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M O D U L A T O R alomone labs M ole cular Too ls for t he Neuroscience C om m uni ty Headquarters: Alomone Labs Ltd. Har Hotzvim Hi-Tech Park P.O. Box 4287, Jerusalem 91042, Israel. Tel: +972-2-587 2202 Fax: +972-2-587 1101 or +972-2-642 6975 email: [email protected] http://www.alomone.com Regional expression of cardiac ion channels and cardiac electrical activity Gerno t Schra m M.D., Ma rc Po urrier B.Sc., Peter Melnyk B.Sc., Stanle y Nattel M. D. Introduction Important differences in electrophysiological properties have been noted between different regions of the heart. Electrophysiological heterogeneity has also been detected within different parts of a given tissue, such as the ventricular subendocardium, midmyocardium and subepicardium. Although many molecular candidates for native ionic currents have been identified, the molecular basis of most currents is not completely understood. Heterogeneity of channel protein composition might well underlie the differences observed among the properties of ionic currents or the shape of the action potential in different regions of the heart. Techniques such as immunocytochemistry, immunohistochemistry and Western blotting have played an important role in identifying tissue expression of channel proteins as well as their cellular localization. This review summarizes the electrophysiological differences observed in different regions of the heart and correlates them with information regarding expression patterns of ion channel subunits that might account for regional functional variation. The inward rectifier current, I K1 IK1 is responsible for the maintenance of the cardiac resting potential and the final phase of cardiac repolar ization. It is believed that differences between atrial and ventricular IK1 are responsible for the differences observed between the atr ial and ventricular action potential. The atrial action potential has a short plateau phase and relatively slow repolarization, whereas the ventricular action potential has a long plateau and a much faster repolarization phase.1 Patch clamp studies have revealed significant differences betw een atr ial and ventricular IK1. Atrial IK1 has a 4-10 fold lower current density and conducts less outward current than ventricular IK1.1-3 It is believed that a smaller I K1 contributes to the less negative r esti ng potenti al and s low er ter mi nal repolarization in atrial cells.2 Furukawa et al reported a lar ger outward component of I K1 in endocardial cells than in epicardial cells in the cat. No differences in si ngl e channel conduc tance and open probability were observed, suggesting that observed differences are due to differences in current density and not to differences in mol ecul ar c omposi tion. 4 H ow ever, no differences in IK1 current density or kinetics have been found across the left ventricular wall in myocytes isolated from guinea pig5 or dog.6 The observed discrepancies might be due to Re la t e d P roduc t s Anti-Kir2. 1 Anti-Kir2. 3 Cat. # APC-026 50 µl $98.00 0.2 ml $320.00 Cat. # APC-032 50 µl $98.00 0.2 ml $320.00 (IR K1, Kcnj2) Host: Rabbit Epitope: Pept ide corresponding to amino acid residues 392-41 0 of hum an Kir2.1. Epitope location: Intracellular, C-t erminal part. Homology with other species: R abbit, bovine, pig, guinea pig - identical; rat , mouse - 17/19 residues identica l; chic ken -15/19 residu es iden tic al; pigeon - 14/18 residues identica l. Reactivity confirmed: R at. Western blotting: Rat brain mem branes (1:200). Immunohistochemistry: R at brain sect ions. Control antigen included in price. References using this antibody: 1. Keren-R aif man, T. et al. (2000) Bio chem. Bio phys. Res. Comm un. 274, 852. (IR K3, BIR 11, Kcnj4) 1 2 3 Western blotting of rat brain (1,3) or kidney (2,4) membranes: 1,2. Anti-Kir2.3 antibody (#APC-032) (1:200) 3,4. Anti-Kir2.3 antibody, preincubated with the control peptide antigen. 1 4 97 66 45 31 2 97 66 45 31 Western blotting of rat brain membranes: 1. Anti-Kir2.1 (#APC-026) (1:200). 2. Anti-Kir2.1, preincubated with the control peptide antigen. Regional expression of cardiac ion channels and cardiac ele ctrical activity Host: Rabbit Epitope: Pe ptid e corresp onding to a mino acid residues 418-437 of rat Kir2.3. Epitope location: Intracellular, C-t erminal part. Homology with other species: M ouse - id entical; g uine a pig - 19/20 residies identical; hamster, human, Xenop us - 18 /20 residues identical. Reactivity confirmed: R at. Western blotting: Rat brain me mbranes, rat kidney membranes (1: 200). Immunohistochemistry: Rat brain sect ions. Control antigen included in price. MODULAT OR I ss ue No. 15 1 M O D U L A T O R alomone labs M olecula r Tools for the Neuroscie nc e Co mm unity species-specific variations. Clones of the Kir2 family are believed to underlie IK1. Four different alpha subunits have been cloned and shown to be present in the human heart.2, 7-9 Kir2.1 mRNA is the most abundant subunit, with similar concentrations in atrium and ventricle.2 Kir 2.2 mRNA expression was relatively weak in both atrium and ventricle. Kir2.3 concentration is approximately 12-fold higher in atrium than in ventricle, but about 10fold lower than Kir2.1.2 The abundance of Kir2.4 in human heart has not been determined. It has been speculated that the comparatively high abundance of Kir2.3, a lower-conductance subunit, in atrium might contribute to the smaller current density of atrial IK1.2 Recent data suggests that Kir5.1 can act like an endogenous dominant negative subunit, co-assemble with Kir2.1 and lead to the formation of nonconducting inward rectifier channels in the brain.10 It is unclear if this mechanism operates in the heart. Nothing is known at present about the cellular localization of Kir2 subunits. The delayed rectifier current, IK IK consists of two distinct components, the rapidly activating I Kr and the slowly activating IKs .11 IK is the main phase 3 repolarizing current in the heart. Comparison of IK between canine right and left atrium showed a consistently higher current density of IKr in the left atrium.12 No differences in current kinetics were observed. Western blot experiments showed a significantly greater expression of human ethera-go-go-related gene (Herg) protein in the left atrium, consistent with the electrophysiological data. No significant differences were found in IKs current densities.12 These results are significant, given the prominent role of the left atrium in AF maintenance,13 which may in part be due to abbreviated left atrial refractoriness due to larger IKr. Comparison of Herg protein expression with functional IKr expression in rat found Herg protein and IKr to be more prominent in atria than in ventricles, whereas Herg pr otein expression in mice and humans was higher in the ventricle. 14 RNase protection assays found similar levels of Herg mRNA in rabbit left atrium, left ventricle, SA node and in canine Pur kinje fi br es, left and r ight ventr icle suggesting that either interspecies differences or post-translational mechanisms may lead to differences in the level of expressed protein. Herg mRNA levels are ~1.5-fold more abundant than those of Kv4.3 in canine right ventricle.15 Voltage clamp studies using left ventricular guinea pig myocytes revealed a higher IK current density in sub-epicardial and mid-myocardial than in endocardial myocytes. Both components, IKr and I Ks, were significantly smaller i n sub-endocardial than in midmyocardial or sub-epicardial cells.16 Furukawa et al. reported a higher current density of IK, with faster activation and delayed deactivation, in left ventricular epicardial compared to endocardial cells of the cat. No changes were found in open probability and single channel conductance leading to the suggestion that the observed differences in current density are due to a higher expression of channel protein and not to differences in molecular composition.4 Liu and Antzelevitch described a smaller IK in mid-myocardial cells compared to cells isolated from the endocardium or epicardium in dogs. Further evaluation showed that the observed difference was due to a significantly smaller IKs in mid-myocardium. No changes were found in the current density of IKr nor the kinetics of IKr or IKs in the three cell types.17 In ferret, Herg mRNA transcripts and protein levels were found to be higher in epicardial cell than endocardial cell layers.18 To further investigate the lower IKs density in mid-myocardial cells Péréon and colleagues Re la t e d P rodu c ts Anti-GIRK1 Anti-TASK-1 (Kir 3.1, Kcn j3) (TWIK-Relate d Acid Sen sitive K+ C hannel, TASK, cTBAK-1, Kcnk3) Cat. # APC-005 50 µl $98.00 0.2 ml $320.00 Host: Rabbit. Epitope: GST f usion p rotein w it h sequence corresponding t o re sidues 436-501 o f mouse GIRK1. Epitope location: Intrace l ular, C -terminal part . Homology with other species: Rat - iden tic al; hum an, g uine a pig, chicken - respect iv ely, 64 /66, 63/6 6, and 59/66 resid ues ide ntic al. Reactivity confirmed: Rat, mouse Western blotting: Rat brain membranes (1:200). Immunohistochemistry: Ra t bra in sections. Control antigen included in price. References usin g th is antib ody: 1. Kuzhikandathil, E.V. et al. (1998) Mol. Cell. Neur osci. 12, 390. 2. Kennedy, M.E. et al. (1999) J. Biol. Chem. 274, 2571. 3. Pei, Q . et al. (1999) Neur oscience 90, 621. 4. Singer- Lahat, D. et al. (2000) Eur J. Physiol. 440, 627. 5. Lei, Q. et al. (2000) Pr oc. Natl. Acad. Sci. USA 97, 9771. 6. Jelacic, T.M. et al. (2000) J. Biol. Chem. 275, 36211. 1 Western blotting of rat brain membranes: 1. Anti-TASK-1 (#APC-024) (1:200). 2. Anti-TASK-1, preincubated with the control peptide antigen. 1 2 250 148 60 42 30 22 2 97 66 45 37 Western blotting of rat brain membranes: 1. Anti-GIRK1 (#APC-005) (1:200). 2. Anti-GIRK1, preincubated with the control antigen. Regional e xpression of cardiac ion channels and cardiac electrical activity Cat. # APC-024 50 µl $98.00 0.2 ml $320.00 Host: Rabbit Epitope: Pept ide (C)EDEK RD AEH RALLT R NGQ, correspond ing to amino a cid residu es 252-269 of hu man TASK-1. Epitope location: Intracell ular, C-terminal part. Homology with o ther species: rat, mouse - 17/1 8 residues ide ntic al. Homology with human TASK-3: 11/ 17 residues identical. Reactivity Confirmed: R at. Western blotting: Rat brain membranes (1:200). Immunohistochemistry: R at brain se ctions (see also 3) References using this an tibod y: 1. Lopes, C.M.B. et al. ( 2000) J. Biol. Chem. 275, 16969. 2. Millar, J.A. et al. (2000) Proc. Natl. Acad. Sci. USA 97, 3614. 3. Kindler, C .H. et al. ( 2000) Brain Res. Mol. Br ain. Res. 80, 99. MOD ULAT OR I ss ue N o. 15 2 M O D U L A T O R alomone labs M olec ul ar Tool s f or the Ne uro sc ience C om m unit y used RNase protection assays to determine KvLQT1 message expression across the human right and left ventricular wall. Overall KvLQT1 express ion w as simil ar throughout the ventricular wall. Midmyocardial cells, however, were found to contain a higher percentage of an endogenous N-terminal truncated KvLQT1 splice variant, referred to as KvLQT1 isoform 2, which acts as a dominant negative. Co-expression of isoform 1 with isoform 2 in COS 7 cells in a stoichiometry mimicking that in midmyocardium resulted in a 75% reduction in current amplitude, consistent with the data provided by Liu & Antzelevitch. Current kinetics were not changed by co-expression with KvLQT1 isoform 2. KvLQT1 concentrations in atrium were found to be similar to those in endocardial and epicardial left and ri ght ventricular cells. The regulatory subunit minK w as found to be simi lar ly expressed in midmyocardium, endocardial and epicardial left and right ventricular cells. The transient outward K + current, I to Regional differences in Ito are well described and contribute to the observed differences in action potential configuration in various species.19-23 Ito density has been found to be greater in epicardial cells than in cells isolated from the endocardium in both dog 20 and rat.21,22 In human ventricle, Ito is larger in sub-epicardial than in subendocardial myocytes.24 Differences in inactivation kinetics and 4-AP sensitivity have been found between atrial and ventricular human my oc ytes sugges ting pot enti al differences in their molecular basis.23 Action potentials recorded from regions with a high I to current density show a typical “spike and dome” configuration.20 Based upon differences in activation and inactivation kinetics, as well as recovery from inactivation, Ito1 has been divided into two types, fast (It o,f) and slow (I to,s ).2 5-31 Ito, s density is high in left ventricular epicardial myocytes in humans 28 and ferret.27 It is believed that Kv4.2 and Kv4.3 contribute to the rapid component Ito,f and v1.4 appears to underl ie the sl ow component Ito,s.22 Important differences among various species, as well as differences in the distribution of these subunits across the ventricular wall, are well documented. The distribution of various subunits contributing to Ito has been most extensively studied in rat. In the atrium, only Kv4.2 has been found,32 whereas both Kv4.2 and Kv4.3 have been identified in ventricle33 Kv4.3 and Kv1.4 mRNA expression across the ventricular wall of rat heart is almost uniform, whereas Kv4.2 show s a marked gradient with higher expression levels in epicardial than endocardial cells.34, 35 Kv4.2 expression has been shown to parallel I to current density across the left ventricular wall34 suggesting that Kv4.2 is the main subunit underlying Ito in rat. Kv4.2 express ion pr edominates in the right ventricular wall.22 Confocal and immunohistochemical studies show that Kv4.2 is localized in the transverse-axial tubular system of the rat myocytes.36 Kv4.3 and Kv1.4 may be proportionately more important in the septum.22 Important differences have been found among various species. In the mouse, Kv1.4 has been found in high concentration in the septum and is believed to underlie Ito,s, whereas alpha subunits of the Kv4 subfamily underlie I to ,f in the ventricular apex and septum.37 The properties of It o in rabbit myocytes are similar to those of Kv1.4, suggesting an important role of Kv1.4 in r abbit It o . 38 - 40 In situ hybr idization and immunohistochemistry has shown regional differences in the expression of Kv1.4 and Kv4.2/4.3 in ferret heart, suggesting that Kv1.4 and Kv4.2/4.3 underlie Ito in ferret left ventricular endocar di al and epic ardi al myoc ytes , respectively.27 The molecular basis for canine and human It o has been attributed to Kv4.3.35 RNase protection assays showed that neither Re la t e d Pr oduc t s Anti-Kv1.5 A B C (Kcn a5) SON Cat. # APC-004 50 µl $98.00 0.2 ml $320.00 Host: R abbit Epitope: GST fusion protein w ith seq uence corresp ondin g to residue s 513-602 of mou se Kv1.5. Epitope location: Intra cellular, C-termin us. Homology with other species: Rat, rabb it, human, bovine, dog - respectively, 86/90, 71/90, 70 /90, 66/ 90, and 66/90 residue s ident ic al. Reactivity confirmed: Rat, mouse, horse . Western blotting: R at brain membranes (1: 200). Immunohistochemistry: Rat brain sections (see als o 9) Immunoprecipitation.5 ,7 Control antigen included in price. 1 2 250 148 Immunohistochemical staining of Kv1.5 using Anti-Kv1.5 (#APC-004) in the paraventricular nucleus (PVN) and supra-optic nucleus (SON) in (A). In the PVN (B), higher power magnification shows staining of some neurons (triangle) and of axons which had varicosities (arrows). In the supra-optic nucleus (C), higher power magnification shows staining of cells (triangles) and axons with varicosities (arrows). All patterns were eliminated by pre-incubation with Kv1.5 control antigen. 60 42 30 Western blotting of rat brain membranes: 1. Anti-Kv1.5 (#APC-004) (1:200). 2. Anti-Kv1.5, preincubated with the control antigen. R egional expre ssion of ca rdiac ion channels and cardiac electrical activity R ef eren ces using t his ant ibod y: 1. Hu, X.Q. et al. ( 1998) J. Biol. C hem. , 273, 5337. 2. G uo, W . et al.. (1997) Am. J. Physiol. 272, H2599. 3. G uo, W .et al.( 1997) Eur. J. Physiol. 434, 206. 4. Clement- Chomienne, O. et al.(1999) J. Physiol. 515.3, 653. 5. Sobko, A. et al. ( 1998) J. Neurosci. 18, 10398. 6. Sobko, A et al. (1998) EMBO J. 17, 4723. 7. Maruoka, N.D. et al. (2000) FEBS Letter s 473, 188. 8. Yamashita, T. et al. ( 2000) Circulation 101, 2007. 9. Chung, Y.H. et al. (2000) Brain Res. 875, 164. 10. Peretz, A. et al. (2000) T he EMBO J. 19, 4036. MO DULATO R Is sue No. 15 3 M O D U L A T O R alomone labs M olecula r Tools for the Neuroscie nc e Co mm unity Kv4.1 nor Kv4.2 mR NA is expressed at detectable levels in canine ventricular muscle, whereas Kv4.3 is abundant. Kv4.3 mRNA is expressed in human ventricle at similar levels to those found in canine ventricle.35 Han et al. reported the presence of TEAsensitive Ito in canine Purkinje fibers. Their data suggest that the molecular basis of canine Purkinje Ito is different from Kv4.2/4.3 and Kv1.4, since these channels are TEA-insensitive. It has been proposed that Kv3.3 and Kv3.4 subunits might play an important role in Purkinje Ito, but the exact molecular basis still remains to be determined.41 The Na +-Ca 2+ exchanger (NCX) The Na+-Ca2+ exchanger (NCX) catalyzes the exchange of three Na+ for one Ca2+ across the plasma membrane in many mammalian cells.42 The transport is reversible and can facilitate Ca2+ entry, leading to Ca2+ release from the sarcoplasmic reticulum.43 The exchange activity is especially high in cardiomyocytes and plays a key role in the mai ntenance of C a 2+ homeostasis and relaxation of Ca2+ muscle.42 The exchange of Ca2+ for sodium was first observed in guinea pig atria.44 Western blotting and Northern blot experiments have shown increased expression levels of the NCX1 isoform in heart failure.45-48 NCX proteins in mammals are encoded by three genes: NCX1, NCX2 and NCX3.49- 51 NCX2 and NCX3 are found only in the skeletal muscle and in the br ain.5 2 NCX1 transcripts undergo al ternative splici ng of 6 i nternal exons (A,B,C,D,E and F) to produce tissue-specific isoforms. 53 This splicing confer s distinct functional characteristics to tissue-specific isoforms of the Na+ -Ca2+ exchanger.53-56 For example, the cardiac isoform (NCX1.1) is less sensi tive to depolarizing voltages and to activation by [Ca2+ ] i than the renal isoform. In addition, NCX1.1 is more sensitive to PKA activation than the renal form.57 Komuro et al cloned and characterized the human cardiac Na+ -Ca2+ exchanger in 1992.58 Confocal microscopy of adult guinea pig and rat heart cells has shown that the NCX is present in all membranes of the myocytes that face the extracellular space.59 Dilly et al. showed NCX to be present on the surface and in T-tubule membranes on all cardiac myocytes. 60 Immunohistochemistry has revealed a specific localization in some types of cells.59 Confocal microscopy has show n that in guinea pig myocytes, the NCX is located at the intercalated disks, the transverse tubules and exterior surface of the membrane.61 In rabbit myocytes, the NCX appears to be more prominent in T-tubule membranes than in peripher al sarcolemma.62 contraction coupling in heart,63- 65 and for the plateau phase of the action potential.66 L-type Ca2+ channels cluster in the surface plasma membrane overlying junctional sarcoplasmic reticulum in guinea pig myocytes. 67 N, P, Q and R-type channels have also been identified66,68,69 as high voltage activated calcium channels, 70 but appear not to be expr es sed in cardiomyocytes. T-type (”transient”) ICa inactivates very rapidly The calcium current, ICa Tw o principal Ca 2+ currents hav e been described. The voltage- gated L-type (”long lasting” ) IC a is responsi ble for triggering sarcopl asmi c reticulum Ca 2+ r elease and consequently the initiati on of excitation- Re la t e d Pr oduc t s Anti-Erg1 Anti-HE RG (Et her-a-g o-go-re lat ed K+ Channe l 1, Kcnh2) (Ether-a-go-go-related K + Chan nel 1, Kcnh2) Cat. # APC-016 50 µl $98.00 0.2 ml $320.00 Cat. # APC-062 Host: Rabbit. Epitope: Peptide corresponding to residues 1121-113 7 of rat erg1. Epitope location: Intracellular, near the C-terminus. Homology with other species: Mouse - identic al; human, dog, rabbit - 14/16 residues identic al. Reactivity confirmed: Rat, huma n, mouse, 2 horse,3 opossum.1 Western blotting: HERG-expressing HEK 293 cells (1:400). Rat brain membranes, Rat heart membranes (1:200). Immunohistochemistry: Rat brain sections (see also 2). Immunoprecipitation.3 Control antigen included in price. References usin g th is antib ody: 1. Akbarali, H .I. et al. ( 1999) Am. J. Physiol. 277, C1284. 2. Pond, A.L. et al. (2000) J. Biological Chem. 275, 5997. 3. Dr. Lisa C. F reeman, Kansas State Univer sity, personal communication. 1 2 Western blotting of HERGexpressing HEK 293 cells: 1. Anti-HERG (#APC-062) (1:400). 2. Anti-HERG, preincubated with the control antigen. 1 50 µl $98.00 0.2 ml $320.00 205 117 2 205 117 Western blotting of HERG96 expressing HEK 293 cells: 66 45 1. Anti-Erg1 (#APC-016) (1:200). 2. Anti-Erg1, preincubated with the control peptide antigen. Regional e xpression of cardiac ion channels and cardiac electrical activity Host: R abbit. Epitope: GST fusion protein with seq uence correspo ndin g to residues 1106-11 59 of h uman erg1 (HERG). Epitope location: Intra cellula r, near the C-t erminus. Homology with other species: Rabbit - identical; dog, mouse, rat - re spectively , 51/54 , 50/54, and 50/ 54 residues identical. Reactivity confirmed: Human. Western blotting: H ER G-expressing HEK cells (1:400). Control antigen included in price. MO DULATO R Is sue N o. 15 4 M O D U L A T O R alomone labs M olecula r Tools for the Neuroscie nc e Co mm unity and at relatively negative potentials.64 It is found mainly in sinoatrial node, Purkinje or atrial cells, but its expression is also species dependent.64 The fact that I Ca.T is at high density in nodal cells7 1 and embryonic car diomyocytes 67 ,7 2 suggests that it is important in pacemaker function.65,67 T-type current is present in the guinea pig heart but has not been found in rat or in human adult myocytes.67,73 L-type channels were initially purified from skeletal muscle.74 They are heteromultimers of at least 3 different subunits: α1C, β and α 2δ. The α1C subunit encodes the basic pore-forming protein of the channel, whereas the auxiliary β subunit modulates the expression, the open probability, activation and inactivation.67,75-77 The α2δ subunit is a disulfide-linked dimer78-80 and is ubiquitously expressed in all types of high voltage-dependent Ca2+ channels.81 The α1C subunit is encoded by three different genes (CaCh1-3). Only the product of CaCh2a is present in the heart. Four β subunit genes have been identified (β1 to β4). Genes encoding ICa.T were identified in human heart in 1998. 70,82 The molecular basis for T-type calcium channels has been associated with α1G , α1H and α1I genes.70,82,83 α1G and α1H are expressed in heart and brain at different levels.70 The cell or tissue s pecifici ty has n’t yet been establis hed. Immunoconfocal and immunogold electron microscopy labelling were used81 to show the distribution of L-type Ca2+ channels in cardiac myocytes isolated from rabbit and rat ventricle. The channels were localized on the surface of the plasma membrane and transverse T-tubules in rabbit myocytes, whereas the labelling was more intense in T-tubules than in the surface sarcolemma in rat myocytes. multiple gap junction phenotypes. These differ ent phenotypes appear to have a deliberate and functionally important distribution patter n thr oughout the hear t. Electron microscopy has shown SA nodal myocytes to have small, scattered gap junctions.87 This finding has implications regarding conduction velocity in this region, which is very slow.88 The number and distribution of gap junctions, as well as their composition, are important factors in modulating conduction propagation velocity. In a study of mice heterozygous for a null mutation in the Cx43 gene (Cx43 +/- mice), it was determined that this mutation was responsible for a reduction in the total number of gap junctions while the remaining gap junctions were unaffected in terms of size.89 These mice have a ~40% slower ventricular epicardial conduction velocity.90 Cx43 is the most abundant gap junctional channel in human91 and rat89 ventricles and atria. The expression level of Cx43 in the four chambers of the human heart is more or less uniform.91 Studies have shown that the human SA node has little 92 or no Cx43.86 Western blotting of the AV node reveals a weak signal found primarily in the middle of the region,86 consistent with the important slowly-conducting properties of the AV node. When Purkinje fibres are probed with an antibody for Cx43, the signal is more intense at longitudinal ends than transversely.86 This distribution pattern is likely Connexins/Gap Junctions Gap junctions are more than simple conduits allowing for enhanced current flow between adjacent cardiac myocytes: they allow for the passage of various cations, anions and small, non-charged molecules from one cell to another. Though gap junctions are not directly affected by membrane potential, they can respond to differences in transcellular voltage by altering their conductance.84 As determined by immunocytochemistry, among the channel proteins expressed in cardiac gap junctional plaques are three principal connexins: connexin (Cx)40, Cx43 and Cx45.85 Two other connexins - Cx37 and Cx46 - have also been identified in the heart, albeit in trace amounts.86 Different ratios of these connexins give rise to Anti-Kv4.3 Anti-Kv1.4 Cat. # APC-017 50 µl $98.00 0.2 ml $320.00 Cat. # APC-007 50 µl $98.00 0.2 ml $320.00 (Kcnd3) Re l at e d Prod uc t s (Kcn a4) 1 2 96 Host: Rabbit. Epitope: Peptide corresponding to residues 451 -467 of h uman Kv4.3. Epitope location: Intracellular, C -terminal part . Homology with other species: Rat , ra bbit - iden tic al; mouse - 16/ 17 re sidues identical. Reactivity confirmed: Rat. Western blotting: R at brain membranes (1:200). Immunohistochemistry: Rat bra in sections. Control antigen included in price. References using th is an tibo dy: 1. Yang, E.K. et al. ( 2001) J. Biol. C hem. 276, 4839. 2. Zhang, T.T. et al. (2001) Cir c. Res. 88, 476. Western blotting of rat brain membranes: 1. Anti-Kv1.4 (#APC-007) (1:200). 2. Anti-Kv1.4, preincubated with the control antigen. 1 66 45 31 Host: Ra bbit . Epitope: GST fusion protein with seque nce corre spond ing to residues 589 -655 of rat Kv1.4. Epitope location: I ntracellular, C-terminus. Homology with other species: Mouse - id entical; h uman - 66/67 (or 6 5/67) residues identical, bovine - 64 /67 residues identical. Reactivity confirmed: Rat, m ouse. Western blotting: Rat bra in membra nes (1:20 0). Immunohistochemistry: Rat b rain sections (see also 7-9) Immunoprecipitation.6 Control antigen included in price. 2 209 125 70 45 32 Western blotting of rat brain membranes: 1. Anti-Kv4.3 (#APC-017) (1:200). 2. Anti-Kv4.3, preincubated with the control peptide antigen. Regional e xpression of cardiac ion channels and cardiac electrical activity References usin g th is antib ody: 1. Attali, B. et al. ( 1997) J. Neur osci. 17, 8234. 2. G uo, W . et al. (1997) Eur. J. Physiol. 434, 206. 3. Yuan, X.J. et al. ( 1998) Am. J. Physiol. 274, L621. 4. Meir i, N . et al. ( 1998) Proc. Natl. Acad. Sci. USA 95, 15037. 5. G uo, W . et al. (1998) J. Mol. Cell Cardiol. 30, 1449. 6. Sobko, A. et al. ( 1998) J. Neurosci. 18, 10398. 7. Mienville, J.M. et al. (1999) J. Neur ophysiol. 82, 1303. 8. Chung, Y.H. et al. (2000) Brain Res. 875, 164. 9. G opel, S.O. et al. (2000) J. Physiol. 528.3, 497. MOD ULAT OR I ss ue N o. 15 5 M O D U L A T O R alomone labs M olecula r Tools for the Neuroscie nc e Co mm unity important in the known functionally-important anisotropy of conduction. Cx40 is expressed in human atrium 91 and to a mu ch l es s er deg r ee i n ve nt r ic ul a r subendocardium.86 A study of Cx40 expression in dog also showed that there was a much higher level of this channel in the crista ter minalis compared with left ventricular subepicardium.93 In both man 86 and dog, 85 Purkinje fibres show a far more robust signal for Cx40 than ventricular myocardium. Canine92 and human86 SA nodal cells clearly express Cx40. Human AV nodal cells also express Cx40.86 Low levels of Cx45 can be detected in human ventricles, with more being seen in the atria.91 Both rat94 and human 86 conduction systems (including the SA node, AV node and Purkinje fibres) have an abundant expression of Cx45. In a recent study of Cx45 knockout mice, it was found that these mice die of heart failure at embryonic day 10. Though the hearts of these mice do contract, conduction block through the AV node region is observed.95 Four members (HCN1-4) have been isolated from mouse, rabbit and human tissues,98- 101 and share a homology of ~60% on the amino acid level.101 Northern blot showed that only HCN2 and HCN4 are expressed in the human heart. HCN2 currents activate faster than HCN4. Two different native currents with distinct kinetics have been identified in the heart.102-104 Semiquantitative RT-PCR showed that human HCN2 and HCN4 mRNA is found to be approximately equally abundant throughout the atria and ventricles. 105 Northern blotting revealed that in rabbit, HCN4 mRNA is more abundant in SA nodal cells than in ventricle or atrium. 100 SA nodal total HCN message in general is 140 times the HCN message for the ventricle and 25 times that of Purkinje fibres,106 corresponding to the primary pacemaking role of the SA node and the greater pacemaking activity in Purkinje fibres compared to working muscle. distinct β-subunits involved in the modulation of channel gating and cell surface expression. Ten genes encoding Na+ channel α-subunits have been described (NaV 1.1 to NaV 1.9, and NaX )108 and 3 β-subunits ( β1 to β3) have been identified to date.108-110 Most of the subunits in the Na V 1.x family have been studied in heterologous expression systems and, therefore, the most detailed observations are for this family. At least 2 α- subunit mRNAs are expr essed in human heart: NaV 1.5 and NaV2.1.108,111,112 β1- Subunit mRNA is expressed in rat and human heart 113,114 but not found in mouse heart.115 β1 and β2 subunits have been localized in rat and mouse heart by immunofluorescence. 111 Both proteins are The pacemaker current If A slow membrane depolarization phase between action potentials is responsible for the rhythmic activity of the heart.96,97 The principal current underlying this phenomenon is referred to as If or Ih. Both Na+ and K + ions carry this current with the selectivity being fourfold higher for K +. If is activated on membrane hyperpolarization. The hyperpolarization-activated cyclic nucleotide gated cation (HCN) family of channels have many of the characteristics of If channels. The sodium current, I Na INa is responsible for the rising phase (phase 0 upstroke) of action potentials in electrically excitable cells78, 107,108 and for rapid impulse conduction through cardiac tissue.107 The functional channel consists of a principal α pore-forming subunit composed of four ho mol o gou s d oma i ns ( I- I V) o f s i x transmembrane segments S1- S6 107 and 2 Re la t e d Pr oduc t s Anti-Kv4.2 (Sha l1, RK5, Kcnd2 ) Cat. # APC-023 50 µl $98.00 0.2 ml $320.00 1 Host: Rabbit. Epitope: Peptide corresponding to amino a cid residue s 4 54-469 of rat Kv4.2. Epitope location: Intrace l ular, C -terminal part . Homology with other species: Mouse, h uman - 15/16 residues identical. Reactivity confirmed: Rat. Western blotting: Rat brain membranes (1:200). Immunohistochemistry: Ra t bra in sections. Immunoprecipitation.3 Control antigen included in price. 2 97 66 45 32 Immunohistochemical staining of rat hippocampus using Anti-Kv4.2 (#APC-023), counterstained with cresyl violet. 20 Western blotting of rat brain membranes: 1. Anti-Kv4.2 (#APC-023) (1:200). 2. Anti-Kv4.2, preincubated with the control peptide antigen. Regional e xpression of cardiac ion channels and cardiac electrical activity References usin g th is antib ody: 1. Ander son, A.E. et al. (2000) J. Biol. Chem. 275, 5337. 2. Yamashita, T. et al. ( 2000) Circulation 101, 2007. 3. Adams, J.P. et al. ( 2000) J. Neur ochem. 75, 2277. MOD ULAT OR I ss ue N o. 15 6 M O D U L A T O R alomone labs M olec ul ar Tool s f or the Ne uro sc ience C om m unit y expressed in car diac muscle along the Z lines. 111 The differences in the functional properties of Na+ channel isoforms result in unique conductances in specific cell types.108 Immunocytochemical studies have shown that β1, β2, NaV 1.1 and NaV 1.5 localize along Z lines in adult rat and mouse cardiac myocytes. 111,116 NaV 1.5 has been localized to the surface and T-tubular system of rat hearts and does not display a large variation other than a somew hat enhanced labell ing at the intercalated disks of ventricular myocytes.116 It is possible that this enhanced localization is related to fast conduction in ventricular myocardium. In the compact rabbit AV node, a gradient of Na+ channel expression exists, with peripherally-located cells having stronger signals compared with centrally located ones.117 This gradient is likely important in the slow conduction through this region. bl o tt i ng , i m mun oc y t oc he mi s t r y an d immunohistochemistry may help to determine Kir2 protein expression levels, tissue expression pattern and cellular localization of Kir2 subunits giving further insight into the molecular basis of IK1 . Transmural gradients in I t o are likely important in governing action potential shape and expl ai ning many impor tant ECG phenomena.6,118,120-123 M-cells have longer action potentials than in other ventricular regions, playing an important role in arrhythmias due to excessive prolongation of repolarization (long QT syndrome). Transmural gradients in IKs, 17 likely related to differential distribution of KvLQT1 isoforms,124 is probably responsible. It o dow nr egulati on may be important in ventricular arrhythmogenesis in heart failure, and appears to parallel a decrease in Kv4.3 mRNA,125 although the nature of any regional or transmural differences i s not well-known. Changes in connexin expression may also contribute to arrhythmogenesis. For example, Peters et al. observed a reduction in ventricular Cx43 signal from hypertrophied and infarcted human hearts.126 The above are only limited examples of the importance of regional variations in ion channel expression in physiological and pathological states. In addition to differential expression of por e- for ming subunits, the for mation of functionally distinct heterotetramers and the presence of regulatory subunits likely contribute importantly to regional diversity in channel function, and relatively little is known about them. Much more work clearly remains to be done in this important area. Functional importance The cardiac action potential consists of a fine interplay between a large number of inward and outward currents of which the main ones are carried by K+ , Na+ or Ca2+ ions. Characteristic action potential shapes have been found in different regions of the heart as well as in different layers of the ventricular wall. 26,118 Clones encoding a large number of channel proteins have been identified, some of which cl e ar l y r ec on st i tut e nat i ve c ha nne l properti es. 3 5, 3 4 , 94 , 11 9 , 12 0 H owev er, many discrepancies between native currents and putative underlying clones remain to be resolved. Important regional differences in IK11 are not readily explained by the mRNA distribution of corresponding Kir2 family subunits.2 Future studies using techniques like Western R e f e r e n c e s 1. Giles, W.R. and Imaizumi Y. (1988) J. Physiol. 405, 123. 2. Wang, Z. et al. (1998) Circulation. 98, 2422. 3. Varro, A. et al. (1993) Acta Physiol Scand. 149, 133. 4. Furukawa, T. et al. (1992) Circ Res. 70, 91. 5. Main, M.C. et al. (1998) Exp. Physiol. 83, 747. 6. Liu, D. W. et al. (1993) Circ. Res. 72, 671. Rel a t ed Pro duc t s Anti- α 1C (Ca v1. 2, L -type o f Vo lta ge-Gated Ca2+ Chan nel, Cacna1 c) The α1C subunit of voltage-gated Ca2+ channels in Purkinje cells of the rat cerebellum were visualized with the Anti-α1C antibody (#ACC-003). Cat. # ACC-003 50 µl $98.00 0.2 ml $320.00 Host: Rabbit. Epitope: Pept ide corre spond ing to residues 8 18-835 of rat α1C. Epitope location: Intracell ular loo p betwe en II and III domains. Homology with other species: Mouse - identical; guinea pig (17/18 residues identical) ; huma n, rabbit (16 /18 residues iden tic al). Reactivity confirmed: Rat , mouse, rabbit,2 human.1 0,12 Western blotting: Rat brain membranes (1:200). Immunohistochemistry: R at brain se ctions (see also 3,5,7 ,10). Immunoprecipitation. 2,4 Control antigen included in price. 1 Pictur e contributed by W. Här tig and J. Grosche, Leipzig University, IZKF; picture obtained by confocal laser scanning micr ospcopy with Z eiss LSM 510. 2 205 116 Western blotting of rat brain membranes: 1. Anti-α1C (#ACC-003) (1:200). 2. Anti-α1C, preincubated with the control peptide antigen. R egional expre ssion of ca rdiac ion channels and cardiac electrical activity References using this an tibo dy: 1. Bae, I.H. et al. ( 1999) Kor ean J. Biol. Sci. 3, 53. 2. Hu, X.Q . et al. (1998) J. Biol. Chem. 273, 5337. 3. Pereon, Y. et al. (1998) Eur. J. Physiol 436, 309. 4. Her nandez, M.A. et al. (1999) Neuroendocr inol. 70, 31. 5. Lopez, I. et al. (1999) Neur oscience 92, 773. 6. Br undel, B.J.J.M. et al. ( 1999) Cardiovasc. R es. 42, 443. 7. Jiang, Z. et al. (1999) Eur. J. Neurosci. 11, 3481. 8. Serr ano, C.J. et al. ( 1999) FEBS Lett. 462, 171. 9. Acosta, C.G. and Lopez, H.S. (1999) J. Neurosci. 19, 8337. 10. Kr euzberg, U. et al. ( 2000) Am J. Physiol. 278, H723. 11. Liu, R. et al. (2000) J. Biol. Chem. 275, 8711. 12. Allard, B. et al. (2000) J. Biol. Chem. 275. 25556. MO DULATO R Is sue No. 15 7 M O D U L A T O R alomone labs M olecula r Tools for the Neuroscie nc e Co mm unity 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20, 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. Raab-Graham, K.F. et al. (1994) Neuroreport 5, 2501. Wible, B.A. et al. (1995) Circ. Res. 76, 343. Schram, G., Wang, Z., Nattel, S. (1999) Circulat ion 100, I633. Derst, C. et al. (2001) FEBS Lett. 491, 305. Sanguinetti, M.C. and Jurkiewicz, N.K. (1991) Am J Physiol. 260, H393. Li, D., Zhang, L., Kneller, J., Nattel, S. (2001) Circulation, in press. Mandapati, R. et al. (2000) J. Circulat ion 101, 194. Pond, A.L. et al. (2000) J Biol Chem 275, 5997. Wymore, R.S. et al. (1997) Circ Res 80, 261. Bryant, S.M. et al. (1998). Cardiovasc Res 40, 322. Liu, D.W. and Antzelevitch, C. (1995) Circ Res 76, 351. Brahmajothi, M.V. et al. (1996) Circ Res 78, 1083. Furukawa, T. et al. (1990). Circ Res 67, 1287. Litovsky, S.H. and Antzelevitch, C. (1988) Circ Res 62, 116. Clark, R. B. et al. (1993) Cardiovasc Res 27, 1795. Wickenden, A.D. et al. (1999) Am J Physiol 276, H1599. Amos, G. J. et al. (1996) J Physiol 491, 31. Wett wer, E. et al. (1994) Circ Res 75, 473. Guo, W. et al. (2000) Circ Res 87, 73. Barry, D. M. and Nerbonne, J.M. (1996) Annu Rev Physiol 58, 363. Brahmajothi, M.V. et al. (1999) J Gen Physiol 113, 581. Nabauer, M. et al. (1996) Circulation 93, 168. Nerbonne, J.M. (2000) J Physiol 525, 285. Wei,J. et al. (1999) Circulation 99, 3165. Xu, H. et al. (1999) J Gen Physiol 113, 661. Bou-Abboud, E. and Nerbonne, J.M. (1999) J Physiol 517, 407. Fiset , C. et al. (1997) J Physiol (Lond) 500, 51. Dixon, J. E. and McKinnon, D. (1994) Circ Res 75, 252. Dixon, J. E. et al. (1996) Circ Res 79, 659. Takeuchi, S. et al. (2000) J Mol Cell Cardiol 32, 1361. Guo, W. et al. (1999) J Physiol 521, 587. Tseng-Crank, J.C. et al. (1990) FEBS Let t 268, 63. Pet ersen, K.R. and Nerbonne, J.M. (1999) Pflugers Arch 437, 381. Wang, Z. et al. (1999) Circ Res 84, 551. Han, W. et al. (2000) Am J Physiol Heart Circ Physiol 279, H466. Philipson, K.D. and Nicoll, D.A. (2000) Annu Rev Physiol 62, 111. Kimura, J. et al. (1986) Nature 319, 596. Reuter, H. and Seitz, N.J. (1968) Physiol 195, 451. Dipla, K. et al. (1999) Circ Res 84, 435. Flesch, M. et al. (1996) Circulation 94, 992. Reinecke, H. et al. (1996) Cardiovasc Res 31, 48. Studer, R. et al. (1997) Basic Res Cardiol 92, 53. Nicoll, D.A. et al. (1990) Science 250, 562. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. Nicoll, D.A. et al. (1996) Ann N Y Acad Sci 779, 86. Li, Z. et al. (1994) J Biol Chem 269, 17434. Quednau, B. D. et al. (1997) J Physiol 272, C1250. Ruknudin, A. et al. (2000). J Physiol 529, 599. Dyck, C. et al. (1999) J Gen Physiol 114, 701. Kofuji, P. et al. (1993) Am J Physiol 265, F598. Nakasaki, Y. et al. (1993) J Biochem (Tokyo) 114, 528. Ruknudin, A. et al. (1997) Am J Physiol 273, C257. Komuro, I. et al. (1992) Proc Natl Acad Sci U S A 89, 4769. Blaustein, M.P. and Lederer, W.J. (1999) Physiol Rev 79, 763. Dilly, K. et al. (1997) Biophys.J. 72, A66. Kieval, R.S. et al. (1992) Am J Physiol 263, C545. Frank, J.S. et al. (1992) J Cell Biol 117, 337. Fabiato, A. and Fabiato, F. (1979) Annu Rev Physiol 41, 473. Nargeot, J. et al. (1997) Eur Heart J 18 , A15. Martinez, M.L. and Heredia, M.P. (1999) J Mol Cell Cardiol 31, 1617. Bean, B.P. (1989) Annu Rev Physiol 51, 367. Gathercole, D.V. et al. (2000) J Mol Cell Cardiol 32, 1981. Hess, P. (1990) Annu Rev Neurosci 13, 337. Tsien, R.W. et al. (1991) Trends Pharmacol Sci 12, 349. Cribbs, L.L. et al. (1998) Circ Res 83, 103. Hagiwara, N. et al. (1988) J Physiol 395, 233. Wet zel, G.T. et al. (1993) Circ Res 72, 1065. Ouadid, H. et al. (1991) J Mol Cell Cardiol 23, 41. Hofmann F, Biel M, Bosse E, Flockerzi V, Ruth P, Welling A. I n: Spooner P, Brown AM, Catterall WA, Kaczorowski G, St rauss HC, editors. Ion Channels in the Cardiovascular System. Function and dysfunction. Futura Publishing Company, Inc. Armonk, New York, 1994: 369-381. De Waard, M. et al. (1996) Ion Channels 4, 41. Perez-Reyes, E. et al. (1992) J Biol Chem 267, 1792. Walker, D. and De Waard, M. (1998) Trends Neurosci 21, 148. Catterall, W. A. (2000) Annu Rev Cell Dev Biol 16, 521. Glossmann, H. and Striessnig, J. (1988) Vitam Horm 44, 155. Hofmann, F. et al. (1990) Curr Top Cell Regul 31, 223. Takagishi, Y. et al. (2000). Am J Physiol Cell Physiol 279, C1963. Perez-Reyes E. J. (1998) Bioenerg Biomembr. 30, 313. Perez-Reyes, E. et al. (1998) Nat ure 391, 896. Spray, D. et al. I n: Spooner P, Brown A, Catterall WKG, St rauss H, editors. Ion channels in the cardiovascularsystem. Futura Publishing Company, Inc., Armonk, New York, 1994: 185. Kanter, H.L. et al. (1993) Circ Res. 72, 1124. 86. Davis, L.M. et al. (1995) J Cardiovasc Electrophysiol. 6, 813. 87. Saffitz, J.E. et al. (1997) J Cardiovasc Electrophysiol. 8, 738. 88. Davis, L.M. et al. (1995) J Cardiovasc Electrophysiol. 6, 103. 89. Saffitz, J.E. et al. (2000) Am J Physiol Heart Circ Physiol. 278, H1662. 90. Guerrero, P.A. et al. (1997) J Clin Invest. 99, 1991. 91. Vozzi, C. et al. (1999) J Mol Cell Cardiol. 31, 991. 92. Kwong, K.F. et al. (1998) Circ Res. 82, 604. 93. Saffitz, J.E. et al. (1994) Circ Res. 74, 1065. 94. Coppen, S.R. et al. (1998) Circ Res. 82, 232. 95. Kumai, M. et al. (2000) Development 127, 3501. 96. DiFrancesco, D. (1993) Annu Rev Physiol. 55, 455. 97. Irisawa, H. et al. (1993) Physiol Rev. 73, 197. 98. Ludwig, A. et al. (1998) Nature 393, 587. 99. Santoro, B. et al. (1998) Cell 93, 717. 100. Ishii, T.M. et al. (1999) J Biol Chem. 274, 12835. 101. Ludwig, A. et al. (1999) EMBO J. 18, 2323. 102. DiFrancesco, D. (1986) J Physiol. 377, 61. 103. Maruoka, F. et al. (1994) J Physiol. 477, 423. 104. Liu, Z.W. et al. (1996). J Mol Cell Cardiol. 28, 2523. 105. Ludwig, A. et al. (1999) Cell Physiol Biochem 9, 179. 106. Shi, W. et al. (1999) Circ Res. 85, E1. 107. Balser, J.R. (1999) Cardiovasc Res. 42, 327. 108. Goldin, A. (2001) Annu Rev Physiol. 63, 871. 109. Kazen-Gillespie, K.A. et al. (2000) J Biol Chem 275, 1079. 110. Morgan, K. et al. (2000) Proc Natl Acad Sci U S A 97, 2308. 111. Malhotra, J.D. et al. (2001) Circulation 103, 1303. 112. Rogart, R.B. et al. (1989) Proc Natl Acad Sci U S A. 86, 8170. 113. Isom, L.L. et al. (1992) Science 256, 839. 114. Makita, N. et al. (1994) J Biol Chem. 269, 7571. 115. Grosson, C.L. et al. (1996) Brain Res Mol Brain Res. 42, 222. 116. Cohen, SA. (1996) Circulation 94, 3083. 117. Petrecca, K. et al. (1997). J Physiol. 501, 263. 118. Antzelevitch, C. et al. (1991) Circ Res. 69, 1427. 119. Barhanin, J. et al. (1996) Nat ure 384, 78. 120. Coppen, S.R. et al. (1999). Dev Genet 24, 82. 121. Fedida, D. and Giles, W.R. (1991) J Physiol. 442, 191. 122. Kimura, S. et al. (1990), Circ Res 66, 469. 123. Tseng, G.N. and Hoffman, B.F. (1989) Circ Res. 64, 633. 124. Pereon, Y. et al. (2000) Am J Physiol Heart Circ Physiol. 278, H1908. 125. Kaab, S. et al. (1998) Circulation 98, 1383. 126. Peters, N.S. et al. (1993) Circulation 88, 864. Re la t e d P roduc t s Anti-Cardiac α 1 C (Ca v1 .2a, Cardia c splice form of L-type Voltage -Gated Ca2+ Channe l, Cacna1c) Cat. # ACC-013 50 µl $98.00 0.2 ml $320.00 1 2 207 Host: Rabbit. Epitope: GST fusion prote in with sequence corresponding to residues 1-4 6 of rabbit C av1.2 a, with serine 44 replaced with alanine. Epitope location: Intracell ular, N-te rminus. Homology with other species: R at, guinea pig - 31/46 residues identica l. Reactivity Confirmed: R abbit, rat. Western blotting: Rat h eart membra nes (1:20 0). Immunohistochemistry.2 Immunoprecipitation.1 Control antigen included in price. Western blotting of rat ventricular membranes: 1. Anti-cardiac α1C (#ACC-013) (1:200). 2. Anti-cardiac α1C, preincubated with the control antigen. Ref erences u sin g t his antib ody: 1. Shistik E. et al. (1999) J. Biol. Chem. 274, 31145. 2. W ang, X.T., et al. (2000) Am. J. Pathol. 157, 1549. Regional e xpression of cardiac ion channels and cardiac electrical activity Address for Correspondence: Research Center, Montreal Heart Institute 5000 Belanger Str eet East Montr eal, Quebec, Canada H1T 1C8 S. N attel, M.D. Dir ector of the Montreal Heart Institute Research Centre Pr ofessor of Medicine, University of Montreal +514- 376- 3330 ( telephone) +514- 376- 1355 ( fax) email: [email protected] eal.ca MOD ULAT OR I ss ue N o. 15 8