Ouabain-digoxin antagonism in rat arteries and neurones

Classic' cardiotonic steroids (CTSs) such as digoxin and ouabain selectively inhibit Na+,K+-ATPase (the Na+ pump) and, via Na+/Ca2+ exchange (NCX), exert cardiotonic and vasotonic effects. CTS action is more complex than previously thought: prolonged subcutaneous administration of ouabain, but not digoxin, induces hypertension, and digoxin antagonizes ouabain's hypertensinogenic effect. We studied the acute interactions between CTSs in two indirect assays of Na+ pump function: myogenic tone (MT) in isolated, pressurized rat mesenteric small arteries, and Ca2+ signalling in primary cultured rat hippocampal neurones. The classic' CTSs (0.3-10nm) behaved as agonists': all increased MT70 (MT at 70mmHg) and augmented glutamate-evoked Ca2+ (Fura-2) signals. We then tested one CTS in the presence of another. Most CTSs could be divided into ouabain-like (ouabagenin, dihydroouabain (DHO), strophanthidin) or digoxin-like CTS (digoxigenin, digitoxin, bufalin). Within each group, the CTSs were synergistic, but ouabain-like and digoxin-like CTSs antagonized one another in both assays: For example, the ouabain-evoked (3nm) increases in MT70 and neuronal Ca2+ signals were both greatly attenuated by the addition of 10nm digoxin or 10nm bufalin, and vice versa. Rostafuroxin (PST2238), a digoxigenin derivative that displaces H-3-ouabain from Na+,K+-ATPase, and attenuates some forms of hypertension, antagonized the effects of ouabain, but not digoxin. SEA0400, a Na+/Ca2+ exchanger (NCX) blocker, antagonized the effects of both ouabain and digoxin. CTSs bind to the subunit of pump protomers. Analysis of potential models suggests that, in vivo, Na+ pumps function as tetraprotomers (()(4)) in which the binding of a single CTS to one protomer blocks all pumping activity. The paradoxical ability of digoxin-like CTSs to reactivate the ouabain-inhibited complex can be explained by de-oligomerization of the tetrameric state. The interactions between these common CTSs may be of considerable therapeutic relevance.