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Dexmedetomidine Exerts a Negative Chronotropic Action on Sinoatrial Node Cells Through the Activation of Imidazoline Receptors.

ISHIHARA Mariko KOJIMA Akiko 50447877 DING Wei-guang 80242973 0000-0001-6710-5489 KITAGAWA Hirotoshi 50252391 MATSUURA Hiroshi 60238962 0000-0003-1998-0996 滋賀医科大学

2021.12.01

概要

Dexmedetomidine (DEX), an α2-adrenoreceptor (α2-AR) and imidazoline receptor agonist, is most often used for the sedation of patients in the intensive care unit. Its administration is associated with an increased incidence of bradycardia; however, the precise mechanism of DEX-induced bradycardia has yet to be fully elucidated. This study was undertaken to examine whether DEX modifies pacemaker activity and the underlying ionic channel function through α2-AR and imidazoline receptors. The whole-cell patch-clamp techniques were used to record action potentials and related ionic currents of sinoatrial node cells in guinea pigs. DEX (≥10 nM) reduced sinoatrial node automaticity and the diastolic depolarization rate. DEX reduced the amplitude of hyperpolarization-activated cation current (If or Ih) the pacemaker current, even within the physiological pacemaker potential range. DEX slowed the If current activation kinetics and caused a significant shift in the voltage dependence of channel activation to negative potentials. In addition, efaroxan, an α2-AR and imidazoline I1 receptor antagonist, attenuated the inhibitory effects of DEX on sinoatrial node automaticity and If current activity, whereas yohimbine, an α2-AR-selective antagonist, did not. DEX did not affect the current activities of other channels, including rapidly and slowly activating delayed rectifier K+ currents (IKr and IKs), L-type Ca2+ current (ICa,L), Na+/Ca2+ exchange current (INCX), and muscarinic K+ current (IK,ACh). Our results indicate that DEX, at clinically relevant concentrations, induced a negative chronotropic effect on the sinoatrial node function through the downregulation of If current through an imidazoline I1 receptor other than the α2-AR in the clinical setting.

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Figure Legends

Figure 1

The effect of dexmedetomidine (DEX) on the firing rate of spontaneous action potentials in

guinea pig SA node cells. A, Continuous recording of spontaneous action potentials during

the administration of DEX at concentrations of 5 nM, 10 nM, 100 nM and 1 µM (upper

panel). The simultaneous measurement of the spontaneous firing rate plotted on the same

time scale (lower panel). B, Spontaneous action potentials on an expanded time scale

recorded at the time points indicated by the characters (a-f) in panel A. C and D, The

spontaneous firing rate (C) and diastolic depolarization rate (DDR) (D) before (control) and

during the administration of DEX at each concentration (n = 10-18, N = 9). These data were

analyzed by a one-way ANOVA followed by Dunnett’s test. *P < 0.05 in comparison to

control.

Figure 2

Dexmedetomidine (DEX) induced a decrease in the conductance of If and a hyperpolarizing

shift of channel activation. A, Superimposed current traces of If activated during 2-s

hyperpolarizing steps from a holding potential of -40 mV to test potentials of -50 mV to -140

41

mV, before (control) and during the administration of 100 nM DEX for 5 min. B, The

conductance (gf)-voltage relationship for If constructed using the reversal potential of -31 mV

in the absence (control) and presence of DEX at each concentration (10 nM, 100 nM and 1

µM, fitted with the Boltzmann equation (n = 7-9, N = 8). C, Maximal conductance of If

(gf,max) obtained from fitting with the Boltzmann equation (n = 7-9, N = 8). D, The voltage at

half-maximal activation (Vh) obtained by fitting the conductance-voltage relationship to the

Boltzmann equation in the absence and presence of DEX (n = 7-9, N = 8). E, If current at a

test potential -70 mV before and during the administration of 1 µM DEX or 30 µM

ivabradine. F, The percent inhibition of If at -70 mV induced by DEX at concentrations of 10

nM, 100 nM and 1 µM (n = 7-9, N = 8). These data were analyzed by a paired t test. *P <

0.05 in comparison to control.

Figure 3

The effect of dexmedetomidine (DEX) on the activation rate of If current. A, If activated

during 2-s hyperpolarizing steps to -140 mV from a holding potential of -40 mV, before

(control) and during the administration of 1 µM DEX, which was fitted with two exponential

functions. The right traces show superimposed If, where the peak amplitude of If in the

42

presence of DEX was normalized to that of control to define the slowing of If activation. B, C,

The activation time constants for

fast,

B) and the

slow,

C) components at

-140 mV in the absence and presence of different concentrations of DEX (10 nM, 100 nM

and 1 µM, n = 7-9, N = 8). D, The relative amplitude of the fast component of If activation at

-140 mV in the absence and presence of DEX (n = 7-9, N = 8). These data were analyzed by

a paired t test. *P < 0.05 in comparison to control.

Figure 4

The attenuation of dexmedetomidine (DEX)-induced inhibition of spontaneous action

potentials in SA node cells by the α2-AR and I1R antagonists (efaroxan and idazoxan). A,

Continuous recording of action potentials during the administration of DEX at concentrations

of 10, 100 nM, and 1 µM in the presence of yohimbine (YOH, 1 µM), an α2-AR antagonist

(upper panel). The simultaneous measurement of the spontaneous firing rate plotted on the

same time scale (lower panel). B, The continuous recording of action potentials during the

administration of DEX at concentrations of 10, 100 nM, and 1 µM, in the presence of 10 µM

efaroxan (EFA, 10 µM, upper panel). The simultaneous measurement of the spontaneous

firing rate plotted on the same time scale (lower panel). C, The percent reduction in the firing

43

rate induced by DEX in the absence and presence of YOH (n = 8-9, N = 6). D, The percent

reduction in the firing rate induced by DEX in the absence and presence of EFA (n = 10, N =

5). E, The percent reduction in the firing rate induced by DEX in the absence and presence of

idazoxan (IDA, 10 µM) (n = 7, N =3). Note that the data in the absence of YOH and EFA

shown in panels C, D and E were obtained from the same data shown in Figure 1. These data

were analyzed by an unpaired t test. *P < 0.05 in comparison to control.

Figure 5

Protein kinase C (PKC) failed to suppress the effect of dexmedetomidine (DEX) on

spontaneous action potentials in SA node cells. A, The percent reduction in firing rate

induced by DEX in the absence and presence of a PKC inhibitor, bisindolylmaleimide I

(BIS-I, 200 nM) (n = 6, N = 4). Note that the data in the absence of BIS-I were obtained

from the control data shown in Figure 1. The data were analyzed by an unpaired t test. B,

The firing rate before and during the administration of phorbol 12-myristate 13-acetate

(PMA, 100 nM), a PKC activator, for more than 5 min (n = 7, N = 4). The data were

analyzed by a paired t test.

44

Figure 6

The attenuation of dexmedetomidine (DEX)-induced impairment of If current by efaroxan

(EFA). A, Superimposed current traces of If activated during 2-s hyperpolarizing steps from

a holding potential of -40 mV to test potentials of -50 mV to -140 mV, before (control) and

during the administration of 1 µM DEX for 5 min (upper panel). The lower panel shows

superimposed current traces of If activated during the same hyperpolarizing steps, before

and during the administration of 10 µM EFA and EFA plus 1 µM DEX for 5 min,

respectively. B, Comparison of the maximal conductance of If (gf,max) by fitting the

conductance-voltage relationship to a Boltzmann equation in the absence (control) and

presence of EFA and EFA plus DEX (n = 5, N =3). C, The percent inhibition of If induced

by DEX at -70 mV in the absence and presence of EFA (n = 5-9, N = 3). Note that the data

in the absence of EFA were obtained from the same data shown in Figure 2. D, The voltage

at half-maximal activation (Vh) obtained by a Boltzmann fitting in the absence (control) and

presence of EFA and EFA plus DEX (n = 5, N = 3). E, The

slow,

fast,

middle panel) components of If activation at -140 mV obtained

by fitting with two exponential functions before (control) and during the administration of

EFA and EFA plus DEX. The right panel shows the relative amplitude of the fast component

45

(n = 5, N = 3). The data concerning the gf,max, Vh and time constants were analyzed by a

paired t test, control vs. EFA and EFA vs. EFA+DEX, respectively. The data concerning the

percent inhibition were analyzed by an unpaired t test.

Figure 7

The effect of moxonidine on the firing rate of spontaneous action potentials and If current. A,

Continuous recording of the spontaneous action potentials during administration of

moxonidine (MOX) at concentrations of 100 nM and 1 µM (upper panel). The simultaneous

measurement of the spontaneous firing rate plotted on the same time scale (lower panel). B,

The spontaneous firing rate before (control) and during the administration of MOX at each

concentration (n = 6-9, N = 4). The data were analyzed by a one-way ANOVA followed by

Dunnett’s test. C, Superimposed current traces of If activated during 2-s hyperpolarizing

steps from a holding potential of -40 mV to test potentials of -50 to -140 mV before

(control) and during the administration of 1 µM MOX for 5 min. D, Superimposed current

traces of If activated by the same protocol, before (control) and during the administration of

1 µM rilmenidine (RIL) for 5 min. E, The conductance (gf)-voltage relationship for If

constructed using the reversal potential of -31 mV in the absence (control) and presence of

46

1 µM MOX (n = 8, N = 3) and 1 µM RIL (n = 8, N = 3), fitted with the Boltzmann equation.

F, Comparison of the maximal conductance of If (gf,max) by fitting the conductance-voltage

relationship to a Boltzmann equation in the absence (control) and presence of MOX (n = 8,

N = 3) and RIL (n = 8, N = 3). G, The voltage at half-maximal activation (Vh) obtained by a

Boltzmann fitting in the absence (control) and presence of MOX (n = 8, N = 3) and RIL (n

= 8, N = 3). The data of gf,max and Vh were analyzed by a paired t test. *P < 0.05 in

comparison to control.

Figure 1

Click here to access/download;Figure;Mariko Ishihara et alFigure1.tif

Figure 2

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Figure 3

Click here to access/download;Figure;Mariko Ishihara et al-Figure3.tif

Figure 4

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Figure 5

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Figure 6

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Figure 7

Click here to access/download;Figure;Mariko Ishihara et alFigure7.tif

Table 1

Table 1

Parameters of spontaneous action potentials of SA node cells in the absence and presence of

DEX

Control

DEX

100 nM

1 M

5 nM

10 nM

(n = 18, N = 9)

(n =10, N = 4)

(n = 13, N =7)

(n = 14, N = 8)

APA (mV)

83.5 ± 8.3

84.6 ± 8.4

86.6 ± 7.9

86.3 ± 8.1

86.4 ± 6.2

APD50 (ms)

82.5 ± 13.5

92.3 ± 14.9

81.8 ± 16.8

85.5 ± 20.0

81.6 ± 19.9

APD90 (ms)

136.4 ± 16.8

145.5 ± 19.0

133.1 ± 23.8 133.3 ± 26.8

133.1 ± 27.2

MDP (mV)

-56.7 ± 6.3

-60.1 ± 7.4

-60.1 ± 6.3

-61.43 ± 6.9

-62.9 ± 6.3

max dV/dt (V/s)

11.7 ± 6.0

10.3 ± 4.3

13.7 ± 7.0

12.9 ± 6.4

13.9 ± 4.6

(n = 11, N = 6)

Data are presented as the mean ± SD and were obtained from the experiments shown in Figure 1.

DEX, dexmedetomidine; APA, action potential amplitude; APD50, action potential duration at 50

repolarization; APD90, action potential duration at 90 repolarization; MDP, maximal diastolic

potential; max dV/dt, maximal rate of action potential depolarization. These data were analyzed

by a one-way ANOVA followed by Dunnett’s test.

Supplemental Data File (.doc, .tif, pdf, etc.)

Click here to access/download;Supplemental Data File

(.doc, .tif, pdf, etc.);Mariko Ishihara et al-Supplemental

The effect of dexmedetomidine (DEX) on IKr channel activity. A, Superimposed current traces

during 250-ms depolarization steps from a holding potential of -50 mV to test potentials of 0 mV,

before (control) and during the administration of DEX (1 µM) for 5 min and 5 min after the

subsequent addition of 1 µM E-4031. B, Current-voltage relationships for IKr tail current, determined

as E-4301-sensitive current in the absence (control) and presence of 1 µM DEX. The smooth curves

through the data points represent the least-squares fit of the Boltzmann equation (n = 6, N = 4). C,

The maximal amplitude of IKr (IKr, tail max) in control and in the presence of DEX obtained by

Boltzmann fitting (n = 6, N = 4). The data were analyzed by a paired t test. Supplemental Figure 1

Supplemental Data File (.doc, .tif, pdf, etc.)

Click here to access/download;Supplemental Data File

(.doc, .tif, pdf, etc.);Mariko Ishihara et al-Supplemental

The effect of dexmedetomidine (DEX) on IKs channel activity. A, Superimposed current traces during

2-s depolarization steps from a holding potential of -50 mV to test potentials of -40 mV to +50 mV,

before (control) and during the administration of 1 µM DEX in a cumulative manner for 5 min. B,

Current-voltage relationships for IKs tail currents in the absence and presence of DEX. The smooth

curves through the data points represent the least-squares fit of the Boltzmann equation (n = 6, N = 3).

C, The maximal amplitude of IKs (IKs, tail max) in the absence (control) and presence of DEX obtained by

fitting with the Boltzmann equation(n = 6, N = 3). The data were analyzed by a paired t test. Supplemental Figure 2

Supplemental Data File (.doc, .tif, pdf, etc.)

Click here to access/download;Supplemental Data File

(.doc, .tif, pdf, etc.);Mariko Ishihara et al-Supplemental

The effect of dexmedetomidine (DEX) on ICa,L channel activity. A, The time course of the changes in

the amplitude of ICa,L evoked by 500-ms depolarizing steps from a holding potential of -50 mV to test

potentials of 0 mV in the absence of DEX for 15 min. B, The time course of the changes in the

amplitude of ICa,L evoked by the same protocol in the presence of 1 µM DEX, 8 min after the start of

experiment. C, The percent amplitude of ICa,L in the absence and presence of DEX at the time points

indicated by the characters (a, b in panel A; a’, b’ in panel B, n = 4-6, N = 3). The data were analyzed

by an unpaired t test. Supplemental Figure 3

Supplemental Data File (.doc, .tif, pdf, etc.)

Click here to access/download;Supplemental Data File

(.doc, .tif, pdf, etc.);Mariko Ishihara et al-Supplemental

The effect of dexmedetomidine (DEX) on the INCX activity. (A) The time course of the changes in

membrane currents measured at +40 mV and -120 mV in the voltage-ramp protocol, during the

administration of 1 µM DEX and 1 mM NiCl2, as indicated. B, The current-voltage relationship of

membrane currents at the time points indicated by the characters in panel A. C, The current-voltage

relationships for the DEX-sensitive current (a-b) and NiCl2-sensitive current (a-d) obtained by digital

subtraction of the current traces shown in panel B (n = 4, N = 2). Supplemental Figure 4

Supplemental Data File (.doc, .tif, pdf, etc.)

Click here to access/download;Supplemental Data File

(.doc, .tif, pdf, etc.);Mariko Ishihara et al-Supplemental

The effect of dexmedetomidine (DEX) on the IK,Ach channel activity. A, The time course of the

changes in membrane currents measured at +40 mV and -120 mV in the voltage-ramp protocol,

during the administration of 1 µM DEX and 1 µM acetylcholine (ACh). B, The current-voltage

relationships for membrane currents recorded at the time points indicated by the characters in

panel A. C, The current-voltage relationships for DEX-sensitive current (b-a) and ACh-sensitive

current (d-c) obtained by digital subtraction of the current traces shown in panel B (n = 6, N = 3). Supplemental Figure 5

...

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