Diminished Responsiveness of Gs-Coupled Receptors in Severely Failing Human Hearts: No Difference in Dilated Versus Ischemic Cardiomyopathy

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Abstract
In end-stage heart failure, cardiac β-adrenoceptors are decreased and cardiac Gi protein is increased. We assessed β-adrenoceptors, G proteins, and effects of several β-adrenoceptor agonists, histamine, and 5-HT on adenylyl cyclase activity in right and left atria and left ventricles and on left ventricular contractility in six potential heart transplant donors (nonfailing hearts; NFHs) and in nine patients with end-stage dilated cardiomyopathy (DCM) and 11 patients with endstage ischemic cardiomyopathy (ICM) to establish whether the functional responsiveness of all cardiac Gs-coupled receptors is reduced. β-Adrenoceptors were reduced in all three tissues; in DCM, β1-adrenoceptors were more markedly downregulated; in ICM, both β1- and β2-adrenoceptors were diminished. In all three tissues, isoprenaline-, terbutaline-, histamine- and 5-HT-induced adenylyl cyclase activation was reduced similarly in DCM and ICM. Moreover, in DCM and ICM, guanosine triphosphate (GTP)- (involving Gs and Gi) activated adenylyl cyclase was significantly diminished, whereas NaF-activated (involving only Gs) and Mn2+-activated (acting at the catalytic unit of the enzyme) adenylyl cyclase was unaltered. Left ventricular positive inotropic responses to β1- (noradrenaline, dopamine, and dobutamine), β2- (terbutaline), and β1- and β2-adrenoceptors (isoprenaline, adrenaline, and epinine), as well as H2-receptor (histamine) stimulation were significantly reduced. The extent of reduction was not different for each agonist in ICM and DCM. We conclude that in DCM and ICM, functional responsiveness of all cardiac Gs-coupled receptors is similarly reduced.

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