Pharmacological blockade of voltage-gated calcium channels as a potential cardioprotective strategy
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Voltage-gated Ca2+ channels (VGCCs) are essential for initiating and regulating cardiac function. During the cardiac action potential, Ca2+ influx through L-type channels triggers the sarcoplasmic reticulum Ca2+ release that enables the EC coupling. Ca2+ can also enter cardiac myocytes through low-voltage-activated T-type channels, which are expressed throughout cardiac development until the end of the neonatal period, and can contribute to pacemaker activity as well as EC coupling to some extent. Importantly, T-type channels are re-expressed in ventricular myocytes under diverse pathological conditions such as ischemia or hypertrophy, suggesting that they play a role in cardiac disease. In a first part of this study, we examined the effects of VGCC blockers on the homeostasis and viability of primary cultures of cardiac myocytes (CMs), because of the importance of apoptosis and necrosis in cardiac disease. In a second part, we analyzed the cell mechanisms unleashed by hypoxic and hypertrophic stimuli, the involvement of VGCCs and the putative cytoprotective effects of VGCC blockade. Our results show that L-type and T-type channel blockers induce a low-level and transient ER stress, albeit with a distinct conveyance into cell macroautophagy and viability: whereas L-type channel blockers trigger a macroautophagic process in CMs, ultimately promoting apoptosis, T-type channel blockers exerts the opposite effect, by decreasing the autophagic flux and not affecting cell death. Furthermore, the blockade of T-type channels reduces Beclin-1-dependent autophagy and protects CMs subject to hypoxia-reoxygenation (as an in vitro paradigm for ischemia-reperfusion). We thus identify L-type and T-type channels as new targets for macroautophagy regulation of CMs, and provide new clues to the beneficial actions reported in clinical trials for T-type channel blockers, particularly against pathophysiological conditions involving a maladaptive autophagy.