Key result
Selective NCX inhibitor SAR296968 cuts calcium spark frequency ~33% in human atrial myocardium.
Why the study?
Because NCX is upregulated in human chronic AF and HF and contributes to contractile dysfunction and arrhythmias, specific inhibition may offer therapeutic potential.
Does the selective NCX inhibitor SAR296968 improve Ca2+ handling and contractile function in human atrial cardiomyocytes?
Does the selective NCX inhibitor SAR296968 improve Ca2+ handling and contractile function in human atrial cardiomyocytes?
Absolute Event Rate: 1.802% vs 2.679%
p-value: p=0.0075
The selective NCX inhibitor SAR296968 reduces pro-arrhythmic spontaneous Ca2+ release and improves diastolic and contractile function in human atrial myocardium ex vivo, suggesting therapeutic potential for HFpEF and atrial arrhythmias.
Background: In reverse-mode, cardiac sodium-calcium exchanger (NCX) can increase the cytoplasmic Ca2+ concentration in response to high intracellular Na+ levels, which may contribute to diastolic contractile dysfunction. Furthermore, increased spontaneous Ca2+ release from intracellular stores can activate forward mode NCX. The resulting transient inward current causes delayed afterdepolarization (DAD)-dependent arrhythmias. Moreover, recently, NCX has been associated with impaired relaxation and reduced cardiac function in heart failure with preserved ejection fraction (HFpEF). Since NCX is upregulated in human chronic atrial fibrillation (AF) as well as heart failure (HF), specific inhibition may have therapeutic potential. Objective: We tested the antiarrhythmic, lusitropic and inotropic effects of a novel selective NCX-inhibitor (SAR296968) in human atrial myocardium. Methods and Results: Right atrial appendage biopsies of 46 patients undergoing elective cardiac surgery in a predominant HFpEF cohort (n = 24/46) were investigated. In isolated human atrial cardiomyocytes, SAR296968 reduced the frequency of spontaneous SR Ca2+ release events and increased caffeine transient amplitude. In accordance, in isolated atrial trabeculae, SAR296968 enhanced the developed tension after a 30 s pause of electrical stimulation consistent with reduced diastolic sarcoplasmic reticulum (SR) Ca2+ leak. Moreover, compared to vehicle, SAR296968 decreased steady-state diastolic tension (at 1 Hz) without impairing developed systolic tension. Importantly, SAR296968 did not affect the safety parameters, such as resting membrane potential or action potential duration as measured by patch clamp. Conclusion: The novel selective NCX-inhibitor SAR296968 inhibits atrial pro-arrhythmic activity and improves diastolic and contractile function in human atrial myocardium, which may have therapeutic implications, especially for treatment of HFpEF.
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Hegner et al. (2022) studied Heart failure with preserved ejection fraction (HFpEF) and other conditions requiring cardiac surgery (n=46). SAR296968 vs. Vehicle (0.1% DMSO) was evaluated on Ca2+ spark frequency (CaSpF) in 100 µm‒1 s‒1 (p=0.0075). The selective NCX-inhibitor SAR296968 significantly reduced Ca2+ spark frequency from 2.679 to 1.802 per 100 µm‒1 s‒1 at 3 µM (p=0.0075) and decreased diastolic tension in human atrial myocardium.
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