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Am J Physiol Heart Circ Physiol 281: H1217-H1222, 2001;
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Vol. 281, Issue 3, H1217-H1222, September 2001

Loaded shortening and power output in cardiac myocytes are dependent on myosin heavy chain isoform expression

Todd J. Herron, F. Steven Korte, and Kerry S. McDonald

Department of Physiology, University of Missouri School of Medicine, Columbia, Missouri 65212


    ABSTRACT
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ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

The purpose of this study was to examine the role of myosin heavy chain (MHC) in determining loaded shortening velocities and power output in cardiac myocytes. Cardiac myocytes were obtained from euthyroid rats that expressed alpha -MHC or from thyroidectomized rats that expressed beta -MHC. Skinned myocytes were attached to a force transducer and a position motor, and isotonic shortening velocities were measured at several loads during steady-state maximal Ca2+ activation (PpCa4.5). MHC expression was determined after mechanical measurements using SDS-PAGE. Both alpha -MHC and beta -MHC myocytes generated similar maximal Ca2+-activated force, but alpha -MHC myocytes shortened faster at all loads and generated ~170% greater peak normalized power output. Additionally, the curvature of force-velocity relationships was less, and therefore the relative load optimal for power output (Fopt) was greater in alpha -MHC myocytes. Fopt was 0.31 ± 0.03 PpCa4.5 and 0.20 ± 0.06 PpCa4.5 for alpha -MHC and beta -MHC myocytes, respectively. These results indicate that MHC expression is a primary determinant of the shape of force-velocity relationships, velocity of loaded shortening, and overall power output-generating capacity of individual cardiac myocytes.

cardiac muscle contraction; sarcomere proteins


    INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

THE AMOUNT OF BLOOD PUMPED into the circulatory system during a heartbeat (i.e., stroke volume) is ultimately determined by the rate of myocardial shortening, which depends on several factors, including the afterload against which the ventricles must work, the architecture of the ventricles, and the contractile state of the myocardium. The contractile state of the myocardium is regulated by factors intrinsic to individual myocytes because all myocytes contract during each heartbeat. An example of an intrinsic factor is myoplasmic Ca2+ concentration, which varies on a beat-to-beat basis, thereby modulating myocyte force (19, 10, 13), shortening velocity (11, 10) and, thus, stroke volume. Another likely determinant of myocardial shortening and stroke volume is the isoform of myosin heavy chain (MHC) expressed in individual myocytes. In vertebrates, two MHC isoforms are expressed in the myocardium, alpha -MHC, and beta -MHC (20). These two MHC isoforms show considerable homology, having 93% identical amino acids (12), but they are functionally quite distinct. For instance, alpha -MHC exhibits two to three times the actin-activated ATPase activity (9) and actin filament sliding velocity (5) as beta -MHC. Additionally, myocardial strips containing predominantly alpha -MHC exhibited six times faster maximum shortening velocities than myocardial preparations containing beta -MHC (16). These marked differences in ATPase rates and mechanical shortening velocities imply that power output-generating capabilities would be significantly lower in myocytes expressing beta -MHC. The purpose of this study was to directly assess loaded shortening velocities and power output of single rat cardiac myocytes containing either alpha -MHC or beta -MHC. For these experiments, force-velocity and power-load curves were measured in single ventricular myocytes obtained from euthyroid adult rats that predominantly expressed alpha -MHC and from hypothyroid adult rats that exclusively expressed beta -MHC. To obtain force-velocity and power-load curves, we utilized a single skinned ventricular cardiac myocyte preparation having low-end compliance, minimal passive elastic forces, and enough myosin to assess MHC isoform composition in the same myocyte preparation used for mechanical measurements. These preparations allowed direct comparison of power output capabilities and MHC isoform expressed in the same individual myocyte.


    METHODS
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ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

Experimental animals. Euthyroid and thyroidectomized Sprague-Dawley rats were obtained from Harlan Tekland (Madison, WI), housed in groups of two or three, and provided access to food and water ad libitum. All thyroidectomized animals were treated with propylthiouracil (PTU) as described previously (3). Briefly, PTU (12 mg/kg) was administered daily by intraperitoneal injection to all thyroidectomized rats. The combination of thyroidectomy and PTU supplement has been shown to eliminate circulating plasma 3,5,3'-triiodothyroine and thyroxine (T4) levels (4). Thyroidectomized rats were studied between 2 and 5 wk after surgery. A group of sham-operated control rats were also studied 2-5 wk after surgery to ensure that any postoperative response did not influence myocyte function and, thus, the outcome of this study. All animal usage was performed according to guidelines established by the Animal Care and Use Committee of the University of Missouri.

Cardiac myocyte preparation. Single-skinned cardiac myocytes were obtained by mechanical disruption of hearts from Sprague-Dawley rats as described previously (11). Rats were anesthetized by inhalation of methoxyflurane, and their hearts were excised and rapidly placed in ice-cold relaxing solution. The ventricles were dissected away from the atria, cut into 2- to 3-mm pieces and further disrupted for 5 s in a Waring blender. The resulting suspension of cells was centrifuged for 105 s at 165 g, after which the supernatant was discarded. The myocytes were skinned by resuspending the pellet of cells for 5 min in 0.3% ultrapure Triton X-100 (Pierce Chemical) in relaxing solution. The skinned cells were washed twice with cold relaxing solution, resuspended in 10-15 ml of relaxing solution, and kept on ice during the day of the experiment.

Solutions. Compositions of relaxing and activating solutions used in mechanical measurements were (in mmol/l) 7 EGTA, 1 free Mg2+, 20 imidazole, 4 MgATP, and 14.5 creatine phosphate (pH 7.0); Ca2+ concentrations of 10-9 M (relaxing solution); 10-4.5 M (maximal activating solution); and sufficient KCl to adjust ionic strength to 180 mM. Before each activation, myocyte preparations were immersed for 30 s in preactivating solution (identical to relaxing solution, except that EGTA was reduced to 0.5 mmol/l). This protocol resulted in more rapid steady-state force development and helped preserve the striation pattern during activation. Relaxing solution, in which the ventricles were disrupted, skinned, and resuspended contained (in mmol/l) 2 EGTA, 5 MgCl2, 4 ATP, 10 imidazole, and 100 KCl at pH 7.0.

Experimental apparatus. The experimental apparatus for physiological measurements of myocyte preparations was similar to one previously described in detail (15) and recently modified specifically for cardiac myocyte preparations (11). Briefly, myocyte preparations were attached between a force transducer and torque motor by gently placing the ends of the myocyte into stainless steel troughs (25 gauge). The ends of the myocyte were secured by overlaying a 0.5-mm-long piece of 3-0 monofilament nylon suture (Ethicon) onto each end of the myocyte and then tying the suture into the troughs with two loops of 10-0 monofilament suture (Ethicon). The attachment procedure was performed under a stereomicroscope (approximately ×100 magnification) using finely shaped forceps. Dimensions of the myocyte preparations are provided in Table 1. Sarcomere length of these preparations was set to ~2.25 µm, which yielded passive forces near zero.

                              
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Table 1.   Myocyte preparation dimensions

Before mechanical measurements, the experimental apparatus was mounted on the stage of an inverted microscope (model IX-70, Olympus Instrument), which rested on a pneumatic vibration table with a cut-off frequency of ~1 Hz. Force measurements were made using a capacitance-gauge transducer with 20 mV/mg sensitivity and 600 Hz resonant frequency (model 403, Cambridge Technology; Cambridge, MA). Length changes during mechanical measurements were introduced at one end of the preparation using a DC torque motor (model 308, Cambridge Technology) driven by voltage commands from a personal computer via a 12-bit digital-to-analog converter (AT-MIO-16E-1, National Instruments; Austin, TX). Force and length signals were digitized at 1 kHz using a 12-bit analog-to-digital converter and each was displayed and stored on a personal computer using custom software based on LabView for Windows (National Instruments).

Images of the skinned myocytes were recorded on videotape by using a Hamamatsu charge-coupled device camera (2400) and a Mitsubishi VHS recorder (HS-u780). Videomicroscopy was performed using a ×40 objective (Olympus UWD 40) and a ×2.5 intermediate lens. After each experiment, the tape was played back to allow measurement of sarcomere length while myocytes were relaxed and during activation.

Force-velocity and power-load measurements. All mechanical measurements were made at 13°C. The protocol for force-velocity and power-load measurements has been previously described in detail (10). First, the myocyte preparation was transferred into preactivating solution (30 s) and then into maximal Ca2+-activating solution (PpCa4.5). Once steady-state force developed, a series of force clamps (less than steady-state force) was performed to determine isotonic shortening velocities. With the use of a servo-system, force was maintained constant for a designated period of time (150-250 ms) while the length change was continuously monitored. After the force clamp was performed, the myocyte preparation was slackened to reduce force to near zero to allow estimation of the relative load sustained during isotonic shortening; the myocyte was subsequently reextended to its initial length. Because of the small lengths of the myocyte preparations, the rapid shortening introduced after isotonic shortening did not always slacken the preparation to yield a baseline force value. This resulted in an underestimation of peak force and, thus, of relative force during loaded contractions. More accurate estimates of relative forces during isotonic shortening were obtained by interpolating peak force from isometric Ca2+ activations performed before and after the series of loaded contractions. Ten to twenty force clamps were performed on a myocyte preparation during maximal Ca2+ activation. The preparation was kept in activating solution (2-3 min) throughout the series of force clamps without significant loss of force. If maximal force fell below 75% of initial force during a series of force clamps, the data were not included in the analysis.

Data analysis. Myocyte preparation length traces were fit to a single decaying exponential equation
L=Ae<SUP>−kt</SUP>+C (1)
where L is cell length at time t, A and C are constants with dimensions of length, and k is the rate constant of shortening. Velocity of shortening at any given t was determined as the slope of the tangent to the fitted curve at that time point. In this study, velocities of shortening were calculated at t = 0.

Hyperbolic force-velocity curves were fit to the relative force-velocity data using the Hill equation (6)
(P<IT>+a</IT>)(<IT>V+b</IT>)<IT>=</IT>(P<SUB>o</SUB><IT>+a</IT>)<IT>b</IT> (2)
where P is force during shortening at velocity (V); Po is isometric force; and a and b are constants with dimensions of force and velocity, respectively. Power-load curves were obtained by multiplying force times velocity at each load on the force-velocity curve. The optimal force for mechanical power output (Fopt) was calculated using the equation (25)
F<SUB>opt</SUB><IT>=</IT>(<IT>a</IT><SUP>2</SUP><IT>+a·</IT>P<SUB>o</SUB>)<SUP>1<IT>/</IT>2</SUP><IT>−a</IT> (3)
Curve fitting was performed using a customized program written in Qbasic, as well as commercial software (Sigmaplot).

SDS-PAGE and Western blot analysis. After mechanical measurements, MHC isoform expression was determined for each myocyte preparation. The single myocyte was removed from the experimental apparatus, suspended in 8 µl of SDS sample buffer, and stored at -80°C for subsequent SDS-PAGE analysis. The gel electrophoresis procedure was similar to one previously described (13). The gels for SDS-PAGE were prepared with 3.5% acrylamide in the stacking gel and 12% acrylamide in the resolving gel. Samples were separated by SDS-PAGE at constant voltage (250 V) for 6.5 h. Gels were initially fixed in an acid-alcohol solution, followed by glutaraldehyde fixing. MHC isoforms were visualized by ultrasensitive silver staining, and gels were subsequently dried between mylar sheets.

Expression of other key myofilament proteins was also determined by SDS-PAGE and Western blots to examine whether their expression pattern was altered by hypothyroidism. These experiments were done to ensure that hypothyroidism affected only MHC isoform expression as previously reported (13). Serial dilutions (50, 25, 12.5 µg) of left ventricular homogenates were prepared in SDS sample buffer. Samples were separated by SDS-PAGE using 12% polyacrylamide slab gels and visualized by silver staining as described above. For Western blotting, gels were placed on a prewetted nitrocellulose membrane and the gel-nitrocellulose combination was sandwiched among several sheets of chromatography paper. Separated proteins were then transferred from the gels to nitrocellulose using a semidry blot apparatus. Blotting of gels proceeded for 30-45 min at constant current (100 mA). The nitrocellulose blots were then placed in a blocking buffer consisting of 3% bovine serum albumin (BSA) in Tris-buffered saline plus Tween 20 (TTBS) and were rocked overnight at 4°C. The blocking buffer was removed, and blots were washed for 15 min in TTBS, followed by two subsequent 5-min washes in TTBS. Several primary antibodies were used, which included cardiac troponin T (TnT) (Advanced Immunochemical), tropomyosin (Tm) (Anawa), cardiac troponin I (TnI) (Anawa), and regulatory myosin light chain (RMLC) (Sigma). Primary antibody (TnT 1:2,000 in 0.6% BSA in TTBS; Tm 1:1,000 in 0.6% BSA in TTBS; TnI 1:1,000 in 0.6% BSA in TTBS; RMLC 1:1,000 in 0.6% BSA in TTBS) was allowed to react with blots for 2 h followed by the same washing protocol described above. Secondary antibody (S-adenosyl-L-methionine-IgG 1:2,500 in 0.3% BSA in TTBS or DAR-IgG 1:2,500 in 0.3% in TTBS) reacted for 1 h followed by three washes using TTBS. On completion of the final wash, blots were coated for 1 min with enhanced chemiluminescent substrate (Amersham) that reacts with the secondary antibody. Blots were then removed from the substrate and placed between two pieces of clear acetate. To detect relative amounts of myofibrillar protein isoforms, blots were exposed to photography film for ~1 min, followed by film development. Relative amounts of each isoform were determined by measuring the areas under the peaks using QuantiScan (Biosoft) software and an Epson scanner.

Statistics. One-way ANOVA was used to test for differences among myocyte dimensions, force velocity, and power output characteristics among myocytes from euthyroid, sham-operated euthyroid, and hypothyroid rats. The Student-Newman-Keuls test was used post hoc to assess differences among means. P < 0.05 was chosen as indicating significance. All values are expressed as means ± SD.


    RESULTS
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

Effect of thyroid deficiency on contractile protein expression and myocyte dimensions. Consistent with recent findings (3, 13), thyroidectomy followed by 2-5 wk of PTU treatment yielded a complete shift from predominantly alpha -MHC to beta -MHC as assessed by SDS-PAGE/silver staining, whereas the pattern of expression of other key myofilament proteins was not altered by this treatment as assessed by Western blots. Western blot analysis showed no differences in isoform expression pattern of TnT, Tm, TnI, and RMLC in adult cardiac myocytes from euthyroid, sham-operated euthyroid, and hypothyroid rats (Fig. 1). MHC isoform expression was determined for each individual cardiac myocyte preparation after mechanical measurements by SDS-PAGE and silver staining to provide a definitive relationship between MHC and power output. alpha -MHC and beta -MHC myocyte preparations were similar in size, sarcomere length, and production of passive and maximal Ca2+-activated force (Table 1).


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Fig. 1.   Western blot analysis indicated similar myofibrillar regulatory protein expression in cardiac myocytes from euthyroid, sham-operated, and hypothyroid rats.

Effect of MHC isoform expression on force-velocity and power-load curves. Force-velocity and power-load curves were characterized in single cardiac myocyte preparations containing either alpha -MHC or beta -MHC, as determined by SDS-PAGE/silver staining after functional measurements. Figure 2 shows force-velocity curves, power-load curves, and SDS-PAGE/silver stain analysis of two myocyte preparations, one that expressed alpha -MHC and the other that expressed beta -MHC myocyte. Peak normalized power output was 217% greater in the alpha -MHC myocyte compared with the beta -MHC myocyte [0.111 vs. 0.035 (P/Po · ML/s), where ML is muscle length]. Figure 3 shows cumulative force-velocity and power-load curves for 10 alpha -MHC myocytes from euthyroid rats and 11 beta -MHC myocytes from hypothyroid rats. There were several clear differences in the curves between alpha -MHC and beta -MHC myocytes. First, expression of beta -MHC significantly increased the curvature of the force-velocity relationship, which shifted the relative force that power was optimal (i.e., Fopt) to significantly lower values (0.31 ± 0.03 to 0.20 ± 0.06 PpCa4.5, Table 2). Second, shortening velocities were slower, and, thus, power output was lower in beta -MHC myocytes at all relative loads less than isometric (1.0 PpCa4.5). Peak normalized power output was on average 174% greater in alpha -MHC myocytes versus beta -MHC (Table 2). Interestingly, the difference in shortening velocity between alpha -MHC and beta -MHC myocytes progressively increased from zero load to higher loads until finally converging at isometric force where there was no shortening.


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Fig. 2.   Force-velocity and power-load curves from two myocyte preparations. , Data from a myocyte that expressed 100% alpha -myosin heavy chain (alpha -MHC); open circle , data from a myocyte that expressed 100% beta -MHC (see inset). Myocyte that expressed 100% alpha -MHC demonstrated greater shortening velocities at all loads less than isometric and generated 217% more peak power than the beta -MHC myocyte. P/Po, force relative to isometric force; ML, muscle length.



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Fig. 3.   Cumulative force-velocity and power-load curves from myocytes expressing either alpha -MHC (n = 10) or beta -MHC (n = 11). Myocytes expressing alpha -MHC exhibited faster shortening velocities and greater power output at all loads below isometric. Curvature of the force-velocity relationship was greater in beta -MHC myocytes, resulting in a shift of the relative load at which power was optimal from 0.20 ± 0.06 in beta -MHC myocytes to 0.31 ± 0.03 in alpha -MHC myocytes.


                              
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Table 2.   Po characteristics of alpha -MHC & beta -MHC myocytes during maximal Ca2+ activation

To ensure that the changes in force-velocity and power-load curves were due solely to differences in MHC expression rather than a postoperative cardiac response, experiments were also performed on myocytes obtained from a group of sham-operated rats 2-5 wk postsurgery. Myofibrillar protein expression was similar in sham-operated rats compared with the other two groups (Fig. 1). Sham-operated rats expressed predominantly alpha -MHC and, as expected, produced peak normalized power outputs similar to those observed in myocytes from euthyroid rats and significantly greater than power produced by beta -MHC myocytes. Peak normalized power output in sham-operated alpha -MHC myocytes was 0.073 ± 0.009 ML/s (n = 5) compared with 0.085 ± 0.019 ML/s in euthyroid alpha -MHC myocytes (P = 0.21) and 0.031 ± 0.010 in beta -MHC myocytes (P < 0.001). These results are consistent with the conclusion that reported differences in loaded shortening velocities and power output result from altered MHC isoform expression.


    DISCUSSION
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

This study directly related force-velocity and power-load curves with MHC composition of single skinned cardiac myocyte preparations. Single myocyte preparations were incorporated to more accurately define force-velocity and power-load relationships of alpha -MHC and beta -MHCs in preparations that lack gross mechanical artifacts, which are often present in multi-cellular preparations and tend to obscure isotonic shortening traces. The main findings of this study are as follows: 1) maximal Ca2+-activated isometric force production was similar in alpha -MHC and beta -MHC skinned myocyte preparations; 2) force-velocity relationships were significantly more curved in beta -MHC myocytes; and 3) loaded shortening velocities and power generation were markedly less at all loads in beta -MHC myocytes. Thus we conclude that MHC isoform expression is a primary determinant of the shape of force-velocity relationships, velocities of loaded shortening, and power output-generating capacity of individual cardiac myocytes.

MHC as a determinant of force-velocity relationships and power output in cardiac myocytes. Although alpha -MHC and beta -MHC molecules exhibit nearly 93% amino acid identity (12), there appear to be several important sites of difference within regions of the rod, tail-hinge, lever arm, nucleotide binding site, and actin binding domains (12, 23). In accordance with previous studies, our results suggest that these differences manifest different cross-bridge cycling rates between alpha -MHC and beta -MHC. Previous work has found that myosin composed of alpha -MHC exhibits two to three times more actin-activated ATPase activity (17, 24) and actin filament sliding velocity (5, 23) as beta -MHC. Additionally, myocardial strips and single cardiac myocytes containing predominantly alpha -MHC exhibited five to six times faster maximum shortening velocities than myocardial preparations containing beta -MHC (3, 16). These previous studies assessed the cross-bridge cycling rates in the absence of external loads, which the myocardium actually works against during systole. In this study, we assessed the role that cardiac MHC isoform plays in determining force-velocity relationships and power output. Force-velocity relationships were much more curved in beta -MHC myocyte preparations, which is consistent with the greater curvature reported for slow-twitch skeletal muscle fibers that also express beta -MHC (8). Thus it appears that MHC is a key determinant of force-velocity curvature as opposed to, for instance, alterations in cross-bridge number or cross-bridge cycling rates as determined by thin filament proteins.

Comparison of the cumulative force-velocity relationships between alpha -MHC and beta -MHC myocytes (Fig. 3) also provides some insight into chemomechanical transitions that may be most important in limiting loaded shortening rates and, thus, power output. From Fig. 3, shortening velocities at or near zero load were ~45% faster in alpha -MHC myocytes. Maximum velocity of shortening (i.e., Vmax) is postulated to be limited by the rate of detachment of negatively strained cross-bridges (7), which has been shown to be highly correlated with the ADP release step in the cross-bridge cycle (18). Interestingly, because curvature of the force-velocity curve was greater in beta -MHC myocytes, the difference in loaded shortening velocities progressively increased between alpha -MHC and beta -MHC myocytes as relative load increased from zero until finally converging at isometric force where there is no shortening. For example, at 90% of isometric force, loaded shortening velocity was ~225% faster in the alpha -MHC myocytes compared with 45% faster at zero load. If ADP release limits myocyte shortening velocity over the entire range of loads, this result implies that ADP release varies as a function of load much differently between alpha -MHC and beta -MHC myocytes. Alternatively, the divergence of the two curves may imply that an entirely different step in the cross-bridge cycle is most important in limiting shortening rates over much of the load range. For instance, the transition from weak-binding to strong-binding cross-bridge states, which is thought to be associated with inorganic phosphate release, may limit loaded shortening velocities. Identifying the steps of the cross-bridge cycle that actually limit loaded shortening velocities requires further experiments that probe specific cross-bridge state transitions in alpha -MHC and beta -MHC myocytes during both isometric and isotonic contractions.

Absolute peak power output was more than two times greater in alpha -MHC myocytes compared with beta -MHC myocytes. Because power output is a function of both (shortening) velocity and force, we also normalized power output to isometric force (PpCa4.5). Normalized power output was also more than twice as great in alpha -MHC myocytes than beta -MHC myocytes, which implies that MHC isoform determines power output independent of isometric force development. However, this was not entirely the case because Fopt was significantly lower in beta -MHC myocytes. Thus greater peak power output (both absolute and normalized) in alpha -MHC myocytes resulted for two reasons: 1) faster shortening velocities at Fopt, and 2) greater Fopt values due to less curvature associated with alpha -MHC. Overall, the mechanisms whereby peak power output varies with MHC isoform involves both differences in loaded cross-bridge cycling rates and differences in relative loads where myocytes generate peak power (i.e., Fopt), which is likely the loads where myocytes work in vivo and are most efficient.

Possible implications to impaired cardiac function. A consequence of heart failure, diabetes, and hypothyroidism is depressed cardiac function (2, 21), but the exact molecular mechanism(s) responsible remain unknown. It is well established in rodents that each of these disease states is associated with a shift in MHC isoform expression from alpha -MHC to beta -MHC (1, 13) and a recent report found that only small shifts in the myosin isoform composition (alpha -MHC to beta -MHC) in rodent myocardium disproportionately depressed cardiac contractility (22). Interestingly, such a mechanism may also be involved in the failing human heart. Miyata et al. (14) recently demonstrated that alpha -MHC protein is detectable in nonfailing human left ventricles but is virtually undetectable in failing human left ventricles. Our findings that power output is ~175% greater in alpha -MHC myocytes provides a potential molecular basis that could contribute to the altered cardiac function associated with these various disease states.


    ACKNOWLEDGEMENTS

This work was supported by National Heart, Lung, and Blood Institute Grant HL-57852.


    FOOTNOTES

Address for reprint requests and other correspondence: K. S. McDonald, Dept. of Physiology, School of Medicine, Univ. of Missouri, Columbia, MO 65212 (E-mail: mcdonaldks{at}missouri.edu).

The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

Received 13 December 2000; accepted in final form 4 May 2001.


    REFERENCES
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES

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Am J Physiol Heart Circ Physiol 281(3):H1217-H1222
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