Allosteric activation of Na⁺-Ca²⁺ exchange by L-type Ca²⁺ current augments the trigger flux for SR Ca²⁺ release in ventricular myocytes

The possible contribution of Na⁺-Ca²⁺ exchange to the triggering of Ca²⁺ release from the sarcoplasmic reticulum in ventricular cells remains unresolved. To gain insight into this issue, we measured the "trigger flux" of Ca²⁺ crossing the cell membrane in rabbit ventricular myocytes with Ca²⁺ release disabled pharmacologically. Under conditions that promote Ca²⁺ entry via Na⁺-Ca²⁺ exchange, internal [Na⁺] (10 mM), and positive membrane potential, the Ca²⁺ trigger flux (measured using a fluorescent Ca²⁺ indicator) was much greater than the Ca²⁺ flux through the L-type Ca²⁺ channel, indicating a significant contribution from Na⁺-Ca²⁺ exchange to the trigger flux. The difference between total trigger flux and flux through L-type Ca ²⁺ channels was assessed by whole-cell patch-clamp recordings of Ca²⁺ current and complementary experiments in which internal [Na ⁺] was reduced. However, Ca²⁺ entry via Na ⁺-Ca²⁺ exchange measured in the absence of L-type Ca ²⁺ current was considerably smaller than the amount inferred from the trigger flux measurements. From these results, we surmise that openings of L-type Ca²⁺ channels increase [Ca²⁺] near Na ⁺-Ca²⁺ exchanger molecules and activate this protein. These results help to resolve seemingly contradictory results obtained previously and have implications for our understanding of the triggering of Ca²⁺ release in heart cells under various conditions.