BACKGROUND AND PURPOSE:Doxorubicin (DOX) is a highly effective anthracycline, whose clinical application for cancer is limited by cardiotoxicity. The mechanisms underlying doxorubicin-induced toxic cardiomyopathy (DICM) involve electrophysiological remodelling with intracellular Na+ overload because of increased late INa and hyperactivation of CaMKIIδ. Increased [Na+]i contributes to CaMKIIδ activation through Na-dependent Ca2+ overload, and CaMKIIδ can further amplify late INa. EXPERIMENTAL APPROACH:We tested whether pharmacological inhibition of the late INa by either ranolazine (RAN, 10 μmol·L-1) or empagliflozin (EMPA, 1 μmol·L-1) is sufficient to attenuate DOX-mediated hyperactivation of CaMKIIδ in isolated wildtype (WT) ventricular cardiomyocytes. The contribution of reciprocal CaMKII-dependent stimulation of late INa was tested in transgenic S571A cardiomyocytes lacking the CaMKII-specific phosphorylation site S571A on NaV1.5. Functional readouts were obtained using patch-clamp technique, as well as confocal and epifluorescence microscopy. KEY RESULTS:DOX acutely increased late INa in WT cardiomyocytes by twofold, which was associated with redox- and phospho-dependent activation of CaMKIIδ. Hyperactivated CaMKIIδ led to acutely impaired Ca2+ handling because of diastolic Ca2+ loss from the sarcoplasmic reticulum (SR) mediated by phosphorylation of the RyR2 at the CaMKII-specific phosphorylation site serine-2814. Pharmacological inhibition of late INa by EMPA or RAN, and genetic deletion of the CaMKII-specific phosphorylation-site serine-571 at NaV1.5 prevented DOX-related stimulation of the late INa and subsequent CaMKIIδ hyperactivation, which functionally preserved intracellular Ca handling. CONCLUSION AND IMPLICATIONS:Inhibition of late INa protects cardiomyocytes from pathologic CaMKIIδ hyperactivation and impaired Ca2+ handling in the setting of acute DOX cardiotoxicity.

Background and Aims Circulating proenkephalin (PENK) is a stable endogenous polypeptide with fast response to glomerular dysfunction and tubular damage. This study examined the predictive value of PENK for renal outcomes and mortality in patients with acute coronary syndrome (ACS). Methods Proenkephalin was measured in plasma in a prospective multicentre ACS cohort from Switzerland (n = 4787) and in validation cohorts from the UK (n = 1141), Czechia (n = 927), and Germany (n = 220). A biomarker-enhanced risk score (KID-ACS score) for simultaneous prediction of in-hospital acute kidney injury (AKI) and 30-day mortality was derived and externally validated. Results On multivariable adjustment for established risk factors, circulating PENK remained associated with in-hospital AKI [per log2 increase: adjusted odds ratio 1.53, 95% confidence interval (CI) 1.13-2.09, P = .007] and 30-day mortality (adjusted hazard ratio 2.73, 95% CI 1.85-4.02, P < .001). The KID-ACS score integrates PENK and showed an area under the receiver operating characteristic curve (AUC) of .72 (95% CI .68-.76) for in-hospital AKI and .91 (95% CI .87-.95) for 30-day mortality in the derivation cohort. Upon external validation, KID-ACS achieved similarly high performance for in-hospital AKI (Zurich: AUC .73, 95% CI .70-.77; Czechia: AUC .75, 95% CI .68-.81; Germany: AUC .71, 95% CI .55-.87) and 30-day mortality (UK: AUC .87, 95% CI .83-.91; Czechia: AUC .91, 95% CI .87-.94; Germany: AUC .96, 95% CI .92-1.00), outperforming the contrast-associated AKI score and the Global Registry of Acute Coronary Events 2.0 score, respectively. Conclusions Circulating PENK offers incremental value for predicting in-hospital AKI and mortality in ACS. The simple six-item KID-ACS risk score integrates PENK and provides a novel tool for simultaneous assessment of renal and mortality risk in patients with ACS.

Background:Doxorubicin (DOX)-induced cardiomyopathy (DICM) manifests as left ventricular (LV) systolic dysfunction. DOX triggers oxidative stress and CaMKIIδ activity in cardiac myocytes. CaMKIIδ activation leads to impaired intracellular Ca handling and contractile dysfunction because of pathologic Ca loss from the sarcoplasmic reticulum (SR). While CaMKIIδ is canonically activated by autophosphorylation, it can also be activated via oxidation. Objectives:We aimed to investigate the predominant mode of CaMKIIδ activation in DICM. Methods:We utilized two transgenic mouse models, one lacking CaMKIIδ (CaMKIIδ-/-) and a "redox-dead" CaMKIIδVal281/282 model. Acute changes in intracellular Ca handling and CaMKIIδ activation status were examined following 15 min of DOX exposure. Long-term effects were studied in CaMKIIδ-/- mice (vs. CaMKIIδ+/+ wildtype littermates) and redox-dead CaMKIIδVal281/282 mice (vs. CaMKIIδMet281/282 wildtype littermates) that underwent DOX treatment in-vivo. Cardiac function (via echocardiography), intracellular Ca handling, and CaMKIIδ-related signaling were assessed 12 weeks post-treatment. Results:DOX acutely increased CaMKIIδ activity by autophosphorylation and oxidation in both WT lines, while autophosphorylated CaMKIIδ was still detected in CaMKIIδVal281/282 mice, which resulted in comparably increased SR Ca leakage mediated by CaMKII-dependent RyR2-hyperphosphorylation at pS2814 in all aforementioned groups. In contrast, pharmacological and genetic inhibition of CaMKIIδ (i.e. in CaMKIIδ-/-) prevented DOX-induced CaMKIIδ-hyperactivation, RyR2-hyperphosphorylation and SR Ca loss. Similarly, only CaMKIIδ-/- mice were protected from long-term DOX-induced LV dysfunction in-vivo. Redox-dead CaMKIIδVal281/282 mice exhibited similar LV dysfunction as WT littermates, with persistent CaMKIIδ autophosphorylation, subsequent RyR2 hyperphosphorylation, and increased CaMKIIδ-dependent SR Ca leakage. Conclusions:Persistently increased CaMKIIδ autophosphorylation, but not oxidation, mediates pathologic SR Ca loss in Doxorubicin-induced cardiomyopathy.

BackgroundAcute stimulation of the late sodium current (INaL) as pharmacologically induced by Anemonia toxin II (ATX-II) results in Na+-dependent Ca2+ overload and enhanced formation of reactive oxygen species (ROS). This is accompanied by an acute increase in the amplitude of the systolic Ca2+ transient. Ca2+ transient amplitude is determined by L-type Ca2+-mediated transsarcolemmal Ca2+ influx (ICa) into the cytosol and by systolic Ca2+ release from the sarcoplasmic reticulum (SR). Type-1 protein kinase A (PKARIα) becomes activated upon increased ROS and is capable of stimulating ICa, thereby sustaining the amplitude of the systolic Ca2+ transient upon oxidative stress.ObjectivesWe aimed to investigate whether the increase of the systolic Ca2+ transient as acutely induced by INaL (by ATX-II) may involve stimulation of ICa through oxidized PKARIα.MethodsWe used a transgenic mouse model in which PKARIα was made resistant to oxidative activation by homozygous knock-in replacement of redox-sensitive Cysteine 17 with Serine within the regulatory subunits of PKARIα (KI). ATX-II (at 1 nmol/L) was used to acutely enhance INaL in freshly isolated ventricular myocytes from KI and wild-type (WT) control mice. Epifluorescence and confocal imaging were used to assess intracellular Ca2+ handling and ROS formation. A ruptured-patch whole-cell voltage-clamp was used to measure INaL and ICa. The impact of acutely enhanced INaL on RIα dimer formation and PKA target structures was studied using Western blot analysis.ResultsATX-II increased INaL to a similar extent in KI and WT cells, which was associated with significant cytosolic and mitochondrial ROS formation in both genotypes. Acutely activated Ca2+ handling in terms of increased Ca2+ transient amplitudes and elevated SR Ca2+ load was equally present in KI and WT cells. Likewise, cellular arrhythmias as approximated by non-triggered Ca2+ elevations during Ca2+ transient decay and by diastolic SR Ca2+-spark frequency occurred in a comparable manner in both genotypes. Most importantly and in contrast to our initial hypothesis, ATX-II did not alter the magnitude or inactivation kinetics of ICa in neither WT nor KI cells and did not result in PKARIα dimerization (i.e., oxidation) despite a clear prooxidant intracellular environment.ConclusionsThe inotropic and arrhythmogenic effects of acutely increased INaL are associated with elevated ROS, but do not involve oxidation of PKARIα.

Background:The Bruton tyrosine kinase (BTK) inhibitor Ibrutinib is associated with a higher incidence of cardiotoxic side effects including heart failure (HF).Objectives:Ibrutinib is capable of inhibiting PI3K/Akt signaling in neonatal rat ventricular cardiomyocytes when stimulated with insulin-like growth factor 1 (IGF-1). We therefore hypothesized that Ibrutinib might disrupt IGF-1-mediated activation of intracellular Ca handling in adult mouse cardiomyocytes by inhibiting PI3K/Akt signaling.Methods:Isolated ventricular myocytes (C57BL6/J) were exposed to IGF-1 at 10 nmol/L in the presence or absence of Ibrutinib (1 µmol/L) or Acalabrutinib (10 µmol/L; cell culture for 24 ± 2 h). Intracellular Ca handling was measured by epifluorescence (Fura-2 AM) and confocal microscopy (Fluo-4 AM). Ruptured-patch whole-cell voltage-clamp was used to measure ICa. Levels of key cardiac Ca handling proteins were investigated by immunoblots.Results:IGF-1 significantly increased Ca transient amplitudes by ∼83% as compared to vehicle treated control cells. This was associated with unaffected diastolic Ca, enhanced SR Ca loading and increased ICa. Co-treatment with Ibrutinib attenuated both the IGF-1-mediated increase in SR Ca content and in ICa. IGF-1 treated cardiomyocytes had significantly increased levels of pS473Akt/Akt and SERCA2a expression as compared to cells concomitantly treated with IGF-1 and Ibrutinib. SR Ca release (as assessed by Ca spark frequency) was unaffected by either treatment. In order to test for potential off-target effects, second generation BTK inhibitor Acalabrutinib with greater BTK selectivity and lower cardiovascular toxicity was tested for IGF1-mediated activation of intracellular Ca handling. Acalabrutinib induced similar effects on Ca handling in IGF-1 treated cultured myocytes as Ibrutinib in regard to decreased Ca transient amplitude and slowed Ca transient decay, hence implying a functional class effect of BTK inhibitors in cardiac myocytes.Conclusions:Inhibition of BTK by Ibrutinib impairs IGF-1-dependent activation of intracellular Ca handling in adult ventricular mouse myocytes in the face of disrupted Akt signaling and absent SERCA2a upregulation.

Abstract Background Ethanol consumption is the most important self-triggered cause of atrial fibrillation (AF). As abstinence often fails, alternative therapies are needed. CaMKII-activation upon ethanol with consecutive Ca2+-leak from the sarcoplasmic reticulum (SR) appears to be an important pathomechanism for ethanol-induced AF, but is not a druggable target. CaMKII has previously been shown to induce late sodium current (late INa) which could be proarrhythmogenic. Purpose We hypothesized that late INa might be involved in the development of AF upon acute ethanol exposition and that thus, the antianginal drug ranolazine (an inhibitor of late INa) could be repurposed to prevent ethanol-induced AF. Methods Acute effects of ethanol were investigated in vivo and in vitro as compared to vehicle. The occurrence of AF in vivo was assessed by programmed electrical stimulation in mice. To test the role of late INa, we used ranolazine in vivo and in vitro, as well as tetrodotoxin in vitro. We measured late INa and cytosolic sodium concentration, recorded stimulated action potentials and spontaneous delayed afterdepolarizations (DAD), and assessed SR Ca2+-leak by recording Ca2+-sparks. Mechanistically, we inhibited CaMKII using AIP and used NaV1.5 S571A mice to specifically investigate the role of CaMKII-mediated late INa. Human biopsies were acquired during surgery and were used for cell isolation or chunk incubation. Results Ethanol acutely induced late INa, sodium overload, SR Ca2+-leak and delayed afterdepolarizations in isolated atrial cardiomyocytes, as well as atrial fibrillation in vivo (10 of 10 mice). All of these cellular ethanol effects were prevented by pharmacologic inhibition of late INa. Importantly, ranolazine prevented the development of AF upon ethanol exposure in vivo. Mechanistically, CaMKII-activation and, accordingly, CaMKII-dependent NaV1.5 phosphorylation (S571) were increased by ethanol exposure. Indeed, the phosphoresistant NaV1.5 S571A mutation prevented late INa, SR Ca2+-leak and in vivo AF upon ethanol, demonstrating a critical role of CaMKII-mediated NaV1.5 phosphorylation for acute ethanol effects. Conclusion We show that ethanol acutely induces late INa upstream of arrhythmogenic SR Ca2+-leak and delayed afterdepolarizations, dependent on NaV1.5 S571 phosphorylation, leading to atrial fibrillation in vivo. Importantly, these effects as well as AF in vivo can be prevented using the late INa inhibitor ranolazine. We suggest that this antianginal drug could be repurposed to prevent ethanol-induced AF.Late INa (Patch-Clamp)In vivo AF (programmed stimulation)

Abstract Background Cardiotoxicity represents a major complication of cancer therapy with anthracyclines, whose main known compound is doxorubicine (DOX). Although mechanisms of DOX-induced toxic cardiomyopathy (DICM) are not entirely understood, CaMKIIδ-activity is known to be increased upon acute DOX exposure, contributing to impaired Calcium (Ca) handling. However, currently no studies have addressed the question, whether CaMKIIδ is involved in DOX-induced long-term cardiotoxicity. Purpose We aimed to investigate cardiac function and intracellular Ca handling using an in-vivo DOX treated mouse model, examining whether CaMKIIδ is involved in DOX-induced long-term cardiotoxicity. Methods Cardiac function and excitation-contraction coupling of CaMKIIdWT and CaMKIId-/- (global CaMKIId knockout) mice were tested in an in-vivo DOX treated mouse model (cumulative dose 12 mg/kg, intraperitoneal injection). Cardiac function was determined by echocardiography after 12 weeks. Ca handling of freshly isolated cardiomyocytes was assessed by epifluorescence microscopy (Fura2-AM) and confocal microscopy (Fluo4-AM). Histological analyses regarding cardiac fibrosis and cell dimensions were examined. Results Long-term DOX exposure reduced left ventricular ejection fraction (EF) by ∼13% and markedly increased cardiac fibrosis in CaMKIIδWT mice. Moreover, CaMKIIdWT hearts displayed decreased cell volume indicating atrophy following DOX treatment. Coinciding with the reduction in EF, CaMKIIdWT mice showed depressed Ca transient amplitudes as well as slowed Ca transient decay indicating depressed Ca uptake into the sarcoplasmic reticulum (SR). In addition, spontaneous diastolic Ca leakage from the SR was dramatically increased. In contrast, CaMKIId-/- mice showed preserved EF following 12 weeks of DOX treatment as compared to CaMKIIdWT in line with maintained Ca transient amplitudes. As an underlying cause, SR Ca leakage was not increased in CaMKIId-/- myocytes despite DOX-treatment. Pharmacological CaMKII inhibition using AIP (1µM) prevented SR Ca leak and restored Ca transient amplitudes in DOX-treated CaMKIIdWT myocytes. Conclusion Our study shows that CaMKIId contributes to long-term DOX-induced cardiotoxicity. We found that chronic DOX treatment induced depressed cardiac function and myocardial fibrosis, associated with impaired calcium handling as a consequence of CaMKIId-mediated SR Ca leak, which was absent in our CaMKIId-/- mouse model. In line, pharmacological inhibition of CaMKII rescued impaired Ca handling in DOX-treated CaMKIIdWT myocytes.

Background: Pulmonary vein (PV) reconnection is the major cause of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). The probability of reconnection is higher if the primary lesion is not sufficiently effective, which can be unmasked with an adenosine provocation test (APT). High-power short-duration radiofrequency energy (HPSD) guided with ablation index (AI) and the third generation of the visually guided laser balloon (VGLB) are new methods for PVI. Methods: A total of 70 participants (35 in each group) who underwent a PVI with either AI-guided HPSD (50 W; AI 500 for the anterior and 400 for the posterior wall, respectively) or VGLB ablation were included in this observational pilot trial. Twenty minutes after each PVI, an APT was performed. The primary endpoint was the event-free survival from AF after three years. Results: A total of 137 (100%) PVs in the HPSD arm and 131 PVs (98.5%) in the VGLB arm were initially successfully isolated (p = 0.24). The overall procedure duration was similar in both arms (155 ± 39 in HPSD vs. 175 ± 58 min in VGLB, p = 0.191). Fluoroscopy time, left atrial dwelling time and duration from the first to the last ablation were longer in the VGLB arm (23 ± 8 vs. 12 ± 3 min, p < 0.001; 157 (111–185) vs. 134 (104–154) min, p = 0.049; 92(59–108) vs. 72 (43–85) min, p = 0.010). A total of 127 (93%) in the HPSD arm and 126 (95%) PVs in the VGLB arm remained isolated after APT (p = 0.34). The primary endpoint was met 1107 ± 68 days after ablation in 71% vs. 66% in the VGLB and HPSD arms, respectively (p = 0.65). Conclusions: HPSD and VGLB did not differ with respect to long-term outcome of PVI. A large, randomized study should be conducted to compare clinical outcomes with respect to these new ablation techniques.

Background Ethanol consumption is the most important self-triggered cause of atrial fibrillation (AF). As abstinence often fails, alternative therapies are needed. CaMKII-activation upon ethanol with consecutive Ca2+-leak from the sarcoplasmic reticulum (SR) appears to be an important pathomechanism for ethanol-induced AF, but is not a druggable target. CaMKII has previously been shown to induce late sodium current (late INa) which could be proarrhythmogenic. Purpose We hypothesized that late INa might be involved in the development of AF upon acute ethanol exposition and that thus, the antianginal drug ranolazine (an inhibitor of late INa) could be repurposed to prevent ethanol-induced AF. Methods Acute effects of ethanol were investigated in vivo and in vitro as compared to vehicle. The occurrence of AF in vivo was assessed by programmed electrical stimulation in mice. To test the role of late INa, we used ranolazine in vivo and in vitro, as well as tetrodotoxin in vitro. We measured late INa and cytosolic sodium concentration, recorded stimulated action potentials and spontaneous delayed afterdepolarizations (DAD), and assessed SR Ca2+-leak by recording Ca2+-sparks. Mechanistically, we inhibited CaMKII using AIP and used NaV1.5 S571A mice to specifically investigate the role of CaMKII-mediated late INa. Human biopsies were acquired during surgery and were used for cell isolation or chunk incubation. Results Ethanol acutely induced late INa, sodium overload, SR Ca2+-leak and delayed afterdepolarizations in isolated atrial cardiomyocytes, as well as atrial fibrillation in vivo (10 of 10 mice). All of these cellular ethanol effects were prevented by pharmacologic inhibition of late INa. Importantly, ranolazine prevented the development of AF upon ethanol exposure in vivo. Mechanistically, CaMKII-activation and, accordingly, CaMKII-dependent NaV1.5 phosphorylation (S571) were increased by ethanol exposure. Indeed, the phosphoresistant NaV1.5 S571A mutation prevented late INa, SR Ca2+-leak and in vivo AF upon ethanol, demonstrating a critical role of CaMKII-mediated NaV1.5 phosphorylation for acute ethanol effects. Conclusion We show that ethanol acutely induces late INa upstream of arrhythmogenic SR Ca2+-leak and delayed afterdepolarizations, dependent on NaV1.5 S571 phosphorylation, leading to atrial fibrillation in vivo. Importantly, these effects as well as AF in vivo can be prevented using the late INa inhibitor ranolazine. We suggest that this antianginal drug could be repurposed to prevent ethanol-induced AF.Late INa (Patch-Clamp)In vivo AF (programmed stimulation)

Background PKARIα (protein kinase A type I‐α regulatory subunit) is redox‐active independent of its physiologic agonist cAMP. However, it is unknown whether this alternative mechanism of PKARIα activation may be of relevance to cardiac excitation–contraction coupling. Methods and Results We used a redox‐dead transgenic mouse model with homozygous knock‐in replacement of redox‐sensitive cysteine 17 with serine within the regulatory subunits of PKARIα (KI). Reactive oxygen species were acutely evoked by exposure of isolated cardiac myocytes to AngII (angiotensin II, 1 µmol/L). The long‐term relevance of oxidized PKARIα was investigated in KI mice and their wild‐type (WT) littermates following transverse aortic constriction (TAC). AngII increased reactive oxygen species in both groups but with RIα dimer formation in WT only. AngII induced translocation of PKARI to the cell membrane and resulted in protein kinase A–dependent stimulation of I Ca (L‐type Ca current) in WT with no effect in KI myocytes. Consequently, Ca transients were reduced in KI myocytes as compared with WT cells following acute AngII exposure. Transverse aortic constriction–related reactive oxygen species formation resulted in RIα oxidation in WT but not in KI mice. Within 6 weeks after TAC, KI mice showed an enhanced deterioration of contractile function and impaired survival compared with WT. In accordance, compared with WT, ventricular myocytes from failing KI mice displayed significantly reduced Ca transient amplitudes and lack of I Ca stimulation. Conversely, direct pharmacological stimulation of I Ca using Bay K8644 rescued Ca transients in AngII‐treated KI myocytes and contractile function in failing KI mice in vivo. Conclusions Oxidative activation of PKARIα with subsequent stimulation of I Ca preserves cardiac function in the setting of acute and chronic oxidative stress.

The current study shows that activation of CaMKIIδ through Met281/282 oxidation is neither required for CaMKII-dependent recovery of Ca2+ transients during acidosis nor relevant for the occurrence of postacidic cellular arrhythmias. Despite a usually prooxidant increase in cytosolic Na+, acidosis reduces the cytosolic glutathione redox state within cardiac myocytes. This novel finding suggests that oxidation of cytosolic proteins is less likely to occur during acidosis.

BACKGROUND CaMKIId is needed for the recovery of Ca2+ transients during acidosis, but also mediates post-acidic arrhythmias. CaMKIId can sustain its activity following oxidation. Increasing intracellular Na+ during acidosis as well as post-acidic pH normalization should result in pro-oxidant conditions within the cell favoring oxidative CaMKIId activation. RATIONALE We tested whether oxidative CaMKIId activation is needed for the recovery of Ca2+-transients during acidosis and for cellular arrhythmias post acidosis. METHODS AND RESULTS Cardiomyocytes from a well-established mouse model in which CaMKIId was made resistant to oxidative activation by knock-in replacement of two oxidant-sensitive methionines (M281/282) with valines (MM-VV) were exposed to extracellular acidosis. Recovery of Ca2+-transients during acidosis was present in both, WT control and MM-VV cardiomyocytes, and post-acidic cellular arrhythmias occurred to a similar extent in both groups. Inhibition of global CaMKII activity using AIP prevented recovery of Ca2+-transients during acidosis and attenuated post-acidic arrhythmias in MM-VV cells. Using cardiomyocytes expressing redox-sensitive green fluorescent protein 2 coupled to glutaredoxin-1, we found that acidosis reduced the cytosolic redox potential despite a significant increase in intracellular Na+. CONCLUSIONS Our study shows that oxidative activation of CaMKIId is neither required for recovery of Ca2+-transients during acidosis nor relevant for post-acidic arrhythmias in isolated cardiac myocytes. Moreover, acidosis actually reduces the cytosolic redox potential of isolated cardiac myocytes. Pharmacological inhibition of global CaMKII activity completely prevents recovery of Ca2+-transients and protects from post-acidic arrhythmias in MM-VV myocytes which confirms the relevance of CaMKII activity in the context of acidosis.

An inflammatory systemic reaction is common after Transcatheter Aortic Valve Implantation (TAVI). We recently reported about an involvement of Mon2-monocytes, the CD11b expression on monocytes and parameters of systemic inflammation before TAVI correlating with early mortality after TAVI. Here, we provide data of monocyte subpopulations, CD11b expression and parameters of a systemic inflammation in dependence of three-month mortality after TAVI. With this, we provide further insights into inflammatory mechanism after TAVI. The data were collected by flow-cytometric quantification analyses of peripheral blood in 120 consecutive patients who underwent TAVI (on day 1 and 7 after TAVI). Monocyte-subsets were identified by their CD14 and CD16 expression and monocyte-platelet-aggregates (MPA) by CD14/CD41 co-expression. The extent of monocyte activation was determined by quantification of CD11b-expression (activate epitope). Additionally, pro-inflammatory cytokines such as interleukin (IL)-6, IL-8, C-reactive protein, procalcitonin were measured using the cytometric bead array method or standard laboratory tests. Additionally, we report procedural outcomes in dependence of three-month mortality. Furthermore, correlations of CD11b-expression on monocytes with parameters of platelet activation or further inflammatory parameters are presented. For further interpretation of the presented data, please see the research article "Mon2-Monocytes and Increased CD-11b Expression Before Transcatheter Aortic Valve Implantation are Associated with Earlier Death" by Pfluecke et al.[1].

Phosphorylation of L-type calcium channels (LTCC) by cAMP-dependent protein kinase A (PKA) increases calcium current (ICa). However, it is unclear if PKA-dependent regulation of ICa is impaired in heart failure (HF) despite evidence for impaired β-adrenergic signaling. Recently, a novel PKA activation pathway by oxidation of regulatory subunit I (RI) has been identified. We investigated the impact of redox-activated PKA for regulation of ICa, intracellular calcium (Ca) handling and contractile function in a pressure overload heart failure mouse model. Knock-in mice (KI) that lack redox-dependent PKA activation (exchange of cysteine 17 of RI with serine) were compared to wild-type (WT) at baseline, 7 days and 6 weeks after transverse aortic constriction (TAC). Mouse echocardiography was performed to evaluate in-vivo cardiac function. ICa was measured by whole-cell patch clamp, PKA activity, cAMP levels, and protein levels of central Ca handling proteins were assessed at different time points in vitro. At baseline, no alterations of left ventricular (LV) function (echocardiography) were observed between WT and KI. TAC induced a significant RI oxidation in WT but not KI mice. Despite this difference, at 7 days after TAC, development of LV hypertrophy and impairment of systolic LV function in vivo were similar between WT and KI. Compared to baseline, 7 days after TAC a significant stimulation of peak ICa was observed in WT. In contrast to WT, the stimulation of peak ICa was absent in KI mice at 7 days after TAC. This impairment in peak ICa occurred despite a comparable increase in global PKA activity (ELISA), which was most likely due to increased cAMP levels in our TAC model (assessed by FLIM-FRET). Notably, cAMP levels were comparably increased in between groups (ELISA). Importantly, at 6 weeks after TAC, WT mice showed a mild additional deterioration of systolic LV function in vivo. In contrast, LV function was significantly more impaired in KI mice 6 weeks after TAC, which was accompanied by a significant increase in KI mice mortality. Comparing 6 weeks to 7 days after TAC, there was no stimulation of peak ICa in WT and even a significant decrease in peak ICa in KI mice. In accordance, PKA-dependent LTCC phosphorylation was absent in KI mice 6 weeks after TAC (western blotting). Redox-activated PKA seems to exert a protective role by stimulation of ICa during pressure overload. Type of funding source: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft

Background: In the first three months after Transcatheter aortic valve implantation (TAVI), a remarkable number of patients have an unfavorable outcome. An inflammatory response after TAVI is suspected to have negative effects. The exact mechanisms remain unclear. We examined the influence of monocyte subpopulations on the clinical outcome, along with the degree of monocyte activation and further parameters of inflammation and platelet activation. Methods: Flow-cytometlic quantification analyses of peripheral blood were done in 120 consecutive patients who underwent TAVI (one day before TAVI and on day 1 and 7 after TAVI). Monocyte-subsets were defined by their CD14 and CD16 expression, monocyte-platelet-aggregates (MPA) by CD14/CD41 co-ex pression. The extent of monocyte activation was determined by quantification of CD11b-expression (activation epitope). Additionally, pro-inflammatoiy cytokines such as interleukin (IL)-6, IL-8, C-reactive protein were measured with the cytometric bead array method or standard laboratory tests. Results: Elevated Mon2 (CD14(-+)CD16(+)) - monocytes (38 vs. 62 cells/mu l, p < 0.001) and a high expression of CD11b prior to TAVI (MIL 50.1 vs. 84.6, p < 0.05) were independently associated with death 3 months after TAVI. Mon2 showed the highest CD11b-expression and CD11b correlated with platelet activation and markers of systemic inflammation. Even CRP and IL-8 before TAVI were associated with death after TAVI. In contrast, a systemic inflammation response shortly after TAVI was not associated with early death. Conclusions: Elevated Mon2-monocytes and a high level of monocyte activation before TAVI are associated with early mortality after TAVI. Chronic inflammation in aging patients seems to be an important risk factor after TAVI. (C) 2020 Elsevier B.V. All rights reserved.

Aims It is hypothesized that inflammation could promote structural and electrical remodelling processes in atrial fibrillation (AF). Atrial infiltration of monocytes and granulocytes has been shown to be dependent on CD11b expression. The aim of this study was to investigate whether treatment of AF by pulmonary vein isolation (PVI) may lead to reduced inflammation, as indicated by a decrease of CD11b expression on monocytes and granulocytes. Methods and results Flow-cytometric quantification analysis and determination of systemic inflammatory markers of peripheral blood were performed in 75 patients undergoing PVI 1 day before and 6 months after PVI. The extent of activation of monocytes and granulocytes was measured by quantifying the cell adhesion molecule CD11b. The mean expression of CD11b on monocytes (20.9 ± 2.5 vs. 10.2 ± 1.4; P < 0.001) and granulocytes (13.9 ± 1.6 vs. 6.8 ± 0.5; P < 0.001), as well as the relative count of CD11b-positive monocytes (P < 0.05) and CD11b-positive granulocytes (P < 0.01) were significantly reduced when comparing the identical patients before and 6 months after PVI. Systemic inflammatory parameters showed only a declining tendency after 6 months. Patients with unsuccessful PVI and ongoing AF on the day of follow-up showed no decrease in CD11b expression. Conclusions A significant reduction of CD11b expression on monocytes and granulocytes, as a sign of reduced cellular inflammation, was achieved by treatment of AF using PVI. These data strongly support that AF is not only a consequence of but also a cause for inflammatory processes, which, in turn, may contribute to atrial remodelling.

AIMS:The EMPA-REG OUTCOME study showed reduced mortality and hospitalization due to heart failure (HF) in diabetic patients treated with empagliflozin. Overexpression and Ca2+ -dependent activation of Ca2+ /calmodulin-dependent kinase II (CaMKII) are hallmarks of HF, leading to contractile dysfunction and arrhythmias. We tested whether empagliflozin reduces CaMKII- activity and improves Ca2+ -handling in human and murine ventricular myocytes.METHODS AND RESULTS:Myocytes from wild-type mice, mice with transverse aortic constriction (TAC) as a model of HF, and human failing ventricular myocytes were exposed to empagliflozin (1 μmol/L) or vehicle. CaMKII activity was assessed by CaMKII-histone deacetylase pulldown assay. Ca2+ spark frequency (CaSpF) as a measure of sarcoplasmic reticulum (SR) Ca2+ leak was investigated by confocal microscopy. [Na+ ]i was measured using Na+ /Ca2+ -exchanger (NCX) currents (whole-cell patch clamp). Compared with vehicle, 24 h empagliflozin exposure of murine myocytes reduced CaMKII activity (1.6 ± 0.7 vs. 4.2 ± 0.9, P < 0.05, n = 10 mice), and also CaMKII-dependent ryanodine receptor phosphorylation (0.8 ± 0.1 vs. 1.0 ± 0.1, P < 0.05, n = 11 mice), with similar results upon TAC. In murine myocytes, empagliflozin reduced CaSpF (TAC: 1.7 ± 0.3 vs. 2.5 ± 0.4 1/100 μm-1  s-1 , P < 0.05, n = 4 mice) but increased SR Ca2+ load and Ca2+ transient amplitude. Importantly, empagliflozin also significantly reduced CaSpF in human failing ventricular myocytes (1 ± 0.2 vs. 3.3 ± 0.9, P < 0.05, n = 4 patients), while Ca2+ transient amplitude was increased (F/F0 : 0.53 ± 0.05 vs. 0.36 ± 0.02, P < 0.05, n = 3 patients). In contrast, 30 min exposure with empagliflozin did not affect CaMKII activity nor Ca2+ -handling but significantly reduced [Na+ ]i .CONCLUSIONS:We show for the first time that empagliflozin reduces CaMKII activity and CaMKII-dependent SR Ca2+ leak. Reduced Ca2+ leak and improved Ca2+ transients may contribute to the beneficial effects of empagliflozin in HF.