An update on heart disease risk associated with testosterone boosting medications.

INTRODUCTION: The cardiovascular (CV) safety of testosterone replacement therapy (TRT) remains a crucial issue in the management of subjects with late-onset hypogonadism. The authors systematically reviewed and discussed the available evidence focusing our analysis on heart-related issues. AREAS COVERED: All the available data from prospective observational studies evaluating the role endogenous T levels on the risk of acute myocardial infarction (AMI) were collected and analyzed. In addition, the impact of TRT on heart-related diseases, as derived from pharmaco-epidemiological studies as well as from randomized placebo-controlled trials (RCTs), was also investigated. EXPERT OPINION: Available evidence indicates that endogenous low T represents a risk factor of AMI incidence and its related mortality. TRT in hypogonadal patients is able to improve angina symptoms in subjects with ischemic heart diseases and exercise ability in patients with heart failure (HF). In addition, when prescribed according to the recommended dosage, TRT does not increase the risk of heart-related events.

Compartmentalization of Ca2+ signaling and Ca2+ pools in pancreatic acini. Implications for the quantal behavior of Ca2+ release.

Streptolysin O-permeabilized pancreatic acini were used to study compartmentalization of Ca2+ signaling and Ca2+ pools. In these cells, the inositol 1,4,5-trisphosphate (IP3)-dependent Ca2+ channels could be activated by a number of agonists (carbachol, cholecystokinin, or bombesin) or by activation of the entire cellular phospholipase C pool with GTP gamma S. Surprisingly, each of the antagonists interacting with acinar cells inactivated the channels after stimulation with GTP gamma S. In addition, when permeabilized cells were stimulated with more than one agonist, any antagonist to the specific agonists employed inactivated the channels. The aberrant behavior of the antagonists in permeable cells was not related to a loss of specificity since (a) when added before GTP gamma S, the antagonists had no effect on Ca2+ release and (b) when cells were stimulated with a single agonist, the antagonists prevented only the effect of their specific agonist. The differential behavior of the antagonists in intact and permeable cells suggests a compartmentalization of Ca2+ signaling into separate, agonist-specific units that is modified by cell permeabilization. Further evidence for compartmentalization of signaling was obtained by showing that the partial agonist (the CCK octapeptide analogue JMV-180) can access and release only 50% of the cholecystokinin- or IP3-mobilizable Ca2+ pool in intact and permeable cells. Kinetic measurements revealed a multiphasic time course of agonist-evoked Ca2+ release in permeable cells. At high agonist concentrations, all phases were fast and merged into an apparent single event of Ca2+ release. The phases were separated by three independent protocols: reduction in agonist concentrations, addition of heparin, or addition of guanosine-5'-O-(thio)diphosphate. Since all protocols that caused phase separation reduce IP3-mediated Ca2+ release, these findings demonstrate heterogeneity in the affinity for IP3 of channels present in compartmentalized Ca2+ pools of the same cells. Compartmentalization of signaling and the heterogeneity in the affinity for IP3 resulted in a quantal agonist-evoked Ca2+ release. The overall findings are discussed in the context of an integrated model of compartmentalization of signaling complexes, Ca2+ pools, and IP3-activated Ca2+ channels.

Antagonists inactivate the inositol 1,4,5-trisphosphate (Ins-1,4,5-P3)-dependent Ca2+ channel independent of Ins-1,4,5-P3 metabolism.

Streptolysin O-permeable pancreatic acini, which retain intact signaling systems, were used to study the regulation of the inositol 1,4,5-trisphosphate (Ins-1,4,5-P3)-activated Ca2+ channel during agonist stimulation and antagonist inhibition. Stimulation of permeable cells with carbachol induced rapid Ca2+ release from internal stores. Addition of heparin prior to or after agonist stimulation inhibited the release, indicating the activation of the Ins-1,4,5-P3-dependent Ca2+ channels by the agonist. Termination of cell stimulation with the specific antagonist atropine rapidly inactivated the release channels. Channel inactivation by the antagonist was independent of Ins-1,4,5-P3 levels since (a) addition of atropine to carbachol-stimulated cells resulted in a slow hydrolysis of Ins-1,4,5-P3, (b) addition of 10-fold excess Ins-1,4,5-P3 together with the agonist did not prevent channel inactivation by the antagonist, and (c) the antagonist inactivated Ca2+ release in the presence of saturating concentration of the nonhydrolyzable Ins-2,4,5-P3. Hence, the antagonist appears to stabilize the Ins-1,4,5-P3-activated Ca2+ channel in a state refractory to Ins-1,4,5-P3. These findings are the first direct evidence that the channel can exist in such a refractory state.

Depletion of intracellular Ca2+ stores activates nitric-oxide synthase to generate cGMP and regulate Ca2+ influx.

The mechanism of activation of the agonist-stimulated Ca2+ entry pathway in the plasma membrane is not known. To determine the role of nitric-oxide synthase (NOS) and cGMP in the regulation of this pathway, we used intact and streptolysin O (SLO)-permeable pancreatic acini and measured the relationship between Ca2+ release from internal stores, the NO metabolic pathway, generation of cGMP, and activation of Ca2+ entry. We found that agonist- or thapsigargin (Tg)-activated Ca2+ entry is inhibited by L-NA, a specific inhibitor of NOS, and by LY83583, an inhibitor of guanylyl cyclase. Inhibition of Ca2+ entry by inhibition of NOS was reversed by the NO releasing molecules NO2- and sodium nitroprusside (SNP) and by Bt2cGMP. Inhibition of Ca2+ entry by inhibition of guanylyl cyclase was reversed by Bt2cGMP, but not by the NO releasing agents. The use of L-NA-treated cells and different concentrations of SNP revealed that cGMP has a dual effect on Ca2+ entry. Increasing cGMP up to 10-fold above control activated Ca2+ entry. Further increase in cGMP up to 80-fold above control inhibited Ca2+ entry in a concentration-dependent manner. Measurement of cellular cGMP in intact cells showed that carbachol, Tg, and NO2- increased cGMP to similar levels. The effects of carbachol and Tg were inhibited by L-NA and LY83586, whereas the effect of NO2- was inhibited only by LY83583. SLO-permeabilized cells were shown to be agonist-competent in that the agonist induced Ca2+ release from the inositol 1,4,5-trisphosphate (IP3) pool and activated a NO-dependent generation of cGMP. These cells were used to study the regulation of NOS by Ca2+ and by Ca2+ content of the internal stores. When internal stores were maintained loaded with Ca2+, increasing medium [Ca2+] up to 2.5 microM only modestly increased NOS activity. In contrast, the depletion of Ca2+ from internal stores markedly increased NOS activity independent of medium [Ca2+]. Thus, NOS senses both cytosolic [Ca2+]i and internal store Ca2+ load. We propose that activation of Ca2+ entry involves an agonist-mediated Ca2+ release from internal stores which activates a cellular pool of NOS to generate cGMP, which then modulates Ca2+ entry pathway in the plasma membrane. This mechanism can explain the capacitative nature of Ca2+ entry. The biphasic effect of cGMP provides the cells with a negative feedback mechanism which inhibits Ca2+ entry during periods of high cell [Ca2+]i. This could allow oscillatory behavior of Ca2+ entry.