L-type Ca2+ channels provide a major pathway for iron entry into cardiomyocytes in iron-overload cardiomyopathy
Abstract
Under conditions of iron overload, which are now reaching epidemic proportions worldwide, iron-overload cardiomyopathy is the most important prognostic factor in patient survival. We hypothesize that in iron-overload disorders, iron accumulation in the heart depends on ferrous iron (Fe2+) permeation through the L-type voltage-dependent Ca2+ channel (LVDCC), a promiscuous divalent cation transporter. Iron overload in mice was associated with increased mortality, systolic and diastolic dysfunction, bradycardia, hypotension, increased myocardial fibrosis and elevated oxidative stress. Treatment with LVDCC blockers (CCBs; amlodipine and verapamil) at therapeutic levels inhibited the LVDCC current in cardiomyocytes, attenuated myocardial iron accumulation and oxidative stress, improved survival, prevented hypotension and preserved heart structure and function. Consistent with the role of LVDCCs in myocardial iron uptake, iron-overloaded transgenic mice with cardiac-specific overexpression of the LVDCC alpha1-subunit had twofold higher myocardial iron and oxidative stress levels, as well as greater impairment in cardiac function, compared with littermate controls; LVDCC blockade was again protective. Our results indicate that cardiac LVDCCs are key transporters of iron into cardiomyocytes under iron-overloaded conditions, and potentially represent a new therapeutic target to reduce the cardiovascular burden from iron overload.
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The clinical severity of hemochromatosis is related to NTBI, a toxic iron species bound to low molecular weight molecules, easily taken up by hepatocytes and pancreatic cells via ZIP14 transporter and by cardiomyocytes through other transporters.
“The clinical severity of hemochromatosis is related to NTBI, a toxic iron species bound to low molecular weight molecules, easily taken up by hepatocytes and pancreatic cells via ZIP14 transporter82 and by cardiomyocytes through other transporters.83”
From Iron metabolism and iron disorders revisited in the hepcidin era (2020) · cites this paper as [83]
Aside from L-type calcium channels, which have some iron carrying capability, no compelling candidates have been identified that transport iron atoms directly into cells.
“However, aside from L-type calcium channels, which have some iron carrying capability, 73 no compelling candidates have been identified that transport iron atoms directly into cells.”
From Forging a field: the golden age of iron biology. (2008) · cites this paper as [73]
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- Authors
- Oudit, G. Y., Sun, H., Trivieri, M. G., Koch, S. E., Dawood, F., Ackerley, C., Yazdanpanah, M., Wilson, G. J., Schwartz, A., Liu, P. P., & Backx, P. H.
- Affiliations
- University of Toronto (CA)
- University of Cincinnati Medical Center (US)
- Hospital for Sick Children (CA)
- University Health Network (CA)
- Corresponding author
- Backx, Peter H
- Venue
- Nature Medicine
- Published
- 2003-08-24
- Volume
- 9
- Issue
- 9
- Pages
- 1187-1194
- ISSN
- 1078-8956 (ISSN-L)
- 1546-170X
- OpenAlex
- W2094765038
- Cited by
- 480
- References
- 65
- Citations by year
- 2026: 11 · 2025: 20 · 2024: 21 · 2023: 23 · 2022: 20 · 2021: 24 · 2020: 19 · 2019: 26 · 2018: 22 · 2017: 21 · 2016: 33 · 2015: 25 · 2014: 19 · 2013: 29 · 2012: 25
- FWCI
- 4.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nature Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Pfizer
- National Institutes of Health
- Canadian Institutes of Health Research
- National Heart, Lung, and Blood Institute (T32HL007382, P01HL022619)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Keywords
- iron overload cardiomyopathy, L-type voltage-dependent calcium channels, iron absorption, cardiomyocytes, divalent cation transport, oxidative stress, calcium channel blockers, amlodipine, verapamil, cardiac function, myocardial fibrosis, iron overload
- MeSH terms
- Animals, Biological Transport, Calcium Channel Blockers, Iron, Male, Mice, Inbred Strains, Cardiomyopathies, Myocardium, Verapamil, Calcium Channels, Survival Rate, Amlodipine, Oxidative Stress, Iron Overload, Myocytes, Cardiac, Mice
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