Adriamycin cardiomyopathy in the rabbit: alterations in contractile proteins and myocyte function.

STUDY OBJECTIVE: The aim was to determine the mechanism of the cardiotoxic effect of adriamycin, particularly at the level of the function of the cardiac myocyte. DESIGN: After chronic exposure to adriamycin, the contractile responses of single isolated cardiac myocytes to increasing calcium and isoprenaline were measured, as well as oxygen consumption of myocyte suspensions. Creatine kinase and myosin isoforms were investigated in whole ventricle. The degree of fibrosis of the ventricle was quantified using histological methods. SUBJECTS: 24 white male New Zealand rabbits were treated with adriamycin (1 mg.kg-1) twice a week for eight weeks, and allowed to recover for two weeks. There were 29 untreated controls. Six further rabbits were implanted with mini osmotic pumps delivering a constant infusion of isoprenaline for one week; five controls had pumps containing saline. MEASUREMENTS AND MAIN RESULTS: Cardiac myocytes were enzymatically isolated, and their contraction amplitude and velocity monitored. Cells isolated from adriamycin treated rabbits had a lower contraction amplitude than those from controls when maximally activated with calcium, at 11.1(0.9)% shortening (n = 11) v 13.6(0.5)% (n = 14), p less than 0.02; or with isoprenaline, at 11.6(0.6)% shortening v 13.1(0.4)%, p less than 0.05. Contraction, but not relaxation, velocity in maximum calcium or isoprenaline was also significantly lower in cells from adriamycin treated animals. Oxygen consumption per 10(6) cells was lower in preparations from treated animals (p less than 0.05), but the relative effects of glucose, acetate, 2,4-DNP, and cyanide were unaffected. There was no significant change in creatine kinase or myosin isozyme composition or in amounts of fibrosis following adriamycin treatment. However, the quantity of myosin per g wet weight of tissue was significantly reduced from 8.04(0.45) mg.g-1 wet tissue, n = 4, in controls to 5.76(1.55) mg.g-1, n = 6, in adriamycin treated animals (p less than 0.001). The EC50 for isoprenaline was unchanged in cells from treated animals. Together with the unaltered maximum isoprenaline/calcium ratio, this implies that there is no change in beta adrenoceptor sensitivity following adriamycin treatment. To confirm that it was possible to desensitise rabbit cardiac beta adrenoceptors, and to detect changes in sensitivity on single cells, rabbits were treated with isoprenaline for one week. Such treatment decreased the maximum isoprenaline/calcium contraction amplitude ratio from 0.97(0.15), n = 5, to 0.47(0.12), n = 6 (p less than 0.05), and increased the EC50 from 7.9 to 224 nM (p less than 0.05). CONCLUSIONS: Single cardiac myocytes isolated from the hearts of adriamycin treated rabbits show a decrease in contraction amplitude, velocity, and oxygen consumption compared to controls. The decreased contractility of individual myocytes may relate to their low myosin content, and could contribute to the reduced cardiac output produced by adriamycin treatment. Heart failure induced by adriamycin in the rabbit is not accompanied by beta adrenoceptor desensitisation.

Haemodynamic and regional blood flow changes after acute pulmonary microembolism in conscious rabbits.

The central and peripheral haemodynamic effects of pulmonary embolisation with microspheres were measured in conscious rabbits in which the autonomic and central nervous systems were functioning normally. Sufficient microspheres were given to reduce cardiac output (measured by thermodilution) by one half. This fall in cardiac output was accompanied by a severe fall in arterial pressure and an increase in heart rate and right atrial pressure. Under these conditions cardiac output responded less than normally to an increased right atrial pressure imposed by an infusion of saline. Changes in regional blood flow and resistance were measured with radioactive microspheres injected into the left ventricle. Myocardial blood flow was unaffected by pulmonary embolisation. Cerebral flow was slightly increased. Renal, intestinal, dermal, and skeletal muscle blood flows were all reduced. Myocardial and cerebral tissue vascular resistances decreased; splenic and dermal vascular resistances increased; and renal and skeletal muscle vascular resistances were unchanged.

Regional blood flow and hemodynamics in the rabbit with adriamycin cardiomyopathy: effects of isosorbide dinitrate, dobutamine and captopril.

We have studied the effects of captopril, nitrates and dobutamine on hemodynamics and regional blood flow in the conscious rabbit with adriamycin cardiomyopathy. Rabbits were injected twice weekly with adriamycin (1 mg.kg-1 bw.) for 8 weeks and subsequently maintained for 2 weeks without adriamycin in order to allow recovery from any noncardiac effects. Doses of drug for investigation (captopril, 300 micrograms.kg-1.min-1; isosorbide dinitrate, 10 micrograms.kg-1.min-1; and dobutamine, 10.9 micrograms.kg-1.min-1) were chosen in anticipation of a 20% increase of cardiac output in animals with heart failure. In animals with heart failure myocardial blood flow was increased by dobutamine and to a lesser extent by captopril. Renal blood flow was increased only by captopril and nitrates. Cerebral blood flow was reduced by captopril in control animals but unaltered in animals with heart failure. The observed alterations of blood flow were similar to those known to occur in humans and indicate that this is a useful model of heart failure for the evaluation of new drugs.

Effect of lack of noradrenaline on myocardial oxygen consumption in denervated dog hearts.

Surgical cardiac denervation was carried out in dogs under halothane anaesthesia. In a paired experimental design control biopsy specimens were obtained before surgical denervation. The dogs were allowed to recover and three weeks to elapse before the second biopsy specimen was taken. Both right and left ventricular specimens had higher in vitro oxygen consumption after denervation than before. Other specimens were immediately cooled in hexane at -60 degrees C and stored under liquid nitrogen until analysed. Succinate dehydrogenase and cytochrome oxidase activities were then measured histochemically in sequential 10 or 12 microns sections. There was no significant difference between the enzyme activities measured before or after cardiac denervation (succinate dehydrogenase 20.3(6.3) before, 19.4(4.02) pmol.H2.cm-2.s-1, after; cytochrome oxidase 223(73.4) before, 263(61.6) (measured as extinction coefficient) after). Thus the changes in oxygen consumption in the chronically denervated dog heart are not due to any lack of these mitochondrial enzymes.

An experimental model of chronic cardiac failure using adriamycin in the rabbit: central haemodynamics and regional blood flow.

Central haemodynamics and regional blood flow were studied comprehensively in conscious New Zealand White rabbits before and during the development of chronic low output cardiac failure produced by administration of the anticancer agent adriamycin. After eight weeks of adriamycin treatment, cardiac index fell from 326(40 to 225(56) ml.min-1.kg-1. This was accompanied by an increase in heart rate and total peripheral resistance but no change in mean systemic blood pressure. Myocardial function was shown to be depressed by the measurement of Frank-Starling curves, the slopes of which were appreciably flatter in adriamycin treated rabbits. Regional blood flow (measured by the radioactive microsphere technique) was redistributed. There were decreases in renal, splenic, small gut, and skeletal muscle blood flow, whereas myocardial and cerebral blood flow were unchanged. There was an increase in total body exchangeable sodium, indicating some salt and water retention. Systemic toxic effects of adriamycin could be limited by treating the animals for eight weeks with adriamycin and then allowing a two week recovery period before haemodynamic study. This would appear to be the optimal dosage schedule.

Relation of human cardiac action potential duration to the interval between beats: implications for the validity of rate corrected QT interval (QTc).

Fourteen patients undergoing routine cardiac catheterisation were paced at a steady frequency; after this test, stimuli were introduced with a variable preceding interval (test pulse interval). The QT interval of the electrocardiogram and the duration of the monophasic action potential of the right ventricle were measured. QT interval is a function of action potential duration; the two variables were very closely correlated in this study. Both these variables increased in duration with increasing test pulse interval. A biphasic response, as previously reported, was not seen. An increase in steady state pacing frequency caused QT interval and action potential duration to decrease for any given R-R interval. When frequency of stimulation was suddenly increased and then maintained, there was an immediate action potential shortening followed by a further more gradual shortening occurring over several minutes. These results imply that a simple correction of QT interval for heart rate (QTc) is inadequate. It is concluded that the relation between action potential duration (or QT interval) and heart rate depends on both the instantaneous interval between beats and the duration of the prevailing heart rate.

The mechanisms of action of noradrenaline on ouabain-sensitive rubidium uptake in guinea-pig myocardium.

The mechanism by which noradrenaline stimulates ouabain-sensitive rubidium uptake in guinea-pig myocardial tissue has been studied. The stimulatory action of low concentrations of noradrenaline was reversed by high doses of propranolol (10(-5) mol/l) in atrial tissue, but was not reversed by alpha- or beta-, or combined alpha- and beta- adrenoceptor antagonists in ventricular tissue. Rubidium uptake was also found to increase with increasing extracellular potassium concentration [( K]o). The percentage values of stimulation by noradrenaline decreased with increasing [K]o. Noradrenaline had no effect on the rate of ATP splitting by an isolated membrane preparation of Na,K-ATPase. It is proposed that noradrenaline stimulates active cation transport by either (a) an effect secondary to increased passive efflux of K ions, or (b) an action at a novel adrenergic receptor, distinct from the ATPase enzyme itself.

Effect of chronic surgical denervation of dog heart on myocardial Na+-K+ pump.

The effect of chronic denervation of the myocardium on myocardial Na+-K+ pump activity and numbers of pump sites was studied in dogs. Right ventricular biopsies were taken immediately before and 4 wk after chronic surgical denervation, when depletion of norepinephrine is complete. Na+-K+ pump activity was assayed by ouabain-sensitive 86Rb uptake into ventricular tissue slices. The number of pump sites was measured by [3H]ouabain binding in ventricular tissue slices. Ouabain-sensitive Rb uptake was increased after denervation by an average of 147%. [3H]-ouabain binding at a concentration of 1.25 X 10(-6) M increased by an average of 27.6% after denervation. Acutely applied norepinephrine (2 X 10(-7) M) stimulated ouabain-sensitive Rb uptake both before and after denervation. The stimulation was greater after denervation, indicating supersensitivity. The cause of these changes is not known.

On the change of cardiac action potential with age: a study in dogs.

The action potential duration (APD) was measured using an Ag-AgCl electrode, in open chest anaesthetised dogs (n = 8) and puppies, 4 to 6 months old (n = 8), with complete atrio-ventricular dissociation and beta-adrenergic blockade. They were paced in the control period at a frequency of 120 beats . min-1. Both adults and puppies showed maximum action potential duration at a test pulse interval of over 700 ms. Below this the adult dogs showed a progressive shortening of the action potential duration (mean APD 81.5% at 200 ms). In contrast, the puppies showed much less shortening (91% at 200 ms; p less than 0.001). Measurements of Na+, K+-ATPase activity by the Rb uptake method gave values of 13.4 +/- 1.3 (puppies, n = 4) and 6.1 +/- 1.1 (adults, n = 6). These results may be consistent with the idea of a greater influx and efflux of sodium in the myocardial cells of the puppy compared with the adult dog.

Effects of noradrenaline on the sodium pump of guinea pig ventricle.

The effect of noradrenaline on myocardial sodium-pump activity has been studied, using a direct measure of active ion transport via the pump; namely, the ouabain-sensitive uptake of the radioisotope and potassium analogue rubidium-86 into guinea pig ventricular tissue slices. Physiological concentrations of noradrenaline caused a dose-dependent stimulation of rubidium uptake (peak response at 2 X 10(-7) M). With higher concentrations, the uptake fell progressively. At 6 X 10(-5) M, noradrenaline uptake was lower than control. The stimulatory action is not mediated by classic adrenergic mechanisms. It was not blocked by either alpha- or beta-blockade. Indirect actions via changes in membrane permeability to sodium and potassium ions are also considered. The inhibitory effect of high concentrations of noradrenaline, however, was mediated by alpha-receptors. Stimulation of the pump by noradrenaline could stabilize cellular ion concentrations and resting membrane potential. Since the pump is electrogenic, this is one mechanism by which noradrenaline will cause shortening of action potential. This may provide an explanation for the greater Q-T shortening during exercised-induced tachycardia, compared with atrial pacing. At high concentrations, attained locally during maximal sympathetic stimulation, these advantageous effects may be lost.