Risk-stratified approach to hybrid transcatheter-surgical palliation of hypoplastic left heart syndrome.

We prospectively employed a risk-stratified approach to first-stage palliation of hypoplastic left heart syndrome. High-risk features included severe tricuspid insufficiency, severe right ventricular dysfunction, a severely restrictive or intact atrial septum, an ascending aortic diameter < or = 2 mm, late presentation, weight < 2 kg, or significant extracardiac issues, Infants without high-risk features underwent a Norwood procedure (with Sano modification), whereas infants with high-risk features underwent a hybrid procedure consisting of bilateral pulmonary artery banding, ductal stenting, and atrial septostomy or a Norwood/Sano. Operative survival for 10 infants without high-risk features undergoing a Norwood/Sano procedure was 90%. Operative survival for 5 infants with high-risk features undergoing hybrid palliation was 100%, compared to 29% in 7 infants with high-risk features undergoing the Norwood/Sano procedure. Although only short-term data are available, this hybrid palliative procedure may have a role for infants with hypoplastic left heart syndrome and high-risk features.

Feasibility of pulmonary artery pressure measurements in infants through aorto-pulmonary shunts using a micromanometer pressure wire.

Assessment of pulmonary artery pressure is an essential element in the evaluation of children palliated with surgical aorto-pulmonary shunts prior to definitive surgical repair. We report the ease of use and accuracy of a 0.014 inch micromanometer pressure wire for the measurement of pulmonary artery pressures in children with aorto-pulmonary artery shunts. The study population consisted of 11 infants and children with either a 3.5 mm modified Blalock-Taussig shunt from the subclavian artery to the branch pulmonary artery after stage 1 Norwood repair for hypoplastic left heart syndrome or palliative staged repair for tetralogy of Fallot, or a central shunt for pulmonary atresia or double outlet right ventricle. The unique features of the micromanometer pressure wire allowed rapid access and accurate measurement of pulmonary pressures in all patients studied. We conclude that the micromanometer pressure wire is a unique and accurate alternative device for rapid and safe determinations of pulmonary artery pressures in children with aorto-pulmonary artery shunts.

Functional properties and responses to ischaemia-reperfusion in Langendorff perfused mouse heart.

Despite minimal model characterisation Langendorff perfused murine hearts are increasingly employed in cardiovascular research, and particularly in studies of myocardial ischaemia and reperfusion. Reported contractility remains poor and ischaemic recoveries variable. We characterised function in C57/BL6 mouse hearts using a ventricular balloon or apicobasal displacement and assessed responses to 10-30 min global ischaemia. We examined the functional effects of pacing, ventricular balloon design, perfusate filtration, [Ca(2+)] and temperature. Contractility was high in isovolumically functioning mouse hearts (measured as the change in pressure with time (+dP/dt), 6000-7000 mmHg s(-1)) and was optimal at a heart rate of approximately 420 beats min(-1), with the vasculature sub-maximally dilated, and the cellular energy state high. Post-ischaemic recovery (after 40 min reperfusion) was related to the ischaemic duration: developed pressure recovered by 82 +/- 5 %, 73 +/- 4 %, 68 +/- 3 %, 57 +/- 2 % and 41 +/- 5 % after 10, 15, 20, 25 and 30 min ischaemia, respectively. Ventricular compliance and elastance were both reduced post-ischaemia. Post-ischaemic recoveries were lower in the apicobasal model (80 +/- 4 %, 58 +/- 7 %, 40 +/- 3 %, 32 +/- 7 % and 25 +/- 5 %) despite greater reflow and lower metabolic rate (pre-ischaemic myocardial O(2) consumption (V(O2,myo)) 127 +/- 15 vs. 198 +/- 17 microl O(2) min(-1) g(-1)), contracture, enzyme and purine efflux. Electrical pacing slowed recovery in both models, small ventricular balloons (unpressurised volumes < 50-60 microl) artificially depressed ventricular function and recovery from ischaemia, and failure to filter the perfusion fluid to < 0.45 microm depressed pre- and post-ischaemic function. With attention to these various experimental factors, the buffer perfused isovolumically contracting mouse heart is shown to be stable and highly energized, and to possess a high level of contractility. The isovolumic model is more reliable in assessing ischaemic responses than the commonly employed apicobasal model.

5'-Adenosine monophosphate and adenosine metabolism, and adenosine responses in mouse, rat and guinea pig heart.

We examined myocardial 5'-adenosine monophosphate (5'-AMP) catabolism, adenosine salvage and adenosine responses in perfused guinea pig, rat and mouse heart. MVO(2) increased from 71+/-8 microl O(2)/min per g in guinea pig to 138+/-17 and 221+/-15 microl O(2)/min per g in rat and mouse. VO(2)/beat was 0.42+/-0.03, 0.50+/-0.03 and 0.55+/-0.04 microl O(2)/g in guinea pig, rat and mouse, respectively. Resting and peak coronary flows were highest in mouse vs. rat and guinea pig, and peak ventricular pressures and Ca(2+) sensitivity declined as heart mass increased. Net myocardial 5'-AMP dephosphorylation increased significantly as mass declined (3.8+/-0.5, 9.0+/-1.4 and 11.0+/-1.6 nmol/min per g in guinea pig, rat and mouse, respectively). Despite increased 5'-AMP catabolism, coronary venous [adenosine] was similar in guinea pig, rat and mouse (45+/-8, 69+/-10 and 57+/-14 nM, respectively). Comparable venous [adenosine] was achieved by increased salvage vs. deamination: 64%, 41% and 39% of adenosine formed was rephosphorylated while 23%, 46%, and 50% was deaminated in mouse, rat and guinea pig, respectively. Moreover, only 35-45% of inosine and its catabolites derive from 5'-AMP (vs. IMP) dephosphorylation in all species. Although post-ischemic purine loss was low in mouse (due to these adaptations), functional tolerance to ischemia decreased with heart mass. Cardiovascular sensitivity to adenosine also differed between species, with A(1) receptor sensitivity being greatest in mouse while A(2) sensitivity was greatest in guinea pig. In summary: (i) cardiac 5'-AMP dephosphorylation, VO(2), contractility and Ca(2+) sensitivity all increase as heart mass falls; (ii) adaptations in adenosine salvage vs. deamination limit purine loss and yield similar adenosine levels across species; (iii) ischemic tolerance declines with heart mass; and (iv) cardiovascular sensitivity to adenosine varies, with increasing A(2) sensitivity relative to A(1) sensitivity in larger hearts.

Cardioprotection with adenosine metabolism inhibitors in ischemic-reperfused mouse heart.

OBJECTIVES: To characterize the 'anti-ischemic' effects of adenosine metabolism inhibition in ischemic-reperfused myocardium. METHODS: Perfused C57/B16 mouse hearts were subjected to 20 min ischemia 40 min reperfusion in the absence or presence of adenosine deaminase inhibition (50 microM erythro-2-(2-hydroxy-3-nonyl)adenine; EHNA) adenosine kinase inhibition (10 microM iodotubercidin; IODO), or 10 microM adenosine. Hearts overexpressing A(1) adenosine receptors (A(1)ARs) were also studied. RESULTS: EHNA treatment reduced ischemic contracture and post-ischemic diastolic pressure (14+/-2 vs. 20+/-1 mmHg), increased recovery of developed pressure (66+/-3 vs. 53+/-2%) and reduced LDH efflux (8.9+/-1.6 vs. 18.0+/-1.7 I.U./g). IODO also improved functional recovery (to 60+/-2%) and reduced LDH efflux (5.3+/-1.7 I.U./g), as did treatment with 10 microM adenosine. Protection with EHNA was reversed by co-infusion of IODO or 50 microM 8-rho-sulfophenyltheophylline (adenosine receptor antagonist), but unaltered by 20 microM inosine+10 microm hypoxanthine. Similarly, effects of iodotubercidin were inhibited by EHNA and 8-rho-sulfophenyltheophylline. A(1)AR overexpression exerted similar effects to EHNA and EHNA or IODO alone enhanced recovery while EHNA+IODO reduced recovery in transgenic hearts. Functional recoveries and xanthine oxidase reactant levels were unrelated in the groups studied. CONCLUSIONS: Adenosine deaminase or kinase inhibition protects from ischemia-reperfusion. Cardioprotection via these enzyme inhibitors requires a functioning purine salvage pathway and involves enhanced adenosine receptor activation. Reduced formation of inosine is unimportant in EHNA-mediated protection.

Targeted deletion of A(3) adenosine receptors improves tolerance to ischemia-reperfusion injury in mouse myocardium.

A(3) adenosine receptors (A(3)ARs) have been implicated in regulating mast cell function and in cardioprotection during ischemia-reperfusion injury. The physiological role of A(3)ARs is unclear due to the lack of widely available selective antagonists. Therefore, we examined mice with targeted gene deletion of the A(3)AR together with pharmacological studies to determine the role of A(3)ARs in myocardial ischemia-reperfusion injury. We evaluated the functional response to 15-min global ischemia and 30-min reperfusion in isovolumic Langendorff hearts from A(3)AR(-/-) and wild-type (A(3)AR(+/+)) mice. Loss of contractile function during ischemia was unchanged, but recovery of developed pressure in hearts after reperfusion was improved in A(3)AR(-/-) compared with wild-type hearts (80 +/- 3 vs. 51 +/- 3% at 30 min). Tissue viability assessed by efflux of lactate dehydrogenase was also improved in A(3)AR(-/-) hearts (4.5 +/- 1 vs. 7.5 +/- 1 U/g). The adenosine receptor antagonist BW-A1433 (50 microM) decreased functional recovery following ischemia in A(3)AR(-/-) but not in wild-type hearts. We also examined myocardial infarct size using an intact model with 30-min left anterior descending coronary artery occlusion and 24-h reperfusion. Infarct size was reduced by over 60% in A(3)AR(-/-) hearts. In summary, targeted deletion of the A(3)AR improved functional recovery and tissue viability during reperfusion following ischemia. These data suggest that activation of A(3)ARs contributes to myocardial injury in this setting in the rodent. Since A(3)ARs are thought to be present on resident mast cells in the rodent myocardium, we speculate that A(3)ARs may have proinflammatory actions that mediate the deleterious effects of A(3)AR activation during ischemia-reperfusion injury.

Cardioprotection by K(ATP) channels in wild-type hearts and hearts overexpressing A(1)-adenosine receptors.

We studied the role of mitochondrial ATP-sensitive K(+) (K(ATP)) channels in modifying functional responses to 20 min global ischemia and 30 min reperfusion in wild-type mouse hearts and in hearts with approximately 250-fold overexpression of functionally coupled A(1)-adenosine receptors (A(1)ARs). In wild-type hearts, time to onset of contracture (TOC) was 303 +/- 24 s, with a peak contracture of 89 +/- 5 mmHg. Diastolic pressure remained elevated at 52 +/- 6 mmHg after reperfusion, and developed pressure recovered to 40 +/- 6% of preischemia. A(1)AR overexpression markedly prolonged TOC to 517 +/- 84 s, reduced contracture to 64 +/- 6 mmHg, and improved recovery of diastolic (to 9 +/- 4 mmHg) and developed pressure (to 82 +/- 8%). 5-Hydroxydecanoate (5-HD; 100 microM), a mitochondrial K(ATP) blocker, did not alter ischemic contracture in wild-type hearts, but increased diastolic pressure to 69 +/- 8 mmHg and reduced developed pressure to 10 +/- 5% during reperfusion. In transgenic hearts, 5-HD reduced TOC to 348 +/- 18 s, increased postischemic contracture to 53 +/- 4 mmHg, and reduced recovery of developed pressure to 22 +/- 4%. In summary, these data are the first to demonstrate that endogenous activation of K(ATP) channels improves tolerance to ischemia-reperfusion in murine myocardium. This functional protection occurs without modification of ischemic contracture. The data also support a role for mitochondrial K(ATP) channel activation in the pronounced cardioprotection afforded by overexpression of myocardial A(1)ARs.

Transgenic overexpression of cardiac A(1) adenosine receptors mimics ischemic preconditioning.

The role of A(1) adenosine receptors (A(1)AR) in ischemic preconditioning was investigated in isolated crystalloid-perfused wild-type and transgenic mouse hearts with increased A(1)AR. The effect of preconditioning on postischemic myocardial function, lactate dehydrogenase (LDH) release, and infarct size was examined. Functional recovery was greater in transgenic versus wild-type hearts (44.8 +/- 3.4% baseline vs. 25.6 +/- 1.7%). Preconditioning improved functional recovery in wild-type hearts from 25.6 +/- 1.7% to 37.4 +/- 2.2% but did not change recovery in transgenic hearts (44.8 +/- 3.4% vs. 44.5 +/- 3.9%). In isovolumically contracting hearts, pretreatment with selective A(1) receptor antagonist 1, 3-dipropyl-8-cyclopentylxanthine attenuated the improved functional recovery in both wild-type preconditioned (74.2 +/- 7.3% baseline rate of pressure development over time untreated vs. 29.7 +/- 7.3% treated) and transgenic hearts (84.1 +/- 12.8% untreated vs. 42.1 +/- 6.8% treated). Preconditioning wild-type hearts reduced LDH release (from 7,012 +/- 1,451 to 1,691 +/- 1,256 U. l(-1). g(-1). min(-1)) and infarct size (from 62.6 +/- 5.1% to 32.3 +/- 11.5%). Preconditioning did not affect LDH release or infarct size in hearts overexpressing A(1)AR. Compared with wild-type hearts, A(1)AR overexpression markedly reduced LDH release (from 7,012 +/- 1,451 to 917 +/- 1,123 U. l(-1). g(-1). min(-1)) and infarct size (from 62.6 +/- 5.1% to 6.5 +/- 2.1%). These data demonstrate that murine preconditioning involves endogenous activation of A(1)AR. The beneficial effects of preconditioning and A(1)AR overexpression are not additive. Taken with the observation that A(1)AR blockade equally eliminates the functional protection resulting from both preconditioning and transgenic A(1)AR overexpression, we conclude that the two interventions affect cardioprotection via common mechanisms or pathways.

Deletion of endothelial nitric oxide synthase exacerbates myocardial stunning in an isolated mouse heart model.

BACKGROUND: While endothelial nitric oxide synthase (eNOS) is an important regulator of vascular tone, it is also constitutively expressed in cardiac myocytes and contributes to the regulation of myocardial function. The role of eNOS in ischemia-reperfusion is uncertain, however, with some studies showing beneficial effects while other studies demonstrate increased cardiac injury. We hypothesized that the beneficial effects of eNOS would predominate, and thus that targeted deletion of eNOS would exacerbate myocardial dysfunction following ischemia-reperfusion. MATERIALS AND METHODS: ENOS knockout and wild-type mouse hearts were Langendorff-perfused using Krebs bicarbonate buffer and subjected to 20 min of global normothermic ischemia followed by 30 min of reperfusion. Myocardial function was measured using a ventricular balloon to determine time to onset of contracture, left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), and rate-pressure product (RPP). RESUKTS: Heart rate and coronary resistance were similar in both groups during baseline and reperfusion periods. Diastolic function as determined by peak LVEDP during ischemia and final LVEDP after reperfusion were worse in the eNOS knockout group vs wild-type (114 and 31 mmHg vs 92 and 18 mmHg, P <.05). Although RPP (heart rate x LVDP), measured as an index of systolic function, was initially better in eNOS knockouts (24216 vs 16353), wild-type hearts recovered more function than did eNOS knockout hearts by the end of 30 min of reperfusion (30892 vs 20522, P <.05). CONCLUSIONS: These data suggest that the deletion of eNOS results in increased myocardial dysfunction following ischemia-reperfusion in an isolated heart model.

Chronotropic and vasodilatory responses to adenosine and isoproterenol in mouse heart: effects of adenosine A1 receptor overexpression.

1. Chronotropic and vasodilatory effects of adenosine receptor activation with 2-chloroadenosine (2-ClAdo) and beta-adrenoceptor activation with isoproterenol were studied in wild-type murine hearts and transgenic hearts overexpressing the A1 adenosine receptor. 2. Treatment of wild-type hearts with 2-ClAdo induced bradycardia (pEC50 6.4+/-0.2) and vasodilatation (pEC50 7.9+/-0.1; minimal resistance 2.2+/-0.2 mmHg/mL per min per g). The A1 receptor-mediated bradycardia was 20-fold more sensitive in transgenic hearts (pEC50 7.7+/-0.2), whereas coronary vasoactivity of 2-ClAdo was unaltered (pEC50 7.6+/-0.1). 3. beta-Adrenoceptor stimulation with isoproterenol increased heart rate (pEC50 8.5+/-0.2; maximal rate 594+/-23 b.p.m.) and produced vasodilation (pEC50 8.7+/-0.1; minimal resistance 1.7 +/-0.2 mmHg/ml, per min per g) in wild-type hearts. Treatment with 10 IU/mL adenosine deaminase increased the magnitude of the tachycardia (maximal rate 653+/-27 b.p.m.) without altering potency (pEC50 8.5+/-0.1). Antagonism of A1 receptors with 10nmol/L 8-cyclopentyl-1,3-dipropylxanthine (DPCPX) produced a comparable increase in the magnitude of the chronotropic response (maximal rate 695+/-26b.p.m.) without altering potency (pEC50 8.3+/-0.1). 4. Isoproterenol-mediated vasodilatation was unaltered by transgenic A1 receptor overexpression. Overexpression of A1 receptors significantly reduced the maximal heart rate during beta-adrenoceptor stimulation by 35% (to 381 +/-28 b.p.m.) without altering potency (pEC50 8.4+/-0.2). At 10nmol/L, DPCPX increased the magnitude of the chronotropic response to isoproterenol in transgenic hearts (maximal heart rate 484+/-36 b.p.m.) without altering potency (pECs50 8.3+/-0.2). 5. The data show that transgenic A1 receptor overexpression selectively sensitizes the cardiovascular A1 receptor response and that A1 receptor activation by endogenous adenosine depresses the magnitude, but not potency, of the beta-adrenoceptor-mediated chronotropic response in mouse heart. The A1 receptor-mediated depression of beta-adrenoceptor responsiveness is non-competitive (reduced response magnitude with no change in sensitivity). This indicates that A1 receptor activation non-competitively inhibits effector mechanisms activated by beta-adrenoceptors (e.g. adenylate cyclase) and/or A1 receptors activate unrelated but opposing mechanisms. This inhibitory response may have physiological importance during periods of sympathetic stimulation of cardiac work.

Functional studies in atrium overexpressing A1-adenosine receptors.

1. Adenosine and the A1-adenosine receptor agonist R-PIA, exerted a negative inotropic effect in isolated, electrically driven left atria of wild-type mice. 2. In left atria of mice overexpressing the A1-adenosine receptor, adenosine and R-PIA exerted a positive inotropic effect. 3. The positive inotropic effect of adenosine and R-PIA in transgenic atria could be blocked by the A1-adenosine receptor antagonist DPCPX. 4. In the presence of isoprenaline, adenosine exerted a negative inotropic effect in wild-type atria but a positive inotropic effect in atria from A1-adenosine receptor overexpressing mice. 5. The rate of beating in right atria was lower in mice overexpressing A1-adenosine receptors compared with wild-type. 6. Adenosine exerted comparable negative chronotropic effects in right atria from both A1-adenosine receptor overexpressing and wild-type mice. 7. A1-adenosine receptor overexpression in the mouse heart can reverse the inotropic but not the chronotropic effects of adenosine, implying different receptor-effector coupling mechanisms.

Transgenic A1 adenosine receptor overexpression markedly improves myocardial energy state during ischemia-reperfusion.

A1 adenosine (A1AR) activation may reduce ischemia-reperfusion injury. Metabolic and functional responses to 30 min global normothermic ischemia and 20 min reperfusion were compared in wild-type and transgenic mouse hearts with approximately 100-fold overexpression of coupled cardiac A1ARs. 31P-NMR spectroscopy revealed that ATP was better preserved in transgenic v wild-type hearts: 53 +/- 11% of preischemic ATP remained after ischemia in transgenic hearts v only 4 +/- 4% in wild-type hearts. However, recovery of ATP after reperfusion was similar in transgenic (46 +/- 5%) and wild-type hearts (37 +/- 12%). Reductions in phosphocreatine (PCr) and cytosolic pH during ischemia were similar in both groups. However, recovery of PCR on reperfusion was higher in transgenic (67 +/- 8%) v wild-type hearts (36 +/- 8%), and recovery of pH was greater in transgenic (pH = 7.11 +/- 0.05) v wild-type hearts (pH = 6.90 +/- 0.02). Bioenergetic state ([ATP]/[ADP].[Pi]) was higher in transgenic v wild-type hearts during ischemia-reperfusion. Time to ischemic contracture was prolonged in transgenic (13.6 +/- 0.8 min) v wild-type hearts (10.4 +/- 0.3 min). Degree of contracture was lower and recovery of function in reperfusion higher in transgenic v wild-type hearts. In conclusion, A1AR overexpression reduces ATP loss and improves bioenergetic state during severe ischemic insult and reperfusion. These changes may contribute to improved functional tolerance.

Determination of function in the isolated working mouse heart: issues in experimental design.

The goal of the present study was to compare two common types of isolated working mouse heart models, setting afterload either with (1) a hydrostatic fluid column, or (2) a mechanical resistor. Cardiovascular function in both models was determined by volume- and pressure-loading protocols. During volume loading, both models demonstrated a fixed degree of outflow resistance from the 20-gauge rigid aortic cannula resulting in a small predictable rise in left-ventricular pressure. In the mechanical resistor model, volume loading resulted in a marked increase in afterload, with a >50% increase from baseline aortic pressure. This altered ventricular mechanics, resulting in twice the expected change in dP/dt during volume loading. Additionally, coronary flow in the mechanical resistor model rose by more than four-fold in parallel to the increased preload. When using the fluid column model, however, aortic pressure was unchanged and coronary flow remained stable. During pressure loading, no significant differences in ventricular mechanics or coronary flow between the mechanical resistor and fluid column models were noted. When mouse hemodynamic data were compared to that from larger species, mouse hearts had similar cardiac function and efficiency with higher MVO2 and coronary flows. In summary, the hydrostatic fluid column isolated working mouse heart model is preferred over the mechanical resistor model for studying murine cardiac function. Further, use of this model provides hemodynamic data that is consistent with larger species, albeit with higher MVO2 and basal coronary flow, and should allow relevant study of mouse cardiac physiology.

Myocardial function in the working mouse heart overexpressing cardiac A1 adenosine receptors.

Adenosine, acting via A1 receptors, modulates heart rate and contractility, and provides myocardial protection during times of stress. A transgenic model of cardiac A1 overexpression was produced and it demonstrated cardiac protection from ischemia. Since A1 receptor stimulation can inhibit contractility under some conditions, the present study was undertaken to determine the effects of transgenic A1 overexpression on intrinsic contractility and the response to catecholamine stimulation. Isolated working mouse hearts were subjected to volume- and pressure-loading protocols to assess intrinsic contractility, and isoproterenol infusions to assess catecholamine response. Basal heart rates were lower in transgenic (Trans) hearts than controls (Ctrl), but with pacing baseline cardiac function and contractility (as measured by +dP/dt) were similar. Volume and pressure loading of Ctrl and Trans hearts were also similar along the entire range tested. No differences were seen in the sensitivity to isoproterenol infusion, but at maximal doses there was a decrease in maximum +dP/dt in Trans hearts compared to Ctrl (maximum +dP/dt 152 +/- 6% baseline for Ctrl, 131 +/- 2% baseline for Trans, P < 0.05). In summary, overexpression of A1 receptors does not produce untoward effects on ventricular function or sensitivity to catecholamine stimulation, but does dampen the contractile response at high doses of catecholamines. These data suggest that even with 1000-fold overexpression of A1 adenosine receptors, adenosine plays little or no role in regulating intrinsic myocardial contractility in the sympathectomized isolated working heart, only modulating contractility as the heart becomes stressed during exposure to higher catecholamine levels.

Transgenic A1 adenosine receptor overexpression increases myocardial resistance to ischemia.

Activation of myocardial A1 adenosine receptors (A1AR) protects the heart from ischemic injury. In this study transgenic mice were created using the cardiac-specific alpha-myosin heavy chain promoter and rat A1AR cDNA. Heart membranes from two transgene positive lines displayed approximately 1,000-fold overexpression of A1AR (6,574 +/- 965 and 10,691 +/- 1,002 fmol per mg of protein vs. 8 +/- 5 fmol per mg of protein in control hearts). Compared with control hearts, transgenic Langendorff-perfused hearts had a significantly lower intrinsic heart rate (248 beats per min vs. 318 beats per min, P < 0. 05), lower developed tension (1.2 g vs. 1.6 g, P < 0.05), and similar coronary resistance. The difference in developed tension was eliminated by pacing. Injury of control hearts during global ischemia, indexed by time-to-ischemic contracture, was accelerated by blocking adenosine receptors with 50 microM 8-(p-sulfophenyl) theophylline but was unaffected by addition of 20 nM N6-cyclopentyladenosine, an A1AR agonist. Thus A1ARs in ischemic myocardium are presumably saturated by endogenous adenosine. Overexpressing myocardial A1ARs increased time-to-ischemic contracture and improved functional recovery during reperfusion. The data indicate that A1AR activation by endogenous adenosine affords protection during ischemia, but that the response is limited by A1AR number in murine myocardium. Overexpression of A1AR affords additional protection. These data support the concept that genetic manipulation of A1AR expression may improve myocardial tolerance to ischemia.

Maturational differences in bioenergetic state and purine formation during "supply" and "demand" ischemia.

We examined metabolic effects of "supply" and "demand" ischemia in immature and mature rabbit hearts. Moderate supply ischemia was produced by a 50% reduction in coronary flow (to approximately 5.0 ml min-1 g-1 giving a 50-55% rise in O2 extraction and a 35% drop in O2 supply/demand). Demand ischemia was produced by stimulation of workload and O2 demand with 30 microM norepinephrine at constant coronary flow (55-60% rise in O2 extraction, 35-40% fall in O2 supply/demand). Basal energy state ([ATP]/[ADP].[Pi]) was lower in immature compared to mature hearts, primarily due to reduced [PCr]. Despite a lower energy state, basal purine efflux was lowest in immature hearts. During supply ischemia reductions in [ATP]/[ADP]. [Pi] and elevations in [H+] were greatest in mature compared to immature hearts (P < 0.05). Despite this depressed energy state purine efflux did not increase significantly during supply ischemia. In contrast, during demand ischemia reductions in energy state were greatest in immature compared to mature hearts. Moreover, purine efflux increased more than 30-fold in immature and only four-fold in mature hearts, resulting in two-fold greater purine washout in immature hearts. The data indicate that: (i) maturation increases basal energy state and, paradoxically, purine efflux, (ii) in immature hearts demand ischemia has a greater impact on energy state than supply ischemia, whereas there are minimal differences in the metabolic effects of supply and demand ischemia in mature hearts, (iii) consequently while maturation is associated with a reduction in metabolic/bioenergetic resistance to supply ischemia it is associated with increased resistance to demand ischemia, (iv) markedly reduced purine wash-out from mature myocardium may contribute to this increased resistance during demand ischemia, and (v) control of adenosine formation and purine efflux changes with maturation, and appears to involve mechanisms unrelated to cytosolic energy metabolism.

Interstitial adenosine and cellular metabolism during beta-adrenergic stimulation of the in situ rabbit heart.

OBJECTIVE: Adenosine, derived from hydrolysis of 5'-AMP, may be involved in coupling coronary blood flow to cardiac function and metabolism. The purpose of this study was to measure interstitial fluid (ISF) adenosine and 5'-AMP levels, and cytosolic 5'-AMP in in situ rabbit heart during beta-adrenergic stimulation. METHODS: Isoproterenol was infused into open chest rabbits (n = 7) at 1 and 4 micrograms.kg-1.min-1. Left ventricular ISF adenosine and 5'-AMP levels were measured using microdialysis, and energy metabolism simultaneously monitored using 31P-NMR spectroscopy. RESULTS: Graded beta-stimulation increased heart rate (by 50% and 70%), arterial pulse-pressure (by 55% and 45%), and the rate-pressure product (by 45% and 70%). Dialysate [adenosine] increased 300-400% from a control value of 0.44 +/- 0.13 microM. Dialysate [5'-AMP] increased 200% from a control value of 0.94 +/- 0.22 microM. Cytosolic [ATP], pH and free [Mg2+] remained stable, whereas [PCr] declined by 10-20%. Free cytosolic [5'-AMP] increased 300-400% from a control value of 0.40 microM. Competitive inhibition of ecto-5'-nucleotidase with alpha,beta-methylene-ADP (0.6 mg.kg-1.min-1) significantly reduced ISF adenosine (and enhanced ISF 5'-AMP) during beta-stimulation, but not under basal conditions. CONCLUSIONS: Beta-adrenergic stimulation increases ISF adenosine levels and depresses bioenergetic state in in situ rabbit heart without altering [ATP], pH or [Mg2+], indicating an absence of "demand" ischemia. ISF adenosine originates primarily from cytosolic 5'-AMP under basal conditions whereas increased adenosine during beta-stimulation appears to occur via hydrolysis of both ISF and cytosolic 5'-AMP. ISF adenosine levels achieved during stimulation are appropriate for stimulation of cardiovascular A1 and A2 receptors.

Integration of vascular, contractile and metabolic responses to hypoxia: effects of maturation and adenosine.

We examined myocardial responses to reduced arterial PO2 and the role of endogenous adenosine in constant-pressure perfused hearts from immature (Imm) and mature (Mat) rabbits. During normoxia, coronary flow and myocardial O2 consumption were similar in both groups. With moderate hypoxia, coronary perfusate flow increased by 125 +/- 16% in Imm but by only 68 +/- 12% in Mat hearts. Imm hearts displayed better maintenance of contractile function (87 vs. 67% in Mat hearts) and metabolic state. Blockade of cardiac adenosine receptors with 25 microM 8-p-sulfophenyltheophylline attenuated vasodilation during hypoxia, reduced contractile function, and abolished age-related differences in one response to hypoxia. Myocardial purine release and extracellular purine levels were threefold higher in Mat compared with Imm hearts and was associated with higher cytosolic 5'-AMP concentration (and lower [ATP]/[ADP].[P(i)], where [ATP], [ADP], and [P(i)] are concentrations of ATP, ADP and P(i), respectively) in Mat hearts. In summary, 1) Imm hearts are functionally and metabolically more tolerant of hypoxic perfusion, largely because of improved hypoxia-induced coronary vasodilation; 2) endogenous adenosine mediates this beneficial vasodilation, enhancing hypoxic tolerance; and 3) improved vascular sensitivity to adenosine allows for enhanced vasodilatory responses in the face of lower adenosine levels and higher energy state in immature hearts.

Changes in myocardial A1 adenosine receptor and message levels during fetal development and postnatal maturation.

Previously we have shown myocardial adenosine A1 receptors are up-regulated during the newborn period. The timing of the increase or the mechanism of the changes are not known. The purpose of the present study was to (1) determine the time course of increased A1 adenosine receptors during fetal development and (2) determine if A1 adenosine receptor regulation is secondary to changes in A1 receptor mRNA levels. A1 adenosine receptor density was determined in whole hearts from fetal rats at 14 and 19 days' gestation and from newborn and adult rats using standard receptor-binding techniques. A quantitative PCR assay was developed to measure A1 adenosine receptor mRNA using total RNA samples from the above ages. A1 receptor density (fmol receptor/mg protein) increased during late gestation (79 +/- 14 and 122 +/- 7 in 14 and 19 days' gestation respectively) peaked during the newborn period (136 +/- 12) and decreased in the adult rat (36 +/- 5). A1 receptor message levels (fg message/microgram total RNA) changed in parallel to receptor density (7.2 +/ 1.7, 15.6 +/- 1.8, 19.9 +/- 4.3 and 9.9 +/- 1.3 in 14 and 19 days' gestation, newborn and adult respectively). These results provide evidence for transcriptional control of A1 receptor density and the increased receptor density in the newborn heart supports a possible role for the A1 receptor in the transition to the extrauterine circulation.