Am J Physiol Lung Cell Mol Physiol 294: L1007-L1012, 2008.
First published March 14, 2008; doi:10.1152/ajplung.00171.2007
1040-0605/08 $8.00
Differential effects of intravenous anesthetics on capacitative calcium entry in human pulmonary artery smooth muscle cells
Mikyung Yang,
Xueqin Ding, and
Paul A. Murray
Center for Anesthesiology Research, The Cleveland Clinic Foundation, Cleveland, Ohio; and Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Submitted 27 April 2007
; accepted in final form 12 March 2008
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ABSTRACT
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We assessed the roles of the protein kinase C (PKC) and the tyrosine kinase (TK) signaling pathways in regulating capacitative calcium entry (CCE) in human pulmonary artery smooth muscle cells (PASMCs) and investigated the effects of intravenous anesthetics (midazolam, propofol, thiopental, ketamine, etomidate, morphine, and fentanyl) on CCE in human PASMCs. Fura-2-loaded human PASMCs were placed in a dish (37°C) on an inverted fluorescence microscope. Intracellular Ca2+ concentration ([Ca2+]i) was measured as the 340/380 fluorescence ratio in individual PASMCs. Thapsigargin, a sarcoplasmic reticulum Ca2+-adenosine triphosphatase inhibitor, was used to deplete intracellular Ca2+ stores after removing extracellular Ca2+. CCE was then activated by restoring extracellular Ca2+ (2.2 mM). The effects of PKC activation and inhibition, TK inhibition, and the intravenous anesthetics on CCE were assessed. Thapsigargin caused a transient increase in [Ca2+]i. Restoring extracellular Ca2+ caused a rapid peak increase in [Ca2+]i, followed by a sustained increase in [Ca2+]i; i.e., CCE was stimulated in human PASMCs. PKC activation attenuated (P < 0.05), whereas PKC inhibition potentiated (P < 0.05), both peak and sustained CCE. TK inhibition attenuated (P < 0.05) both peak and sustained CCE. Midazolam, propofol, and thiopental each attenuated (P < 0.05) both peak and sustained CCE, whereas ketamine, etomidate, morphine, and fentanyl had no effect on CCE. Our results suggest that CCE in human PASMCs is influenced by both the TK and PKC signaling pathways. Midazolam, propofol, and thiopental each attenuated CCE, whereas ketamine, etomidate, morphine, and fentanyl had no effect on CCE.
protein kinase C; tyrosine kinase
INTRAVENOUS ANESTHETICS ARE widely used in anesthetic practice as premedicants, induction agents, or main anesthetics in total intravenous anesthesia. In general, intravenous anesthetic agents have been shown to exert a pulmonary vasodilator influence (24, 28). Modulation of intracellular calcium concentration ([Ca2+]i) is a key factor in the regulation of vascular smooth muscle tone. Capacitative calcium entry (CCE) is activated by depletion of intracellular Ca2+ stores (3, 27). It is a critical mechanism for refilling intracellular Ca2+ stores and maintaining a sustained increase in [Ca2+]i (5, 20). CCE is a possible cellular target for anesthetic agents that alter vascular smooth muscle tone (11). CCE has been demonstrated in human pulmonary artery smooth muscle cells (HPASMCs) (16), although the mechanism by which CCE regulates vascular smooth muscle tone in HPASM is unknown. Moreover, the effects of intravenous anesthetics on CCE have not been elucidated.
We have previously demonstrated that the protein kinase C (PKC) and tyrosine kinase (TK) signaling pathways are involved in CCE in canine PASMCs (11, 18), whereas only TK is involved in CCE in canine pulmonary venous smooth muscle cells (PVSMCs) (30). Moreover, we have reported that intravenous anesthetics attenuate CCE via the PKC signaling pathway in canine PASMCs (18) and via the TK signaling pathway in canine PVSMCs (30). The goal of the current study was to investigate the effects of intravenous anesthetics on CCE in HPASMCs and to assess the roles of the PKC and TK signaling pathways in regulating CCE.
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MATERIALS AND METHODS
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All procedures were approved by the Cleveland Clinic Institutional Animal Care and Use Committee (Cleveland, OH).
Cell culture of HPASMCs.
To initiate cultures, cryopreserved HPASMCs (Cascade Biologics, Portland, OR) were thawed and inoculated in 25-cm2 culture flasks (Becton Dickinson Labware, Franklin Lakes, NJ). Cells were nourished by Medium 231(Cascade Biologics) containing Smooth Muscle Growth Supplement (Cascade Biologics) and antibiotic mixture solution (10,000 U/ml penicillin and 10,000 µg/ml streptomycin; Life Technologies, Rockville, MD). Cells were kept in a humidified atmosphere of 5% CO2-95% air at 37°C and were allowed to proliferate for 7–10 days until confluence was achieved. Cells were then subcultured to 35-mm culture dishes specially designed for fluorescence microscopy (Bioptechs
T System, Butler, PA) and used for experimentation within 72 h after subculture. Cells from the third passage were used for experiments.
Fura-2 loading procedure.
Twenty-four hours before experimentation, the culture medium containing 10% fetal bovine serum was replaced with serum-free medium to arrest cell growth, allow for establishment of steady-state cellular events independent of cell division, and to prevent a false estimate of [Ca2+]i resulting from binding of available dye to serum protein in the medium. HPASMCs were loaded with the acetoxymethyl ester form of fura-2 (fura-2-AM: 2 µM) at ambient temperature. After the 30-min loading period, the cells were washed twice in Krebs-Ringer buffer, which contained 125 mM NaCl, 5 mM KCl, 1.2 mM MgSO4, 11 mM glucose, 2.5 mM CaCl2, and 25 mM HEPES, at pH 7.40 adjusted with NaOH at ambient temperature for an additional 20 min before initiating the study. This provided enough time to wash away any extracellular fura-2-AM and for intracellular esterases to cleave fura-2-AM into the active fura-2.
Determination of intracellular free calcium concentration.
Culture dishes containing fura-2-loaded HPASMCs were placed in a temperature-regulated (37°C) chamber (Bioptechs) mounted on the stage of an Olympus IX-70 inverted fluorescence microscope (Olympus America, Lake Success, NY). Fluorescence measurements were performed on individual HPASMCs in a cultured monolayer using a dual wavelength spectrofluorometer (Deltascan RFK6002; Photon Technology International, So. Brunswick, NJ) at excitation wavelengths of 340 and 380 nm and an emission wavelength of 510 nm. The volume of the chamber was 1.5 ml. The cells were bathed with Krebs-Ringer buffer. The temperature of all solutions was maintained at 37°C in a water bath. Solution changes were accomplished rapidly by aspirating the buffer in the dish and infusing new solution. Just before data acquisition, background fluorescence (i.e., fluorescence between cells) was measured and subtracted automatically from the subsequent experimental measurements. Fura-2 fluorescence signals (340, 380, and 340/380 ratio) originating from single HPASMCs were continuously monitored at a sampling frequency of 25 Hz and were collected using a software package from Photon Technology International. [Ca2+]i was measured as the 340/380 fluorescence ratio in individual HPASMCs.
Experimental protocols.
Thapsigargin (1 µM), a sarcoplasmic reticulum (SR) Ca2+-ATPase inhibitor (33), was used to deplete intracellular Ca2+ stores after removing extracellular Ca2+. CCE was induced when extracellular Ca2+ (2.2 mM) was restored. Any given HPASMC was exposed to only one agent. The effects of L-type voltage-dependent Ca2+ channel inhibition (nifedipine: 10 µM), nonselective Ca2+ channel inhibition (SKF-96365: 50 µM), TK inhibition (Tyrphostin 23: 100 µM), PKC activation (phorbol 12-myristate 13-acetate; PMA, 1 µM), and PKC inhibition (bisindolylmaleimide 1; BIS1, 1 µM) on CCE were investigated. The concentration of each inhibitor was chosen based on previous experience in PASMCs (11, 18) and PVSMCs (9, 10). The effects of intravenous anesthetics [midazolam (100 µM), propofol (100 µM), thiopental (100 µM), ketamine (100 µM), etomidate (100 µM), morphine (100 µM), and fentanyl (1 µM)] on CCE were also assessed.
Reagents.
Midazolam and morphine were purchased from Baxter Healthcare (Deerfield, IL). Tyrphostin 23, thiopental, thapsigargin, and nifedipine were obtained from Sigma Chemical (St. Louis, MO), propofol from Aldrich (Milwaukee, WI), ketamine from Fort Dodge Animal Health (Fort Dodge, IA), and etomidate and fentanyl from Abbott Laboratories (N. Chicago, IL). BIS1, PMA, and SKF-96365 were obtained from Calbiochem (La Jolla, CA), and fura-2-AM was purchased from Teflabs (Austin, TX). Etomidate, fentanyl, ketamine, midazolam, and morphine were dissolved in distilled water as stock solutions. BIS1, fura-2-AM, nifedipine, propofol, PMA, SKF-96365, thapsigargin, and Tyrphostin 23 were dissolved in DMSO (Sigma Chemical) as stock solutions. Aliquots of each stock solution were diluted 1:1,000 in Krebs-Ringer buffer to achieve final concentrations. Similar dilutions of DMSO in Krebs-Ringer buffer had no effect on [Ca2+]i (10). Pure propofol was used to avoid any effects of the intralipid emulsion on the fluorescence signal.
Data analysis.
The peak and sustained 340/380 fluorescence signals were measured when the solution was switched from a Ca2+-free solution to a solution containing 2.2 mM Ca2+. Triplicate CCE responses were measured in each cell. The peak ratio was obtained by reading the highest point of the trace. The sustained ratio was obtained by averaging the fluorescence values measured 5 min after reintroduction of the Ca2+-containing solution. The change in the 340/380 fluorescence ratio was then calculated by subtracting the resting ratio value (baseline) of each intervention. Changes in the peak and sustained ratio in response to the agents are expressed as percent of control. The control response was the first CCE response in each cell, and this value was set at 100%. Data are expressed as means ± SE. Statistical analysis utilized repeated measures analysis of variance and Student's t-test for intra- and intergroup comparison, respectively. Differences were considered statistically significant at P < 0.05.
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RESULTS
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CCE in HPASMCs.
CCE was triggered by thapsigargin-induced depletion of intracellular Ca2+ stores. Thapsigargin stimulated a transient increase in [Ca2+]i by releasing Ca2+ from SR Ca2+ stores. After [Ca2+]i had returned to baseline, the extracellular Ca2+ concentration ([Ca2+]o) was restored (2.2 mM) in the continued presence of thapsigargin. Restoring [Ca2+]o caused a rapid peak increase in [Ca2+]i (242 ± 24%), followed by a sustained increase in [Ca2+]i (186 ± 13%), i.e., CCE was stimulated in HPASMCs (Fig. 1A). To assess the reproducibility of inducing CCE in the same HPASMC, extracellular Ca2+ was sequentially removed and restored three consecutive times in the continued presence of thapsigargin. There were no significant differences in the peak or sustained increases in [Ca2+]i between the first and the second CCE, but the third CCE was slightly smaller (P < 0.05) in magnitude in the peak and sustained increases in [Ca2+]i compared with the first CCE (Fig. 1B). In all subsequent experiments, the second CCE response in paired untreated HPASMCs was compared with the second CCE response in HPASMCs pretreated with either an inhibitor, an activator, or an intravenous anesthetic.

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Fig. 1. A: representative trace depicting capacitative calcium entry (CCE) after depletion of sarcoplasmic reticulum Ca2+ stores with thapsigargin. Extracellular Ca2+ (2.2 mM) was sequentially added and removed 3 times. Adding extracellular Ca2+ caused a peak and sustained increase in intracellular Ca2+ concentration. B: summarized data showing the reproducibility of the CCE response. The third CCE response was slightly smaller in magnitude compared with the first CCE. *P < 0.05 compared with the first CCE (n = 11 cells).
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Effect of voltage-operated Ca2+ channel inhibition on CCE.
Nifedipine was used to inhibit voltage-dependent Ca2+ channels. Nifedipine (10 µM) was applied 5 min before [Ca2+]o was restored the second time (Fig. 2A). As expected, nifedipine had no effect on the peak or sustained increases in [Ca2+]i due to CCE (Fig. 2B).

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Fig. 2. A: representative trace depicting effect of voltage-gated L-type Ca2+ channel blocker, nifedipine (10 µM), on CCE. B: summarized data showing that nifedipine had no effect on CCE (n = 6 cells).
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Effect of receptor-operated Ca2+ channel inhibition on CCE.
SKF-96365 is a nonselective Ca2+ channel inhibitor that has been used by many investigators to inhibit CCE (34). SKF-96365 (50 µM) was applied 5 min before [Ca2+]o was restored the second time (Fig. 3A). SKF-96365 attenuated (P < 0.05) peak and sustained CCE by 79 ± 2% and 73 ± 2%, respectively (Fig. 3B).

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Fig. 3. A: representative trace depicting effect of nonselective Ca2+ channel blocker (SKF-96365; 50 µM) on CCE. B: summarized data showing inhibitory effect of SKF-96365 on CCE. *P < 0.05 compared with untreated (n = 8 cells).
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Effects of PKC activation and inhibition on CCE.
PMA (1 µM) and BIS1 (1 µM) were used to activate and inhibit PKC, respectively. They were applied 5 min before [Ca2+]o was restored the second time. The PKC activator PMA (1 µM) attenuated (P < 0.05) peak and sustained CCE (Fig. 4A), whereas PKC inhibition with BIS1 (1 µM) slightly potentiated (P < 0.05) peak and sustained CCE (Fig. 4B).

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Fig. 4. A: summarized data showing inhibitory effect of protein kinase C activation (PMA; 1 µM) on CCE. *P < 0.05 compared with untreated (n = 9 cells). B: summarized data showing potentiating effect of protein kinase C inhibition (BIS1; 1 µM) on CCE. *P < 0.05 compared with untreated (n = 8 cells).
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Effect of TK inhibition on CCE.
Tyrphostin 23 was used to inhibit TK. Tyrphostin 23 (100 µM) was applied 5 min before [Ca2+]o was restored the second time. Tyrphostin 23 attenuated (P < 0.05) peak and sustained CCE (Fig. 5).

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Fig. 5. Summarized data showing inhibitory effect of tyrosine kinase inhibition (Tyrphostin 23; 100 µM) on CCE. *P < 0.05 compared with untreated (n = 9 cells).
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Effects of intravenous anesthetics on CCE.
The intravenous anesthetics were applied 15 min before [Ca2+]o was restored the second time. Midazolam (100 µM), propofol (100 µM), and thiopental (100 µM) each attenuated (P < 0.05) both peak and sustained CCE (Fig. 6). However, ketamine (100 µM), etomidate (100 µM), morphine (100 µM), and fentanyl (1 µM) each failed to attenuate peak or sustained CCE (Fig. 7 and 8).

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Fig. 6. A: summarized data showing inhibitory effect of midazolam (100 µM) on CCE. *P < 0.05 compared with untreated (n = 9 cells). B: summarized data showing inhibitory effect of propofol (100 µM) on CCE. *P < 0.05 compared with untreated (n = 9 cells). C: summarized data showing inhibitory effect of thiopental (100 µM) on CCE. *P < 0.05 compared with untreated (n = 10 cells).
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Fig. 7. A: summarized data showing that ketamine (100 µM) had no effect on CCE (n = 11 cells). B: summarized data showing that etomidate (100 µM) had no effect on CCE (n = 8 cells).
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Fig. 8. A: summarized data showing that morphine (100 µM) had no effect on CCE (n = 6 cells). B: summarized data showing that fentanyl (1 µM) had no effect on CCE (n = 7 cells).
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DISCUSSION
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The main findings of this study are as follows. First, both PKC and TK are involved in the signal transduction pathway for CCE in HPASMCs. The TK signaling pathway positively regulates CCE, whereas PKC negatively regulates CCE. Second, intravenous anesthetics have differential effects on CCE. Midazolam, thiopental, and propofol attenuate CCE, whereas ketamine, etomidate, morphine, and fentanyl have no effect on CCE.
Regulation of [Ca2+]i is vital for vascular smooth muscle function. Increases in [Ca2+]i lead to activation of myosin light chain kinase and phosphorylation of the 20-kDa light chains of myosin (MLC20) (12). MLC20 phosphorylation allows the binding of myosin to actin, which increases actomyosin adenosinetriphosphatase (ATPase) activity and causes vascular smooth muscle contraction (31). Agonist-induced changes in [Ca2+]i usually consist of initial Ca2+ release from the SR, followed by sustained Ca2+ entry though sarcolemmal Ca2+ channels. Depletion of SR Ca2+ due to agonist-induced Ca2+ release triggers Ca2+ influx though store-operated Ca2+ channels in the plasma membrane, namely CCE (26). Therefore, CCE is a mechanism that links [Ca2+]SR (calcium concentration in the sarcoplasmic reticulum) to membrane Ca2+ permeability (5, 20) and serves as an important pathway to refill intracellular Ca2+ stores and maintain sustained Ca2+ influx (20). In the current study, thapsigargin was used as a tool to deplete the SR pool of Ca2+ in the absence of extracellular Ca2+ and thereby activate CCE. Consistent with our previous studies (18, 30), the amplitude of the thapsigargin-induced increase in [Ca2+]i was variable, which likely reflects differences in the size of the SR store in different cells. A number of studies have indicated that the contractile response to SR Ca2+-ATPase inhibitors in smooth muscle is caused by Ca2+ entry through both voltage-operated calcium channels (VOCCs) and store-operated calcium channels (SOCCs); the relative contribution of each depends on the smooth muscle type (14), with SOCCs appearing to be of greater importance in tonic smooth muscle, such as found in the gastric fundus and pulmonary artery (14). In this study, the L-type VOCC blocker, nifedipine, had no effect on CCE, whereas SKF-96365 markedly attenuated both the peak and sustained increases in [Ca2+]i due to CCE. These results suggest that CCE is insensitive to voltage-gated Ca2+ channel inhibitors in HPASMCs.
The mechanism linking store depletion to the opening of SOCCs remains elusive. It might involve the generation of a diffusible chemical messenger or a direct protein-protein interaction between the SR and the plasma membrane (14). It is well established that PKC regulates many aspects of Ca2+ signaling. These include inhibition of IP3 production (4, 13, 17), thereby inhibiting hormone-dependent Ca2+ release and facilitation (6, 25) or inhibition (21, 22, 25) of CCE. In the present study, activation of PKC with PMA attenuated both peak and sustained CCE. In contrast, PKC inhibition with BIS1 potentiated both peak and sustained CCE. Thus, PKC negatively regulates CCE in HPASMCs.
Besides PKC, tyrosine phosphorylation has been reported to modulate CCE in a variety of cells (11, 21, 22, 29, 30). It has been reported that depletion of intracellular Ca2+ stores triggers tyrosine phosphorylation (29), and inhibition of TK attenuates CCE in a number of cell types (2, 32), including smooth muscle (8). We have demonstrated that inhibition of TK attenuates CCE in canine PASMCs and PVSMCs (18, 30). Consistent with these previous studies, the TK inhibitor Tyrphostin 23 attenuated CCE in HPASMCs. This suggests that the TK signaling pathway is involved in CCE in HPASMCs. Together, these results suggest that CCE in HPASMCs involves both PKC and TK pathways.
Two studies have investigated CCE in HPASMCs (15, 19). One of them demonstrated that CCE is an important mechanism required to maintain the elevated [Ca2+]i and stored [Ca2+] in HPASMCs via a novel gene family, transient receptor potential (TRP) genes. It has been reported that TRP-encoded proteins may be the putative channels responsible for CCE (5, 7). Moreover, PKC and TK have been shown to regulate the phosphorylation of TRP (1, 23). Therefore, PKC and TK may regulate CCE in HPASMCs via regulating the phosphorylation of TRP.
Because CCE is involved in the regulation of [Ca2+]i and vasomotor tone in PASMCs (11), the ion channel associated with CCE may serve as a cellular target for intravenous anesthetics. We previously demonstrated that propofol attenuated CCE in canine PASMCs via a PKC-dependent mechanism (18), and thiopental, midazolam, and ketamine each attenuated CCE in canine PVSMCs via a TK-dependent mechanism (30). However, the effects of intravenous anesthetics on CCE in human pulmonary arterial smooth muscle have not been investigated. In the present study, midazolam, propofol, and thiopental each attenuated CCE, whereas etomidate, ketamine, morphine, and fentanyl had no effect on CCE in HPASMCs. The cellular target for the intravenous anesthetics-induced attenuation of CCE remains to be elucidated, although possible mechanisms could involve inhibition of expression of TRP, as well as the PKC and/or TK signaling pathways.
We acknowledge that results obtained from this in vitro study can only be cautiously extrapolated to clinical practice. However, because CCE is an important mechanism for regulating vascular smooth muscle contraction, our results provide new insight concerning the effects of intravenous anesthetics on human pulmonary arterial smooth muscle contraction. CCE should be considered as a possible cellular target for anesthetic agents that alter vascular smooth muscle tone.
In summary, CCE exists in HPASMCs. The PKC signaling pathway negatively regulates CCE, whereas the TK signaling pathway positively regulates CCE. Midazolam, propofol, and thiopental each attenuate CCE, whereas ketamine, etomidate, morphine, and fentanyl had no effect on CCE in HPASMCs. We will investigate the cellular mechanism by which the intravenous anesthetics attenuated CCE in HPASMCs in future studies.
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FOOTNOTES
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Address for reprint requests and other correspondence: P. A. Murray, Center for Anesthesiology Research, NE63, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195 (e-mail: murrayp{at}ccf.org)
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.
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