André Renner
- Department of Thoracic, Cardiac and Vascular Surgery (Heart and Diabetes Center), North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Thoracic, Cardiac and Vascular Surgery (Heart and Diabetes Center), North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Thomas Fischer
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Sophie Van Linthout
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Berlin-Brandenburg Center for Regenerative Therapies and German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Berlin-Brandenburg Center for Regenerative Therapies and German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Katrin Streckfuss-Bömeke
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Gerd Hasenfuss
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Nazha Hamdani
- Department of Systems Physiology, Ruhr University Bochum, Bochum, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.,Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
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Pabel S, Bollenberg H, Bengel P, Tirilomis P, Mustroph J, Wagner S, Fischer T, Streckfuss-Boemeke K, Maier L, Hasenfuss G, Hamdani N, Sossalla S. P1509Empagliflozin directly improves diastolic function in human heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Pabel
- University Hospital Regensburg, Internal Medicine II, Heart Center, Regensburg, Germany
| | - H Bollenberg
- University Medical Center Gottingen (UMG), Dept. of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - P Bengel
- University Medical Center Gottingen (UMG), Dept. of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - P Tirilomis
- University Medical Center Gottingen (UMG), Dept. of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - J Mustroph
- University Hospital Regensburg, Internal Medicine II, Heart Center, Regensburg, Germany
| | - S Wagner
- University Hospital Regensburg, Internal Medicine II, Heart Center, Regensburg, Germany
| | - T Fischer
- University Medical Center Gottingen (UMG), Dept. of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - K Streckfuss-Boemeke
- University Medical Center Gottingen (UMG), Dept. of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - L Maier
- University Hospital Regensburg, Internal Medicine II, Heart Center, Regensburg, Germany
| | - G Hasenfuss
- University Medical Center Gottingen (UMG), Dept. of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - N Hamdani
- Ruhr University Bochum (RUB), Department of Cardiovascular Physiology, Bochum, Germany
| | - S Sossalla
- University Hospital Regensburg, Internal Medicine II, Heart Center, Regensburg, Germany
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27
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Lebek S, Pichler K, Mustroph J, Tafelmeier M, Camboni D, Rupprecht L, Schmid C, Maier LS, Arzt M, Wagner S. P2833Sleep-disordered breathing is associated with enhanced CaMKII-dependent late INa and pro-arrhythmic activity. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Lebek
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - K Pichler
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - J Mustroph
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - M Tafelmeier
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - D Camboni
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - L Rupprecht
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - C Schmid
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - L S Maier
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - M Arzt
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - S Wagner
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
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28
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Mustroph J, Wagemann O, Lücht CM, Trum M, Hammer KP, Sag CM, Lebek S, Tarnowski D, Reinders J, Perbellini F, Terracciano C, Schmid C, Schopka S, Hilker M, Zausig Y, Pabel S, Sossalla ST, Schweda F, Maier LS, Wagner S. Empagliflozin reduces Ca/calmodulin-dependent kinase II activity in isolated ventricular cardiomyocytes. ESC Heart Fail 2018; 5:642-648. [PMID: 30117720 PMCID: PMC6073019 DOI: 10.1002/ehf2.12336] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 06/22/2018] [Indexed: 12/14/2022] Open
Abstract
AIMS The EMPA-REG OUTCOME study showed reduced mortality and hospitalization due to heart failure (HF) in diabetic patients treated with empagliflozin. Overexpression and Ca2+ -dependent activation of Ca2+ /calmodulin-dependent kinase II (CaMKII) are hallmarks of HF, leading to contractile dysfunction and arrhythmias. We tested whether empagliflozin reduces CaMKII- activity and improves Ca2+ -handling in human and murine ventricular myocytes. METHODS AND RESULTS Myocytes from wild-type mice, mice with transverse aortic constriction (TAC) as a model of HF, and human failing ventricular myocytes were exposed to empagliflozin (1 μmol/L) or vehicle. CaMKII activity was assessed by CaMKII-histone deacetylase pulldown assay. Ca2+ spark frequency (CaSpF) as a measure of sarcoplasmic reticulum (SR) Ca2+ leak was investigated by confocal microscopy. [Na+ ]i was measured using Na+ /Ca2+ -exchanger (NCX) currents (whole-cell patch clamp). Compared with vehicle, 24 h empagliflozin exposure of murine myocytes reduced CaMKII activity (1.6 ± 0.7 vs. 4.2 ± 0.9, P < 0.05, n = 10 mice), and also CaMKII-dependent ryanodine receptor phosphorylation (0.8 ± 0.1 vs. 1.0 ± 0.1, P < 0.05, n = 11 mice), with similar results upon TAC. In murine myocytes, empagliflozin reduced CaSpF (TAC: 1.7 ± 0.3 vs. 2.5 ± 0.4 1/100 μm-1 s-1 , P < 0.05, n = 4 mice) but increased SR Ca2+ load and Ca2+ transient amplitude. Importantly, empagliflozin also significantly reduced CaSpF in human failing ventricular myocytes (1 ± 0.2 vs. 3.3 ± 0.9, P < 0.05, n = 4 patients), while Ca2+ transient amplitude was increased (F/F0 : 0.53 ± 0.05 vs. 0.36 ± 0.02, P < 0.05, n = 3 patients). In contrast, 30 min exposure with empagliflozin did not affect CaMKII activity nor Ca2+ -handling but significantly reduced [Na+ ]i . CONCLUSIONS We show for the first time that empagliflozin reduces CaMKII activity and CaMKII-dependent SR Ca2+ leak. Reduced Ca2+ leak and improved Ca2+ transients may contribute to the beneficial effects of empagliflozin in HF.
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Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Olivia Wagemann
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Charlotte M. Lücht
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Maximilian Trum
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Karin P. Hammer
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Can Martin Sag
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Simon Lebek
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Daniel Tarnowski
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Jörg Reinders
- Leibniz Research Centre for Working Environment and Human FactorsUniversity of DortmundDortmundGermany
| | - Filippo Perbellini
- Laboratory of Myocardial Electrophysiology, Imperial Centre for Translational and Experimental MedicineImperial College LondonLondonUK
| | - Cesare Terracciano
- Laboratory of Myocardial Electrophysiology, Imperial Centre for Translational and Experimental MedicineImperial College LondonLondonUK
| | - Christof Schmid
- Department of Cardiothoracic SurgeryUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Simon Schopka
- Department of Cardiothoracic SurgeryUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Michael Hilker
- Department of Cardiothoracic SurgeryUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - York Zausig
- Department of AnesthesiologyUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Steffen Pabel
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Samuel T. Sossalla
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
- Clinic for Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
| | - Frank Schweda
- Department of PhysiologyUniversity of RegensburgRegensburgGermany
| | - Lars S. Maier
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
| | - Stefan Wagner
- Department of Internal Medicine IIUniversity Medical Center RegensburgFranz‐Josef‐Strauß‐Allee 1193053RegensburgGermany
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Mustroph J, Wagemann O, Trum M, Lebek S, Tarnowski D, Reinders J, Schmid C, Schopka S, Hilker M, Graf B, Pabel S, Sossalla S, Schweda F, Maier LS, Wagner S. 3145Empagliflozin potently reduces sarcoplasmic Ca leak and increases Ca transient amplitude of human failing ventricular cardiomyocytes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Mustroph
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - O Wagemann
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - M Trum
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Lebek
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - D Tarnowski
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - J Reinders
- University of Regensburg, Institute of Functional Genomics, Regensburg, Germany
| | - C Schmid
- University Hospital Regensburg, Department of Cardio-thoracic surgery, Regensburg, Germany
| | - S Schopka
- University Hospital Regensburg, Department of Cardio-thoracic surgery, Regensburg, Germany
| | - M Hilker
- University Hospital Regensburg, Department of Cardio-thoracic surgery, Regensburg, Germany
| | - B Graf
- University Hospital Regensburg, Department of Anesthesiology, Regensburg, Germany
| | - S Pabel
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Sossalla
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - F Schweda
- University of Regensburg, Department of Physiology, Regensburg, Germany
| | - L S Maier
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - S Wagner
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
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Mustroph J, Wagemann O, Lebek S, Tarnowski D, Ackermann J, Drzymalski M, Pabel S, Schmid C, Wagner S, Sossalla S, Maier LS, Neef S. SR Ca 2+-leak and disordered excitation-contraction coupling as the basis for arrhythmogenic and negative inotropic effects of acute ethanol exposure. J Mol Cell Cardiol 2018; 116:81-90. [PMID: 29410242 DOI: 10.1016/j.yjmcc.2018.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 02/03/2023]
Abstract
AIMS Ethanol has acute negative inotropic and arrhythmogenic effects. The underlying mechanisms, however, are largely unknown. Sarcoplasmic reticulum Ca2+-leak is an important mechanism for reduced contractility and arrhythmias. Ca2+-leak can be induced by oxidative stress and Ca2+/Calmodulin-dependent protein kinase II (CaMKII). Therefore, we investigated the influence of acute ethanol exposure on excitation-contraction coupling in atrial and ventricular cardiomyocytes. METHODS AND RESULTS Isolated human atrial and murine atrial or ventricular cardiomyocytes were preincubated for 30 min and then superfused with control solution or solution containing ethanol. Ethanol had acute negative inotropic and positive lusitropic effects in human atrial muscle strips and murine ventricular cardiomyocytes. Accordingly, Ca2+-imaging indicated lower Ca2+-transient amplitudes and increased SERCA2a activity, while myofilament Ca2+-sensitivity was reduced. SR Ca2+-leak was assessed by measuring Ca2+-sparks. Ethanol induced severe SR Ca2+-leak in human atrial cardiomyocytes (calculated leak: 4.60 ± 0.45 mF/F0 vs 1.86 ± 0.26 in control, n ≥ 80). This effect was dose-dependent, while spontaneous arrhythmogenic Ca2+-waves increased ~5-fold, as investigated in murine cardiomyocytes. Delayed afterdepolarizations, which can result from increased SR Ca2+-leak, were significantly increased by ethanol. Measurements using the reactive oxygen species (ROS) sensor CM-H2DCFDA showed increased ROS-stress in ethanol treated cells. ROS-scavenging with N-acetylcysteine prevented negative inotropic and positive lusitropic effects in human muscle strips. Ethanol-induced Ca2+-leak was abolished in mice with knockout of NOX2 (the main source for ROS in cardiomyocytes). Importantly, mice with oxidation-resistant CaMKII (Met281/282Val mutation) were protected from ethanol-induced Ca2+-leak. CONCLUSION We show for the first time that ethanol acutely induces strong SR Ca2+-leak, also altering excitation-contraction coupling. Acute negative inotropic effects of ethanol can be explained by reduced systolic Ca2+-release. Mechanistically, ROS-production via NOX2 and oxidative activation of CaMKII appear to play central roles. This provides a mechanism for the arrhythmogenic and negative inotropic effects of ethanol and suggests a druggable target (CaMKII).
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Affiliation(s)
- Julian Mustroph
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Olivia Wagemann
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Simon Lebek
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Daniel Tarnowski
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Jasmin Ackermann
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Marzena Drzymalski
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Steffen Pabel
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Dept. of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Wagner
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Samuel Sossalla
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Lars S Maier
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Neef
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
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Neef S, Steffens A, Pellicena P, Mustroph J, Lebek S, Ort KR, Schulman H, Maier LS. Improvement of cardiomyocyte function by a novel pyrimidine-based CaMKII-inhibitor. J Mol Cell Cardiol 2017; 115:73-81. [PMID: 29294328 DOI: 10.1016/j.yjmcc.2017.12.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 12/12/2017] [Accepted: 12/29/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pathologically increased activity of Ca2+/calmodulin-dependent protein kinase II (CaMKII) and the associated Ca2+-leak from the sarcoplasmic reticulum are recognized to be important novel pharmacotherapeutic targets in heart failure and cardiac arrhythmias. However, CaMKII-inhibitory compounds for therapeutic use are still lacking. We now report on the cellular and molecular effects of a novel pyrimidine-based CaMKII inhibitor developed towards clinical use. METHODS AND RESULTS Our findings demonstrate that AS105 is a high-affinity ATP-competitive CaMKII-inhibitor that by its mode of action is also effective against autophosphorylated CaMKII (in contrast to the commonly used allosteric CaMKII-inhibitor KN-93). In isolated atrial cardiomyocytes from human donors and ventricular myocytes from CaMKIIδC-overexpressing mice with heart failure, AS105 effectively reduced diastolic SR Ca2+ leak by 38% to 65% as measured by Ca2+-sparks or tetracaine-sensitive shift in [Ca2+]i. Consistent with this, we found that AS105 suppressed arrhythmogenic spontaneous cardiomyocyte Ca2+-release (by 53%). Also, the ability of the SR to accumulate Ca2+ was enhanced by AS105, as indicated by improved post-rest potentiation of Ca2+-transient amplitudes and increased SR Ca2+-content in the murine cells. Accordingly, these cells had improved systolic Ca2+-transient amplitudes and contractility during basal stimulation. Importantly, CaMKII inhibition did not compromise systolic fractional Ca2+-release, diastolic SR Ca2+-reuptake via SERCA2a or Ca2+-extrusion via NCX. CONCLUSION AS105 is a novel, highly potent ATP-competitive CaMKII inhibitor. In vitro, it effectively reduced SR Ca2+-leak, thus improving SR Ca2+-accumulation and reducing cellular arrhythmogenic correlates, without negatively influencing excitation-contraction coupling. These findings further validate CaMKII as a key target in cardiovascular disease, implicated by genetic, allosteric inhibitors, and pseudo-substrate inhibitors.
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Affiliation(s)
- Stefan Neef
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Alexander Steffens
- Dept. of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Julian Mustroph
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Simon Lebek
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Katharina R Ort
- Dept. of Thoracic, Cardiac and Vascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | | | - Lars S Maier
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
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Abstract
Calcium/calmodulin-dependent protein kinase II (CaMKII) has emerged as key enzyme in many cardiac pathologies, especially heart failure (HF), myocardial infarction and cardiomyopathies, thus leading to contractile dysfunction and malignant arrhythmias. While many pathways leading to CaMKII activation have been elucidated in recent years, hardly any clinically viable compounds affecting CaMKII activity have progressed from basic in vitro science to in vivo studies. This review focuses on recent advances in anti-arrhythmic strategies involving CaMKII. Specifically, both inhibition of CaMKII itself to prevent arrhythmias, as well as anti-arrhythmic approaches affecting CaMKII activity via alterations in signaling cascades upstream and downstream of CaMKII will be discussed.
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Affiliation(s)
- Julian Mustroph
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Stefan Neef
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Lars S Maier
- Universitäres Herzzentrum Regensburg, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany.
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Abstract
Cardiac K channels are critical determinants of cardiac excitability. In hypertrophied and failing myocardium, alterations in the expression and activity of voltage-gated K channels are frequently observed and contribute to the increased propensity for life-threatening arrhythmias. Thus, understanding the mechanisms of disturbed K channel regulation in heart failure (HF) is of critical importance. Amongst others, Ca/calmodulin-dependent protein kinase II (CaMKII) has been identified as an important regulator of K channel activity. In human HF but also various animal models, increased CaMKII expression and activity has been linked to deteriorated contractile function and arrhythmias. This review will discuss the current knowledge about CaMKII regulation of several K channels, its influence on action potential properties, dispersion of repolarization, and arrhythmias with special focus on HF.
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Affiliation(s)
- Julian Mustroph
- Department of Cardiology, University Medical Center Göttingen Göttingen, Germany
| | - Lars S Maier
- Department of Cardiology, University Medical Center Göttingen Göttingen, Germany
| | - Stefan Wagner
- Department of Cardiology, University Medical Center Göttingen Göttingen, Germany
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