No / Recent studies have gained positive results using nanoparticles (NPs) in treating atherosclerosis on animals. But their toxicity and application in treating other heart diseases such as heart failure and endocarditis still need proper investigation. Gold nanoparticles (Au-NPs) were chosen as model substances as they have been successfully used in treating cancer. In this study, we use both H9C2 myoblasts and rat peripheral blood mononuclear cells to determine the influence of Au-NP size on their cytotoxicity and cell apoptosis. H9C2 cells were treated with Au-NPs of a diameter of 5, 20, 40 and 100nmfor 24 hrs before their cell viabilities tested by MTT assay, cell apoptosis measured by flow cytometry, and the generation of reactive oxygen species (ROS) detected by Fluorometric Intracellular ROS Kit. Distribution of the Au-NPs and their effects on the structure of mitochondria and lysosome were detected by electron microscopy. In addition, we obtained rat peripheral blood mononuclear cells and treated them with Au-NPs same with H9C2 cell line. Our results showed NPs of 5, 40, and 100 nm reduced cell viabilities on H9C2 cells while20nm showed no change on cell viability (Ctrl: 100±8.2 vs 20nm: 95.39±9.13, P>0.05, n=6) and some protect effect on ISO induced H9C2 cells apoptosis (ISO: 100±13.5 vs 20nm: 80.19±17.36, P>0.05, n=6). All size of Au-NPs reduced cell viabilities on rat peripheral blood mononuclear cells while 40nm showed the least reduction on cell viability (Ctrl: 100.0±3.0 vs 40nm: 76.31±3.68, P<0.001, n=6) and significant protect effect on ISO-induced rat peripheral monocytes apoptosis (ISO: 100±1.86 vs 40nm: 45.34±10.32, P<0.05, n=6). In addition, 20nm Au-NP showed some protect effect on ROS generation on ISO-induced H9C2 cells (ISO: 100±3.79 vs 20nm: 94.84±4.98, P>0.05, n=6), while 40nm produced more ROS (ISO: 100±3.79 vs 40nm: 141.63±42.81, P>0.05, n=6). Electron microscopy detection showed correlated results in structure. These results on H9C2 cell line are basically in agreeable to our animal study. The protective effect of 20nm may due to its ability to protect ISO-induced ROS generation. The results on rat peripheral monocytes are slightly different to those on H9C2 cells. Further investigation need to focus on the role of NPs size on cell apoptosis by detecting autophagy specific protein through western blotting. / Abstract of conference paper.

Previous studies report oxidative stress induced apoptosis and necrosis occur following myocardial infarction. Effects of conditioned medium (CM) prepared from mouse embryonic stem (ES) cells on H2O2 induced apoptosis and necrosis in different cells types is under investigation. Additionally, effects of CM from ES cells primed with TGF-b2 on stress-induced apoptosis and necrosis in H9c2 cells have not been determined. In this study, H20i induced apoptosis was confirmed by trypan blue staining, terminal deoxynucleotide transferase dUTP-mediated nick-end labeling (TUNEL), and apoptotic enzyme labeled immunosorhent assay (ELISA) whereas necrosis was determined by LDH assay. Next, we generated CM from ES cells primed with and without TGF-b2 and determined their effects on H2O2 induced apoptosis and necrosis in H9c2 cells. Apoptosis and necrosis was significantly (P < 0.05) reduced with ES-CM compared with cell culture control. Next, our data showed TGF-B2 primed ES-CM further reduced cell death compared with ES-CM, suggesting increased amounts of cytoprotective released factors from mouse ES cells following TGF-B2 treatment. Furthermore, the treatment of H9c2 cells with TGF-b2 alone did not significantly (P < 0.05) reduce apoptotic cell death. In conclusion, we suggest that factors released from ES cells with and without TGF-B2 treatment contain anti-apoptotic and anti-necrotic factors that inhibit H2O2 induced cell death. Further studies are needed to determine potential additional benefits of the · released factors from TGF-B2 primed ES cells.

O processo de isquemia-reperfusão é responsável pela geração de um dano agudo em uma série de órgãos do corpo humano, e, no coração, é o principal causador da doença crônica conhecida por insuficiências cardíaca. Atualmente não existe nenhuma opção terapêutica disponível na prática clínica contra esta injúria. Com o objetivo de desenvolver uma nova estratégia de combate a este dano, no presente trabalho investigamos a promessa da aplicação da recém-descoberta via UPRam num modelo de hipóxia reoxigenação in-vitro, sem obter sucesso. Contudo, os resultados gerados nestes experimentos forneceram pistas de que o uso do desacoplador CCCP é capaz de reduzir o dano deste insulto, porém o mecanismo celular responsável por esta proteção permanece desconhecido. Tentativas de desvendar este mecanismo utilizando a via lisossomal-autofágica ou a clivagem de OPA-1 falharam, mas produziram importantes insights a respeito do papel da protease mitocondrial OMA-1 no processo de hipóxia-reoxigenação, abrindo caminho para novos estudos subsequentes. / Ischemia-reperfusion injury is a process that occurs in many human organs including the heart, where it is the main trigger to heart failure, a chronic disease that kills over 40% patients only five years following the first diagnosis. Despite the bulky research on the subject, there is no available therapy on clinical practice against this insult. Attempting to develop a novel strategy to mitigate this damage, we investigated if the pro-survival effect of the recently discovered UPRam pathway could be protective in an in-vitro model of ischemia reperfusion. Despite the negative results regarding its conservation on mammalian cells, treatment with the mitochondrial uncoupler CCCP was proven to reduce cell death under this process, but the cellular mechanism responsible for this protection remained elusive. Aspiring to unravel this cellular response, we tested whether autophagy or OPA-1 cleavage was capable of abrogating the verified protection, but the results came back negative. Regardless of that, the behavior of OMA-/- cells over H/R stress has given new insights on novel strategies comprising I/R injury abrogation.

Herbs have been used for many centuries in diverse civilizations for the treatment of heart disease. Only a few natural supplements claim to have direct cardiovascular actions including hawthorn (Crataegus spp.) and berberine derived from the Berberidaceae family. Several different studies indicate important cardiovascular effects of hawthorn and berberine. For example, both exert positive inotropic effects and have been used in the treatment of congestive heart failure. Recently, it was shown that hawthorn extract preparations cause negative chronotropic effects in a cultured neonatal murine cardiomyocyte assay independent of beta-adrenergic receptor blockade. The aim of this study was to further characterize the effect of hawthorn extract to decrease the contraction rate of cultured cardiomyocytes. We hypothesized that hawthorn extract may be acting through muscarinic receptors to decrease contraction rate of cardiomyocytes. Atrial and ventricular cardiomyocytes were treated with hawthorn extract in the presence of atropine or himbacine. Changes in the contraction rate of cultured cardiomyocytes revealed that both muscarinic antagonists significantly attenuated the negative chronotropic activity of hawthorn extract. Using quinuclidinyl benzilate, L-[benzylic-4,4'-3H] ([³H]-QNB) as a radioligand antagonist, the effect of a partially purified hawthorn extract fraction to inhibit muscarinic receptor binding was quantified. Hawthorn extract fraction 3 dose-dependently inhibited [³H]-QNB binding to mouse heart membranes. These findings suggest that muscarinic receptors may be involved in the negative chronotropic effect of hawthorn extracts in neonatal murine cardiomyocytes. Berberine exhibits variable positive and negative chronotropic effects in different species. Our first aim was to examine the effect of berberine in a cultured neonatal murine cardiomyocyte assay. Our study demonstrates that berberine has significant negative chronotropic actions on cardiomyocytes which is not an effect of beta-adrenergic receptor blockade. Pertussis toxin (PTX), a Gi/o protein inhibitor, blocked the negative chronotropic activity of berberine. Muscarinic, adenosine, opioid, and α₂ receptors are coupled through a G-protein (Gi/o) to adenylyl cyclase in an inhibitory fashion. Activation of these receptors are primarily responsible for PTX-sensitive negative chronotropic effects in heart. We hypothesized that berberine may be acting through one of these receptor type to decrease contraction rate of cardiomyocytes. For this purpose, we studied the effects of the muscarinic-receptor antagonists, atropine, himbacine, or AF- DX 116 on the negative chronotropic activity of berberine. Muscarinic antagonists completely blocked the effect of berberine on contraction rate of cardiomyocytes, whereas the bradycardic effect of berberine was not inhibited by the opioid, adenosine, or α2 receptor antagonists naloxone, CGS 15943, or phentolamine, respectively. Using [³H]QNB as a radioligand, we demonstrated that berberine bound to muscarinic receptors of adult mouse heart membranes with relatively high affinity. Furthermore, berberine dose-dependently inhibited [³H]QNB binding to muscarinic M2 receptors exogenously expressed in HEK 293 cells. Therefore, the findings of the present study suggest that berberine has muscarinic agonist effects in cultured neonatal murine cardiomyocytes, potentially explaining reported physiological effects of berberine. Cardiac hypertrophy represents the most important factor in the development of congestive heart failure. We investigated the inhibitory effect of berberine on hypertrophy of H9c2 cells. In rat heart-derived H9c2 myoblast cells treated with different hypertrophic agonists such as insulin growth factor II (IGF-II), arginine vasopressin (AVP), phenylephrine, and isoproterenol, protein content and size of cells were significantly increased compared to control group. However, the number of H9c2 cells after treatment with hypertrophic agonists did not differ significantly compared to control. The increases in area of cells and protein content induced by the hypertrophic agonists were inhibited by treatment with berberine in a concentration-dependent manner. Our findings have provided the first scientific evidence that berberine may have an inhibitory effect on hypertrophy of heart-derived cells, and provide a rationale for further studies to evaluate berberine's cardiac activity. / Graduation date: 2010

The aim of this study was to investigate the mode of action of pavetamine on rat cardiomyocytes. Pavetamine is the causative agent of gousiekte (“quick-disease”), a disease of ruminants characterized by acute heart failure following ingestion of certain rubiaceous plants. Two in vitro rat cardiomyocyte models were utilized in this study, namely the rat embryonic cardiac cell line, H9c2, and primary neonatal rat cardiomyocytes. Cytotoxicity of pavetamine was evaluated in H9c2 cells using the MTT and LDH release assays. The eventual cell death of H9c2 cells was due to necrosis, with LDH release into the culture medium after exposure to pavetamine for 72 h. Pavetamine did not induce apoptosis, as the typical features of apoptosis were not observed. Electron microscopy was employed to study ultrastructural alterations caused by pavetamine in H9c2 cells. The mitochondria and sarcoplasmic reticula showed abnormalities after 48 h exposure of the cells to pavetamine. Abundant secondary lysosomes with electron dense material were present in treated cells. Numerous vacuoles were also present in treated cells, indicative of autophagy. During this exposure time, the nuclei appeared normal, with no chromatin condensation as would be expected for apoptosis. Abnormalities in the morphology of the nuclei were only evident after 72 h exposure. The nuclei became fragmented and plasma membrane blebbing occurred. The mitochondrial membrane potential was investigated with a fluorescent probe, which demonstrated that pavetamine caused significant hyperpolarization of the mitochondrial membrane, in contrast to the depolarization caused by apoptotic inducers. Pavetamine did not cause opening of the mitochondrial permeability transition pore, because cyclosporine A, which is an inhibitor of the mitochondrial permeability transition pore, did not reduce the cytotoxicity of pavetamine significantly. Fluorescent probes were used to investigate subcellular changes induced by pavetamine in H9c2 cells. The mitochondria and sarcoplasmic reticula showed abnormal features compared to the control cells, which is consistent with the electron microscopy studies. The lysosomes of treated cells were more abundant and enlarged. The activity of cytosolic hexosaminidase was nearly three times higher in the treated cells than in the control cells, which suggested increased lysosomal membrane permeability. The activity of acid phosphatase was also increased in comparison to the control cells. In addition, the organization of the cytoskeletal F-actin of treated cells was severely affected by pavetamine. Rat neonatal cardiomyocytes were labelled with antibodies to detect the three major contractile proteins (titin, actin and myosin) and cytoskeletal proteins (F-actin, desmin and β-tubulin). Cells treated with pavetamine had degraded myosin and titin, with altered morphology of sarcomeric actin. Vacuoles appeared in the β-tubulin network, but the appearance of desmin was normal. F-actin was severely disrupted in cardiomyocytes treated with pavetamine and was degraded or even absent in treated cells. Ultrastructurally, the sarcomeres of rat neonatal cardiomyocytes exposed to pavetamine were disorganized and disengaged from the Z-lines, which can also be observed in the hearts of ruminants that have died of gousiekte. It is concluded that the pathological alteration to the major contractile and cytoskeleton proteins caused by pavetamine could explain the cardiac dysfunction that characterizes gousiekte. F-actin is involved in protein synthesis and therefore can play a role in the inhibition of protein synthesis in the myocardium of ruminants suffering from gousiekte. Apart from inhibition of protein synthesis in the heart, there is also increased degradation of cardiac proteins in an animal with gousiekte. The mitochondrial damage will lead to an energy deficiency and possibly to generation of reactive oxygen species. The sarcoplasmic reticula are involved in protein synthesis and any damage to them will affect protein synthesis, folding and post-translational modifications. This will activate the unfolded protein response (UPR) and sarcoplasmic reticula-associated protein degradation (ERAD). If the oxidizing environment of the sarcoplasmic reticula is disturbed, it will activate the ubiquitin-proteasome pathway (UPP) to clear aggregated and misfolded proteins. Lastly, the mitochondria, sarcoplasmic reticula and F-actin are involved in calcium homeostasis. Any damage to these organelles will have a profound influence on calcium flux in the heart and will further contribute to the contractile dysfunction that characterizes gousiekte. / Thesis (PhD)--University of Pretoria, 2010. / Paraclinical Sciences / unrestricted

Contexte : Au cours de la dernière décennie, le nombre de personnes en attente d’une transplantation cardiaque a augmenté d’environ 25%, tandis que le nombre de greffes effectuées chaque année est resté stable. Le taux de décès des patients en attente d’une greffe cardiaque est d’environ 15-20%. Le don d’organe suite à un décès cardiocirculatoire (DDC) est une alternative au don après décès neurologique (DDN) qui a permis d’augmenter le nombre d’organes disponibles comme les poumons, les reins et les foies. Compte tenu de la survenue d’une mort cardiovasculaire dans les protocoles DDC, le cœur est rarement greffé à cause des dommages infligés durant la période d’ischémie chaude. Notre équipe a précédemment démontré que l’utilisation du Celastrol, ainsi que notre analogue synthétique inhibiteur de la HSP90 ont des effets cardioprotecteurs, quand administrés au moment de la reperfusion dans des modèles in vitro de culture cellulaire et ex vivo dans des cœurs de rats montés sur le système de perfusion Langendorff. L’objectif est d’évaluer les mécanismes cardioprotecteurs rapides d’une nouvelle formulation de l’inhibiteur HSP90, et de comprendre l’efficacité de ce nouveau composé synthétique sur deux lignées de cellules : les cardiomyoblastes H9c2 issus de rats et les cardiomyocytes dérivés de cellules souches pluripotentes humaines (iPSC-CMs). Méthodes/Résultats : Les cellules H9c2 et iPSC-CMs ont été cultivées. La signalisation cellulaire a été analysée par western blot pour évaluer le niveau d’activation de ces différentes voies. Suite à l’optimisation des conditions pour les cellules iPSC-CMs, les deux lignées cellulaires ont été mises en condition ischémique (sans glucose, 95% N2, 5% CO2) durant la nuit, puis reperfusées, en conditions normales, avec différentes concentrations de l’inhibiteur HSP90. La viabilité cellulaire ainsi que l’ouverture des pores mitochondriaux (mPTP) ont été évaluées à l’aide de kits d’analyses, la production de radicaux libres d’oxygène à l’aide de kits de fluorescence et l’expression des ARN messagers de gènes antioxydants à l’aide de la réaction en chaîne par polymérase (PCR). Les résultats ont montré une augmentation de l’activation des voies cytoprotectrices quand les deux lignées cellulaires étaient traitées à la concentration 10-6M du composé sans stress 4 ischémique : augmentation de HO-1 and HSP-70 dans les 30 premières minutes et AKT et ERK après 1 heure de traitement et 3 heures de récupération. Contrairement à nos attentes, le traitement au moment de la reperfusion à la concentration 10-6M a montré une diminution de la viabilité des cellules, alors que la concentration 10-7M l’a augmenté. À une concentration de 10- 7M, il y a eu diminution de la production de radicaux libres comparativement au groupe témoin. Comme attendu, cette concentration a aussi démontré une diminution de l’ouverture des mPTP. Tous ces résultats ont été observés, autant dans les cellules humaines que celles de rats. Une évaluation préliminaire de l’expression des gènes antioxydants dans les cellules H9c2 a seulement montré une augmentation de l’expression des gènes CAT et HO-1. Conclusion : Notre groupe de recherche a précédemment démontré l’efficacité des composés issus du Celastrol sur la réduction des dommages myocardiques dus à la reperfusion dans les modèles d’ischémie, incluant l’infarctus du myocarde et la donation après décès cardiocirculatoire. Ces expériences ont montré les effets bénéfiques du nouveau composé synthétique sur l’expression des gènes antioxydants, et sur l’activation d’une série de voies cytoprotectrices permettant la stabilisation de la membrane mitochondriale, réduisant aussi la production de radicaux libres, et améliorant ultimement la survie cellulaire. Des études supplémentaires sont en cours afin d’améliorer la compréhension des modes d’action, des mécanismes et des dosages optimaux du médicament, ce qui nous permettra de commencer les essais sur animaux dans le but d’introduire cette molécule en clinique dans le contexte de don d’organes. / Background: During the last decade, the number of people waiting for a cardiac transplantation has increased by about 25%, while the number of yearly transplant surgeries performed has remained steady. The death rate of patients awaiting heart transplant is about 15-20%. Organ donation after circulatory death (DCD) is an alternative to donation after neurological death (DND) that has allowed to increase the number of available organs like lungs, livers, and kidneys. However, because of the cardiac death in DCD protocols, the heart is rarely used because of the injuries suffered by the warm ischemia period. Our group has previously shown that Celastrol, along with a synthetic HSP90 inhibitor analog, have cardioprotective effects when given as postconditioning agents at the moment of reperfusion in an in vitro model on cellular cultures and an ex vivo model on rat hearts mounted on a Langendorff perfusion system. The objective is to evaluate the rapid cardioprotective mechanisms of a novel formulation of the HSP90 inhibitor compound, and to understand the efficacy of this new synthetic compound on two cell lines: rat H9c2 cardiomyoblasts and human induced pluripotent stem cell-derived cardiomyocytes (iPSCCMs). Methods/Results: H9c2 rat cardiomyoblasts and human iPSC-CMs were cultured. Cell signaling was analyzed by western blot to evaluate pathway activations. Both cell lines were put in ischemic conditions (no glucose, 95% N2, 5% CO2) overnight, then reperfused (normal conditions) with different concentrations of HSP90i after optimizing the human iPSC-CMs’ stress experiment. Cell viability and mitochondrial permeability transition pore (mPTP) opening were evaluated using assays, oxygen-free radical production by fluorescence assay and antioxidant gene messenger RNA expression via polymerase chain reaction (PCR). Results showed an increase in cytoprotective pathway activation when both cell lines were treated with 10-6M of the compound without any stress: HO-1 and HSP-70 in the first 30 minutes while AKT and ERK after 1 hour of treatment and 3 hours of recuperation. Interestingly, treatment with the compound at 10-6M at the moment of reperfusion showed decreased viability of the cells while 10-7M improved it. Free radical production was also decreased at a concentration of 10-7M 6 when compared to the baseline, and as expected, the compound also decreased mPTP opening. These results were seen in both human and rat cell lines. Preliminary evaluation of antioxidant gene expression in H9c2 cells only showed an increase in the expression of the cytoprotective CAT and HO-1 genes. Conclusion: Our research group has previously demonstrated the efficacy of Celastrol compounds in reducing reperfusion damage in myocardial ischemia models, including myocardial infarction and donation after circulatory death. These experiments have shown that the beneficial effects of this new synthetic compound include the expression of antioxidant genes and the launching of a series of cytoprotective pathways that stabilize the mitochondrial membrane, reduce free radical production, and improve cell survival. Additional studies to fully understand the mode of action, the mechanisms and the optimal dosages are underway to allow us to move to animal trials in order to ultimately introduce the molecule in the clinical field in the context of organ donation.

Cardiovascular diseases are among the leading causes of death worldwide and particularly in the developed World. The search for new therapeutic approaches for improving the functions of the damaged heart is therefore a critical endeavour. Myocardial infarction, which can lead to heart failure, is associated with irreversible loss of functional cardiomyocytes. The loss of cardiomyocytes poses a major difficulty for treating the damaged heart since terminally differentiated cardiomyocytes have very limited regeneration potential. Currently, the only effective treatment for severe heart failure is heart transplantation but this option is limited by the acute shortage of donor hearts. The high incidence of heart diseases and the scarcity donor hearts underline the urgent need to find alternative therapeutic approaches for treating cardiovascular diseases. Pluripotent embryonic stem (ES) cells can differentiate into functional cardiomyocytes. Therefore the engraftment of ES cell-derived functional cardiomyocytes or cardiac progenitor cells into the damaged heart to regenerate healthy myocardial tissues may be used to treat damaged hearts. Stem cell-based therapy therefore holds a great potential as a very attractive alternative to heart transplant for treating heart failure and other cardiovascular diseases. A major obstacle to the realisation of stem cell-based therapy is the lack of donor cells and this in turn is due to the fact that, currently, the molecular mechanisms or the regulatory signal transduction mechanisms that are responsible for mediating ES cell differentiation into cardiomyocytes are not well understood. Overcoming this huge scientific challenge is absolutely necessary before the use of stem cell-derived cardiomyocytes to treat the damaged heart can become a reality. Therefore the aim of this thesis was to investigate the signal transduction pathways that are involved in the differentiation of stem cells into cardiomyocytes. The first objective was the establishment and use of cardiomyocyte differentiation models using H9c2 cells and P19 stem cells to accomplish the specific objectives of the thesis. The specific objectives of the thesis were, the investigation of the roles of (i) nitric oxide (ii) protein kinase C (PKC), (iii) p38 mitogen-activated protein kinase (p38 MAPK) (vi) phosphoinositide 3-kinase (PI3K) and (vi) nuclear factor-kappa B (NF-kB) signalling pathways in the differentiation of stem cells to cardiomyocytes and, more importantly, to identify where possible any points of convergence and potential cross-talk between pathways that may be critical for differentiation to occur. P19 cells were routinely cultured in alpha minimal essential medium (α-MEM) supplemented with 100 units/ml penicillin /100 μg/ml streptomycin and 10% foetal bovine serum (FBS). P19 cell differentiation was initiated by culturing the cells in microbiological plates in medium containing 0.8 % DMSO to form embryoid bodies (EB). This was followed by transfer of EBs to cell culture grade dishes after four days. H9c2 cells were cultured in Dulbecco’s Modified Eagle’s medium (DMEM) supplemented with 10% FBS. Differentiation was initiated by incubating the cells in medium containing 1% FBS. In both models, when drugs were employed, they were added to cells for one hour prior to initiating differentiation. Cell monolayers were monitored daily over a period of 12 or 14 days. H9c2 cells were monitored for morphological changes and P19 cells were monitored for beating cardiomyocytes. Lysates were generated in parallel for western blot analysis of changes in cardiac myosin heavy chain (MHC), ventricular myosin chain light chain 1(MLC-1v) or troponin I (cTnI) using specific monoclonal antibodies. H9c2 cells cultured in 1% serum underwent differentiation as shown by the timedependent formation of myotubes, accompanied by a parallel increase in expression of both MHC and MLC-1v. These changes were however not apparent until 4 to 6 days after growth arrest and increased with time, reaching a peak at day 12 to 14. P19 stem cells cultured in DMSO containing medium differentiated as shown by the timedependent appearance of beating cardiomyocytes and this was accompanied by the expression of cTnI. The differentiation of both P19 stem cells and H9c2 into cardiomyocytes was blocked by the PI3K inhibitor LY294002, PKC inhibitor BIM-I and the p38 MAPK inhibitor SB2035800. However when LY294002, BIM-I or SB2035800 were added after the initiation of DMSO-induced P19 stem cell differentiation, each inhibitor failed to block the cell differentiation into beating cardiomyocytes. The NF-kB activation inhibitor, CAPE, blocked H9c2 cell differentiation into cardiomyocytes. Fast nitric oxide releasing donors (SIN-1 and NOC-5) markedly delayed the onset of differentiation of H9c2 cells into cardiomyocytes while slow nitric oxide releasing donors (SNAP and NOC-18) were less effective in delaying the onset of differentiation or long term differentiation of H9c2 cells into cardiomyocytes. Akt (protein kinase B) is the key downstream target of PI3K. Our cross-talk data also showed that PKC inhibition and p38 MAPK inhibition respectively enhanced and reduced the activation of Akt, as determined by the phosphorylation of Akt at serine residue 473. In conclusion, PKC, PI3K, p38 MAPK and NF-kB are relevant for the differentiation of stem cells into cardiomyocytes. Our data also show that the PKC, PI3K and p38 MAPK signalling pathways are activated as very early events during the differentiation of stem cells into cardiomyocytes. Our data also suggest that PKC may negatively regulate Akt activation while p38 MAPK inhibition inhibits Akt activation. Our fast NO releasing donor data suggest that nitric oxide may negatively regulate H9c2 cell differentiation.