Biomedical subjects
J H Kirkels
Publications and source records attributed to J H Kirkels.
Early expression of natriuretic peptides and SERCA in mild heart failure: association with severity of the disease.
BACKGROUND: We investigated changes in genetic expression of atrial and brain natriuretic peptides (ANP and BNP) and sarcoplasmic reticulum Ca(2+)-ATPase (SERCA) in patients with stable mild to moderate chronic heart failure (CHF), since data on this topic were primarily obtained in end-stage CHF. METHODS: We studied tissue from 25 patients with idiopathic dilated cardiomyopathy (IDC) in New York Heart Association (NYHA) class II (n=12) and III-IV (n=13). Myocardial tissue from normal hearts (n=10) served as controls. Messenger RNA (mRNA) expression of ANP, BNP, and SERCA was isolated, and correlated with severity of CHF, left ventricular function (LVEF), peak oxygen uptake (peak VO(2)), and wedge pressure. RESULTS: A significant trend for gradual changes in mRNA expression according to increasing NYHA class was found for ANP, BNP (P<0.0001) and SERCA (P=0.04), with a marked increase in patients with more advanced CHF (ANP and BNP: P<0.01 vs. controls; SERCA: NS) and less pronounced changes in patients with mild CHF. mRNA of ANP and BNP correlated strongly with LVEF (-0.621 and -0.621, respectively, both P<0.01) and peak VO(2) (-0.625 and -0.555, respectively, both P<0.01) and, to a lesser extent, with wedge pressure (0.440 and 0.488, respectively, both P<0.05). SERCA correlated most strongly with wedge pressure (-0.623, P<0.01), and weak, non-significant correlations with LVEF and peak VO(2) were found. CONCLUSIONS: Genetic expression of ANP, BNP, and SERCA is progressively altered in proportion to the severity of CHF, although this is more marked for ANP and to a lesser extent BNP, than for SERCA. These changes support the concept that already early in CHF, genetic expression is affected, which has implications for the understanding of the pathophysiology of CHF.
Predictability and other aspects of post-transplant diabetes mellitus in heart transplant recipients.
BACKGROUND: Diabetes mellitus that develops after organ transplantation may predispose patients to further complications. We studied the value of pre-transplant oral glucose tolerance testing or maximum random plasma glucose, and HLA-DR3 and/or DR4 phenotype as predictors of post-transplantation diabetes mellitus in heart transplant recipients. PATIENTS AND METHODS: In 228 cardiac allograft recipients (median age, 50 years; mean follow-up, 4.77 years), we used either pre-transplant oral glucose tolerance testing results (Group I, n = 141)-excluding patients with pre-existing diabetes (n = 9)--or maximum random plasma glucose values (Group II, n = 78) to study predictability of post-transplant diabetes. In addition, we investigated its relation to rejection treatment and clinical course. RESULTS: Cumulative incidence of post-transplant diabetes (n = 43) was 19.6%, 83% of which became manifest within 3 months post-transplant; pre-transplant body mass index was higher (p < 0.01) in this group. Mortality did not increase. Of 123 patients in Group I who survived > 3 months, post-transplant diabetes occurred in 32% vs 16% of those with impaired and normal glucose tolerance respectively (ns), and in 55% of patients with isolated post-load hyperglycemia (p < 0.05 vs normal). Maximum random glucose values (Group II) did not predict post-transplant diabetes. Prevalence of the HLA-DR3, DR4, and DR3DR4 phenotypes did not increase in post-transplant diabetes; relation to rejection treatment was likely in 30%. Approximately 50% of posttransplant diabetes patients required only temporary drug treatment. CONCLUSIONS: The risk of post-transplant diabetes increased parallel to pre-transplant degree of glucose intolerance, but was considerable even in normal glucose tolerance. HLA-DR3 and/or DR4 phenotype was not a predisposing factor.
[Successful pregnancy after heart transplantation].
A 32-year-old woman underwent heart transplantation after having suffered two myocardial infarctions, the first when parturition was pharmacologically induced, the second during diagnostic catheterization. Three years after the heart transplantation she became pregnant three times. In the first two pregnancies therapeutic abortion was performed because of trisomy-21. The third pregnancy was uneventful until week 36. At that time labour was induced because of signs of pre-ecclampsia. A healthy boy was born with normal physical and psychological development after four years. In pregnancy after heart transplantation teratogenic effects of the medication have not been described. The main problems are hypertension and pre-eclampsia in the mother and prematurity and low birth weight in the newborn. A major problem is the limited life expectancy after heart transplantation due to which a patient will only rarely see his or her child grow up into adulthood.
Postischaemic metabolic and functional recovery of rat heart after transient reperfusion with various low Ca2+ concentrations.
OBJECTIVE: The effects of transient low Ca2+ reperfusion after ischaemia on metabolic and functional recovery were studied in isolated rat hearts. METHODS: 31P nuclear magnetic resonance (NMR) was used to monitor creatine phosphate, ATP, intracellular inorganic phosphate (Pi), and intracellular pH during control perfusion (15 min), total ischaemia (30 min), and reperfusion (30 min). During early reperfusion (0-10 min) perfusate [Ca2+] amounted to 1.3 (control group), 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, or 0.7 mmol.litre-1. During late reperfusion (10-30 min) perfusate [Ca2+] was 1.3 mmol.litre-1. Isolated rat hearts were used and perfused according to Langendorff. RESULTS: Recovery of creatine phosphate during early reperfusion was partly abolished during late reperfusion in the 0.1-0.4 mmol.litre-1 groups (p < 0.01). In the 0.1 mmol.litre-1 group creatine phosphate content after 30 min reperfusion was lower (p < 0.05) than in the control group. Recovery of ATP during early reperfusion in the 0.3 mmol.litre-1 group was better than in the control group (p < 0.01). After 30 min reperfusion ATP recovery was better in the 0.3 mmol.litre-1 group (p < 0.01) and worse in the 0.1 mmol.litre-1 group (p = 0.05) than in the control group. Decline of Pi during early reperfusion was more pronounced in the 0.2 and 0.3 mmol.litre-1 groups (p < 0.01) and in the 0.5 and 0.6 mmol.litre-1 groups (p < 0.05) than in the control group. In the 0.3 and 0.4 mmol.litre-1 groups, Pi after 30 min reperfusion was higher (p < 0.05) than after 10 min reperfusion. After 30 min reperfusion left ventricular developed pressure, measured with an intraventricular balloon, was lower in the 0.1 mmol.litre-1 group (p < 0.01) than in the control group. CONCLUSIONS: The data show that under the experimental conditions used successive postischaemic reperfusion with 0.1 and 1.3 mmol.litre-1 Ca2+ resulted in poorer metabolic and functional recovery of the hearts than continuous reperfusion with 1.3 mmol.litre-1 Ca2+. Postischaemic reperfusion with 0.1 mmol.litre-1 Ca2+ may predispose the heart to a mild calcium paradox. Successive reperfusion with 0.3 and 1.3 mmol.litre-1 Ca2+ was optimal in terms of ATP recovery but did not result in an increased recovery of left ventricular developed pressure.
Possible mechanisms of the protective effect of pretreatment with anipamil in ischemic-reperfused isolated rat hearts.
Rats were given anipamil (5 mg/kg) or glucose, intraperitoneally twice daily for 5 days. During this period the mean arterial blood pressure and heart rate were measured daily. The heart was then isolated and perfused. Energy metabolism and intracellular pH were monitored by 31P nuclear magnetic resonance spectroscopy during 30 minutes of ischemia followed by 30 minutes of reperfusion, with a simultaneous isovolumetric measurement of left ventricular contraction. Myocardial norepinephrine and glycogen were assayed immediately after excision of the heart, after 15 minutes oxygenated perfusion, at the end of ischemia and at the end of reperfusion. Metabolic and functional recovery during reperfusion were significantly better in hearts pretreated with anipamil (p less than 0.0005 vs controls). However, protection was not preceded by an effect on mean arterial pressure or heart rate in vivo, or a negative inotropic effect during control perfusion of the isolated hearts. There was no energy sparing effect during ischemia; but intracellular pH during ischemia stabilized at a higher level (p less than 0.0005 vs controls). Myocardial norepinephrine and glycogen stores were not decreased by pretreatment with anipamil, and their release or degradation due to ischemia and reperfusion were also not different from controls. Commonly known mechanisms of myocardial protection by calcium antagonists fail to explain the protection by pretreatment with anipamil as observed in our experiments, and alternative mechanisms are to be considered.
Chronic cardiotoxicity of adriamycin studied in a rat model by 31P NMR.
Adriamycin induced cardiotoxicity is, among other factors, characterized by an impairment of mitochondrial function and altered energy metabolism. The possible merits of 31P NMR in timely detection of this cardiotoxicity were studied in perfused hearts of chronically treated rats after cumulative doses of 6, 8, 10, 12 and 13 mg adriamycin/kg body wt and compared to histological evaluation. After high cumulative doses the Phosphocreatine (PCr)/ATP ratio was significantly decreased in the hearts of treated animals, compared to the control animals (1.65 +/- 0.13 vs. 2.47 +/- 0.36 (p less than 0.001) at 12 mg/kg and 1.92 +/- 0.22 vs. 2.37 +/- 0.15 (p less than 0.01) at 13 mg/kg adriamycin, respectively). This decrease coincides with a sudden increase in the histological score from 2.0 at 10 mg/kg to 8.0 at 12 mg/kg adriamycin on a scale of 10.0. The Pi/PCr ratio, coronary flow and rate pressure product (RPP) of the isolated hearts of treated animals were not significantly different from controls. When heart rates were increased, parallel changes in PCr/ATP ratio, Pi/PCr ratio, RPP and coronary flow were observed in both control and treated groups, except for the 12 mg/kg adriamycin group in which pacing failed to increase RPP. In addition, in this group the Pi/PCr ratio at higher heart rates was significantly increased (p less than 0.001) compared to controls. At 13 mg/kg similar effects were observed but less pronounced. The decreased PCr/ATP ratio may indicate an increased ADP concentration and altered regulation of energy metabolism. Differences between control and treated groups in RPP and Pi/PCr ratio during pacing may also be related to cardiotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)
Intracellular sodium during ischemia and calcium-free perfusion: a 23Na NMR study.
Accumulation of sodium-ions (Na+) in myocardial cells during both ischemia and calcium (Ca2+)-free perfusion has been suggested to play an important role in the damage occurring during subsequent reperfusion and calcium repletion, respectively. We have used 23Na NMR spectroscopy in combination with shift reagents to determine intracellular Na(+)-concentration [( Na+]i) in isolated rat hearts during either control perfusion followed by ischemia and reperfusion, or during control perfusion, Ca(2+)-free perfusion and subsequent ischemia. [Na+]i during control perfusion was found to be 10.5 +/- 0.6 mmol/l. During 30 min of ischemia [Na+]i rose substantially to 25.0 +/- 3.2 mmol/l. During 15 min of reperfusion [Na+]i initially decreased, but leveled off after approximately 3 min and was 17.9 +/- 3.7 mmol/l at the end of the reperfusion period. Most surprisingly, however, no significant increase of [Na+]i was observed during 30 min of Ca(2+)-free perfusion, although severe calcium paradox damage was shown to occur under the used conditions, when calcium was readmitted to the heart. The absence of a rise of [Na+]i during Ca(2+)-free perfusion was substantiated when during subsequent ischemia a similar rise of [Na+]i was observed as during ischemia without previous Ca(2+)-depletion. We conclude that an increased [Na+]i during Ca(2+)-depletion is not a prerequisite for the calcium paradox to occur, but that increased [Na+]i during ischemia may influence the subsequent reperfusion damage through Na(+)-Ca2+ exchange.
Effect of pretreatment with anipamil on a submaximal calcium paradox in the isolated rat heart.
Successive perfusion of a heart with a Ca(2+)-free and Ca(2+)-containing solution results in irreversible myocardial cell damage: the calcium paradox. Experiments were undertaken to assess whether pretreatment of rats with the new calcium antagonist anipamil (5 mg/kg body weight, twice daily for 5 days) protects the isolated heart against a submaximal calcium paradox. A submaximal calcium paradox was induced by successive perfusion with a Ca(2+)-free solution and a solution containing 0.1 mM Ca2+. Hearts from rats pre-treated with anipamil did not show a negative inotropic effect during control perfusion. During reperfusion in the presence of 0.1 Ca2+, after 10 minutes of Ca(2+)-free perfusion, creatine kinase release in hearts from treated rats was significantly less than in hearts from untreated rats (p less than 0.001). It is suggested that anipamil makes the sarcolemma less sensitive to conformational changes upon Ca2+ repletion.
Intracellular magnesium during myocardial ischemia and reperfusion: possible consequences for postischemic recovery.
Magnesium (Mg2+) is an important regulator of cell energy metabolism, since only MgATP can serve as a substrate for ATP utilizing processes. We used 31P NMR spectroscopy to determine the complexation of ATP with Mg2+ and intracellular free Mg2+ (Mgf) in isolated rat hearts during control perfusion, ischemia and reperfusion. Atomic absorption spectrophotometry was used to determine preischemic and postischemic tissue Mg2+ and release of Mg2+ into the coronary effluent during reperfusion. Mgf increased from 0.60 mmol/l during control perfusion to greater than 6.5 mmol/l after 15 min of ischemia, while we estimated that at that time 6.7 mmol/l Mg2+ had been liberated from ATP. Less than 2% of cellular Mg2+ was released to the effluent during reperfusion after 30 min of ischemia. From spectra obtained during reperfusion the fraction of ATP that was bound to Mg2+ was calculated to be approximately 96% (compared to 94% during control perfusion), indicating that intracellular Mg2+ did not limit the metabolic use of the newly produced ATP. Mgf remained elevated during reperfusion (0.85 mmol/l). We conclude that intracellular Mg2+ deficiency due to leakage of Mg2+ to the extracellular space does not play a role in the poor postischemic recovery in this isolated rat heart model. Nevertheless, high Mg2+ prior to ischemia or during reperfusion may well be protective, due to interactions of Mg2+ with the sarcolemma or intracellular sites, affecting Ca2+,K+ and Na+ distribution and fluxes.
Low Ca2+ reperfusion and enhanced susceptibility of the postischemic heart to the calcium paradox.
This study was designed to define the effect of postischemic low Ca2+ perfusion on recovery of high-energy phosphates, intracellular pH, and contractile function in isolated rat hearts. Phosphorus-31 nuclear magnetic resonance spectroscopy was used to follow creatine phosphate, adenosine triphosphate, intracellular inorganic phosphate, and intracellular pH during control perfusion (15 minutes), total ischemia (30 minutes), and reperfusion (30 minutes). In Group I the perfusate [Ca2+] was 1.3 mmol/l throughout the experiment, whereas in Group II the perfusate [Ca2+] was reduced to 0.05 mmol/l during the first 10 minutes of reperfusion. Hearts from Group III were not made ischemic but were subjected to 10 minutes of low Ca2+ perfusion followed by 20 minutes of normal Ca2+ perfusion. During low Ca2+ reperfusion (Group II) recovery of high-energy phosphates and pH was significantly better than in controls (Group I). However, after reexposure to normal Ca2+, metabolic recovery was largely abolished, coronary flow was suddenly impaired, and contracture developed without any rhythmic contractions. These observations indicated the occurrence of a calcium paradox rather than postponed ischemia-reperfusion damage. On the other hand, normoxic hearts (Group III) tolerated temporary perfusion with 0.05 mmol/l Ca2+ very well with respect to left ventricular developed pressure, coronary flow, and metabolic parameters. In conclusion, postischemic low Ca2+ (0.05 mmol/l) perfusion may reduce reperfusion damage, but at the same time ischemia appears to enhance the susceptibility of the heart to the calcium paradox.
Protective effect of pretreatment with the calcium antagonist anipamil on the ischemic-reperfused rat myocardium: a phosphorus-31 nuclear magnetic resonance study.
To assess whether the prophylactic administration of anipamil, a new calcium antagonist, protects the heart against the effects of ischemia and reperfusion, rats were injected intraperitoneally twice daily for 5 days with 5 mg/kg body weight of this drug. The heart was then isolated and perfused by the Langendorff technique. Phosphorus-31 nuclear magnetic resonance spectroscopy was used to monitor myocardial energy metabolism and intracellular pH during control perfusion and 30 min of total ischemia (37 degrees C), followed by 30 min of reperfusion. Pretreatment with anipamil altered neither left ventricular developed pressure under normoxic conditions nor the rate and extent of depletion of adenosine triphosphate (ATP) and creatine phosphate during ischemia. Intracellular acidification, however, was attenuated. On reperfusion, hearts from anipamil-pretreated animals recovered significantly better than untreated hearts with respect to replenishment of ATP and creatine phosphate stores, restitution of low levels of intracellular inorganic phosphate and recovery of left ventricular function and coronary flow. Intracellular pH recovered rapidly to preischemic levels, whereas in untreated hearts a complex intracellular inorganic phosphate peak indicated the existence of areas of different pH within the myocardium. It is concluded that anipamil pretreatment protects the heart against some of the deleterious effects of ischemia and reperfusion. Because this protection occurred in the absence of a negative inotropic effect during normoxia, it cannot be attributed to an energy-sparing effect during ischemia. Therefore, alternative mechanisms of action are to be considered.
31P NMR study of intracellular pH during the calcium paradox.
Reperfusion of an isolated mammalian heart with a calcium-containing solution after a brief calcium-free perfusion results in irreversible cell damage: the calcium paradox. It has been suggested that acidification of the cytosol, as a result of hydrolysis of ATP and accumulation of calcium by mitochondria, is an important factor in the development of the calcium paradox. Phosphorus nuclear magnetic resonance (31P NMR) spectroscopy was used to investigate the course of intracellular pH during the calcium paradox in isolated rabbit heart at 37 degrees C. Intracellular pH was measured from the chemical shift of the intracellular inorganic phosphate (Pi) peak. During control perfusion and the subsequent calcium-free period intracellular pH amounted to 7.1. After induction of the calcium paradox by readmitting calcium to the perfusion fluid, intracellular pH amounted to 7.0. It is concluded that acidification of the cytosol does not play a causal role in the development of the calcium paradox.
A phosphorus-31 nuclear magnetic resonance study of myocardial ATP content during postischemic low calcium reperfusion.
Postischemic reperfusion injury can be modified by transient low calcium (Ca2+) reperfusion, although the data on the optimal [Ca2+] are controversial. High-energy phosphates and contractile function of isolated perfused rat hearts (37 degrees C, 300 beats/min) were studied simultaneously during global ischemia (30 min) and reperfusion (10 min at [Ca2+] = 1.3, 0.05, 0.1, 0.3, 0.5 and 0.7 mmol/l, followed by 20 min at [Ca2+] = 1.3 mmol/l), using phosphorus-31 nuclear magnetic resonance (31P NMR) spectroscopy. Reperfusion with 1.3 mmol/l Ca2+ after 0.05 or 0.1 mmol/l Ca2+ largely abolished the recovery of ATP obtained during initial low Ca2+ reperfusion (calcium paradox effect). A [Ca2+] of 0.3 mmol/l was sufficiently high to prevent this detrimental effect; at the same time this concentration was sufficiently low to cause a substantial recovery of ATP, which was maintained upon switching to 1.3 mmol/l Ca2+. Recovery of ATP did not correlate with recovery of contractile function.