Mineralocorticoid modulation of cardiac ryanodine
receptor activity is associated with downregulation of
Ana Mar´ ıa G´ omez, Ang´ elica Rueda, Yannis Sainte-Marie, Laetitia Pereira,
Spyros Zissimopoulos, Xinsheng Zhu, Roxane Schaub, Emeline Perrier,
Romain Perrier, C´ eline Latouche, et al.
To cite this version:
Ana Mar´ ıa G´ omez, Ang´ elica Rueda, Yannis Sainte-Marie, Laetitia Pereira, Spyros Zissimopou-
los, et al..Mineralocorticoid modulation of cardiac ryanodine receptor activity is associ-
ated with downregulation of FK506-binding proteins.. Circulation, American Heart Associ-
ation, 2009, 119 (16), pp.2179-87. <10.1161/CIRCULATIONAHA.108.805804>. <inserm-
HAL Id: inserm-00422024
Submitted on 5 Oct 2009
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Mineralocorticoid modulation of cardiac ryanodine receptor activity is associated with FKBP
Gómez: Aldosterone modulation of Ca2+ sparks
Ana María Gómez, PhD1, Angélica Rueda, PhD1, Yannis Sainte-Marie, PhD2, Laetitia Pereira
PhD1, Spyros Zissimopoulos PhD3, Xinsheng Zhu, PhD4, Roxane Schaub, MD5, Emeline Perrier,
PhD1, Romain Perrier PhD1, Céline Latouche, MS2, Sylvain Richard, PhD1, Marie-Christine Picot,
MD PhD5, Frederic Jaisser, MD PhD2, F Anthony Lai, PhD3, Héctor H Valdivia, MD PhD4 and
Jean-Pierre Benitah, PhD1
1INSERM, U637, Université Montpellier, France.
2INSERM, U772, Collège de France, Paris, France.
3Wales Heart Research Institute, Cardiff University School of Medicine, Cardiff, UK.
4Department of Physiology, University of Wisconsin Medical School, Madison, USA.
5Département de l'Information Médicale, Hôpital Lapeyronie, CHU Montpellier, France
Laboratoire de physiopathologie cardiovasculaire
CHU Arnaud de Villeneuve
34295 MONTPELLIER, France
Tel 33 4 67 41 52 38
Fax 33 4 67 41 52 42
The total word count 5981
Subject Codes  
Background. The mineralocorticoid pathway is involved in cardiac arrhythmias associated
with heart failure (HF) through yet incompletely understood mechanisms. Defective regulation of
the cardiac ryanodine receptor (RyR) is an important cause in the initiation of arrhythmias. Here,
we examined whether the aldosterone pathway might modulate RyR function.
Methods and results. Using whole-cell patch-clamp, we observed an increase in the
occurrence of delayed after-depolarizations during action potential recordings in isolated adult rat
ventricular myocytes exposed 48 hours to 100 nmol/L aldosterone, in freshly isolated myocytes
from transgenic mice with human mineralocorticoid receptor expression in the heart and in wild-
type littermates treated with aldosterone. Sarcoplasmic reticulum Ca2+ load and RyR expression
were not altered, however, RyR activity, visualized in situ by confocal microscopy, was increased
in all these cells, as evidenced by an increased occurrence and redistribution to long-lasting and
broader populations of spontaneous Ca2+ sparks. These changes were associated with down-
regulation of FK506-binding proteins (FKBP12 and 12.6), regulatory proteins of the RyR
Conclusions. We suggest that, in addition to modulation of Ca2+ influx, over stimulation of
the cardiac mineralocorticoid pathway in the heart might be a major upstream factor for aberrant
Ca2+ release during diastole, contributing to cardiac arrhythmia in HF.
Key Words: aldosterone, Ca2+ sparks, FKBP, arrhythmia
During the past decade, research has focused on the actions of aldosterone in target organs
beyond the kidney, expanding the role of the aldosterone pathway in cardiovascular pathogenesis1.
Indeed, mineralocorticoid receptors (MR), which mainly underlie aldosterone action, have been
detected in a range of non-renal tissues including the brain, blood vessels and the heart2, suggesting
a broader pattern of biological activity for aldosterone than previously anticipated. The pivotal role
of aldosterone, causing sodium retention with expansion of the extracellular volume, resulting in
deterioration of hemodynamic responsiveness and a fall in cardiac output, has long been recognized
in heart failure (HF)3,4. In addition, accumulating experimental and clinical evidence suggests that
aldosterone has direct adverse cardiac effects independent of its effects on blood pressure,
especially an increased risk of arrhythmic death3,4. Interestingly, major clinical trials involving MR
antagonists have shown significant benefits on risk of cardiovascular events, in particular sudden
death in HF5,6. A pertinent question is, therefore, how activation of cardiac MR participates in life-
Most fatal arrhythmias in experimental HF initiate by nonreentrant mechanisms arising from
abnormal ventricular automaticity or triggered activity7,8. The latter consists of either early after-
depolarizations (EADs) occurring in the plateau phase of the action potential (AP) or delayed after-
depolarizations (DADs) occurring at repolarized membrane potentials9. EADs typically occur in the
setting of prolonged repolarization due to alterations in ionic currents and to reactivation of Ca2+
current (ICa). DADs are caused by membrane depolarization initiated by spontaneous Ca2+ release
from the sarcoplasmic reticulum (SR) through the ryanodine receptor (RyR). We have accumulated
evidence, both ex and in vivo, that the modulation of Ca2+ influx is a central factor in the cardiac
action of aldosterone pathway10-14 and might be involved in EAD-related fatal ventricular
tachyarrhythmia14. Moreover, enhanced diastolic leak of Ca2+ via the RyRs generates DADs and is
a fundamental mechanism underlying several genetic or acquired arrhythmias15,16. Therefore, we
tested here whether the activation of aldosterone pathway modulates diastolic RyR activity in heart.
All experiments were carried out according to European Union Council Directives
(86/609/EEC) for the care of laboratory animals. The authors had full access to and take full
responsibility for the integrity of the data. All authors have read and agree to the manuscript as
A detailed Methods section can be found in the online Supplemental Material.
Cell isolation and incubation
Isolated ventricular myocytes from adult male Wistar rats (250-350 g) were incubated for 48
hours, with or without 100-nmol/L D-Aldosterone (Sigma). In some experiments, 10-mol/L
RU28318 was added to aldosterone10,11.
hMR transgenic mice and in vivo aldosterone exposure
Cardiac-specific expression of human MR (hMR) was obtained by crossing a tetO-hMR
mouse strain with an α-MHC-tTA transactivator mouse strain14. Littermate wild-type, gender-
matched mice (WT) were used as controls. In some of them, after pentobarbital sodium anesthesia
(30 mg/kg), osmotic minipumps (Model 2 ML4, Alza Corporation) were subcutaneously implanted
for constant delivery of 50g/day D-Aldosterone (dissolved in 0.9% saline) over 3 weeks. Chronic
aldosterone infusion significantly increased the plasma aldosterone concentration above control
levels (from 278±77 [n=7] to 1374±150 [n=7] pg/ml, P<0.05). Mice were devoid of cardiac
hypertrophy either on whole organ (heart weight-to-body weight ratio in mg/g: 5.9±0.4 [n=15],
5.9±0.3 [n=11] and 5.3±0.4[n=6] in WT, aldosterone-treated and hMR mice, respectively, P>0.05)
or at cellular level (membrane capacitance in pF: 201.8±6.1 [n=30], 199.6±12.7 [n=21] and
199.0±11.0 [n=26] for isolated ventricular myocytes from WT, aldosterone-treated and hMR mice,
Action potential recording
Whole cell patch clamp method was used in current clamp configuration to record APs using
solutions and protocol as described11.
Spontaneous local SR Ca2+ release: Ca2+ sparks
Fluo-3AM loaded cells were imaged in Tyrode solution (in mmol/L: NaCl 130, NaH2PO4 0.4,
NaHCO3 5.8, CaCl2 1, MgCl2 0.5, KCl 5.4, glucose 22, HEPES 25, insulin 0.01, pH 7.4) using a
confocal microscope in line scan mode11.
Cell lysate and SR-enriched membrane fraction (SR fraction)
Cell lysates were prepared with homogenization buffer (in mmol/L: sucrose 300, NaF 20,
HEPES 20, Aprotinin 5.2 10-4, Benzamidine 0.5, Leupeptin, 0.012, PMSF 0.1, pH 7.2) using a
Potter-Elvehjem and spun at 2,000 g for 10 min. SR fractions were isolated by ultracentrifugation at
40,000 g for 30 min at 4°C17. 17Protein concentration by Bradford method and binding of
[3H]ryanodine to SR fractions were assessed17.
Analysis of RyR single-channel activity was done by fusing SR vesicles into planar lipid
bilayers using Cs+ as charge carrier17. Only bilayers containing a single channel were used. Channel
activity was always tested for sensitivity to EGTA, added in the cis chamber at the end of each
Total RNA was extracted using Trizol (InVitrogen). First strand cDNA was synthesized after
DNaseI treatment (DNAfree, Ambion) using 1 µg of total RNA, random hexamers (Amersham) and
Superscript II reverse transcriptase (InVitrogen). Transcripts levels were analyzed in triplicate by
real time PCR with an iCycler iQ apparatus (Bio-Rad) using a qPCR Core Kit for SYBR Green I
(Eurogentec) containing 500 nmol/L of specific primers (Table S1) and 3 µL of diluted template
cDNA. Relative expression of FKBPs and RyR were normalized by the geometric average of
relative quantities for reference genes. Serial dilutions of pooled cDNA were used in each
experiment to assess PCR efficiency.
Immunoblots were prepared from cell lysates using anti-FKBP12/12.6 (1:1000, Santa-Cruz
Biotechnology Inc), anti-RyR (1:3000, Affinity Bioreagents), and anti-actin (1:20000, Sigma)
antibodies. FKBP12/12.6-RyR interaction was assessed on SR fractions using anti-FKBP12/12.6
(1:200) and anti-RyR (1:1000) antibodies from Affinity BioReagents. Immunoblots of RyR
phosphorylation were performed using anti–RyR-PS2809 (1:5000) antibody from Badrilla (Leeds,
West Yorkshire, UK) and anti–RyR-PS2815 (1:5000) antibody generously provided by Dr A.R.
Marks (Columbia University, New York, NY).
Preliminary descriptive analyses include frequencies for categorical variables and means±SD for
continuous ones. A conditional hierarchical linear model was used (SAS/UNIX statistical software,
SAS Institute, Cary, N.C. proc mixed) to compare continuous variables between groups to take into
account for multiple observations per animals. The group was a fixed effect, animals were a random
effect nested in the group and, in case of repeated measures on cells, we add a random effect for cell
Data are presented as mean±SEM and compared using Student's t test (for two groups) or ANOVA
(for more groups followed up with a post-hoc pairwise Tukey’s HSD test). Significance was
defined at P<0.05.
Aldosterone pathway increases occurrence of DADs.
During AP recordings, at 0.1-Hz cycle length in ventricular myocytes isolated from transgenic
mice expressing hMR in the heart (hMR mice, Fig.1A), we observed oscillations in membrane
potential following completion of the driven AP (Fig.1A middle). Eventually, the DAD was large
enough to reach the threshold to trigger spontaneous AP (Fig.1A right). The occurrence of DADs
was greatly enhanced by the activation of aldosterone pathway (Fig.1B). Ex vivo, after 48-hours
exposure of isolated rat ventricular myocytes to 100-nmol/L aldosterone, the occurrence of DADs
increased compared with control myocytes kept 48 hours in absence of aldosterone. Likewise in
vivo, increases of DAD occurrence appeared after 3-week minipump infusion of aldosterone in WT
mice or in hMR mice, as compared to untreated WT littermates.
Modulation of Ca2+ sparks by aldosterone pathway.
DADs are commonly initiated by non-electrically driven, spontaneous Ca2+ release from the
SR via the RyRs8. We thus examined the properties of RyRs in situ, by visualizing spontaneous
Ca2+ sparks that reflect brief and local Ca2+ release events occurring when RyRs open18,19. Figure
2A shows line scan images of cells isolated from WT, aldosterone-treated and hMR mice. Either
elevated circulating aldosterone or cardiac hMR expression resulted in ~1.6-fold increase of Ca2+
spark frequency (Table S2, Fig.2B). No differences in mean values for Ca2+ spark amplitude
(Fig.2C) or rise time (Fig.2D) were seen between the 3 groups. As noticed in Figure 2A, besides
“classical” Ca2+ sparks characterized by a brief and localized increase in the fluorescence signal (a
half time of decay ~30 ms and a diameter of ~2 m)18, we also observed the appearance of widened
(>4 m) and long-lasting Ca2+ release events (>80 ms). A mixed-effect model revealed increases of
both averaged Ca2+ spark full widths (FWHM) and durations (FDHM) at half maximal in
aldosterone-treated and hMR mice (Table S2), which might reflect differences in population
proportions. The distributions of FWHM and FDHM were empirically fitted to bimodal Gaussian
functions (Fig.2E and F). The distributions of FWHM showed a prominent mode near 2.8 µm and a
second minor mode near 4.3 m, whatever the conditions. However, the proportion of events
showing larger width was greater in aldosterone-treated and hMR mice compared with WT (Table
1). Moreover, events lasting more than 50 ms were more frequent in aldosterone-treated and hMR
mice compared with WT. Distributions of log(FDHM) were fitted by 2 Gaussian distributions with
2 distinct peaks ~32 and 87 ms, but the frequency of long-lasting signals were larger in aldosterone-
treated and hMR mice than that observed in WT mice (Table 1). No correlation between Ca2+ spark
spatio-temporal characteristics was observed. This is consistent with occurrence of three different
populations of Ca2+ sparks, whose redistributions to long-lasting and larger spread area populations
were increased by activation of the cardiac aldosterone pathway.
While the effects of aldosterone in vivo are presumably due to its direct cardiomyocyte effect,
aldosterone might cause release of second messengers from non-cardiac cells that can affect Ca2+
sparks. To exclude this possibility we examined the properties of spontaneous Ca2+ sparks of
isolated rat ventricular myocytes kept 48 hours with or without 100-nmol/L aldosterone. Three
different populations of Ca2+ sparks were also observed (Fig.3): the normal Ca2+ sparks are narrow
and brief (Fig.3A); the second population of Ca2+ sparks is substantially wider in space, but only
slightly longer in duration (Fig.3B); the third population of Ca2+ sparks has the same width as the
normal but is very much longer in duration (Fig.3C). Analysis of the distributions of FWHM
(Fig.3D) and FDHM (Fig.3E) showed that ex vivo aldosterone exposure increases the occurrence of
both wider and longer populations (Tables 1 and S2). In addition, we observed a 1.9-fold increase in
Ca2+ spark frequency (Table S2, Fig.3F), whereas mean Ca2+ spark amplitude (Fig.3G) and rise
time (Fig.3H) were not affected. Co-incubation with a specific MR antagonist, RU2831811,12,13,
prevented aldosterone-induced changes in Ca2+ spark properties (Fig.3).
Aldosterone effects on Ca2+ sparks might arise from modulation of RyR intrinsic properties.
The open probability of RyRs is influenced by the amount of Ca2+ stored in the SR20. A
potential increase of SR Ca2+ load by aldosterone could therefore underlie the observed effects on
Ca2+ sparks. SR Ca2+ load was estimated by rapid caffeine application (10 mmol/L) in the same
intact cells used for Ca2+ sparks11,21. No difference (P>0.05) was observed in hMR mice (peak F/F0:
4.0±0.1, n=56) and in aldosterone-treated mice (3.8±0.2, n=43) compared to WT (4.1±0.1, n=29).
As well, no difference in the caffeine-evoked Ca2+ transients was noticed after ex vivo aldosterone
exposure (3.7±0.2 and 4.0±0.2 in control [n=13] and aldosterone treated myocytes [n=13],
respectively, P>0.05). These results are consistent with the absence of alteration in Ca2+ spark
amplitude and suggest that aldosterone does not modulate RyR activity (and hence, Ca2+ sparks), by
altering SR content.
Ca2+ sparks result from the opening of clusters of RyRs, thus, increased Ca2+ spark frequency
might result from increased RyR expression. Immunoblot analysis of cell lysates showed similar
RyR amounts (after normalization against control, ratios of RyR to actin levels were: 1±0.3 [n=8],
0.95±0.3 [n=4] and 0.82±0.3 [n=4] in WT, WT+Aldo and hMR mice, respectively, P>0.05; and
1±0.2 [n=8], 0.94±0.2 [n=4] in rat ventricular myocytes kept 48 hours without and with aldosterone,
respectively, P>0.05). RyR expression of isolated rat cardiomyocytes kept 48 hours with or without
aldosterone, examined by [3H]ryanodine binding to SR fractions, indicated unchanged high-affinity
binding site for ryanodine (Kd values in nmol/L: 1.5±0.2 and 1.8±0.4 after 48 hours incubation with
[n=6] and without aldosterone [n=6], respectively; P>0.05) and similar expression levels of RyR
after aldosterone exposure (maximal receptor density: 0.24±0.04and 0.29±0.03 pmol/mg of protein,
These results showed that activation of the aldosterone pathway in cardiac myocytes alters
Ca2+ spark properties without modifying SR Ca2+ content or RyR expression. Therefore,
aldosterone modulation of Ca2+ sparks might arise from changes in the intrinsic activity of the RyR
complex. As an index, we fused SR fractions from control and aldosterone-treated rat
cardiomyocytes into planar lipid bilayers to record single channel activity of RyR. Besides classical
bimodal gating20, characterized by sequences of flickering openings with low (Fig.4A) and high
(Fig.4B) open probability, a clearly distinct long and relatively stable openings with similar unitary
current amplitude were observed (Fig.4C). Measurements from holding potentials –35 to +35 mV
showed that current-voltage relationships had similar conductance of 639, 632 and 640 pS (for
Fig.4A, B and C, respectively). These results suggested that all recorded channel activity
corresponded to RyRs, however, although the burst and long-lasting modes were observed in
channels with and without aldosterone treatment, these modes occurred more frequently after
aldosterone exposure (Fig.4D).
FKBP12/12.6 downregulation by mineralocorticoid pathway.
Taken together, our results indicate that aldosterone through MR increases the likelihood that
RyRs open abnormally during diastole, which might reflect changes in intrinsic properties of the
RyR. Activity of RyR is tightly regulated by several accessory proteins that form a macromolecular
signaling complex with RyR15,16. Among these ancillary proteins, FK506-binding proteins
(FKBP12 and 12.6) have been involved in the incidence of subsets of cardiac Ca2+ sparks with
longer duration and wider spatial spread, along with increased frequency21-23. Therefore, we
assessed the expression of FKBP12/12.6 protein levels. Compared to the respective controls,
immunoblot analysis of cell lysates showed decreases in the amount of FKBP12/12.6 relative to
actin levels after in or ex vivo aldosterone exposure and in hMR mice (Fig.5A). The RyR-
FKBP12/12.6 association was indirectly assessed by measuring the ratio of FKBP12/12.6 to RyR
detected in the SR fractions24-26. Immunoblot analysis indicates that the relative amounts of
FKBP12/12.6 to RyR are decreased in the heart of hMR mice or WT mice treated with aldosterone
compared to control WT (Fig.5B). Because RyR phosphorylation could influence FKBP12/12.6-
RyR association15,16, we examined RyR phosphorylation status following activation of the
mineralocorticoid pathway. RyR contains multiple phosphorylation sites including RyR-Ser2815
(phosphorylated by CaMKII)27 and RyR-Ser2809 (phosphorylated by both CaMKII and PKA)28.
Using 2 different phospho-specific antibodies (RyR-PS2815 and RyR-PS2809) on SR fractions, we
observed no difference in the ratio of phosphorylated RyR to total RyR among groups (Fig.5C). To
distinguish FKBP12 versus FKBP12.6 expression, real-time quantitative PCR was used to assess
mRNA levels with specific primers. At mRNA level, a decreased expression of both FKBP12 and
12.6 was observed in the 3 models studied compared to respective controls (Fig.5D), whereas
mRNA levels of RyR were not altered (data not shown).
In summary, long-term aldosterone exposure ex or in vivo, or cardiac hMR expression in
transgenic mice, increases the occurrence of DADs, in line with abnormal diastolic openings of
RyR, which are associated with down-regulation of FKBP12 and 12.6. While the link might be
circumstantial, several lines of evidence suggest that over-stimulation of the cardiac
mineralocorticoid pathway may be a major upstream factor for aberrant Ca2+ release during
diastole, contributing to cardiac arrhythmia in HF.
Numerous experimental and clinical studies indicate that the aldosterone pathway participates
in cardiac alterations associated with hypertension, HF, diabetes and other pathologies1,3-6,12,14.
Notably, inappropriate activation of cardiac MR is a likely participant in the development of poor
outcomes for patients with HF, especially those associated with cardiac arrhythmia5,6. Interestingly,
hMR mice presented high mortality and increased occurrence of arrhythmia14. One of the possible
cellular mechanisms for those arrhythmias is triggered activity caused by EADs and DADs, both of
which are commonly associated with intracellular Ca2+mishandling. We previously reported that
along with AP lengthening, EADs occur in hMR mice14. The incidence of EADs was (in %) 1, 11
and 14 in ventricular myocytes isolated from WT, aldosterone-treated and hMR littermate mice,
respectively. In addition, we observed that 10% of rat ventricular myocytes incubated 48 hours with
aldosterone presented EADs, whereas none was observed in control. Here, we found that the
incidence of DAD is approximately 2-fold higher, thus constituting a substantial mechanism for
aldosterone pathway-induced arrhythmias.
Whereas many Ca2+-handling proteins are involved in DAD-related arrhythmias, abnormal
opening of the RyR during diastole is an essential component7,8. We show here that aldosterone
pathway increased the occurrence, and changed the spatio-temporal properties, of spontaneous Ca2+
sparks. Similar alterations were found either ex vivo by incubating adult cardiac myocytes with
aldosterone, or in vivo in mouse hearts after chronic delivery of aldosterone or hMR expression.
These consistent findings suggest that a direct activation of cardiac MR by aldosterone modifies
Ca2+ spark phenotype, independently of other compensatory changes in vivo. Indeed, ex vivo
aldosterone effects are prevented by a specific MR antagonist. In addition, hMR mice have
increased aldosterone receptor activity, presumably due to physiologic aldosterone levels, as
assessed by prevention of phenotype effects with MR antagonist14. Moreover, MR antagonists also
prevented other aldosterone-induced cardiac effects10,11,13.
Although we cannot exclude that the effects might be secondary to other modulations in
myocyte Ca2+ handling, several lines of evidence suggest that activation of MR by aldosterone
directly affects RyR activity. The increase in Ca2+ spark frequency is not due to an increase in SR
Ca2+ load but rather might reflect a modulation of the intrinsic properties of the RyR complex.
Besides the increase in Ca2+ spark frequency, we observed a redistribution of Ca2+ sparks to long-
lasting and broader populations. These “abnormal” Ca2+ sparks were also seen in control conditions,
but at much lower frequency. Others have also found Ca2+ sparks that are longer or wider than the
“classic” Ca2+ sparks in control conditions18,21,29-31. The incidence of wide (>2 m) and long (60-80
ms) Ca2+ sparks is increased in left ventricular hypertrophy in the dog without alteration in Ca2+
spark amplitude32. Here, aldosterone exposure or cardiac hMR expression increased the proportions
of long and wide Ca2+ sparks from 4-6% to 9-19% and from 4-6% to 16-30%, respectively,
constituting a substantial effect. This indicates that aldosterone does not induce a new kind of Ca2+
sparks, but modifies the activity of functional release units.
Along with this alteration, we observed a significant down-regulation of FKBP12 and 12.6
expressions without variation in the density of RyRs. Even if other alterations may contribute to the
observed modifications of Ca2+ sparks characteristics, no other RyR-associated proteins have been
shown to induce similar modulations as FKBP does. The FKBP12/12.6 binding to RyRs modulates
the Ca2+-flux properties of the channel complex; in particular, it regulates RyR open probability and
stability at rest20,33,34 (but see also35). FKBP12.6 removal by pharmacological approaches22,36,37 or
transgenic animal models23, and conversely adenoviral short-term FKBP12.6 overexpression21,38
modulated Ca2+ sparks frequency and occurrence of longer and wider Ca2+ sparks, in a similar
manner to what we observed here. We showed that activation of cardiac aldosterone pathway
produced a decreased expression of FKBPs. In addition, we have assessed the RyR-FKBP12/12.6
association in hMR transgenic and WT mice treated with aldosterone. Our results suggest that in
mouse hearts, activation of the aldosterone pathway results in substantially reduced RyR-
FKBP12/12.6 interaction that could be the cause of the observed RyR-mediated Ca2+ leak. These
effects are not associated with alteration of RyR phosphorylation status but might reflect a genomic
regulation of FKBP12/12.6 by cardiac aldosterone pathway, as evidenced by the decrease in mRNA
levels of FKBP12 and 12.6. Now, partial loss of FKBP12.6 from RyR in HF has been shown to
cause diastolic Ca2+ leak that may result in higher propensity of DADs and consequent triggered
arrhythmias15,16,23,39-45. In addition, myocardial FKBP12.6 overexpression prevents triggered
arrhythmias in normal hearts, probably by reducing diastolic SR Ca2+ leakage46. Beyond the
controversial hypothesis for excess RyR activity due to hyperphosphorylation reducing RyR affinity
for FKBP12.647, most of the studies show a reduction of FKBP protein level in HF23,39-45. Thus, we
suggest that activation of the aldosterone pathway might be an essential step in the cascade of
molecular events leading to FKBP deficiency that causes RyR Ca2+ leakage, and trigger malignant
cardiac arrhythmias in HF.
Taken together, our findings may partly explain why the use of MR antagonists on top of
optimal medical therapy is associated with improved survival, and fewer sudden cardiac deaths in
This work was supported by Agence Nationale de la Recherche (project
#A05071FS/APV05030FSA), Institut National de la Santé et de la Recherche Médicale (INSERM),
the British Heart Foundation (PG/05/077) and the European Union (FPG, Life Science Genomics
and Biotechnology for Health, #CT 2005 N°018802, CONTICA).
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Figure 1. Activation of aldosterone pathway increases the occurrence of delayed after-
depolarizations (DADs). A. Representative action potentials recorded from the same hMR
cardiomyocyte, elicited at 0.1 Hz, showing the appearance of spontaneous depolarization (middle,
DAD indicated by the arrows) and triggering spontaneous AP (right). B. Bar graph plots number of
cells presenting at least 1 DAD in rat ventricular myocytes incubated 48 hours with or without 100-
nmol/L aldosterone and in ventricular myocytes isolated from WT, aldosterone-treated WT and
hMR littermate mice. n is the total cell number. * P<0.05.
Figure 2. Change of the spatio-temporal properties of Ca2+ sparks induced by
mineralocorticoid in vivo. A. Sample line-scan fluorescence images record from cells isolated from
wild-type (WT, top), aldosterone-treated (WT+Aldo, middle) and hMR mice (bottom). B through
D, Comparison of the frequency of occurrence, amplitude (F/F0), and rise time of Ca2+ sparks at rest
in myocytes from WT (red open bars), WT+Aldo, (light blue bars) and hMR mice (blue bars). In B,
n is the cell number, whereas in C and D it is the number of Ca2+ sparks. * P<0.05. Probability
Density function (PDf) of Ca2+ spark widths (E) and durations (F) at half maximal amplitude in
WT, WT+Aldo, and hMR mice. Curves represent mixed Gaussians fitted to the histograms. In F,
analyses were conducted on log(FDHM) and corresponding results are presented after back
Figure 3. Ex vivo aldosterone exposure promotes the occurrence of wide-spread and long-
lasting Ca2+ sparks. A to C. Representative spark images and spatio-temporal profiles from a 48-
hour aldosterone-treated cell showing that spontaneous Ca2+ sparks can be: short (A), large (B) or
long (C). The distance along the cell is represented vertically, and the time is represented
horizontally. D and E. PDf of FWHM and FDHM after 48 hours incubation under control (cont, red
open bars), 100-nmol/L aldosterone without (Aldo; blue bars) and with 10-mol/L RU28318
(Aldo+RU; blue open bars) conditions. Histograms were fitted by the sum of 2 Gaussian
distributions. F to H. Bar graphs of mean ± SEM values for Ca2+ spark frequency (F), amplitude
(F/F0, G), and rise time (H). In F, n is the cell number whereas in G and H it is the number of Ca2+
sparks. ** P<0.005.
Figure 4. Single RyR channels reconstituted in lipid bilayers display three different kinetic
behaviors: (A) short, (B) burst and (C) long openings. Each panel shows representative examples
of single channel behaviors of RyR reconstituted from the same SR-enriched membrane fraction of
rat ventricular myocytes incubated 48 hours in the presence of aldosterone: (top) 2-min and 500-ms
section of the recording on an expanded time scale of single-channel traces recorded at +25 mV
with channel openings (o) in the upward direction; (bottom) Current-voltage relationship of the
corresponding incorporated RyR. D. Bar graphs plots the percentage of the occurrence of modal
behaviors of reconstituted RyR channels from SR fractions of cells kept 48 hours with (Aldo, gray
bars, n=15) and without aldosterone (cont, open bars, n=11). ** P<0.005.
Figure 5. Down regulation of FKBP12 and 12.6 expressions after activation of cardiac
aldosterone pathway. A to C. Representative immunoblots and quantification of (A) FKBP12/12.6
protein levels in cardiac cell lysates (normalized to the corresponding actin level and normalized to
respective controls), (B) FKBP12/12.6 and RyR content in SR-enriched membrane fractions (the
cumulative data presented are derived from four different heart preparations, each immunoblotted
four times, and are illustrated after normalization against the WT, non-treated sample) and (C)
Pooled data represent ratios of RyR-P2815 and RyR-P2809 to RyR from SR-enriched membrane
fractions normalized to respective controls from WT (open bars), aldosterone-treated WT
(WT+Aldo, hatched bar) and hMR (closed bars) mice; and in rat ventricular myocytes incubated 48
hours with (+Aldo, closed bar) or without (cont, open bar) 100-nmol/L aldosterone. D. Real time
RT-PCR analysis of the cardiac tissue content of FKBP12 and 12.6. 2-microglobulin, GAPDH,
HPRT and UBC were used as reference genes and the relative mRNA levels were normalized to the
geometric average of relative quantities for reference genes. * P<0.05.
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Table 1. Mean (), standard deviation (), proportion (p in %) and coefficient of determination (r2)
of Gaussian fits to Ca2+ spark parameters.
Aldo in vivo
WT 2.79 0.91 93.5 4.32 0.60 6.5 0.98 30.9 5.6 96.0 85.2 23.9 4.0 0.98
WT+Aldo 2.80 0.84 83.8 4.30 1.20 16.2 0.99 32.4 5.9 91.0 87.6 30.2 9.0 0.99
hMR 2.78 0.71 70.2 4.33 1.15 28.8 0.99 33.4 5.9 81.6 89.4 27.9 18.4 0.99
Aldo ex vivo
control 2.61 0.89 94.5 4.85 0.71 5.5 0.99 33.7 6.3 94.0 103.0 41.1 6.0 0.99
Aldo 2.62 0.91 72.0 4.60 1.25 28.0 0.99 33.5 6.3 81.7 106.0 50.3 18.3 0.99
Aldo+RU 2.54 0.78 95.8 4.53 0.70 4.2 0.99 33.7 5.7 95.7 105.3 35.2 4.3 0.99
FWHM and FDHM: Full width and duration at half maximal amplitude.