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Experimental Physiology 89.4 pp 407-416
DOI: 10.1113/expphysiol.2004.027482
© The Physiological Society 2004
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Right arrow Muscle

Catecholamine-induced apoptosis and necrosis in cardiac and skeletal myocytes of the rat in vivo: the same or separate death pathways?

David F. Goldspink1, Jatin G. Burniston1, Georgina M. Ellison1, William A. Clark2 and Lip-Bun Tan3

1 The Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 15–21 Webster Street, Liverpool L3 2ET, UK2 Michael Reese Hospital and Medical Center, 2929 S Ellis, Chicago, IL 60616-3990, USA3 Academic Unit of Molecular and Vascular Medicine, Martin Wing, Leeds General Infirmary, Leeds LS2 9JT, UK


    Abstract
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
High levels of catecholamines are myotoxic but the relative amounts of apoptosis and necrosis have not been established in vivo in cardiac and skeletal muscles. Immunohistochemistry was used to detect and quantify myocyte-specific necrosis (myosin antibody in vivo) and apoptosis (caspase-3 antibody in vitro) in the heart and soleus muscles of male Wistar rats that had received single subcutaneous injections of isoprenaline over the range 1 µg to 5 mg [kg body weight (BW)]–1. Peak myocyte apoptosis occurred 3–6 h after, and necrosis 18 h after, a single injection of 5 mg (kg BW)–1 isoprenaline in vivo. In the heart myocyte death was mediated through the ß1-adrenergic receptor whereas myocyte death in the soleus muscle was mediated through the ß2-adrenergic receptor. Cardiomyocyte death was heterogeneously distributed throughout the heart, being greatest in the left ventricle (LV) subendocardium and peaking close to the apex, but with significantly more necrosis than apoptosis. Extensive co-localization of caspase-3 and myosin labelling was found in the myocytes of both the heart and the slow-twitch soleus muscle. This, together with similar spatial distributions and responses to catecholamine doses, suggests that either caspase-3 activation occurs in necrotic as well as apoptotic myocytes or that a large proportion of apoptotic myocytes progress to secondary necrosis in vivo.

(Received 18 February 2004; accepted after revision 20 April 2004; first published online 6 May 2004)
Corresponding author D. F Goldspink: The Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, 15–21 Webster Street, Liverpool L3 2ET, UK. Email: D.Goldspink{at}livjm.ac.uk


    Introduction
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
At least three types of cell death have been described, i.e. apoptosis, autophagy and necrosis (Engelhardt et al. 1999; Knaapen et al. 2001; Goldspink et al. 2003). Although originally regarded as separate processes, exhibiting different morphological and biochemical characteristics, some aspects of their presumed distinctiveness are now being questioned (Lockshin et al. 2000). For example, are apoptotic cells always caspase-dependent and the other forms caspase-independent? How well do the many observations of cell death in vitro reflect events in intact tissues in vivo? Does cell size and type affect a cell's ultimate fate?

In recent years much greater emphasis has been placed on studying apoptosis, compared with other forms of cell death. Consequently, very few studies have attempted simultaneously to quantify the relative amounts of cellular apoptosis and necrosis in any tissue in vivo (Kajstura et al. 1996, 1998; Blom et al. 1999; Dumount et al. 2000; Sun et al. 2001). Even where attempted, in most cases insufficient preliminary studies were undertaken to establish the optimal conditions, with respect to the dose and temporal–spatial distributions of the injury, to ensure accurate and meaningful quantification of, and hence comparison between, different forms of cell death.

To address such issues we employed the isoprenaline challenge model that we, and others, have previously used to induce necrosis in cardiomyocytes of the heart (Benjamin et al. 1989; Teerlink et al. 1994; Ng et al. 2002; Tan et al. 2003). After optimizing the experimental conditions, myocyte-specific necrosis and apoptosis were detected and quantified in both the heart and a skeletal muscle using sensitive techniques of immunohistochemistry and image analysis. This approach has enabled us to question whether one form of cell death in vivo predominates over the other and whether apoptosis and necrosis in vivo represent two distinctive pathways or a continuum of events.


    Materials and methods
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Male Wistar rats (311 ± 4.4 g) from a conventionally bred colony were allowed free access to food and water. All experimental procedures were carried out in accordance with the Home Office of Great Britain and Northern Ireland Animals (Scientific Procedures) Act 1986.

Myocyte death was induced in both cardiac and skeletal muscles by a single subcutaneous injection of isoprenaline. In dose–response studies this ranged from 0.01 µg to 5 mg (kg BW)–1. Myocyte-specific necrosis was detected by administering (via intraperitoneal injection) 1 mg of an anti-myosin monoclonal antibody (Ab) to each rat 1 h before either the isoprenaline (i.e. experimental groups) or saline vehicle (i.e. negative control group), as previously described (Clark et al. 1980; Kajstura et al. 1996, 1998). This Ab interacts with the ß-myosin found in all striated muscles (Clark et al. 1980; Ng et al. 2002). The Ab is too large to traverse the intact membranes of viable myocytes, but readily enters necrotic myocytes through their disrupted sarcolemmal membranes (Goldspink et al. 2003), enabling us to exploit this end-stage of cellular necrosis (Ng et al. 2002; Tan et al. 2003).

Rats were killed by cervical dislocation at different time intervals (0–24 h) after administration of the isoprenaline. Hearts were rapidly isolated and both atria removed. The intact ventricles were mounted whole, snap frozen in super cooled isopentane and transverse cryosections (5 µm) taken at 200 µm intervals along the longitudinal axis, from the apex to the base. Soleus muscles (predominantly slow-oxidative) were also isolated and samples taken from the mid-belly of each muscle. These were supported by blocks of liver and embedded in Optimal Cutting Temperature compound before being snap frozen in isopentane. Transverse and longitudinal cryosections (5 µm) were then cut.

In both striated muscles, necrotic myocytes, with the Ab bound to their myosin, stained brown after sections were developed with a secondary, horseradish-peroxidase-conjugated Ab and 3–3'diaminobenzedine (DAB) (Fig. 1C and F). In serial sections apoptotic cells stained brick red (Fig. 1B and E) when exposed to an Ab directed against the 17 kDa subunit of caspase-3 (R & D Systems, Minneapolis, USA) and Nova Red (Vector Laboratories, Burlingame, CA, USA). Using a combination of light microscopy and image analysis a minimum of 500 fibres in each soleus was counted and the proportions of apoptotic and necrotic myocytes determined. In the heart, cardiomyocyte damage was quantified in six randomly chosen fields of view of either the left or the right ventricular subendocardia or subepicardia. Areas staining either brown (i.e. necrotic myocytes) or red (apoptotic myocytes) were measured against the haematoxylin-counterstained background of normal cardiomyocytes. The values obtained in each of these areas were averaged and expressed as the percentage area of either apoptosis or necrosis. All sections were analysed blindly.



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Figure 1.  Isoprenaline-induced apoptosis and necrosis in cardiac and skeletal myocytes
One hour before administering isoprenaline [5 mg (kg BW)–1] each rat received anti-myosin Ab [1 mg (kg BW)–1]. Twelve hours later they were killed and cryosections cut transversely for the heart (A–C) and soleus (D–F). These were developed to visualize apoptotic (exposed to caspase-3 Ab; B and E) and necrotic (containing the myosin Ab; C and F) myocytes. No cell death was found in control muscles (A and D) that had been exposed to the primary Ab, but not isoprenaline. When serial cryosections of the solei from animals exposed to isoprenaline were stained with caspase-3 (G) and TUNEL (H), co-localization of the two markers was observed. Annexin V-biotin-labelled cardiomyocytes were also clearly discernible in the subendocardium of animals administered isoprenaline (I). The nuclear changes concomitant with apoptosis were confirmed using the ssDNA (J) and TUNEL (K) techniques. All are images of 5 µm cryosections. Positive (brown/red) staining represents secondary immunoperoxidase amplification of primary Ab binding; all sections are counterstained with haematoxylin. Cryosections of the heart (A–C and I–K) are shown at 1000 x magnification (scale bar = 10 µm), the soleus muscle is shown at either 200 x (D–F) or 400 x (G and H) magnification and the scale bar represents 100 µm in each case.

 
Routine detection of apoptosis was achieved using an anti-caspase-3 Ab (rabbit anti-caspase-3 active; R & D Systems). An indirect immunoperoxidase protocol was performed on cryosections; the primary Ab was applied at a dilution of 1: 200 and incubated overnight at 4°C; Ab binding was visualized with Nova Red and tissues were then counterstained in haematoxylin and permanently mounted. Tissue taken from the involuting mammary gland of a post-lactating female Wistar rat was used as a positive control for apoptosis (Casey et al. 1996; Trump et al. 1997). Heat-denatured (3 min at 96°C) anti-caspase-3 Ab was used as the negative control, with all other stages being identical. In addition, all experiments included a negative control group, i.e. animals that received the saline vehicle only, to detect the presence of any apoptosis induced by experimental stress or tissue processing.

To verify the apoptosis labelling using the caspase-3 Ab, a subset of animals (n= 3 in each group) were administered annexin V-biotin (Nexins Research, Netherlands) to detect the externalization of phosphatidylserine (PS) in vivo. Annexin V-biotin [25 mg (kg BW)–1] was administered intravenously 3.25 h after the administration of 5 mg (kg BW)–1 isoprenaline (experimental groups) or saline vehicle only (control group). Muscles were harvested at the optimized time point (3 h post-ß-agonist administration) and processed using standard immunohistochemical techniques, as previously described (Dumount et al. 2000). Annexin V-biotin is cleared through the kidney. Hence, renal tissue was used as the positive control (data not shown) to demonstrate both positive staining and to verify that the annexin V-biotin had reached, and passed through, the circulation. Tissues from the saline control animals were stained alongside experimental tissues to control for any post mortem changes and clearly demonstrated that apoptosis occurred in response to the experimental intervention.

Formamide-induced DNA denaturation detected using an anti-single strand DNA (ssDNA) Ab was used to confirm the nuclear changes concomitant with apoptosis.

Cryosections of muscles taken from control and experimental animals were heated in formamide as described by Frankfurt & Krishan (2001). The denatured DNA of apoptotic cells was then detected using an anti-ssDNA Ab (Chemicon International, Temecula, CA, USA) according to the manufacturer's instructions. Cryosections of mammary gland and small intestine were included as immunohistochemical controls alongside the experimental tissues; as a negative immunohistochemical control these sections were not heated in formamide.

Strand-breaks in the DNA of apoptotic cells were detected using a commercially available TUNEL kit (R & D Systems) according to the instructions provided. Positive control sections were exposed to DNase I and on separate sections the TdT enzyme was omitted to provide an immunohistochemical negative control.

With the exception of the topographical investigation, apoptosis in the heart was only quantified in the subendocardial region of the LV. For each section, six to eight fields of view (100 x magnification), encompassing the entire subendocardial region, were digitized. Positive staining (apoptosis) was differentiated from the haematoxylin background, quantified using image analysis and the incidence of apoptosis expressed as the percentage area relative to the field of view. The coefficient of variation using this technique was 4.7%.

To quantify apoptosis in the soleus, three random fields of view (100 x magnification) across each transverse section were digitized. Both apoptotic and viable myocytes were counted (> 700), and the number of apoptotic fibres expressed as a percentage of the total. The coefficient of variation for this technique was 3.5%.

Double immunofluorescence was used to investigate the co-localization of apoptosis and necrosis within the same myocytes. Primary detection of the anti-myosin (necrosis) and anti-caspase-3 (apoptosis) Ab was visualized with a Fluorescein-conjugated horse anti-mouse Ab (necrosis) or a Texas-Red-conjugated goat anti-rabbit Ab (apoptosis) and viewed as either separate or combined images on the image analyser.

To identify the adrenergic receptor pathway mediating the isoprenaline-induced myocyte necrosis and apoptosis, selective ß1- (bisoprolol) or ß2- (ICI-118551) adrenoceptor (AR) antagonists were injected at 25 and 10 mg (kg BW)–1, respectively, 1 h before the isoprenaline challenge. We have previously shown that these doses provide selective and near complete inhibition of these ß-AR subtypes (Tan et al. 2003).

Statistical analyses were carried out using one-way ANOVA, with multiple post hoc tests. P < 0.05 was considered to be significant.


    Results
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Throughout these studies no baseline myocyte death was detected in any control hearts or soleus muscles (Fig. 1A and D). That is, muscles from rats that had received the saline vehicle in the absence of isoprenaline showed no labelling with either monoclonal anti-myosin Ab or caspase-3. This also demonstrates the absence of non-specific staining due to tissue processing or immunohistochemical techniques.

By contrast, a single injection of isoprenaline [5 mg (kg BW)–1]in vivo induced significant (P < 0.05) apoptosis (Fig. 1B and E) and necrosis (Fig. 1C and F) in both striated muscles. However, skeletal myocyte death by either mode was induced by a much lower dose (about 100-fold lower; Fig. 2A and B). The extent of injury was dose dependent, with both apoptosis and necrosis occurring with a dose of 0.01 mg (kg BW)–1 in cardiac myocytes and with an even lower dose of 0.001 mg (kg BW)–1 in skeletal myocytes. Peak values were reached in response to a dose of isoprenaline of 5 mg (kg BW)–1. This optimal dose was employed in all subsequent studies.



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Figure 2.  Myocyte necrosis and apoptosis in response to isoprenaline dose
Apoptosis ({square}) and necrosis ({blacksquare}) were measured in the heart (A) and soleus (B) 12 h after receiving a single subcutaneous injection of one of the above doses of isoprenaline. Values are means ±S.E.M., with n= 4–6. First, any detectable isoprenaline-induced apoptosis or necrosis must be of biological significance when compared with the absence of cell death in control muscles. Statistically significant differences (*P < 0.05) were also found between 5 mg kg–1 and other doses of isoprenaline, using one-way ANOVA, with Tukey post hoc test.

 
The time courses for cardiomyocyte death by apoptosis and necrosis are shown in Fig. 3. The onset (1 h) and peak (between 3 and 6 h) of apoptosis occurred approximately 12 h earlier than those of necrosis. When the areas under these curves were integrated over time, the ratio of necrotic to apoptotic cardiac myocytes was found to be in excess of 3/1.



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Figure 3.  Time-related changes in necrosis and apoptosis in the LV
Cardiomyocyte apoptosis ({square}) and necrosis ({blacksquare}) were measured at various times after administering isoprenaline [5 mg (kg BW)–1]. Values are means ±S.E.M., for n= 3–9.

 
Importantly, the extent of isoprenaline-induced injury varied throughout the ventricles (Fig. 4). Despite this, both apoptosis and necrosis exhibited very similar patterns of spatial distribution along both longitudinal (Fig. 4A) and transverse (Fig. 4B) axes. We found it impractical to quantify cellular damage at every site and every time point (Fig. 3) for all experiments and therefore considered that the most meaningful approach was to reproducibly sample at the peak incidence of cardiomyocyte death, i.e. temporally (3–6 h for apoptosis and 18 h for necrosis: Fig. 3), spatially (2.2 mm from the apex; Fig. 4A) and using the optimal dose [5 mg (kg BW)–1] of the synthetic catecholamine. When measured under these optimal conditions, the LV subendocardium contained 10–30 times more damaged cells than the LV subepicardium or right ventricle (RV) subendocardium. In each of these three regions significantly (P < 0.01) more necrosis than apoptosis was consistently found, with ratios of 3.5/1, 6/1 and 10/1, in the LV subendocardium, subepicardium and RV subendocardium, respectively.



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Figure 4.  Spatial distribution of cardiomyocyte death along longitudinal and transverse axes of the ventricles
Cardiomyocyte apoptosis ({square}) and necrosis ({blacksquare}) were quantified at 200 µm intervals along the entire length of LV subendocardium (A) and in cross-section (B) cut at the peak incidence of damage (i.e. 2.2 mm from the apex). This was undertaken either 3 or 18 h after administering 5 mg (kg BW)–1 isoprenaline to coincide with the temporal peaks of apoptosis and necrosis (see Fig. 3). In B the x-axis denotes antero-septal (ant-septal), anterior, antero-lateral (ant-lat), postero-lateral (post-lat), posterior and postero-septal (post-septal) regions. Data are means ±S.E.M., for n= 6–9.

 
Using the same optimal conditions, selective ß-AR inhibitors were used to explore whether the isoprenaline-induced apoptosis and necrosis were mediated through the same or different ß-AR subtypes (Fig. 5). Selective ß1-AR inhibition using bisoprolol significantly (P < 0.05) prevented (> 95%) both myocyte apoptosis and necrosis in the heart (Fig. 5A), whereas selective ß2-AR blockade using ICI 118511 was ineffectual (Fig. 5A). Exactly the opposite was observed in soleus muscles from the same animals, selective ß2-AR blockade was effective and significantly (P < 0.05) reduced isoprenaline-induced myocyte death by > 76% but selective ß1-AR inhibition was not (Fig. 5B). We have previously shown that combined ß1- and ß2-AR antagonism using propranolol protects both the heart and the soleus from isoprenaline-induced necrosis (Ng et al. 2002).



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Figure 5.  Protection afforded by ß-AR blockade
The selective ß1-AR inhibitor bisoprolol (at 25 mg kg–1) or ß2-AR selective antagonist ICI 118 551 (at 10 mg kg–1) or saline vehicle were administered subcutaneously 1 h prior to 5 mg (kg BW)–1 isoprenaline. Apoptotic ({square}) and necrotic ({blacksquare}) myocytes in the heart (A) and soleus (B) were quantified either 3 h (peak apoptosis) or 18 h (peak necrosis) later. Values are means ±S.E.M. for n= 6–10, with levels of statistical significance (*P< 0.05, **P< 0.01) determined when compared with unopposed isoprenaline values, using one-way ANOVA, with Tukey post hoc test

 
The very close similarities in the initiation dose (Fig. 2), spatial distribution (Fig. 4) and ß-AR pathways (Fig. 5) for myocyte apoptosis and necrosis prompted us to examine the possibility of cellular co-localization of the two death pathways. We chose a time point (12 h) when both apoptotic and necrotic cells were present (Fig. 3) to examine both cardiac and soleus myocytes using fluorochrome-conjugated antibodies (Fig. 6).



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Figure 6.  Co-localization of isoprenaline-induced myocyte apoptosis and necrosis
Transverse cryosections were stained with Texas Red and Fluorescin to show apoptosis (A and B) and necrosis (C and D), respectively, 12 h after 5 mg (kg BW)–1 isoprenaline. When the images are combined (E and F), any co-labelling within the same myocyte becomes apparent.

 
Many cardiomyocytes that individually stained for apoptosis (Fig. 6A) and necrosis (Fig. 6C) were clearly labelled by both markers of cell death (Fig. 6E). Because of their different temporal distributions (Fig. 3) and difficulties in clearly delineating the outlines of the cardiomyocytes, it was not possible to quantify the amount of this cardiomyocyte co-localization accurately. Nonetheless, it was readily apparent on the image analyser that most, if not all, apoptotic cells were also labelled as necrotic. The remaining and larger proportion of damaged cardiomyocytes was labelled purely as necrotic (Fig. 6C).

Quantification was more straightforward in the soleus muscle. Damaged myocytes (n= 350) in randomly selected fields of view from ten different muscles were examined 12 h after isoprenaline injection. All 350 fibres stained positively for the presence of the monoclonal anti-myosin Ab (Fig. 6D), whereas 249 (71%) were labelled as caspase-3 positive (Fig. 6B). On closer examination, we confirmed that all of the caspase-3-positive fibres were co-labelled as necrotic (Fig. 6F), leaving just 101 fibres (29%) staining as necrotic only with no detectable caspase-3-positive labelling. The probability that this observation was due to chance was P < 0.001, using a chi-squared association test (1, n= 350) = 62.58.


    Discussion
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 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
Current concepts (mainly derived from studies in vitro) distinguish apoptosis and necrosis through distinctive morphological differences (Saraste & Pulkki, 2000) and the fact that apoptosis is supposedly caspase-dependent whereas necrosis is caspase-independent (Saraste & Pulkki, 2000; Goldspink et al. 2003). Two prominent morphological features are thought to discriminate apoptotic from necrotic cell death: (1) the maintenance of membrane integrity and (2) the formation of apoptotic bodies. However, when studied in vitro, apoptotic bodies undergo lysis after a period of time (Honda et al. 2000). This delayed loss of membrane integrity after the initiation of apoptosis has been termed ‘secondary necrosis’ or ‘apoptosis–necrosis’ (Majno & Joris, 1995). The above observations are clearly not consistent with our findings in striated muscles in vivo. That is, no apoptotic bodies were observed despite the fact that apoptosis of myocytes occurred, as confirmed by annexin V-biotin in vivo and ssDNA or TUNEL in vitro (Fig. 1), as well as caspase-3, labelling. Indeed, apoptotic myocytes had a very similar appearance to those stained positive for the presence of the anti-myosin Ab.

The lysis of apoptotic cells in vivo will undoubtedly instigate an inflammatory response that may result in the demise of adjacent cells that were not directly damaged by the original insult. In the current work, the very close similarities in dose–responses (Fig. 2), spatial distributions (Fig. 4) and receptor mediation 1-AR in the myocardium or ß2-AR in the soleus; Fig. 5) for myocyte apoptosis and necrosis suggest that either the two processes originate from common initial pathways or that they are one and the same process, i.e. a continuum of events. The earlier time course of cardiomyocyte apoptosis peaking at 3–6 h relative to necrosis peaking at 18 h (Fig. 3) and the greater number of necrotic compared with apoptotic myocytes (ranging from 3.5/1 to 10/1 in the heart, and 1.4/1 in the soleus) both suggest that some of the necrosis measured 18 h after isoprenaline administration may, in fact, be secondary to the apoptosis measured at the earlier time points, i.e. secondary necrosis. Confirmation of this is provided by the observation of caspase-3-positive myocytes with disrupted sarcolemmal membranes 12 h after the administration of isoprenaline (Fig. 6E and F). Intuition suggests that the greater size, particularly of skeletal myocytes, would impede their phagocytosis by tissue macrophages and so these cells would be more likely to progress to secondary necrosis. Indeed, a greater proportion (70%) of skeletal myocytes were co-labelled than the smaller myocytes of the myocardium (~30%). Despite this, the rate of removal of necrotic skeletal myocytes (Ng et al. 2002) appears to be similar, both to the smaller cardiomyocytes (Fig. 3) and to even smaller hepatocytes (Blom et al. 1999; Sun et al. 2001). If secondary necrosis does indeed occur in vivo, it would appear to do so before the formation of classical apoptotic bodies (Goldspink et al. 2003) as no such structures were seen in our studies. This further highlights the importance of recognizing differences in observations derived from studies in vitro and in vivo.

An alternative explanation to this ‘continuum of events’ hypothesis is provided by the growing body of research on the role of the mitochondria in cell death. This has provided some fascinating new insights into the relationship between apoptosis and necrosis. Apoptosis and necrosis have been shown to coexist in the heart following experimentally induced ischaemic damage (Kajstura et al. 1996) and myocardial infarctions (James, 1998). Permeablization of the outer membrane of mitochondria is a common feature of both apoptosis and necrosis (Lemasters et al. 1999, 2002). This process of simultaneous induction of apoptotic and necrotic death has been termed ‘necrapoptosis’ (Lemasters, 1999). After permeablization of the outer mitochondrial membrane, the subsequent phenotype of cell death (i.e. apoptotic or necrotic) may be determined by the availability of ATP (Eguchi et al. 1997; Leist & Jaattela, 2001). That is, cells depleted of ATP undergo necrosis rather than apoptosis. This dual induction of both cell death phenotypes following a common insult could equally well explain the current findings.

Regardless of the exact intracellular events leading to the observed myocyte death, the realisation that different cell death phenotypes can co-exist within the same cell or tissue in response to a single stimulus questions the validity of the findings of many publications that have focused only on one cell death pathway. Clearly, the data presented here support the proposal that both apoptosis and necrosis should be investigated simultaneously, with the distinctiveness of the different death pathways as yet unresolved. Indeed, the fact that we have not investigated the incidence of autophagic cell death represents a limitation to the current study, which we intend to rectify in the near future. The current findings also demonstrate that in order to attempt to evaluate the relative importance of the different cell death pathways, preliminary investigations of the dose dependency and time course of cell death are required.

Elevated catecholamines have long been known to induce necrotic damage in the heart (Benjamin et al. 1989; Teerlink et al. 1994; Ng et al. 2002; Tan et al. 2003). Recently, we added to knowledge in this area by showing that the slow-twitch soleus muscle can be similarly damaged by the synthetic catecholamine, isoprenaline (Ng et al. 2002). The current work reveals that the incidence of necrotic myocyte death in response to isoprenaline is three to ten times greater than that of apoptotic death, depending on the time point at which myocyte death is quantified. Clearly, not all myocytes responded equally to isoprenaline challenge, as myocyte death in the soleus was induced by a much lower dose than that required to induce damage in the heart (Fig. 2). In both studies the fast-twitch tibialis anterior muscle was not damaged by isoprenaline administration; this may be explained by the development-dependent disappearance of the caspase-3 protein in this muscle (Ruest et al. 2002).

Our data are supported by studies (Mann et al. 1992) on cardiomyocytes in vitro that have elegantly demonstrated that catecholamine-induced death is mediated by the ß1-AR and preceded by an elevation in cyclical AMP and Ca2+i overload. Using the current model, isoprenaline-induced myocyte death can be mimicked by the phosphodiesterase inhibitor, milrinone (our unpublished results), suggesting that the same mechanisms mediate myocyte death in vivo. Myocyte death observed in the soleus muscle was mediated through the ß2-AR. This is a novel observation and the involvement of different ß-AR subtypes, i.e. ß1-AR in the heart and ß2-AR in skeletal muscle, in catecholamine-induced myocyte death has potential clinical relevance (vide infra).

It is tempting to suggest that the disparate sensitivity of the two striated muscles is due to differences in ß-AR subtype density. However, by combining data on the density of ß-AR in the heart and the triceps surae (gastrocnemius, plantaris and soleus) muscles (Rothwell et al. 1987) and data on the ratio of the ß-AR subtypes in the heart (Van Veldhuisen et al. 1995) and skeletal muscles (Rothwell et al. 1987; Jenson et al. 1995), we estimate that the heart has approximately 3.5-fold more ß1-AR receptors than the soleus has ß2-AR. Therefore, ß-AR density per se cannot explain these findings. This suggests that stimulation of the ß2-AR pathway in the soleus may be a more potent mediator of cell death than the ß1-AR of cardiomyocytes. Alternatively, the Ca2+i handling capabilities of the two striated muscles may also account for the disparate sensitivities of these muscles to catecholamine challenge. Intracellular Ca2+ transients are inextricably linked to ß-AR signalling and deregulation of [Ca2+]1 is implicated in cell death. As mitochondria are involved in the regulation of [Ca2+]1, it is our hypothesis that the greater mitochondrial density of cardiomyocytes (Murakami et al. 1995) would afford these cells greater protection against hyper-stimulation of the ß-AR. This, however, has not been shown empirically.

Whether administered in vivo (Fig. 5A) or in vitro (Communal et al. 1999), the stimulation of ß1-AR by isoprenaline leads to cardiomyocyte apoptosis. Similarly, over-expression of the same AR subtype leads to heart failure (Engelhardt et al. 1999). The stimulation of cardiomyocyte ß1- or ß2-AR subtypes in vitro is known to regulate the apoptotic death of these cells differentially. That is, isoprenaline-induced apoptosis of cardiomyocytes is prevented by the ß1-AR antagonist, CGP 20712A (Communal et al. 1999), consistent with our findings using bisoprolol in vivo (Fig. 5A). However, Communal et al. (1999) also found that blockade of ß2-AR increased the incidence of apoptosis in response to isoprenaline. From this observation these authors concluded that ß2-AR agonism has an inhibitory affect on pro-apoptotic ß1-AR signalling. Clearly this is not the case when studied in vivo. In the current work prior blockade of ß2-AR did not increase, but rather decreased the incidence of cardiomyocyte death (Fig. 5A). Based on our knowledge of the cardiotoxic effects of the ß2-AR selective agonist, clenbuterol (Burniston et al. 2002), we propose that a component of the cardiomyocyte death induced by isoprenaline in vivo is due to its ß2-AR-mediated facilitation of noradrenaline release from the sympathetic varicosities.

Inevitably these observations raise a number of important questions. For example, when quantifying the amounts of apoptosis, either singularly or relative to other forms of non-apoptotic cell death, in a complex solid organ such as the heart highly systematic and reproducible sampling protocols are essential. Random sampling from the myocardium, either in time (Fig. 3) or in space (Fig. 4), is likely to give widely variable results, and such data could potentially give rise to misleading conclusions. For example, 9 h after isoprenaline administration cardiomyocyte death would appear to arise from equal contributions of apoptosis and necrosis (Fig. 3). However, if 3 h were chosen instead, the observation would consist entirely of apoptosis, whereas after 18 h the majority of the myocyte loss would appear to be due to necrosis. These findings serve as an important reminder that care should be exercised when interpreting results, paying particular attention to the sampling protocols used.

Our findings are also of clinical relevance because over-activation of the sympathetic system in patients with pheochromocytoma and heart failure leads to sustained pathophysiological levels of catecholamines (Anker et al. 1997). Pharmacological levels of these hormones and their analogues are also used in resuscitative and intensive care practice. Dramatic and widespread losses in muscle bulk (Murdoch & McMurray, 1999) and concomitant muscle weakness (Mancini et al. 1994), as well as progressive cardiac dysfunction, are known to occur in such conditions. Indeed, heart failure is now recognized as a generalized, rather than a mere cardio-specific myopathic process (Opasich et al. 1999). Hence, less selective ß-AR inhibitors (i.e. blocking both ß1-AR in the myocardium and ß2-AR in skeletal muscles) may provide a more effective overall treatment than cardio-specific ß1-AR antagonists.

Clearly, the processes associated with cell death in vivo are more complex than those in vitro, from where the bulk of our information is currently derived. There is a real need to acquire more information about all forms of cell death in vivo. In the case of catecholamine-induced injury to cardiac and skeletal myocytes, it is clear that measurements of apoptosis alone may substantially underestimate the total biological impact of the insult.


    References
 Top
 Abstract
 Introduction
 Materials and methods
 Results
 Discussion
 References
 
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    Acknowledgements
 
We are grateful to Dr C. Reutelingsperger (University of Maastricht) for the kind donation of the annexin V-biotin, to Helen Cox for her technical assistance and the British Heart Foundation (BHF) and the National Heart Research Fund for supporting this research. J.G.B. was a PhD student (FS2000078) and L.-B.T. was a Senior Lecturer of the BHF.




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