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Introduction to e-Series A: Cardiovascular Diseases, Volume Four Part 2: Regenerative Medicine

Introduction to e-Series A: Cardiovascular Diseases, Volume Four Part 2: Regenerative Medicine

Author and Curator: Larry H Bernstein, MD, FCAP

and

Curator: Aviva Lev-Ari, PhD, RN

This document is entirely devoted to medical and surgical therapies that have made huge strides in

  • simplification of interventional procedures,
  • reduced complexity, resulting in procedures previously requiring surgery are now done, circumstances permitting, by medical intervention.

This revolution in cardiovascular interventional therapy is regenerative medicine.  It is regenerative because it is largely driven by

  • the introduction into the impaired vasculature of an induced pleuripotent cell, called a stem cell, although
  • the level of differentiation may not be a most primitive cell line.

There is also a very closely aligned development in cell biology that extends beyond and including vascular regeneration that is called synthetic biology.  These developments have occurred at an accelerated rate in the last 15 years. The methods of interventional cardiology were already well developed in the mid 1980s.  This was at the peak of cardiothoracic bypass surgery.

Research on the endothelial cell,

  • endothelial cell proliferation,
  • shear flow in small arteries, especially at branch points, and
  • endothelial-platelet interactions

led to insights about plaque formation and vessel thrombosis.

Much was learned in biomechanics about the shear flow stresses on the luminal surface of the vasculature, and there was also

  • the concomitant discovery of nitric oxide,
  • oxidative stress, and
  • the isoenzymes of nitric oxide synthase (eNOS, iNOS, and nNOS).

It became a fundamental tenet of vascular biology that

  • atherogenesis is a maladjustment to oxidative stress not only through genetic, but also
  • non-genetic nutritional factors that could be related to the balance of omega (ω)-3 and omega (ω)-6 fatty acids,
  • a pro-inflammatory state that elicits inflammatory cytokines, such as, interleukin-6 (IL6) and c-reactive protein(CRP),
  • insulin resistance with excess carbohydrate associated with type 2 diabetes and beta (β) cell stress,
  • excess trans- and saturated fats, and perhaps
  • the now plausible colonic microbial population of the gastrointestinal tract (GIT).

There is also an association of abdominal adiposity,

  • including the visceral peritoneum, with both T2DM and with arteriosclerotic vessel disease,
  • which is presenting at a young age, and has ties to
  • the effects of an adipokine, adiponectin.

Much important work has already been discussed in the domain of cardiac catheterization and research done to

  • prevent atheroembolization.and beyond that,
  • research done to implant an endothelial growth matrix.

Even then, dramatic work had already been done on

  • the platelet structure and metabolism, and
  • this has transformed our knowledge of platelet biology.

The coagulation process has been discussed in detailed in a previous document.  The result was the development of a

  • new class of platelet aggregation inhibitors designed to block the activation of protein on the platelet surface that
  • is critical in the coagulation cascade.

In addition, the term long used to describe atherosclerosis, atheroma notwithstanding, is “hardening of the arteries”.  This is particularly notable with respect to mid-size arteries and arterioles that feed the heart and kidneys. Whether it is preceded by or develops concurrently with chronic renal insufficiency and lowered glomerular filtration rate is perhaps arguable.  However, there is now a body of evidence that points to

  • a change in the vascular muscularis and vessel stiffness, in addition to the endothelial features already mentioned.

This has provided a basis for

  • targeted pharmaceutical intervention, and
  • reduction in salt intake.

So we have a  group of metabolic disorders, which may alone or in combination,

  • lead to and be associated with the long term effects of cardiovascular disease, including
  • congestive heart failure.

This has been classically broken down into forward and backward failure,

  • depending on decrease outflow through the aorta (ejection fraction), or
  • decreased venous return through the vena cava,

which involves increased pulmonary vascular resistance and decreased return into the left atrium.

This also has ties to several causes, which may be cardiac or vascular. This document, as the previous, has four pats.  They are broadly:

  1. Stem Cells in Cardiovascular Diseases
  2. Regenerative Cell and Molecular Biology
  3. Therapeutics Levels In Molecular Cardiology
  4. Research Proposals for Endogenous Augmentation of circulating Endothelial Progenitor Cells (cEPCs)

As in the previous section, we start with the biology of the stem cell and the degeneration in cardiovascular diseases, then proceed to regeneration, then therapeutics, and finally – proposals for augmenting therapy with circulating endogenous endothelial progenitor cells (cEPCs).

 

context

stem cells

 

theme

regeneration

 

 

 

 

theme

Therapeutics

 

theme

augmentation

 

 

 

 

 

 

 

 

 

 

Key pathways involving NO

Key pathways involving NO

 

 

 

 

stem cell lin28

stem cellLlin28

1479-5876-10-175-1-l  translational research with feedback loops

Tranlational Research -Lab to Bedside

 

 

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Richard Lifton, MD, PhD of Yale University & Howard Hughes Medical Institute: Recipient of 2014 Breakthrough Prizes Awarded in Life Sciences for the Discovery of Genes and Biochemical Mechanisms that cause Hypertension

Curator: Aviva Lev-Ari, PhD, RN

Article ID #118: Richard Lifton, MD, PhD of Yale University and Howard Hughes Medical Institute: Recipient of 2014 Breakthrough Prizes Awarded in Life Sciences for the Discovery of Genes and Biochemical Mechanisms that cause Hypertension. Published on 3/3/2014

WordCloud Image Produced by Adam Tubman

 

Yale’s Lifton receives $3 million science prize at gala Silicon Valley ceremony

Friday, December 13, 2013

Bill Hathaway / 203-432-1322

Read this article on YaleNews

Richard Lifton, Sterling Professor of Genetics and chair of the Department of Genetics, has received a $3 million Breakthrough Prize in Life Sciences, created by top Silicon Valley entrepreneurs.

Lifton was one of eight scientists honored Dec. 12 with $21 million in prizes at gala ceremonies hosted by actor Kevin Spacey in Mountain View, California. Celebrities — including Conan O’Brien, Glenn Close, Rob Lowe, and Michael C. Hall — handed out awards to six winners of the life sciences prizes and two co-winners of the Breakthrough Prize in Fundamental Physics.

“Scientists should be celebrated as heroes, and we are honored to be part of today’s celebration,” said Google co-founder Sergey Brin and his wife, biologist and entrepreneur Anne Wojcicki, two of the event’s sponsors.

Lifton, who is also an investigator for the Howard Hughes Medical Institute, was recognized for his pioneering work to identify the genetic and biochemical underpinnings of hypertension, a disease that affects more than 1 billion people worldwide and that contributes to 17 million deaths annually from heart attack and stroke. Lifton and his colleagues identified patients around the world with exceptionally high or low blood pressure due to single gene mutations. They identified the mutated genes and established their role in salt reabsorption by the kidney and regulation of blood pressure. The work gave scientific rationale to limit dietary salt intake and suggested rational combinations of antihypertensive medications and development of new therapies.

Other sponsors of the event are Chinese internet entrepreneur Jack Ma and Cathy Zhang; Russian entrepreneur and venture capitalist Yuri Milner and his wife, Julia Milner; and Facebook founder Mark Zuckerberg and Priscilla Chan.

At the end of the ceremonies, which will be televised on the Science Channel at 9 p.m. on Jan. 27, Milner and Zuckerberg announced the creation of a $3 million Breakthrough Prize in Mathematics that will be awarded next year.

Additional information on the prizes can be found atwww.breakthroughprizeinlifesciences.org or www.fundamentalphysicsprize.org.


SOURCE

http://www.bizjournals.com/sanfrancisco/prnewswire/press_releases/California/2013/12/13/NY33121

THE DISCOVERY

Laliotis MD, Zhang J, Volkman HM, Kahle KT, Hoffmann, KE, Toka HR, Nelson-Williams C, Ellison, DH, Flavell, R, Booth, CJ, Lu Y, Geller, DS, Lifton, RP. Wnk4 controls blood pressure and potassium homeostasis via regulation of mass and activity of the distal convoluted tubule. Nature Genetics, in press

Earlier Research Results on this discovey
Proc Natl Acad Sci U S A. 2003 Jan 21;100(2):680-4. Epub 2003 Jan 6.

Molecular pathogenesis of inherited hypertension with hyperkalemia: the Na-Cl cotransporter is inhibited by wild-type but not mutant WNK4.

Wilson FH1Kahle KTSabath ELalioti MDRapson AKHoover RSHebert SCGamba GLifton RP.

Abstract

Mutations in the serine-threonine kinases WNK1 and WNK4 [with no lysine (K) at a key catalytic residue] cause pseudohypoaldosteronism type II (PHAII), a Mendelian disease featuring hypertension, hyperkalemia, hyperchloremia, and metabolic acidosis. Both kinases are expressed in the distal nephron, although the regulators and targets of WNK signaling cascades are unknown. The Cl(-) dependence of PHAII phenotypes, their sensitivity to thiazide diuretics, and the observation that they constitute a “mirror image” of the phenotypes resulting from loss of function mutations in the thiazide-sensitive Na-Cl cotransporter (NCCT) suggest that PHAII may result from increased NCCT activity due to altered WNK signaling. To address this possibility, we measured NCCT-mediated Na(+) influx and membrane expression in the presence of wild-type and mutant WNK4 by heterologous expression in Xenopus oocytes. Wild-type WNK4 inhibits NCCT-mediated Na-influx by reducing membrane expression of the cotransporter ((22)Na-influx reduced 50%, P < 1 x 10(-9), surface expression reduced 75%, P < 1 x 10(-14) in the presence of WNK4). This inhibition depends on WNK4 kinase activity, because missense mutations that abrogate kinase function prevent this effect. PHAII-causing missense mutations, which are remote from the kinase domain, also prevent inhibition of NCCT activity, providing insight into the pathophysiology of the disorder. The specificity of this effect is indicated by the finding that WNK4 and the carboxyl terminus of NCCT coimmunoprecipitate when expressed in HEK 293T cells. Together, these findings demonstrate that WNK4 negatively regulates surface expression of NCCT and implicate loss of this regulation in the molecular pathogenesis of an inherited form of hypertension.

Images from this publication.See all images (4)Free text

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SOURCE

LISTEN TO AUDIO TAPE by Prof. Richard Lifton

http://streaming.yale.edu/opa/podcasts/audio/schools/health_and_medicine/lifton_092007.mp3

January 27, 2014
Richard Lifton

Yale’s Richard Lifton is one of eight world-changing researchers whose work is celebrated during a program airing tonight (Jan. 27) on the Science Channel at 9 p.m. EST.

Lifton, Sterling Professor of Genetics and chair of the Department of Genetics, received a $3 million Breakthrough Prize in Life Sciences, created by top Silicon Valley entrepreneurs.

The Science Channel program features the Dec. 12 ceremony where Lifton and others received their prize. The festivities were hosted by actor Kevin Spacey and featured such celebrities as Conan O’Brien, Glenn Close, Rob Lowe, and Michael C. Hall, as well as tech leaders Mark Zuckerberg, Larry Page, Sergey Brin, Anne Wojcicki, Jimmy Wales, and Yuri Milner.

SOURCE

http://news.yale.edu/2014/01/27/tonight-lifton-honored-star-studded-ceremony

Yale consortium awarded $6 million to study therapies for vascular disease

Tuesday, January 21, 2014


Contact

Helen Dodson / 203-436-3984

Stacey Buba / 203-432-1333

Read this article on YaleNews

An international research team spearheaded by William C. Sessa, the Alfred Gilman Professor of Pharmacology and professor of medicine (cardiology), has been awarded a $6 million Transatlantic Networks of Excellence grant from the Fondation Leducq in France.

Sessa will be the U.S. coordinator for the consortium as it explores the mechanisms of secreted microRNAs and microRNA-based therapies for vascular disease. Sessa will be joined by a European coordinator, Dr. Thomas Thum, director of the Institute for Molecular and Translational Therapeutic Strategies at Hanover Medical School in Germany, and five investigators including recent Yale recruit, Carlos Fenandez-Hernando, associate professor of comparative medicine. The grant will be distributed over five years.

Sessa is director of the vascular biology and therapeutics program and vice chairman of pharmacology at Yale School of Medicine.

Sessa has long worked at the intersection of pharmacology and cardiovascular disease. He is on the scientific advisory board of the William Harvey Research Institute and NIHR Biomedical Research Unit in London, and also served on the joint strategy committee for the Yale-UCL collaborative in cardiovascular research.

“I am grateful to Fondation Leducq for funding this new international collaboration to find new and effective ways to treat a disease that kills millions of people each year,” Sessa said. “We have assembled a fantastic team of world class scientists to tackle the basic questions of how microRNAs are packaged and transferred between cells, and their therapeutic potential in vascular diseases.”

Fondation Leducq is a French non-profit health research foundation. Its mission is to improve human health through international efforts to combat cardiovascular disease. To this end, Fondation Leducq created the Transatlantic Networks of Excellence in Cardiovascular Research Program, which is designed to promote collaborative research involving centers in North America and Europe in the areas of cardiovascular and neurovascular disease.

Yale has had two previous Leducq grants — to Dr. Richard Lifton, chair of genetics, and Dr. Michael Simons, director of the Yale Cardiovascular Research Center.

SOURCE

http://bbs.yale.edu/about/article.aspx?id=6569

International Activity

  • YALE-UCL Collaborative
    London, United Kingdom (2011)
    Dr. Lifton is on the Joint Strategy Committee for the Yale-UCL Collaborative, an alliance which will provide opportunities for high-level scientific research, clinical and educational collaboration across the institutions involved: Yale University, Yale School of Medicine, Yale-New Haven Hospital and UCL (University College London) and UCL Partners
  • Transatlantic Network on Hypertension-Renal Salt Handling in the Control of Blood Pressure
    France (2007)
    Drs Hebert and Lifton will join leading researchers in Switzerland, France and Mexico in a transatlantic collaboration aimed at pinpointing the kidney’s role in high blood pressure.

Education & Training

M.D.
Stanford University (1982)
Ph.D.
Stanford University (1986)

Honors & Recognition

  • National Academy of Sciences
  • The Basic Science Prize
    American Heart Association
  • Homer Smith Award
    American Society of Nephrology
  • MSD International Award
    International Society of Hypertension

Research Interests

Molecular genetics of common human diseases


Research Summary

The common human diseases that account for the vast majority of morbidity and mortality in human populations are known to have underlying inherited components. Advances in human genetics have made the identification of genetic variants contributing to these traits feasible. Such identification promises to revolutionize the diagnostic and therapeutic approaches to these disorders. We have focused on cardiovascular and renal disease. To date, we have identified mutations underlying more than 20 human diseases; these include a host of diseases that define molecular determinants of hypertension, stroke and heart attack. We have gone on from these starting points to use biochemistry and animal models to define the physiologic mechanisms linking genotype and phenotype. These findings have provided new insight into normal and disease biology, are identifying new pathways underlying disease pathogenesis, and are identifying new targets for development of novel therapeutics.

Extensive Research Description

Cardiovascular disease is the leading cause of death world-wide. Epidemiologic studies have identified hypertension, high cholesterol, diabetes and smoking as major risk factors. By investigation of rare families recruited from around the world that segregate single genes with large effect, we have identified genes that contribute to these traits, putting a molecular face on their pathogenesis. For example, we have identified mutations in 8 genes that cause high blood pressure (hypertension) and another 8 that cause low blood pressure. These mutations all converge on a final common pathway, the regulation of net salt reabsorption in the kidney. These findings have established the key role of variation in renal salt handling in blood pressure variation, and have led to changes in the approach to treatment of this disease in the general population. They have also identified new therapeutic targets that are predicted to have greater efficacy with reduced side effects. Finally, they have identified new signaling pathways involved in the regulation of blood pressure homeostasis. We have taken similar approaches to another common disease, osteoporosis, with the identification of gain of function mutations in LRP5, a component of the Wnt signaling pathway, in development of high bone density. This finding has led to intensive efforts to identify small molecules that impact this pathway to protect against and/or reverse osteoporosis in the general population. Ongoing studies use both emerging and novel approaches to identification of genes that contribute to disease burden in the population, and to understanding the pathways that link genes to disease. Mutations that affect blood pressure in humans. A diagram of a nephron, the filtering unit of the kidney, is shown. The molecular pathways mediating NaCl reabsorption in individual renal cells along the nephron are shown, along with the pathway of the renin-angiotensin system, a major regulator of renal salt reabsorption. Inherited diseases affecting these pathways are indicated, with hypertensive disorders in red and hypotensive disorders in blue. From Lifton, Gharavi, and Geller. Cell, 104:545-556, 2001.


Selected Publications

  • Mani, A., et al. (2007). LRP6 mutation in a family with early coronary disease and metabolic risk factors. Science 315:1278-82.
  • Ring, A.M., et al. (2007). An SGK1 site in WNK4 regulates Na+ channel and K+ channel activity and has implications for aldosterone signaling and K+ homeostasis. Proc. Natl. Acad. Sci. (USA) 104:4025-9.
  • Lalioti MD, Zhang J, Volkman HM, Kahle KT, Hoffmann, KE, Toka HR, Nelson-Williams C, Ellison, DH, Flavell, R, Booth, CJ, Lu Y, Geller, DS, Lifton, RP. Wnk4 controls blood pressure and potassium homeostasis via regulation of mass and activity of the distal convoluted tubule. Nature Genetics, in press.
  • Wilson FH, Hariri A, Farhi A, Zhao H, Peterson K, Toka HR, Nelson- Williams C, Raja KM, Kashgarian M, Shulman GI, Scheinman SJ, Lifton RP. A cluster of metabolic defects caused by mutation in a mitochondrial tRNA. Science, 306:1190-94, 2004.
  • Boyden LM, Mao J, Belsky J, Mitzner L, Farhi A, Mitnick MA, Wu D, Insogna K, Lifton RP. High bone density due to a mutation in LDL-receptor-related protein 5. New Engl J Med. 346:1513-1521, 2002.
  • Wilson FH, Disse-Nicodème S, Choate KA, Ishikawa K, Nelson-Williams C, Desitter I, Gunel M, Milford DV, Lipkin GW, Achard JM, Feely MP, Dussol B, Berland Y, Unwin RJ, Mayan H, Simon DB, Farfel Z, Jeunemaitre X, Lifton RP. Human Hypertension Caused by Mutations in WNK Kinases. Science, 293:1107-1112, 2001.
  • Lifton RP, Gharavi A, Geller DS. Molecular mechanisms of human hypertension. Cell, 104:545-556, 2001.
  • Geller DS, Farhi A, Pinkerton N, Fradley M, Moritz M, Spitzer A, Meinke G, Tsai TF, Sigler P, Lifton RP. Activating mineralocorticoid receptor mutation in hypertension exacerbated by pregnancy. Science, 289:119-123, 2000.
  • Simon DB, Lu Y, Choate KA, Velazquez H, Al-Sabban E, Praga M, Casari G, Bettinelli A, Colussi G, Rodriguez-Soriano J, McCredie D, Milford D, Sanjad S, Lifton RP. Paracellin-1, a renal tight junction protein required for paracellular Mg2+ reabsorption. Science, 285:103-106, 1999.

SOURCE
http://bbs.yale.edu/people/richard_lifton-3.profile

PubMed Results: 10

Select item 225138461.

Protein phosphatase 1 modulates the inhibitory effect of With-no-Lysine kinase 4 on ROMK channels.

Lin DH, Yue P, Rinehart J, Sun P, Wang Z, Lifton R, Wang WH.

Am J Physiol Renal Physiol. 2012 Jul 1;303(1):F110-9. doi: 10.1152/ajprenal.00676.2011. Epub 2012 Apr 18.

PMID:

22513846

[PubMed – indexed for MEDLINE]

Free PMC Article

Related citations

Select item 165287062.

Haplotype analysis in the presence of informatively missing genotype data.

Liu N, Beerman I, Lifton R, Zhao H.

Genet Epidemiol. 2006 May;30(4):290-300.

PMID:

16528706

[PubMed – indexed for MEDLINE]

Related citations

Select item 165282533.

Familial aggregation of primary glomerulonephritis in an Italian population isolate: Valtrompia study.

Izzi C, Sanna-Cherchi S, Prati E, Belleri R, Remedio A, Tardanico R, Foramitti M, Guerini S, Viola BF, Movilli E, Beerman I, Lifton R, Leone L, Gharavi A, Scolari F.

Kidney Int. 2006 Mar;69(6):1033-40.

PMID:

16528253

[PubMed – indexed for MEDLINE]

Related citations

Select item 127823554.

Mice lacking the B1 subunit of H+ -ATPase have normal hearing.

Dou H, Finberg K, Cardell EL, Lifton R, Choo D.

Hear Res. 2003 Jun;180(1-2):76-84.

PMID:

12782355

[PubMed – indexed for MEDLINE]

Related citations

Select item 113430495.

Glucocorticoid-remediable aldosteronism is associated with severe hypertension in early childhood.

Dluhy RG, Anderson B, Harlin B, Ingelfinger J, Lifton R.

J Pediatr. 2001 May;138(5):715-20.

PMID:

11343049

[PubMed – indexed for MEDLINE]

Related citations

Select item 102327426.

Elevated ambulatory blood pressure in 20 subjects with Williams syndrome.

Broder K, Reinhardt E, Ahern J, Lifton R, Tamborlane W, Pober B.

Am J Med Genet. 1999 Apr 23;83(5):356-60.

PMID:

10232742

[PubMed – indexed for MEDLINE]

Related citations

Select item 97986657.

Coincident acute myelogenous leukemia and ischemic heart disease: use of the cardioprotectant dexrazoxane during induction chemotherapy.

Woodlock TJ, Lifton R, DiSalle M.

Am J Hematol. 1998 Nov;59(3):246-8.

PMID:

9798665

[PubMed – indexed for MEDLINE]

Related citations

Select item 95012578.

In vivo phosphorylation of the epithelial sodium channel.

Shimkets RA, Lifton R, Canessa CM.

Proc Natl Acad Sci U S A. 1998 Mar 17;95(6):3301-5.

PMID:

9501257

[PubMed – indexed for MEDLINE]

Free PMC Article

Related citations

Select item 91562619.

Autotransplantation for relapsed or refractory non-Hodgkin’s lymphoma (NHL): long-term follow-up and analysis of prognostic factors.

Rapoport AP, Lifton R, Constine LS, Duerst RE, Abboud CN, Liesveld JL, Packman CH, Eberly S, Raubertas RF, Martin BA, Flesher WR, Kouides PA, DiPersio JF, Rowe JM.

Bone Marrow Transplant. 1997 May;19(9):883-90.

PMID:

9156261

[PubMed – indexed for MEDLINE]

Free Article

Related citations

 

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Curation, HealthCare System in the US, and Calcium Signaling Effects on Cardiac Contraction, Heart Failure, and Atrial Fibrillation, and the Relationship of Calcium Release at the Myoneural Junction to Beta Adrenergic Release

Curation, HealthCare System in the US, and Calcium Signaling Effects on Cardiac Contraction, Heart Failure, and Atrial Fibrillation, and the Relationship of Calcium Release at the Myoneural Junction to Beta Adrenergic Release

Curator and e-book Contributor: Larry H. Bernstein, MD, FCAP
Curator and BioMedicine e-Series Editor-in-Chief: Aviva Lev Ari, PhD, RN

and 

Content Consultant to Six-Volume e-SERIES A: Cardiovascular Diseases: Justin Pearlman, MD, PhD, FACC

This portion summarises what we have covered and is now familiar to the reader.  There are three related topics, and an extension of this embraces other volumes and chapters before and after this reading.  This approach to the document has advantages over the multiple authored textbooks that are and have been pervasive as a result of the traditional publication technology.  It has been stated by the founder of ScoopIt, that amount of time involved is considerably less than required for the original publications used, but the organization and construction is a separate creative process.  In these curations we amassed on average five articles in one curation, to which, two or three curators contributed their views.  There were surprises, and there were unfulfilled answers along the way.  The greatest problem that is being envisioned is the building a vision that bridges and unmasks the hidden “dark matter” between the now declared “OMICS”, to get a more real perspective on what is conjecture and what is actionable.  This is in some respects unavoidable because the genome is an alphabet that is matched to the mino acid sequences of proteins, which themselves are three dimensional drivers of sequences of metabolic reactions that can be altered by the accumulation of substrates in critical placements, and in addition, the proteome has functional proteins whose activity is a regulatory function and not easily identified.  In the end, we have to have a practical conception, recognizing the breadth of evolutionary change, and make sense of what we have, while searching for more.

We introduced the content as follows:

1. We introduce the concept of curation in the digital context, and it’s application to medicine and related scientific discovery.

Topics were chosen were used to illustrate this process in the form of a pattern, which is mostly curation, but is significantly creative, as it emerges in the context of this e-book.

  • Alternative solutions in Treatment of Heart Failure (HF), medical devices, biomarkers and agent efficacy is handled all in one chapter.
  • PCI for valves vs Open heart Valve replacement
  • PDA and Complications of Surgery — only curation could create the picture of this unique combination of debate, as exemplified of Endarterectomy (CEA) vs Stenting the Carotid Artery (CAS), ischemic leg, renal artery stenosis.

2. The etiology, or causes, of cardiovascular diseases consist of mechanistic explanations for dysfunction relating to the heart or vascular system. Every one of a long list of abnormalities has a path that explains the deviation from normal. With the completion of the analysis of the human genome, in principle all of the genetic basis for function and dysfunction are delineated. While all genes are identified, and the genes code for all the gene products that constitute body functions, there remains more unknown than known.

3. Human genome, and in combination with improved imaging methods, genomics offers great promise in changing the course of disease and aging.

4. If we tie together Part 1 and Part 2, there is ample room for considering clinical outcomes based on individual and organizational factors for best performance. This can really only be realized with considerable improvement in information infrastructure, which has miles to go.

Curation

Curation is an active filtering of the web’s  and peer reviewed literature found by such means – immense amount of relevant and irrelevant content. As a result content may be disruptive. However, in doing good curation, one does more than simply assign value by presentation of creative work in any category. Great curators comment and share experience across content, authors and themes.
Great curators may see patterns others don’t, or may challenge or debate complex and apparently conflicting points of view.  Answers to specifically focused questions comes from the hard work of many in laboratory settings creatively establishing answers to definitive questions, each a part of the larger knowledge-base of reference. There are those rare “Einstein’s” who imagine a whole universe, unlike the three blindmen of the Sufi tale.  One held the tail, the other the trunk, the other the ear, and they all said this is an elephant!
In my reading, I learn that the optimal ratio of curation to creation may be as high as 90% curation to 10% creation. Creating content is expensive. Curation, by comparison, is much less expensive.  The same source says “Scoop.it is my content marketing testing “sandbox”. In sharing, he says that comments provide the framework for what and how content is shared.

Healthcare and Affordable Care Act

We enter year 2014 with the Affordable Care Act off to a slow start because of the implementation of the internet signup requiring a major repair, which is, unfortunately, as expected for such as complex job across the US, and with many states unwilling to participate.  But several states – California, Connecticut, and Kentucky – had very effective state designed signups, separate from the federal system.  There has been a very large rush and an extension to sign up. There are many features that we can take note of:

1. The healthcare system needed changes because we have the most costly system, are endowed with advanced technology, and we have inexcusable outcomes in several domains of care, including, infant mortality, and prenatal care – but not in cardiology.

2. These changes that are notable are:

  • The disparities in outcome are magnified by a large disparity in highest to lowest income bracket.
  • This is also reflected in educational status, and which plays out in childhood school lunches, and is also affected by larger class size and cutbacks in school programs.
  • This is not  helped by a large paralysis in the two party political system and the three legs of government unable to deal with work and distraction.
  • Unemployment is high, and the banking and home construction, home buying, and rental are in realignment, but interest rates are problematic.

3.  The  medical care system is affected by the issues above, but the complexity is not to be discounted.

  •  The medical schools are unable at this time to provide the influx of new physicians needed, so we depend on a major influx of physicians from other countries
  • The technology for laboratories, proteomic and genomic as well as applied medical research is rejuvenating the practice in cardiology more rapidly than any other field.
  • In fields that are imaging related the life cycle of instruments is shorter than the actual lifetime use of the instruments, which introduces a shortening of ROI.
  • Hospitals are consolidating into large consortia in order to maintain a more viable system for referral of specialty cases, and also is centralizing all terms of business related to billing.
  • There is reduction in independent physician practices that are being incorporated into the hospital enterprise with Part B billing under the Physician Organization – as in Partners in Greater Boston, with the exception of “concierge” medical practices.
  • There is consolidation of specialty laboratory services within state, with only the most specialized testing going out of state (Quest, LabCorp, etc.)
  • Medicaid is expanded substantially under the new ACA.
  • The federal government as provider of services is reducing the number of contractors for – medical devices, diabetes self-testing, etc.
  • The current rearrangements seeks to provide a balance between capital expenses and fixed labor costs that it can control, reduce variable costs (reagents, pharmaceutical), and to take in more patients with less delay and better performance – defined by outside agencies.

Cardiology, Genomics, and calcium ion signaling and ion-channels in cardiomyocyte function in health and disease – including heart failure, rhythm abnormalities, and the myoneural release of neurotransmitter at the vesicle junction.

This portion is outlined as follows:

2.1 Human Genome: Congenital Etiological Sources of Cardiovascular Disease

2.2 The Role of Calcium in Health and Disease

2.3 Vasculature and Myocardium: Diagnosing the Conditions of Disease

Genomics & Genetics of Cardiovascular Disease Diagnoses

actin cytoskeleton

wall stress, ventricular workload, contractile reserve

Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging

calcium and actin skeleton, signaling, cell motility

hypertension & vascular compliance

Genetics of Conduction Disease

Ca+ stimulated exostosis: calmodulin & PKC (neurotransmitter)

complications & MVR

disruption of Ca2+ homeostasis cardiac & vascular smooth muscle

synaptotagmin as Ca2+ sensor & vesicles

atherosclerosis & ion channels


It is increasingly clear that there are mutations that underlie many human diseases, and this is true of the cardiovascular system.  The mutations are mistakes in the insertion of a purine nucleotide, which may or may not have any consequence.  This is why the associations that are being discovered in research require careful validation, and even require demonstration in “models” before pursuing the design of pharmacological “target therapy”.  The genomics in cardiovascular disease involves very serious congenital disorders that are asserted early in life, but the effects of and development of atherosclerosis involving large and medium size arteries has a slow progression and is not dominated by genomic expression.  This is characterized by loss of arterial elasticity. In addition there is the development of heart failure, which involves the cardiomyocyte specifically.  The emergence of regenerative medical interventions, based on pleuripotent inducible stem cell therapy is developing rapidly as an intervention in this sector.

Finally, it is incumbent on me to call attention to the huge contribution that research on calcium (Ca2+) signaling has made toward the understanding of cardiac contraction and to the maintenance of the heart rhythm.  The heart is a syncytium, different than skeletal and smooth muscle, and the innervation is by the vagus nerve, which has terminal endings at vesicles which discharge at the myocyte junction.  The heart specifically has calmodulin kinase CaMK II, and it has been established that calmodulin is involved in the calcium spark that triggers contraction.  That is only part of the story.  Ion transport occurs into or out of the cell, the latter termed exostosis.  Exostosis involves CaMK II and pyruvate kinase (PKC), and they have independent roles.  This also involves K+-Na+-ATPase.  The cytoskeleton is also discussed, but the role of aquaporin in water transport appears elsewhere, as the transport of water between cells.  When we consider the Gibbs-Donnan equilibrium, which precedes the current work by a century, we recall that there is an essential balance between extracellular Na+ + Ca2+ and the intracellular K+ + Mg2+, and this has been superceded by an incompletely defined relationship between ions that are cytoplasmic and those that are mitochondrial.  The glass is half full!

 

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The Cost to Value Conundrum in Cardiovascular Healthcare Provision

The Cost to Value Conundrum in Cardiovascular Healthcare Provision

Author: Larry H. Bernstein, MD, FCAP

Article ID #98: The Cost to Value Conundrum in Cardiovascular Healthcare Provision. Published on 1/1/2014

WordCloud Image Produced by Adam Tubman

I write this introduction to Volume 2 of the e-series on Cardiovascular Diseases, which curates the basic structure and physiology of the heart, the vasculature, and related structures, e.g., the kidney, with respect to:

1. Pathogenesis
2. Diagnosis
3. Treatment

Curation is an introductory portion to Volume Two, which is necessary to introduce the methodological design used to create the following articles. More needs not to be discussed about the methodology, which will become clear, if only that the content curated is changing based on success or failure of both diagnostic and treatment technology availability, as well as the systems needed to support the ongoing advances.  Curation requires:

  • meaningful selection,
  • enrichment, and
  • sharing combining sources and
  • creation of new synnthesis

Curators have to create a new perspective or idea on top of the existing media which supports the content in the original. The curator has to select from the myriad upon myriad options available, to re-share and critically view the work. A search can be overwhelming in size of the output, but the curator has to successfully pluck the best material straight out of that noise.

Part 1 is a highly important treatment that is not technological, but about the system now outdated to support our healthcare system, the most technolog-ically advanced in the world, with major problems in the availability of care related to economic disparities.  It is not about technology, per se, but about how we allocate healthcare resources, about individuals’ roles in a not full list of lifestyle maintenance options for self-care, and about the important advances emerging out of the Affordable Care Act (ACA), impacting enormously on Medicaid, which depends on state-level acceptance, on community hospital, ambulatory, and home-care or hospice restructuring, which includes the reduction of management overhead by the formation of regional healthcare alliances, the incorporation of physicians into hospital-based practices (with the hospital collecting and distributing the Part B reimbursement to the physician, with “performance-based” targets for privileges and payment – essential to the success of an Accountable Care Organization (AC)).  One problem that ACA has definitively address is the elimination of the exclusion of patients based on preconditions.  One problem that has been left unresolved is the continuing existence of private policies that meet financial capabilities of the contract to provide, but which provide little value to the “purchaser” of care.  This is a holdout that persists in for-profit managed care as an option.  A physician response to the new system of care, largely fostered by a refusal to accept Medicaid, is the formation of direct physician-patient contracted care without an intermediary.

In this respect, the problem is not simple, but is resolvable.  A proposal for improved economic stability has been prepared by Edward Ingram. A concern for American families and businesses is substantially addressed in a macroeconomic design concept, so that financial services like housing, government, and business finance, savings and pensions, boosting confidence at every level giving everyone a better chance of success in planning their personal savings and lifetime and business finances.

http://macro-economic-design.blogspot.com/p/book.html

Part 2 is a collection of scientific articles on the current advances in cardiac care by the best trained physicians the world has known, with mastery of the most advanced vascular instrumentation for medical or surgical interventions, the latest diagnostic ultrasound and imaging tools that are becoming outdated before the useful lifetime of the capital investment has been completed.  If we tie together Part 1 and Part 2, there is ample room for considering  clinical outcomes based on individual and organizational factors for best performance. This can really only be realized with considerable improvement in information infrastructure, which has miles to go.  Why should this be?  Because for generations of IT support systems, they are historically focused on billing and have made insignificant inroads into the front-end needs of the clinical staff.

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Atherosclerosis Independence: Genetic Polymorphisms of Ion Channels Role in the Pathogenesis of Coronary Microvascular Dysfunction and Myocardial Ischemia (Coronary Artery Disease (CAD))

Reviewer and Co-Curator: Larry H Bernstein, MD, FCAP

and

Curator: Aviva Lev-Ari, PhD, RN

Article XII Atherosclerosis Independence Genetic Polymorphisms of Ion Channels Role in the Pathogenesis of Coronary Microvascular Dysfunction and Myocardial Ischemia (Coronary Artery

Image created by Adina Hazan 06/30/2021

The role of ion channels in Na(+)-K(+)-ATPase: regulation of ion
transport across the plasma membrane has been studied by our Team in 2012 and 2013. This is article TWELVE in a 13 article series listed at the end of this article.

Chiefly, our sources of inspiration were the following:

1.            2013 Nobel work on vesicles and calcium flux at the neuromuscular junction

Machinery Regulating Vesicle Traffic, A Major Transport System in our Cells 

The 2013 Nobel Prize in Physiology or Medicine is awarded to Dr. James E. Rothman, Dr. Randy W. Schekman and Dr. Thomas C. Südhof for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells. This represents a paradigm shift in our understanding of how the eukaryotic cell, with its complex internal compartmentalization, organizes the routing of molecules packaged in vesicles to various intracellular destinations, as well as to the outside of the cell. Specificity in the delivery of molecular cargo is essential for cell function and survival. 

http://www.nobelprize.org/nobel_prizes/medicine/laureates/2013/advanced-medicineprize2013.pdf

Synaptotagmin functions as a Calcium Sensor: How Calcium Ions Regulate the fusion of vesicles with cell membranes during Neurotransmission

Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

http://pharmaceuticalintelligence.com/2013/09/10/synaptotagmin-functions-as-a-calcium-sensor-how-calcium-ions-regulate-the-fusion-of-vesicles-with-cell-membranes-during-neurotransmission/

2. Perspectives on Nitric Oxide in Disease Mechanisms

available on Kindle Store @ Amazon.com

http://www.amazon.com/dp/B00DINFFYC

http://pharmaceuticalintelligence.com/biomed-e-books/series-a-e-books-on-cardiovascular-diseases/perspectives-on-nitric-oxide-in-disease-mechanisms-v2/

3.            Professor David Lichtstein, Hebrew University of Jerusalem, Dean, School of Medicine

Lichtstein’s main research focus is the regulation of ion transport across the plasma membrane of eukaryotic cells. His work led to the discovery that specific steroids that have crucial roles, as the regulation of cell viability, heart contractility, blood pressure and brain function. His research has implications for the fundamental understanding of body functions, as well as for several pathological states such as heart failure, hypertension and neurological and psychiatric diseases.

Physiologist, Professor Lichtstein, Chair in Heart Studies at The Hebrew University elected Dean of the Faculty of Medicine at The Hebrew University of Jerusalem

Reporter: Aviva Lev-Ari, PhD, RN

http://pharmaceuticalintelligence.com/2013/12/18/physiologist-professor-lichtstein-chair-in-heart-studies-at-the-hebrew-university-elected-dean-of-the-faculty-of-medicine-at-the-hebrew-university-of-jerusalem/

4.            Professor Roger J. Hajjar, MD at Mount Sinai School of Medicine

Calcium Cycling (ATPase Pump) in Cardiac Gene Therapy: Inhalable Gene Therapy for Pulmonary Arterial Hypertension and Percutaneous Intra-coronary Artery Infusion for Heart Failure: Contributions by Roger J. Hajjar, MD

Aviva Lev-Ari, PhD, RN

http://pharmaceuticalintelligence.com/2013/08/01/calcium-molecule-in-cardiac-gene-therapy-inhalable-gene-therapy-for-pulmonary-arterial-hypertension-and-percutaneous-intra-coronary-artery-infusion-for-heart-failure-contributions-by-roger-j-hajjar/

5.            Seminal Curations by Dr. Aviva Lev-Ari on Genetics and Genomics of Cardiovascular Diseases with a focus on Conduction and Cardiac Contractility

Aviva Lev-Ari, PhD, RN

Aviva Lev-Ari, PhD, RN

Aviva Lev-Ari, PhD, RN and Larry H. Bernstein, MD, FCAP

Justin Pearlman, MD, PhD, FACC, Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN

Other related research by the Team of Leaders in Pharmaceutical Business Intelligence published on the Open Access Online Scientific Journal

http://pharmaceuticalintelligence.com

See References to articles at the end of this article on

  • ION CHANNEL and Cardiovascular Diseases

http://pharmaceuticalintelligence.com/?s=Ion+Channel

  • Calcium Role in Cardiovascular Diseases – The Role of Calcium Calmodulin Kinase  (CKCaII) and Ca(2) flux
  • Mitochondria and Oxidative Stress Role in Cardiovascular Diseases

Thus, the following article follows a series of articles on ion-channels and cardiac contractility mentioned, above. The following article is closely related to the work of Prof. Lichtstein.

These investigators studied the possible correlation between

  • Myocardial Ischemia (Coronary Artery Disease (CAD)) aka Ischemic Heart Disease (IHD) and
  • single-nucleotide polymorphisms  (SNPs) genes encoding several regulators involved in Coronary Blood Flow Regulation (CBFR), including
  • ion channels acting in vascular smooth muscle and/or
  • endothelial cells of coronary arteries.

They completely analyzed exon 3 of both KCNJ8 and KCNJ11 genes (Kir6.1 and Kir6.2 subunit, respectively) as well as

  • the whole coding region of KCN5A gene (Kv1.5 channel).
The work suggests certain genetic polymorphisms may represent a non-modifiable protective factor that could be used
  • to identify individuals at relatively low-risk for cardiovascular disease
  • an independent protective role of the
    • rs5215_GG against developing CAD and
    • a trend for rs5219_AA to be associated with protection against coronary microvascular dysfunction

Their findings are a lead into further investigations on ion channels and IHD affecting the microvasculature.

Role of genetic polymorphisms of ion channels in the pathophysiology of coronary microvascular dysfunction and ischemic heart disease

BasicResCardiol(2013)108:387   http//dx.dio.org/10.1007/s00395-013-0387-4

F Fedele1•M Mancone1•WM Chilian2•P Severino2•E Canali•S Logan•ML DeMarchis3•M Volterrani4•R Palmirotta3•F Guadagni3

1Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences,Sapienza University of Rome, UmbertoI Policlinic, Rome, Italy  e-mail:francesco.fedele@uniroma1.it
2Department of Integrative Medical Sciences, Northeastern Ohio Universities College of Medicine, Rootstown,OH
3Department of Advanced Biotechnologies and Bioimaging, IRCCS San Raffaele Pisana,Rome,It
4Cardiovascular Research Unit, Department of Medical Sciences, Centre for Clinical and Basic Research, Raffaele Pisana, Rome, Italy (CBFR)

BasicResCardiol(2013)108:387   http//dx.dio.org/10.1007/s00395-013-0387-4
This article is published with open access at Springerlink.com

Abstract

Conventionally,ischemic heart disease (IHD) study is equated with large vessel coronary disease (CAD). However, recent evidence has suggested

  • a role of compromised microvascular regulation in the etiology of IHD.

Because regulation of coronary blood flow likely involves

  • activity of specific ion-channels, and
  • key factors involved in endothelium-dependent dilation,

genetic anomalies of ion-channels or specific endothelial-regulators may underlie coronary microvascular disease.

We aimed to evaluate the clinical impact of single-nucleotide polymorphisms in genes encoding for

  • ion-channels expressed in the coronary vasculature and the possible
  • correlation with IHD resulting from microvascular dysfunction.

242 consecutive patients who were candidates for coronary angiography were enrolled. A prospective, observational, single-center study was conducted, 

  • analyzing genetic polymorphisms relative to

(1) NOS3 encoding for endothelial nitric oxide synthase (eNOS);
(2) ATP2A2 encoding for the Ca/H-ATP-ase pump (SERCA);
(3) SCN5A encoding for the voltage-dependent Na channel (Nav1.5);
(4) KCNJ8 and in KCNJ11 encoding for the Kir6.1and Kir6.2 subunits
of genetic K-ATP channels, respectively;and
(5) KCN5A encoding for the voltage-gated K channel (Kv1.5).

No significant associations between clinical IHD manifestations and

  • polymorphisms for SERCA, Kir6.1, and Kv1.5. were observed (p[0.05),

whereas specific polymorphisms detected in eNOS, as well as in Kir6.2 and Nav1.5 were found to be correlated with

  • IHD and microvascular dysfunction.

 Interestingly, genetic polymorphisms of ion-channels  seem to have an important clinical impact

  • influencing the susceptibility for microvascular dysfunction and (IHD,
  • independent of the presence of classic cardiovascular risk factors: atherosclerosis   

http//dx.dio.org/10.1007/s00395-013-0387-4

Keywords: Ion-channels, Genetic polymorphisms, Coronary microcirculation, Endothelium, Atherosclerosis Ischemic heart disease

 Introduction

Historically, in the interrogation of altered vascular function in patientswith ischemic heart disease (IHD), scientists have focused their attention on the correlation between

  • endothelial dysfunction and
  • atherosclerosis [11, 53, 6567].

The endothelium-independent dysfunction in coronary microcirculation and its possible correlations with  

  • atherosclerotic disease and
  • myocardial ischemia has not been extensively investigated.

In normal conditions, coronary blood flow regulation (CBFR) is mediated by several different systems, including

  • endothelial,
  • nervous,
  • neurohumoral,
  • myogenic, and
  • metabolic mechanisms [2, 10, 14, 15, 63, 64, 69].

Physiologic CBFR depends also on several ion channels, such as

  • ATP-sensitive potassium (KATP) channels,
  • voltage-gated potassium (Kv) channels,
  • voltage-gated sodium (Nav) channels, and others.

Ion channels regulate the concentration of calcium in both

  • coronary smooth muscle and endothelial cells, which
  • modulates the degree of contractile tone in vascular muscle and
  • the amount of nitric oxide that is produced by the endothelium

Ion channels play a primary role in the rapid response of both

  • the endothelium and vascular smooth muscle cells of coronary arterioles
  • to the perpetually fluctuating demands of the myocardium for blood flow
    [5, 6, 13, 18, 33, 45, 46, 51, 52, 61, 73, 75].

Despite this knowledge, there still exists an important gap about 

  • the clinical relevance and 
  • causes of microvascular dysfunction in IHD

By altering the overall

  • regulation of blood flow in the coronary system,
  • microvascular dysfunction could alter the normal distribution of shear forces in large coronary arteries

Proximal coronary artery stenosis could

  • contribute to microvascular dysfunction [29, 60]. But
  • ion channels play a critical role in microvascular endothelial
  • and smooth muscle function.

Therefore, we hypothesized  that alterations of coronary ion  channels could be the primary cause in a chain of events leading to

  • microvascular dysfunction and 
  • myocardial ischemia

independent of the presence of atherosclerosis.

Therefore, the objective of our study was to evaluate the possible correlation between

  • IHD and single-nucleotide polymorphisms  (SNPs) for genes encoding several regulators involved in CBFR, including
  • ion channels acting in vascular smooth muscle and/or
  • endothelial cells of coronary arteries.

Discussion

Implications of the present work. This study describes the possible correlation of polymorphisms in genes encoding for CBFR effectors (i.e., ion channels, nitric oxide synthase, and SERCA) with the susceptibility for microcirculation dysfunction and IHD.

Our main findings are as follows: (Group 3 – Normal Patients – anatomically and functionally normal coronary arteries).

  • In Group 3, the genotype distribution of SNP rs5215 (Kir6.2/KCNJ11) moderately deviates from the HW equilibrium (p = 0.05).
  • In Group 1 (CAD), the polymorphism rs6599230 of Nav1.5/SCN5A showed deviation from HW equilibrium (p = 0.017).
  • The genotypic distribution of rs1799983 polymorphism for eNOS/NOS3 is inconsistent with the HW equilibrium in groups 1, 2, and 3 (p = 0.0001, p = 0.0012 and p = 0.0001, respectively).

Haplotype analyses revealed that there is no linkage disequilibrium between polymorphisms of the analyzed genes. There was no significant difference in the prevalence of T2DM (p = 0.185) or dyslipidemia (p = 0.271) between groups, as shown in Table2. In regards to genetic characteristics, no significant differences between the three.

1. A marked HW disequilibrium in the genotypic distribution of rs1799983 polymorphism for eNOS/NOS3 was observed in all three populations. Moreover, this SNP seems to be an independent risk factor for microvascular dysfunction, as evidenced by multivariate analysis;
2. The SNPs rs5215_GG, rs5218_CT, and rs5219_AA for Kir6.2/KCJ11 could reduce susceptibility to IHD, since they were present more frequently in patients with anatomically and functionally normal coronary arteries;
3. In particular, with regard to rs5215 for Kir6.2/KCJ11, we observed a moderate deviation from the HW equilibrium in the genotypic
distribution in the control group. In addition, this genotype appears to be an independent protective factor in the development of IHD, as evidenced by multivariate analysis;
4. Furthermore, the trend observed for the SNP  rs5219_AA of Kir6.2/KCNJ11 may suggest an independent protective factor  in the development of coronary microvascular dysfunction
5. The rs1805124_GG genotype of Nav1.5/SCN5A seems to play a role against CAD;
6. No association seems to exist between the polymorphisms of SERCA/ATP2A2, Kir6.1/KCNJ8, and Kv1.5/KCNA5 and the presence of IHD;
7. All groups are comparable regarding the cardiovascular risk factors of T2DM and dyslipidemia, illustrating a potentially important implication of genetic polymorphisms in the susceptibility to IHD.

It is important to underline that the control group (Group 3) is a high-risk population, because of their cardiovascular risk factors

  • hypertension = 17 %,
  • T2DM = 34.1 %,
  • dyslipidemia = 41.4 %,

with an appropriate indication for coronary angiography, in accordance with current guidelines. Nevertheless, these patients were demonstrated to have both anatomically and functionally normal coronary arteries. Moreover, as shown in Tables 2 and 3, we observed that

  • rs5215_GG, rs5218_CT and rs5219_AA for Kir6.2/KCNJ11 had a higher prevalence in this group,compared to patients with CAD
  • and patients with microvascular dysfunction.

Moreover, as shown in Table 4, the presence of the rs5215_GG polymorphism for the Kir6.2 subunit was

  • inversely correlated with the prevalence of cardiovascular risk factors and CAD,whereas
  • rs5219_AA of the Kir6.2 subunit trended towards an inverse correlation with coronary microvascular dysfunction.

On the other hand, the SNP rs1799983_GT of eNOS was

  • confirmed to be an independent risk factor for microvascular dysfunction.

Our data suggest that the presence of certain genetic polymorphisms may represent a non-modifiable protective factor that could be used

  • to identify individuals at relatively low-risk for cardiovascular disease,
  • regardless of the presence of T2DM and dyslipidemia.

Current Clinical and Research Context

In normal coronary arteries, particularly the coronary microcirculation, there are several different mechanisms of CBFR, including

  • endothelial, neural, myogenic, and metabolic mediators [2, 8, 10, 12, 14, 15, 37, 55, 63, 64, 69].

In particular, endothelium-dependent vasodilation acts mainly via eNOS-derived nitric oxide (NO) in response to acetylcholine and shear stress.

  • NO increases intracellular cyclic guanosine monophosphate. It also causes vasodilation via
  • activation of both K-Ca channels and K-ATP channels.

Recent data suggested a pathophysiologically relevant role for the polymorphisms of eNOS/NOS3 in human coronary vasomotion [40–43]. Our data suggest that rs1799983_GT at exon 7 (Glu298Asp, GAG-GAT) of eNOS/NOS3 represents

  • an independent risk factor for coronary micro-vascular dysfunction, which agrees with a recent meta-analysis reporting an
  • association of this SNP with CAD in Asian populations [74]. In addition,
  • this SNP has been associated with endothelial dysfunction, although the mechanisms are not well defined [30].

Consistently, a recent study performed on 60 Indian patients with documented history of CAD reported a significantly higher frequency of rs1799983 (p.05) compared to control subjects, indicating that

  • variations in NOS3 gene may be useful clinical markers of endothelial dysfunction in CAD [54].
Interestingly, another association between rs1799983_GT and impaired collateral development has been observed in patientswith a

  • high-grade coronary stenosis or occlusion [19].
As is well known, the significance of the mechanisms of CBFR is partly determined by the location within the coronary vasculature. For instance, for vessels with a diameter of < 200 µm—which comprise the coronary microcirculation—metabolic regulation of coronary blood flow is considered the most important mechanism [24, 63]. Importantly, many of these mediators of metabolic regulation act through specific ion channels. In particular, in both coronary artery smooth muscle cells and endothelial cells
  • potassium channels determine the resting membrane potential (Em) and serve as targets of endogenous and therapeutic vasodilators [9, 27].
Several types of K+ channels are expressed in the coronary tree.
  • The K-ATP channels couple cell metabolic demand to conductance, via pore-forming (Kir6.1 and/or Kir6.2) subunits and regulatory
    [sulphonylurea-binding (SUR 1, 2A, or 2B)] subunits.
  • Kir6.x allows for channel inhibition by ATP, while SURx is responsible for channel activation by ADP and Mg2+.
K-ATP channel activation results in an outward flux of potassium and

  • consequent hyperpolarization, resulting in
  • voltage-gated calcium channel closure,
  • decreased Ca2+ influx, and ultimately
  • vasodilation [1, 5, 18, 20, 21, 33, 61, 62, 73, 75].

Our data do not support any significant difference regarding the Kir6.1 subunit of the K-ATP channel. On the other hand, this study suggests

  • an important role of specific SNPs for the Kir6.2 subunit (Tables 2, 3)—i.e., rs5215, rs5219, and rs5218—

in the susceptibility to IHD and microvascular dysfunction. These SNPs are among the most studied K-ATP channel polymorphisms, especially in the context of diabetes mellitus. In fact, in both Caucasian and Asian populations, these three SNPs as well as other genetic polymorphisms for the KCNJ11 gene have been associated with diabetes mellitus [34, 35, 44, 50, 57, 58, 70].

Nevertheless, the precise

  • structure–function impacts of the various amino acid substitutions remain unclear.

The rs5215 and rs5219 polymorphisms, also known as I337V and E23K, respectively, are highly linked with reported

  • concordance rates between 72 and 100 % [22, 23, 56].

The high concordance between rs5219 and rs5215 suggests that these polymorphisms

  • may have originated in a common ancestor, further indicating a
  • possible evolutionary advantage to their maintenance in the general population [49].

In our study, multivariate analysis suggests both an independent protective role of the

  • rs5215_GG against developing CAD and
  • a trend for rs5219_AA to be associated with protection against coronary microvascular dysfunction (Table 4a, b).
  • The variant rs5215_GG is a missense SNP located in the gene KCNJ11 at exon 1009 (ATC-GTC) and results in
    the substitution of isoleucine (I) residue with valine (V) [23].

Future studies are necessary to better understand the influence of this single amino acid variant on the function of the channel.

In humans, vasodilation of the coronary microvasculature in response to hypoxia and K-ATP channel opening
  • are both impaired in diabetes mellitus [39].
It is also described that gain-of-function mutations of the KCNJ11 gene cause neonatal diabetes mellitus, and loss-of-function mutations lead to congenital hyperinsulinism [43]. Our study is not discordant with previous studies about the correlation of SNPs of the Kir6.2 subunit and diabetes mellitus. Rather, our findings show that these SNPs are correlated with anatomically and functionally normal coronary arteries,
  • independent of the presence of either diabetes mellitus or dyslipidemia.
These data suggest the possibility that these particular SNPs may identify individuals with decreased risk for coronary microcirculatory dysfunction and IHD,
  • regardless of the presence of T2DM and/or dyslipidemia.

However, further studies are necessary to confirm these findings. In this context, to better investigate the implications of genetic variation in the K-ATP channel,

  • future studies should include ion channel’s functional modification due to the SNPs and analysis of SUR subunits.

More than 40-kV channel subunits have been identified in the heart, and sections of human coronary smooth muscle cells demonstrate Kv1.5 immunoreactivity [16, 17, 27, 38]. Through constant regulation of smooth muscle tone, Kv channels contribute to the control of coronary microvascular resistance [4, 7]. Pharmacologic molecules that inhibit Kv1.5 channels such as

  • pergolide [25],
  • 4-amino-pyridine [32], and
  • correolide [17]

lead to coronary smooth muscle cell contraction and block the coupling between

  • cardiac metabolic demand and
  • coronary blood flow.

However, no significant differences were identified between the study groups in terms of the particular polymorphisms for Kv1.5 that were analyzed in this study. Expression of

  • the voltage-dependent Na+ channel (Nav) has been demonstrated in coronary microvascular endothelia cells [3, 66].

Our analysis reveals a possible implication of the polymorphism rs1805124_GG for Nav1.5 channel with the presence of anatomically and functionally normal coronary arteries. This SNP leads to a homozygous 1673A-G transition, resulting in a His558-to-Arg (H558R) substitution. It is important to underline that

  • our data are the first to correlate the polymorphism rs1805124_GG with IHD.

Further research is necessary to confirm the observed implication.

Finally, we have analyzed the sarco/endoplasmic reticulum calcium transporting Ca2+-ATPase (SERCA), which is fundamental in the regulation of intracellular Ca2+ concentration [6].

SERCA is an intracellular pump that

  • catalyzes the hydrolysis of ATP coupled with the
  • translocation of calcium from the cytosol into the lumen of the sarcoplasmic reticulum.

Although this pump plays a critical role in regulation of the contraction/relaxation cycle, our analysis did not reveal any apparent association between

  • genetic variants of SERCA and the
  • prevalence of microvascular dysfunction or IHD.

Conclusions

This pilot study is the first to compare the prevalence of SNPs in genes encoding coronary ion channels between patients
  • with CAD or microvascular dysfunction and those with both anatomically and functionally normal coronary arteries.
Taken together, these results suggest the possibility of associations between SNPs and IHD and microvascular dysfunction, although

  • the precise manners by which specific genetic polymorphisms affect ion channel function and expression
have to be clarified by further research involving larger cohorts.

Limitations and future perspectives

Notable limitations of this pilot study are as follows:

1. Due to the lack of pre-existing data, the power calculation was performed in advance on the basis of assumptions of allele frequencies and the population at risk.
2. The sample size for each group is small, mainly due to both the difficulty in enrolling patients with normal coronary arteries and normal microvascular function (group 3) and the elevated costs of the supplies such as Doppler flow wires.
3. There is a lack of ethnic diversity of our cohort.
4. Currently, there is an absence of supportive findings in another independent cohort or population. However, our pilot study included patients within a well-defined, specific population and was aimed to identify the presence of statistical associations between selected genetic polymorphisms and the prevalence of a specific disease.
5. There is a lack of functional characterization of the described genetic polymorphisms.
6. We have not identified any correlation between novel SNPs and IHD. Nevertheless, we completely analyzed exon 3 of both KCNJ8 and KCNJ11 genes (Kir6.1 and Kir6.2 subunit, respectively) as well as the whole coding region of KCN5A gene (Kv1.5 channel).  Moreover, we examined previously described SNPs since there are no data in the literature regarding the possible association of the prevalences of those polymorphisms in the examined population.More extensive studies are necessary to confirm our  findings, possibly with a larger number of patients. Future investigations are also required to confirm the roles of ion  channels in the pathogenesis of coronary microvascular dysfunction and IHD. These studies should involve analysis of both other subunits of the K-ATP channels

  • sulfonylurea receptor, SURx and further coronary ion channels (e.g., calcium-dependent K channels), as well as
  • in vitro evaluation of ion channel activity by patch clamp and analysis of channel expression in the human cardiac tissue.

Moreover, to better address the significance of microvascular dysfunction in IHD, it could be interesting to analyze

  • typical atherosclerosis susceptibility genes (e.g., PPAP2B, ICAM1, et al.).

Methods

In this prospective, observational, single-center study – 242 consecutive patients admitted to our department were enrolled with

  • the indication to undergo coronary angiography .

All patients matched inclusion criteria

  1. age [18];
  2. suspected or documented diagnosis of acute coronary syndrome or stable angina
  3. with indication(s) for coronary angiography, in accordance with current guidelines [36, 68], and
  4. the same ethno-geographic Caucasian origin) and

Exclusion Criteria

  1. previous allergic reaction to iodine contrast,
  2. renal failure,
  3. simultaneous genetic disease,
  4. cardiogenic shock,
  5. non- ischemic cardiomyopathy

All patients signed an informed consent document  –

prior to participation in the study, which included

  • acknowledgement of the testing procedures to be performed
    (i.e., coronary angiography; intracoronary tests; genetic analysis, and processing of personal data).

The study was approved by the Institution’s Ethics Committee.
All clinical and instrumental characteristics were collected in a dedicated  database.

 Study Design

(a)  Standard therapies were administered, according to current guidelines [36, 68].
(b) An echocardiography was performed before and after coronary angiography
(c)  Coronary angiography was performed using radial artery or femoral artery
Judkins approach via sheath insertion.
(d) In patients showing normal epicardial arteries, intracoronary functional tests
were performed through Doppler flow wire to evaluate

  1. both endothelium-dependent microvascular function
    [via intracoronary (IC) infusion of acetylcholine (2.5–10 lg)] and
  2. nonendothelium-dependent microvascular function
    [via IC infusion of adenosine (5 lg)] [31]. 

(e) In all enrolled patients, a peripheral blood sample for genetic analysis was taken. 

On the basis  of the  coronary angiography and the intracoronary functional tests, 

  • the 242 patients were divided into three groups (see also Fig. 1).
  1. Group 1: 155 patients with anatomic coronary alteration
    (comprising patients with acute coronary syndrome and chronic stable angina).

    • microvascular dysfunction defined as coronary flow reserve (CFR) \ 2.5
    • after IC infusion of acetylcholine and adenosine].
  2. Group 2: 46 patients with functional coronary alteration
    [normal coronary arteries as assessed by angiography, and

    • as assessed by angiography and with normal functional tests
      (CFR C 2.5 after intracoronary infusion of acetylcholine and adenosine) (Fig. 1).
  3. Group 3: 41 patients with anatomically and functionally normal coronary arteries

 

BRC 2013 fedele genetic polymorphisms of ion channels.pdf_page_2

Fig. 1 Study design: 242 consecutive not randomized patients matching inclusion and exclusion criteria were enrolled.
In all patients, coronary angiography was performed, according to current ESC/ACC/AHA guidelines. In patients with
angiographically normal coronary artery, intracoronary functional tests were performed. In 242 patients
(155 with coronary artery disease, 46 patients with micro-vascular dysfunction, endothelium and/or non-endothelium
dependent, and 41 patients with anatomically and functionally normal coronary arteries) genetic analysis was performed.

Genetic Analysis

In conformity with the study protocol, ethylenediaminetetraacetic acid (EDTA) whole blood samples were collected according
to the international guidelines reported in the literature [48]. Samples were transferred to the Interinstitutional Multidisciplinary
BioBank (BioBIM) of IRCCS San Raffaele Pisana (Rome) and stored at -80 C until DNA extraction. Bibliographic research by
PubMed and web tools OMIM (http://www.ncbi.nlm.nih.gov/omim), Entrez SNP (http://www.ncbi.nlm.nih.gov/snp), and
Ensembl (http://www.ensembl.org/index.html) were used to select variants of genes involved in signaling pathways

  • related to ion channels and/or reported to be associated with
  • microvascular dysfunction and/or myocardial ischemia and/or
  • diseases correlated to IHD, such as diabetes mellitus.
Polymorphisms for the following genes were analyzed:
  1. NOS3 (endothelial nitric oxide synthase, eNOS),
  2. ATP2A2 (Ca2+/H+-ATPase pump, SERCA2),
  3. SCN5A (voltage-dependent Na+ channel,
  4. Nav1.5),
  5. KCNJ11 (ATP-sensitive K+ channel, Kir6.2 subunit),
  6. KCNJ8 (ATP-sensitive K+ channel, Kir6.1 subunit) and
  7. KCNA5 (voltage-gated K+ channel, Kv1.5).

In particular, we completely analyzed by direct sequencing

  • exon 3 of KCNJ8 (Kir6.1 subunit), which includes eight SNPs, as well as
  • the whole coding region of KCNA5 (Kv1.5 channel), which includes 32 SNPs and
  • four previously described variants [26, 47, 71, 72].
We also examined
  • the whole coding region of KCNJ11 (Kir6.2 subunit), for which sequence variants are described [26, 28].

All SNPs and sequence variants analyzed—a total of 62 variants of 6 genes—are listed in Table 1.

BRC 2013 fedele genetic polymorphisms of ion channels_page_004
BRC 2013 fedele genetic polymorphisms of ion channels_page_005

DNA was isolated from EDTA anticoagulated whole blood using the MagNA Pure LC instrument and theMagNA Pure LC
total DNA isolation kit I (Roche Diagnostics, Mannheim, Germany) according to the manufacturer’s instructions. Standard
PCR was performed in a GeneAmp PCR System 9700 (Applied Biosystems, CA) using HotStarTaq Master Mix
(HotStarTaq Master Mix Kit, QIAGEN Inc, CA). PCR conditions and primer sequences are listed in Table 1.

In order to exclude preanalytical and analytical errors, all direct sequencing analyses were carried out on both
strands using Big Dye Terminator v3.1 Cycle Sequencing kit
(Applied Biosystems), run on an ABI 3130
Genetic Analyzer (Applied Biosystems), and repeated on PCR products obtained from new nucleic acid extractions.
All data analyses were performed in a blind fashion.

Statistical Analysis

This report, intended as pilot study, is the first to compare

  • the prevalence of SNPs in genes encoding  several effectors (including ion channels)
  • involved in CBFR between these groups of patients.

No definite sample size could be calculated to establish a power analysis. groups of patients. However, assuming

  • a 15 % prevalence of normal  macrovascular and microvascular coronary findings in unselected patients
    undergoing coronary angiography,

we estimated that

  • a sample size of at least 150 patients could enable the computation of two-sided 95 % confidence intervals for
    • such prevalence estimates ranging between -5.0 and + 5.0 %.

The significance of the differences of observed alleles and genotypes between groups, as well as

  • analysis of multiple inheritance models for SNPs were also tested
    (co-dominant, dominant, recessive, over-dominant and log-additive)
  • using a free web-based application (http://213. 151.99.166/index.php?module=Snpstats)
  • designed from a genetic epidemiology  point of view to analyze association studies.

Akaike Information Criterion (AIC) was used to determine the best-fitting inheritance model for analyzed SNPs,

  • with the model with the lowest AIC reflecting the best balance of  goodness-of-fit and parsimony.

Moreover,  the allelic frequencies were estimated by gene counting, and the genotypes were scored. For each gene,

  • the observed numbers of each genotype were compared with those expected for a population in Hardy–Weinberg (HW) equilibrium
  • using a free web-based application  (http://213.151.99.166/index.php?module=Snpstats) [59].

Linkage disequilibrium coefficient (D0) and  haplotype analyses were assessed using  the  Haploview 4.1 program.
Statistical analysis was performed using SPSS software package for Windows v.16.0 (SPSS Inc., Chicago, IL).

All categorical variables are expressed as percentages, and all continuous variables as mean ± standard deviation.
Differences between categorical variables

  • were analyzed by Pearson’s Chi-SQ test.

Given the presence of three groups, differences  between continuous variables, were calculated using
(including the number of SNPs tested),

  • one-way ANOVA; a post-hoc analysis with Bonferroni correction was made for multiple comparisons.

Univariate and multivariate logistic regression analyses

  • the independent impact of genetic polymorphisms on
    • coronary artery disease and microvascular dysfunction,

were performed to assess the independent impact of

  • genetic polymorphisms on coronary artery disease
    and microvascular dysfunction
    ,

while adjusting for other confounding variables.  The following parameters were entered into the model:

  • age,
  • male gender,
  • type 2 diabetes mellitus (T2DM),
  • systemic arterial hypertension,
  • dyslipidemia,
  • smoking status, and
  • family history of myocardial infarction (MI).

Only variables with a p value < 0.10 after univariate analysis were entered

  • into the multivariable model as covariates.

A two-tailed p < 0.05 was considered statistically significant.

Definition of Cardiovascular Risk Factors

Patients were classified as having T2DM if they had

  • fasting levels of glucose of >126 mg/dL in two separate measurements or
  • if they were taking hypoglycemic drugs.

Systemic arterial hypertension was defined as

  • systolic blood pressure  > 140 mmHg / diastolic blood pressure > 90 mmHg
  • in two separate measurements or
  • if the patient was currently taking antihypertensive drugs.

Dyslipidemia was considered to be present if

  • serum cholesterol levels were>220 mg/dL or
  • if the patient was being treated with cholesterol-lowering drugs.

Family history of MI was defined as a first-degree relative with MI before the age of 60 years.

Results

Sixty-two polymorphisms distributed among six genes coding for
  • nitric oxide synthase,
  • the SERCA pump, and
  • ion channels
    • were screened for sequence variations using PCR amplification and
    • direct DNA sequencing analysis

in the population of

  • 155 patients with CAD (group 1),
  • 46 patients with microvascular dysfunction (group 2), and
  • 41 patients with normal coronary arteries and
    • normal endothelium dependent and endothelium-independent vasodilation (group 3).
In Group 3, the genotype distribution of

  • SNP rs5215 (Kir6.2/KCNJ11) moderately deviates from the HW equilibrium (p = 0.05).
In Group 1 (CAD), the polymorphism

  • rs6599230 of Nav1.5/SCN5A showed deviation from HW equilibrium (p = 0.017).
The genotypic distribution of groups in terms of polymorphisms for
  • eNOS/NOS3, SERCA/ATP2A2, Nav1.5/SCN5A, Kir6.1/KCNJ8, or Kv1.5/KCNA5
were noticed. However, significant differences (p.05) for the SNPs
  • rs5215_GG, and
  • rs5219_AA of Kir6.2/KCNJ11 were observed,
as shown in Table 2. 

Table 3 displays 
significant differences between normal subjects (group 3) and
  • patients with either CAD (group 1) or microvascular dysfunction (group 2).

BRC 2013 fedele genetic polymorphisms of ion channels_page_006

When correcting for other covariates as risk factors, the rs5215_GG genotype of Kir6.2/KCNJ11 was found to be 

  • significantly associated with CAD after multivariate analysis (OR = 0.319, p = 0.047, 95 % CI = 0.100–0.991), evidencing
  • a ‘‘protective’’ role of this genotype, as shown in Table 4a.

Similarly, a trend that supports this role of Kir6.2/KCNJ11 was also observed

  • in microvascular dysfunction for rs5219 AA. In contrast,
  • rs1799983_GT for eNOS/NOS3 was identified as an independent risk factor

following multivariate analysis (Table 4b), which agrees with literature findings as described below. 

BRC 2013 fedele genetic polymorphisms of ion channels_page_007

SOURCE for TABLES

BasicResCardiol(2013)108:387   http//dx.dio.org/10.1007/s00395-013-0387-4

Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest.
Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

REFERENCES

1. Alekseev AE, Hodgson DM, Karger AB, Park S, Zingman LV, Terzic A (2005) ATP-sensitive K? channel channel/enzyme multimer: metabolic gating in the heart. J Mol
Cell Cardiol 38:895–905. doi:10.1016/j.yjmcc.2005.02.022
2. Baumgart D, Naber C, Haude M, Oldenburg O, Erbel R, Heusch G, Siffert W (1999) G protein beta3 subunit 825T allele and enhanced coronary vasoconstriction on
alpha(2)-adrenoceptor activation. Circ Res 85:965–969. doi:10.1161/01.RES.85.10.965
3. Belardinelli L, Shryock JC, Fraser H (2006) Inhibition of the late sodium current as a potential cardioprotective principle: effects of the late sodium current inhibitor
ranolazine. Heart 92:6–14. doi:10.1136/hrt.2005.078790
4. Berwick ZC, Moberly SP, Kohr MC, Morrical EB, Kurian MM, Dick GM, Tune JD (2012) Contribution of voltage-dependent K+ and Ca2+ channels to coronary pressure-
flow autoregulation. Basic Res Cardiol 107:264. doi:10.1007/s00395-012-0264-6
5. Brayden JE (2002) Functional roles of KATP channels in vascular smooth muscle. Clin Exp Pharmacol Physiol 29:312–316. doi:10.1046/j.1440-1681.2002.03650.x
6. Brini M, Carafoli E (2009) Calcium pumps in health and disease. Physiol Rev 89:1341–1378. doi:10.1152/physrev.00032.2008
7. Chen TT, Luykenaar KD, Walsh EJ, Walsh MP, Cole WC (2006) Key role of Kv1 channels in vasoregulation. Circ Res 99:53–60. doi:10.1161/01.RES.0000229654.45090.57
8. Cohen KD, Jackson WF (2005) Membrane hyperpolarization is not required for sustained muscarinic agonist-induced increases in intracellular Ca2+ in arteriolar endothelial
cells. Microcirculation 12:169–182. doi:10.1080/10739680590904973
9. Daut J, Maier-Rudolph W, von Beckerath N, Mehrke G, Gu¨nter K, Goedel-Meinen L (1990) Hypoxic dilation of coronary arteries is mediated by ATP-sensitive potassium
channels. Science 247:1341–1344. doi:10.1126/science.2107575
10. Davidson SM, Duchen MR (2007) Endothelial mitochondria: contributing to vascular function and disease. Circ Res 100:1128–1141. doi:10.1161/01.RES.0000261970.18328.1d
…. 75

SOURCE for References 1-75

Basic Res Cardiol (2013) 108:387   http://dx.doi.org/10.1007/s00395-013-0387-4

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Physiologist, Professor Lichtstein, Chair in Heart Studies at The Hebrew University elected Dean of the Faculty of Medicine at The Hebrew University of Jerusalem

Reporter: Aviva Lev-Ari, PhD, RN

Professor David Lichtstein Elected Dean of Hebrew University’s Faculty of Medicine

December 2, 2013

Jerusalem — Professor David Lichtstein has been elected dean of the Faculty of Medicine at The Hebrew University of Jerusalem. Professor Lichtstein is the Walter & Greta Stiel Chair in Heart Studies at The Hebrew University. He replaces Professor Eran Leitersdorf, who recently completed his four-year term as dean.

According to Professor Lichtstein, “The Hebrew University’s Faculty of Medicine is devoted to creating innovative teaching, research and patient care programs that will meet the demands of 21st century health care. As global health care moves towaProfessor David Lichtsteinrd prevention, wellness and cost effectiveness, we are adapting how we train the next generation of physicians, nurses, pharmacists and biomedical researchers. Through fruitful collaborations between preclinical and clinical faculty, we are also translating basic biomedical insights into clinical treatments. Thus, the Faculty of Medicine is well-positioned to maintain its leading role in the scientific community of Israel and the world.”

Professor Lichtstein was born in Lodz, Poland, and immigrated to Israel with his family in 1957. As a student at The Hebrew University, he completed a Bachelor’s degree in Physiology and Zoology in 1970, followed by a Master’s degree in Physiology in 1972 and a Ph.D. in Physiology in 1977. He joined the Department of Physiology of The Hebrew University-Hadassah Medical School in 1980 as a lecturer, and received full professorship in 1994. Prof. Lichtstein has held many roles at The Hebrew University and its Faculty of Medicine, including Chairman of the Neurobiology Teaching Division, Chairman of the Department of Physiology, Chairman of the Institute for Medical Sciences and, until recently, Chairman of the Faculty of Medicine. From 2007 to 2011, Professor Lichtstein was the Jacob Gitlin Chair in Physiology at The Hebrew University. In 2011 he was named the Walter & Greta Stiel Chair in Heart Studies at The Hebrew University. He also served as the President of the Israel Society for Physiology and Pharmacology from 1996 to 1999.

From 1977-1979 Professor Lichtstein was a Postdoctoral Fellow at the Roche Institute of Molecular Biology in New Jersey. He was a visiting scientist at the National Institute of Child Health and Human Development (1985-1986) and the Eye Institute (1997-1998) at the National Institutes of Health in Maryland, and a visiting professor at the Toledo School of Medicine in Ohio (2007).

Professor. Lichtstein’s main research focus is the regulation of ion transport across the plasma membrane of eukaryotic cells. His work led to the discovery that specific steroids that were known to be present in plants and amphibians are actually normal constituents of the human body and have crucial roles, such as the regulation of cell viability, heart contractility, blood pressure and brain function. His research has implications for the fundamental understanding of body functions, as well as for several pathological states such as heart failure, hypertension and neurological and psychiatric diseases.

SOURCE

http://www.afhu.org/professor-david-lichtstein-elected-dean-hebrew-universitys-faculty-medicine

Field of Study

Regulation of ion transport across the plasma membrane:
The primary focus of the research in my laboratory is the regulation of ion transport across the plasma membrane of eukaryotic cells. In particular, we study the main transport system for sodium and potassium, the sodium-potassium-ATPase, and its regulation by cardiac steroids.
Specific areas of interest:
Identification of endogenous cardiac steroids in mammalian tissue; The biological consequences of the interaction of cardiac steroids with the sodium-potassium-ATPase; Biosynthesis of the cardiac steroids in the adrenal gland; Effects of endogenous sodium-potassium-ATPase inhibitors on cell differentiation; Determination of the levels of endogenous sodium-potassium-ATPase inhibitors in pathological states, including hypertension, preeclampsia; malignancies (cancer) and manic depressive illnesses; Involvement of the sodium-potassium–ATPase/cardiac steroids system in depressive disorders; Involvement of the sodium-potassium-ATPase/cardiac steroids system in cardiac function; Involvement of intestinal signals in the regulation of phosphate homeostasis; Volume regulation and its involvement in the mitogenic response.
Cardiac Steroids and the Na+, K+-ATPase and Cardiac Steroids
Cardiac steroids, such as ouabain, digoxin and bufalin are hormones synthesized by and released from the adrenal gland and the hypothalamus. These compounds, the structure of which resembles that of plant and amphibian and butterfly steroids, interact only with the plasma membrane Na+, K+-ATPase (Figure 1). This interaction elicits numerous specific biological responses affecting the function of cells and organs.
Topics Currently under investigation include
Cardiac Steroids
  • Ouabain
  • Bufalin
  • Dogoxin
Involvement of the sodium-potassium–ATPase/cardiac steroids system in depressive disorders
Depressive disorders, including major depression, dysthymia and bipolar disorder, are a serious and devastating group of diseases that have a major impact on the patients’ quality of life, and pose a significant concern for public health. The etiology of depressive disorders remains unclear. The Monoaminergic Hypothesis, suggesting that alterations in monoamine metabolism in the brain are responsible for the etiology of depressive disorders, is now recognized as insufficient to explain by itself the complex etiology of these diseases. Data from our and other laboratories has provided initial evidence that endogenous cardiac steroids and their only established receptor, the Na+, K+-ATPase, are involved in the mechanism underlining depressive disorders, and BD in particular. Our study (Biol. Psychiatry. 60:491-499, 2006) has proven that Na+, K+-ATPase and DLC are involved in depressive disorders particularly in manic-depression. We have also shown that specific genetic alterations in the Na+, K+-ATPase α isoforms are associated with bipolar disorders (Biol. Psychiatry, 65:985-991, 2009). Our recent study in this project (Eur. Neuropsychopharmacol. 22:72-729, 2012) showed that drugs affecting the Na+, K+-ATPase/cardiac steroids system are beneficial for the treatment of depression. Hence our work is in accordance to the proposition that mal functioning of the Na+, K+-ATPase/cardiac steroids system may be involved in manifestation of depressive disorders and identify new compounds as potential drug for the treatment of these maladies.
Involvement of the sodium-potassium-ATPase/cardiac steroids system in cardiac function
The classical and best documented effect of cardiac steroids, as their name implies, is to increase the force of contraction of heart muscle. Indeed, cardiac steroids were widely used in Western and Eastern clinical practices for the treatment of heart failure and atrial fibrillation. Despite extensive research, the mechanism underlying cardiac steroids actions have not been fully elucidated. The dogmatic explanation for cardiac steroids-induced increase in heart contractility is that the inhibition of Na+, K+-ATPase by the steroids causes an increase in intracellular Na+ which, in turn, attenuates the Na+/Ca++ exchange, resulting in an increased intracellular Ca++ concentration, and hence greater contractility. However, recent observations led to the hypothesis that the ability of cardiac steroids to modulate a number of intracellular signaling processes may be responsible for both short- and long-term changes in CS action on cardiac function. We are addressing this hypothesis using the zebrafish model and our ability to quantify heart function in-vivo. Heart contractility measurements were performed using a series of software tools for the analysis of high-speed video microscopic images, allowing the determination of ventricular heart diameter and perimeter during both diastole and systole. The ejection fraction (EF) and fractional area changes (FAC) were calculated from these measurements, providing two independent parameters of heart contractility (see attached movie bellow). We are currently testing the effect of cardiac steroids in the presence and absence of intracellular signaling pathways (MAP, AKT, IP3R) inhibitors. Reduction in the steroids ability to increase the force of contraction will serve as the first evidence, in-vivo, for the participation of the signaling processes in the molecular mechanisms responsible for the action of cardiac steroids on heart muscle.
Laboratory Techniques
We employ a broad range of preparations and techniques. These include isolated organs (arterial rings, smooth and cardiac muscle strips) and isolated nerve endings, as well as primary and established tissue-cultured cells. Our studies involve the application of biochemical and immunological techniques (transport and enzymatic activity measurements, RIA, ELISA), molecular biological techniques (e.g., Western and Northern blotting, and PCR), protein purification (HPLC), cellular techniques muscle contractility, cell proliferation and differentiation’ in-vivo measurements of heart contractility and blood flow in Zebrafish and behavior measurements in rodents.

Biography

Education
1970
B.Sc. in Physiology and Zoology, The Hebrew University, Jerusalem, Israel
1970-1972 M.Sc. in Physiology, Department of Physiology, The Hebrew University, Hadassah Medical School, Jerusalem, Israel.
1973-1977
Ph.D., Department of Physiology, Hebrew University Hadassah Medical School, Jerusalem, Israel. (Thesis: “Increased Production of Gamma Aminobutyryl choline in Cerebral Cortex Caused by Afferent Electrical Stimulation” (Thesis Advisors: Prof. J. Dobkin and Prof. J. Magnes).
1977-1979
Postdoctoral Fellow, Department of Physiological Chemistry and Pharmacology, Roche Institute of Molecular Biology, Nutley, New Jersey, U.S.A.
Positions held

1970-1972
Teaching and Research Assistant, Department of Physiology, The Hebrew University, Hadassah Medical School, Jerusalem, Israel
1972-1974 Assistant Instructor, Department of Physiology, The Hebrew University, Hadassah Medical School, Jerusalem, Israel
1975-1977 Instructor, Department of Physiology, The Hebrew University, Hadassah Medical School, Jerusalem, Israel
1977-1979
Postdoctoral Fellow, Department of Physiological Chemistry and Pharmacology, Roche Institute of Molecular Biology, Nutley, New Jersey, U.S.A.
1979-1983
Lecturer, (REVSON fellowship) Department of Physiology, The Hebrew University, Hadassah Medical School, Jerusalem, Israel
1981 (summer)
Visiting Scientist, Department of Physiological Chemistry and Pharmacology, Roche Institute of Molecular Biology, Nutley, New Jersey, USA
1983-1987 Senior Lecturer, Department of Physiology, The Hebrew University Hadassah Medical School, Jerusalem, Israel.
1985-1986
Visiting Scientist, Laboratory of Theoretical and Physical Biology, NICHD, National Institutes of Health, Bethesda, Maryland, USA
1988-1994 Associate Professor, Department of Physiology, The Hebrew University Hadassah Medical School, Jerusalem, Israel
1994-present Professor of Physiology, Department of Physiology, The Hebrew University Hadassah Medical School, Jerusalem, Israel
1997-1998 Visiting Scientist, Laboratory of Mechanisms of Ocular Diseases, NEI, National Institutes of Health, Bethesda, Maryland, USA
2007 (summer)
Visiting Professor, Department of Physiology, Pharmacology, Metabolism and cardiovascular Sciences, Medical Center University of Toledo, Toledo, Ohio, USA
2007-2011 Jacob Gitlin Chair in Physiology, The Hebrew University, Jerusalem, Israel
2011-present ​Walter & Greta Stiel Chair in Heart Studies, The Hebrew University, Jerusalem
Professional Membership
1979-present International Society of Neurochemistry
1979-present Israel Society for Physiological and Pharmacological
1980-present Society of Neurosciences (Europe)
1986-present The American Society of Hypertension
1992-present Israeli Society for Neurosciences
1999-present The American Physiological Society
Editorial Tasks
Serving as a Reviewer for the scientific journals:
American Journal of Hypertension Journal of Neural Transmission
American Journal of Physiology Journal of Neurochemistry
Apoptosis Journal of Pharmacology and Experimental Therapeutics
Biochemical and Biophysical Research Communications Life Sciences
Basic Journal of Physiology and Pharmacology NANO
Brain Research Neurochemistry International
Bioconjugate Chemistry Neuroscience
Cell Calcium Neurotoxicity Research
Clinical Science Pathophysiology
Endocrinology Physiology and Behavior
European Neuropsychopharmacology PNAS
General and Comparative Endocrinology Psychiatry Research
Hypertension Translational Research
Journal of Cell Sciences
University and Other Activities
1982-1985 Chairman of the Neurobiology Teaching Division, The Hebrew University, Jerusalem
1988-1994 Elected representative of the Senior Lecturers and Associate Professors for the University Senate
1989-1997 Member of the admission committee of the Medical School, The Hebrew University, Jerusalem
1990-1996 Member of the Committee for cellular biology of the graduate studies, The Hebrew University, Jerusalem
1992-1996 Member of the Teaching Committee, Faculty of Medicine, The Hebrew University, Jerusalem
1992-1996
Chairman, Department of Physiology, The Hebrew University, Hadassah Medical School, Jerusalem
1994-1997 Member of the Committee for graduate studies, The Hebrew University, Jerusalem
1992-2002
Member of the Management Committee of The Institute for Medical Sciences, Faculty of Medicine, The Hebrew University, Jerusalem
1996-1999
President of the Israel Society for Physiology and Pharmacology
1998- 2002 Chairman, Institute of Medical Sciences, The Hebrew University, Hadassah Medical School, Jerusalem
1999-2002 Member of the Planning and Development Committee of the Faculty of Medicine, The Hebrew University, Jerusalem
2007–Present Elected representative of the Professors for the executive University Senate
2008-2012 Member of the Planning and Development Committee of the Faculty of Medicine, The Hebrew University, Jerusalem
2008-2012 Chairman, Institute for Medical Research Israel-Canada, The Hebrew University, Hadassah Medical School, Jerusalem
2009 – Present Elected member of the Senate to the Executive Committee of the Hebrew University

PUBLICATIONS 2006 – 2012

Search By:  Author Abeles, M Abramovitch, R Allweis, C Altuvia, S Amedi, A Amster-Choder, O Anglister, L Aqeilan, RI Aronovitch, Y Bachrach, U Baniyash, M Barak, V Barenholz, Y Bar-Shalita, T Bar-Shavit, R Bar-Shavit, Z Bar-Tana, J Becker, Y Behar, O Ben-Ishay, Z Benita, S Ben-Neriah, Y Benny, O Ben-Or, S Ben-porath, I Ben-Sasson, S Ben-Sasson, SZ Ben-Shaul, Y Ben-Yehuda, S Bercovier, H Berger, M Bergman, H Bergman, Y Berry, E Bialer, M Binshtok, AM Blum, G Brandes, R Brautbar, C Breuer, E Cedar, H Chevion, M Chinitz, D Citri, N Cohen, A Cohen, E Deutsch, J Dikstein, S Domb, A Dor, Y Dror, OE Dzikowski, R Elkin, M Engelberg-Kulka, H Even-Ram, S Eyal, S Fainsod, A Feintuch, U Friedlander, y Friedman, M Gallily, R Gatt, S Gerlitz, O Gertz, SD Gibson, D Glaser, G Goelman, G Goldberg, I Goldberg, JA Goldblum, A Golenser, J Golomb, G Golos, A Gordon, A Gorinstein, S Gorodetsky, R Granot, Z Greenblatt, CL Greenwald, T Gross, E Grover, N Gutman, Y Hahn-Markowitz, J Hamburger, J Hanani, M Hanski, E Hartman-Maeir, A Hellman, A Hochner, H Hoffman, A Honigman, A Horowitz, M Ilani, A Inbal, A Jaffe, CL Jarrous, N Kaempfer, R Kalcheim, C Kanner, BI Kapitulnik, J Karni, R Katz, E Katzav, S Katz-Brull, R Katzhendler, J Kedar, E Keren, N Keshet, E Klar, A Kohen, R Konijn, A Kotler, M Langer, D Laskov, R Lazarovici, P Levi-Schaffer, F Lev-Tov, A Lichtstein, D Liebergall, M Lorberboum-Galski, H Magen, H Mandelboim, O Manor, O Margalit, H Matok, I Mechoulam, R Meiri, H Melloul, D Meyuhas, O Minke, B Mishani, E Mitrani-Rosenbaum, S Mumcuoglu, K Naor, D Naveh-Many, T Neumark, Y Nussinovitch, I Oppenheim, A Ornoy, A Panet, A Paroush, Z Parush, S Peled, A Pikarsky, E Pines, O Priel, A Prut, Y Rachmilewitz, J Rahamimoff, H Ravid, S Razin, A Razin, E Razin, S Reich, R Reshef, L Richter, E Ringel, I Rokem, JS Rom, M Ron, A Rosen, H Rosenshine, I Rotenberg-Shpigelman, S Rotshenker, S Rottem, S Rubinstein, A Samueloff, S Samuni, A Sasson, S Schlein, Y Schlesinger, M Schueler-Furman, O Sharon, D Sharon, R Shaulian, E Shlomai, J Shmueli, A Shohami, E Shtarkshall, R Shurki, A Simon, I Smith, P Sohmer, H Sperling, D Steinitz, M Stern-Bach, Y Tal, M Taraboulos, A Ta-Shma, R Tirosh, B Touitou, E Trachtenberg, S Traub, R Treinin, M Tsvelikhovsky, D Vaadia, E Warburg, A Weinstock, M  Weintraub, N Weiss, D Weiss, R Wiener, R Wormser, U Yaari, Y Yagen, B Yaka, R yanai, J Yavin, E Yedgar, S Yefenof, E Yisraeli, JK Yochman, A Yogev, D Yosselson-Superstine, S Zajicek, G Zakay-Rones, Z  Sort By:  Year Descending Year Ascending  Text:
Dvela, M., Rosen, H., Ben-Ami, H. C., Lichtstein, D.
American journal of physiology. Cell physiology, 302(2), C442-52, 2012
Goldstein, I., Lax, E., Gispan-Herman, I., Ovadia, H., Rosen, H., Yadid, G., Lichtstein, D.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 22(1), 72-9, 2012
Nesher, M., Shpolansky, U., Viola, N., Dvela, M., Buzaglo, N., Cohen Ben-Ami, H., Rosen, H., Lichtstein, D.
British journal of pharmacology, 160(2), 346-54, 2010
Guttmann-Rubinstein, L., Lichtstein, D., Ilani, A., Gal-Moscovici, A., Scherzer, P., Rubinger, D.
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme, 42(4), 230-6, 2010
Jaiswal, M. K., Dvela, M., Lichtstein, D., Mallick, B. N.
Journal of sleep research, 19(1 Pt 2), 183-91, 2010
Nesher, M., Dvela, M., Igbokwe, V. U., Rosen, H., Lichtstein, D.
American journal of physiology. Heart and circulatory physiology, 297(6), H2026-34, 2009
Goldstein, I., Lerer, E., Laiba, E., Mallet, J., Mujaheed, M., Laurent, C., Rosen, H., Ebstein, R. P., Lichtstein, D.
Biological psychiatry, 65(11), 985-91, 2009
Nesher, M., Vachutinsky, Y., Fridkin, G., Schwarz, Y., Sasson, K., Fridkin, M., Shechter, Y., Lichtstein, D.
Bioconjugate chemistry, 19(1), 342-8, 2008
Dvela, M., Rosen, H., Feldmann, T., Nesher, M., Lichtstein, D.
Pathophysiology : the official journal of the International Society for Pathophysiology / ISP, 14(3-4), 159-66, 2007
Feldmann, T., Glukmann, V., Medvenev, E., Shpolansky, U., Galili, D., Lichtstein, D., Rosen, H.
American journal of physiology. Cell physiology, 293(3), C885-96, 2007
Chirinos, J. A., Corrales-Medina, V. F., Garcia, S., Lichtstein, D. M., Bisno, A. L., Chakko, S.
Clinical rheumatology, 26(4), 590-5, 2007
Lichtstein, D. M., Arteaga, R. B.
The American journal of the medical sciences, 332(2), 103-5, 2006
Morla, D., Alazemi, S., Lichtstein, D.
Journal of general internal medicine, 21(7), C11-3, 2006
Chirinos, J. A., Corrales, V. F., Lichtstein, D. M.
Clinical rheumatology, 25(1), 111-2, 2006
Deutsch, J., Jang, H. G., Mansur, N., Ilovich, O., Shpolansky, U., Galili, D., Feldman, T., Rosen, H., Lichtstein, D.
Journal of medicinal chemistry, 49(2), 600-6, 2006
Goldstein, I., Levy, T., Galili, D., Ovadia, H., Yirmiya, R., Rosen, H., Lichtstein, D.
Biological psychiatry, 60(5), 491-9, 2006
Chirinos, J. A., Garcia, J., Alcaide, M. L., Toledo, G., Baracco, G. J., Lichtstein, D. M.
American journal of cardiovascular drugs : drugs, devices, and other interventions, 6(1), 9-14, 2006
Rosen, H., Glukmann, V., Feldmann, T., Fridman, E., Lichtstein, D.
Cellular and molecular biology (Noisy-le-Grand, France), 52(8), 78-86, 2006

SOURCE

https://medicine.ekmd.huji.ac.il/En/Publications/publications/Pages/default.aspx?aut=Lichtstein,%20D

 

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Gene Study of Blood Pressure Response to Dietary Potassium Intervention: Genetic Epidemiology of Salt Sensitivity

Reporter: Aviva Lev-Ari, PhD, RN

Genome-Wide Linkage and Positional Candidate Gene Study of Blood Pressure Response to Dietary Potassium Intervention

The Genetic Epidemiology Network of Salt Sensitivity Study

Tanika N. Kelly, PhD, James E. Hixson, PhD, Dabeeru C. Rao, PhD, Hao Mei, MD, PhD,Treva K. Rice, PhD, Cashell E. Jaquish, PhD, Lawrence C. Shimmin, PhD, Karen Schwander, MS, Chung-Shuian Chen, MS, Depei Liu, PhD, Jichun Chen, MD,Concetta Bormans, PhD, Pramila Shukla, MS, Naveed Farhana, MS, Colin Stuart, BS,Paul K. Whelton, MD, MSc, Jiang He, MD, PhD and Dongfeng Gu, MD, PhD

Author Affiliations

From the Department of Epidemiology (T.N.K., H.M., C.-S.C., J.H.), Tulane University School of Public Health and Tropical Medicine, and Department of Medicine (J.H.), Tulane University School of Medicine, New Orleans, La; Department of Epidemiology (J.E.H., L.C.S., C.B., P.S., N.F., C.S.), University of Texas School of Public Health, Houston, Tex; Division of Biostatistics (D.C.R., T.K.R., K.S.), Washington University School of Medicine, St Louis, Mo; Division of Prevention and Population Sciences (C.E.J.), National Heart, Lung, Blood Institute, Bethesda, Md; National Laboratory of Medical Molecular Biology (D.L.), Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Cardiovascular Institute and Fuwai Hospital (J.C., D.G.), Chinese Academy of Medical Sciences and Peking Union Medical College and Chinese National Center for Cardiovascular Disease Control and Research, Beijing, China; and Office of the President (P.K.W.), Loyola University Health System and Medical Center, Maywood, Ill.

Correspondence to Dongfeng Gu, MD, PhD, Division of Population Genetics and Prevention, Cardiovascular Institute and Fuwai Hospital, 167 Beilishi Rd, Beijing 100037, China. E-mail gudongfeng@vip.sina.com

Abstract

Background— Genetic determinants of blood pressure (BP) response to potassium, or potassium sensitivity, are largely unknown. We conducted a genome-wide linkage scan and positional candidate gene analysis to identify genetic determinants of potassium sensitivity.

Conclusions— Genetic regions on chromosomes 3 and 11 may harbor important susceptibility loci for potassium sensitivity. Furthermore, the AGTR1 gene was a significant predictor of BP responses to potassium intake.

SOURCE:

Circulation: Cardiovascular Genetics. 2010; 3: 539-547

Published online before print September 22, 2010,

doi: 10.1161/ CIRCGENETICS.110.940635

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The Role of Tight Junction Proteins in Water and Electrolyte Transport

 

Reviewer and Curator: Larry H. Bernstein, MD, FCAP 

 

This article is Part II of a series that explores the physiology, genomics, and the proteomics of water and electrolytes in human and mammalian function in health and disease.  In this portion of curation, we examine the role of special proteins at the tight junctions of cells, including the claudins.  Consistent with the exploration of cation homeostasis, the last featured article is one of the altered handling of calcium (Ca2+) in CHF, and the closely regulated calcium efflux by the sodium-calcium exchanger (NCX).

The Role of Aquaporin and Tight Junction Proteins in the Regulation of Water Movement in Larval Zebrafish (Danio rerio).

Kwong RW, Kumai Y, Perry SF.
Department of Biology, University of Ottawa, Ottawa, Ontario, Canada.
PLoS One. 2013 Aug 14;8(8):e70764.
http://dx.doi.org/10.1371/journal.pone.0070764   eCollection 2013.

Teleost fish living in freshwater are challenged by passive water influx; however the molecular mechanisms regulating water influx in fish are not well understood. The potential involvement of aquaporins (AQP) and epithelial tight junction proteins in the regulation of transcellular and paracellular water movement was investigated in larval zebrafish (Danio rerio).

We observed that the half-time for saturation of water influx (K u) was 4.3±0.9 min, and reached equilibrium at approximately 30 min. These findings suggest a high turnover rate of water between the fish and the environment. Water influx was reduced by the putative AQP inhibitor phloretin (100 or 500 μM). Immunohistochemistry and confocal microscopy revealed that AQP1a1 protein was expressed in cells on the yolk sac epithelium. A substantial number of these AQP1a1-positive cells were identified as ionocytes, either H(+)-ATPase-rich cells or Na(+)/K(+)-ATPase-rich cells. AQP1a1 appeared to be expressed predominantly on the basolateral membranes of ionocytes, suggesting its potential involvement in regulating ionocyte volume and/or water flux into the circulation.

Additionally, translational gene knockdown of AQP1a1 protein reduced water influx by approximately 30%, further indicating a role for AQP1a1 in facilitating transcellular water uptake. On the other hand, incubation with the Ca(2+)-chelator EDTA or knockdown of the epithelial tight junction protein claudin-b significantly increased water influx. These findings indicate that the epithelial tight junctions normally act to restrict paracellular water influx. Together, the results of the present study provide direct in vivo evidence that water movement can occur through transcellular routes (via AQP); the paracellular routes may become significant when the paracellular permeability is increased.

PMID:  23967101  PMCID: PMC3743848    http://www.ncbi.nlm.nih.gov/pubmed/23967101

The tight junction protein claudin-b regulates epithelial permeability and sodium handling in larval zebrafish, Danio rerio.

Kwong RW, Perry SF.
Department of Biology, University of Ottawa, Ottawa, Ontario, Canada. wkwong@uottawa.ca
Am J Physiol Regul Integr Comp Physiol. Apr 1, 2013; 304(7):R504-13. http://dx.doi.org/10.1152/ajpregu.00385.2012  Epub 2013 Jan 30.

The functional role of the tight junction protein claudin-b in larval zebrafish (Danio rerio) was investigated. We showed that claudin-b protein is expressed at epithelial cell-cell contacts on the skin. Translational gene knockdown of claudin-b protein expression caused developmental defects, including edema in the pericardial cavity and yolk sac.

Claudin-b morphants exhibited an increase in epithelial permeability to the paracellular marker polyethylene glycol (PEG-4000) and fluorescein isothiocyanate-dextran (FD-4). Accumulation of FD-4 was confined mainly to the yolk sac and pericardial cavity in the claudin-b morphants, suggesting these regions became particularly leaky in the absence of claudin-b expression.

Additionally, Na(+) efflux was substantially increased in the claudin-b morphants, which contributed to a significant reduction in whole-body Na(+) levels. These results indicate that claudin-b normally acts as a paracellular barrier to Na(+). Nevertheless, the elevated loss of Na(+) in the morphants was compensated by an increase in Na(+) uptake.

Notably, we observed that the increased Na(+) uptake in the morphants was attenuated in the presence of the selective Na(+)/Cl(-)-cotransporter (NCC) inhibitor metolazone, or during exposure to Cl(-)-free water. These results suggested that the increased Na(+) uptake in the morphants was, at least in part, mediated by NCC. Furthermore, treatment with an H(+)-ATPase inhibitor bafilomycin A1 was found to reduce Na(+) uptake in the morphants, suggesting that H(+)-ATPase activity was essential to provide a driving force for Na(+) uptake. Overall, the results suggest that claudin-b plays an important role in regulating epithelial permeability and Na(+) handling in zebrafish.
PMID: 23364531   http://www.ncbi.nlm.nih.gov/pubmed/23364531

Evidence for a role of tight junctions in regulating sodium permeability in zebrafish (Danio rerio) acclimated to ion-poor water.

Kwong RW, Kumai Y, Perry SF.
Department of Biology, University of Ottawa, Ottawa, ON, Canada. wkwong@uottawa.ca
J Comp Physiol B. Feb 2013 ;183(2):203-13.
http://dx.doi.org/10.1007/s00360-012-0700-9  Epub 2012 Jul 29.

Freshwater teleosts are challenged by diffusive ion loss across permeable epithelia including gills and skin. Although the mechanisms regulating ion loss are poorly understood, a significant component is thought to involve paracellular efflux through pathways formed via tight junction proteins. The mammalian orthologue (claudin-4) of zebrafish (Danio rerio) tight junction protein, claudin-b, has been proposed to form a cation-selective barrier regulating the paracellular loss of Na(+).

The present study investigated the cellular localization and regulation of claudin-b, as well as its potential contribution to Na(+) homeostasis in adult zebrafish acclimated to ion-poor water. Using a green fluorescent protein-expressing line of transgenic zebrafish, we found that claudin-b was expressed along the lamellar epithelium as well as on the filament in the inter-lamellar regions. Co-localization of claudin-b and Na(+)/K(+)-ATPase was observed, suggesting its interaction with mitochondrion-rich cells. Claudin-b also appeared to be associated with other cell types, including the pavement cells. In the kidney, claudin-b was expressed predominantly in the collecting tubules. In addition,

exposure to ion-poor water caused a significant increase in claudin-b abundance as well as a decrease in Na(+) efflux, suggesting a possible role for claudin-b in regulating paracellular Na(+) loss. Interestingly, the whole-body uptake of a paracellular permeability marker, polyethylene glycol-400, increased significantly after prolonged exposure to ion-poor water, indicating that an increase in epithelial permeability is not necessarily coupled with an increase in passive Na(+) loss. Overall, our study suggests that in ion-poor conditions, claudin-b may contribute to a selective reduction in passive Na(+) loss in zebrafish.
PMID: 22843140   http://www.ncbi.nlm.nih.gov/pubmed/22843140

Claudin-16 and claudin-19 function in the thick ascending limb.

Hou J, Goodenough DA.
Washington University School of Medicine, Div Renal Diseases, St Louis, Missouri
Curr Opin Nephrol Hypertens. Sep 2010; 19(5):483-8. http://dx.doi.org/10.1097/MNH.0b013e32833b7125.

The thick ascending limb (TAL) of the loop of Henle is responsible for reabsorbing 25–40% of filtered Na+, 50–60% of filtered Mg2+ and 30–35% of filtered Ca2+. The dissociation of salt and water reabsorption in the TAL serves both to dilute the urine and to establish the corticomedullary osmolality gradient. Active transcellular salt reabsorption results in a lumen-positive transepithelial voltage that drives passive paracellular reabsorption of divalent cations. Claudins are the key components of the paracellular channel. The paracellular channels in the tight junction have properties of ion selectivity, pH dependence and anomalous mole fraction effects, similar to conventional transmembrane channels. Genetic mutations in claudin-16 and claudin-19 cause an inherited human renal disorder, familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC).

In the TAL of Henle’s loop, the epithelial cells form a water-impermeable barrier, actively transport Na+ and Cl− via the transcellular route, and provide a paracellular pathway for the selective absorption of cations. Na+ K+ and Cl− enter the cell through the Na-K-2Cl cotransporter (NKCC2) in the luminal membrane. Na+ exits the cell through the Na+/K+-ATPase, in exchange for K+ entry. K+ is secreted into the lumen through the renal outer medullary potassium channel. Cl− leaves the cell through the basolateral Cl− channel, made up of two subunits, ClCKb and barttin. The polarized distribution of luminal K+ versus basolateral Cl− conductance generates a spontaneous voltage source (Vsp) of +7−8mV , depending on active transcellular NaCl reabsorption. With continuous NaCl reabsorption along the axis of the TAL segment, the luminal fluid is diluted to 30–60mmol/l  and a large NaCl transepithelial chemical gradient develops at the end of the TAL. Because the paracellular permeability of the TAL is cation-selective (with a PNa/PCl value between 2 and 4), the diffusion voltage (Vdi) is superimposed onto the active transport voltage (Vsp) and becomes the major source of the transepithelial voltage (Vte), which now increases up to +30mV.

Early in-vivo micropuncture studies have shown that approximately 50–60% of the filtered Mg2+ is reabsorbed in the TAL. The flux–voltage relationship indicates that Mg2+ is passively reabsorbed from the lumen to the peritubular space through the paracellular pathway in this segment, driven by a lumen positive Vte.  Vte is made of the sum of Vsp and Vdi. There are two prerequisites required for the paracellular Mg2+ reabsorption in the TAL: the lumen-positive Vte as the driving force and the paracellular permeability for the divalent cation Mg2+.

Claudin-16 and claudin-19 underlie familial hypercalciuric hypomagnesemia with nephrocalcinosis

Claudin-16 and claudin-19 play a major role in the regulation of magnesium reabsorption in the thick ascending limb (TAL). This review describes recent findings of the physiological function of claudin-16 and claudin-19 underlying normal transport function for magnesium reabsorption in the TAL. Mutations in the genes encoding the tight junction proteins claudin-16 and claudin-19 cause the inherited human renal disorder familial hypomagnesemia with hypercalciuria and nephrocalcinosis. FHHNC, OMIM #248250, is a rare autosomal recessive tubular disorder. As a consequence of excessive renal Mg2+ and Ca2+ wasting, patients develop the characteristic triad of hypomagnesemia, hypercalciuria and nephrocalcinosis. Recurrent urinary tract infections and polyuria/polydipsia are frequent initial symptoms. Other clinical symptoms include nephrolithiasis, abdominal pain, convulsions, muscular tetany, and failure to thrive. Additional laboratory findings include elevated serum parathyroid hormone levels before the onset of chronic renal failure, incomplete distal tubular acidosis, hypocitraturia, and hyperuricemia. In contrast to hypomagnesemia and secondary hypocalcemia (HSH, OMIM #602014), FHHNC is generally complicated by end-stage renal failure in early childhood or adolescence.

Simon et al. used the positional cloning strategy and identified claudin-16 (formerly known as paracellin-1), which is mutated in patients with FHHNC. Most mutations reported to date in claudin-16 are missense mutations clustering in the first extracellular loop composing the putative ion selectivity filter. Konrad et al. have found mutations in another tight junction gene encoding claudin-19 from new cohorts of FHHNC patients (OMIM #248190). The renal tubular phenotypes are indistinguishable between patients with mutations in claudin-16 and those with mutations in claudin-19. Although claudin-16 and claudin-19 underlie FHHNC and paracellular Mg2+ reabsorption in the TAL, the transient receptor potential channel melastatin 6 (TRPM6) regulates the apical entry of Mg2+ into the distal convoluted tubule epithelia. Mutations in TRPM6 cause the HSH syndrome.

These above data suggested the hypothesis that claudin-16 and/or claudin-19 forms a selective paracellular Mg2+/Ca2+ channel, which was tested in a number of in-vitro studies. Ikari et al. transfected low-resistance Madin-Darby canine kidney (MDCK) cells with claudin-16 and reported that the Ca2+ flux in these cells was increased in the apical to basolateral direction, whereas the Ca2+ flux in the opposite direction remained unchanged. The Mg2+ flux was without any noticeable change. Kausalya et al.  transfected the high-resistance MDCK-C7 cell line and found that claudin-16 only moderately increased Mg2+ permeability without any directional preference. The effects of claudin-16 on Mg2+/Ca2+ permeation appeared so small (<50%) that the Mg2+/Ca2+ channel theory incompletely explains the dramatic effect of mutations in claudin-16 on Mg2+ and Ca2+ homoeostasis in FHHNC patients. However, , Hou et al.  transfected the anion-selective LLC-PK1 cell line with claudin-16 and found a large increase in Na+ permeability (PNa) accompanied by a moderately enhanced Mg2+ permeability (PMg). The permeability of claudin-16 to other alkali metal cations was found to be: K+ > Rb+ > Na+.  Yu et al. emphasized that these residue replacements can influence protein structures that may have impacts on ion permeability independent of amino acid charge.

The cation selectivity of the tight junction is vital for generating the lumen positive transepithelial potential in the TAL, which drives paracellular absorption of magnesium. Claudin-16 and claudin-19 require each other for assembly into tight junctions in the TAL. Heteromeric claudin-16 and claudin-19 interaction forms a cation selective tight junction paracellular channel. Loss of either claudin-16 or claudin-19 in the mouse kidney abolishes the cation selectivity for the TAL paracellular pathway, leading to excessive renal wasting of magnesium.

Claudins interact with each other both intracellularly and intercellularly: they copolymerize linearly within the plasma membrane of the cell, together with the integral protein occludin, to form the classical intramembrane fibrils or strands visible in freeze-fracture replicas. These intramembrane interactions (side-to-side) can involve one claudin protein (homomeric or homopolymeric) or different claudins (heteromeric or heteropolymeric). In the formation of the intercellular junction, claudins may interact head-to-head with claudins in an adjacent cell, generating both homotypic and heterotypic claudin–claudin interactions. Using the split-ubiquitin yeast 2-hybrid assay, Hou et al. found strong claudin-16 and claudin-19 heteromeric interaction. The point mutations in claudin-16 (L145P, L151F, G191R, A209T, and F232C) or claudin-19 (L90P and G123R) that are known to cause human FHHNC disrupted the claudin-16 and claudin-19 heteromeric interaction. In mammalian cells such as the human embryonic kidney 293 cells, claudin-16 can be coimmunoprecipitated with claudin-19. Freeze-fracture replicas revealed the assembly of tight junction strands in L cells coexpressing claudin-16 and claudin-19, supporting their heteromeric interaction.

Coexpression of claudin-16 and claudin-19 in LLC-PK1 cells resulted in a dramatic upregulation of PNa and down-regulation of PCl, generating a highly cation-selective paracellular pathway. Certain FHHNC mutations in claudin-16 (L145P, L151F, G191R, A209T, and F232C) or claudin-19 (L90P and G123R) that disrupted their heteromeric interaction abolished this physiological change. As claudin-16 colocalizes with claudin-19 in the TAL epithelia of the kidney, claudin-16 and claudin-19 association through heteromeric interactions confers cation selectivity to the tight junction in the TAL. Human FHHNC mutations in claudin-16 or claudin-19 that abolish the cation selectivity diminish the lumen-positive Vdi as the driving force for Mg2+ and Ca2+ reabsorption, readily explaining the devastating phenotypes in FHHNC patients.  Hou et al. generated claudin-16 deficient mouse models using lentiviral transgenesis of siRNA to knock down claudin-16 expression by more than 99% in mouse kidneys. Claudin-16 knockdown mice show significantly reduced plasma Mg2+ levels and excessive urinary excretions (approximately four-fold) of Mg2+ and Ca2+. Calcium deposits are observed in the basement membranes of the medullary tubules and the interstitium in the kidney of claudin-16 knockdown mice. These phenotypes of claudin-16 knockdown mice recapitulate the symptoms in human FHHNC patients.

The paracellular reabsorption of Mg2+ and Ca2+ is driven by a lumen-positive Vte made up of two components: Vsp and Vdi. When isolated TAL segments were perfused ex vivo with symmetrical NaCl solutions, there was no difference in Vsp between claudin-16 knockdown and wild-type mice, indicating Vsp was normal in claudin-16 knockdown. Blocking the NKCC2 channel with furosemide (thus dissipating VSP), the cation selectivity (PNa/PCl) was significantly reduced from3.1 ± 0.3 in wild type to 1.5 ± 0.1 in claudin-16 knockdown, resulting in the loss of Vdi. When perfused with a NaCl gradient of 145mmol/l (bath) versus 30mmol/l (lumen), the resulting Vdi was +18mV in wild type, but only +6.6mV in claudin-16 knockdown. Thus, the reduction in Vdi accounted for a substantive loss of the driving force for Mg2+ and Ca2+ reabsorption.

Renal handling of Na+ in claudin-16 knockdown mice is more complex. In the early TAL segment, the transcellular and paracellular pathways form a current loop in which the currents traversing the two pathways are of equal size but opposite direction. Net luminal K+ secretion and basolateral Cl− absorption polarize the TAL epithelium and generate Vsp. As the paracellular pathway is cation selective (PNa/PCl=2–4 , the majority of the current driven by Vsp through the paracellular pathway is carried by Na+ moving from the lumen to the interstitium. Hebert et al. estimated that, for each Na+ absorbed through the trans-cellular pathway, one Na+ is absorbed through the paracellular pathway. With the loss of claudin-16 and the concomitant loss of paracellular cation selectivity, Na+ absorption through the paracellular pathway is reduced.  In the late TAL segment, dilution of NaCl in the luminal space creates an increasing chemical transepithelial gradient; back diffusion of Na+ through the cation-selective tight junction generates a lumen-positive Vdi across the epithelium. The paracellular absorption of Na+ will be diminished when Vdi equals Vsp, and reversed when Vdi exceeds Vsp. As an equilibrium potential, Vdi blocks further Na+ backleak into the lumen. Without claudin-16, Vdi will be markedly reduced well below normal, providing a driving force for substantial Na+ secretion. Indeed, claudin-16 knockdown mice had increased fractional excretion of Na+ (FENa) and developed hypotension and secondary hyperaldosteronism. The observed Na+ and volume loss are consistent with human FHHNC phenotypes. For example, polyuria and polydipsia are the most frequently reported symptoms from FHHNC patients.

Epithelial paracellular channels are increasingly understood to be formed from claudin oligomeric complexes. In the mouse TAL, claudin-16 and claudin-19 cooperate to form cation-selective paracellular channels required for normal levels of magnesium reabsorption. Different subsets of the claudin family of tight junction proteins are found distributed throughout the nephron, and understanding their roles in paracellular ion transport will be fundamental to understanding renal ion homeostasis.

Keywords: claudin; hypomagnesemia; thick ascending limb; tight junction; transepithelial voltage.     PMID: 20616717  PMCID: PMC3378375  http://www.ncbi.nlm.nih.gov/pubmed/20616717

Function and regulation of claudins in the thick ascending limb of Henle.

Günzel D, Yu AS.
Depart Clin Physiol, Charité, Campus Benjamin Franklin, Berlin, Germany.
Pflugers Arch. May 2009; 458(1):77-88.
http://dx.doi.org/10.1007/s00424-008-0589-z  Epub 2008 Sep 16.

The thick ascending limb (TAL) of Henle mediates transcellular reabsorption of NaCl while generating a lumen-positive voltage that drives passive paracellular reabsorption of divalent cations. Disturbance of paracellular reabsorption leads to Ca(2+) and Mg(2+) wasting in patients with the rare inherited disorder of familial hypercalciuric hypomagnesemia with nephrocalcinosis (FHHNC). Recent work has shown that the claudin family of tight junction proteins form paracellular pores and determine the ion selectivity of paracellular permeability. Importantly, FHHNC has been found to be caused by mutations in two of these genes, claudin-16 and claudin-19, and mice with knockdown of claudin-16 reproduce many of the features of FHHNC. Here, we review the physiology of TAL ion transport, present the current view of the role and mechanism of claudins in determining paracellular permeability, and discuss the possible pathogenic mechanisms responsible for FHHNC.

Tight junctions form the paracellular barrier in epithelia. Claudins are ~22 kDa proteins that were first identified by Mikio Furuse in the laboratory of the late Shoichiro Tsukita as proteins that copurified in a tight junction fraction from the chicken liver [23]. The observation that they were transmembrane proteins with 4 predicted membrane domains and 2 extracellular domains raised early on the possibility that they could play a key role in intercellular adhesion and formation of the paracellular barrier. In 1999, Richard Lifton’s group identified mutations in a novel gene, which they called paracellin, as the cause of familial hypercalciuric hypomagnesemia, an inherited disorder believed to be due to failure of paracellular reabsorption of divalent cations in the thick ascending limb of the renal tubule. Paracellin turned out to be a claudin family member (claudin-16). This suggested that claudins in general might be directly involved in regulating paracellular transport in all epithelia. This is now supported by numerous studies demonstrating that overexpressing or ablating expression of various claudin isoforms in cultured cell lines or in mice affects both the degree of paracellular permeability and its selectivity (vide infra). Furthermore, in mammals alone there are ~24 claudin genes and each exhibits a distinct tissue-specific, pattern of expression. Thus, the specific claudin isoform(s) expressed in each tissue might explain its paracellular permeability properties.

Each nephron segment expresses a unique set of multiple claudin isoforms, and each isoform is expressed in multiple segments, thus making a complicated picture which even varies between different species. The role of combinations of claudins in determining paracellular permeability properties has hardly been studied yet. In mouse, rabbit and cattle, the thick ascending limb of Henle’s loop is thought to express claudins 3, 10, 11, 16  in adulthood, and, at least in mouse, additionally claudin-6 during development. In addition, claudin-4 has been found in cattle and claudin-8 in rabbit. To date, the distribution of Claudin-19 has been investigated in mouse, rat, and man where its presence in the TAL was demonstrated.

The thick ascending limb (TAL) of Henle’s loop, working as “diluting segment” of the nephron, is characterized by two major properties: high transepithelial, resorptive transport of electrolytes and low permeability to water. Major players to achieve electrolyte transport are the apical Na+-K+-2Cl−symporter (NKCC2), the apical K+ channel ROMK, the basolateral Cl− channel (CLC-Kb) together with its subunit barttin and the basolateral Na+/K+-ATPase . The combined actions of these transport systems have been extensively reviewed and are therefore only briefly summarized here. Na+ and Cl− are resorbed by entering the cells apically through NKCC2 and leaving the cells basolaterally through the Na+/K+-ATPase and CLC-Kb, respectively. In contrast, K+ is either recycled across the apical membrane as it is entering through NKCC2 and leaving through ROMK, or even secreted, as it is also entering the cells basolaterally through the Na+/K+-ATPase. Taking these ion movements together, there is a net movement of positive charge from the basolateral to the apical side of the epithelium, giving rise to a lumen positive voltage (3 – 9 mV [11]; about 5 – 7 mV [30,31]; 7 – 8 mV [57]). Over the length of the TAL, luminal NaCl concentration decreases gradually to concentrations of 30 – 60 mM at the transition to the distal tubule, depending on the flow rate within the tubule (low flow rates resulting in low concentrations).

To keep up such a high gradient, the TAL epithelium has to be tight to water and various studies summarized by Burg and Good report water permeability values from 28 µm/s down to values indistinguishable from zero. Tight junctions of the TAL are, however, highly permeable to cations with PNa being about 2 – 2.7 fold, 2.5 fold or even up to 6 fold that of PCl. Amongst the monovalent cations, a permeability sequence of PK > PNa > PRb = PLi > PCs > Porganic cation was observed which is similar to Eisenman sequence VIII or IX, indicating a strong interaction between the permeating ion and the paracellular pore that enables at least partial removal of the hydration shell (see below). As reviewed by Burg and Good, the transepithelial sodium and chloride permeabilities, estimated from radioisotope fluxes, are high (in the range of 10 – 63·10−6 cm/s) and the transepithelial electrical resistance is correspondingly low (21 – 25 W cm2 ; 30 – 40 W cm2 ; 11 – 34 W cm2 . Blocking active transport by the application of furosemide or ouabain increases transepithelial resistance only slightly, indicating that the low values are primarily due to a very high paracellular permeability. Due to these properties of TAL epithelial cells, Na+ ions leak back into the lumen of the tubule, creating a diffusion (dilution) potential that adds another 10 – 15 mV to the lumen positive potential, so that considerable potential differences (25 mV ; 30 mV; cTAL 23 mV, mTAL 17 mV ) may be reached at very slow flow rates.

Considerable proportions of the initially filtrated Mg2+ (50 – 60%; 50 – 70%; 65 – 75%) and Ca2+ (20%; 30 – 35% are resorbed in the TAL. The transepithelial potential is considered to provide the driving force for the predominantly paracellular resorption of Mg2+ and Ca2+ as in many studies, transport of both divalent ions in the TAL has been found to be strictly voltage dependent (resorbtive at lumen positive potentials, zero at 0 mV and secretory at lumen negative potentials) and permeability considerable (PCa 7.7·10−6 cm/s, i.e. approximately 25% of PNa). There is however, some conflicting evidence, e.g. by Suki et al. and Friedman. Both studies used cTAL (cortical TAL) and found that decreasing the transepithelial potential by applying furosemide did either not alter the unidirectional lumen to bath Ca2+ flux (rabbit) or left a substantial net Ca2+ resorption (mouse). Similarly, Rocha et al. found that bath application of ouabain almost abolished the transepithelial potential, but hardly affected net Ca2+ resorption and conclude that (a) all segments of Henle’s loop are relatively impermeable to calcium and (b) net calcium resorption occurs in the thick ascending limb which cannot be explained by passive mechanisms.  Mandon et al. conclude that both Mg2+ and Ca2+ are transported in the cTAL but not in the mTAL (medullary TAL) of rat and mouse, although transepithelial potential differences were similar in both segments, and even if the transepithelial potential was experimentally elevated to values above 20 mV. Wittner et al. even found evidence that in mouse mTAL the passive permeability to divalent cations is very low and that Ca2+ and Mg2+ can be secreted into the luminal fluid under conditions which elicit large lumen-positive transepithelial potential differences. They conclude that this Ca2+ and Mg2+ transport is most probably of cellular origin. In contrast, in rabbit, both ions are transported along the whole length of the TAL.

Both, Mg2+ and Ca2+ resorption are modulated through the action of the basolateral Ca (and Mg) sensing receptor (CaSR) which is found along the entire nephron but especially in the loop of Henle, distal convoluted tubule (DCT) and the inner medullary collecting duct. Different modes of action on Ca2+ and Mg2+ homeostasis exist, such as an indirect action through the modulation of PTH secretion or direct effects on the cells expressing CaSR. In the TAL the latter model is based on the assumptions depicted above, i.e. that Mg2+ and Ca2+ are resorbed paracellularly, driven by the lumen positive potential, so that a reduction in NaCl resorption causes a reduction in driving force for Mg2+ and Ca2+ resorption. As reviewed by Hebert and Ward, CaSR is activated through an increase in basolateral Ca2+ and/or Mg2+ concentration which triggers an increase in the intracellular Ca2+ concentration. This reduces the activity of the adenylate cyclase which, in turn, inhibits transcellular transport of Na+ and Cl−. In addition, the increase in intracellular Ca2+ activates phospholipase A2 (PLA2) and thus increases the intracellular concentration of arachidonic acid and its derivative, 20-HETE. 20-HETE inhibits NKCC2, ROMK and the Na+/K+-ATPase and by this Mg2+ and Ca2+ resorption. In keeping with this hypothesis, mutations in CaSR affect Ca/Mg resorption. Inactivating mutations cause hypercalcemia, hypocalciuria, hypomagnesiuria and, in some patients hypermagnesemia. Conversely, activating mutations (gain of function mutations) lead to hypocalcemia, hypercalciuria, hypermagnesiuria and in up to 50% of the patients mild hypomagnesemia.

Bartter syndrome type I (mutations in NKCC2), and type II (mutations in ROMK) lead to hypercalciuria and thus cause nephrocalcinosis, but no hypomagnesemia is observed. Reports on hypermagnesiuria are conflicting: while Kleta and Bockenhauer link it to nephrocalcinosis seen in these patients, Rodriguez-Soriano states that patients with neonatal Bartter syndrome (i.e. type I or II) show a lack of hypermagnesiuria that may be explained by compensation in the DCT. Hypomagnesemia is occationally present in Bartter type III (CLC-Kb). However, here it is believed to be mainly due to effects on DCT, where CLC-Kb shows highest expression. Patients with Bartter syndrome IV (CLC-Kbsubunit barttin) may or may not present nephrocalcinosis, while Mg2+ homeostasis appears undisturbed. Interestingly, the largest effects on Mg2+-homeostasis are observed in Gitelman syndrome, a defect in the Na+/Cl− symport (NCC) predominantly found in the DCT, where Mg2+ is transported along the transcellular route. Affected patients suffer from hypomagnesemia, hypermagnesuria and hypocalciuria. The effect on Mg2+ in Gitelman syndrome is still poorly understood and possibly due to a concomitant down-regulation of TRPM6, the apical Mg2+ uptake channel in DCT.

More than 30 different claudin-16 mutations have now been reported in families with FHHNC. Because of the large number of unique mutations, it has not been possible to identify any clear qualitative correlation between the phenotype and individual mutations, although certain mutations are associated with greater severity of disease. In 2006, a second locus was identified, CLDN19, which encodes claudin-19. In the initial report, the phenotype appeared similar to that due to claudin-16 mutations, with the exception that there was a high prevalence of ocular abnormalities, including macular colobomata, nystagmus and myopia. Claudin-19 is normally expressed at high levels in the retina, but why it causes these ocular disorders is unknown.

In vitro studies of claudin function comprise inducible or non-inducible transfection of various cells lines with cDNA for claudins that are not endogenously expressed by the cell line used. Alternatively, cells can be transfected with siRNA directed against an endogenous claudin. In both cases, cells are then grown to confluence on permeable filter supports that allow measurement of transepithelial permeabilities. Before the results of permeability studies can be interpreted, however, several parameters have to be controlled.

First, special care has to be taken to make sure that the exogenous claudin is correctly inserted into the tight junction. This can be achieved e.g. by confocal laser scanning microscopy, colocalizing the claudin of interest  with a tight junction marker protein such as occludin.

Second, it has to be ensured that endogenous claudin expression remains unaffected, as permeability changes always result from the combined effects of alterations in endogenous and exogenous claudins.

Third, it has to be kept in mind that, typically, epithelia express several different claudins that act together to produce tissue specific permeability properties. Thus, ideally, a cell line should be chosen that provides a claudin background resembling that usually experienced by the claudin investigated. The latter two points may be the reason for contradicting results obtained in permeability studies expressing a specific claudin in different cell lines.

Studies of paracellular permeabilities can be divided into two groups, those employing electrophysiological measurements (e.g. determination of diffusion potentials), and those measuring ion or solute flux, using either radioactive isotopes or various analytical methods to determine the amount transported.

Although transepithelial conductances depend on paracellular permeabilities of the predominant ions in the bath solution, conductance changes alone cannot be used to predict ion permeabilities.

Firstly, conductances always depend on both ion and counter-ion, not on one ion species alone.

Secondly, transepithelial conductances are the sum of the conductances of the transcellular and paracellular pathways.

Thus, they only reflect paracellular permeability, if paracellular conductance dominates transepithelial conductance and if transcellular conductance remains constant throughout the experiment. This, however, is often not the case, as concentration changes of the ions investigated may affect transcellular conductance, e.g. by activating ion transporters or by inhibiting ion channels. Thirdly, the specific conductance of each solution employed may differ and has therefore to be assessed and taken into account. Thus, comparison of results from diffusion potential measurements or flux studies and conductance measurements may even yield contradicting results. For the same reasons, other methods based on pure conductance/resistance measurements, including the more sophisticated conductance scanning method or one-path impedance spectroscopy are not ion specific and do not allow the measurement of paracellular permeabilities to single ions.

In contrast to electrophysiological measurements, flux measurements are not limited to ions but can also be extended to uncharged molecules.  Flux measurements per se do not distinguish between transcellular or paracellular transport. Therefore, to estimate paracellular permeabilities, inhibition or at least estimation of the transcellular flux is necessary. Assuming that transcellular flux for energetic reasons is not easily reversible while paracellular flux is passive and thus generally assumed to be symmetric, the transcellular proportion is often estimated by calculating the difference between apical to basolateral and basolateral to apical fluxes. All flux measurements are very sensitive to the development of diffusion zones (“unstirred layers”) near the cells. These layers are depleted/enriched in the compound transported and thus alter the driving forces acting on these compounds, if bath solutions are not continually circulated. If ionic fluxes are investigated, transepithelial potentials may develop that diminish or completely inhibit the flux investigated.

All the techniques described above have been employed to investigate the function of claudin-16 and -19, especially with respect to their ability to increase paracellular permeability to divalent cations. The hypothesis, that claudin-16 (then called paracellin-1) may be a paracellular Mg2+ and Ca2+ pore was originally expressed by Simon et al. It was based on the findings that mutations in claudin-16 were the cause of the severe disturbance in Mg2+ and Ca2+ homeostasis in FHHNC patients together with the observations that claudin-16 is a tight junction protein located in the TAL, i.e. the nephron segment responsible for bulk Mg2+ resoption along the paracellular pathway. When, recently, it was found that claudin-19 mutations were underlying hitherto unexplained cases of FHHNC and that claudin-19 co-localized with claudin-16, the hypothesis was extended to claudin-19.

  1. Cole DEC, Quamme GA. Inherited disorders of renal magnesium handling. J Am Soc Nephrol 2000;11:1937–1947. [PubMed: 11004227]
  2. de Rouffignac C, Quamme G. Renal magnesium handling and its hormonal control. Physiol Rev 1994;74:305–322. [PubMed: 8171116]  
  3. Meij IC, van den Heuvel LP, Knoers NV. Genetic disorders of magnesium homeostasis. BioMetals 2002;15:297–307. [PubMed: 12206395]
  4. Satoh J, Romero MF. Mg2+ transport in the kidney. BioMetals 2002;15:285–295. [PubMed: 12206394]  
  5. Schlingmann KP, Konrad M, Seyberth HW. Genetics of hereditary disorders of magnesium homeostasis. Pediatr Nephrol 2004;19:13–25. [PubMed: 14634861]  
  6. Simon DB, Lu Y, Choate KA, et al. Paracellin-1, a renal tight junction protein required for paracellular Mg2+ resorption. Science 1999;285:103–106. [PubMed: 10390358]

PMID: 18795318  PMCID:  PMC2666100  http://www.ncbi.nlm.nih.gov/pubmed/18795318

Deletion of claudin-10 (Cldn10) in the thick ascending limb impairs paracellular sodium permeability and leads to hypermagnesemia and nephrocalcinosis.

Breiderhoff T, Himmerkus N, Stuiver M, Mutig K, Will C, Meij IC et al.
Max Delbrück Center for Molec Med, Berlin, Germany. t.breiderhoff@mdc-berlin.de

Erratum in Proc Natl Acad Sci. 2012 Sep 11;109(37):15072.
Proc Natl Acad Sci. Aug 28, 2012; 109(35):14241-6.   http://dx.doi.org/10.1073/pnas.1203834109. Epub 2012 Aug 13.

In the kidney, tight junction proteins contribute to segment specific selectivity and permeability of paracellular ion transport. In the thick ascending limb (TAL) of Henle’s loop, chloride is reabsorbed transcellularly, whereas sodium reabsorption takes transcellular and paracellular routes. TAL salt transport maintains the concentrating ability of the kidney and generates a transepithelial voltage that drives the reabsorption of calcium and magnesium. Thus, functionality of TAL ion transport depends strongly on the properties of the paracellular pathway. To elucidate the role of the tight junction protein claudin-10 in TAL function, we generated mice with a deletion of Cldn10 in this segment. We show that claudin-10 determines paracellular sodium permeability, and that its loss leads to hypermagnesemia and nephrocalcinosis. In isolated perfused TAL tubules of claudin-10-deficient mice, paracellular permeability of sodium is decreased, and the relative permeability of calcium and magnesium is increased. Moreover, furosemide-inhibitable transepithelial voltage is increased, leading to a shift from paracellular sodium transport to paracellular hyperabsorption of calcium and magnesium. These data identify claudin-10 as a key factor in control of cation selectivity and transport in the TAL, and deficiency in this pathway as a cause of nephrocalcinosis.

Whereas regulation of transporters and channels involved in trans-cellular ion transport has been characterized in much detail, the functional and molecular determinants of paracellular ion trans­port in the kidney remain incompletely understood. In the thick ascending limb (TAL) of Henle’s loop, both trans-cellular and paracellular ion transport pathways contribute to reabsorption of Na+, Cl, Mg2+, and Ca2+. Na+ and Clare reabsorbed mostly transcellularly by the concerted action of chan­nels and transporters. Mutations in five of the genes involved lead to Bartter syndrome, a disorder characterized by salt wasting and polyuria. Whereas Clis transported exclusively transcellularly, 50% of the Na+ load, as well as Ca2+ and Mg2+, are reabsorbed via paracellular pathways. In the TAL, this paracellular route is highly cation-selective. The paracellular passage is largely controlled by the tight junction (TJ), a supramolecular structure of membrane-spanning proteins, their intracellular adapters, and scaffolding proteins. Claudins, a family comprising 27 members, are the main components of the TJ defining the permeability properties. They interact via their extracellular loops with corre­sponding claudins of the neighboring cell to allow or restrict pas­sage of specific solutes (5, 6). In the kidney, their expression pattern is closely related to the corresponding segment-specific solute reabsorption profile. Several claudins are expressed in the TAL, including claudin-16, -19, -10, -3, and -18 The importance of claudin-16 and -19 in this tissue is documented by mutations in CLDN16 and CLDN19, which cause familial hypomagnesemia, hypercalciuria, and nephrocalcinosis, an autosomal recessive dis­order that leads to end-stage renal disease. The relevance of CLDN16 for paracellular reabsorption of Mg2+ and Ca2+ was confirmed in mouse models with targeted gene disruption. In addition, claudin-14, expressed in the TAL of mice on a high-calcium diet, was identified as negative regulator of claudin-16 function (15), and sequence variants in CLDN14 have been asso­ciated with human kidney stone disease. The functional significance of claudin-10, which is also ex­pressed in the TAL, remains unclear. This TJ protein is expressed in two isoforms, claudin-10a and claudin-10b, which differ in their first extracellular loop. In cultured epithelial cells, heter-ologous expression of claudin-10a increases paracellular anion transport, whereas claudin-10b expression increases paracellular cation transport. Both isoforms are expressed differentially along the nephron, with claudin-10a found predominantly in cortical segments, whereas claudin-10b is enriched in the medullary region.  In the present study we generated a mouse model with a TAL-specific Cldn10 gene defect to query the role of this protein in renal paracellular in transport in vivo. We found that claudin-10 is crucial to paracellular Na+ handling in the TAL, and that its absence leads to a shift from paracellular sodium transport to paracellular hyperreabsorption of Ca2+ and Mg2+.

Analysis of claudin-10 expression in the kidney. (A) Western blot analysis of kidney membrane extracts from control (ctr) and cKO mice. A dramatic reduction in claudin-10 protein can be seen in kidneys of cKO mice. Levels of the TJ marker occludin are unchanged. (B) Gene expression analysis of Cldn10 variants on cDNA from isolated segments of the nephron. (C) Immunohistological detection of claudin-10 and markers for PCT (NHE3) and TAL (NKCC2) on sections from control mice (ctr) and cKO mice demonstrates no difference in the signal for claudin-10 in the PCT between WT and cKO. Claudin-10 is expressed in TAL tubules positive for NKCC2. No specific clau-din-10 staining is evident in the TAL of cKO mice. Claudin-10 is detected in TJs positive for ZO-1. This signal is absent in cKO mice, whereas ZO-1 staining is unchanged. (Scale bar: 25 μm.)

In control animals, claudin-10 is located mainly in the TAL, as documented by coimmunostaining with the Na+K+2Clcotrans-porter (NKCC2). In this segment, a large portion of the claudin-10 immunofluorescence signal is located outside of the TJ; however, claudin-10 is present in the TJ, as demonstrated by colocalization with the TJ protein ZO-1. PCTs positive for the sodium-proton exchanger NHE-3 showed a considerably weaker signal restricted to the TJ area. Claudin-10 immunoreactivity was virtually absent in NKCC2-positive tubules of cKO mice, in line with the activity of Cre recombinase in this cell type. The immu-noreactivity of claudin-10 in PCTs of cKOs remained unchanged, however. ZO-1 staining in TAL sections of cKOs was unchanged compared with controls, indicating no unspecific effect on TJ structures. The TJ localization of claudin-16 and claudin-19 in medullary rays was similar in cKOs and controls.   To investigate the phenotypic consequences of renal claudin-10 deficiency, we per­formed a histological examination of the kidneys of 10-wk-old cKO mice and their respective controls. Kidneys from cKO mice contained extensive medullary calcium deposits, as revealed by von Kossa and alizarin red S staining. The deposits were found along the outer stripe of the outer medulla. The detection of extensive calcification suggests alterations in renal ion homeostasis in mice deficient for claudin-10.  Serum Na+ and Cllevels and their renal FE excretion rates were not different be­tween genotypes. In addition, serum creatinine and glomerular filtration rate were not altered compared with controls. Taken together, these findings indicate that calcium deposition does not nonpecifically affect overall glomerular or tubular function.

Fig 4. Gene expression analysis of renal claudins (A) and representative renal ion transporters and channels (B) by real-time PCR. Cldn10 deficiency results in differential gene expression of several genes. Values from cKO animals are shown relative to control mice (mean ± SEM). Wnk1, Wnk1-KS, Kcnj1, and Trpm6, n = 5/4; all other genes, n = 10/10. *P < 0.05; **P < 0.01; ***P < 0.001.    The thiazide-sensitive NaCl cotransporter NCC (Slc12a3), the protein involved in NaCl absorption in the DCT, and the respective inhibitory, kidney-specific kinase-defective KS-WNK1 were expressed at lower levels in the cKO mice. Taken together, these data suggest specific compensatory alterations in components of both paracellular and transcellular renal ion transport mechanisms in mice deficient in claudin-10 in the TAL.

Urinalysis demonstrated that the inhibition of TAL tubular transport by furosemide resulted in a completely differ­ent pattern of tubular Ca2+ and Mg2+ handling that identifies the TAL as the major nephron segment affected by claudin-10 deficiency.  Interestingly, the different effects on plasma Mg2+ and Ca2+ levels reflect the different major reabsorption sites of these ions. Some 60% of the filtered Mg2+ is reabsorbed in the TAL, compared with only 20% of the filtered Ca2+ load (20). Ca2+ hyperreabsorption in TAL seems to be balanced by reduced (proximal and) distal tubular Ca2+ transport. The hyperreabsorption of divalent cations in mice deficient in claudin-10 is in opposition to the loss of divalent cations seen in mouse models of claudin-16 deficiency and in human patients with mutation in CLDN16 or CLDN19. This finding indicates that claudins in the TAL have functions that differentially affect paracellular cation transport in this segment. Mice deficient for claudin-10b in the TAL exhibit decreased permeability for Na+ and increased permeability for Ca2+ and Mg2+, whereas in mice with claudin-16 or claudin-19 deficiency, decreased sodium per­meability in the TAL is paralleled by decreased reabsorption of Ca2+ and Mg2+.

1. Greger R (1981) Cation selectivity of the isolated perfused cortical thick ascending limb of Henle’s loop of rabbit kidney. Pflugers Arch 390:30–37.
2. Furuse M (2010) Molecular basis of the core structure of tight junctions. Cold Spring Harb Perspect Biol 2:a002907.
3. Konrad M, et al. (2006) Mutations in the tight-junction gene claudin 19 (CLDN19) are associated with renal magnesium wasting, renal failure, and severe ocular in­volvement. Am J Hum Genet 79:949–957.
4.  Simon DB, et al. (1999) Paracellin-1, a renal tight junction protein required for par-acellular Mg2+ resorption. Science 285:103–106.
5. Hou J, et al. (2007) Transgenic RNAi depletion of claudin-16 and the renal handling of magnesium. J Biol Chem 282:17114–17122.
6. Himmerkus N, et al. (2008) Salt and acid-base metabolism in claudin-16 knockdown mice: Impact for the pathophysiology of FHHNC patients. Am J Physiol Renal Physiol 295:F1641–F1647.

 PMID: 22891322  PMCID: PMC3435183   http://www.ncbi.nlm.nih.gov/pubmed/22891322

Paracellin-1 is critical for magnesium and calcium reabsorption in the human thick ascending limb of Henle.

Blanchard A, Jeunemaitre X, Coudol P, Dechaux M, Froissart M, et al.
Université Pierre et Marie Curie, INSERM and Laboratoire de Génétique Moléculaire, Hôpital Universitaire Européen Georges Pompidou, Paris, France. blanch@ccr.jussieu.fr
Kidney Int. 2001 Jun; 59(6):2206-15.

A new protein, named paracellin 1 (PCLN-1), expressed in human thick ascending limb (TAL) tight junctions, possibly plays a critical role in the control of magnesium and calcium reabsorption, since mutations of PCLN-1 are present in the hypomagnesemia hypercalciuria syndrome (HHS).
No functional experiments have demonstrated that TAL magnesium and calcium reabsorption were actually impaired in patients with HHS.
Genetic studies were performed in the kindred of two unrelated patients with HHS.

We found two yet undescribed mutations of PCLN-1 (Gly 162 Val, Ala 139 Val). In patients with HHS, renal magnesium and calcium reabsorptions were impaired as expected; NaCl renal conservation during NaCl deprivation and NaCl tubular reabsorption in diluting segment were intact. Furosemide infusion in CS markedly increased NaCl, Mg, and Ca urinary excretion rates. In HHS patients, furosemide similarly increased NaCl excretion, but failed to increase Mg and Ca excretion. Acute MgCl(2) infusion in CS and ERH patient provoked a dramatic increase in urinary calcium excretion without change in NaCl excretion. When combined with MgCl(2) infusion, furosemide infusion remained able to induce normal natriuretic response, but was unable to increase urinary magnesium and calcium excretion further. In HHS patients, calciuric response to MgCl(2) infusion was blunted.

In patients with HHS, levels of circulating renin and aldosterone were normal, suggesting normal blood and extracellular volume. In addition, HHS patient 2 was normally able to lower her sodium excretion below 10 mmol/day during sodium deprivation, and in HHS pa­tient 1, sodium reabsorption in the diluting segment was normal as assessed by hypotonic saline infusion.  After oral NH4Cl load: Minimal urinary pH was 5.8 (normal value <5.4), and maximal net acid excretion reached only 24 pmol/min (normal value >80). Both subjects had hypocitraturia. The latter data suggested in the two probands distal defect of urinary acidification, probably related to nephrocalcinosis.

Because the filtered load of calcium but not the filtered load of magnesium remains unchanged during acute magnesium infusion in humans, the increase in calcium excretion is a better index of the inhibitory effect of peritubular magnesium on renal tubular divalent cation transport.  Urinary sodium excretion remained almost constant in both subjects during MgCl2 infusion (data not shown). Accordingly, the FECa/FENa ratio, which should remain constant if sodium reabsorption was primarily affected, increased in the CS and EHR patient.  Before the furosemide infusion, serum ultrafilterable (UF) Ca concentrations were similar in patients with HHS and the controls. However, Ca excretion markedly differed and was approximately five times higher in HHS patients than in controls.

In the two patients with homozygous mutations in the PCLN-1 gene, an impairment in renal tubular magne­sium and calcium reabsorption with normal NaCl recla­recla­mation was demonstrated. Accordingly, comparative studies performed under baseline condition in one pa­tient with ERH and in HHS patients demonstrated that the magnesium and calcium excretion in HHS patients were inappropriately high when compared with serum magnesium and calcium concentrations. However, renal NaCl reabsorption in HHS patients was intact. There was no clinical evidence of extracellular fluid volume  contraction. Furthermore, basal circulating renin and aldosterone concentrations were normal and adapted to the normal Na intake. Finally, abnormal NaCl reclama­tion in the diluting segment of the nephron was excluded in one patient, while the other was able to adapt normally to a sodium deprived diet.

This study is the first to our knowledge to demonstrate that homozygous mutations of PCLN-1 result in a selective defect in paracellular Mg and Ca reabsorption in the TAL, with intact NaCl reabsorption ability at this site. In addition, the study supports a selective physiological effect of basolateral Mg(2+) and Ca(2+) concentration on TAL divalent cation paracellular permeability, that is, PCLN-1 activity.   PMID: 11380823   http://www.ncbi.nlm.nih.gov/pubmed/11380823

Development of a Novel Sodium-Hydrogen Exchanger Inhibitor for Heart Failure

Elizabeth Juneman*, Reza Arsanjani, Hoang M Thai, Jordan Lancaster, Jeffrey B Madwed, Steven Goldman
Citation: Elizabeth Juneman, et al. (2013) Development of a Novel Sodium-Hydrogen Exchanger Inhibitor for Heart Failure. J Cardio Vasc Med 1: 1-6

This study was designed to determine the potential therapeutic effects of a new sodium-hydrogen exchanger (NHE-1) inhibitor in the rat coronary artery ligation model of chronic heart failure. After the induction of acute myocardial infarction, rats were entered randomly dose dranging from 0.3 mg/kg, 1.0 mg/kg, and 3.0 mg/kg. Solid state micrometer hemodynamics, echocardiographic, and pressure-volume relationships were measured after 6 weeks of treatment. Treatment with this NHE- 1 inhibitor at 3 mg/kg increased (P< 0.05) ejection fraction from 23±3% (N=6) to 33±2% (N=13) while the 1 mg/kg dose decreased (P< 0.05) the infarct size in CHF rats from 21.7±1.4% (N=7) to 15.9±0.7% (N=3) and prevented (P< 0.05) dilatation of the left ventricle in CHF rats in diastole (1.0±0.1 cm, N=6) to 0.9±0.1 cm, N=10) and in systole (0.9±0.1 cm, N=6) to 0.8±0.1, N=10). These study results suggest that this new NHE-1 inhibitor may be potentially useful in treating CHF with an improvement in maladaptive left ventricule remodeling. Because the mechanism of action of this agent is entirely different than the currently applied approach in treating CHF that focuses on aggressive neurohormonal blockade and because this agent does not adversely affect important hemodynamic variables, further investigations with this agent may be warranted.

Keywords: Congestive heart failure; Sodium/hydrogen exchange; Cardiovascular disease; Cardiovascular drugs; CHF: Chronic Heart Failure; NHE-1: Sodium-Hydrogen Exchanger; NCX: Sodium-Calcium Exchanger; Ca2+: Calcium; Na+: Sodium; Na+-K+ATPase: Sodium-Potassium ATPase; NKCC: Sodium-Potassium-Chloride co-transporter; MI: Myocardial Infarction; BI: Boehringer Ingelheim; LV: left Ventricle; EF: Ejection Fraction; LVD: left ventricular dysfunction; PV: Pressure-Volume; SE: Standard Error; ARB: Angiotensin Receptor Blocker; ACE: Angiotensin Converting Enzyme

Without reviewing the pathophysiology of CHF here, altered calcium (Ca2+) handling is a hallmark of CHF. Intracellular Ca2+ concentration is closely regulated by sodium-calcium exchanger (NCX) and Ca2+ efflux is dependent on the intracellular sodium (Na+) concentration and trans-sarcolemmal Na gradient. Multiple channels including sodium-potassium ATPase (Na+-K+ ATPase), sodium-hydrogen exporter (NHE), sodium-bicarbonate co-transporter, sodium-potassium-chloride co-transporter (NKCC), and sodium-magnesium exchanger are responsible for regulation of intracellular sodium in cardiac myocytes. The intracellular concentration of Na+ is significantly increased in heart failure, primarily due to influx of Na+. The NHE plays an integral part in rise of intracellular Na+ concentration and development of hypertrophy in heart failure. Because of its multifaceted role in myocardial function, there has been interest in examining the effects of NHE-1 inhibitors in heart failure.

In this study we report the physiologic responses of a new NHE-1 inhibitor, in a rodent model of heart failure. Previous evaluation of the pharmacokinetic properties of this agent in rat and dog revealed low clearance and robust oral bioavailability, suggesting a potential for once daily oral administration. This new compound was found to be potentially effective in preventing ischemic injury in isolated cells systems and in ischemic injury in isolated cells systems and in a Langendorff isolated heart preparation. Based on these encouraging a pharmacokinetic data, and the established preclinical roof of principle, the next step in new drug development was to test this inhibitor in an appropriate disease-relevant animal model. For this, we chose the rat coronary ligation model of CHF, which is the established model of chronic ischemic heart failure and well performed in our laboratory. The model with permanent occlusion of the left coronary artery is important because this model a similar to the clinical syndrome of CHF. This rat coronary artery model of CHF is the same model used in the classic study defining the beneficial use of angiotensin converting enzyme inhibition with captopril in the treatment of CHF. Thus results in this model have the potential to be predictive of the clinical response seen in patients.

Results

In vivohemodynamic effect of NHE1: As noted previously by our laboratory, rats with severe CHF compared to Sham had changes (P< 0.05) in right ventricular weight, mean arterial pressure, tau, the time constant of LV relaxation, LV systolic pressure, LV end-diastolic pressure, +LVdP/dt, -LVdP/dt, dead volume and peak developed pressure. In this study, treatment resulted in no changes in body weight, chamber weight or hemodynamics. Because we stopped the lowest dose (0.3 mg/kg) there are only hemodynamic data with this dose in rats with CHF.

Echocardiographic changes in LV function and Dimensions with NHE1: Rats with CHF have decreases in EF accompanied by increases in LV systolic and diastolic dimensions. There was no change in anterior wallsystolic displacement. These data are consistent with other reports in this model showing that at 6 weeks after left coronary artery ligation, rats with large MIs have dilated left ventricles with LV remodeling and poor LV function (14,15). Treatment with the highest dose of 3 mg/kg increased (P< 0.05) ejection fraction from 23±3% (N=6) to 33±2% (N=13). Treatment with 1 mg/kg prevented maladaptive LV remodeling, it prevented (P< 0.05) dilatation of the LV in CHF rats in diastole (1.0±0.1 cm, N=6) to 0.9±0.1 cm, N=10) and in systole (0.9±0.1 cm, N=6) to 0.8±0.1, N=10) with no change anterior wall thickening.

Pressure-Volume relationships:  Although there are no significant changes in the PV relationships for either the Sham or CHF rats, there is a trend for the PV loop in CHF to be shifted toward the pressure axis with treatment. These data are consistent with the trend toward decreases in LV dimensions seen with treatment in CHF rats.

Discussion

This study can be viewed as a corollary of a pilot Phase II clinical trial to look for a signal of a beneficial physiologic effect of this new NHE-1 inhibitor in CHF. In terms of drug development, this is an appropriate approach, i.e., take an agent with a therapeutic focus, with an acceptable toxicology profile, alter its pharmacokinetics to improve its oral delivery and bioavailability and then study the drug in an appropriate animal model. The administration of this agent to rats with CHF after left coronary artery ligation resulted in a therapeutic benefit with an increase in EF and a decrease in infarct size in rats with the largest infarcts. There is a suggestion of the prevention of LV remodeling with decreases in LV end-diastolic and end-systolic dimensions accompanied by a similar trend in the PV loop with a shift toward the pressure axis. There were no changes in hemodynamics.

Importantly, the decrease in infarct size with no changes in hemodynamicswould positively affect LV remodeling by minimizing LV dilatation without changes in LV afterload. From a therapeutic perspective, an agent like this may be advantageous in the treatment of heart failure after MI. The lack of hemodynamic changes is not a clinical problem because we already have agents that decrease afterload and lower LV end-diastolic pressure such as angiotensin converting enzyme (ACE) inhibitors and angiotens in receptor blockers (ARBs). In treating CHF, we also have diuretics to control blood volume, which in turn reduces LV end-diastolic pressure. The other potential advantage of an NHE-1 inhibitor is that as opposed to our current use of aggressive neurohormonal blockade, this represents a different approach to treating CHF. This is attractive because we essentially have exhausted or maximized our effects of neurohumoral blockade and with no real new treatments for CHF introduced in the last 10-15 years, need to look for other approaches to treat CHF.

Drug development is obviously a complicated and expensive undertaking. In exploring this agent, we would proposea stepwise approach. In this case with an agent whose analogs have been studied extensively, our thought would be to perform a larger dose ranging study in CHF rats to define dose response curves for systolic function as well as obtain more information on pharmacokinetics, as well as diastolic function and structural changes.

An attractive aspect of this work is that we are examining an agent with a different mechanisms of action that current treatments for heart failure. The stimulus to study the agent in an animal model of heart failure was based on multifaceted roles of sodium-hydrogen exchangers on myocardial function. Nine isoforms of NHE have currently been identified, with NHE- 1 being the predominant isoform in the plasma membrane of the myocardium [3,24]. Because NHE is activated by intracellular acidosis, angiotensin II, and catecholamines, its activity is expectedly increased in heart failure. Inhibition of NHE-1 has previously been associated with decreased fibrosis, apoptosis, preserved contractility, and attenuation of hypertrophy and development of heart failure.

1. Baartscheer A, van Borren MMGJ (2008) Sodium Ion Transporters as New Therapeutic Targets in Heart Failure. Cardiovasc Hematol Agents Med Chem 6: 229-236.
2. Murphy E, Eisner DA (2009) Regulation of Intracellular and Mitochondrial Sodium in Health and Disease. Circ Res 104: 292-303
3. Despa S, Islam MA, Weber CR, Pogwizd SM, Bers DM (2002) Intracellular Na(+) Concentration is Elevated in Heart Failure but Na/K Pump Function is Unchanged. Circulation 105: 2543-2548.
4. Baartscheer A, Schumacher CA, van Borren MMGJ, Belterman CNW, Coronel R, et al. (2003) Increased Na+/H+-Exchange Activity is the Cause of Increased [Na+]i and Underlies Disturbed Calcium Handling in the Rabbit Pressure and Volume Overload Heart Failure Model. Cardiovasc Res 57: 1015-1024.
5.  Pieske B, Houser SR (2003) [Na+]i Handling in the Failing Human Heart. Cardiovasc Res 57: 874-886.
6.  Engelhardt S, Hein L, Keller U, Klämbt K, Lohse MJ (2002) Inhibition of Na(+)-H(+) Exchange Prevents Hypertrophy, Fibrosis, and Heart Failure in Beta(1)- Adrenergic Receptor Transgenic Mice. Circ Res 90: 814-819.
7.  Chen L, Chen CX, Gan XT, Beier N, Scholz W, et al. (2004) Inhibition and Reversal of Myocardial Infarction-Induced Hypertrophy and Heart Failure by NHE-1 Inhibition. Am J Physiol Heart Circ Physiol 286: 381-387.
8.  Marano G, Vergari A, Catalano L, Gaudi S, Palazzesi S, et al. (2004) Na+/ H+ Exchange Inhibition Attenuates Left Ventricular Remodeling and Preserves Systolic Function in Pressure-Overloaded Hearts. Br J Pharmacol 141: 526-532.
9. Goldman S, Raya TE (1995) Rat Infarct Model of Myocardial Infarction and Heart Failure. J Card Fail 1: 169-177.
10. Gaballa MA, Goldman S (2002) Ventricular Remodeling in Heart Failure. J Card Fail. 8: 476-485.
11. Pfeffer MA, Pfeffer JM, Steinberg C, Finn P (1985) Survival After Experimental Myocardial Infarction: Beneficial Effects of Long-Term Therapy with Captopril. Circulation 72: 406-412.
12. Raya TE, Gay RG, Aguirre M, Goldman S (1989) Importance of Venodilatation in Prevention of Left Ventricular Dilatation after Chronic Large Myocardial Infarction in Rats: A Comparison of Captopril and Hydralazine. Circ Res 64: 330-337.

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68-76.hwp

pone.0070764.g006  Morpholino knockdown of aquaporin-1a1 reduces water influx.       NIHMS262281.html

nihms81087f1  Localization of claudin proteins in mammalian kidney.      F1.medium  intracellular Mg2+ in normal and Mg2+ depleted immortalized mouse distal convoluted tubule (MDCT) cells

F2.small  membrane voltage influences Mg2+ uptake in MDCT cells    pnas.1203834109fig04  Gene expression analysis of renal claudins

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Selective Ion Conduction

Reviewer and Curator: Larry H Bernstein, MD, FCAP

Introduction

This is Part III of a series of articles on Translational Medicine in water transport or paracellelar flow, and ion conductance.  The first article was solely on the aquaporins (Part I), and the second goes from paracellular flow (dealing with paracellin-1 and the familay of claudins.  These proteins factor into a number of diseases of kidney function and Mg(2+) homeostasis, as well as a relationship between congestive heart failure related to infarct remodeling and the sodium-calcium transporter, with a model for treatment (Part II).  The last explores the basis of selective ion conduction, based on the 2003 Nobel Prize presentation by Roderick MacKinnon (Part III).

POTASSIUM CHANNELS AND THE ATOMIC BASIS OF SELECTIVE ION CONDUCTION

Nobel Lecture, December 8, 2003
Roderick MacKinnon
Howard Hughes Medical Institute, Laboratory of Molecular Neurobiology and Biophysics, Rockefeller University ,NewYork, NY 

Water is an electrically polarizable substance, which means that its molecules rearrange in an ion’s electric field, pointing negative oxygen atoms in the direction of cations and positive hydrogen atoms toward anions. These electrically stabilizing interac­tions are much weaker in a less polarizable substance such as oil. Thus, an ion will tend to stay in the water on either side of a cell membrane rather than en­ter and cross the membrane. And yet numerous cellular processes, ranging from electrolyte transport across epithelia to electrical signal production in neurons, depend on the flow of ions across the membrane. To mediate the flow, specific protein catalysts known as ion channels exist in the cell mem­brane. Ion channels exhibit the following three essential properties: (1) they conduct ions rapidly, (2) many ion channels are highly selective, meaning only certain ion species flow while others are excluded, (3) their function is regu­lated by processes known as gating, that is, ion conduction is turned on and off in response to specific environmental stimuli. Figure 1 summarizes these properties (figure 1).

MacKinnon. Fig 1  Ion channels exhibit three basic properties

Figure 1. Ion channels exhibit three basic properties depicted in the cartoon. They conduct specific ions (for example K ) at high rates, they are selective (a K  channel essentially excludes Na ), and conduction is turned on and off by opening and closing a gate, which can be regulated by an external stimulus such as ligand-binding or membrane voltage. The relative size of K and Naions is shown.

The modern history of ion channels began in 1952 when Hodgkin and Huxley published their seminal papers on the theory of the action potential in the squid giant axon (Hodgkin and Huxley, 1952a; Hodgkin and Huxley, 1952b; Hodgkin and Huxley, 1952c; Hodgkin and Huxley, 1952d). A funda­mental element of their theory was that the axon membrane undergoes changes in its permeability to Na+ and K+ ions. The Hodgkin-Huxley theory did not address the mechanism by which the membrane permeability changes occur: ions could potentially cross the membrane through channels or by a carrier-mediated mechanism. In their words ‘Details of the mecha­nism will probably not be settled for some time’ (Hodgkin and Huxley, 1952a). It is fair to say that the pursuit of this statement has accounted for much ion channel research over the past fifty years.

As early as 1955 experimental evidence for channel mediated ion flow was obtained when Hodgkin and Keynes measured the directional flow of K+ ions across axon membranes using the isotope 42K+ (Hodgkin and Keynes, 1955). They observed that K+ flow in one direction across the membrane depends on flow in the opposite direction, and suggested that ‘the ions should be con­strained to move in single file and that there should, on average, be several ions in a channel at any moment’. Over the following two decades Armstrong and Hille used electrophysiological methods to demonstrate that Na+ and K+ ions cross cell membranes through unique protein pores – Na+ channels and K+ channels – and developed the concepts of selectivity filter for ion discrim­ination and gate for regulating ion flow (Hille, 1970; Hille, 1971; Hille, 1973; Armstrong, 1971; Armstrong et al., 1973; Armstrong and Bezanilla, 1977; Armstrong, 1981). The patch recording technique invented by Neher and Sakmann then revealed the electrical signals from individual ion channels, as well as the extraordinary diversity of ion channels in living cells throughout nature (Neher and Sakmann, 1976).

The past twenty years have been the era of molecular biology for ion chan­nels. The ability to manipulate amino acid sequences and express ion chan­nels at high levels opened up entirely new possibilities for analysis. The ad­vancement of techniques for protein structure determination and the devel­opment of synchrotron facilities also created new possibilities. For me, a sci­entist who became fascinated with understanding the atomic basis of life’s electrical system, there could not have been a more opportune time to enter the field.

The past twenty years have been the era of molecular biology for ion channels. The ability to manipulate amino acid sequences and express ion channels at high levels opened up entirely new possibilities for analysis. The advancement of techniques for protein structure determination and the development of synchrotron facilities also created new possibilities. For me, a scientist who became fascinated with understanding the atomic basis of life’s electrical system, there could not have been a more opportune time to enter the field. 

MY EARLY STUDIES: THE K+ CHANNEL SIGNATURE SEQUENCE

The cloning of the Shaker K+ channel gene from Drosophila melanogaster by Jan, Tanouye, and Pongs revealed for the first time a K+ channel amino acid se­quence and stimulated efforts by many laboratories to discover which of these amino acids form the pore, selectivity filter, and gate (Tempel et al., 1987; Kamb et al., 1987; Pongs et al., 1988). At Brandeis University in Chris Miller’s laboratory I had an approach to find the pore amino acids. Chris and I had just completed a study showing that charybdotoxin, a small protein from scor­pion venom, inhibits a K+ channel isolated from skeletal muscle cells by plug­ging the pore and obstructing the flow of ions (MacKinnon and Miller, 1988). In one of those late night ‘let’s see what happens if’ experiments while taking a molecular biology course at Cold Spring Harbor I found that the toxin – or what turned out to be a variant of it present in the charybdotoxin prepara­tion – inhibited the Shaker K+ channel (MacKinnon et al., 1988; Garcia et al., 1994). This observation meant I could use the toxin to find the pore, and it did not take very long to identify the first site-directed mutants of the Shaker K+ channel with altered binding of toxin (MacKinnon and Miller, 1989). I continued these experiments at Harvard Medical School where I began as as­sistant professor in 1989. Working with my small group at Harvard, including Tatiana Abramson, Lise Heginbotham, and Zhe Lu, and sometimes with Gary Yellen at Johns Hopkins University, we reached several interesting conclusions concerning the architecture of K+ channels. They had to be tetramers in which four subunits encircle a central ion pathway (MacKinnon, 1991). This conclusion was not terribly surprising but the experiments and analysis to reach it gave me great pleasure since they required only simple measure­ments and clear reasoning with binomial statistics. We also deduced that each subunit presents a ‘pore loop’ to the central ion pathway (figure 2) (MacKinnon, 1995).

MacKinnon. Fig 2.  tetramer K channel

Figure 2. Early picture of a tetramer K+ channel with a selectivity filter made of pore loops. A linear representation of a Shaker K+ channel subunit on top shows shaded hydrophobic segments S1 to S6 and a region designated the pore loop. A partial amino acid sequence from the Shaker K+ channel pore loop highlights amino acids shown to interact with ex-tracellular scorpion toxins (*), intracellular tetraethylammonium (↑) and K+ ions (+). The pore loop was proposed to reach into the membrane (middle) and form a selectivity filter at the center of four subunits (bottom).

This ‘loop’ formed the binding sites for scorpion toxins (MacKinnon and Miller, 1989; Hidalgo and MacKinnon, 1995; Ranganathan et al., 1996) as well as the small-molecule inhibitor tetraethylammonium ion (MacKinnon and Yellen, 1990; Yellen et al., 1991), which had been used by Armstrong and Hille decades earlier in their pioneering analysis of K+ channels (Armstrong, 1971; Armstrong and Hille, 1972). Most important to my thinking, mutations of certain amino acids within the ‘loop’ affected the channel’s ability to discriminate between K+ and Na+, the selectivity hallmark of K+ channels (Heginbotham et al., 1992; Heginbotham et al., 1994). Meanwhile, new K+ channel genes were discovered and they all had one ob­vious feature in common: the very amino acids that we had found to be im­portant for K+ selectivity were conserved (figure 3). We called these amino acids the K+ channel signature sequence, and imagined four pore loops somehow forming a selectivity filter with the signature sequence amino acids inside the pore (Heginbotham et al., 1994; MacKinnon, 1995).

Figure 3. The K+ channel signature sequence shown as single letter amino acid code (blue) is highly conserved in organisms throughout the tree of life. Some K+ channels contain six membrane-spanning segments per subunit (6TM) while others contain only two (2TM). 2TM K+ channels correspond to 6TM K+ channels without the first four membrane-span­ning segments (S1-S4 in figure 2).

When you consider the single channel conductance of many K+ channels found in cells you realize just how incredible these molecular devices are. With typical cellular electrochemical gradients, K+ ions conduct at a rate of 107 to 108 ions per second. That rate approaches the expected collision fre­quency of K+ ions from solution with the entryway to the pore. This means that K+ ions flow through the pore almost as fast as they diffuse up to it. For this to occur the energetic barriers in the channel have to be very low, some­thing like those encountered by K+ ions diffusing through water. All the more remarkable, the high rates are achieved in the setting of exquisite selectivity: the K+ channel conducts K+, a monovalent cation of Pauling radius 1.33 Å, while essentially excluding Na+, a monovalent cation of Pauling radius 0.95 Å. And this ion selectivity is critical to the survival of a cell. How does nature ac­complish high conduction rates and high selectivity at the same time? The an­swer to this question would require knowing the atomic structure formed by the signature sequence amino acids, that much was clear. The conservation of the signature sequence amino acids in K+ channels throughout the tree of life, from bacteria (Milkman, 1994) to higher eukaryotic cells, implied that nature had settled upon a very special solution to achieve rapid, selective K+ conduction across the cell membrane. For me, this realization provided in­spiration to want to directly visualize a K+ channel and its selectivity filter.

THE KCSA STRUCTURE AND SELECTIVE K+ CONDUCTION

I did not know how we would ever reach the point of ob­taining enough K+ channel protein to attempt crystallization, but the K+ channel signature sequence continued to appear in a growing number of prokaryotic genes, making expression in Escherichia coli possible. We focused our effort on a bacterial K+ channel called KcsA from Streptomyces lividans, dis­covered by Schrempf (Schrempf et al., 1995). The KcsA channel has a simple topology with only two membrane spanning segments per subunit corre­sponding to the Shaker K+ channel without S1 through S4 (figure 2). Despite its prokaryotic origin KcsA closely resembled the Shaker K+ channel’s pore amino acid sequence, and even exhibited many of its pharmacological prop­erties, including inhibition by scorpion toxins (MacKinnon et al., 1998). This surprised us from an evolutionary standpoint, because why should a scorpion want to inhibit a bacterial K+ channel! But from the utilitarian point of view of protein biophysicists we knew exactly what the scorpion toxin sensitivity meant, that KcsA had to be very similar in structure to the Shaker K+ channel.

The KcsA channel produced crystals but they were poorly ordered and not very useful in the X-ray beam. After we struggled for quite a while I began to wonder whether some part of the channel was intrinsically disordered and in­terfering with crystallization. Fortunately my neighbor Brian Chait and his postdoctoral colleague Steve Cohen were experts in the analysis of soluble proteins by limited proteolysis and mass spectrometry, and their techniques applied beautifully to a membrane protein. We found that KcsA was as solid as a rock, except for its C-terminus. After removing disordered amino acids from the c-terminus with chymotrypsin the crystals improved dramatically, and we were able to solve an initial structure at a resolution of 3.2 Å (Doyle et al., 1998). We could not clearly see K+ in the pore at this resolution, but my years of work on K+ channel function told me that Rb+ and Cs+ should be valuable electron dense substitutes for K+, and they were. Rubidium and Cs+ difference Fourier maps showed these ions lined up in the pore – as Hodgkin and Keynes might have imagined in 1955 (Hodgkin and Keynes, 1955).

The KcsA structure was altogether illuminating, but before I describe it, I will depart from chronology to explain the next important technical step. A very accurate description of the ion coordination chemistry inside the selec­tivity filter would require a higher resolution structure. With 3.2 Å data we could infer the positions of the main-chain carbonyl oxygen atoms by apply­ing our knowledge of small molecule structures, that is our intu­ition, but we needed to see the selectivity filter atoms in detail. A high-resolu­tion structure was actually quite difficult to obtain. After more than three ad­ditional years of work by João and then Yufeng (Fenny) Zhou we finally man­aged to produce high-quality crystals by attaching monoclonal Fab fragments to KcsA. These crystals provided the information we needed, a structure at a resolution of 2.0 Å in which K+ ions could be visualized in the grasp of selectivity filter protein atoms (figure 4) (Zhou et al., 2001b). What did the K+ channel structure tell us and why did nature conserve the K+ channel signa­ture sequence amino acids?

MacKinnon Fig 4. Electron density KcsA K channel

Figure 4. Electron density (2Fo-Fc contoured at 2 ir) from a high-resolution structure of the KcsA K+ channel is shown as blue mesh. This region of the channel features the selectivity filter with K+ ions and water molecules along the ion pathway. The refined atomic model is shown in the electron density. Adapted from (Zhou et al., 2001b).

Not all protein structures speak to you in an understandable language, but the KcsA K+ channel does. Four subunits surround a central ion pathway that crosses the membrane (figure 5A). Two of the four subunits are shown in fig­ure 5B with electron density from K+ ions and water along the pore. Near the center of the membrane the ion pathway is very wide, forming a cavity about 10 Å in diameter with a hydrated K+ ion at its center. Each subunit directs the C-terminal end of a ‘pore helix’, shown in red, toward the ion. The C-termi­nal end of an á-helix is associated with a negative ‘end charge’ due to car­bonyl oxygen atoms that do not participate in secondary structure hydrogen bonding, so the pore helices are directed as if to stabilize the K+ ion in the cavity. At the beginning of this lecture I raised the fundamental issue of the cell membrane being an energetic barrier to ion flow because of its oily inte­rior. KcsA allows us to intuit a simple logic encoded in its structure, and elec­trostatic calculations support the intuition (Roux and MacKinnon, 1999): the K+ channel lowers the membrane dielectric barrier by hydrating a K+ ion deep inside the membrane, and by stabilizing it with á-helix end charges.

MacKinnon Fig 5.  KcsA K+ channel   pore-helices (red) and selectivity filter (yellow)

Figure 5. (A) A ribbon representation of the KcsA K+ channel with its four subunits colored uniquely. The channel is oriented with the extracellular solution on top. (B) The KcsA K+ channel with front and back subunits removed, colored to highlight the selectivity filter (yellow). Electron density in blue mesh is shown along the ion pathway. Labels identify the pore, outer, and inner helices and the inner helix bundle. The outer and inner helices correspond to S5 and S6 in figure 2

How does the K+ channel distinguish K+ from Na+? Our earlier mutagene-sis studies had indicated that the signature sequence amino acids would be re­sponsible for this most basic function of a K+ channel. Figure 6 shows the structure formed by the signature sequence – the selectivity filter – located in the extracellular third of the ion pathway. The glycine amino acids in the se­quence TVGYG have dihedral angles in or near the left-handed helical region of the Ramachandran plot, as does the threonine, allowing the main-chain carbonyl oxygen atoms to point in one direction, toward the ions along the pore. It is easy to understand why this sequence is so conserved among K+ channels: the alternating glycine amino acids permit the required dihedral angles, the threonine hydroxyl oxygen atom coordinates a K+ ion, and the side-chains of valine and tyrosine are directed into the protein core sur­rounding the filter to impose geometric constraint.

MacKinnon Figure 6. Detailed structure of the K+ selectivity filter

Figure 6. Detailed structure of the K+ selectivity filter (two subunits). Oxygen atoms coordi­nate K+ ions (green spheres) at positions 1 to 4 from the extracellular side. Single letter amino acid code identifies select signature sequence amino acids. Yellow, blue and red cor­respond to carbon, nitrogen and oxygen atoms, respectively. Green and gray dashed lines show oxygen-K+ and hydrogen bonding interactions.

The end result when the subunits come together is a narrow tube consisting of four equal spaced K+ binding sites, labeled 1 to 4 from the extracellular side. Each binding site is a cage formed by eight oxygen atoms on the vertices of a cube, or a twisted cube called a square antiprism (figure 7). The binding sites are very similar to the single alkali metal site in nonactin, a K+ selective antibiotic with nearly identical K+-oxygen distances (Dobler et al., 1969; Dunitz and Dobler, 1977). The principle of K+ selectivity is implied in a subtle feature of the KcsA crystal structure. The oxygen atoms surrounding K+ ions in the selectivity filter are arranged quite like the water molecules surrounding the hydrated K+ ion in the cavity. This comparison conveys a visual impression of binding sites in the filter paying for the energetic cost of K+ dehydration. The Na+ ion is appar­ently too small for these K+-sized binding sites, so its dehydration energy is not compensated.

MacKinnon Fig 7 K+ channel mimics the hydration shell surrounding a K+ ion

Figure 7. A K+ channel mimics the hydration shell surrounding a K+ ion. Electron density (blue mesh) for K+ ions in the filter and for a K+ ion and water molecules in the central cav­ity are shown. White lines highlight the coordination geometry of K+ in the filter and in wa­ter. Adapted from (Zhou et al., 2001b).

The question that compelled us most after seeing the structure was exactly how many ions are in the selectivity filter at a given time? To begin to under­stand how ions move through the filter we needed to know the stoichiometry of the ion conduction reaction, and that meant knowing how many ions can occupy the filter. Four binding sites were apparent, but are they all occupied at once? Four K+ ions in a row separated by an average center-to-center dis­tance of 3.3 Å seemed unlikely for electrostatic reasons. From an early stage we suspected that the correct number would be closer to two, because two ions more easily explained the electron density we observed for the larger al­kali metal cations Rb+ and Cs+ (Doyle et al., 1998; Morais-Cabral et al., 2001). Quantitative evidence for the precise number of ions came with the high-res­olution structure and with the analysis of Tl+ (Zhou and MacKinnon, 2003). Thallium is the most ideally suited ‘K+ analog’ because it flows through K+ channels, has a radius and dehydration energy very close to K+, and has the favorable crystallographic attributes of high electron density and an anom­alous signal. The one serious difficulty in working with Tl+ is its insolubility with Cl. Fenny meticulously worked out the experimental conditions and de­termined that on average there are between two and two and a half conduct­ing ions in the filter at once, with an occupancy at each position around one half.

We also observed that if the concentration of K+ (or Tl+) bathing the crys­tals is lowered sufficiently (below normal intracellular levels) then a reduc­tion in the number of ions from two to one occurs and is associated with a structural change to a ‘collapsed’ filter conformation, which is pinched closed in the middle (Zhou et al., 2001b; Zhou and MacKinnon, 2003). At concentrations above 20 mM the entry of a second K+ ion drives the filter to a ‘conductive’ conformation, as shown in figure 8. Sodium on the other hand does not drive the filter to a ‘conductive’ conformation even at concentra­tions up to 500 mM.

MacKinnon Figure 8. The selectivity filter can adopt two conformations

Figure 8. The selectivity filter can adopt two conformations. At low concentrations of K+ on average one K+ ion resides at either of two sites near the ends of the filter, which is col­lapsed in the middle. At high concentrations of K+ a second ion enters the filter as it changes to a conductive conformation. On average, two K+ ions in the conductive filter re­side at four sites, each with about half occupancy.

The K+-induced conformational change has thermodynamic consequences for the affinity of two K+ ions in the ‘conductive’ filter. It implies that a frac­tion of the second ion’s binding energy must be expended as work to bring about the filter’s conformational change, and as a result the two ions will bind with reduced affinity. To understand this statement at an intuitive level, rec­ognize that for two ions to reside in the filter they must oppose its tendency to collapse and force one of them out, i.e. the two-ion ‘conductive’ conforma­tion is under some tension, which will tend to lower K+ affinity. This is a de­sirable property for an ion channel because weak binding favors high con­duction rates. The same principle, referred to as the ‘induced fit’ hypothesis, had been proposed decades earlier by enzymologists to explain high speci­ficity with low substrate affinity in enzyme catalysis (Jencks, 1987).

In the ‘conductive’ filter if two K+ ions were randomly distributed then they would occupy four sites in six possible ways. But several lines of evidence hint­ed to us that the ion positions are not random. For example Rb+ and Cs+ ex-hibit preferred positions with obviously low occupancy at position 2 (Morais-Cabral et al., 2001; Zhou and MacKinnon, 2003). In K+ we observed an un­usual doublet peak of electron density at the extracellular entryway to the se­lectivity filter, shown in figure 9 (Zhou et al., 2001b). We could explain this density if K+ is attracted from solution by the negative protein surface charge near the entryway and at the same time repelled by K+ ions inside the filter. Two discrete peaks implied two distributions of ions in the filter.

MacKinnon Fig 9  Figure 9. Two K+ ions in the selectivity filter are hypothesized to exist predominantly in two specific configurations 1,3 and 2,4 as shown.

Figure 9. Two K+ ions in the selectivity filter are hypothesized to exist predominantly in two specific configurations 1,3 and 2,4 as shown. K+ ions and water molecules are shown as green and red spheres, respectively. Adapted from (Zhou et al., 2001b).

Discrete configurations of an ion pair suggested a mechanism for ion con­duction (figure 10A) (Morais-Cabral et al., 2001). The K+ ion pair could dif­fuse back and forth between 1,3 and 2,4 configurations (bottom pathway), or alternatively an ion could enter the filter from one side of the membrane as the ion-water queue moves and a K+ exits at the opposite side (the top path­way). Movements would have to be concerted because the filter is no wider than a K+ ion or water molecule. The two paths complete a cycle: in one com­plete cycle each ion moves only a fraction of the total distance through the fil­ter, but the overall electrical effect is to move one charge all the way.

MacKinnon Fig 10 Figure 10. The selectivity filter is represented as five square planes of oxygen atoms.

Figure 10. (A) Through-put cycle for K+ conduction invoking 1,3 and 2,4 configurations. The selectivity filter is represented as five square planes of oxygen atoms. K+ and water are shown as green and red spheres, respectively. (B) Simulated K+ flux around the cycle is graphed as a function of the energy difference between the 1,3 and 2,4 configurations. Adapted from (Morais-Cabral et al., 2001).

A simulation of ions diffusing around the cycle offers a possible explanation: maximum flux is achieved when the energy difference between the 1,3 and 2,4 configurations is zero because that is the condition under which the ‘energy landscape’ for the con­duction cycle is smoothest (figure 10B). The energetic balance between the configurations therefore might reflect the optimization of conduction rate by natural selection (Morais-Cabral et al., 2001). It is not so easy to demonstrate this point experimentally but it is certainly fascinating to ponder.

COMMON STRUCTURAL PRINCIPLES UNDERLIE K+ AND Cl SELECTIVITY

The focus of this lecture is K+ channels, but for a brief interlude I would like to show you a Cl selective transport protein. By comparing a K+ channel and a Cl ‘channel’ we can begin to appreciate familiar themes in nature’s solu­tions to different problems: getting cations and anions across the cell mem­brane. ClC Cl channels are found in many different cell types and are associ­ated with a number of physiological processes that require Cl ion flow across lipid membranes (Jentsch et al., 1999; Maduke et al., 2000). As is the case for K+ channels, ClC family genes are abundant in prokaryotes, a fortunate cir­cumstance for protein expression and structural analysis. When Raimund Dutzler joined my laboratory he, Ernest Campbell and I set out to address the structural basis of Cl ion selectivity. We determined crystal structures of two bacterial members of the ClC Cl channel family, one from Escherichia coli (EcClC) and another from Salmonella typhimurium (StClC) (Dutzler et al., 2002). Recent studies by Miller on the function of EcClC have shown that it is actually a Cl – proton exchanger (Accardi and Miller, 2004). We do not yet know why certain members of this family of Cl transport proteins function as channels and others as exchangers, but the crystal structures are fascinating and give us a view of Cl selectivity. Architecturally the ClC proteins are unre­lated to K+ channels, but if we focus on the ion pathway certain features are similar (figure 11).

MacKinnon Fig 11 CIC Cl transport protein

Figure 11. The overall architecture of K+ channels and ClC Cl transport proteins is very dif­ferent but certain general features are similar. One similarity shown here is the use of á-he-lix end charges directed toward the ion pathway. The negative C-terminal end charge (red) points to K+. The positive N-terminal end charge (blue) points to Cl.

As we saw in K+ channels, the ClC proteins have a-helices pointed at the ion pathway, but the direction is reversed with the positive charge of the N-terminus close to Cl. This makes perfect sense for lowering the dielectric barrier for a Cl ion. In ClC we see that ions in its selectivity fil­ter tend to be coordinated by main chain protein atoms, with amide nitrogen atoms surrounding Cl instead of carbonyl oxygen atoms surrounding K+ (figure 12). We also see that both the K+ and Cl selectivity filters contain multiple close-spaced binding sites and appear to contain more than one ion, perhaps to exploit electrostatic repulsion between ions in the pore. I find these simi­larities fascinating. They tell us that certain basic physical principles are im­portant, such as the use of á-helix end charges to lower the dielectric barrier when ions cross the lipid membrane.

TRYING TO SEE A K+ CHANNEL OPEN AND CLOSE

channels conduct when called upon by a specific stimulus such as the binding of a ligand or a change in membrane voltage (Hille, 2001). The processes by which ion conduction is turned on are called gating. The con­duction of ions occurs on a time scale that is far too rapid to involve very large protein conformational changes.

Figure 12. K+ and Cl- selectivity filters make use of main chain atoms to coordinate ions

Figure 12. K+ and Cl selectivity filters make use of main chain atoms to coordinate ions: car­bonyl oxygen atoms for K+ ions (green spheres) and amide nitrogen atoms for Cl ions (red spheres). Both filters contain multiple close-spaced ion binding sites. The Cl selectivity fil­ter is that of a mutant ClC in which a glutamate amino acid was changed to glutamine (Dutzler et al., 2003).

In the KcsA K+ channel gating is controlled by intracellular pH and lipid membrane composition, but unfortunately the KcsA channel’s open proba­bility reaches a maximum value of only a few percent in functional assays (Cuello et al., 1998; Heginbotham et al., 1998). At first we had no definitive way to know whether a gate was open or closed in the crystal structures. In the 1970s Armstrong had proposed the existence of a gate near the intracel­lular side of the membrane in voltage dependent K+ channels because he could ‘trap’ large organic cations inside the pore between a selectivity filter near the extracellular side and a gate near the intracellular side (Armstrong, 1971; Armstrong, 1974). Following these ideas we crystallized KcsA with a heavy atom version of one of his organic cations, tetrabutyl antimony (TBA), and found that it binds inside the central cavity of KcsA (Zhou et al., 2001a). This was very interesting because the ~10 Å diameter of TBA far exceeds the pore diameter leading up to the cavity: in KcsA the intracellular pore entry­way is constricted to about 3.5 Å by the inner helix bundle (figure 5B). Seeing TBA ‘trapped’ in the cavity behind the inner helix bundle evoked Arm-strong’s classical view of K+ channel gating, and implied that the inner helix bundle serves as a gate and is closed in KcsA. Mutational and spectroscopic studies in other laboratories also pointed to the inner helix bundle as a pos­sible gate-forming structural element (Perozo et al., 1999; del Camino et al., 2000).

We subsequently determined the crystal structure of MthK, complete K+ channel containing RCK domains, from Methanobacterium thermoautotrophicus (figure 13) (Jiang et al., 2002a). This structure was extremely informative. The RCK domains form a ‘gating ring’ on the intracellular side of the pore. In clefts between domains we could see what appeared to be divalent cation binding sites, and the crys­tals had been grown in the presence of Ca2+. In functional assays we discov­ered that the open probability of the MthK channel increased as Ca2+ or Mg2+ concentration was raised, giving us good reason to believe that the crystal structure should represent the open conformation of a K+ channel.

In our MthK structure the inner helix bundle is opened like the aperture of a camera (figure 14) (Jiang et al., 2002b). As a result, the pathway leading up to the selectivity filter from the intracellular side is about 10 Å wide, explaining how Armstrong’s large organic cations can enter the cavity to block a K+ chan-nel, and how K+ ions gain free access to the selectivity filter through aqueous diffusion. By comparing the KcsA and MthK channel structures it seemed that we were looking at examples of closed and opened K+ channels, and could easily imagine the pore undergoing a conformational change from closed to open.

In the crystal of KvAP the voltage sen­sors, held by monoclonal Fab fragments, adopted a non-native conformation. This observation in itself is meaningful as it underscores the intrinsic flexibil­ity of voltage sensors: in contrast Fab fragments had little effect on the more rigid KcsA K+ channel and ClC Cl channel homolog, both of which we deter­mined in the presence and absence of Fab fragments (Doyle et al., 1998; Zhou et al., 2001b; Dutzler et al., 2002; Dutzler et al., 2003). KvAP’s voltage sensors contain a hydrophobic helix-turn-helix element with arginine residues beside the pore (Jiang et al., 2003a).

The KvAP structure and associated functional studies have provided a conceptual model for voltage-dependent gating – one in which the voltage sensors move at the protein-lipid interface in response to a balance between hydrophobic and electrostatic forces. Rees and colleagues at the California Institute of Technology determined the structure of a voltage regulated mechanosensitive channel called MscS, and although it is unrelated to traditional voltage-dependent channels, it too con­tains hydrophobic helix-turn-helix elements with arginine residues apparent­ly against the lipid membrane (Bass et al., 2002). MscS and KvAP are fascinat­ing membrane protein structures. They do not fit into the standard category of membrane proteins with rigid hydrophobic walls against the lipid mem­brane core. I find such proteins intriguing.

Selected Refernces

Accardi, A. and Miller, C. (2004) Proton-coupled chloride transport mediated by ClC-ec1, a bacterial homologue of the ClC chloride channels. Biophys.J. 86[1], 286a.
Armstrong, C. M. (1971). Interaction of tetraethylammonium ion derivatives with the potassium channels of giant axons. J. Gen. Physiol. 58, 413–437.
Armstrong, C. M. (1981). Sodium channels and gating currents. Physiol. Rev. 61, 645–683.
Armstrong, C. M. and Hille, B. (1972). The inner quaternary ammonium ion receptor in potassium channels of the node of Ranvier. J. Gen. Physiol. 59, 388–400.
Armstrong, C. M. (1974). Ionic pores, gates, and gating currents. Q. Rev. Biophys. 7, 179–210
Armstrong, C. M. and Bezanilla, F. (1977). Inactivation of the sodium channel. II. Gating current experiments. J. Gen. Physiol 70, 567–590.
Atkinson, N. S., Robertson, G. A., and Ganetzky, B. (1991). A component of calcium-actvated potassium channels encoded by the Drosophila slo locus. Science 253, 551–555
Bass, R. B., Strop, P., Barclay, M., and Rees, D. C. (2002). Crystal structure of Escherichia coli MscS, a voltage-modulated and mechanosensitive channel. Science 298, 1582–1587.
Bezanilla, F. (2000). The voltage sensor in voltage-dependent ion channels. Physiol Rev. 80, 555–592
del Camino, D., Holmgren, M., Liu, Y., and Yellen, G. (2000). Blocker protection in the pore of a voltage-gated K+ channel and its structural implications. Nature 403, 321–325.
Doyle, D. A., Morais Cabral, J. H., Pfuetzner, R. A., Kuo, A., Gulbis, J. M., Cohen, S. L., Chait, B. T., and MacKinnon,R. (1998). The structure of the potassium channel: molecular basis of K+ conduction and selectivity. Science 280, 69–77.
Dutzler, R., Campbell, E. B., Cadene, M., Chait, B. T., and MacKinnon,R. (2002). X-ray structure of a ClC chloride channel at 3.0 Å reveals the molecular basis of anion selectivity. Nature 415, 287–294.
Dutzler, R., Campbell, E. B., and MacKinnon, R. (2003). Gating the selectivity filter in ClC chloride channels. Science 300, 108–112.
Garcia, M. L., Garcia-Calvo, M., Hidalgo, P., Lee, A., and MacKinnon, R. (1994). Purification and charaterization of three inhibitors of voltage-dependent K+ channels from Leiurus quinquestriatus var. hebraeus venom. Biochemistry 33, 6834–6839.
Gulbis, J. M., Mann, S., and MacKinnon, R. (1999). Structure of a voltage-dependent K+ channel beta subunit. Cell 97, 943–952.
Gulbis, J. M., Zhou, M., Mann, S., and MacKinnon, R. (2000). Structure of the cytoplasmic f3 subunit-T1 assembly of voltage-dependent K+ channels. Science 289, 123–127.
Heginbotham, L., Abramson, T., and MacKinnon, R. (1992). A functional connection between the pores of distantly related ion channels as revealed by mutant K+ channels. Science 258, 1152–1155.
Heginbotham, L., Lu, Z., Abramson, T., and MacKinnon, R. (1994). Mutations in the K+ channel signature sequence. Biophys. J. 66, 1061–1067.
Hidalgo, P. and MacKinnon, R. (1995). Revealing the architecture of a K+ channel pore through mutant cycles with a peptide inhibitor. Science 268, 307–310.
Hille, B. (1970). Ionic channels in nerve membranes. Prog. Biophys. Mol. Biol. 21, 1–32.
Hille, B. (1973). Potassium channels in myelinated nerve. Selective permeability to small cations. J. Gen. Physiol. 61, 669–686.
Hille, B. (2001). Ion Channels of Excitable Membranes. (Sunderland, MA: Sinauer Associates, Inc.).
Hille, B. (1971). The permeability of the sodium channel to organic cations in myelinated nerve. J. Gen. Physiol. 58, 599–619.
Hodgkin, A. L. and Huxley, A. F. (1952a). A quantitative description of membrane current and its application to conduction and excitation in nerve. J. Physiol. 117, 500–544.
Hodgkin, A. L. and Huxley, A. F. (1952b). Currents carried by sodium and potassium ions through the membrane of the giant axon of Loligo. J. Physiol. 116, 449–472.
Hodgkin, A. L. and Huxley, A. F. (1952c). The components of membrane conductance in the giant axon of Loligo. J. Physiol. 116, 473–496.
Hodgkin, A. L. and Huxley, A. F. (1952d). The dual effect of membrane potential on sodium conductance in the giant axon of Loligo. J. Physiol. 116, 497–506.
Hodgkin, A. L. and Keynes, R. D. (1955). The potassium permeability of a giant nerve fibre. J. Physiol. (Lond) 128, 61–88.
Jencks, W. P. (1987). Catalysis in Chemistry and Enzymology. (Dover Publications, Inc.).
Jentsch, T. J., Friedrich, T., Schriever, A., and Yamada, H. (1999). The CLC chloride channel family. Pflugers Arch. 437, 783–795.
Jiang, Y., Lee, A., Chen, J., Ruta, V., Cadene, M., Chait, B., and MacKinnon, R. (2003a). X-ray structure of a voltage-dependent K+ channel. Nature 423, 33–41.
Jiang, Y., Ruta, V., Chen, J., Lee, A., and MacKinnon, R. (2003b). The principle of gating charge movement in a voltage-dependent K+ channel. Nature 423, 42–48.
Jiang, Y., Lee, A., Chen, J., Cadene, M., Chait, B. T., and MacKinnon, R. (2002a). Crystal structure and mechanism of a calcium-gated potassium channel. Nature 417, 515–522.
Jiang, Y., Lee, A., Chen, J., Cadene, M., Chait, B. T., and MacKinnon, R. (2002b). The open pore conformation of potassium channels. Nature 417, 523–526.
Jiang, Y., Pico, A., Cadene, M., Chait, B. T., and MacKinnon, R. (2001). Structure of the RCK domain from the E. coli K+ channel and demonstration of its presence in the human BK channel. Neuron 29, 593–601.
MacKinnon, R. (1999). The cavity and pore helices in the KcsA K+ channel: electrostatic stabilization of monovalent cations. Science 285, 100–102.
Ruta, V., Jiang, Y., Lee, A., Chen, J., and MacKinnon, R. (2003). Functional analysis of an archeabacterial voltage-dependent K+ channel. Nature 422, 180–185.
Zhou, M. and MacKinnon, R. (2004). A mutant KcsA K+ channel with altered conduction properties and selectivity filter ion distribution. J.Mol.Biol. 338, 839–846.
Zhou, M., Morais-Cabral, J. H., Mann, S., and MacKinnon, R. (2001a). Potassium channel receptor site for the inactivation gate and quaternary amine inhibitors. Nature 411, 657–661.
Zhou, Y. and MacKinnon, R. (2003). The occupancy of ions in the K+ selectivity filter: Charge balance and coupling of ion binding to a protein conformational change underlie high conduction rates. J. Mol. Biol. 333, 965–975.
Zhou, Y., Morais-Cabral, J. H., Kaufman, A., and MacKinnon, R. (2001b). Chemistry of ion coordination and hydration revealed by a K+ channel- Fab complex at 2.0 Å resolution. Nature 414, 43–48.

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Translational Research on the Mechanism of Water and Electrolyte Movements into the Cell

Reviewer and Curator: Larry H. Bernstein, MD, FACP

Introduction

This article is the first in a three part curation covering work that has great importance to our understanding of hydration and possibly the effects of dehydration in cell physiology, and studied effects on renal function and brain, with possible implications for heart failure, myocardial contraction, heart rate, and arrhythmiagenesis.  The discovery of aquaporins and the elucidation of potassium channels and selective ion conduction was jointly awarded the Nobel Prize in Chemistry in 2003 to Peter Agre, at the Johns Hopkins School of Medicine, Baltimore, and Roderick Mac Kinnon, at the Howard Hughes Medical Institute, Laboratory of Molecular Neurobiology and Biophysics, Rockefeller University, New York, NY.  The transport of water, it was assumed, is associated with the movements of Na(+), K(+), Ca(2+), Mg(2+).  The calmodulin kinase, rhyanodine, and calcium sparks in the Ca(2+) release from sarcolemma is covered elsewhere in cardiac contraction, skeletal muscle, smooth muscle, and neural stimulation of muscle and adrenergic release.  The sodium/potassium exchange is depicted in diagrams, but not discussed.  In traditional chemistry we would think in terms of a cationic and anionic balance that has to be maintained in charge equivalents on both sides of a membrane.  However, the intricacies of membrane structure as well as active transporters has been delineated and has been a transformative factor in our understanding of organ function in health and disease.

Aquaporin Water Channels

AQUAPORIN WATER CHANNELS: Nobel Lecture, Dec 8, 2003, by Peter Agre. http://www.nobelprize.org/nobel_prizes/chemistry/laureates/2003/agre-lecture.pdfagre-lecture Fig1 Membrane orientation of AQP1

We have studied the aquaporin water channels for several years, and we now understand that they explain how water crosses biological membranes. Our bodies are 70% water, and all other vertebrates, invertebrates, microbes, and plants are also primarily water. The organization of water within biological compartments is fundamental to life, and the aquaporins serve as the plumbing systems for cells. Aquaporins explain how our
brains secrete and absorb spinal fluid, how we can generate aqueous humor within our eyes, how we can secrete tears, saliva, sweat, and bile, and how our kidneys can concentrate urine so effectively. These proteins are fundamental to mammalian physiology, but they are also very important in the lives of microorganisms and plants.
It was correctly proposed  in the 1920’s that water could move through the cell membrane simply by diffusing through the lipid bilayer. The current view is that the lipid bilayer has a finite permeability for water, but, in addition, a set of proteins exists that we now refer to as “aquaporins.” Their existence was suggested by a group of pioneers in the water transport field who preceded us by decades – people including Arthur K. Solomon in Boston, Alan Finkelstein in New York, Robert Macey in Berkeley, Gheorghe Benga in Romania, Guillermo Whittembury in Venezuela, Mario Parisi in Argentina – who by biophysical methods predicted that water channels must exist in certain cell types with high water permeability such as renal tubules, salivary glands, and red cells (reviewed by Finkelstein, 1987).
The difference between diffusional and channel-mediated water perme-ability is fairly distinct. Diffusion is a low capacity, bidirectional movement of water that occurs in all cell membranes, whereas the membranes of a subset of cells with aquaporin proteins have very high capacity for permeation by water.
This permeability is selective, since water (H O) crosses through the membranes with almost no resistance, while acid, the hydronium ion (H O ) does not permeate the proteins. This distinction is essential to life. The movement of water is directed by osmotic gradients, so aquaporins are not pumps or exchangers. They form a simple pore that allows water to rapidly pass through membranes by osmosis. There are also other differences between diffusion and channel-mediated water transport. No inhibitors are known for simple diffusion. In contrast, mercurials were discovered by Robert Macey to inhibit water transport in red cells but water permeability was restored by treatment with reducing agents (Macey and Farmer, 1970). These observations predicted that water channels must be proteins with sulfhydryls and characteristically low Arrhenius activation energy.
A number of investigators using ver y logical approaches attempted to identify the water channel molecule; identification proved a very difficult prolem. Isotopic mercurials labeled several membrane proteins – the anion exchanger (band 3). Solomon and a group of several proteins (band 4.5) by Benga. None of the proteins were isolated, reconstituted, and shown  to transport watter (reviewed by Agre et al., 1993a).

DISCOVERY OF AQP1

The field was essentially stuck, but following the well known scientific approach known as “sheer blind luck,” we stumbled upon the protein. Looking through our notebooks for the earliest studies that showed there was such a protein water channel. We were at that time attempting to raise antibodies in rabbits to the denatured partially purified Rh polypeptide.  The rabbits vigorously produced antibodies, but we failed to recognize initially that our antibody did not react with the core Rh polypeptide that migrated at 32 kDa, seen clearly by silver staining of sodium dodecyl sulfate polyacryamide electrophoresis gels (SDS-PAGE). Instead, our antibodies reacted only with a 28 kDa polypeptide. The 28 kDa was an unrelated protein.  Silver staining of SDS-PAGE migration of the isolated protein revealed a discrete band of 28 kDa in detergent insoluble extracts (it failed to stain with the conventional protein stains such as Coomassie blue). The protein was then purified in large amounts from human red cell membranes (Denker et al., 1988; Smith and Agre, 1991).  The 28 kDa protein was strikingly abundant. With approximately  copies per red cell, it was one of the major proteins in the membrane. The protein had features suggesting that it was a tetrameric membrane-spanning protein – suggesting that it was a channel, but a channel for what? The purified protein also provided us the N-terminal amino acid sequence that we used for cDNA cloning. Using our antibody, we looked at several other tissues and found the protein is also strikingly abundant in human kidney. We observed staining over the apical and basolateral membranes of proximal renal tubules and the descending thin limb of the loops of Henle, but we were still frustrated by our failure to recognize what the protein’s function might be.  My clinical mentor, John C. Parker (1935–1993) at the University of North Carolina at Chapel Hill, was the first to suggest to me that red cells and renal tubules were exceedingly permeable to water. He recommended that we consider a role in membrane water transport. While John did not live to see our later studies, he did live to see our initial discovery and we celebrated together.
Postdoctoral fellow Gregor y Preston cloned the cDNA from an erythroid brary (Preston and Agre, 1991). The coding region corresponded to a 269 amino acid polypeptide, predicted by hydropathy analysis to have six bilayer-spanning domains. Interestingly, the amino terminal half (repeat-1) and the carboxy terminal half of the molecule (repeat-2) were genetically related – about 20% identical. Two loops B and E were more highly related to each other, and each contained the signature motif – asparagine, proline, alanine (NPA) [Fig. 1]. Examining the genetics database, we recognized several sequence-related DNAs from diverse sources: lens of cow eyes, brains of fruit flies, bacteria, and plants. Nevertheless, none was functionally defined.
Figure 1. Membrane orientation of AQP1 predicted from primary amino acid sequence. Two tandem repeats each have three bilayer-spanning domains; the repeats are oriented 180˚ with respect to each other. The loops B and E each contain the conser ved motif, Asn- Pro-Ala (NPA)
These clues heightened our suspicion that the 28 kDa protein was a transporter, so we tested for possible water transport function with our colleague Bill Guggino at Johns Hopkins. We used oocytes the frog Xenopus laevis, a useful model, since frog oocytes have very low water permeability. Control oocytes were injected with water alone; oocytes were injected with 2 ng of cRNA encoding our protein. After days of protein synthesis, the oocytes appeared essentially identical. Then we stressed the oocytes by transferring them to distilled water, and an amazing difference was immediately apparent. Having exceedingly low water perme-
ability, the control oocytes failed to swell. In contrast, the test oocytes were highly permeable to water and exploded like popcorn [Fig. 2] (Preston et al., 1992).  The protein was christened “aquaporin” and is now officially designated “AQP1,” the first functionally defined water channel protein (Agre et al., 1993b).
Figure 2. Functional expression of AQP1 water channels in Xenopus laevis oocytes. Control oocyte (left) was injected with water; AQP1 oocyte (right) was injected with cRNA. The oocytes were transferred to hypotonic buffer. After 30 seconds (top) the AQP1 oocyte has begun to swell; after 3 minutes (bottom), the AQP1 oocyte has exploded. Modified and reprinted from Science with permission (Preston et al., 1992).
We  confirmed the function of this protein by studying the purified AQP1 reconstituted into synthetic lipid vesicles of ~0.1 micron diameter prepared by our colleague Suresh Ambudkar at Johns Hopkins (Zeidel et al., 1992). These simple membrane vesicles were examined by freeze fracture electron microscopy by our colleague Arvid Maunsbach, from the University of Aarhus. When lipid was reconstituted without protein, the membrane surfaces were smooth; however, membranes reconstituted with AQP1 contained many intramembraneous particles 0.01 micron diameter (Zeidel et al., 1994). We tested the membranes for water permeability in collaboration with Mark Zeidel at Har vard Medical School. Using stopped flow transfer to hypertonic buffer, the simple liposomes shrank, reaching equilibrium in about one half
second; this is believed to represent the baseline water permeability. When membranes reconstituted with AQP1 were examined, the shrinking occurred much more rapidly, reaching equilibrium in about 20 milliseconds. The channel-mediated flow of water was confirmed, since it was inhibited with mercurials. We calculated the Arrhenius activation energy (<5 kcal/mol), and we determined the unit permeability to be ~3×10 water molecules per subunit per second. Importantly, we attempted to measure proton permeation of AQP1, but despite massive water permeability, acid permeation was not detected. These studies verified that we had, in fact, isolated the long-sought water channel protein.

STRUCTURE OF AQP1

Subsequent efforts were devoted to identifying the mercurial inhibitory site predicted by the studies of Macey. Mercurials react with free sulfhydryls in the amino acid cysteine. Four cysteines are found in the AQP1 polypeptide, but only the residue in loop E (Cys-189 proximal to the second NPA motif) is inhibited by mercurials. We altered the AQP1 sequence by site-directed mutagenesis and expressed the recombinants in oocytes for water permeability studies. Mutation of this residue to serine (Cys-189-Ser) resulted in full water permeability without mercurial inhibition. When we then replaced the alanine in the corresponding position of loop B with a cysteine (Ala-73-Cys), the protein exhibited mercurial sensitive water permeability (Preston et al., 1993). Substitutions elsewhere in the AQP1 failed to produce this behavior. This suggested to us that loops B and E in opposite parts of the molecule must somehow form the aqueous pore. The model that we concocted turned out to be schematically correct and was termed “the hourglass.” The ancient timepiece allows sand to run from upper chamber to lower chamber; if inverted, the sand will flow in the opposite direction. Six bilayer spanning domains were predicted to surround a central domain containing loop B, dipping into the membrane from the cytoplasmic surface, and loop E, dipping into the membrane from the extracellular surface [Fig. 3 left and right].
Figure 3. Hourglass model for membrane topology of AQP1 subunit.
Left panel – Schematic folding of loops B and E overlap within the lipid bilayer to form a single aqueous pathway.
Right panel – Ribbon model of three dimensional structure of AQP1 subunit confirms hourglass with single aqueous pathway. Modified and reprinted with permission from Jour-
nal of Biological Chemistr y (Jung et al., 1994b) and Journal of Clinical Investigation (Kozono et al., 2002).
The overlap of loops B and E was predicted to form a single aqueous pore through the center of the molecule with the NPA motifs juxtaposed and mercurial inhibitory site alongside (Jung et al., 1994b). The AQP1 protein tetrameric with a central pore in each subunit. Thus, AQP1 is structurally like ion channel proteins where four subunits surround a single central as discussed by Rod MacKinnon in his lecture.
We  then sought to establish the high resolution structure of AQP1 in collaboration with Andreas Engel and his group at the Biozentrum in Basel. We were later joined with Yoshinori Fujiyoshi and his group at Kyoto University. Human red cell AQP1 protein was purified by Barb Smith in our lab; Andreas’s student Tom Walz reconstituted it into synthetic membranes at very high protein concentrations. Under these conditions, the AQP1 protein forms remarkably symmetrical arrays referred to as membrane crystals. By measuring the water permeability, we confirmed that the function was 100% retained, giving us confidence that the structure we deduced would be the biologically relevant structure (Walz et al., 1994).
Figure 4. Functional representation for selective water flow through AQP1 subunit and residues involved in human disease.
Left panel – Schematic of sagittal cross-section of AQP1 reveals bulk water in extracellu- lar and intracellular vestibules of hourglass. These are separated by a 20Å span where water passes in single file with transient interactions with pore-lining residues that prevent hy- drogen bonding between water molecules (bold colors). Two structures are believed to pre- vent permeation by protons (H O ): electrostatic repulsion is created by a fixed positive
charge from pore-lining arginine (R195) at a 2.8Å narrowing in the channel; water dipole reorientation occurs from simultaneous hydrogen bonding of water molecule with side chains of two asparagines residues in NPA motifs (N192 and N76). Two partial positive charges at the center of the channel result from orientation of two non-membrane span- ning alpha helices distal to the NPA motifs

THE AQUAPORIN AND AQUAGLYCEROPORIN PROTEIN FAMILY

While we were pursuing studies of AQP1, several other research groups from around the world became interested in what is now known to be a large family of related proteins. The combined efforts of these labs have led to the molecular identification of 12 mammalian aquaporin homologs, and several hundred related proteins have been recognized in other vertebrates as well as invertebrates, plants, and unicellular micro-organisms. The mammalian homologs may be loosely clustered into two subsets [Fig. 5]. The first is referred to as “classical aquaporins”, since they were initially considered to be exclusive water pores. The second is referred to as “aquaglyceroporins”, since they are permeated by water plus glycerol. Interestingly, E. coli has one member of
each – AqpZ (Calamita et al., 1995), and GlpF, isolated by other investigators much earlier. Together, the mammalian aquaporins and aquaglyceroporins are now known to contribute to multiple physiological processes that occur during our daily lives.
Figure 5. Human aquaporin gene family contains two subsets. Homologs freely permeated by water (classical aquaporins, blue) or water and glycerol (aquaglyceroporins, yellow) are represented. E. coli has one aquaporin (AqpZ) and one aquaglyceroporin (GlpF). Reprinted with permission from Journal of Physiology (Agre et al., 2002)
 The remainder of the Nobel Lecture (2003) can be found at the Nobel Prize site.  This portion is sufficient to cover the genesis and advancement of the water transport discovery.

Urinary Excretion of Aquaporin-2 Water Channel Differentiates Psychogenic Polydipsia from Central Diabetes Insipidus

T Saito, San-e Ishikawa, T Ito, H Oda, F Ando, … and T Saito Division of Endocrinology and Metabolism (Ta.S., S.I., F.A., Mi.H., S.N., To.S.), Department of Medicine, Jichi Medical School, Tochigi 329-0498; and Departments of Medicine and Psychiatry (T.I., H.O., Ma.H.), Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Jp 
correspondence to: San-e Ishikawa, M.D., Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical School, Tochigi 329-0498, Japan. E-mail: saneiskw@jichi.ac.jp. http://jcem.endojournals.org/full/84/6/2235
The present study was undertaken to determine whether urinary excretion of aquaporin-2 (AQP-2) water channel under ad libitum water intake is of value to differentiate polyuria caused by psychogenic polydipsia from central diabetes insipidus. A 30-min urine collection was made at 0900 h in 3 groups of: 11 patients with central diabetes insipidus (22–68 yr old), 10 patients with psychogenic polydipsia (28–60 yr old), and 15 normal subjects (21–38 yr old). In the patients with central diabetes insipidus, the plasma arginine vasopressin level was low despite hyperosmolality, resulting in hypotonic urine. Urinary excretion of AQP-2 was 37 ± 15 fmol/mg creatinine, a value one-fifth less than that in the normal subjects. In the patients with psychogenic polydipsia, plasma arginine vasopressin and urinary osmolality were as low as those in the patients with central diabetes insipidus. However, urinary excretion of AQP-2 of 187 ± 45 fmol/mg creatinine was not decreased, and its excretion was equal to that in the normal subjects. These results indicate that urinary excretion of AQP-2, under ad libitum water drinking, participates in the differentiation of psychogenic polydipsia from central diabetes insipidus. 
PSYCHOGENIC polydipsia causes a marked polyuria with hypotonic urine (1, 2). Arginine vasopressin (AVP) secretion is suppressed by hypoosmolality caused by excess intake of water. Suppression of AVP release obliges us to differentiate psychogenic polydipsia from central diabetes insipidus. Osmotic stimulation tests have been carried out to determine the reserve function of the posterior pituitary gland. Plasma AVP levels increase in response to an increase in plasma osmolality (Posm) in patients with psychogenic polydipsia but not in those with central diabetes insipidus.
In response to AVP, concentrated urine is produced by water reabsorption across the renal collecting duct (3, 4). Aquaporin-2 (AQP-2) is an AVP-regulated water channel of the collecting duct; it is translocated from the cytoplasmic vesicles to the apical plasma membranes by shuttle trafficking when the cells are stimulated by AVP (5, 6, 7), and it is again redistributed into the cytoplasmic vesicles after removal of AVP stimulation (8). Also, AQP-2 is, in part, excreted into the urine (9, 10). We demonstrated that urinary excretion of AQP-2 is of great value in diagnosing central diabetes insipidus in the hypertonic saline infusion test and impaired water excretion in the acute oral water load test (11, 12).   The present study was undertaken to determine whether urinary excretion of AQP-2, under ad libitum water intake, is a useful tool for diagnosing psychogenic polydipsia.

Subjects and study design

Three groups of subjects were examined in the present study.
[1]  11 patients who had been diagnosed as having idiopathic central diabetes insipidus. They had taken 1-deamino-8-D-AVP (DDAVP) intranasally, twice a day, and discontinued the DDAVP therapy 24 h before the study.
[2] 10 patients were diagnosed as having psychogenic polydipsia. They had been treated for psychiatric disorders, including schizophrenia, atypical psychiatric disorder, and chronic alcoholism.
[3] 15 normal volunteers, with ages ranging from 21–38 yr. (the age range of [1] and [2] reached 60)
All the subjects drank water ad libitum, and 30-min urine collection was made and blood drawn at 0900 h. Urine samples were subjected to measurements of urinary osmolality (Uosm) and urinary excretion of creatinine and AQP-2. Blood samples were used to measure Posm and plasma AVP levels. Uosm and Posm were measured by freezing-point depression (Model 3W2, Advanced Instruments, Needham Height, MA). Urinary creatinine was measured with an automatic clinical analyzer (Model 736, Hitachi Co., Tokyo, Jp). Plasma AVP levels were determined by RIA using AVP RIA kits (Mitsubishi Chemistry, Tokyo, Jp) (13). Urinary excretion of AQP-2 was measured as described below.

RIA of AQP-2

The RIA of urinary AQP-2 was performed by the method described in our previous reports (11, 12). Urinary AQP-2-like immunoreactivity was measured by a specific RIA that used the polyclonal antibody against a synthetic portion (Tyr0-AQP-2[ V257-A271]) of the C-terminal of human AQP-2 raised in rabbits. A synthetic peptide [Tyr0-AQP-2 (V257-A271)] was radioiodinated with iodine-125 (New England Nuclear, Boston, MA) by the chloramine-T method.  All samples were analyzed in duplicate. The intra- and interassay coefficients of variation were less than 10%. The minimal detectable quantity of AQP-2 was 0.86 pmol/tube, and an amount equivalent to 6.9 pmol/tube caused 50% inhibition of binding of the radiolabeled ligand.

Results

In the patients with central diabetes insipidus, the plasma AVP level was low despite hyperosmolality of 297.8 ± 3.4 mosmol/kg H2O, resulting in hypotonic urine (Fig. 1⇓). Urinary excretion of AQP-2 was one-fifth less in the patients with central diabetes insipidus than in the normal subjects. AQP-2 is the AVP-dependent water channel of collecting duct cells and is recycling between the cytoplasmic vesicles and the apical plasma membranes in the cells (5, 6, 7, 8). AQP-2 is partly excreted into the urine, which is approximately 3% of AQP-2 in the collecting duct cells (14). In normal subjects, urinary excretion of AQP-2 is changeable in a wide range in physiological conditions (11). Because urinary excretion of AQP-2 has a positive correlation with plasma AVP levels in normal subjects (11), the reduced urinary excretion of AQP-2 was in concert with the impaired secretion of AVP in central diabetes insipidus.
Figure 1.
Posm, plasma AVP (Pavp), Uosm, and urinary excretion of AQP-2 (UAQP-2), under ad libitum water drinking, in 15 normal subjects (NL, •), 11 patients with central diabetes insipidus (CDI, ○) and 10 patients with psychogenic polydipsia (PP, □). *, P < 0.01; **, P < 0.05 vs. the normal subjects. Value are means ± sem.
In the patients with psychogenic polydipsia, Uosm was as low as that in the patients with central diabetes insipidus (Fig. 1⇑). The plasma AVP level was low because of the reduced Posm, which was derived from an exaggerated intake of water. Urinary excretion of AQP-2, however, was not decreased; and rather, its excretion kept the normal range. The relationship between plasma AVP levels and urinary excretion of AQP-2 is shown in Fig. 2⇓. The urinary excretion of AQP-2 in the patients with psychogenic polydipsia was dissociated from the positive correlation between plasma AVP and urinary excretion of AQP-2 in the normal subjects.
Figure 2.
Relationship between plasma AVP levels and UAQP-2. •, Normal subjects (n = 15); ○, patients with central diabetes insipidus (n = 11); □, patients with psychogenic polydipsia (n = 10). Values are means ± sem.

Discussion

The present study demonstrated the clinical tool, of urinary excretion of AQP-2, in differentiating psychogenic polydipsia from central diabetes insipidus. What is involved in the marked difference in urinary excretion of AQP-2 in these two disorders? There is a possibility that, as patients with psychogenic polydipsia reduce water intake during sleep, antidiuresis may occur periodically at night and the production of AQP-2 be somewhat restored. Because approximately 3% of AQP-2 in collecting duct cells is excreted into the urine, urinary excretion of AQP-2 may keep relatively high, despite hypotonic urine. The difference may come from the periodicity of water intake in a day, in the patients with psychogenic polydipsia. As a whole, these changes may disrupt the positive relationship between urinary excretion of AQP-2 and plasma AVP levels. At the present time, however, other factors involved in urinary excretion of AQP-2 remain undetermined.
In conclusion, urinary excretion of AQP-2, under ad libitum water drinking, participates in the differentiation of polyuria caused by psychogenic polydipsia from central diabetes insipidus.

References

Jose CI, Perez-Cruet J. 1979 Incidence and morbidity of self-induced water intoxication in state mental hospital patients. Am J Psychiatry. 136:221–222.  Medline
Goldman MB, Luchins DJ, Robertson GL. 1988 Mechanisms of altered water metabolism in psychiatric patients with polydipsia and hyponatremia. N Engl J Med. 318:397–403.  Medline
Ishikawa S. 1993 Cellular action of arginine vasopressin in the kidney. Endocr J. 40:373–386.  Medline
Fushimi K, Uchida S, Hara Y, Hirata Y, Marumo F, Sasaki S. 1993 Cloning and expression of apical membrane water channel of rat kidney collecting tubule. Nature. 361:549–552.  CrossRefMedline
Sasaki S, Fushimi K, Saito H, et al. 1994 Cloning, characterization and chromosomal mapping of human aquaporin of collecting duct. J Clin Invest. 93:1250–1256.
Nielsen S, DiGiovanni SR, Christensen EI, Knepper MA, Harris HW. 1993 Cellular and subcellular immunolocalization of vasopressin-regulated water channel in rat kidney. Proc Natl Acad Sci USA. 90:11663–11667.  Abstract/FREE Full Text
Saito T, Ishikawa S, Sasaki S, et al. 1997 Alteration in water channel AQP-2 by removal of AVP stimulation in collecting duct cells of dehydrated rats. Am J Physiol. 272:F183–F191.
Kanno K, Sasaki S, Ishikawa S, et al. 1995 Urinary excretion of aquaporin-2 in patients with diabetes insipidus. N Engl J Med. 332:1540–1545. CrossRefMedline
Elliot S, Goldsmith P, Knepper MA, Haughey M, Olson B. 1996 Urinary excretion of aquaporin-2 in humans: a potential marker of collecting duct responsiveness to vasopressin. J Am Soc Nephrol. 7:403–409.  Abstract
Saito T, Ishikawa S, Sasaki S, et al. 1997 Urinary excretion of aquaporin-2 in the diagnosis of central diabetes insipidus. J Clin Endocrinol Metab. 82:1823–1827.   Abstract/FREE Full Text
Saito T, Ishikawa S, Ando F, et al. 1998 Exaggerated urinary excretion of aquaporin-2 in the pathological state of impaired water excretion dependent upon arginine vasopressin. J Clin Endocrinol Metab. 83:4034–4040.  Abstract/FREE Full Text
Terris J, Ecelbarger CA, Nielsen S, Knepper MA. 1996 Long-term regulation of four renal aquaporins in rats. Am J Physiol. 271:F414–F422. Clin Endocrinology & Metabolism  1999; 84(6):2235-2237   http://dx.doi.org/10.1210/jc.84.6.2235

Comparison of cardiovascular aquaporin-1 changes during water restriction between 25- and 50-day-old rats.

Netti VA, Vatrella MC, Chamorro MF, Rosón MI, Zotta E, Fellet AL, Balaszczuk AM.
Cátedra de Fisiología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, IQUIMEFA, CONICET, Junín 956, C1113AAD, Buenos Aires, Argentina, vnetti@conicet.gov.ar.
Eur J Nutr. Apr 27, 2013
Aquaporin-1 (AQP1) is the predominant water channel in the heart, linked to cardiovascular homeostasis. Our aim was to study cardiovascular AQP1 distribution and protein levels during osmotic stress and subsequent hydration during postnatal growth.
Rats aged 25 and 50 days were divided in: 3d-WR: water restriction 3 days; 3d-WAL: water ad libitum 3 days; 6d-WR+ORS: water restriction 3 days + oral rehydration solution (ORS) 3 days; and 6d-WAL: water ad libitum 6 days. AQP1 was evaluated by immunohistochemistry and western blot in left ventricle, right atrium and thoracic aorta.
Water restriction induced a hypohydration state in both age groups (40 and 25 % loss of body weight in 25- and 50-day-old rats, respectively), reversible with ORS therapy. Cardiac AQP1 was localized in the endocardium and endothelium in both age groups, being evident in cardiomyocytes membrane only in 50-day-old 3d-WR group, which presented increased protein levels of AQP1; no changes were observed in the ventricle of pups. In vascular tissue, AQP1 was present in the smooth muscle of pups; in the oldest group, it was found in the endothelium, increasing after rehydration in smooth muscle. No differences were observed between control groups 3d-WAL and 6d-WAL of both ages.
Our findings suggest that cardiovascular AQP1 can be differentially regulated in response to hydration status in vivo, being this response dependent on postnatal growth. The lack of adaptive mechanisms of mature animals in young pups may indicate an important role of this water channel in maintaining fluid balance during hypovolemic state.

 Clinical application of aquaporin research: aquaporin-1 in the peritoneal membrane

Nishino T, Devuyst O.
Division of Renal Care Unit, Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Jp
Peritoneal dialysis (PD) is an established mode of renal replacement therapy based on the exchange of fluid and solutes between blood and a dialysate that has been instilled in the peritoneal cavity. The dialysis process involves osmosis, as well as diffusive and convective transports through the highly vascularized peritoneal membrane. The membrane contains ultrasmall pores responsible for the selective transport of water across the capillary endothelium. The distribution of the water channel aquaporin-1 (AQP1), as well as its molecular structure ensuring an exquisite selectivity for water, fit with the characteristics of the ultrasmall pore. Peritoneal transport studies using AQP1 knockout mice demonstrated that the osmotic water flux across the peritoneal membrane is mediated by AQP1. This water transport accounts for 50% of the ultrafiltration during PD. Treatment with high-dose corticosteroids upregulates the expression of AQP1 in peritoneal capillaries, resulting in increased water transport and ultrafiltration in rats. These data illustrate the potential of the peritoneal membrane as an experimental model in the investigation of the role of AQP1 in the endothelium. They emphasize the critical role of AQP1 during PD and suggest that manipulating AQP1 expression could be clinically useful in PD patients.

Corticosteroids induce expression of aquaporin-1 and increase transcellular water transport in rat peritoneum

Stoenoiu MS, Ni J, Verkaeren C, Debaix H, Jonas JC, Lameire N, Verbavatz JM, Devuyst O.
Division of Nephrology and ENDO Unit, Université Catholique de Louvain Medical School, Brussels, Belgium
J Am Soc Nephrol. Mar 2003; 14(3):555-565.
The water channel aquaporin-1 (AQP1) is the molecular counterpart of the ultrasmall pore responsible for transcellular water permeability during peritoneal dialysis (PD). This water permeability accounts for up to 50% of ultrafiltration (UF) during a hypertonic dwell, and its loss can be a major clinical problem for PD patients. By analogy with the lung, the hypothesis was tested that corticosteroids may increase AQP1 expression in the peritoneal membrane (PM) and improve water permeability and UF in rats. First, the expression and distribution of the glucocorticoid receptor (GR) in the PM and capillary endothelium was documented. Time-course and dose-response analyses showed that a daily IM injection of dexamethasone (1 or 4 mg/kg) for 5 d induced an approximately twofold increase in the expression of AQP1 at the mRNA and protein levels. The GR antagonist RU-486 completely inhibited the dexamethasone effect. The functional counterpart of the increased AQP1 expression was a significant increase in sodium sieving and net UF across the PM, contrasting with a lack of effect on the osmotic gradient and permeability for small solutes. The latter observation reflected the lack of effect of corticosteroids on nitric oxide synthase (NOS) activity and endothelial NOS isoform expression in the PM. In conclusion, corticosteroids induce AQP1 expression in the capillary endothelium of the PM, which is reflected by increased transcellular water permeability and UF. These data emphasize the critical role of AQP1 during PD and suggest that pharmacologic regulation of AQP1 may provide a target for manipulating water permeability across the PM.

Aquaporins: relevance to cerebrospinal fluid physiology and therapeutic potential in hydrocephalus

Owler BK, Pitham T, Wang D.
Kids Neurosurgical Research Unit, Children’s Hospital at Westmead, Westmead NSW 2145, Australia. brian@sydneyneurosurgeon.com.au.
Cerebrospinal Fluid Res.  Sep 22, 2010; 7:15.  http://dx.doi.org/10.1186/1743-8454-7-15.
The discovery of a family of membrane water channel proteins called aquaporins, and the finding that aquaporin 1 was located in the choroid plexus, has prompted interest in the role of aquaporins in cerebrospinal fluid (CSF) production and consequently hydrocephalus. While the role of aquaporin 1 in choroidal CSF production has been demonstrated, the relevance of aquaporin 1 to the pathophysiology of hydrocephalus remains debated. This has been further hampered by the lack of a non-toxic specific pharmacological blocking agent for aquaporin 1. In recent times aquaporin 4, the most abundant aquaporin within the brain itself, which has also been shown to have a role in brain water physiology and relevance to brain oedema in trauma and tumours, has become an alternative focus of attention for hydrocephalus research. This review summarises current knowledge and concepts in relation to aquaporins, specifically aquaporin 1 and 4, and hydrocephalus. It also examines the relevance of aquaporins as potential therapeutic targets in hydrocephalus and other CSF circulation disorders.
PMID: 20860832  PMCID:  PMC2949735

Pathophysiology of the aquaporin water channels

King LS, Agre P.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
Annu Rev Physiol. 1996; 58:619-48.
Discovery of aquaporin water channel proteins has provided insight into the molecular mechanism of membrane water permeability. The distribution of known mammalian aquaporins predicts roles in physiology and disease.
Aquaporin-1 mediates proximal tubule fluid reabsorption, secretion of aqueous humor and cerebrospinal fluid, and lung water homeostasis.
Aquaporin-2 mediates vasopressin-dependent renal collecting duct water permeability; mutations or downregulation can cause nephrogenic diabetes insipidus.
Aquaporin-3 in the basolateral membrane of the collecting duct provides an exit pathway for reabsorbed water.
Aquaporin-4 is abundant in brain and probably participates in reabsorption of cerebrospinal fluid, osmoregulation, and regulation of brain edema.
Aquaporin-5 mediates fluid secretion in salivary and lacrimal glands and is abundant in alveolar epithelium of the lung.
Specific regulation of membrane water permeability will likely prove important to understanding edema formation and fluid balance in both normal physiology and disease.

Discovery of aquaporins: a breakthrough in research on renal water transport

van Lieburg AF, Knoers NV, Deen PM.
Department of Pediatrics, University of Nijmegen, The Netherlands.
Pediatr Nephrol. Apr 1995; 9(2):228-34.
Several membranes of the kidney are highly water permeable, thereby enabling this organ to retain large quantities of water. Recently, the molecular identification of water channels responsible for this high water permeability has finally been accomplished. At present, four distinct renal water channels have been identified, all members of the family of major intrinsic proteins.
Aquaporin 1 (AQP1), aquaporin 2 (AQP2) and the mercury-insensitive water channel (MIWC) are water-selective channel proteins, whereas the fourth,
Aquaporin 3 (AQP3), permits transport of urea and glycerol as well. Furthermore, a putative renal water channel (WCH3) has been found.
AQP1 is expressed in apical and basolateral membranes of proximal tubules and descending limbs of Henle,
AQP2 predominantly in apical membranes of principal and inner medullary collecting duct cells and
AQP3 in basolateral membranes of kidney collecting duct cells.
MIWC is expressed in the inner medulla of the kidney and has been suggested to be localised in the vasa recta.
The human genes encoding AQP1 and AQP2 have been cloned, permitting deduction of their amino acid sequence, prediction of their two-dimensional structure by hydropathy analysis, speculations on their way of functioning and DNA analysis in patients with diseases possibly caused by mutant aquaporins. Mutations in the AQP1 gene were recently detected in clinically normal individuals, a finding which contradicts the presumed vital importance of this protein. Mutations in the AQP2 gene were shown to cause autosomal recessive nephrogenic diabetes insipidus. The renal unresponsiveness to arginine vasopressin, which characterises this disease, is in accordance with the assumption that AQP2 is the effector protein of the renal vasopressin pathway.(ABSTRACT TRUNCATED AT 250 WORDS)

Selectivity of the renal collecting duct water channel aquaporin-3

Echevarría M, Windhager EE, Frindt G.
Depart Physiol Biophys, Cornell University Medical College, New York, NY
J Biol Chem. Oct 11, 1996; 271(41):25079-82.
Aquaporin-3 (AQP3) is a water channel found in the basolateral cell membrane of principal cells of the renal collecting tubule as well as in other epithelia. To examine the selectivity of AQP3, the permeability to water (Pf), urea (Pur), and glycerol (Pgly) of Xenopus oocytes injected with cRNA encoding AQP3 was measured. Oocytes injected with cRNA encoding either human or rat aquaporin-1 (AQP1) were used as controls. Although both aquaporins permit water flow across the cell membrane, only AQP3 was permeable to glycerol and urea (Pgly > Pur). The uptake of glycerol into oocytes expressing AQP3 was linear up to 165 mM. For AQP3 the Arrhenius energy of activation for Pf was 3 kcal/mol, whereas for Pgly and Pur it was >12 kcal/mol. The sulfhydryl reagent p-chloromercuriphenylsulfonate (1 mM) abolished Pf of AQP3, whereas it did not affect Pgly. In addition, phloretin (0.1 mM) inhibited Pf of AQP3 by 35%, whereas it did not alter Pgly or Pur. We conclude that water does not share the same pathway with glycerol or urea in AQP3 and that this aquaporin, therefore, forms a water-selective channel.

The aquaporin family of water channels in kidney

Agre P, Nielsen S.
Depart of Med, Johns Hopkins University School of Medicine, Baltimore, MD
Nephrologie. 1996;17(7):409-15.
The longstanding puzzle of membrane water-permeability was advanced by discovery of a new class of proteins known as the “aquaporins” (AQPs). First identified in red blood cells, AQP1 was shown to function as a water channel when expressed in Xenopus oocytes or when pure AQP1 protein was reconstituted into synthetic membranes. Analysis of the primary sequence revealed that the two halves of the AQP1 polypeptide are tandem repeats; site directed mutagenesis studies indicate that the repeats may fold into an obversely symmetric structure which resembles an hourglass. Electron crystallography elucidated the tetrameric organization of AQP1, and functional studies suggest that each tetramer contains multiple functionally independent aqueous pores.
AQP1 is abundant in the apical and basolateral membranes of renal proximal tubules and descending thin limbs, and is also present in multiple extra renal tissues.
AQP2 is expressed only in the principal cells of renal collecting duct where it is the predominant vasopressin (ADH, antidiuretic hormone) regulated water channel. AQP2 is localized in the apical membrane and in intracellular vesicles which are targeted to the apical plasma membranes when stimulated by ADH. Humans with mutations in genes encoding AQP1 and AQP2 exhibit contrasting clinical phenotypes.
AQP3 resides in the basolateral membranes of renal collecting duct principal cells providing an exit pathway for water;
AQP4 is abundant in brain where it may function as the hypothalamic osmoreceptor responsible for secretion of ADH. Continued analysis of the aquaporins is providing detailed molecular insight into the fundamental physiological problems of water balance and disorders of water balance.

Aquaporins in the kidney: from molecules to medicine

Nielsen S, Frøkiaer J, Marples D, Kwon TH, Agre P, Knepper MA.
The Water and Salt Res Center, Anatomy and Exper Clin Res Institutes, University of Aarhus, Aarhus, Denmark. sn@ana.au.dk
Physiol Rev. Jan 2002; 82(1):205-44.  http://dx.doi.org/10.1152/physrev.00024.2001

The molecular identity of membrane water channels long-standing biophysical question of how water crosses long remained elusive until the pioneering discovery of biological membranes specifically, and provided insight, at the molecular level, of AQP1 by Agre and colleagues around 1989 –1991,  The discovery of aquaporin-1 (AQP1) answered the long-standing biophysical question of how water specifically crosses biological membranes. In the kidney, at least seven aquaporins are expressed at distinct sites. AQP1 is extremely abundant in the proximal tubule and descending thin limb and is essential for urinary concentration. AQP2 is exclusively expressed in the principal cells of the connecting tubule and collecting duct and is the predominant vasopressin-regulated water channel. AQP3 and AQP4 are both present in the basolateral plasma membrane of collecting duct principal cells and represent exit pathways for water reabsorbed apically via AQP2. Studies in patients and transgenic mice have demonstrated that both AQP2 and AQP3 are essential for urinary concentration.

Since the discovery of aquaporins, major efforts have been aimed at elucidating their structural organization. Hydropathy analysis of the deduced amino acid sequence of AQP1 led to the prediction that the protein resides primarily within the lipid bilayer (191), consistent with the initial studies of AQP1 in red cell membranes (46). AQP1 contains an internal repeat with the NH – and the first provided a molecular answer to the long-standing COOH-terminal halves being sequence related and each
containing the signature motif Asn-Pro-Ala (NPA) (181,252). This is consistent with earlier observations on the homologous major intrinsic protein from lens, (MIP, nowreferred to as AQP0). When evaluated by hydropathy analysis, six bilayer-spanning domains are apparent (Fig.1); however, the apparent interhelical loops B and E also exhibit significant hydrophobicity. Critical to the topology is the location of loop C which connects the two halves of the molecule. Preston et al. (194) demonstrated that loop C resides at the extracellular surface of the oocytes, confirming the obverse sym-metry of the NH – and COOH-terminal halves of the mol-lar surface of the oocytes, confirming the obverse symmetry of the NH – and COOH-terminal halves of the mol-ecule.The structural organization of other aquaporins such as bacterial aquaporin-Z and plant aquaporins have also been deduced. How can water channels avoid passage of protons (H O )? As predicted, loops B and E are associated by Van der Waals interactions between the two NPA motifs. Free hydrogen bonding occurs in the column of water within the pore, except at the very center where a single water molecule transiently reorients to bond with the two asparagines residues of the NPA motif. This results in minimum resistance to the flow of water, thus permitting kidneys to perform their important physiological roles of reabsorbing water while excreting acid.

FIG. 1. A: schematic representation of the structural organization of aquaporin-1 (AQP1) monomers in the membrane (top and bottom). Aquaporins have six membrane-spanning regions, both intracellular NH and COOH termini, and internal tandem repeats that, presumably, are due to an ancient gene duplication (top). The topology is consistent with an obverse symmetry for the two similar NH – and COOH- 2 terminal halves (bottom). The tandem repeat structure with two asparagine-proline-alanine (NPA) sequences has been proposed to form tight turn structures that interact in the membrane to form the pathway for translocation of water across the plasma membrane. Of the five loops in AQP1, the B and E loops dip into the lipid bilayer, and it has been proposed that they form “hemichannels” that connect between the leaflets to form a single aqueous pathway within a symmetric structure that resembles an “hourglass.” B: AQP1 is a multisubunit oligomer that is organized as a tetrameric assembly of four identical polypeptide subunits with a large glycan attached to only one.

Discovery and Biophysical Characterization of the First Molecular Water Channel AQP1 Expression of AQP1 in X. laevis oocytes by Preston et al. (192) demonstrated that AQP1-expressing oocytes exhibited remarkably high osmotic water permeability (P
cm/s), causing the cells to swell rapidly and explode in hypotonic buffer. The osmotically induced swelling of oocytes expressing AQP1 occurs with a low activation energy and is reversibly inhibited by HgCl or other mercurials. Only inward water flow (swelling) was examined, but it was predicted that the direction of water flow through AQP1 is determined by the orientation of the osmotic gradient. Consistent with this, it was later demonstrated that AQP1-expressing oocytes swell in hyposmolar buffers but shrink in hyperosmolar buffers (160).  Swelling of oocytes expressing AQP1 occurs with a low activation energy and is reversibly inhibited by HgCl or other mercurials. Only inward water flow (swelling) was examined, but it was predicted that the direction of water flow through AQP1 is determined by the orientation of the osmotic gradient. Consistent with this, it was later demonstrated that AQP1-expressing oocytes swell in hyposmolar buffers but shrink in hyperosmolar buffers (160).

Over the past 4 years a series of studies have explored the issues of selectivity and polytransport function of aquaporins. This has led to a division of aquaporins (4) into a group that transports water relatively selectively (the “orthodox” set or “aquaporins”) and a group of water channels that also conduct glycerol and other small solutes in addition to water (the “cocktail” set or aquaglyceroporins). This appears to represent an ancient phylogenetic divergence between glycerol transporters and pure water channels (185). Recently, it has become clear that transport properties are even more diverse, since AQP6 has been demonstrated to conduct anions as well (263), and it has also been demonstrated that aquaporins can be regulated by gating, as discussed below.

The signal transduction pathways have been de­scribed thoroughly in previous reviews. cAMP levels in collecting duct principal cells are in­creased by binding of vasopressin to V2 receptors. The synthesis of cAMP by adenylate cyclase is stim­ulated by a V2 receptor-coupled heterotrimeric GTP-bind-ing protein, Gs. Gs interconverts between an inactive responses to vasopressin. In this study it was demon­strated that changes in AQP2 labeling density of the apical plasma membrane correlated closely with the water per­meability in the same tubules, while there were reciprocal changes in the intracellular labeling for AQP2. In vivo studies using normal rats or vasopressin-deficient Brattleboro rats also showed a marked increase in apical plasma membrane labeling of AQP2 in response to vasopressin or dDAVP treatment.  The acute treatment of rats with vasopressin V2-receptor antagonist or acute water loading (to reduce endogenous vasopressin levels, both re­ducing vasopressin action, resulted in a prominent inter­nalization of AQP2 from the apical plasma membrane to small intracellular vesicles further underscoring the role of AQP2 trafficking in the regulation of collecting duct water permeability.

PGE2 inhibits vasopressin-induced water permeabil­ity by reducing cAMP levels. In preliminary studies, Zelenina et al. investigated the effect of PGE2 on PKA phosphorylation of AQP2 in kidney papilla, and the results suggest that the action of prostaglandins is associated with retrieval of AQP2 from the plasma membrane, but that this appears to be independent of AQP2 phosphorylation by PKA.  Phosphorylation of AQP2 by other kinases, e.g., pro­tein kinase C or casein kinase II, may potentially partici­pate in regulation of AQP2 trafficking (Fig. 9C). Phosphorylation of other cytoplasmic or vesicular regulatory proteins may also be involved. These issues remain to be investigated directly.

Since the fundamentals of the shuttle hypothesis have been confirmed, interest has turned to the cellular mechanisms mediating the vasopressin-induced transfer of AQP2 to the apical plasma membrane. The shuttle hypothesis has a number of features whose molecular basis remains poorly understood. First, AQP2 is delivered in a relatively rapid and coordinated fashion, and vesicles move from a distribution throughout the cell to the apical region of the cell in response to vasopressin stimulation. Furthermore, AQP2 is delivered specifically to the apical plasma membrane. Finally, AQP2-bearing vesicles fuse with the apical plasma membrane in response to vasopressin, but not to a significant degree in the absence of stimulation (e.g., in vasopressin-deficient Brattleboro rats where < 5% of total AQP2 is present in the apical plasma membrane. Thus there must be some kind of a “clamp” preventing fusion in the unstimulated state and/or a “trigger” when activation occurs.

The coordinated delivery of AQP2-bearing vesicles to the apical part of the cell appears to depend on the translocation of the vesicles along the cytoskeletal ele­ments. In particular, the microtubular network has been implicated in this process, since chemical disruption of microtubules inhibits the increase in permeability both in the toad bladder and in the mammalian collecting duct. Because microtubule-disruptive agents inhibit the development of the hydrosmotic response to vaso-pressin, but have no effect on the maintenance of an established response, and because they have been re­ported to slow the development of the response without affecting the final permeability in toad bladders , it has been deduced that microtubules appear to be involved in the coordinated delivery of water channels, without being involved in the actual insertion process.

In addition to increasing cAMP levels in collecting duct principal cells, vasopressin acting through the V2 receptor has also been demonstrated to transiently in­crease intracellular Ca2+. The increase occurs in the absence of activation of the phosphoinositide signaling pathway and has recently been dem­onstrated to be due to activation of ryanodine-sensitive calcium release channels in the collecting duct cells. Buffering intracellular calcium with BAPTA or inhibition of calmodulin completely blocked the water permeability response to vasopressin in isolated perfused inner med­ullary collecting ducts, suggesting a critical role for cal­cium at some step in the process of AQP2 vesicle traffick­ing.

In addition to the acute regulation of collecting duct water permeability brought about by the trafficking of AQP2 described above, it is now clear that there are longer term adaptational changes that modulate this acute response. These occur during prolonged changes in body hydration status and form an appropriate physiolog­ical response to such challenges. However, similar long ­term changes also appear to be important in a wide variety of pathological conditions,  and an understanding of the mechanisms involved in these adaptational responses may provide the basis both for a better understanding of, and for potential therapeutic ap­proaches to, pathological disorders of water balance.  Microtubules are polar structures, arising from microtubule organizing centers (MTOCs), at which their minus ends are anchored, and with the plus ends growing away “into” the cell. In fibroblastic cells, there is a single MTOC in the perinuclear region, and the plus ends project to the periphery of the cell. However, there is increasing evidence that in polarized epithelia microtubules arise from multiple MTOCs in the apical region, with their plus ends projecting down toward the basolateral membrane. If this is the case in collecting duct cells, and there is some evidence that it is , then a minus end-directed motor protein such as dynein would be expected to be involved in the movement of vesicles toward the apical plasma membrane.  Recently, it has been shown that dynein is present in the kidney of several mammalian spe­cies and that both dynein and dynactin, a protein complex believed to mediate the interaction of dynein with vesicles, associate with AQP2-bearing vesicles. It seems likely that dynein may drive the microtubule-dependent delivery of AQP2-bearing vesicles toward the apical plasma mem­brane.

The apical part of the collecting duct principal cells contains a prominent terminal web made up of actin filaments. These also appear to be involved in the hydrosmotic response, since disruption of microfilaments with cytochalasins inhibits the response in the toad bladder. Cytochalasins can also inhibit an estab­lished response, and even the offset of the response. From this it has been concluded that microfilaments are probably involved in the final movement of vesicles through the terminal web, their fusion with the plasma membrane, and the subsequent endocytic retrieval of the water channels. Interestingly, vasopressin itself causes actin depolymerization, suggesting that reor­ganization of the terminal web is an important part of the cellular response to vasopressin, a conclusion reached on morphological grounds by DiBona.

The problem of delivering vesicles to a particular domain and allowing them to fuse when, and only when, a signal arrives is conceptually very similar to the situa­tion in the neuronal synapse. It therefore seemed possible that a molecular apparatus similar to the SNAP/SNARE system described there might be present in the collecting duct principal cells.  There are specific proteins on the vesicles (vSNAREs) and the target plasma membrane (tSNAREs) that interact with components of a fusion complex to induce fusion of the vesicles only with the required target membrane. The process is thought to be regulated by other protein com­ponents that sense the signal for fusion (i.e., increased calcium in the synapse). Several groups have now shown that vSNAREs such as VAMP-2 are present in the collect­ing duct principal cells and colocalize with AQP2 in the same vesicles .

A putative tSNARE, SNAP23, has been found in collecting duct principal cells both in the apical plasma membrane and in AQP2-bearing vesicles. Some soluble components of the fusion complex, including NEM-sensitive factor (NSF) and a-soluble NSF-associated protein (SNAP), have also been identified in these cells. Thus it seems likely that the exocytic insertion of AQP2 is indeed controlled by a set of proteins similar to those involved in synaptic transmission, al­though considerable work remains to be done in isolating and characterizing the components, their regulation, and prime physiological function.

 Body water balance is tightly regulated by vasopressin, and multiple studies now have underscored the essential roles of AQP2 in this.
Vasopressin regulates acutely the water permeability of the kidney collecting duct by trafficking of AQP2 from intracellular vesicles to the apical plasma membrane.
The long-term adaptational changes in body water balance are controlled in part by regulated changes in AQP2 and AQP3 expression levels. Lack of functional AQP2 is seen in primary forms of diabetes insipidus, and reduced expression and targeting are seen in several diseases associated with urinary concentrating defects such as acquired nephrogenic diabetes insipidus, postobstructive polyuria, as well as acute and chronic renal failure. In contrast, in conditions with water retention such as severe congestive heart failure, pregnancy, and syndrome of inappropriate antidiuretic hormone secretion, both AQP2 expression levels and apical plasma membrane targetting are increased, suggesting a role for AQP2 in the development of water retention. Continued analysis of the aquaporins is providing detailed molecular insight into the fundamental physiology and pathophysiology of water balance and water balance disorders.
Three additional aquaporins are present in the kidney. AQP6 is present in intracellular vesicles in collecting duct intercalated cells, and AQP8 is present intracellularly at low abundance in proximal tubules and collecting duct principal cells, but the physiological function of these two channels remains undefined. AQP7 is abundant in the brush border of proximal tubule cells and is likely to be involved in proximal tubule water reabsorption.

Fluid transport across leaky epithelia: central role of the tight junction and supporting role of aquaporins.

Fischbarg J.
Institute of Cardiology Research , A. C. Taquini, University of Buenos Aires and National Council for Scientific and Technical Investigations, Buenos Aires, Argentina. jf20@columbia.edu
Physiol Rev. Oct 2010; 90(4):1271-90. http://dx.doi.org/10.1152/physrev.00025.2009.
The mechanism of epithelial fluid transport remains unsolved, which is partly due to inherent experimental difficulties. However, a preparation with which our laboratory works, the corneal endothelium, is a simple leaky secretory epithelium in which we have made some experimental and theoretical headway. As we have reported, transendothelial fluid movements can be generated by electrical currents as long as there is tight junction integrity. The direction of the fluid movement can be reversed by current reversal or by changing junctional electrical charges by polylysine. Residual endothelial fluid transport persists even when no anions (hence no salt) are being transported by the tissue and is only eliminated when all local recirculating electrical currents are.   The notion that transepithelial movement of water depends on the movement of electrolytes arises from a finding by Peter Curran and Arthur K. Solomon that transintestinal water flow (“solvent” flow) depended on the transport of NaCl (“solute” flux) by that layer. That gave birth to the question of how the flow of solute (or “salt”) is linked to the movement of solvent (or “fluid”), or in the short jargon of the field, how solute-solvent cou­pling arises. 
To be noted, gradientless flow is different from transepithelial osmosis a` la Dutrochet. In this last one, in the presence of an osmotic gradient across an epithelial layer, water obligingly traverses the layer. This is well exempli­fied by the kidney collecting duct, a tight epithelium for which we accept nowadays that the water goes across both cell plasma membranes in series, traversing their aquaporins.  There is also the special case of the anuran skin epithelia, whose intercellular junctions are tight, and which water also appears to traverse through cell membrane aquaporins. As a rule, epithelia specialized to transport fluid do so in the absence of any external osmotic gradient across their layers; that is, fluid is transported between compartments of similar osmolarity.  That gave birth to the question of how the flow of solute (or “salt”) is linked to the movement of solvent (or “fluid”), or in the short jargon of the field, how solute-solvent cou­pling arises.
The progression of the ideas on fluid transport is linked to those in a parallel field, that of water channels.  After early advances in their characterization and isolation, they were molecularly identified by Peter Agre and co-workers in the early 1990s, who termed them aquaporins (AQPs). It was subsequently de­termined that AQPs were present in many fluid transport­ing epithelia  and were also present in water-perme­able kidney segments while absent in relatively water-impermeable ones . By then, the measurements of osmotic permeabilities of epithelial cell membranes had been refined using video microscopy techniques. The lab­oratories of Kenneth Spring (working on gallbladders)  and of the Welling brothers (working on kidney proximal tubule) found rather high osmotic perme­ability (or “filtration” permeability, Pf) values (Persson and Spring: 550 and 1,200 pm/s for the apical and baso-lateral membranes, respectively; Welling: -300 pm/s). Both laboratories suggested that, given such high Pf values, a few milliosmoles of osmotic pressure difference across the cell boundaries would suffice to drive the transported fluids through the cells.

There had been all along experimental evidence for the diverging view that fluid transport across leaky epi­thelia took place via paracellular, transjunctional water flow. That contrary evidence came from the laboratories of Adrian Hill using gallbladder, John Pappenheimer and his fellow James Madara using intestine, and Guillermo Whittembury and Gerhard Malnic using kidney proximal tubule. The contrary view of paracellular flow had remained a minority opinion. Still and all, these “rebels” stood their ground, led by an utterly unconvinced Adrian Hill. Con­sidering the divergent views, Kenneth Spring and col­leagues decided to take the bull by the horns and use confocal microscopy to look for evidence for or against transjunctional water flow in epithelia.
Paracellular, transjunctional fluid flow in an absorbing epithelium would lead to significant dilution of a paracellular fluorescent marker trapped in the inter­cellular spaces, which in turn would be detectable by the optical sectioning methods they mastered; all very ele­gant, for sure.

And so we come to the paper Spring and colleagues published in May of 1998  reporting that they had found no transjunctional water flow in cultured Madin-Darby canine kidney (MDCK) cell layers. Understandably, their statement had a very large impact. And yet, only some months afterwards, this notion had to be revised as it became clear that the preparation they had chosen presumably transported little if any water. By Spring’s own admission in October of the same 1998, “ . . . the fluid transport rate of MDCK cells is only about 1% of that of the renal proximal tubule… ”  To spell out the obvious, little or no fluid transport means no transjunctional (or trans-cellular) water flow either, so in perspective, the findings of Spring and colleagues (“absence of junctional flow”) bring no surprise and have no bearing on the issue of the route of fluid flow in general.

After the demise of the 1998 paper above, doubts about local osmosis continued to be fueled. Adrian Hill had been joined in his criticism of it by Thomas Zeuthen and Ernest Wright. In particular, Zeuthen and co-workers had developed an alternative model for transcellular water transfer based on molecular cotransport through transporters. Predictably, Hill’s views were newly sought out. In a thorough review written with his wife and colleague Bruria Shachar-Hill, they restated the evidence from theirs and collaborating laboratories for junctional flow for Necturus and rabbit gallbladder, Necturus intestine, Rhodnius Malpighian tubule, and rat and rabbit salivary gland. In addition, they gave a convincing account of the evidence consistent with junctional water flow for renal proximal tubule, exocrine gland (salivary, lacrimal), and small intestine. Here we will simply call attention to those arguments and will concentrate on other arguments plus additional evidence of our own.

By the end of the 1990s, Alan Verkman’s laboratory had been investigating the physiological effects of knock­ing out AQPs in mice.  The dele­tion of AQPs resulted in drastic decreases of cell mem­brane osmotic permeability, but only in rather mild decreases in rates of fluid transport, and this last to boot only in tissues that transported fluid at high rates. Verkman and colleagues generally discuss those results in a guarded manner, underlining the role of aquaporins as routes for cell water permeability without making pro­nouncements on the mechanism of transtissue fluid trans­port. Yet, paraphrasing the comments by Hill and col­leagues in another cogent review, the effects seen in the AQP knockouts are sometimes difficult to explain, and not commensurate with the deletion of what would be hypothetically a major route for transcellular transtissue water transfer.

Perhaps the existence and the location of electrogenic transporters and channels are telling us something very fundamental about the function of these layers. There does not seem to be an explanation of why epithelia in general, and specifically leaky epithelia, would have evolved to have an electrical potential difference across the layer. In principle, salts could simply be transported neutrally. In a similar vein, apical Na channels that allow Na to leak back into the cell would not make sense if the task of an epithelial cell would be to transport salt from the serosal (basal) to the luminal (apical) side. However, both of these apparent incongruencies suddenly make sense if the raison d’être of these epithelia is to perform tasks such as electro-osmosis. The electrical potential might not be an evolutionary leftover but a central fea­ture. The Na channel would not be apical by accident but to help build up the local current meant for electro-osmosis. As mentioned above, aside from the corneal endothelium , there is evidence for electro-osmosis in small intestine, kidney proximal tubule, and frog skin glands. Hence, it would be desirable if the presence of electro-osmosis would be explored in other fluid-transporting epithelia.

Electro-osmotic coupling would result in somewhat (perhaps 30%) hypotonic emerging fluid. This entails that the fluid left behind at the intercellular spaces might be correspondingly hypertonic. Such osmolarity difference in turn might be sensed by the cell and trigger mechanisms that would affect sites for regulation at basolateral and apical sites for HCO3  and Na transports, and perhaps also at the junction so as to modify the characteristics of the coupling. It is conceivable that such regulation might take place with some degree of period­icity. There may be a role for AQP1 in this regulation, which would explain the mild effects seen on fluid trans­port in this and other preparations in experiments done with AQP1 null cells. This would explain what has been noted by Verkman and colleagues, namely, that effects of AQP deletion are more pronounced in epithelia that gen­erate higher rates of fluid transport. Thus AQP deletion reduced near-isosmolar fluid transport in kidney proximal tubule and salivary gland, where fluid transport is rapid, but not in lung, lacrimal gland, sweat gland, or corneal endothelium where fluid trans­port is relatively slow.

Aquaporin (AQP) 1 is the only AQP present in these cells, and its deletion in AQP1 null mice significantly affects cell osmotic permeability (by > 40%) but fluid transport much less ( > 20%), which militates against the presence of sizable water movements across the cell. In contrast, AQP1 null mice cells have reduced regulatory volume decrease (only 60% of control), which suggests a possible involvement of AQP1 in either the function or the expression of volume-sensitive membrane channels/transporters. A mathematical model of corneal endothelium we have developed correctly predicts experimental results only when paracellular electro-osmosis is assumed rather than transcellular local osmosis. Our evidence therefore suggests that the fluid is transported across this layer via the paracellular route by a mechanism that we attribute to electro-osmotic coupling at the junctions. From our findings we have developed a novel paradigm for this preparation that includes

1) paracellular fluid flow;
2) a crucial role for the junctions;
3) hypotonicity of the primary secretion; and
4) an AQP role in regulation rather than as a significant water pathway.
These elements are remarkably similar to those proposed by the laboratory of Adrian Hill for fluid transport across other leaky epithelia.

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 1743-8454-7-15-1  Distribution in brain of aquaporin-1 (AQP1, blue) and AQP4 (orange), schematically illustrated on a sagittal section of a human brain
centralpore-small  Tetrameric Pore                     AQP-highlight
Created with The GIMP                           Gating of aquaporins
AQP-thumbnail  Gas Molecules Commute into Cell      aqpz-glpf  water channels
GlpF-ABF  Molecular Obstacle Course              nihms365271f1   Roles of water-selective aquaporins (AQPs, shown in purple).
building_a_model-02-full     nihms365271f2  Roles of water-glycerol-transporting aquaporins (aquaglyceroporins).

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