Altered cardiac repolarization associated with cellular electrophysiological remodeling following chronic testosterone undecanoate administration in a canine model
Authors: Topal L , Pinter J , Polyak A , Farkas A , Farkas A , Virag L , Jost N , Baczko I , Varro A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The influence of testosterone on ventricular ion channels is widely investigated. Despite the legally stipulated availability of different androgen anabolic steroids (AAS), these agents are very popular among young adults, however, the direct effects of supra-physiological testosterone level are still unclear. Supposedly, the chronic use of AASs may result in structural and functional remodeling of the heart.

Purpose
The aim of our study was to investigate the potential electrophysiological effects of chronic administration of testosterone-undecanoate in a canine model in in vivo and in vitro studies.

Methods
Eight male beagle dogs were randomized into control (’Cont’) and treated (’Tr’) groups (n = 4; n = 4). The latter group received 15 mg/kg of long-lasting testosterone-undecanoate intramuscular injections weekly for 3 months. Blood samples were taken for monitoring testosterone levels. To investigate the altered repolarization in conscious dogs electrocardiography studies were performed. Ventricular myocytes were enzymatically dissociated via retrograde perfusion. The transmembrane ionic currents were recorded using the whole-cell configuration of the patch-clamp technique and the action potential duration (APD) was measured by the perforated patch-clamp technique.

Results
Testosterone level was significantly higher in the ‘Tr’ group compared to the ‘Cont’ group (47.02 nm/L vs. 15.23 nm/L; p=0.0002). The chronic treatment did not affect the heart rate between the examined groups (93.7±23.5 vs.108.8±21.4 beats/min), however, it resulted in significantly shortened QT (226±49 vs. 244.9±26.6 ms; p&lt;0.05) and QTc (26.06±2.5 vs. 29.6±3.01 ms, p&lt;0.05) intervals. ECG recordings also presented prolonged PQ (112.1±15.5 vs. 61.65±12.7ms; p&lt;0.05), QRS (72.37±15.4 vs. 61.65±12.7 ms; p&lt;0.05), and Tp-Te (32.95±7.45 vs. 53.46±16.6 ms; p&lt;0.05) intervals in the ‘Tr’ group. Additionally, the APD of isolated left ventricular myocytes significantly shortened in the ‘Tr’ group compared to the ‘Con’ group (235.2±26.7 vs. 283.6±28.5 ms; p&lt;0.05). Patch-clamp experiments revealed increased magnitude of transient outward potassium current (Ito), the inward rectifier potassium current (Ik1), and the slowed delayed rectifier potassium current (Iks) in the ‘Tr’ group.

Conclusion
The repolarization of the canine ventricular myocardium was significantly modified by constantly high level of testosterone. Many beneficial effects are attributed to physiological testosterone levels; however, the supra-physiological testosterone level may lead to potentially harmful alternations in the cardiac repolarization that may promote arrhythmogenesis, especially in the presence of various heart diseases. Presumably, the constantly high testosterone level induced electrophysiological changes may contribute to the development of life-threatening arrhythmias under certain circumstances.