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See article by Yanczewski et al. [11] (pages 468–480) in this issue. …After them, the (scientific) philosophers appear…who proclaim that only they are wise and all other mortals are but shadows flapping about. … [The philosophers] build uncountable worlds as …they hypothesize without hesitation causes for …unexplainable things, as if they were secretaries of Nature, architects of all things, as if they appeared among us from a meeting of gods. Meanwhile, Nature laughs at them and their speculations, because that they have uncovered nothing is demonstrated by the fact that they immediately cross their swords on each single issue without results…From Moriae Encomium (the Praise of Folly) by Desiderius Erasmus (1509 AD).For the maintenance of cardiac function, there may be no more important molecule than calcium. During each heartbeat, a small leak of calcium through the voltage-dependent L-type calcium channels (VDLC) triggers massive calcium release from an internal storage pool in the sarcoplasmatic reticulum (SR) through SR-bound ryanodine receptors (RyR) into the cytoplasm of heart muscle cells, which triggers muscle contraction. Cardiac relaxation is initiated by the concerted action of the sodium/calcium exchanger (NCX) and muscle-specific SR calcium ATPase-2 (SERCA2), which resequesters calcium into the internal calcium storage pool, allowing for the next quantal release of calcium. SERCA2 thereby promotes both cardiac relaxation and contractility. Phospholamban, an endogenous muscle-specific SERCA2 inhibitor, interacts with SERCA2, and determines the rate of calcium reuptake into the SR. On top of this elaborate system of calcium pumps, the cardiac β-adrenergic receptor system controls the magnitude of the calcium transient by means of activating protein kinase A (PKA), a kinase that by virtue of its direct phosphorylation of the VDLC, RyR, SERCA2 and phospholamban allows for intracellular calcium transients … *Corresponding author. Tel.: +31-30-212-1800; fax: +31-30-212-1801. Email address: dewindt{at}niob.knaw.nl

Calcium cycling in heart failure: how the fast became too furious