Cardiac contractility modulation with the impulse dynamics signal: studies in dogs with chronic heart failure.

The intravenous use of positive inotropic agents, such as sympathomimetics and phosphodiesterase inhibitors, in heart failure is limited by pro-arrhythmic and positive chronotropic effects. Chronic use of these agents, while eliciting an improvement in the quality of life of patients with advanced heart failure, has been abandoned because of marked increase in mortality when compared to placebo. Nevertheless, patients with advanced heart failure can benefit from long-term positive inotropic support if the therapy can be delivered 'on demand' and in a manner that is both safe and effective. In this review, we will examine the use of a novel, non-stimulatory electrical signal that can acutely modulate left ventricular (LV) contractility in dogs with chronic heart failure in such a way as to elicit a positive inotropic support. Cardiac contractility modulation (CCM) with the Impulse Dynamic(trade mark) signal was examined in dogs with chronic heart failure produced by intracoronary microembolizations. Delivery of the CCM signal from a lead placed in the great coronary vein for periods up to 10 minutes resulted in significant improvements in cardiac output, LV peak+dP/dt, LV fractional area of shortening and LV ejection fraction measured angiographically. Discontinuation of the signal resulted in a return of all functional parameters to baseline values. In cardiomyocytes isolated from dogs with chronic heart failure, application of the CCM signal resulted in improved shortening, rate of change of shortening and rate of change of relengthening suggesting that CCM application is associated with intrinsic improvement of cardiomyocyte function. The improvement in isolated cardiomyocyte function after application of the CCM signal was accompanied by an increase in the peak and integral of the Ca(2+) transient suggesting modulation of calcium cycling by CCM application. In a limited number of normal dogs, intermittent chronic delivery of the CCM signal for up to 7 days showed chronic maintenance of LV functional improvement. In conclusion, pre-clinical results to date with the Impulse Dynamics CCM signal indicate that this non-pharmacologic therapeutic modality can provide short-term positive inotropic support to the failing heart and as such, may be a useful adjunct in the treatment of advanced heart failure. Additional, long-term studies in dogs with heart failure are needed to establish the safety and efficacy of this therapeutic modality for the chronic treatment of this disease syndrome.

Effects of angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists in rats with heart failure. Role of kinins and angiotensin II type 2 receptors.

Angiotensin-converting enzyme inhibitors (ACEi) improve cardiac function and remodeling and prolong survival in patients with heart failure (HF). Blockade of the renin-angiotensin system (RAS) with an angiotensin II type 1 receptor antagonist (AT1-ant) may have a similar beneficial effect. In addition to inhibition of the RAS, ACEi may also act by inhibiting kinin destruction, whereas AT1-ant may block the RAS at the level of the AT1 receptor and activate the angiotensin II type 2 (AT2) receptor. Using a model of HF induced by myocardial infarction (MI) in rats, we studied the role of kinins in the cardioprotective effect of ACEi. We also investigated whether an AT1-ant has a similar effect and whether these effects are partly due to activation of the AT2 receptor. Two months after MI, rats were treated for 2 mo with: (a) vehicle; (b) the ACEi ramipril, with and without the B2 receptor antagonist icatibant (B2-ant); or (c) an AT1-ant with and without an AT2-antagonist (AT2-ant) or B2-ant. Vehicle-treated rats had a significant increase in left ventricular end-diastolic (LVEDV) and end-systolic volume (LVESV) as well as interstitial collagen deposition and cardiomyocyte size, whereas ejection fraction was decreased. Left ventricular remodeling and cardiac function were improved by the ACEi and AT1-ant. The B2-ant blocked most of the cardioprotective effect of the ACEi, whereas the effect of the AT1-ant was blocked by the AT2-ant. The decreases in LVEDV and LVESV caused by the AT1-ant were also partially blocked by the B2-ant. We concluded that (a) in HF both ACEi and AT1-ant have a cardioprotective effect, which could be due to either a direct action on the heart or secondary to altered hemodynamics, or both; and (b) the effect of the ACEi is mediated in part by kinins, whereas that of the AT1-ant is triggered by activation of the AT2 receptor and is also mediated in part by kinins. We speculate that in HF, blockade of AT1 receptors increases both renin and angiotensins; these angiotensins stimulate the AT2 receptor, which in turn may play an important role in the therapeutic effect of the AT1-ant via kinins and other autacoids.

Chronic heart failure induced by coronary artery ligation in Lewis inbred rats.

Rat models of heart failure (HF) secondary to myocardial infarction (MI) are useful in studying the progression of cardiac dysfunction and in testing therapeutic approaches. Sprague-Dawley rats are frequently used; however, this model is hampered by high mortality and a marked variability in infarct size and cardiac dysfunction, necessitating large numbers of rats and prolonged follow-up when studying the progression of dysfunction. In the present work, we developed a model of HF utilizing Lewis inbred rats. Ligation of the left anterior descending coronary artery in Lewis rats produced more uniform and larger infarcts (40 +/- 1.7 vs. 28 +/- 2.3%; P < 0.001) and lower mortality (16 vs. 36%; P < 0.001) than in Sprague-Dawley rats. Using this rat model, we further studied the course of left ventricular (LV) dysfunction and enlargement from 1 wk to 6 mo after MI with cineventriculography. LV end-systolic volume and end-diastolic volume were determined with the area-length method. LV ejection fraction ranged between 0.57 and 0.62 in control rats; after MI, it decreased significantly to 0.48 +/- 0.04 at 1 wk, 0.36 +/- 0.02 at 2 wk, 0.48 +/- 0.02 at 1 mo, 0.35 +/- 0.03 at 2 mo, 0.30 +/- 0.02 at 3 mo, 0.31 +/- 0.02 at 4 mo, and 0.24 +/- 0.02 at 6 mo (P < 0.001, MI vs. sham). LV end-diastolic volume in control rats ranged between 0.32 and 0.42 ml; it increased to 0.48 +/- 0.04 ml at 1 wk, 0.46 +/- 0.02 ml at 2 wk, and 0.46 +/- 0.03 ml at 1 mo. It markedly increased to 0.79 +/- 0.03, 0.79 +/- 0.06, 0.78 +/- 0.03, and 0.80 +/- 0.05 ml at 2, 3, 4, and 6 mo, respectively, after MI (P < 0.001 vs. sham). LV end-diastolic pressure was significantly elevated at all time points. Thus coronary ligation in Lewis inbred rats produces uniformly large infarcts with low mortality, progressive LV dysfunction, and increased LV chamber size. This model may be useful in studying chronic HF secondary to MI.

In vitro studies of conjunctival cells from eyes with and without pseudoexfoliation.

The aim of the study was to examine for possible differences between cell cultures derived from eye with and without pseudoexfoliation. In both populations, scanning electron microscopy showed flattened epithelial cells and also spindleshaped fibroblast-like cells. The presence of these cell types was further confirmed by immunohistochemical demonstration of cytokeratin and vimentin in the cultured cells. The cells maintained in vitro showed a linear increase in uptake of leucine during a 12-h period. Within this period, the leucine recovered in the TCA precipitable fraction was considerably higher than the nonbound fraction. In cultures maintained in medium with and without L-ascorbic acid, the presence of L-ascorbic acid significantly increase the uptake of leucine into TCA precipitable material, and to a similar extent in cultures from the two populations. In conclusion, cells derived from eyes with and without pseudoexfoliation material and maintained in vitro showed similar morphology, presence of intermediate filaments, as well as uptake of leucine under various culture conditions.

Outgrowth of cells from human conjunctival explants onto cornea in vitro.

The epithelium was removed from human corneas, and samples of conjunctival tissue were cultured as explants on the denuded corneal surface for 1 and 2 weeks. Cells migrating from the conjunctival explants onto the corneal surface produced a multilayer where cells on the surface generally showed a flattened appearance. The apical membrane of these cells demonstrated villi as well as microplicae. Surface projections were also detected on cells in the deeper layers of the epithelium. Neighbouring cells were connected by junctional complexes. After 2 weeks, however, a lack of intercellular junctions in some areas resulted in the formation of intraepithelial cystoid spaces. Basal cells were connected to the underlying basement membrane by hemidesmosomes. Although transdifferentiation of the cells into a corneal epithelium was not observed within the 2 weeks, the present system provides a tool for studies on factors affecting reepithelialization of corneal epithelial defects by conjunctival cells.