Abstract-Local, rhythmic, subsarcolemmal Ca 2ϩ releases (LCRs) from the sarcoplasmic reticulum (SR) during diastolic depolarization in sinoatrial nodal cells (SANC) occur even in the basal state and activate an inward Na ϩ -Ca 2ϩ exchanger current that affects spontaneous beating. Why SANC can generate spontaneous LCRs under basal conditions, whereas ventricular cells cannot, has not previously been explained. Here we show that a high basal cAMP level of isolated rabbit SANC and its attendant increase in protein kinase A (PKA)-dependent phosphorylation are obligatory for the occurrence of spontaneous, basal LCRs and for spontaneous beating. Gradations in basal PKA activity, indexed by gradations in phospholamban phosphorylation effected by a specific PKA inhibitory peptide were highly correlated with concomitant gradations in LCR spatiotemporal synchronization and phase, as well as beating rate. Higher levels of basal PKA inhibition abolish LCRs and spontaneous beating ceases. Stimulation of ␤-adrenergic receptors extends the range of PKA-dependent control of LCRs and beating rate beyond that in the basal state. The link between SR Ca 2ϩ cycling and beating rate is also present in vivo, as the regulation of beating rate by local ␤-adrenergic receptor stimulation of the sinoatrial node in intact dogs is markedly blunted when SR Ca 2ϩ cycling is disrupted by ryanodine. Thus, PKA-dependent phosphorylation of proteins that regulate cell Ca 2ϩ balance and spontaneous SR Ca 2ϩ cycling, ie, phospholamban and L-type Ca 2ϩ channels (and likely others not measured in this study), controls the phase and size of LCRs and the resultant Na ϩ -Ca 2ϩ exchanger current and is crucial for both basal and reserve cardiac pacemaker function. R ecent studies have demonstrated that in sinoatrial (SA) nodal cells (SANC) generate local, rhythmic, subsarcolemmal Ca 2ϩ releases (LCRs) under basal conditions, ie, even in the absence of experimental Ca 2ϩ loading or stimulation of ␤-adrenergic receptors (␤-ARs). [1][2][3] In rabbit SANC, spontaneous, rhythmic LCRs occur during the late diastolic depolarization and activate Na ϩ -Ca 2ϩ exchanger (NCX) to generate an inward current that accelerates the depolarization rate, and, thus, LCRs are involved in control of spontaneous beating rate of SANC. 1 The mechanisms that permit SANC, but not ventricular myocytes, to generate rhythmic LCRs under basal conditions, however, have not been delineated.Spontaneous SR Ca 2ϩ release is facilitated by factors that increase the rate at which the SR can pump Ca 2ϩ , foremost among which are elevated cell Ca 2ϩ or elevated cAMP and its attendant protein kinase A (PKA)-dependent protein phosphorylation that results from intense ␤-AR stimulation. Whereas the cytosolic Ca 2ϩ concentration does not appreciably differ in rabbit ventricular cells and SANC, 2,4 the cAMP level of the intact SA node is high, 5 and it has been suspected that the basal cAMP level within SANC is elevated. 6,7 The SA node, however, is highly innervated, and neither the basal cAMP le...

Abstract-Spontaneous beating of rabbit sinoatrial node cells (SANCs) is controlled by cAMP-mediated, protein kinase A-dependent local subsarcolemmal ryanodine receptor Ca 2ϩ releases (LCRs). LCRs activated an inward Na ϩ /Ca 2ϩ exchange current that increases the terminal diastolic depolarization rate and, therefore, the spontaneous SANC beating rate. Basal cAMP in SANCs is elevated, suggesting that cAMP degradation by phosphodiesterases (PDEs) may be low. Surprisingly, total suppression of PDE activity with a broad-spectrum PDE inhibitor, 3Ј-isobutylmethylxanthine (IBMX), produced a 9-fold increase in the cAMP level, doubled cAMP-mediated, protein kinase A-dependent phospholamban phosphorylation, and increased SANC firing rate by Ϸ55%, indicating a high basal activity of PDEs in SANCs. A comparison of specific PDE1 to -5 inhibitors revealed that the specific PDE3 inhibitor, milrinone, accelerated spontaneous firing by Ϸ47% (effects of others were minor) and increased amplitude of L-type Ca 2ϩ current (I Ca,L ) by Ϸ46%, indicating that PDE3 was the major constitutively active PDE in the basal state. PDE-dependent control of the spontaneous SANC firing was critically dependent on subsarcolemmal LCRs, ie, PDE inhibition increased LCR amplitude and size and decreased LCR period, leading to earlier and augmented LCR Ca 2ϩ release, Na ϩ /Ca 2ϩ exchange current, and an increase in the firing rate. When ryanodine receptors were disabled by ryanodine, neither IBMX nor milrinone was able to amplify LCRs, accelerate diastolic depolarization rate, or increase the SANC firing rate, despite preserved PDE inhibition-induced augmentation of I Ca,L amplitude. Thus, basal constitutive PDE activation provides a novel and powerful mechanism to decrease cAMP, limit cAMP-mediated, protein kinase A-dependent increase of diastolic ryanodine receptor Ca 2ϩ release, and restrict the spontaneous SANC beating rate. Key Words: sinoatrial node Ⅲ phosphodiesterase Ⅲ ryanodine receptors Ⅲ local Ca 2ϩ release T he sinoatrial (SA) node is the primary physiological pacemaker of the heart. The pacemaker action potential (AP) is initiated within the SA node center and then propagates to the atria and ventricle to initiate contraction. 1,2 Our recent studies have demonstrated that spontaneous firing of SA node pacemaker cells (SANCs) is controlled by local subsarcolemmal Ca 2ϩ releases (LCRs) from ryanodine receptors (RyR) that occur during the second half of spontaneous diastolic depolarization (DD), just prior to the AP upstroke. 3 LCRs activate inward Na ϩ /Ca 2ϩ exchange (NCX) current that accelerates the rate of DD, leading to an earlier occurrence of the subsequent spontaneous AP, ie, to an increase in the beating rate. 3 Although LCRs do not require membrane depolarization, 4 they are critically dependent on levels of cAMP and cAMP-mediated, protein kinase (PKA)-dependent phosphorylation, both of which are markedly higher in SANCs than in atrial or ventricular myocytes, because of constitutive activation of adenylyl cyclases (ACs). 5 T...

Abstract-The cardiac troponin T (TnT) I79N mutation has been linked to familial hypertrophic cardiomyopathy and high incidence of sudden death, despite causing little or no cardiac hypertrophy in patients. Transgenic mice expressing mutant human TnT (I79N-Tg) have increased cardiac contractility, but no ventricular hypertrophy or fibrosis. Enhanced cardiac function has been associated with myofilament Ca 2ϩ sensitization, suggesting altered cellular Ca 2ϩ handling. In the present study, we compare cellular Ca 2ϩ transients and electrophysiological parameters of 64 I79N-Tg and 106 control mice in isolated myocytes, isolated perfused hearts, and whole animals. Ventricular action potentials (APs) measured in isolated I79N-Tg hearts and myocytes were significantly shortened only at 70% repolarization. No significant differences were found either in L-type Ca 2ϩ or transient outward K ϩ currents, but inward rectifier K ϩ current (IK1) was significantly decreased. More critically, Ca 2ϩ transients of field-stimulated ventricular I79N-Tg myocytes were reduced and had slow decay kinetics, consistent with increased Ca 2ϩ sensitivity of I79N mutant fibers. AP differences were abolished when myocytes were dialyzed with Ca 2ϩ buffers or after the Na ϩ -Ca 2ϩ exchanger was blocked by Li ϩ . At higher pacing rates or in presence of isoproterenol, diastolic Ca 2ϩ became significantly elevated in I79N-Tg compared with control myocytes. Ventricular ectopy could be induced by isoproterenol-challenge in isolated I79N-Tg hearts and anesthetized I79N-Tg mice. Freely moving I79N-Tg mice had a higher incidence of nonsustained ventricular tachycardia (VT) during mental stress (warm air jets). We conclude that the TnT-I79N mutation causes stress-induced VT even in absence of hypertrophy and/or fibrosis, arising possibly from the combination of AP remodeling related to altered Ca is an autosomal-dominant disease resulting from mutations in genes encoding cardiac contractile proteins and is an important cause of sudden cardiac death. 1 Genotype/phenotype correlation studies suggest that the prognostic significance of most mutations is related to the degree of cardiac hypertrophy and fibrosis. 2,3 An exception to this are patients with cardiac troponin T (TnT) mutations such as TnT-I79N, 4 who often die suddenly at a young age, 5 even though cardiac hypertrophy and fibrosis are either mild or nonexistent. 6 Although it is generally assumed that these sudden deaths are caused be ventricular arrhythmias, such evidence has been difficult to obtain, 7 and no data exist for the TnT-I79N mutation.In vitro studies of skinned fibers reconstituted with mutant TnT protein show that FHC-linked troponin T mutations almost universally increase myofilament Ca 2ϩ sensitivity. 8 Because Ca 2ϩ binding to the troponin complex represents the largest component of dynamic Ca 2ϩ buffering during the cardiac cycle, 9 our modeling studies predict that the increased myofilament Ca 2ϩ sensitivity would significantly alter intracellular Ca 2ϩ transients. 10 Thus, T...

Beneficial clinical bradycardic effects of ivabradine (IVA) have been interpreted solely on the basis of If inhibition, because IVA specifically inhibits If in sinoatrial nodal pacemaker cells (SANC). However, it has been recently hypothesized that SANC normal automaticity is regulated by crosstalk between an “M clock,” the ensemble of surface membrane ion channels, and a “Ca2+ clock,” the sarcoplasmic reticulum (SR). We tested the hypothesis that crosstalk between the two clocks regulates SANC automaticity, and that indirect suppression of the Ca2+ clock further contributes to IVA-induced bradycardia. IVA (3μM) not only reduced If amplitude by 45±6% in isolated rabbit SANC, but the IVA-induced slowing of the action potential (AP) firing rate was accompanied by reduced SR Ca2+ load, slowed intracellular Ca2+ cycling kinetics, and prolonged the period of spontaneous local Ca2+ releases (LCRs) occurring during diastolic depolarization. Direct and specific inhibition of SERCA2 by cyclopiazonic acid (CPA) had effects similar to IVA on LCR period and AP cycle length. Specifically, the LCR period and AP cycle length shift toward longer times almost equally by either direct perturbations of the M clock (IVA) or the Ca2+ clock (CPA), indicating that the LCR period reports the crosstalk between the clocks. Our numerical model simulations predict that entrainment between the two clocks that involves a reduction in INCX during diastolic depolarization is required to explain the experimentally AP firing rate reduction by IVA. In summary, our study provides new evidence that a coupled-clock system regulates normal cardiac pacemaker cell automaticity. Thus, IVA-induced bradycardia includes a suppression of both clocks within this system.

In sinoatrial node cells of the heart, beating rate is controlled, in part, by local Ca²(+) releases (LCRs) from the sarcoplasmic reticulum, which couple to the action potential via electrogenic Na(+)/Ca²(+) exchange. We observed persisting, roughly periodic LCRs in depolarized rabbit sinoatrial node cells (SANCs). The features of these LCRs were reproduced by a numerical model consisting of a two-dimensional array of stochastic, diffusively coupled Ca²(+) release units (CRUs) with fixed refractory period. Because previous experimental studies showed that β-adrenergic receptor stimulation increases the rate of Ca²(+) release through each CRU (dubbed I(spark)), we explored the link between LCRs and I(spark) in our model. Increasing the CRU release current I(spark) facilitated Ca²(+)-induced-Ca²(+) release and local recruitment of neighboring CRUs to fire more synchronously. This resulted in a progression in simulated LCR size (from sparks to wavelets to global waves), LCR rhythmicity, and decrease of LCR period that parallels the changes observed experimentally with β-adrenergic receptor stimulation. The transition in LCR characteristics was steeply nonlinear over a narrow range of I(spark), resembling a phase transition. We conclude that the (partial) periodicity and rate regulation of the "Calcium clock" in SANCs are emergent properties of the diffusive coupling of an ensemble of interacting stochastic CRUs. The variation in LCR period and size with I(spark) is sufficient to account for β-adrenergic regulation of SANC beating rate.

Rationale Sinoatrial node cells (SANC) generate local, subsarcolemmal Ca2+ releases (LCRs) from sarcoplasmic reticulum (SR) during late diastolic depolarization (DD). LCRs activate an inward Na+-Ca2+ exchange current (INCX) which accelerates DD rate, prompting the next action potential (AP). The LCR period, i.e., a delay between AP-induced Ca2+ transient and LCR appearance, defines the time of late DD INCX activation. Mechanisms that control the LCR period, however, are still unidentified. Objective To determine dependence of the LCR period on SR Ca2+ refilling kinetics and establish links between regulation of SR Ca2+ replenishment, LCR period and spontaneous cycle length. Methods and Results Spontaneous APs and SR luminal or cytosolic Ca2+ were recorded using perforated patch and confocal microscopy, respectively. Time to 90% replenishment of SR Ca2+ following AP-induced Ca2+ transient was highly correlated with the time to 90% decay of cytosolic Ca2+ transient (T-90C). Local SR Ca2+ depletions mirror their cytosolic counterparts, LCRs, and occur following SR Ca2+ refilling. Inhibition of SR Ca2+ pump by cyclopiazonic acid (CPA) dose-dependently suppressed spontaneous SANC firing up to ~50%. CPA and graded changes in phospholamban phosphorylation produced by β-AR stimulation, phosphodiesterase or PKA inhibition shifted T-90C and proportionally shifted the LCR period and spontaneous cycle length (R2=0.98). Conclusions The LCR period, a critical determinant of the spontaneous SANC cycle length, is defined by the rate of SR Ca2+ replenishment, which is critically dependent on SR pumping rate, Ca2+ available for pumping, supplied by L-type Ca2+ channel, and RyR Ca2+ release flux each of which is modulated by cAMP-mediated PKA-dependent phosphorylation.

Although the ensemble of voltage- and time-dependent rhythms of surface membrane ion channels, the membrane "Clock", is the immediate cause of a sinoatrial nodal cell (SANC) action potential (AP), it does not necessarily follow that this ion channel ensemble is the formal cause of spontaneous, rhythmic APs. SANC also generates intracellular oscillatory spontaneous Ca(2+) releases that ignite excitation (SCaRIE) of the surface membrane via Na(+)/Ca(2+) exchanger activation. The idea that a rhythmic intracellular Ca(2+) Clock might keep time for normal automaticity of SANC, however, has not been assimilated into mainstream pacemaker dogma. Recent experimental evidence, derived from simultaneous, confocal imaging of submembrane Ca(2+) and membrane potential of SANC, and supported by numerical modeling, indicates that normal automaticity of SANC is entrained and stabilized by the tight integration of the SR Ca(2+) Clock that generates rhythmic SCaRIE, and the surface membrane Clock that responds to SCaRIE to immediately produce APs of an adequate shape. Thus, tightly controlled, rhythmic SCaRIE does not merely fine tune SANC AP firing, but is the formal cause of the basal and reserve rhythms, insuring pacemaker stability by rhythmically integrating multiple Ca(2+)-dependent functions, and effects normal automaticity by rhythmic ignition of the surface membrane Clock.

We have studied the physiological effects of the troponin T (TnT) F110I and R278C mutations associated with familial hypertrophic cardiomyopathy (FHC) in humans. Three to four-month-old transgenic (Tg) mice expressing F110I-TnT and R278C-TnT did not develop significant hypertrophy or ventricular fibrosis even after chronic exercise challenge. The F110I mutation impaired acute exercise tolerance, whereas R278C did not. Skinned papillary muscle fibers from transgenic mice expressing F110I-TnT demonstrated increased Ca 2؉ sensitivity of force and ATPase activity, and likewise an increased Ca 2؉ sensitivity of force was observed in F110I-TnT-reconstituted human cardiac muscle preparations. In contrast, no changes in force or the ATPase-pCa dependencies were observed in transgenic R278C fibers or in human fibers reconstituted with the R278C-TnT mutant. The maximal level of force development was dramatically decreased in both transgenic mice. However, the maximal ATPase was not different (R278C-TnT) or only slightly less (F110I-TnT) than that of non-Tg and WT-Tg littermates. Consequently, their ratios of ATPase/force (energy cost) at all Ca 2؉ concentrations were dramatically higher compared with non-Tg and WT-Tg fibers. This increase in energy cost most likely results from a decrease in force per myosin cross-bridge, because forcing all cross-bridges into the force generating state by substitution of MgADP for MgATP in maximum contracting solutions resulted in the same increase in maximal force (15%) in all transgenic and non-transgenic preparations. The combination of increased Ca 2؉ sensitivity and energy cost in the F110I hearts may be responsible for the greater severity of this phenotype compared with the R278C mutation.