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1.
J Biol Chem ; 298(2): 101508, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-34942149

RESUMEN

The mitochondrial solute carrier family 8 sodium/calcium/lithium exchanger, member B1 (NCLX) is an important mediator of calcium extrusion from mitochondria. In this study, we tested the hypothesis that physiological expression levels of NCLX are essential for maintaining neuronal resilience in the face of excitotoxic challenge. Using an shRNA-mediated approach, we showed that reduced NCLX expression exacerbates neuronal mitochondrial calcium dysregulation, mitochondrial membrane potential (ΔΨm) breakdown, and reactive oxygen species generation during excitotoxic stimulation of primary hippocampal cultures. Moreover, NCLX knockdown-which affected both neurons and glia-resulted not only in enhanced neurodegeneration following an excitotoxic insult but also in neuronal and astrocytic cell death under basal conditions. Our data also revealed that synaptic activity, which promotes neuroprotective signaling, can become lethal upon NCLX depletion; expression of NCLX-targeted shRNA impaired the clearance of mitochondrial calcium following action potential bursts, and was associated both with ΔΨm breakdown and substantial neurodegeneration in hippocampal cultures undergoing synaptic activity. Finally, we showed that NCLX knockdown within the hippocampal cornu ammonis 1 region in vivo causes substantial neurodegeneration and astrodegeneration. In summary, we demonstrated that dysregulated NCLX expression not only sensitizes neuroglial networks to excitotoxic stimuli but also notably renders otherwise neuroprotective synaptic activity toxic. These findings may explain the emergence of neurodegeneration and astrodegeneration in patients with disorders characterized by disrupted NCLX expression or function, and suggest that treatments aimed at enhancing or restoring NCLX function may prevent central nervous system damage in these disease states.


Asunto(s)
Calcio , Proteínas Mitocondriales , Red Nerviosa , Neuroglía , Intercambiador de Sodio-Calcio , Calcio/metabolismo , Humanos , Mitocondrias/genética , Mitocondrias/metabolismo , Proteínas Mitocondriales/biosíntesis , Proteínas Mitocondriales/genética , Proteínas Mitocondriales/metabolismo , Red Nerviosa/metabolismo , Neuroglía/metabolismo , ARN Interferente Pequeño/genética , ARN Interferente Pequeño/metabolismo , Intercambiador de Sodio-Calcio/biosíntesis , Intercambiador de Sodio-Calcio/genética , Intercambiador de Sodio-Calcio/metabolismo
2.
Stroke ; 52(11): 3680-3691, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34694864

RESUMEN

Background and Purpose: NCX3 (Na+-Ca2+ exchanger 3) plays a relevant role in stroke; indeed its pharmacological blockade or its genetic ablation exacerbates brain ischemic damage, whereas its upregulation takes part in the neuroprotection elicited by ischemic preconditioning. To identify an effective strategy to induce an overexpression of NCX3, we examined transcription factors and epigenetic mechanisms potentially involved in NCX3 gene regulation. Methods: Brain ischemia and ischemic preconditioning were induced in vitro by exposure of cortical neurons to oxygen and glucose deprivation plus reoxygenation (OGD/Reoxy) and in vivo by transient middle cerebral artery occlusion. Western blot and quantitative real-time polymerase chain reaction were used to evaluate transcripts and proteins of GATA3 (GATA-binding protein 3), KMT2A (lysine-methyltransferase-2A), and NCX3. GATA3 and KMT2A binding on NCX3 gene was evaluated by chromatin immunoprecipitation and Rechromatin immunoprecipitation experiments. Results: Among the putative transcription factors sharing a consensus sequence on the ncx3 brain promoter region, GATA3 was the only able to up-regulate ncx3. Interestingly, GATA3 physically interacted with KMT2A, and their overexpression or knocking-down increased or downregulated NCX3 mRNA and protein, respectively. Notably, site-direct mutagenesis of GATA site on ncx3 brain promoter region counteracted GATA3 and KMT2A binding on NCX3 gene. More importantly, we found that in the perischemic cortical regions of preconditioned rats GATA3 recruited KMT2A and the complex H3K4-3me (trimethylated lysine-4 of histone-3) on ncx3 brain promoter region, thus reducing transient middle cerebral artery occlusion­induced damage. Consistently, in vivo silencing of either GATA3 or KMT2A prevented NCX3 upregulation and consequently the neuroprotective effect of preconditioning stimulus. The involvement of GATA3/KMT2A complex in neuroprotection elicited by ischemic preconditioning was further confirmed by in vitro experiments in which the knocking-down of GATA3 and KMT2A reverted the neuroprotection induced by NCX3 overexpression in cortical neurons exposed to anoxic preconditioning followed by oxygen and glucose deprivation plus reoxygenation. Conclusions: Collectively, our results revealed that GATA3/KMT2A complex epigenetically activates NCX3 gene transcription during ischemic preconditioning.


Asunto(s)
Factor de Transcripción GATA3/metabolismo , Regulación de la Expresión Génica/fisiología , N-Metiltransferasa de Histona-Lisina/metabolismo , Precondicionamiento Isquémico , Neuroprotección/fisiología , Intercambiador de Sodio-Calcio/biosíntesis , Animales , Encéfalo/irrigación sanguínea , Isquemia Encefálica/metabolismo , Histonas/metabolismo , Masculino , Ratones , Ratas , Ratas Sprague-Dawley , Regulación hacia Arriba
3.
Mol Neurobiol ; 57(5): 2358-2376, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32048166

RESUMEN

The Na+/Ca2+ exchanger 1 (NCX1) participates in the maintenance of neuronal Na+ and Ca2+ homeostasis, and it is highly expressed at synapse level of some brain areas involved in learning and memory processes, including the hippocampus, cortex, and amygdala. Furthermore, NCX1 increases Akt1 phosphorylation and enhances glutamate-mediated Ca2+ influx during depolarization in hippocampal and cortical neurons, two processes involved in learning and memory mechanisms. We investigated whether the modulation of NCX1 expression/activity might influence learning and memory processes. To this aim, we used a knock-in mouse overexpressing NCX1 in hippocampal, cortical, and amygdala neurons (ncx1.4over) and a newly synthesized selective NCX1 stimulating compound, named CN-PYB2. Both ncx1.4over and CN-PYB2-treated mice showed an amelioration in spatial learning performance in Barnes maze task, and in context-dependent memory consolidation after trace fear conditioning. On the other hand, these mice showed no improvement in novel object recognition task which is mainly dependent on non-spatial memory and displayed an increase in the active phosphorylated CaMKIIα levels in the hippocampus. Interestingly, both of these mice showed an increased level of context-dependent anxiety.Altogether, these results demonstrate that neuronal NCX1 participates in spatial-dependent hippocampal learning and memory processes.


Asunto(s)
Hipocampo/fisiología , Intercambiador de Sodio-Calcio/biosíntesis , Aprendizaje Espacial/fisiología , Memoria Espacial/fisiología , Animales , Conducta Animal/efectos de los fármacos , Conducta Animal/fisiología , Calcio/metabolismo , Proteína Quinasa Tipo 2 Dependiente de Calcio Calmodulina/metabolismo , Línea Celular , Cricetinae , Técnicas de Sustitución del Gen , Células HEK293 , Hipocampo/metabolismo , Humanos , Transporte Iónico/efectos de los fármacos , Masculino , Mesocricetus , Ratones , Ratones Endogámicos C57BL , Técnicas de Placa-Clamp , Fosforilación , Procesamiento Proteico-Postraduccional/efectos de los fármacos , Reconocimiento en Psicología/efectos de los fármacos , Reconocimiento en Psicología/fisiología , Proteínas Recombinantes/metabolismo , Sodio/metabolismo , Intercambiador de Sodio-Calcio/agonistas , Intercambiador de Sodio-Calcio/genética , Aprendizaje Espacial/efectos de los fármacos , Memoria Espacial/efectos de los fármacos , Regulación hacia Arriba/efectos de los fármacos
4.
Neuropharmacology ; 135: 180-191, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29551690

RESUMEN

Hypoxic-ischemic encephalopathy (HI) accounts for the majority of developmental, motor and cognitive deficits in children, leading to life-long neurological impairments. Since the plasmamembrane sodium/calcium exchanger (NCX) plays a fundamental role in maintaining ionic homeostasis during adult brain ischemia, in the present work we aimed to demonstrate (1)the involvement of NCX in the pathophysiology of neonatal HI and (2)a possible NCX-based pharmacological intervention. HI was induced in neonatal mice at postnatal day 7(P7) by unilateral cut of the right common carotid artery, followed by 60 min exposure to 8%O2. Expression profiles of NCX isoforms from embryos stage to adulthood was evaluated in the hippocampus of hypoxic-ischemic and control mice. To assess the effect of NCX pharmacological stimulation, brain infarct volume was evaluated in brain sections, obtained at several time intervals after systemic administration of the newly synthesized NCX activator neurounina. Moreover, the long term effect of NCX activation was evaluated in adult mice (P60) subjected to neonatal HI and daily treated with neurounina for three weeks. Hypoxic-ischemic insult induced a reduction of NCX1 and NCX3 expression starting from day 7 until day 60. Notably, 8 weeks after HI induction in P7 mice, NCX pharmacological stimulation not only reduced infarct volume but improved also motor behaviour, spatial and visual memory. The present study highlights the significant role of NCX in the evolution of neonatal brain injury and in the learning and memory processes that are impaired in mice injured in the neonatal period.


Asunto(s)
Benzodiazepinonas/farmacología , Hipoxia-Isquemia Encefálica/tratamiento farmacológico , Hipoxia-Isquemia Encefálica/prevención & control , Pirrolidinas/farmacología , Intercambiador de Sodio-Calcio/metabolismo , Animales , Animales Recién Nacidos , Conducta Animal/efectos de los fármacos , Benzodiazepinonas/uso terapéutico , Encéfalo/patología , Femenino , Hipocampo/metabolismo , Hipoxia-Isquemia Encefálica/metabolismo , Hipoxia-Isquemia Encefálica/patología , Masculino , Ratones , Isoformas de Proteínas , Pirrolidinas/uso terapéutico , Intercambiador de Sodio-Calcio/biosíntesis , Factores de Tiempo
5.
Cell Death Dis ; 9(2): 206, 2018 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-29434186

RESUMEN

Preconditioning (PC) is a phenomenon wherein a mild insult induces resistance to a later, severe injury. Although PC has been extensively studied in several neurological disorders, no studies have been performed in amyotrophic lateral sclerosis (ALS). Here we hypothesize that a sub-toxic acute exposure to the cycad neurotoxin beta-methylamino-L-alanine (L-BMAA) is able to delay ALS progression in SOD1 G93A mice and that NCX3, a membrane transporter able to handle the deregulation of ionic homeostasis occurring during ALS, takes part to this neuroprotective effect. Preconditioning effect was examined on disease onset and duration, motor functions, and motor neurons in terms of functional declines and severity of histological damage in male and female mice. Our findings demonstrate that a sub-toxic dose of L-BMAA works as preconditioning stimulus and is able to delay ALS onset and to prolong ALS mice survival. Interestingly, preconditioning prevented NCX3 downregulation in SOD1 G93A mice spinal cord, leading to an increased number of motor neurons associated to a reduced astrogliosis, and reduced the denervation of neuromuscular junctions observed in SOD1 G93A mice. These protective effects were mitigated in ncx3+/- mice. This study established for the first time an animal model of preconditioning in ALS and candidates NCX3 as a new therapeutic target.


Asunto(s)
Aminoácidos Diaminos/farmacología , Esclerosis Amiotrófica Lateral/metabolismo , Regulación hacia Abajo/efectos de los fármacos , Neurotoxinas/farmacología , Intercambiador de Sodio-Calcio/biosíntesis , Esclerosis Amiotrófica Lateral/genética , Esclerosis Amiotrófica Lateral/patología , Esclerosis Amiotrófica Lateral/terapia , Animales , Toxinas de Cianobacterias , Ratones , Ratones Transgénicos , Intercambiador de Sodio-Calcio/genética , Superóxido Dismutasa/genética , Superóxido Dismutasa/metabolismo , Superóxido Dismutasa-1/genética , Superóxido Dismutasa-1/metabolismo
6.
Heart Rhythm ; 14(8): 1247-1253, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28495655

RESUMEN

BACKGROUND: The cardiac sodium/calcium (Na+/Ca2+) exchanger (NCX) contributes to diastolic depolarization in cardiac pacemaker cells. Increased NCX activity has been found in heart failure and atrial fibrillation. The influence of increased NCX activity on resting heart rate, beta-adrenergic-mediated increase in heart rate, and cardiac conduction properties is unknown. OBJECTIVE: The purpose of this study was to investigate the influence of NCX overexpression in a homozygous transgenic whole-heart mouse model (NCX-OE) on sinus and AV nodal function. METHODS: Langendorff-perfused, beating whole hearts of NCX-OE and the corresponding wild-type (WT) were studied ± isoproterenol (ISO; 0.2 µM). Epicardial ECG, AV nodal Wenckebach cycle length (AVN-WCL), and retrograde AVN-WCL were obtained. RESULTS: At baseline, basal heart rate was unaltered between NCX-OE and WT (WT: cycle length [CL] 177.6 ± 40.0 ms, no. of hearts [n] = 20; NCX-OE: CL 185.9 ± 30.5 ms, n = 18; P = .21). In the presence of ISO, NCX-OE exhibited a significantly higher heart rate compared to WT (WT: CL 133.4 ± 13.4 ms, n = 20; NCX-OE: CL 117.7 ± 14.2 ms, n = 18; P <.001). ISO led to a significant shortening of the anterograde and retrograde AVN-WCL without differences between NCX-OE and WT. CONCLUSION: This study is the first to demonstrate that increased NCX activity enhances beta-adrenergic increase of heart rate. Mechanistically, increased NCX inward mode activity may promote acceleration of diastolic depolarization in sinus nodal pacemaker cells, thus enhancing chronotropy in NCX-OE. These findings suggest a novel potential therapeutic target for heart rate control in the presence of increased NCX activity, such as heart failure.


Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Frecuencia Cardíaca/fisiología , Isoproterenol/farmacología , Contracción Miocárdica/fisiología , Miocitos Cardíacos/patología , Nodo Sinoatrial/fisiopatología , Intercambiador de Sodio-Calcio/biosíntesis , Agonistas Adrenérgicos beta/farmacología , Animales , Calcio/metabolismo , Modelos Animales de Enfermedad , Insuficiencia Cardíaca/metabolismo , Ratones , Ratones Transgénicos , Miocitos Cardíacos/metabolismo , Nodo Sinoatrial/metabolismo , Intercambiador de Sodio-Calcio/efectos de los fármacos
7.
Heart Rhythm ; 14(5): 739-748, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28188930

RESUMEN

BACKGROUND: Complete atrioventricular block (CAVB) causes arrhythmogenic remodeling and increases the risk of torsades de pointes arrhythmias. MicroRNAs (miRNAs) are key regulators of gene expression that contribute to cardiac remodeling. OBJECTIVE: The purpose of this study was to assess miRNA changes after CAVB and identify novel candidates potentially involved in arrhythmogenic cardiac remodeling. METHODS: CAVB was induced in mice via His-bundle ablation. Expression of miRNAs was evaluated by pan-miRNA microarray with quantitative polymerase chain reaction (qPCR) confirmation, on samples obtained 24 hours and 4 weeks post-CAVB. MiRNA target prediction algorithms were used to identify potential target genes. Targets confirmed by luciferase assays in HEK293 cells were followed up with overexpression studies in neonatal rat ventricular myocytes to evaluate regulation using real time- quantitative polymerase chain reaction (RT-qPCR), western blots, cell shortening measurements, and fura-2 Ca2+ fluorescence imaging. RESULTS: Of >400 miRNAs assayed, only miRNA-135a (miR-135a) was altered at 24 hours, down-regulated 78% (P <.001). Algorithms predicted miR-135a regulation of the sodium-calcium exchanger type 1 (NCX1). miR-135a transfection suppressed NCX1 3'UTR reporter activity by 42% (P <.001), mRNA expression by 34% (P <.001), and protein levels by 45% (P <.001) vs noncoding miRNA control. miR-135a overexpression reduced spontaneous beating frequency of neonatal rat ventricular myocytes by 63% (P <.001) while slowing decay (by 56%, P <.05) of caffeine-induced Ca2+ transients. miR-135a also suppressed the Ca2+ loading effects of ouabain and ouabain-induced spontaneous Ca2+ release events. CONCLUSION: NCX1 is negatively regulated by miR-135a, a microRNA that is down-regulated in the heart after CAVB in mice. By controlling NCX1 expression, miR-135a modulates cardiomyocyte automaticity, Ca2+ extrusion, and arrhythmogenic Ca2+ loading/spontaneous Ca2+ release events. Therefore, miR-135a may contribute to proarrhythmic remodeling after CAVB.


Asunto(s)
Bloqueo Atrioventricular/genética , Bloqueo Atrioventricular/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , MicroARNs/genética , Intercambiador de Sodio-Calcio/genética , Animales , Modelos Animales de Enfermedad , Regulación hacia Abajo , Expresión Génica , Regulación de la Expresión Génica , Células HEK293 , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/fisiopatología , Humanos , Ratones , MicroARNs/fisiología , Miocitos Cardíacos/fisiología , Ratas , Intercambiador de Sodio-Calcio/biosíntesis , Intercambiador de Sodio-Calcio/metabolismo , Torsades de Pointes/fisiopatología
8.
J Pharmacol Sci ; 132(3): 181-186, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27816547

RESUMEN

In gastric smooth muscles, the released Ca2+ activates the contractile proteins and Ca2+ taken up from the cytosol cause relaxation. The Na+/Ca2+ exchanger (NCX) is an antiporter membrane protein that controls Ca2+ influx and efflux across the membrane. However, the possible relation of NCX in gastric fundus motility is largely unknown. Here, we investigated electric field stimulation (EFS)-induced relaxations in the circular muscles of the gastric fundus in smooth muscle-specific NCX1 transgenic mice (Tg). EFS caused a bi-phasic response, transient and sustained relaxation. The sustained relaxation prolonged for an extended period after the end of the stimulus. EFS-induced transient relaxation and sustained relaxation were greater in Tg than in wild-type mice (WT). Disruption of nitric oxide component by N-nitro-l-arginine, EFS-induced transient and sustained relaxations caused still marked in Tg compared to WT. Inhibition of PACAP by antagonist, EFS-induced sustained relaxation in Tg was not seen, similar to WT. Nevertheless, transient relaxation remained more pronounced in Tg than in WT. Next, we examined responses to NO and PACAP in smooth muscles. The magnitudes of NOR-1, which generates NO, and PACAP-induced relaxations were greater in Tg than in WT. In this study, we demonstrate that NCX1 regulates gastric fundus motility.


Asunto(s)
Fundus Gástrico/fisiología , Intercambiador de Sodio-Calcio/biosíntesis , Animales , Estimulación Eléctrica , Fundus Gástrico/metabolismo , Técnicas In Vitro , Ratones , Ratones Endogámicos C57BL , Ratones Transgénicos , Relajación Muscular/fisiología , Músculo Liso/metabolismo , Músculo Liso/fisiología
9.
Elife ; 52016 10 11.
Artículo en Inglés | MEDLINE | ID: mdl-27725084

RESUMEN

The mammalian heartbeat is thought to begin just prior to the linear heart tube stage of development. How the initial contractions are established and the downstream consequences of the earliest contractile function on cardiac differentiation and morphogenesis have not been described. Using high-resolution live imaging of mouse embryos, we observed randomly distributed spontaneous asynchronous Ca2+-oscillations (SACOs) in the forming cardiac crescent (stage E7.75) prior to overt beating. Nascent contraction initiated at around E8.0 and was associated with sarcomeric assembly and rapid Ca2+ transients, underpinned by sequential expression of the Na+-Ca2+ exchanger (NCX1) and L-type Ca2+ channel (LTCC). Pharmacological inhibition of NCX1 and LTCC revealed rapid development of Ca2+ handling in the early heart and an essential early role for NCX1 in establishing SACOs through to the initiation of beating. NCX1 blockade impacted on CaMKII signalling to down-regulate cardiac gene expression, leading to impaired differentiation and failed crescent maturation.


Asunto(s)
Calcio/metabolismo , Corazón/embriología , Contracción Miocárdica , Miocitos Cardíacos/metabolismo , Animales , Canales de Calcio Tipo L/biosíntesis , Expresión Génica , Microscopía Intravital , Ratones , Intercambiador de Sodio-Calcio/biosíntesis
10.
Neurogastroenterol Motil ; 28(6): 827-36, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-26787195

RESUMEN

BACKGROUND: For the contraction and relaxation of gastric smooth muscles to occur, the intracellular Ca(2+) concentration must be increased and decreased, respectively. The Na(+) /Ca(2+) exchanger (NCX) is a plasma membrane transporter that is involved in regulating intracellular Ca(2+) concentrations. METHODS: To determine the role of NCX in gastrointestinal tissues, we examined electric field stimulation (EFS)-induced relaxations in the circular muscles of the gastric fundus in NCX1 and NCX2 heterozygote knockout mice (HET). KEY RESULTS: The myenteric plexus layers and the longitudinal and circular muscle layers in the gastric fundus of wild-type mice (WT) were strongly immunoreactive to NCX1 and NCX2. EFS induced a transient relaxation that was apparent during the stimulus and a sustained relaxation that persisted after the end of the stimulus. The amplitudes of EFS-induced transient relaxation and sustained relaxation were greater in NCX1 HET and NCX2 HET than in WT. When an inhibitor of nitric oxide synthase was added following the EFS, neither NCX1 HET nor NCX2 HET exhibited transient relaxation, similar to WT. Furthermore, when a PACAP antagonist was added following the EFS, sustained relaxation in NCX1 HET and NCX2 HET was not observed, similar to WT. Next, we examined the effect of NCX heterozygous deficiency on relaxation in response to NO and PACAP in smooth muscles. The magnitude of NOR-1- and PACAP-induced relaxations in NCX1 HET and NCX2 HET was similar to that of WT. CONCLUSIONS & INFERENCES: In this study, we demonstrate that NCX1 and NCX2 expressed in neurons regulate the motility in the gastric fundus.


Asunto(s)
Fundus Gástrico/fisiología , Tránsito Gastrointestinal/fisiología , Heterocigoto , Relajación Muscular/fisiología , Intercambiador de Sodio-Calcio/biosíntesis , Animales , Motilidad Gastrointestinal/fisiología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Técnicas de Cultivo de Órganos , Intercambiador de Sodio-Calcio/genética
11.
Heart Rhythm ; 13(3): 743-52, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26538326

RESUMEN

BACKGROUND: In a canine model of premature ventricular contraction-induced cardiomyopathy (PVC-CM), Cav1.2 is downregulated and misplaced from transverse tubules (T tubules). Junctophilin-2 (JPH-2) is also downregulated. OBJECTIVES: The objectives of this study were to understand the role of JPH-2 in PVC-CM and to probe changes in other proteins involved in dyad structure and function. METHODS: We quantify T-tubule contents (di-8-ANEPPS fluorescence in live myocytes), examine myocyte ultrastructures (electron microscopy), probe JPH-2-interacting proteins (co-immunoprecipitation), quantify dyad and nondyad protein levels (immunoblotting), and examine subcellular distributions of dyad proteins (immunofluorescence/confocal microscopy). We also test direct JPH-2 modulation of channel function (vs indirect modulation through dyad formation) using heterologous expression. RESULTS: PVC myocytes have reduced T-tubule contents but otherwise normal ultrastructures. Among 19 proteins examined, only JPH-2, bridging integrator-1 (BIN-1), and Cav1.2 are highly downregulated in PVC hearts. However, statistical analysis indicates a general reduction in dyad protein levels when JPH-2 is downregulated. Furthermore, several dyad proteins, including Na/Ca exchanger, are missing or shifted from dyads to the peripheral surface in PVC myocytes. JPH-2 directly or indirectly interacts with Cai-handling proteins, Cav1.2 and KCNQ1, although not BIN-1 or other scaffolding proteins tested. Expression in mammalian cells that do not have dyads confirms direct JPH-2 modulation of the L-type Ca channel current (Cav1.2/voltage-gated Ca channel ß subunit 2) and slow delayed rectifier current (KCNQ1/KCNE1). CONCLUSION: JPH-2 is more than a "dyad glue": it can modulate Cai handling and ion channel function in the dyad region. Downregulation of JPH-2, BIN-1, and Cav1.2 plays a deterministic role in PVC-CM. Dissecting the hierarchical relationship among the three is necessary for the design of therapeutic interventions to prevent the progression of PVC-CM.


Asunto(s)
Cardiomiopatías/metabolismo , Proteínas de la Membrana/biosíntesis , Miocardio/metabolismo , Intercambiador de Sodio-Calcio/biosíntesis , Complejos Prematuros Ventriculares/metabolismo , Animales , Cardiomiopatías/etiología , Cardiomiopatías/patología , Células Cultivadas , Modelos Animales de Enfermedad , Perros , Immunoblotting , Microscopía Confocal , Microscopía Electrónica , Miocardio/patología , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/ultraestructura , Complejos Prematuros Ventriculares/complicaciones , Complejos Prematuros Ventriculares/patología
12.
J Biol Chem ; 290(30): 18412-28, 2015 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-25979335

RESUMEN

Thrombin acts on the endothelium by activating protease-activated receptors (PARs). The endothelial thrombin-PAR system becomes deregulated during pathological conditions resulting in loss of barrier function and a pro-inflammatory and pro-angiogenic endothelial phenotype. We reported recently that the ion transporter Na(+)/Ca(2+) exchanger (NCX) operating in the Ca(2+)-influx (reverse) mode promoted ERK1/2 activation and angiogenesis in vascular endothelial growth factor-stimulated primary human vascular endothelial cells. Here, we investigated whether Ca(2+) influx through NCX was involved in ERK1/2 activation, angiogenesis, and endothelial barrier dysfunction in response to thrombin. Reverse-mode NCX inhibitors and RNAi-mediated NCX1 knockdown attenuated ERK1/2 phosphorylation in response to thrombin or an agonist of PAR-1, the main endothelial thrombin receptor. Conversely, promoting reverse-mode NCX by suppressing Na(+)-K(+)-ATPase activity enhanced ERK1/2 activation. Reverse-mode NCX inhibitors and NCX1 siRNA suppressed thrombin-induced primary human vascular endothelial cell angiogenesis, quantified as proliferation and tubular differentiation. Reverse-mode NCX inhibitors or NCX1 knockdown preserved barrier integrity upon thrombin stimulation in vitro. Moreover, the reverse-mode NCX inhibitor SEA0400 suppressed Evans' blue albumin extravasation to the lung and kidneys and attenuated edema formation and ERK1/2 activation in the lungs of mice challenged with a peptide activator of PAR-1. Mechanistically, thrombin-induced ERK1/2 activation required NADPH oxidase 2-mediated reactive oxygen species (ROS) production, and reverse-mode NCX inhibitors and NCX1 siRNA suppressed thrombin-induced ROS production. We propose that reverse-mode NCX is a novel mechanism contributing to thrombin-induced angiogenesis and hyperpermeability by mediating ERK1/2 activation in a ROS-dependent manner. Targeting reverse-mode NCX could be beneficial in pathological conditions involving unregulated thrombin signaling.


Asunto(s)
Calcio/metabolismo , Glicoproteínas de Membrana/metabolismo , NADPH Oxidasas/metabolismo , Neovascularización Fisiológica/genética , Especies Reactivas de Oxígeno/metabolismo , Intercambiador de Sodio-Calcio/genética , Compuestos de Anilina/administración & dosificación , Animales , Endotelio/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Células Endoteliales de la Vena Umbilical Humana , Humanos , Sistema de Señalización de MAP Quinasas/genética , Glicoproteínas de Membrana/genética , Ratones , NADPH Oxidasa 2 , NADPH Oxidasas/genética , Neovascularización Fisiológica/efectos de los fármacos , Permeabilidad/efectos de los fármacos , Éteres Fenílicos/administración & dosificación , ARN Interferente Pequeño/genética , Receptor PAR-1/genética , Receptor PAR-1/metabolismo , Transducción de Señal/efectos de los fármacos , Intercambiador de Sodio-Calcio/biosíntesis , Intercambiador de Sodio-Calcio/metabolismo , Trombina/administración & dosificación
13.
Stem Cells Dev ; 24(1): 11-20, 2015 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-25075536

RESUMEN

The prospective isolation of defined contractile human pluripotent stem cell (hPSC)-derived cardiomyocytes is advantageous for regenerative medicine and drug screening applications. Currently, enrichment of cardiomyocyte populations from such cultures can be achieved by combinations of cell surface markers or the labor-intensive genetic modification of cardiac developmental genes, such as NKX2.5 or MYH6, with fluorescent reporters. To create a facile, portable method for the isolation of contractile cardiomyocytes from cardiomyogenic hPSC cultures, we employed a highly conserved cardiac enhancer sequence in the SLC8A1 (NCX1) gene to generate a lentivirally deliverable, antibiotic-selectable NCX1cp-EGFP reporter. We show that human embryonic stem cells (and induced pluripotent stem cells) transduced with the NCX1cp-EGFP reporter cassette exhibit enhanced green fluorescent protein (EGFP) expression in cardiac progenitors from 5 days into the directed cardiac hPSC differentiation protocol, with all reporter-positive cells transitioning to spontaneously contracting foci 3 days later. In subsequent stages of cardiomyocyte maturation, NCX1cp-EGFP expression was exclusively limited to contractile cells expressing high levels of cardiac troponin T (CTNT), MLC2a/v, and α-actinin proteins, and was not present in CD90/THY1(+) cardiac stromal cells or CD31/PECAM(+) endothelial cells. Flow-assisted cytometrically sorted EGFP(+) fractions of differentiated cultures were highly enriched in both early (NKX2.5 and TBX5) and late (CTNT/TNNI2, MYH6, MYH7, NPPA, and MYL2) cardiomyocyte markers, with a significant proportion of cells displaying a ventricular-like action potential pattern in patch-clamp recordings. We conclude that the use of the cardiac-specific promoter of the human SLC8A1(NCX1) gene is an effective strategy to isolate contractile cardiac cells and their progenitors from hPSC-derived cardiomyogenic cultures.


Asunto(s)
Genes Reporteros , Proteínas Fluorescentes Verdes/biosíntesis , Células Madre Pluripotentes Inducidas/metabolismo , Miocitos Cardíacos/metabolismo , Proteínas Recombinantes de Fusión/biosíntesis , Intercambiador de Sodio-Calcio/biosíntesis , Técnicas de Cultivo de Célula , Línea Celular , Citometría de Flujo , Proteínas Fluorescentes Verdes/genética , Humanos , Células Madre Pluripotentes Inducidas/citología , Contracción Miocárdica , Miocitos Cardíacos/citología , Proteínas Recombinantes de Fusión/genética , Intercambiador de Sodio-Calcio/genética
14.
Adv Exp Med Biol ; 961: 125-35, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23224875

RESUMEN

Changes in cardiac gene expression contribute to the progression of heart failure by affecting cardiomyocyte growth, function, and survival. The Na(+)-Ca(2+) exchanger gene (Ncx1) is upregulated in hypertrophy and is often found elevated in end-stage heart failure. Studies have shown that the change in its expression contributes to contractile dysfunction. Several transcriptional pathways mediate Ncx1 expression in pathological cardiac remodeling. Both α-adrenergic receptor (α-AR) and ß-adrenergic receptor (ß-AR) signaling can play a role in the regulation of calcium homeostasis in the cardiomyocyte, but chronic activation in periods of cardiac stress contributes to heart failure by mechanisms which include Ncx1 upregulation. Our studies have even demonstrated that NCX1 can directly act as a regulator of "activity-dependent signal transduction" mediating changes in its own expression. Finally, we present evidence that histone deacetylases (HDACs) and histone acetyltransferases (HATs) act as master regulators of Ncx1 expression. We show that many of the transcription factors regulating Ncx1 expression are important in cardiac development and also in the regulation of many other genes in the so-called fetal gene program, which are activated by pathological stimuli. Importantly, studies have revealed that the transcriptional network regulating Ncx1 expression is also mediating many of the other changes in genetic remodeling contributing to the development of cardiac dysfunction and revealed potential therapeutic targets for the treatment of hypertrophy and failure.


Asunto(s)
Cardiomegalia/metabolismo , Regulación de la Expresión Génica , Insuficiencia Cardíaca/metabolismo , Proteínas Musculares/biosíntesis , Intercambiador de Sodio-Calcio/biosíntesis , Transcripción Genética , Animales , Calcio/metabolismo , Cardiomegalia/genética , Cardiomegalia/patología , Cardiomegalia/terapia , Insuficiencia Cardíaca/genética , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/terapia , Histona Acetiltransferasas/genética , Histona Acetiltransferasas/metabolismo , Histona Desacetilasas/genética , Histona Desacetilasas/metabolismo , Humanos , Proteínas Musculares/genética , Contracción Miocárdica/genética , Receptores Adrenérgicos alfa/genética , Receptores Adrenérgicos alfa/metabolismo , Receptores Adrenérgicos beta/genética , Receptores Adrenérgicos beta/metabolismo , Intercambiador de Sodio-Calcio/genética
15.
Adv Exp Med Biol ; 961: 137-45, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23224876

RESUMEN

The ubiquitous sodium-calcium exchanger isoform 1 (NCX1) is a -bidirectional transporter that plays a relevant role under physiological and pathophysiological conditions including brain ischemia by regulating intraneuronal Ca(2+) and Na(+) homeostasis. Although changes in ncx1 protein and transcript expression have been detected during stroke, its transcriptional regulation is still largely unexplored. Here, we reviewed our recent findings on several transcription factors including cAMP response element-binding protein (CREB), nuclear factor kappa B (NF-κB), and hypoxia-inducible factor-1 (HIF-1) in the control of the ncx1 gene expression in neuronal cells.


Asunto(s)
Isquemia Encefálica/metabolismo , Regulación de la Expresión Génica , Proteínas del Tejido Nervioso/metabolismo , Intercambiador de Sodio-Calcio/biosíntesis , Accidente Cerebrovascular/metabolismo , Transcripción Genética , Animales , Encéfalo , Isquemia Encefálica/patología , Calcio/metabolismo , Proteína de Unión a Elemento de Respuesta al AMP Cíclico/metabolismo , Humanos , Factor 1 Inducible por Hipoxia/metabolismo , FN-kappa B/metabolismo , Neuronas/metabolismo , Neuronas/patología , Sodio/metabolismo , Accidente Cerebrovascular/patología
16.
Adv Exp Med Biol ; 961: 275-87, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23224887

RESUMEN

Although the three mammalian Na(+)-Ca(2+) exchangers share considerable amino acid sequence homology, they exhibit substantial immunosuppressive drug specificity. We have shown that cyclosporin A (CsA) treatment of NCX1-, NCX2-, or NCX3-transfected HEK 293 cells and non-transfected H9c2, L6, and aortic smooth muscle cells, which express NCX1 protein naturally, reduces NCX surface expression and transport activity but has no impact on total cell NCX protein. Similar effect on functional expression of NCX1 protein can be obtained also without CsA treatment by knockdown of cell cyclophilin A (CypA), one of the cellular receptor of CsA. This suggests that CypA has a role in acquisition of function competence of NCX1 protein.Unlike CsA treatment, which affects the functional expression of all three mammalian NCX proteins similarly, FK506 and rapamycin treatment modulates only the functional expression of NCX2 and NCX3 proteins. FK506 reduces NCX2 and NCX3 surface expression and transport activity without affecting cell NCX protein. Rapamycin reduces NCX2 and NCX3 transport activity but has no effect on their surface expression or total cell NCX protein expression suggesting that, although it shares a common receptor FKBP with FK506, its mode of action follows a different pathway.We are showing now that the large cytosolic loop of NCX1, NCX2, and NCX3 is involved in acquisition of immunosuppressive drug specificity: truncation of the large cytosolic loop of NCX1 renders the protein sensitive to FK506. Exchange of the large cytosolic loop of NCX3 with that of NCX1 renders the mutant protein insensitive to FK506.


Asunto(s)
Ciclofilina A/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Inmunosupresores/farmacocinética , Intercambiador de Sodio-Calcio/biosíntesis , Animales , Ciclofilina A/genética , Regulación de la Expresión Génica/genética , Células HEK293 , Humanos , Inmunosupresores/farmacología , Unión Proteica , Isoformas de Proteínas/biosíntesis , Isoformas de Proteínas/genética , Estructura Secundaria de Proteína , Transporte de Proteínas/efectos de los fármacos , Transporte de Proteínas/genética , Intercambiador de Sodio-Calcio/genética
17.
Adv Exp Med Biol ; 961: 317-26, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23224891

RESUMEN

The Na(+)/Ca(2+) exchanger (NCX) is a plasma membrane protein that can switch Na(+) and Ca(2+) in either direction to maintain the homeostasis of intracellular Ca(2+). A family of three genes (NCX1, NCX2, and NCX3) has been identified in neurons and muscle cells. NCX activity has also been reported in certain immune cells (e.g., mast cells). We have examined the expression and function of these NCX isoforms in the human monocytes and lung macrophages. Monocytes were purified from peripheral blood of healthy donors. Macrophages (HLM) were isolated and purified from the lung parenchyma of patients undergoing thoracic surgery. NCX1 and NCX3, but not NCX2, were expressed in HLM and monocytes at both mRNA and protein level. Exposure to Na(+)-free medium induced a significant increase in intracellular calcium concentration ([Ca(2+)](i)) in both cell types, suggesting that NCX isoforms expressed on these cells were functionally active. This response was completely abolished by the NCX inhibitor 5-(N-4-chlorobenzyl)-20,40-dimethylbenzamil (CB-DMB). In addition, incubation of macrophages with Na(+)-free medium induced a marked release of TNF-α. Preincubation of HLM with CB-DMB and RNAi-mediated knockdown of NCX1 blocked TNF-α release. Our results demonstrate that human macrophages and monocytes express NCX1 and NCX3 that operate in a bidirectional manner to restore [Ca(2+)](i) to generate Ca(2+) signals and to induce TNF-α production. We suggest that NCX may modulate Ca(2+) homeostasis and proinflammatory functions in human macrophages and monocytes.


Asunto(s)
Señalización del Calcio/fisiología , Regulación de la Expresión Génica/fisiología , Macrófagos/metabolismo , Monocitos/metabolismo , Intercambiador de Sodio-Calcio/biosíntesis , Calcio/metabolismo , Señalización del Calcio/efectos de los fármacos , Regulación de la Expresión Génica/efectos de los fármacos , Técnicas de Silenciamiento del Gen , Humanos , Macrófagos/citología , Monocitos/citología , Isoformas de Proteínas/antagonistas & inhibidores , Isoformas de Proteínas/biosíntesis , Isoformas de Proteínas/genética , Intercambiador de Sodio-Calcio/antagonistas & inhibidores , Intercambiador de Sodio-Calcio/genética , Factor de Necrosis Tumoral alfa/genética , Factor de Necrosis Tumoral alfa/metabolismo
18.
Adv Exp Med Biol ; 961: 329-43, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23224892

RESUMEN

Plasma membrane protein Na(+)/Ca(2+) exchanger (NCX) in vascular smooth muscle (VSM) cells plays an important role in intracellular Ca(2+) homeostasis, Ca(2+) signaling, and arterial contractility. Recent evidence in intact animals reveals that VSM NCX type 1 (NCX1) is importantly involved in the control of arterial blood pressure (BP) in the normal state and in hypertension. Increased expression of vascular NCX1 has been implicated in human primary pulmonary hypertension and several salt-dependent hypertensive animal models. Our aim is to determine the molecular and physiological mechanisms by which vascular NCX influences vasoconstriction and BP normally and in salt-dependent hypertension. Here, we describe the relative contribution of VSM NCX1 to Ca(2+) signaling and arterial contraction, including recent data from transgenic mice (NCX1(smTg/Tg), overexpressors; NCX1(sm-/-), knockouts) that has begun to elucidate the specific contributions of NCX to BP regulation. Arterial contraction and BP correlate with the level of NCX1 expression in smooth muscle: NCX1(sm-/-) mice have decreased arterial myogenic tone (MT), vasoconstriction, and low BP. NCX1(smTg/Tg) mice have high BP and are more sensitive to salt; their arteries exhibit upregulated transient receptor potential canonical channel 6 (TRPC6) protein, increased MT, and vasoconstriction. These observations suggest that NCX is a key component of certain distinct signaling pathways that activate VSM contraction in response to stretch (i.e., myogenic response) and to activation of certain G-protein-coupled receptors. Arterial NCX expression and mechanisms that control the local (sub-plasma membrane) Na(+) gradient, including cation-selective receptor-operated channels containing TRPC6, regulate arterial Ca(2+) and constriction, and thus BP.


Asunto(s)
Arterias/metabolismo , Presión Sanguínea , Proteínas Musculares/biosíntesis , Músculo Liso Vascular/metabolismo , Intercambiador de Sodio-Calcio/biosíntesis , Animales , Calcio/metabolismo , Regulación de la Expresión Génica/genética , Humanos , Hipertensión Pulmonar/genética , Hipertensión Pulmonar/metabolismo , Hipertensión Pulmonar/patología , Hipertensión Pulmonar/fisiopatología , Ratones , Ratones Noqueados , Proteínas Musculares/genética , Músculo Liso Vascular/patología , Intercambiador de Sodio-Calcio/genética , Canales Catiónicos TRPC/biosíntesis , Canales Catiónicos TRPC/genética , Canal Catiónico TRPC6 , Vasoconstricción/genética
19.
BMC Nephrol ; 13: 160, 2012 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-23199000

RESUMEN

BACKGROUND: Urinary Ca2+ excretion increases with dietary NaCl. NaCl-induced calciuria may be associated with hypertension, urinary stone formation and osteoporosis, but its mechanism and long-term effects are not fully understood. This study examined alterations in the expressions of renal Ca2+ transporters, channels and claudins upon salt loading to better understand the mechanism of salt-induced urinary Ca2+ loss. METHODS: Eight-week old Wistar-Kyoto rats were fed either 0.3% or 8% NaCl diet for 8 weeks. Renal cortical expressions of Na+/Ca2+ exchanger 1 (NCX1), Ca2+ pump (PCMA1b), Ca2+ channel (TRPV5), calbindin-D28k, and claudins (CLDN-2, -7, -8, -16 and -19) were analyzed by quantitative PCR, western blot and/or immunohistochemistry. RESULTS: Fractional excretion of Ca2+ increased 6.0 fold with high-salt diet. Renal cortical claudin-2 protein decreased by approximately 20% with decreased immunological staining on tissue sections. Claudin-16 and -19 expressions were not altered. Renal cortical TRPV5, calbindin-D28k and NCX1 expressions increased 1.6, 1.5 and 1.2 fold, respectively. CONCLUSIONS: Chronic high-salt diet decreased claudin-2 protein and increased renal TRPV5, calbindin-D28k, and NCX1. Salt loading is known to reduce the proximal tubular reabsorption of both Na+ and Ca2+. The reduction in claudin-2 protein expression may be partly responsible for the reduced Ca2+ reabsorption in this segment. The concerted upregulation of more distal Ca2+-transporting molecules may be a physiological response to curtail the loss of Ca2+, although the magnitude of compensation does not seem adequate to bring the urinary Ca2+ excretion down to that of the normal-diet group.


Asunto(s)
Canales de Calcio/biosíntesis , Claudina-2/biosíntesis , Túbulos Renales/metabolismo , Proteína G de Unión al Calcio S100/biosíntesis , Cloruro de Sodio Dietético/administración & dosificación , Intercambiador de Sodio-Calcio/biosíntesis , Canales Catiónicos TRPV/biosíntesis , Animales , Calbindina 1 , Calbindinas , Calcio/orina , Regulación de la Expresión Génica , Ratas , Ratas Endogámicas WKY , Cloruro de Sodio Dietético/efectos adversos
20.
J Cell Mol Med ; 16(12): 3052-61, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22970977

RESUMEN

There are controversies concerning the capacity of Rosuvastatin to attenuate heart failure in end-stage hypertension. The aim of the study was to show whether the Rosuvastatin might be effective or not for the heart failure treatment. Twenty-one spontaneously hypertensive rats (SHRs) aged 52 weeks with heart failure were randomly divided into three groups: two receiving Rosuvastatin at 20 and 40 mg/kg/day, respectively, and the third, placebo for comparison with seven Wistar-Kyoto rats (WKYs) as controls. After an 8-week treatment, the systolic blood pressure (SBP) and echocardiographic features were evaluated; mRNA level of B-type natriuretic peptide (BNP) and plasma NT-proBNP concentration were measured; the heart tissues were observed under electron microscope (EM); myocardial sarcoplasmic reticulum Ca(2+) pump (SERCA-2) activity and mitochondria cytochrome C oxidase (CCO) activity were measured; the expressions of SERCA-2a, phospholamban (PLB), ryanodine receptor2 (RyR2), sodium-calcium exchanger 1 (NCX1), Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) and protein phosphatase inhibitor-1 (PPI-1) were detected by Western blot and RT-qPCR; and the total and phosphorylation of protein kinase Cα/ß (PKCα/ß) were measured. Aged SHRs with heart failure was characterized by significantly decreased left ventricular ejection fraction and left ventricular fraction shortening, enhanced left ventricular end-diastolic diameter and LV Volume, accompanied by increased plasma NT-proBNP and elevated BNP gene expression. Damaged myofibrils, vacuolated mitochondria and swollen sarcoplasmic reticulum were observed by EM. Myocardium mitochondria CCO and SERCA-2 activity decreased. The expressions of PLB and NCX1 increased significantly with up-regulation of PPI-1 and down-regulation of CaMKII, whereas that of RyR2 decreased. Rosuvastatin was found to ameliorate the heart failure in aged SHRs and to improve changes in SERCA-2a, PLB, RyR2, NCX1, CaMKII and PPI-1; PKCα/ß2 signal pathway to be suppressed; the protective effect of Rosuvastatin to be dose dependent. In conclusion, the heart failure of aged SHRs that was developed during the end stage of hypertension could be ameliorated by Rosuvastatin.


Asunto(s)
Fluorobencenos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Proteína Quinasa C beta/metabolismo , Proteína Quinasa C-alfa/metabolismo , Pirimidinas/uso terapéutico , Sulfonamidas/uso terapéutico , Envejecimiento , Animales , Presión Sanguínea/efectos de los fármacos , Proteínas de Unión al Calcio/biosíntesis , Proteína Quinasa Tipo 2 Dependiente de Calcio Calmodulina/biosíntesis , Regulación hacia Abajo , Complejo IV de Transporte de Electrones/metabolismo , Masculino , Mitocondrias/metabolismo , Mitocondrias/patología , Miofibrillas/efectos de los fármacos , Miofibrillas/patología , Péptido Natriurético Encefálico/sangre , Péptido Natriurético Encefálico/genética , Fragmentos de Péptidos/sangre , Fosforilación , Proteínas/análisis , ARN Mensajero/biosíntesis , Ratas , Ratas Endogámicas SHR , Ratas Endogámicas WKY , Rosuvastatina Cálcica , Canal Liberador de Calcio Receptor de Rianodina/biosíntesis , Retículo Sarcoplasmático/efectos de los fármacos , Retículo Sarcoplasmático/patología , ATPasas Transportadoras de Calcio del Retículo Sarcoplásmico/metabolismo , Transducción de Señal , Intercambiador de Sodio-Calcio/biosíntesis , Volumen Sistólico/efectos de los fármacos , Regulación hacia Arriba , Función Ventricular Izquierda/efectos de los fármacos
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