cal for superinfection by cytomegalovirus. Science. 2010;328(5974) Is ryanodine receptor phosphorylation key to the fight or flight response and heart failure?
Thomas EschenhagenDepartment of Experimental Pharmacology and Toxicology, Cardiovascular Research Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.In situations of stress the heart beats faster and stronger. According to Marks and colleagues, this response is, to a large extent, the consequence of facilitated Ca 2+ release from intracellular Ca 2+ stores via ryanodine receptor 2 (RyR2), thought to be due to catecholamine-induced increases in RyR2 phosphorylation at serine 2808 (S2808). If catecholamine stimulation is sustained (for example, as occurs in heart failure), RyR2 becomes hyperphosphorylated and "leaky," leading to arrhythmias and other pathology. This "leaky RyR2 hypothesis" is highly controversial. In this issue of the JCI, Marks and colleagues report on two new mouse lines with mutations in S2808 that provide strong evidence supporting their theory. Moreover, the experiments revealed an influence of redox modifications of RyR2 that may account for some discrepancies in the field.The heart has a remarkable capacity to react to altered demand by changing the rate at which it beats and the force with which it contracts, thereby changing its output. Both the reduction of cardiac output in phases of rest and its increase in physical and emotional exercise (the fight or flight response) are essential for normal body homeostasis and long-term survival. It is not surprising therefore that cardiac rate and force are regulated at multiple levels, extrinsic and intrinsic to the heart, and in a highly complex and secured fashion. Stimulation of b 1 -adrenergic receptors by the sympathetic neurotransmitter norepinephrine induces increased production of the second messenger cAMP. cAMP directly and indirectly (via activation of PKA) induces faster depolarization in sinoatrial node cells (the cells that generate the action potentials that trigger cardiac contraction) and thus acceleration of heart rate (i.e., it has a "positive chronotropic effect") and stronger contraction (i.e., it has a "positive inotropic effect") and faster relaxation (i.e., it has a "positive lusitropic effect") in working myocytes. In chronic heart failure, one of the most frequent life-threatening diseases in Western societies, norepinephrine levels are chronically elevated, which leads to desensitization of the b-adrenergic signalling cascade and blunted responses. b-Blockers, introduced by Waagstein and colleagues in the mid 1970s, protect the heart from chronic sympathetic stimulation and provide the largest prognostic benefit for patients with chronic heart failure.
Cardiac excitation-contraction couplingThe positive inotropic and lusitropic consequences of b 1 -adrenergic receptor stimulation in cardiomyocytes are explained by changes in excitation-contraction coupling, i.e., the relationship between the cardiac action potential and myofilament acti...