Key result
NaV1.8 inhibition reduces proarrhythmic sarcoplasmic reticulum calcium leak ~50% in human hypertrophic cardiomyocytes.
Why the study?
The electrophysiological role of neuronal sodium channel NaV1.8 in human hypertrophied myocardium and its contribution to proarrhythmic persistent Na+ current (INaL) were not previously investigated.
Does inhibition of NaV1.8 reduce proarrhythmic late sodium current and SR-Ca2+ leak in human hypertrophied myocardium?
Does inhibition of NaV1.8 reduce proarrhythmic late sodium current and SR-Ca2+ leak in human hypertrophied myocardium?
Effect estimate: 50% decrease
Absolute Event Rate: 0.27% vs 0.68%
p-value: p=≤0.01
NaV1.8 is upregulated in human hypertrophied myocardium, and its inhibition reduces proarrhythmic triggers, suggesting a novel antiarrhythmic therapeutic target.
NaV1.8 inhibition may curb proarrhythmic triggers in hypertrophy; hypothesis-generating for clinical translation from Level 5 data.
Aims In hypertrophy and heart failure, the proarrhythmic persistent Na+ current (INaL) is enhanced. We aimed to investigate the electrophysiological role of neuronal sodium channel NaV1.8 in human hypertrophied myocardium. Methods and results Myocardial tissue of 24 patients suffering from symptomatic severe aortic stenosis and concomitant significant afterload-induced hypertrophy with preserved ejection fraction was used and compared with 12 healthy controls. We performed quantitative real-time PCR and western blot and detected a significant up-regulation of NaV1.8 mRNA (2.34-fold) and protein expression (1.96-fold) in human hypertrophied myocardium compared with healthy hearts. Interestingly, NaV1.5 protein expression was significantly reduced in parallel (0.60-fold). Using whole-cell patch-clamp technique, we found that the prominent INaL was significantly reduced after addition of novel NaV1.8-specific blockers either A-803467 (30 nM) or PF-01247324 (1 μM) in human hypertrophic cardiomyocytes. This clearly demonstrates the relevant contribution of NaV1.8 to this proarrhythmic current. We observed a significant action potential duration shortening and performed confocal microscopy, demonstrating a 50% decrease in proarrhythmic diastolic sarcoplasmic reticulum (SR)-Ca2+ leak and SR-Ca2+ spark frequency after exposure to both NaV1.8 inhibitors. Conclusions We show for the first time that the neuronal sodium channel NaV1.8 is up-regulated on mRNA and protein level in the human hypertrophied myocardium. Furthermore, inhibition of NaV1.8 reduced augmented INaL, abbreviated the action potential duration, and decreased the SR-Ca2+ leak. The findings of our study suggest that NaV1.8 could be a promising antiarrhythmic therapeutic target and merits further investigation.
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Ahmad et al. (2018) studied Left ventricular hypertrophy with preserved ejection fraction due to severe aortic stenosis (n=36). NaV1.8-specific blockers (A-803467 or PF-01247324) vs. Untreated hypertrophic cardiomyocytes was evaluated on Calcium spark frequency (CaSpF) (50% decrease, p=≤0.01). Inhibition of NaV1.8 with specific blockers significantly reduced augmented late sodium current, abbreviated action potential duration, and decreased proarrhythmic SR-Ca2+ leak by approximately 50% in human hypertrophic cardiomyocytes.
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