Sarcoplasmic Ca²⁺ release is prolonged in nonfailing myocardium of diabetic patients

Background: Asymptomatic diabetic patients have a high incidence of clinically unrecognized left ventricular dysfunction with an abnormal cardiac response to exercise. We, therefore, examined subclinical defects in the contraction-relaxation cycle and intracellular Ca²⁺ regulation in myocardium of asymptomatic type 2 diabetic patients. Methods: Alterations in the dynamics of the intracellular Ca²⁺ transient and contractility were recorded in right atrial myocardium of type 2 diabetic patients and non-diabetic control tissue loaded with fura-2. In order to gain an insight into mechanisms underlying the altered Ca²⁺ handling in diabetic myocardium levels of mRNA, protein expression and phosphorylation of key proteins in sarcoplasmic Ca²⁺ handling were determined. Results: In isolated atrial trabeculae of diabetic myocardium the rise of systolic Ca²⁺ was significantly prolonged, but relaxation of the Ca²⁺ transient was unaltered compared to control tissue. Accordingly, the levels of expression of mRNA and protein of the Ca²⁺ release channel (RyR2) of the sarcoplasmic reticulum were reduced by 68 and 22%, respectively. Endogenous phosphorylation of RyR2 by protein kinases C, however, was increased by 31% in diabetic myocardium, as assessed by the back-phosphorylation technique. Levels of expression of SERCA2 and phospholamban were unaltered between both groups. Conclusions: Intracellular Ca²⁺ release is prolonged in non-failing myocardium of type 2 diabetic patients and this may be primarily due to a decreased expression of RyR2. This defective Ca²⁺ release may represent an early stage of ventricular dysfunction in type 2 diabetes and would favor the abnormal response to exercise frequently observed in asymptomatic diabetic patients.