Cardiac Development pp 239-259 | Cite as
Molecular and Pharmacological Aspects of the Developing Heart
Summary
From the evidence presented in this article, it is quite clear that fetal and newborn hearts are functionally less developed as compared to adult hearts. In immature hearts, different pharmacological responses differ from the adult hearts but these are species dependent. Regulation of the sympathetic system and β-adrenoceptor blocking agents which modulate the sympathetic activity affect the myocardium differently at various stages of development from fetus, neonates and adulthood. The role of the renin-angiotensin system is crucial in development as angiotensin II receptors are increased during fetal development and morphogenesis but these decline after birth. Ca2+-handling in neonates is not the same as in adult hearts as the intracellular Ca2+ in newborns is mainly regulated by mechanisms such as Ca2+- influx via L type Ca2+-channels and Na+-Ca2+ exchange in sarcolemma. Furthermore, Ca2+- uptake, storage and release by sarcoplasmic reticulum in neonatal hearts are less developed and thus the effects of various Ca2+-antagonists and other such agents are mediated through the Ca2+-channels and Na+-Ca2+ exchange. Responses to cardiac glycosides that modulate Na+-K+ ATPase and Na+-Ca2+ exchange activities are also determined by developmental changes in the heart. Since phosphodiesterases, which hydrolyze cAMP, undergo developmental changes, the responses of the heart to phosphodiesterase inhibitors vary markedly during the development. Although our understanding of the developmental aspects of the heart has increased significantly, the complexity of the developing heart and the mechanisms of action of different pharmacological agents in the immature heart still remain to be examined carefully.
Keywords
Adenylyl Cyclase Sympathetic Innervation Positive Inotropic Effect Adenylyl Cyclase Activity Adult HeartPreview
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