Influence of the novel inotropic agent levosimendan on isometric tension and calcium cycling in failing human myocardium.

BACKGROUND: Levosimendan was shown to increase calcium sensitivity by a novel mechanism and to inhibit phosphodiesterase III activity in animal myocardium. METHODS AND RESULTS: We investigated the influence of levosimendan on isometric contractions and calcium transients (aequorin method) in muscle strips from human hearts with end-stage failing dilated or ischemic cardiomyopathy (n=27). Data were compared with the effects of the phosphodiesterase inhibitor milrinone (n=9). The average maximum increase in twitch tension was 47+/-14% (range, 6% to 150%) at a levosimendan concentration of 0. 8+/-0.3 micromol/L (P<0.01). This was associated with significant increases in maximum rates of tension rise and fall and decreases in times to peak tension, to 50% relaxation, and to 95% relaxation. In aequorin-loaded muscles, levosimendan 10(-6) mol/L increased average tension by 50% (P<0.02), associated with a nonsignificant increase in aequorin light (16%). With milrinone 10(-5) mol/L, average tension increased by 58% and aequorin light by 49% (P<0.05). In those muscle strips with pronounced inotropic effects (>50% increase in tension), there was a comparable and pronounced increase in aequorin light with both agents. However, in muscle strips with weak inotropic responses (<50% increase in tension), the increase in light was significantly higher with milrinone than with levosimendan. CONCLUSIONS: Levosimendan has inotropic and lusitropic actions in failing human myocardium. Comparison with the phosphodiesterase inhibitor milrinone indicates that in case of pronounced inotropic stimulation, the modes of action of the two agents may be similar (phosphodiesterase inhibition), whereas small inotropic effects of levosimendan may result predominantly from calcium sensitization.

Increased expression of erbB3 in colorectal cancer is associated with concomitant increase in the level of erbB2.

ErbB3 is a transmembrane signaling molecule that shares close structural homology with epidermal growth factor receptor (EGFR), erbB2, and erbB4. They have all been implicated in cell transformation and tumor pathogenesis, but very little is known about the role of erbB3 in normal colon and colorectal cancer. Therefore, in the current study, we determined whether erbB3 is found in normal human colon and whether its expression is altered in colorectal cancer. Because of some evidence that erbB3 might interact with erbB2 and EGFR, respectively, by heterodimerization, we also included erbB2 and EGFR analysis with special regard to coexpression. The study was performed on 35 patients operated on for colorectal carcinoma. The normal human colon showed weak erbB3 and erbB2 immunostaining, predominantly in surface epithelial cells. EGFR immunoreactivity in normal colon varied from weak to strong. In contrast, in 31 of 35 (89%) and in 29 of 35 (83%) colonic cancers, moderate to strong immunoreactivity for erbB3 and erbB2, respectively, was present in most epithelial cancer cells. A concomitant erbB3 and erbB2 immunostaining advantage could be found in 77% of cancerous tissues in comparison with the normal colon. No difference in EGFR immunostaining was evident between normal colon and cancer. Northern blot analysis showed an increase in erbB3 and erbB2 mRNA levels in 64% of cancers in comparison with normal colon samples. By densitometry, 2.3-fold and a 1.5-fold significant increases in erbB3 and erbB2 mRNA levels, respectively, were calculated in the cancerous tissues. Eighty-five percent of cancers with erbB3 mRNA overexpression showed an increase in erbB2 mRNA. Southern blot analysis did not indicate any gene amplification or rearrangement responsible for erbB2 or erbB3 overexpression. EGFR, however, was decreased in cancer on mRNA level. These findings indicate that erbB2 and erbB3, but not EGFR, may contribute to tumor growth and disease progression in colon cancer. The correlation between increased erbB2 and erbB3 expression in both Northern blots and immunohistochemical analysis suggests a co-overexpression of erbB2 and erbB3 and might support the hypothesis that these two growth factor receptors act together by heterodimer formation.

Over-expression of ICAM-1, VCAM-1 and ELAM-1 might influence tumor progression in colorectal cancer.

Adhesion molecules might play a role in tumor progression. We investigated expression of the adhesion molecules ICAM-1, VCAM-1 and ELAM-1 in 24 primary colorectal carcinomas using immuno-histochemistry and Northern blot analysis. Normal colonic tissue from the same patients served as controls. ICAM-1 immunostaining was restricted to the intercellular matrix and vascular endothelial cells. The vast majority of normal tissue samples revealed only faint ICAM-1 immunoreactivity. However, moderate to strong immunostaining was found in 86% of cancerous sections. The ICAM-1 immunoreaction was more intense in well-differentiated carcinomas as well as in the adenomatous parts and transition zones of cancers. Similarly, the cancers exhibited markedly enhanced VCAM-1 and ELAM-1 immunostaining in the endothelial cells of small blood vessels. The intense vascular immunostaining by ICAM-1 and VCAM-1 was associated with a strong presence of CD3-positive T lymphocytes, whereas ELAM-1 immunoreactivity did not correlate with round cell infiltration. On Northern blot analysis, ICAM-1, VCAM-1 and ELAM-1 mRNA levels were increased in 67%, 57% and 63% of carcinomas, respectively, in comparison with normal tissue samples. Densitometric analysis of Northern blots revealed an increase in ICAM-1 by 2.1-fold, an increase in VCAM-1 by 3.4-fold and an increase in ELAM-1 by 2.2-fold in cancerous tissues compared to normal controls. Over-expression of ICAM-I might prevent cell-cell disruption and, hence, tumor dissemination. Furthermore, over-expression of ICAM-1 and VCAM-1, but not ELAM-1, might favor host anti-tumor defense by trafficking of lymphocytes.

[New methods for effective prevention of thromboembolism in surgical medicine exemplified by trauma surgery]. / Neue Wege einer effektiveren Thromboembolieprophylaxe in der operativen Medizin am Beispiel der Unfallchirurgie.

Under conventional prevention (pharmacological and physical) of thromboembolism 30-40% of surgical patients develop deep vein thrombosis (DVT). Mechanical methods significantly increase the efficacy of prophylaxis for thromboembolism: these include intermittent pneumatic compression, A-V impulse systems and ankle motion devices. For all trauma patients it is advisable that conventional prophylaxis of thromboembolism be supplemented with elements of mechanical prophylaxis in order to reduce the continuing high thrombosis rate significantly.

Alterations in intracellular calcium handling associated with the inverse force-frequency relation in human dilated cardiomyopathy.

BACKGROUND: The present study was performed to test the hypothesis that the altered force-frequency relation in human failing dilated cardiomyopathy may be attributed to alterations in intracellular calcium handling. METHODS AND RESULTS: The force-frequency relation was investigated in isometrically contracting ventricular muscle strip preparations from 5 nonfailing human hearts and 7 hearts with end-stage failing dilated cardiomyopathy. Intracellular calcium cycling was measured simultaneously by use of the bioluminescent photoprotein aequorin. Stimulation frequency was increased stepwise from 15 to 180 beats per minute (37 degrees C). In nonfailing myocardium, twitch tension and aequorin light emission rose with increasing rates of stimulation. Maximum average twitch tension was reached at 150 min-1 and was increased to 212 +/- 34% (P < .05) of the value at 15 min-1. Aequorin light emission was lowest at 15 min-1 and was maximally increased at 180 min-1 to 218 +/- 39% (P < .01). In the failing myocardium, average isometric tension was maximum at 60 min-1 (106 +/- 7% of the basal value at 15 min-1, P = NS) and then decreased continuously to 62 +/- 9% of the basal value at 180 min-1 (P < .002). In the failing myocardium, aequorin light emission was highest at 15 min-1. At 180 min-1, it was decreased to 71 +/- 7% of the basal value (P < .01). Including both failing and nonfailing myocardium, there was a close correlation between the frequencies at which aequorin light emission and isometric tension were maximum (r = .92; n = 19; P < .001). Action potential duration decreased similarly with increasing stimulation frequencies in nonfailing and end-stage failing myocardium. Sarcoplasmic reticulum 45Ca2+ uptake, measured in homogenates from the same hearts, was significantly reduced in failing myocardium (3.60 +/- 0.51 versus 1.94 +/- 0.18 (nmol/L).min-1.mg protein-1, P < .005). CONCLUSIONS: These data indicate that the altered force-frequency relation of the failing human myocardium results from disturbed excitation-contraction coupling with decreased calcium cycling at higher rates of stimulation.

Effects of calcium sensitizers on intracellular calcium handling and myocardial energetics.

Calcium sensitizers may influence myocardial energetics by their action on calcium turnover and on crossbridge behavior. Using a myothermal method, the effects of the Ca2+ sensitizer EMD-53998 on calcium cycling, crossbridge behavior, and myocardial energy turnover were compared with the effects of an increase in extracellular calcium from 1.25 to 7.5 mM and with the effects of the catecholamine isoproterenol. All three inotropic interventions increased isometric force development in right ventricular rabbit papillary muscles. Relaxation time was decreased with isoproterenol, unchanged with high calcium, and increased with EMD 53998. Calcium cycling-related energy consumption, as measured by tension-independent heat, increased by 234% with high calcium, by 439% with isoproterenol, and by 77% with EMD 53998. In contrast to high calcium and isoproterenol, EMD 53998 increased economy of crossbridge cycling by increasing the force-time integral of the individual crossbridge cycle. The data indicate that EMD 53998 acts by phosphodiesterase inhibition and myofilament calcium sensitization. The latter effect is in part mediated by alteration of crossbridge behavior. Because of its effects on calcium cycling and crossbridge function myocardial energy turnover was reduced significantly with EMD 53998, whereas energy turnover was unchanged with high calcium and was increased with isoproterenol. The new calcium sensitizer levosimendan was investigated in isolated failing human myocardium. Levosimendan dose-dependently increased isometric tension. The inotropic effect was associated with increased rate of relaxation and reduced relaxation time. Measurements of intracellular calcium using the photoprotein aequorin suggest that levosimendan acts by increasing myofilament calcium sensitivity and by increasing cAMP due to phosphodiesterase inhibition. However, the contribution of the cAMP system to the action of levosimendan appears to be rather small. Therefore, the finding of a positive lusitropic effect of levosimendan may be consistent with the notion that levosimendan binds to troponin-C and increases calcium sensitivity only at high (systolic) intracellular calcium concentrations.

Influence of sorbitol and mannitol on the reactions of kidney excretory function evoked by arterial chemoreceptor stimulation with almitrine in anaesthetized and artificially ventilated cats.

The reactions of renal hemodynamics, as well as of excretory and concentrating function (clearance-technique) in response to arterial chemoreceptor stimulation by almitrine bismesylate were studied in 3 groups of chloralosed, relaxed, and constantly ventilated cats. In 2 groups of chemoreceptor-intact animals an osmotic diuresis was induced by intravenous infusion of an isoionic solution containing equivalent amounts of either sorbitol or mannitol. Under similar conditions the 3rd series of experiments was carried out in cats under mannitol diuresis but with deafferented arterial chemoreceptors. The changes of mean arterial and central venous pressures as well as of the parameters of the arterial acid-base balance were similar in all groups of cats studied. The chemoreceptor-intact animals undergoing sorbitol diuresis did not show any natriuresis in response to the drug but reacted with a remarkable increase in their U/Posm and TCH2O/Cosm ratios. In contrast, the chemoreceptor-intact animals infused with mannitol in saline reacted to almitrine with a transient natriuresis but with only a weak increase in their U/Posm and TCH2O/Cosm ratios. The data suggest that arterial chemoreceptor stimulation inhibits proximal tubular sodium reabsorption. In the sorbitol-experiments during chemoreceptor stimulation the enhanced delivery of sodium by the proximal fluid was reabsorbed in the thick ascending limb of Henle's loop thus increasing medullary osmolality and renal concentrating ability. Mannitol apparently limited this additional sodium reabsorption in the thick ascending limb of Henle's loop; therefore in the mannitol-experiments during chemoreceptor stimulation a natriuresis but only relatively weak changes of renal concentrating function occurred. The data also suggest that a pharmacological chemoreceptor stimulation might support the recovery of renal excretory function post-anaesthetically, although the optimal solution infused to induce an osmotic diuresis remains to be determined.

Influence of infusion of deoxycorticosterone acetate on the responses of kidney function elicited by stimulation of the peripheral arterial chemoreceptors with almitrine bismesylate in anaesthetized rats.

In two groups of male, normotensive, spontaneously breathing rats in chloralose-urethane anaesthesia the peripheral arterial chemoreceptors were stimulated by intravenous infusion of almitrine bismesylate (0.25 mg/kg). The experiments were carried out in moderate osmotic diuresis. In one series desoxycorticosterone acetate (DOCA) was infused at a rate of 35-40 ng/min.100 g body weight. Urine was collected via a bladder catheter. Kidney hemodynamics as well as tubular and excretory function were determined using the clearance-technique. In both groups of animals administration of almitrine caused an increase of breathing rate as well as an increase of the oxygen tensions and the pH-values in the arterial blood. Mean systemic arterial blood pressure, effective renal plasma flow and glomerular filtration rate decreased slowly with the time of the experiments, whereas renal hemodynamic resistance tended to increase both in the control and in the DOCA treated group. In both groups of animals intravenous infusion of almitrine was followed by an inhibition of renal tubular sodium reabsorption and an increase of both the absolute and the fractional salt excretion. The data indicate that arterial chemoreceptor stimulation in rats causes an inhibition of renal tubular sodium reabsorption which does not result from a reduced tubular action of mineralocorticoid hormones.