Objectives. Electrical stimulation of the dorsal aspect of the upper thoracic spinal cord is used increasingly to treat patients with angina pectoris refractory to conventional therapeutic strategies. The purpose of this study was to determine whether spinal cord stimulation (SCS) in dogs affects regional myocardial blood flow and left-ventricular (LV) function before and during transient obstruction of the left anterior descending coronary artery (LAD). Methods. In anesthetized dogs, regional myocardial blood flow distribution was determined using radiolabeled microspheres and left-ventricular function was measured by impedance-derived pressure-volume loops. SCS was accomplished by stimulating the dorsal T1-T2 segments of the spinal cord using epidural bipolar electrodes at 90% of motor threshold (MT) (50 Hz, 0.2-ms duration). Effects of 5-min SCS were assessed under basal conditions and during 4-min occlusion of the LAD. Results. SCS alone evoked no change in regional myocardial blood flow or cardiovascular indices. Transient LAD occlusion significantly diminished blood flow within ischemic, but not in non-ischemic myocardial tissue. Left ventricular pressure-volume loops were shifted rightward during LAD occlusion. Cardiac indices were altered similarly during LAD occlusion and concurrent SCS. Conclusions. SCS does not influence the distribution of blood flow within the non-ischemic or ischemic myocardium. Nor does it modify LV pressure-volume dynamics in the anesthetized experimental preparation.

Indiana University-Purdue University Indianapolis (IUPUI) / Recent clinical outcome studies demonstrate that Sodium glucose cotransporter 2 inhibitors (SGLT2i) significantly reduce major adverse cardiovascular events and heart failure outcomes in subjects with type 2 diabetes mellitus. At present, several hypotheses have been proposed to explain the observed cardiovascular benefit of SGLT2i, however, the mechanisms responsible remain to be elucidated. This investigation tested the hypothesis that SGLT2i improves cardiac function and efficiency during acute, regional ischemia/reperfusion injury via preferential shifts in myocardial substrate selection and/or inhibition of cardiac sodium/hydrogen exchanger-1 (NHE-1). Our initial investigation evaluated the effects of 24 hour pretreatment of the SGLT2i canagliflozin on cardiac contractile function, substrate utilization, and efficiency before and during regional myocardial ischemia/reperfusion injury in healthy swine. At the onset of ischemia, canagliflozin increased left ventricular end diastolic and systolic volumes which returned to baseline with reperfusion. This increased end diastolic volume was directly associated with increased stroke volume and stroke work relative to controls during ischemia. Canagliflozin also increased cardiac work efficiency during ischemia relative to control swine. No differences in myocardial substrate uptake of glucose, lactate, fatty acids or ketones were detected between groups. In separate experiments using a longer 60 min coronary occlusion, canagliflozin significantly diminished myocardial infarct size. Subsequent studies investigated the effect of an acute administration (15-30 min pre-treatment) of canagliflozin and the NHE-1i cariporide on cardiac contractile function efficiency in response to myocardial ischemia/reperfusion injury. Similar to our initial studies, canagliflozin increased diastolic filling, stroke work and improved cardiac work efficiency relative to untreated control hearts during the ischemic period. In contrast, cariporide did not alter ventricular filling volume, cardiac output or work efficiency at any time point. Additional examination of AP-1 cells transfected with wild-type NHE-1 showed dose-dependent inhibition of NHE-1 activity by cariporide, while canagliflozin had minimal effect on overall activity. This investigation demonstrates that SGLT2i improves cardiac function and efficiency during acute, regional ischemia in healthy swine. However, the present data fail to support the hypothesis that these SGLT2i-mediated improvements involve either preferential alterations in myocardial substrate utilization or the inhibition of NHE-1 activity.

Indiana University-Purdue University Indianapolis (IUPUI) / Acute kidney injury (AKI) affects millions of patients worldwide yet has few treatment options. There is a critical need to identify novel interventions for AKI, especially approaches targeting cell types that are central to the disease, such as neutrophils. Neutrophils are professional phagocytic cells that respond early to tissue injury. In rodent models of severe ischemic-reperfusion-injury AKI, neutrophils transiently infiltrate the injured kidney, appearing within 6 hours, and are gone by 72 hours. These infiltrating neutrophils are considered proinflammatory and harmful to tissue repair and recovery of kidney function. However, neutrophils can exhibit atypical activity such as antigen presentation and have a central role in recovery from myocardial ischemic injury. Furthermore, little is known of neutrophil polarization, atypical activity, or neutrophil diversity in AKI. Lastly, the kidney generated and renal-protective immunomodulatory protein uromodulin (Tamm-Horsfall Protein, THP) regulates granulopoiesis. In the absence of uromodulin, there is a systemic increase in neutrophils and mouse kidneys are sensitive to injury in AKI. To elucidate neutrophil diversity in AKI and their sensitivity to uromodulin, I performed a series of single-cell sequencing experiments to generate transcriptional profiles of neutrophils from the blood and kidneys of wild-type and THPknockout mice after renal ischemic-reperfusion-injury (IRI). Neutrophil diversity was detected following IRI of the mouse kidney in the blood and kidney. The distribution of subpopulations was sensitive to the kidney milieu. Within the kidney, this diversity and the transcriptional programs of neutrophil subpopulations was sensitive to the severity of ischemic injury. Lastly, Cxcl3 was uniquely upregulated in specific neutrophils after severe ischemic injury. Using single-cell sequencing of uromodulin knock-out mice, I detected the upregulation of toll-like receptor pathways and complement cascades across neutrophil subpopulations in a THP sensitive manner. Furthermore, CXCR2 ligand expression was a combination of moderate and severe injury in wild-type mice. This confirmed previously reported cytokine dysregulation in the uromodulin knock-out mouse after IRI and uncovers a novel role for Cxcl3. Thus, upon revisiting the well-studied neutrophil, I have uncovered novel neutrophil diversity that correlates with recovery of kidney function in AKI and suggests new roles for an old player.

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21677号 / 医博第4483号 / 新制||医||1036(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 木村 剛, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The use of human adipose-derived mesenchymal stem cells (ASCs) for cell-based therapeutic approaches, in terms of repair and regeneration of various tissues and organs, offers an alternative therapeutic tool in the field of regenerative medicine. The ability of ASCs to differentiate along mesenchymal lineages is not the only property that makes these cells particularly attractive for therapeutic purposes. Their promising functions in promoting angiogenesis, reducing inflammation as well as in functional tissue restoration are largely related to the trophic effects of a broad panel of secreted cytokines and growth factors. However, in cell-based approaches, the cell-loaded construct often is exposed to an ischemic microenvironment characterized by severe oxidative and nutritional stress after transplantation due to the initial lack of vascular connection, resulting in reduced cell viability and altered cell behaviour. Therefore, the effective use of ASCs in regenerative medicine first requires a comprehensive characterization of the cells in terms of their viability, differentiation capacity and especially their secretory capabilities under ischemia-mimicking conditions in order to better understand their beneficial role. Accordingly, in the first part of this work, ASCs were investigated under different ischemic conditions, in which cells were exposed to both glucose and oxygen deprivation, with respect to viability and secretory function. Using mRNA gene expression analysis, significantly higher expression of selected angiogenic, anti-apoptotic and immunomodulatory factors (IL-6, VEGF, STC-1) could be demonstrated under harsh ischemic conditions. These results were reflected at the protein expression level by a significantly increased secretion of these factors. For stanniocalcin-1 (STC-1), a factor not yet described in ASCs, a particularly high expression with significant secreted amounts of the protein could be demonstrated under harsh ischemic conditions. Thus, the first part of this work, in addition to the characterization of the viability, provided first insights into the secretory response of ASCs under ischemic conditions. The response of ASCs to glucose deficiency in combination with severe hypoxia has been little explored to date. Thus, the focus of the second part of this work was on a more detailed investigation of the secretory response of ASCs under glucose and oxygen deprivation. For a more comprehensive analysis of the secretion profile, a cytokine antibody array was performed, which allowed the detection of a broad panel of secreted angiogenic factors (IL-8, ANG), matrix-regulating proteins (TIMP-1, TIMP-2), chemokines (MCP-1/CCL2, IP-10/CXCL 10) and other factors under ischemic conditions. To verify these results, selected factors were examined using ELISA. The analysis revealed that the secretion of individual factors (e.g., STC-1, VEGF) was significantly upregulated by the combination of glucose and oxygen deprivation compared to oxygen deprivation alone. In order to investigate the impact of the secretome of ischemic ASCs on cell types involved in tissue regeneration, the effect of conditioned medium of ischemia-challenged ASCs on both endothelial cells and fibroblasts was investigated in subsequent experiments. Significantly increased viability and tube formation of endothelial cells as well as activated migration of fibroblasts by the secreted factors of ischemic ASCs could be demonstrated. A direct correlation of these effects to STC-1, which was significantly upregulated under ischemic conditions and has been described as a regulator of key cellular functions, could not be verified. The particular secretory capacity of ASCs provides a valuable tool for cell-based therapies, such as cell-assisted lipotransfer (CAL), where by enriching fat grafts with isolated ASCs, a significantly improved survival rate of the transplanted construct is achieved with less resorption of the fat tissue as well as a reduction in adverse implications, such as fibrosis and cyst formation. In order to better understand the function of ASCs in CAL, an autologous transwell-based lipograft-ASC co-culture was established in the last part of this work, in which first investigations showed a markedly increased secretion of VEGF compared to lipografts without added ASCs. As the stability rate of the fat tissue and thus the success of CAL is presumably also dependent on the preparation of the tissue before transplantation, the conventional preparation method of fat tissue for vocal fold augmentation in laryngoplasty was additionally evaluated in vitro in a pilot experiment. By analyzing the viability and tissue structure of the clinically prepared injection material, a large number of dead cells and a clearly damaged tissue structure with necrotic areas could be demonstrated. In comparison, the preparation method of the fat tissue established in this work as small tissue fragments was able to provide a clearly intact, vital, and vascularized tissue structure. This type of adipose tissue preparation represents a promising alternative for clinical vocal fold augmentation. In conclusion, the results of this work contribute to a comprehensive characterization of ASCs under ischemic conditions, such as those prevalent at the transplantation site or in tissue regeneration. The results obtained, especially on the secretory capacity of ASCs, provide new insights into how ASCs mediate regenerative effects in an ischemic milieu and why their use for therapeutic purposes is highly attractive and promising. / Der Einsatz von humanen mesenchymalen Stammzellen aus dem Fettgewebe (ASCs) für zell-basierte Therapieansätze zur Reparatur und Regeneration von verschiedenen Geweben und Organen bietet eine alternative therapeutische Lösung im Bereich der regenerativen Medizin. Die Fähigkeit der ASCs zur Differenzierung in verschiedene mesenchymale Zelltypen ist jedoch nicht die einzige Eigenschaft, die diese Zellen für therapeutische Zwecke besonders attraktiv macht. ASCs sezernieren vielmehr ein breites Spektrum an Zytokinen und Wachstumsfaktoren, die z.B. durch Förderung der Angiogenese oder der Reduktion von Entzündungsprozessen eine wichtige Rolle bei regenerativen Therapien spielen können. Allerdings ist in zellbasierten Ansätzen, das zellbeladene Konstrukt nach der Transplantation – durch den anfänglich fehlenden Gefäßanschluss und die damit einhergehende mangelnde Versorgung des implantierten Gewebes – starkem oxidativem und ernährungsbedingtem Stress, einem ischämischen Milieu, ausgesetzt, was zu einer reduzierten Zellviabilität und einem veränderten Zellverhalten führt. Der effektive Einsatz der ASCs in der regenerativen Medizin erfordert demnach zunächst eine umfassende Charakterisierung der Zellen in Bezug auf deren Lebensfähigkeit, Differenzierungsfähigkeit und insbesondere die sekretorischen Fähigkeiten unter simulierten ischämischen Bedingungen, um ihren therapeutischen Effekt besser verstehen und optimieren zu können. Dazu wurden im ersten Teil dieser Arbeit die ASCs unter verschiedenen ischämischen Bedingungen, bei denen die Zellen sowohl einem Glukose- als auch Sauerstoffmangel ausgesetzt waren, hinsichtlich der Viabilität und der sekretorischen Funktion in vitro untersucht. Durch mRNA Genexpressionsanalysen konnte für ausgewählte angiogene, anti-apoptotische und immunmodulatorische Faktoren (IL-6, VEGF, STC-1) eine signifikant höhere Expression unter stark ischämischen Bedingungen gezeigt werden. Diese Ergebnisse spiegelten sich gleichermaßen auf Proteinebene durch eine signifikant erhöhte Sekretion der Faktoren wider. Für Stanniocalcin-1 (STC-1), einen Faktor, dessen Rolle bislang im Zusammenhang mit ASCs noch nicht beschrieben ist, konnte eine besonders hohe Expression mit signifikanten sezernierten Mengen des Proteins bei hoher ischämischer Belastung der Zellen gezeigt werden. Somit konnten im ersten Abschnitt der Arbeit neben einer ersten Charakterisierung der ASCs auch erste Erkenntnisse über das sekretorische Verhalten der Zellen in einem ischämischen Milieu gewonnen werden. Die Reaktion von ASCs auf Glukosemangel in Kombination mit Hypoxie ist bislang wenig untersucht. Somit lag der Fokus im zweiten Teil dieser Arbeit auf der detaillierteren Untersuchung des Sekretionsverhaltens von ASCs unter Glucose- und Sauerstoffdeprivation. Für eine umfassende Analyse des Sekretionsprofils wurde ein Zytokin-Antikörper-Array durchgeführt, mit welchem die Sekretion eines breiten Panels von angiogenen Faktoren (IL-8, ANG), matrixregulierenden Proteinen (TIMP-1, TIMP-2), Chemokinen (MCP-1/CCL2, IP-10/CXCL 10) sowie weiterer Faktoren unter ischämischen Bedingungen nachgewiesen werden konnte. Zur Verifizierung dieser Ergebnisse wurden ausgewählte Faktoren mittels ELISA untersucht. Durch diese Analyse konnte gezeigt werden, dass die Sekretion einzelner Faktoren (z.B. STC-1, VEGF) durch die Kombination von Glukose- und Sauerstoffentzug deutlich hochreguliert wird, z.B. gegenüber nur dem Entzug von Sauerstoff. Um die Wirkung des Sekretoms von ischämischen ASCs auf Zelltypen, die in der Regeneration von Geweben eine Rolle spielen, zu untersuchen, wurde in nachfolgenden Experimenten die Wirkung von konditioniertem Medium ischämischer ASCs sowohl auf Endothelzellen als auch auf Fibroblasten untersucht. Dabei konnte sowohl eine deutlich gesteigerte Röhrenbildung („tube formation“) von Endothelzellen als auch eine aktivierte Migration von Fibroblasten durch die sezernierten Faktoren der ischämischen ASCs nachgewiesen werden. Ein direkter Zusammenhang dieser Effekte mit dem unter ischämischen Bedingungen signifikant hochregulierten Faktor STC-1, welcher als Regulator zellulärer Schlüsselfunktionen beschrieben wird, konnte hingegen nicht nachgewiesen werden. Die besondere Sekretionsfähigkeit von ASCs stellt ein wertvolles Werkzeug für zellbasierte Therapien dar, wie z.B. den zellassistierten Lipotransfer (CAL), bei dem durch die Anreicherung von Fetttransplantaten mit isolierten ASCs eine deutliche Verbesserung der Überlebensrate des transplantierten Konstrukts mit einer geringeren Resorption des Fettgewebes sowie einer Verringerung von unerwünschten Folgen, wie Fibrosen und Zystenbildung, erzielt wird. Um die Funktion der ASCs im CAL besser charakterisieren zu können, wurde im letzten Teil dieser Arbeit eine autologe Transwell-basierte Lipograft-ASC-Kokultur etabliert, in welcher durch erste Untersuchungen eine signifikant erhöhte Sekretion von VEGF im Vergleich zu den Lipografts ohne Zusatz von isolierten ASCs gezeigt werden konnte. Da die Stabilitätsrate des Fettgewebes und damit der Erfolg des CAL mutmaßlich auch von der Aufbereitung des Gewebes vor der Transplantation abhängig ist, wurde in einem Pilot-Experiment die konventionelle Präparationsmethode von Fettgewebe für die Stimmlippenaugmentation in der Laryngoplastik in vitro evaluiert. Durch Analysen zur Viabilität und Gewebestruktur konnte bei dem klinisch aufbereiteten Injektionsmaterial eine große Anzahl abgestorbener Zellen sowie eine deutlich geschädigte Gewebestruktur mit nekrotischen Arealen nachgewiesen werden. Im Vergleich dazu konnte mit der in dieser Arbeit etablierten Präparationsmethode des Fettgewebes als kleine Gewebsfragmente eine deutlich intakte, vitale und vaskularisierte Gewebestruktur erhalten werden. Damit bietet diese Art der Aufbereitung von Fettgewebe eine vielversprechende Alternative für die klinische Stimmlippenaugmentation.  Zusammengefasst tragen die Ergebnisse dieser Arbeit zu einer umfassenden Charakterisierung von ASCs unter ischämischen Bedingungen bei, wie sie beispielsweise am Transplantationsort oder in der Geweberegeneration vorliegen können. Die gewonnenen Ergebnisse, insbesondere zu den sekretorischen Fähigkeiten der ASCs, liefern neue Erkenntnisse darüber, wie ASCs regenerative Effekte in einem ischämischen Milieu vermitteln und weshalb deren Verwendung für therapeutische Zwecke besonders attraktiv und vielversprechend ist.

Generation of free radicals upon reperfusion has been cited as one of the major causes of ischaemia/reperfusion injury. The following series of experiments was designed to study the effect of manganese superoxide dismutase (MnSOD) overexpression in transgenic mice on ischemia/reperfusion injury. A species of 1.4 kb human MnSOD mRNA was expressed, and a 325% increase in MnSOD activity was detected in the hearts of transgenic mice with no changes in the other antioxidant enzymes or heat shock proteins. Immunocytochemical study indicated an increased labeling of MnSOD mainly in the heart mitochondria of the transgenic mice. When these hearts were perfused as Langendorff preparations for 45 min after 35 min of global ischemia, the functional recovery of the hearts, expressed as heart rate x left ventricular developed pressure, was 52 ± 4% in the transgenic hearts as compared to 31 ± 4% in the non-transgenic hearts. This protection was accompanied by a significant decrease in lactate dehydrogenase release from the transgenic hearts. Overexpression of MnSOD limited the infarct size in vivo in a left coronary artery ligation model. Our results demonstrate that overexpression of MnSOD renders the heart more resistant to ischemia/reperfusion injury.

No description available.

Ataxia-telangiectasia mutated kinase (ATM), a serine/threonine kinase primarily located in the nucleus, is typically activated in response to DNA damage. Individuals with mutations in ATM gene develop a disease called Ataxia telangiectasia (AT). These individuals are more susceptible to ischemic heart disease and metabolic disorder. Our lab has previously shown that ATM plays a critical role in β-adrenergic receptor (β-AR) - and myocardial infarction (MI)-stimulated myocyte apoptosis and cardiac remodeling. This study tested the hypothesis that ATM plays a critical role in cardiac autophagy and glucose metabolism following MI and ischemia, respectively. Early during MI (4 hours after its onset) and 4 hours post-treatment with ATM inhibitor KU-55933, ATM deficiency resulted in autophagic impairment in the heart and in cardiac fibroblasts, respectively. Such autophagic changes in the heart and in cardiac fibroblasts associated with the activation of GSK-3β and mTOR, and inactivation of Akt and AMPK. ATM deficiency also augmented autophagy in the infarct region of the heart 28 days post-MI as well as in cardiac fibroblasts treated with ATM inhibitor KU-55933 for 24 hours. Autophagic changes in the infarct region during ATM deficiency associated with enhanced Akt, Erk1/2, and mTOR activation. Additionally, the lack of ATM accelerated glycolysis and gluconeogenesis and augmented TCA cycle metabolism under non-ischemic conditions. Following a 20 minute global ischemic period, the glycolytic pathway, not the gluconeogenic pathway, was down-regulated during ATM deficiency which was found to be associated with alterations in TCA cycle metabolism. Such metabolic rearrangements associated with changes in the phosphorylation of Akt, GSK-3β, and AMPK alongside alterations in Glut4 protein expression. Thus, ATM deficiency impairs autophagy early after the onset of MI and in cardiac fibroblasts treated with ATM inhibitor KU-55933 for 4 hours. In contrast, ATM deficiency appears to augment autophagy late post-MI in the infarct region of the heart and in cardiac fibroblasts treated with ATM inhibitor KU-55933 for 24 hours. Lack of ATM alters glucose and TCA cycle metabolism with and without ischemia. Such findings implicate ATM as a key player in autophagic changes in the heart in response to MI as well as in glucose metabolism under non-ischemic and ischemic conditions.

Stroke is a devastating neurological disease with limited treatment opportunities. Recent advances in understanding the underlying pathogenesis of cerebral ischemia support the involvement of multiple biochemical pathways in the development of the ischemic injury. The work reported in this thesis was undertaken to investigate the hypothesis that fenamate NSAIDs have neuroprotective properties against ischemic stroke and to explore the underlying mechanisms for any efficacy. Fenamates are non-selective inhibitors of cyclooxygenases. In addition, fenamates are antagonists of non-selective cation channels, subtype-selective modutators of GABAA receptors, weak inhibitors of glutaniate receptors and activators of some potassium channels, all potentially important in the pathogenesis of ischemic stroke, Mefenamic acid, a prototype fenamate, administered by intracerebroventricular (ICV) infusion, reduced the ischemic brain damage and edema volume in the middle cerebral artery occlusion model in male rats. Consistent with these results; systemic administration of mefenamic acid, by multiple intravenous injections, also reduced the ischemic damage and edema volume measured by morphometric analysis and as a function of brain water content. These are the first set of experiments to demonstrate a significant neuroprotective effect of a fenamate against an in vivo model of ischemic stroke. In vitro, mefenamic acid was also shown to reduce glutamate-evoked cell death (excitotoxicity) in a concentration-dependent manner in cultured embryonic rat hippocampal neurons. Similarly, selected other fenamates also reduced excitotoxicity in the rank order (from highest): mefenamic acid > flufenamic acid ≥ meclofenamic acid > niflumic acid supporting the idea that this is a drug class action. Three pharmacological properties of fenamates, cyclooxygenase inhibition, GABAA receptor modulation and potassium channel activation were investigated as the potential mechanism(s} for the neuroprotective effects of mefenamic acid against excitotoxicity. The experimental results suggest that these are not the primary mechanisms for neuroprotective effects of mefenamic acid against glutamate-evoked cell death. Collectively, these data support the hypothesis that fenamate NSAIDs are neuroprotective against experimental models of cerebral ischemia and suggest they should be further investigated as potential pharmacological treatments for stroke.