Mechanisms of atrial-selective block of Na⁺ channels by ranolazine: I. Experimental analysis of the use-dependent block

Atrial-selective inhibition of cardiac Na(+) channel current (I(Na)) and I(Na)-dependent parameters has been shown to contribute to the safe and effective management of atrial fibrillation. The present study examined the basis for the atrial-selective actions of ranolazine. Whole cell I(Na) was recorded at 15°C in canine atrial and ventricular myocytes and in human embryonic kidney (HEK)-293 cells expressing SCN5A. Tonic block was negligible at holding potentials from -140 to -100 mV, suggesting minimal drug interactions with the closed state. Trains of 40 pulses were elicited over a range of holding potentials to determine use-dependent block. Guarded receptor formalism was used to analyze the development of block during pulse trains. Use-dependent block by ranolazine increased at more depolarized holding potentials, consistent with an interaction of the drug with either preopen or inactivated states, but was unaffected by longer pulse durations between 5 and 200 ms, suggesting a weak interaction with the inactivated state. Block was significantly increased at shorter diastolic intervals between 20 and 200 ms. Responses in atrial and ventricular myocytes and in HEK-293 cells displayed a similar pattern. Ranolazine is an open state blocker that unbinds from closed Na(+) channels unusually fast but is trapped in the inactivated state. Kinetic rates of ranolazine interactions with different states of atrial and ventricular Na(+) channels were similar. Our data suggest that the atrial selectivity of ranolazine is due to a more negative steady-state inactivation curve, less negative resting membrane potential, and shorter diastolic intervals in atrial cells compared with ventricular cells at rapid rates.     

Left septal fascicular block: myth or reality?

Anatomic studies have shown that the left bundle branch divides into three fascicles in most humans. Changes in the 12 lead ECG (electrocardiogram) due to conduction abnormalities of the left anterior fascicle and left posterior fascicle are now part of the standard repertoire of electrocardiographic interpretation. There are no standard criteria for detecting conduction defects involving the third left fascicle, the septal or median fascicle, and the very existence of such defects is still a matter of controversy. The purposes of this article are to review the available evidence on this subject, suggest electrocardiographic criteria for its recognition, and present examples which illustrate that left septal fascicular block does indeed exist as a specific entity. Left septal fascicular block is a polymorphic conduction defect which may explain some previously inadequately understood electrocardiographic abnormalities.     

How do presynaptic PLA2 neurotoxins block nerve terminals?

Snake presynaptic neurotoxins with phospholipase A2 activity block nerve terminals in an unknown way. Here, we propose that they enter the lumen of synaptic vesicles following endocytosis and hydrolyse phospholipids of the inner leaflet of the membrane. The transmembrane pH gradient drives the translocation of fatty acids to the cytosolic monolayer, leaving lysophospholipids on the lumenal layer. Such vesicles are highly fusogenic and release neurotransmitter upon fusion with the presynaptic membrane, but cannot be retrieved because of the high local concentration of fatty acids and lysophospholipids, which prevents vesicle neck closure.     

Synthesis of a conformationally constrained δ-amino acid building block

Conformationally restricted amino acids are important components in peptidomimetics and drug design. Herein, we describe the synthesis of a novel, non-proteinogenic constrained delta amino acid containing a cyclobutane ring, cis-3(aminomethyl)cyclobutane carboxylic acid (ACCA). The synthesis of the target amino acid was achieved in seven steps, with the key reaction being a base induced intramolecular nucleophilic substitution. A small library of dipeptides was prepared through the coupling of ACCA with proteinogenic amino acids.     

Proton block of the CLC-5 Cl?/H+ exchanger

CLC-5 is a H⁺/Cl⁻ exchanger that is expressed primarily in endosomes but can traffic to the plasma membrane in overexpression systems. Mutations altering the expression or function of CLC-5 lead to Dent’s disease. Currents mediated by this transporter show extreme outward rectification and are inhibited by acidic extracellular pH. The mechanistic origins of both phenomena are currently not well understood. It has been proposed that rectification arises from the voltage dependence of a H⁺ transport step, and that inhibition of CLC-5 currents by low extracellular pH is a result of a reduction in the driving force for exchange caused by a pH gradient. We show here that the pH dependence of CLC-5 currents arises from H⁺ binding to a single site located halfway through the transmembrane electric field and driving the transport cycle in a less permissive direction, rather than a reduction in the driving force. We propose that protons bind to the extracellular gating glutamate E211 in CLC-5. It has been shown that CLC-5 becomes severely uncoupled when SCN⁻ is the main charge carrier: H⁺ transport is drastically reduced while the rate of anion movement is increased. We found that in these conditions, rectification and pH dependence are unaltered. This implies that H⁺ translocation is not the main cause of rectification. We propose a simple transport cycle model that qualitatively accounts for these findings.     

Zinc ions block H⁺/OH⁻ channels in Chara australis

Chara australis cells exposed to media of pH 10 and above exhibit high conductance, arising from the opening of H⁺/OH^‐ channels in the plasma membrane. This high conductance can be totally inhibited by 1.0 mm ZnCl₂ and restored by 0.5 mm 2‐mercaptoethanol (ME). Important for carbon fixation, H⁺/OH^‐ channels play a key role in cell pH banding. Banding was also shown to be abolished by 1.0 mm ZnCl₂ and restored in some cells by ME. The proton pump is also involved in banding, but was little affected by ZnCl₂ over the periods needed for the inhibition of H⁺/OH^‐ channels. Previously, we postulated that H⁺/OH^‐ channels open transiently at the onset of saline stress in salt‐sensitive C. australis, causing membrane potential difference (PD) noise; and remain open in latter stages of saline stress, contributing to cell deterioration. ZnCl₂ totally inhibited the saline noise and the upwardly concave I/V characteristics associated with the putative H⁺/OH^‐ currents. Again, ME reversed both these effects. We discuss the mode of action of zinc ions and ME with reference to animal voltage‐gated H⁺ channels and water channels.     

Computer modelling study on the compatibility of PEO–PMMA block copolymers

The compatibility of six kinds of designed poly(ethylene oxide)-block-poly(methyl methacrylate) (PEO-b-PMMA) copolymers was studied at 270, 298 and 400 K by mesoscopic modelling. The values of order parameter depended on both the structures of block copolymers and the simulation temperatures, while the values of order parameter of the long chains were higher than those of the short ones; temperature showed a more obvious effect on long chains than on short ones. These plain copolymers doped with PEO or PMMA homopolymer showed different order parameter values. When the triblock copolymer was composed of the same component at both ends and was doped with a homopolymer with the same component as that in the middle or the end of triblock copolymer, the values of order parameter depended on the simulation temperature, such as A5B6A5 doped with B6 at 400 K and A5B6A5 doped with A5 at 270 K, it showed the highest order parameter values. The study of copolymers doped with nanoparticles showed that the mesoscopic phase was influenced by not only the properties of the nanoparticles, such as the size and density, but also the compositions of copolymers. Among them, increasing the size of doped nanoparticles was the most significant effect on changing the phase morphologies.     

Anti-Dll4 therapy: can we block tumour growth by increasing angiogenesis?

Since the early 1970s, the dogma postulating that blocking tumour angiogenesis can inhibit tumour growth has been accepted widely and has resulted in the generation of a variety of successful anti-angiogenic therapies. More recently, new signalling pathways, such as the Dll4-Notch signalling pathway, have been shown to regulate angiogenesis during development. In pathological conditions, such as cancer, Dll4 is up-regulated strongly in the tumour vasculature. Based on this expression pattern, different molecules have been generated to block Dll4 signalling. Unexpectedly, these blocking agents inhibited tumour growth in vivo by triggering excessive but nonfunctional angiogenesis. Altogether, these molecules constitute a new category of pro-angiogenic yet anticancer agents and offer an exciting alternative to previously described vascular targeting molecules.     

Elderly patients in a general surgical unit: do they block beds?

In a prospective study of patients aged 65 years and over admitted to a general surgical unit only one patient in 10 remained in hospital for more than a month and fewer than one patient in a hundred became a "bed-blocker." While the over-65s had mean and median durations of stay which were longer than those of younger patients, in almost all cases a prolonged stay in hospital resulted from postoperative morbidity and was not related to social or administrative factors. Only a reduction in the incidence of postoperative morbidity could achieve a significant saving in the number of bed-days occupied by elderly people.     

Serial block face scanning electron microscopy—the future of cell ultrastructure imaging

One of the major drawbacks in transmission electron microscopy has been the production of three-dimensional views of cells and tissues. Currently, there is no one suitable 3D microscopy technique that answers all questions and serial block face scanning electron microscopy (SEM) fills the gap between 3D imaging using high-end fluorescence microscopy and the high resolution offered by electron tomography. In this review, we discuss the potential of the serial block face SEM technique for studying the three-dimensional organisation of animal, plant and microbial cells.     

Conductance and block of hair-cell mechanotransducer channels in transmembrane channel–like protein mutants

Transmembrane channel–like (TMC) proteins TMC1 and TMC2 are crucial to the function of the mechanotransducer (MT) channel of inner ear hair cells, but their precise function has been controversial. To provide more insight, we characterized single MT channels in cochlear hair cells from wild-type mice and mice with mutations in Tmc1, Tmc2, or both. Channels were recorded in whole-cell mode after tip link destruction with BAPTA or after attenuating the MT current with GsMTx-4, a peptide toxin we found to block the channels with high affinity. In both cases, the MT channels in outer hair cells (OHCs) of wild-type mice displayed a tonotopic gradient in conductance, with channels from the cochlear base having a conductance (110 pS) nearly twice that of those at the apex (62 pS). This gradient was absent, with channels at both cochlear locations having similar small conductances, with two different Tmc1 mutations. The conductance of MT channels in inner hair cells was invariant with cochlear location but, as in OHCs, was reduced in either Tmc1 mutant. The gradient of OHC conductance also disappeared in Tmc1/Tmc2 double mutants, in which a mechanically sensitive current could be activated by anomalous negative displacements of the hair bundle. This “reversed stimulus–polarity” current was seen with two different Tmc1/Tmc2 double mutants, and with Tmc1/Tmc2/Tmc3 triple mutants, and had a pharmacological sensitivity comparable to that of native MT currents for most antagonists, except dihydrostreptomycin, for which the affinity was less, and for curare, which exhibited incomplete block. The existence in the Tmc1/Tmc2 double mutants of MT channels with most properties resembling those of wild-type channels indicates that proteins other than TMCs must be part of the channel pore. We suggest that an external vestibule of the MT channel may partly account for the channel’s large unitary conductance, high Ca²⁺ permeability, and pharmacological profile, and that this vestibule is disrupted in Tmc mutants.     

5‐Hydroxymethylcytosine: a new kid on the epigenetic block?

The discovery of the Ten‐Eleven‐Translocation (TET) oxygenases that catalyze the hydroxylation of 5‐methylcytosine (5mC) to 5‐hydroxymethylcytosine (5hmC) has triggered an avalanche of studies aiming to resolve the role of 5hmC in gene regulation if any. Hitherto, TET1 is reported to bind to CpG‐island (CGI) and bivalent promoters in mouse embryonic stem cells, whereas binding at DNAseI hypersensitive sites (HS) had escaped previous analysis. Significant enrichment/accumulation of 5hmC but not 5mC can indeed be detected at bivalent promoters and at DNaseI‐HS. Surprisingly, however, 5hmC is not detected or present at very low levels at CGI promoters notwithstanding the presence of TET1. Our meta‐analysis of DNA methylation profiling points to potential issues with regard to the various methodologies that are part of the toolbox used to detect 5mC and 5hmC. Discrepancies between published studies and technical limitations prevent an unambiguous assignment of 5hmC as a ‘true’ epigenetic mark, that is, read and interpreted by other factors and/or as a transiently accumulating intermediary product of the conversion of 5mC to unmodified cytosines.     

B cell block: is rituximab a new possible treatment for systemic sclerosis?

There is no treatment for fibrotic diseases, including the autoimmune disease systemic sclerosis (sclerderma, SSc). Although broad spectrum immune suppressants have little to no effect on the fibrosis in SSc, agents targeting specific proinflammatory agents are currently being considered as possible therapeutic approaches to combating SSc. B cells are lymphocytes that proliferate and secrete antibody molecules which drive the autoimmune response. CD20 is a B cell marker; the agent rituximab is an antibody against CD20. In a recent report by Bosello and colleagues (Arthritis Res. Ther. 12(2): R54, 2010), rituximab was tolerated in SSc patients and appeared to result in an improvement of the skin score and of clinical symptoms of SSc. This report is one of a series of recent studies suggesting that rituximab may be a possible treatment for SSc. This commentary summarizes these observations.