Genomic upregulation of cardiac Cav1.2α and NCX1 by estrogen in women

Rita Papp, Glenna C.L. Bett, Agnieszka Lis, Randall L. Rasmusson, István Baczkó, András Varró, Guy Salama

Research output: Contribution to journalArticle

8 Citations (Scopus)


Background: Women have a higher risk of lethal arrhythmias than men in long QT syndrome type 2 (LQTS2), but the mechanisms remain uncertain due to the limited availability of healthy control human tissue. We have previously reported that in female rabbits, estrogen increases arrhythmia risk in drug-induced LQTS2 by upregulating L-type Ca2+ (ICa,L) and sodium-calcium exchange (INCX) currents at the base of the epicardium by a genomic mechanism. This study investigates if the effects of estrogen on rabbit ICa,L and INCX apply to human hearts. Methods: Postmortem human left ventricular tissue samples were probed with selective antibodies for regional heterogeneities of ion channel protein expression and compared to rabbit myocardium. Functionally, ICa,L and INCX were measured from female and male cardiomyocytes derived from human induced pluripotent stem cells (iPS-CMs) with the voltage-clamp technique from control and estrogen-treated iPS-CMs. Results: In women (n = 12), Cav1.2α (primary subunit of the L-type calcium channel protein 1) and NCX1 (sodium-calcium exchange protein) levels were higher at the base than apex of the epicardium (40 ± 14 and 81 ± 30%, respectively, P < 0.05), but not in men (n = 6) or postmenopausal women (n = 6). Similarly, in cardiomyocytes derived from female human iPS-CMs, estrogen (1 nM, 1-2 days) increased ICa,L (31%, P < 0.05) and INCX (7.5-fold, - 90 mV, P < 0.01) and their mRNA levels (P < 0.05). Moreover, in male human iPS-CMs, estrogen failed to alter ICa,L and INCX. Conclusions: The results show that estrogen upregulates cardiac ICa,L and INCX in women through genomic mechanisms that account for sex differences in Ca2+ handling and spatial heterogeneities of repolarization due to base-apex heterogeneities of Cav1.2α and NCX1. By analogy with rabbit studies, these effects account for human sex-difference in arrhythmia risk.

Original languageEnglish
Article number26
JournalBiology of sex differences
Issue number1
Publication statusPublished - Aug 14 2017


  • 17-β-estradiol
  • L-type Ca channel
  • Regional heterogeneities in the heart
  • Sex differences in arrhythmia phenotype
  • Sex differences in the human heart
  • Sodium-calcium exchanger

ASJC Scopus subject areas

  • Gender Studies
  • Endocrinology

Fingerprint Dive into the research topics of 'Genomic upregulation of cardiac Cav1.2α and NCX1 by estrogen in women'. Together they form a unique fingerprint.

  • Cite this