Binding Of Cardiotonic Steroids Research Articles

Whither digitalis? What we can still learn from cardiotonic steroids about heart failure and hypertension.

Cloning of the "Na+ pump" (Na+,K+-ATPase or NKA) and identification of a circulating ligand, endogenous ouabain (EO), a cardiotonic steroid (CTS), triggered seminal discoveries regarding EO and its NKA receptor in cardiovascular function and the pathophysiology of heart failure (HF) and hypertension. Cardiotonic digitalis preparations were a preferred treatment for HF for two centuries, but digoxin was only marginally effective in a large clinical trial (1997). This led to diminished digoxin use. Missing from the trial, however, was any consideration that endogenous CTS might influence digitalis' efficacy. Digoxin, at therapeutic concentrations, acutely inhibits NKA but, remarkably, antagonizes ouabain's action. Prolonged treatment with ouabain, but not digoxin, causes hypertension in rodents; in this model, digoxin lowers blood pressure (BP). Furthermore, NKA-bound ouabain and digoxin modulate different protein kinase signaling pathways and have disparate long-term cardiovascular effects. Reports of "brain ouabain" led to the elucidation of a new, slow neuromodulatory pathway in the brain; locally generated EO and the α2 NKA isoform help regulate sympathetic drive to the heart and vasculature. The roles of EO and α2 NKA have been studied by EO assay, ouabain-resistant mutation of α2 NKA, and immunoneutralization of EO with ouabain-binding Fab fragments. The NKA α2 CTS binding site and its endogenous ligand are required for BP elevation in many common hypertension models and full expression of cardiac remodeling and dysfunction following pressure overload or myocardial infarction. Understanding how endogenous CTS impact hypertension and HF pathophysiology and therapy should foster reconsideration of digoxin's therapeutic utility.

A real-time PCR method to genotype mutant mouse models with altered affinity for cardiotonic steroids on the Na,K-ATPase.

The highly conserved, cardiotonic steroid binding site (also termed ouabain binding site) on the primary α subunit of Na,K-ATPase plays a receptor signaling role in a range of vital cell processes and is a therapeutic target for human disease. Mouse lines with altered affinity for cardiotonic steroids on the α1 or α2 subunit isoform of Na,K-ATPase, without any change in pump activity, were developed by the late Jerry B Lingrel and are a valuable tool for studying its physiological roles and drug actions. In one model, the normally ouabain resistant α1 isoform was rendered sensitive to ouabain binding. In a second model, the normally sensitive α2 isoform was rendered resistant to ouabain binding. Additional useful models are obtained by mating these mice. To further advance their use, we developed a rapid, real-time PCR method that detects mutant alleles using specific primers and fluorescent probes. PCR is performed in fast mode with up to 15 samples processed in 40 min. The method was validated by Sanger sequencing using mice of known genotype, and by comparing results with a previous two-step method that used PCR amplification followed by gel electrophoresis. In addition, we clarified inconsistencies in published sequences, updated numbering to current reference sequences, and confirmed the continued presence of the mutations in the colony. It is expected that a wider availability of these models and a more efficient genotyping protocol will advance studies of the Na,K-ATPase and its cardiotonic steroid receptor.

Cryoelectron microscopy of Na+,K+-ATPase in the two E2P states with and without cardiotonic steroids

Cryoelectron microscopy (cryo-EM) was applied to Na+,K+-ATPase (NKA) to determine the structures of two E2P states, one (E2PATP) formed by ATP and Mg2+ in the forward reaction, and the other (E2PPi) formed by inorganic phosphate (Pi) and Mg2+ in the backward reaction, with and without ouabain or istaroxime, representatives of classical and new-generation cardiotonic steroids (CTSs). These two E2P states exhibit different biochemical properties. In particular, K+-sensitive acceleration of the dephosphorylation reaction is not observed with E2PPi, attributed to the presence of a Mg2+ ion in the transmembrane cation binding sites. The cryo-EM structures of NKA demonstrate that the two E2P structures are nearly identical but Mg2+ in the transmembrane binding cavity is identified only in E2PPi, corroborating the idea that it should be denoted as E2PPi·Mg2+. We can now explain why the absence of transmembrane Mg2+ in E2PATP confers the K+ sensitivity in dephosphorylation. In addition, we show that ATP bridges the actuator (A) and nucleotide binding (N) domains, stabilizing the E2PATP state; CTS binding causes hardly any changes in the structure of NKA, both in E2PATP and E2PPi·Mg2+, indicating that the binding mechanism is conformational selection; and istaroxime binds to NKA, extending its aminoalkyloxime group deep into the cation binding site. This orientation is upside down compared to that of classical CTSs with respect to the steroid ring. Notably, mobile parts of NKA are resolved substantially better in the electron microscopy (EM) maps than in previous X-ray structures, including sugars sticking out from the β-subunit and many phospholipid molecules.

Binding of cardiotonic steroids to Na+,K+-ATPase in the E2P state

The sodium pump (Na+, K+-ATPase, NKA) is vital for animal cells, as it actively maintains Na+ and K+ electrochemical gradients across the cell membrane. It is a target of cardiotonic steroids (CTSs) such as ouabain and digoxin. As CTSs are almost unique strong inhibitors specific to NKA, a wide range of derivatives has been developed for potential therapeutic use. Several crystal structures have been published for NKA-CTS complexes, but they fail to explain the largely different inhibitory properties of the various CTSs. For instance, although CTSs are thought to inhibit ATPase activity by binding to NKA in the E2P state, we do not know if large conformational changes accompany binding, as no crystal structure is available for the E2P state free of CTS. Here, we describe crystal structures of the BeF3- complex of NKA representing the E2P ground state and then eight crystal structures of seven CTSs, including rostafuroxin and istaroxime, two new members under clinical trials, in complex with NKA in the E2P state. The conformations of NKA are virtually identical in all complexes with and without CTSs, showing that CTSs bind to a preformed cavity in NKA. By comparing the inhibitory potency of the CTSs measured under four different conditions, we elucidate how different structural features of the CTSs result in different inhibitory properties. The crystal structures also explain K+-antagonism and suggest a route to isoform specific CTSs.

Ouabain-Induced Cell Death and Survival. Role of α1-Na,K-ATPase-Mediated Signaling and [Na+]i/[K+]i-Dependent Gene Expression.

Ouabain is of cardiotonic steroids (CTS) family that is plant-derived compounds and is known for many years as therapeutic and cytotoxic agents. They are specific inhibitors of Na,K-ATPase, the enzyme, which pumps Na+ and K+ across plasma membrane of animal cells. Treatment of cells by CTS affects various cellular functions connected with the maintenance of the transmembrane gradient of Na+ and K+. Numerous studies demonstrated that binding of CTS to Na,K-ATPase not only suppresses its activity but also induces some signal pathways. This review is focused on different mechanisms of two ouabain effects: their ability (1) to protect rodent cells from apoptosis through the expression of [Na+]i-sensitive genes and (2) to trigger death of non-rodents cells (so-called «oncosis»), possessing combined markers of «classic» necrosis and «classic» apoptosis. Detailed study of oncosis demonstrated that the elevation of the [Na+]i/[K+]i ratio is not a sufficient for its triggering. Non-rodent cell death is determined by the characteristic property of “sensitive” to ouabain α1-subunit of Na,K-ATPase. In this case, ouabain binding leads to enzyme conformational changes triggering the activation of p38 mitogen-activated protein kinases (MAPK) signaling. The survival of rodent cells with ouabain-«resistant» α1-subunit is connected with another conformational transition induced by ouabain binding that results in the activation of ERK 1/2 signaling pathway.

Binding of Ouabain, Digoxin, or Marinobufagenin Induces Different Conformational Changes in Kidney α1-Na+,K+-ATPase Isoforms, Resistant and Sensitive to Cardiotonic Steroids

The affinity of rodent Na+,K+-ATPase α1-subunit to cardiotonic steroids (CTS) is known to be approximately 1000-fold less than the affinity of Na+,K+-ATPase α1-subunit from other mammals. The CTS-resistant isoform of Na+,K+-ATPase α1-subunit (α1R) is expressed in rodent cells, in contrast to the CTS-sensitive isoform of the α1-subunit (α1S), which is expressed in cells of other mammals. Earlier we have established that incubation with ouabain in concentrations that completely suppressed the activity of Na+,K+-ATPase α1-isoform (α1S-Na+,K+-ATPase) led to a death of human endothelial and smooth muscle cells but did not affect the survival of rat cells expressing α1R-Na+,K+-ATPase. Conformational transitions that are induced by CTS binding to Na+,K+-ATPase play a key role in the process of cell survival. To reveal differences in the CTS-induced conformational changes of α1R- and α1S-Na+,K+-ATPase isoforms, we used three different CTS (two cardenelids, ouabain and digoxin, and one bufadienolid, marinobufagenin) and analyzed the trypsinolysis products of α1-subunits in two main conformations of Na+,K+-ATPase (E1 and E2-P). The treatment of the pig kidney α1S-Na,K-ATPase in E1 conformation by trypsin results in a significant decrease of the amount of α1S-subunit and in the appearance of protein fragments with molecular masses of about 40, 35, 23, and 19 kDa. Preincubation of Na+,K+-ATPase in E1 conformation with ouabain or with digoxin (1 mM) leads to a decrease of the amount of α1S-subunit, increase of the amount of polypeptide fragment with molecular mass of about 40 kDa, and a significant rise of the amount of fragment with molecular mass of about 35.5 kDa, which was not found after the preincubation of the Na+,K+-ATPase in E1 conformation with marinobufagenin (1 mM). In the absence of CTS the trypsinolysis of α1S-Na+,K+-ATPase in E2-P conformation results in a decrease of the amount of α1S-subunit and an increase of the amount of proteolytic products with molecular mass of about 40 and 35.5 kDa. Preincubation of the Na+,K+-ATPase in E2-P conformation in the presence of any of the CTS studied induces the appearance of big amount of an additional peptide fragment with molecular mass of about 45 kDa. Preincubation of α1R-Na+,K+-ATPase from rat kidney with any of the CTS does not change the composition of proteolytic products and their molecular masses in either E1 or E2-P conformation. The results suggest that the structure of the CTS-binding site and a conformational response of α1-Na+,K+-ATPase to binding of CTS is mainly determined by the primary structure of the CTS-resistant and CTS-sensitive α1-subunits of the Na+,K+-AТРase.

Spin‐labeled derivatives of cardiotonic steroids as tools for characterization of the extracellular entrance to the binding site on Na+,K+‐ATPase

The information obtained from crystallized complexes of the Na+ ,K+ -ATPase with cardiotonic steroids (CTS) is not sufficient to explain differences in the inhibitory properties of CTS such as stereoselectivity of CTS binding or effect of glycosylation on the preference to enzyme isoforms. The uncertainty is related to the spatial organization of the hydrophilic cavity at the entrance of the CTS-binding site. Therefore, there is a need to supplement the crystallographic description with data obtained in aqueous solution, where molecules have significant degree of flexibility. This work addresses the applicability of the electron paramagnetic resonance (EPR) method for the purpose. We have designed and synthesized spin-labeled compounds based on the cinobufagin steroid core. The length of the spacer arms between the steroid core and the nitroxide group determines the position of the reporting group (N-O) confined to the binding site. High affinity to Na+ ,K+ -ATPase is inferred from their ability to inhibit enzymatic activity. The differences between the EPR spectra in the absence and presence of high ouabain concentrations identify the signature peaks originating from the fraction of the spin labels bound within the ouabain site. The degree of perturbations of the EPR spectra depends on the length of the spacer arm. Docking of the compounds into the CTS site suggests which elements of the protein structure might be responsible for interference with the spin label (e.g., steric clashes or immobilization). Thus, the method is suitable for gathering information on the cavity leading to the CTS-binding site in Na+ ,K+ -ATPase in all conformations with high affinity to CTS.

Toxin-resistant isoforms of Na+/K+-ATPase in snakes do not closely track dietary specialization on toads

Toads are chemically defended by bufadienolides, a class of cardiotonic steroids that exert toxic effects by binding to and disabling the Na+/K+-ATPases of cell membranes. Some predators, including a number of snakes, have evolved resistance to the toxic effects of bufadienolides and prey regularly on toads. Resistance in snakes to the acute effects of these toxins is conferred by at least two amino acid substitutions in the cardiotonic steroid binding pocket of the Na+/K+-ATPase. We surveyed 100 species of snakes from a broad phylogenetic range for the presence or absence of resistance-conferring mutations. We found that such mutations occur in a much wider range of taxa than previously believed. Although all sequenced species known to consume toads exhibited the resistance mutations, many of the species possessing the mutations do not feed on toads, much less specialize on that food source. This suggests that either there is little performance cost associated with these mutations or they provide an unknown benefit. Furthermore, the distribution of the mutation among major clades of advanced snakes suggests that the origin of the mutation reflects evolutionary retention more than dietary constraint.

Mutations to the cardiotonic steroid binding site of Na+/K+-ATPase are associated with high level of resistance to gamabufotalin in a natricine snake

Although toads are defended by bufadienolide toxins, some snakes have evolved resistance to bufadienolides and feed heavily on toads. We compared resistance in Nerodia rhombifer, which possesses mutations that confer target-site resistance, to Pituophis catenifer, which lacks those mutations. Even at the highest dosage tested, Nerodia showed no effects, whereas the lowest dose was lethal to Pituophis. Our results demonstrate a striking level of resistance to bufadienolides in a species possessing the mutations for resistance.

Structures and characterization of digoxin- and bufalin-bound Na+,K+-ATPase compared with the ouabain-bound complex

Cardiotonic steroids (CTSs) are specific and potent inhibitors of the Na(+),K(+)-ATPase, with highest affinity to the phosphoenzyme (E2P) forms. CTSs are comprised of a steroid core, which can be glycosylated, and a varying number of substituents, including a five- or six-membered lactone. These functionalities have specific influence on the binding properties. We report crystal structures of the Na(+),K(+)-ATPase in the E2P form in complex with bufalin (a nonglycosylated CTS with a six-membered lactone) and digoxin (a trisaccharide-conjugated CTS with a five-membered lactone) and compare their characteristics and binding kinetics with the previously described E2P-ouabain complex to derive specific details and the general mechanism of CTS binding and inhibition. CTSs block the extracellular cation exchange pathway, and cation-binding sites I and II are differently occupied: A single Mg(2+) is bound in site II of the digoxin and ouabain complexes, whereas both sites are occupied by K(+) in the E2P-bufalin complex. In all complexes, αM4 adopts a wound form, characteristic for the E2P state and favorable for high-affinity CTS binding. We conclude that the occupants of the cation-binding site and the type of the lactone substituent determine the arrangement of αM4 and hypothesize that winding/unwinding of αM4 represents a trigger for high-affinity CTS binding. We find that the level of glycosylation affects the depth of CTS binding and that the steroid core substituents fine tune the configuration of transmembrane helices αM1-2.

Crystal structure of the high-affinity Na + ,K + -ATPase–ouabain complex with Mg 2+ bound in the cation binding site

The Na(+),K(+)-ATPase maintains electrochemical gradients for Na(+) and K(+) that are critical for animal cells. Cardiotonic steroids (CTSs), widely used in the clinic and recently assigned a role as endogenous regulators of intracellular processes, are highly specific inhibitors of the Na(+),K(+)-ATPase. Here we describe a crystal structure of the phosphorylated pig kidney Na(+),K(+)-ATPase in complex with the CTS representative ouabain, extending to 3.4 Å resolution. The structure provides key details on CTS binding, revealing an extensive hydrogen bonding network formed by the β-surface of the steroid core of ouabain and the side chains of αM1, αM2, and αM6. Furthermore, the structure reveals that cation transport site II is occupied by Mg(2+), and crystallographic studies indicate that Rb(+) and Mn(2+), but not Na(+), bind to this site. Comparison with the low-affinity [K2]E2-MgF(x)-ouabain structure [Ogawa et al. (2009) Proc Natl Acad Sci USA 106(33):13742-13747) shows that the CTS binding pocket of [Mg]E2P allows deep ouabain binding with possible long-range interactions between its polarized five-membered lactone ring and the Mg(2+). K(+) binding at the same site unwinds a turn of αM4, dragging residues Ile318-Val325 toward the cation site and thereby hindering deep ouabain binding. Thus, the structural data establish a basis for the interpretation of the biochemical evidence pointing at direct K(+)-Mg(2+) competition and explain the well-known antagonistic effect of K(+) on CTS binding.

Gender differences in the development of uremic cardiomyopathy following partial nephrectomy: Role of progesterone

Gender difference has been suggested as a risk factor for developing cardiovascular and renal diseases in humans and experimental animals. As a major sex hormone, progesterone was reported to compete with cardiotonic steroid binding to Na/K-ATPase. Our previous publication demonstrated that cardiotonic steroids (e.g., marinobufagenin) play an important role in the development of experimental uremic cardiomyopathy. We also observed that the putative mineralocorticoid antagonists, spironolactone and its major metabolite canrenone, antagonize binding of cardiotonic steroids to Na/K-ATPase in a competitive manner and also ameliorate experimental uremic cardiomyopathy induced by partial nephrectomy. In the following studies, we noted that progesterone displayed competitive inhibition of cardiotonic steroid binding to Na/K-ATPase and partially inhibited collagen synthesis induced by marinobufagenin in cultured cardiac fibroblasts. Therefore, we sought to examine whether female rats displayed less uremic cardiomyopathy than male rats when subjected to partial nephrectomy. Although partial nephrectomy caused the induction of smaller increases in blood pressure of female rats, they appeared to be similarly susceptible to cardiac remodeling induced by partial nephrectomy in terms of hypertrophy and fibrosis as age-matched male rats. The possible explanations for our findings are therefore discussed.

Metal Fluoride Complexes of Na,K-ATPase: CHARACTERIZATION OF FLUORIDE-STABILIZED PHOSPHOENZYME ANALOGUES AND THEIR INTERACTION WITH CARDIOTONIC STEROIDS

The Na,K-ATPase belongs to the P-type ATPase family of primary active cation pumps. Metal fluorides like magnesium-, beryllium-, and aluminum fluoride act as phosphate analogues and inhibit P-type ATPases by interacting with the phosphorylation site, stabilizing conformations that are analogous to specific phosphoenzyme intermediates. Cardiotonic steroids like ouabain used in the treatment of congestive heart failure and arrhythmias specifically inhibit the Na,K-ATPase, and the detailed structure of the highly conserved binding site has recently been described by the crystal structure of the shark Na,K-ATPase in a state analogous to E2·2K(+)·P(i) with ouabain bound with apparently low affinity (1). In the present work inhibition, and subsequent reactivation by high Na(+), after treatment of shark Na,K-ATPase with various metal fluorides are characterized. Half-maximal inhibition of Na,K-ATPase activity by metal fluorides is in the micromolar range. The binding of cardiotonic steroids to the metal fluoride-stabilized enzyme forms was investigated using the fluorescent ouabain derivative 9-anthroyl ouabain and compared with binding to phosphorylated enzyme. The fastest binding was to the Be-fluoride stabilized enzyme suggesting a preformed ouabain binding cavity, in accord with results for Ca-ATPase where Be-fluoride stabilizes the E2-P ground state with an open luminal ion access pathway, which in Na,K-ATPase could be a passage for ouabain. The Be-fluoride stabilized enzyme conformation closely resembles the E2-P ground state according to proteinase K cleavage. Ouabain, but not its aglycone ouabagenin, prevented reactivation of this metal fluoride form by high Na(+) demonstrating the pivotal role of the sugar moiety in closing the extracellular cation pathway.

Structural insights into the high affinity binding of cardiotonic steroids to the Na+,K+-ATPase

The Na+,K+-ATPase belongs to the P-ATPase family, whose characteristic property is the formation of a phosphorylated intermediate. The enzyme is also a defined target for cardiotonic steroids which inhibit its functional activity and initiate intracellular signaling. Here we describe the 4.6 Å resolution crystal structure of the pig kidney Na+,K+-ATPase in its phosphorylated form stabilized by high affinity binding of the cardiotonic steroid ouabain. The steroid binds to a site formed at transmembrane segments αM1-αM6, plugging the ion pathway from the extracellular side. This structure differs from the previously reported low affinity complex with potassium. Most importantly, the A domain has rotated in response to phosphorylation and αM1-2 move towards the ouabain molecule, providing for high affinity interactions and closing the ion pathway from the extracellular side. The observed re-arrangements of the Na+,K+-ATPase stabilized by cardiotonic steroids may affect protein-protein interactions within the intracellular signal transduction networks.

Signaling through the Na/K-ATPase: implications for cardiac fibrosis

the cardiotonic effects of digitalis have been exploited in clinical practice for many years. However, while the existence of endogenous digitalis-like substances (also called cardiotonic steroids) has been accepted for some time, their exact chemical nature has been only recently demonstrated ([1][

Mice expressing ouabain-sensitive α1-Na,K-ATPase have increased susceptibility to pressure overload-induced cardiac hypertrophy

The Na,K-ATPase is a ubiquitous transmembrane pump and a specific receptor for cardiac glycosides such as ouabain and digoxin, which are used in the management of congestive heart failure (CHF). A potential role for these so-called endogenous cardiotonic steroids (CS) has been explored, and it has become apparent that such compounds are elevated and may play an important role in a variety of physiological and pathophysiological conditions such as hypertension and CHF. Recent evidence suggests that the Na,K-ATPase may act as a signal transducer upon CS binding and induce nonproliferative cardiac growth, implicating a role for endogenous CS in the development of cardiac hypertrophy and progressive failure of the heart. In the present study, we tested whether hypertrophic responses to pressure overload would be altered in mutant mice that specifically express ouabain-sensitive or ouabain-resistant α1- and α2-Na,K-ATPase subunits, as follows: α1-resistant, α2-resistant (α1(R/R)α2(R/R)); α1-sensitive, α2-resistant (α1(S/S)α2(R/R)); and α1-resistant, α2-sensitive (α1(R/R)α2(S/S), wild-type). In α1(S/S)α2(R/R) mice, pressure overload by transverse aortic coarctation induced severe left ventricular (LV) hypertrophy with extensive perivascular and replacement fibrosis at only 4 wk. Responses in α1(R/R)α2(S/S) and α1(R/R)α2(R/R) mice were comparatively mild. Mutant α1(S/S)α2(R/R) mice also had LV dilatation and depressed LV systolic contractile function by 4 wk of pressure overload. In separate experiments, chronic Digibind treatment prevented the rapid progression of cardiac hypertrophy and fibrosis in α1(S/S)α2(R/R) mice. These data demonstrate that mice with a ouabain-sensitive α1-Na,K-ATPase subunit have a dramatic susceptibility to the development of cardiac hypertrophy, and failure from LV pressure overload and provide evidence for the involvement of endogenous CS in this process.

Interaction between Cardiotonic Steroids and Na,K-ATPase. Effects of pH and Ouabain-Induced Changes in Enzyme Conformation

The Na,K-ATPase belongs to the P-type ATPase family of primary active cation pumps. It maintains the transmembrane gradients of Na(+) and K(+) across the cell membrane essential for cell homeostasis. The Na,K-ATPase is specifically inhibited by cardiotonic steroids like ouabain, which bind to the extracellular side of the enzyme and is of significant therapeutic value in the treatment of congestive heart failure. In order to further characterize the binding of cardiotonic steroids to shark Na,K-ATPase, we compared the strength and rate of inhibition at varying pH of two cardiac glycosides with either an unsaturated (ouabain) or saturated (dihydroouabain) lactone ring and three aglycons with either a 5-membered (ouabagenin and digitoxigenin) or a 6-membered (bufalin) lactone. Inhibition by ouabain and dihydroouabain, and especially the aglycon ouabagenin, was found to be strongly dependent on pH with an increase in IC(50) by factors of approximately 6, approximately 20, and approximately 66, respectively, when pH increased from 6.5 to 8.5. The finding that ouabagenin was the most pH-sensitive inhibitor indicates that the steroid hydroxyl side chains are pivotal for this pH effect, whereas the lactone ring saturation was less important. The sugar moiety is important in compensating for the pH effect. In contrast, the IC(50) of the two genins bufalin and digitoxigenin increased by a factor of only approximately 2 when pH increased from 6.5 to 8.5, indicating that the pH effect does not relay on whether the lactone is 5- or 6-membered. The rate of inhibition was retarded much more significantly by increasing pH for the glycosides than for the aglycons. Finally, we demonstrate a change in enzyme subconformations following binding of cardiotonic steroids to Na,K-ATPase phosphoenzymes using fluoride analogues of phosphoenzyme intermediates. The results are discussed with reference to the recent high-resolution crystal structures of shark Na,K-ATPase in the unbound and ouabain-bound conformation.

Mice expressing ouabain‐sensitive α1 Na,K‐ATPase have increased susceptibility to pressure overload‐induced cardiac hypertrophy

Endogenous cardiotonic steroids (CS) are elevated in a variety of cardiovascular disease states, but their (patho)physiological role is not well understood. In addition to their conventional role as Na,K‐ATPase inhibitors, studies suggest that CS binding to the Na+ pump may activate signaling pathways that induce cardiac growth, implicating a role in the development of cardiac hypertrophy. In the present study, we hypothesized that the hypertrophic response to pressure overload would be aggravated in mutant mice with a ouabain‐sensitive α1 Na,K‐ATPase subunit (αNKA). We performed transverse aortic constriction (TAC) surgery in α1‐resistant/α2‐resistant (α1R/R α2R/R), α1‐sensitive/α2‐resistant (α1S/Sα2R/R), and α1‐resistant/α2‐sensitive mice (α1R/Rα2S/S, wild type) to induce pressure‐overload left ventricular (LV) hypertrophy. At 4 weeks, echocardio‐graphy revealed a pronounced increase in LV mass and wall thickness in the α1S/Sα2R/R mice. Terminal analyses of histology and function demonstrated extensive perivascular and replacement fibrosis and significantly depressed LV systolic function in α1S/Sα2R/R mice compared to α1R/Rα2S/S, α1R/Rα2R/R and sham‐operated mice. These data reveal that mice expressing a ouabain‐sensitive α1NKA subunit have a dramatically enhanced susceptibility to pressure overload‐induced cardiac hypertrophy.(NIH grants DK57552 & HL28573)

Dermatologic therapy with cardiotonic digitalis?

the use of the cardiotonic steroids known as digitalis to treat cardiac disease dates back to Hippocrates. Although the use of digitalis to treat heart disease has decreased considerably, it appears that this agent still plays a role in modern cardiology. The mechanism of action of digitalis has,

Na-K ATPase Pump as a Receptor for Ouabain-Induced Signaling via SRC During Preimplantation Development.

The investigation of the mechanisms controlling preimplantation development is necessary to optimize embryonic culture conditions, to improve our ability to assess embryonic developmental capacity prior to embryo transfer and to apply assisted reproductive technologies in the most efficient ways possible. The Na-K ATPase plays a pivotal role in preimplantation development, the period from oocyte-sperm union to uterine wall invasion. Activity of the Na-K ATPase pump, after assuming its basolateral position in the trophectoderm, establishes a trans-epithelial ionic gradient that facilitates the movement of water across the epithelium to create the fluid-filled blastocyst cavity. Reaching the blastocyst stage is crucial for implantation, and consequently, successful pregnancy. The Na-K ATPase is also implicated in regulating tight junction assembly and function and most recently in extracellular protein interactions. Signal transduction properties of the Na-K ATPase have been discovered upon binding of cardiotonic steroids (CTS), such as ouabain, to its α subunit leading to SRC activation. We hypothesize that pump activation induced by ouabain leads to SRC and subsequent MAPK activation, resulting in the regulation of trophectoderm tight junction formation and function during preimplantation development. To investigate this hypothesis, embryos were collected following application of superovulation methods applied to MF1 female mice. Morula stage embryos were subjected to treatment with 10-3M, 10-5M, 10-7M, 10-9M ouabain or bufalin to characterize affects of CTS treatment on blastocyst formation. Treatment with 10-5M, 10-7M, and 10-9M concentrations for up to 30 hr did not significantly affect the proportion of morulae that progressed to the blastocyst stage. However, embryos treated with 10-3M ouabain and bufalin did not progress to the blastocyst stage. Embryos treated with 10-5M, 10-7M, and 10-9M concentrations displayed a trend for increased blastocyst diameter and volume compared to untreated controls. Next experiments investigated the effects of treating blastocysts with ouabain at 10-3M, 10-3.5M, 10-4M, 10-4.5M and 10-5 M in KSOMaa medium for 1, 5, and 10 minutes to characterize influences of ouabain treatment on SRC phosphorylation by detecting variations in SRC phosphorylation using whole-mount immunofluorescence methods. The results from these experiments demonstrated an increase in phosphorylated SRC between KSOM controls and 10-3.5M ouabain-treated embryos. Those treated with 10-4M ouabain for 1 minute exhibited a marked increase in Src phosphorylation with a steady decrease at 10-4.5M and 10-5M concentrations. In addition RT-PCR methods were used to detect mRNAs encoding all SRC family members during preimplantation development. Preliminary results indicate that only mRNAs encoding SRC are detectable during preimplantation development while mRNAs encoding Lyn, Lck, Fyn and Yes are not. Our results demonstrate the likelihood of a CTS Na-K ATPase mediated mechanism for activating SRC during preimplantation development. Our future experiments will investigate the consequences of SRC blockade on preimplantation development and the role of SRC signaling in regulating tight junction assembly and function during preimplantation development. These studies contribute to our understanding of the mechanisms controlling preimplantation development. Research supported by operating grant from the Canadian Institutes of Health Research.