IntroductionThe mechanism by which soluble mediators of immune cell origin depress myocardial contractility, either globally as in systemic sepsis, or regionally in areas of inflammatory myocardial infiltrates, remains unclear. When freshly isolated ventricular myocytes from adult rat hearts were preincubated for at least 24 h in medium conditioned by endotoxin (LPS)-activated rat alveolar macrophages, their subsequent inotropic response to the ,-adrenergic agonist isoproterenol was reduced from 225±19% to 155±10% of the baseline amplitude of shortening (mean±SEM, P < 0.05). Neither baseline contractile function nor the contractile response to high extracellular calcium were affected. To determine whether an endogenous nitric-oxide (NO)-signaling pathway within ventricular myocytes was responsible for their decreased responsiveness to isoproterenol, the L-arginine analogue L-NMMA was added to the preincubation medium. While L-NMMA did not affect baseline contractile function or the response of control myocytes to isoproterenol, it completely restored the positive inotropic response to isoproterenol in myocytes preincubated in LPS-activated macrophage medium. Release of NO by ventricular myocytes following exposure to activated macrophage medium was detected as an increase in cGMP content in a reporter-cell Cellular elements of the immune system have long been suspected to play a role in mediating the global myocardial dysfunction characteristic of septic shock, cardiac allograft rejection, and some forms of idiopathic cardiomyopathy (1). However, recent work indicates that direct cell-mediated cytotoxicity is not required to induce myocardial depression in experimental models of sepsis in animals or contractile dysfunction in isolated ventricular myocytes exposed to inflammatory mediators, including sera from patients with septic shock (2-5). Cell-free supernatants obtained from activated lymphocyte or macrophage cultures reversibly inhibit the expected increase in cAMP and concomitant positive inotropic responses of ventricular myocytes to the f3-adrenergic agonist isoproterenol, but they have no effect on basal cAMP levels or on baseline contractile function (2, 3). This effect of activated immune-cell-conditioned medium on myocyte responsiveness to 3 agonists is not immediate, but requires hours to become apparent ( 1).Several cytokines that are known to be present in medium conditioned by activated immune cells have been shown to induce the synthesis of isoform(s) of nitric oxide (NO) in a number of cell types and tissues (6-9). NO is now recognized to be a nearly ubiquitous autocrine and paracrine chemical messenger, with several biologic activities including the activation of soluble intracellular guanylate cyclase ( 10, 11 ). Recent evidence from this laboratory has documented a role for an endogenous, constitutively present, NO-signaling pathway in regulating the physiologic responsiveness ofneonatal and adult rat ventricular myocytes to muscarinic cholinergic and ,Badrenergic agonists, respectively ( ...

Oxidative stress has been implicated in the pathophysiology of myocardial failure. We tested the hypothesis that inhibition of endogenous antioxidant enzymes can regulate the phenotype of cardiac myocytes. Neonatal rat ventricular myocytes in vitro were exposed to diethyldithiocarbamic acid (DDC), an inhibitor of cytosolic (Cu, Zn) and extracellular superoxide dismutase (SOD). DDC inhibited SOD activity and increased intracellular superoxide in a concentration-dependent manner. A low concentration (1 micromol/L) of DDC stimulated myocyte growth, as demonstrated by increases in protein synthesis, cellular protein, prepro-atrial natriuretic peptide, and c-fos mRNAs and decreased sarcoplasmic reticulum Ca(2+)ATPase mRNA. These actions were all inhibited by the superoxide scavenger Tiron (4,5-dihydroxy-1,3-benzene disulfonic acid). Higher concentrations of DDC (100 micromol/L) stimulated myocyte apoptosis, as evidenced by DNA laddering, characteristic nuclear morphology, in situ terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL), and increased bax mRNA expression. DDC-stimulated apoptosis was inhibited by the SOD/catalase mimetic EUK-8. The growth and apoptotic effects of DDC were mimicked by superoxide generation with xanthine plus xanthine oxidase. Thus, increased intracellular superoxide resulting from inhibition of SOD causes activation of a growth program and apoptosis in cardiac myocytes. These findings support a role for oxidative stress in the pathogenesis of myocardial remodeling and failure.

The highly reactive species, peroxynitrite, is produced in endothelial cells in pathological states in which the production of superoxide anion and NO is increased. Here, we show that peroxynitrite added exogenously or generated endogenously in response to exposure to an NO donor or oxidized low-density lipoproteins (oxLDL) increases p21ras activity in bovine aortic endothelial cells. The activation is not dependent on upstream elements but rather is due to direct targeting of p21ras by reversible S-glutathiolation of cysteine thiols as demonstrated by biotin-labeling techniques. The time course of p21ras S-glutathiolation following peroxynitrite corresponds to the increase in its Raf-1 binding activity and translocation to the membrane. Moreover, p21ras S-glutathiolation and activation can be reversed by dithiothreitol, confirming the importance of a disulfide bond. S-glutathiolation also promoted guanine nucleotide exchange of recombinant p21ras. In addition, the oxidant-induced activation of Mek/Erk and PI3 kinase/Akt was abrogated by dominant-negative and Cys-118 p21ras mutants, and the latter also prevented S-glutathiolation of p21ras. These results indicate that peroxynitrite arising from NO donors or pathological stimuli such as oxLDL triggers direct S-glutathiolation of p21ras Cys-118, which increases p21ras activity and mediates downstream signaling.