Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Context: Cardiovascular diseases are the leading cause of death globally. Myocardial infarction is responsible for the highest number of deaths due to cardiovascular disease. Objective: We have previously shown that acute benfotiamine administration at the onset of reperfusion is associated with decreased infarct size and preserved contractile function in response to ischemia-reperfusion. We aimed to evaluate the involvement of the phosphatidylinositol 3-kinase/Akt (PI3K/Akt) and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pro-survival signaling pathways in mediating these cardioprotective effects. Materials and Methods: Part One - Hearts were rapidly excised from Wistar rats and mounted on a Langendorff perfusion apparatus. After stabilization, hearts were subjected to 30 minutes of regional ischemia and 120 minutes of reperfusion. The control group received no treatment. Experimental groups were treated with 100 μM benfotiamine ± 0.1 μM Tyrphostin AG490 or Wortmannin (inhibitors of JAK2 and PI3K, respectively), dissolved in dimethyl sulfoxide. The vehicle control group received an equivalent dose of dimethyl sulfoxide. All treatments were administered for 20 minutes at the onset of reperfusion. Functional parameters were measured throughout, to test the effects of benfotiamine ± pro-survival pathway inhibitors on functional recovery. In addition, hearts were stained with Evans blue and triphenyltetrazolium chloride to assess the effects of benfotiamine ± pro-survival pathway inhibitors on infarct size. Part Two - Hearts that were perfused ± 30 minutes of global ischemia and ± 20 minutes of benfotiamine administration, were used to assess PI3K/Akt and JAK/STAT signaling in response to ischemia-reperfusion and benfotiamine treatment. As with previous experiments, benfotiamine was administered at a concentration of 100 μM, at the onset of reperfusion. Tissues were assessed by Western blot analysis. Results: 20 minutes of acute benfotiamine administration at the onset of reperfusion led to a decrease in infarct size (35.6 ± 2.4% vs. 55.7 ± 5.0% [p<0.05]). Inhibition of PI3K/Akt signaling by addition of Wortmannin abrogated this infarct-limiting effect (51.5 ± 1.3% vs. 35.6 ± 2.4% [p<0.05]). However, inhibition of JAK/STAT signaling had no effect. There were no significant differences in left ventricular developed pressure, coronary flow rate or heart rate during the experiments. In addition, 20 minutes of acute benfotiamine administration at the onset of reperfusion lead to an increase in phospho-FOXO/FOXO in the cytosolic fraction, but no significant change in phospho-STAT3/STAT3 in the nucleus. Conclusions: Our results suggest that acute benfotiamine administration at the onset of reperfusion may act to reduce infarct size via activation of PI3K/Akt pro-survival signaling. / AFRIKAANSE OPSOMMING: Konteks: Kardiovaskulêre siekte is die hoofoorsaak van sterftes wêreldwyd. Miokardiale infarksie is verantwoordelik vir die grootste aantal sterftes weens kardiovaskulêre siekte. Doel: Ons het voorheen getoon dat akute benfotiamientoediening met die aanvang van reperfusie geassosieer is met „n verkleining in die infarkgrootte, en dit het verder ook die kontraktiele funksie in reaksie op ischemie-reperfusie behou. Ons doel was om die betrokkenheid van die fosfatidielinositol 3-kinase/Akt (PI3K/Akt) en Janus kinase/seintransduseerde en aktiveerder van transkripsie (JAK/STAT) pro-oorlewings seinweg in die mediasie van hierdie kardiobeskermende effekte te evalueer. Materiale en Metodes: Deel een - Harte is vinnig vanuit Wistarrotte verwyder en op die Langendorff-perfusieapparaat gemonteer. Na stabilisering is die harte blootsgestel aan 30 minute regionale ischemie en 120 minute reperfusie. Die kontrole groep het geen behandeling ontvang nie. Eksperimentele groepe is met 100 μM benfotiamien ± 0.1 μM Tirfostien AG490 of Wortmannin (inhibeerders van JAK2 en PI3K, onderskeidelik) behandel, opgelos in dimetielsulfoksied. Die draer-kontrole groep het „n ekwivalente dosis van dimetielsulfoksied ontvang. Alle behandelings is toegedien vir 20 minute aan die begin van die reperfusie. Funksionele parameters is deurgaans gemeet om te toets vir die effekte van benfotiamien ± pro-oorlewingsweg inhibeerders op funksionele herstel. Verder is die harte met Evans-blou en trifenieltetrazoliumchloried gekleur om die effek van benfotiamien ± pro-oorlewingsweg inhibeerders op die infarkgrootte te bepaal. Deel twee - Harte is vir ± 30 minute perfuseer met globale ischemie en ± 20 minute met benfotiamientoediening. Dit was gebruik om PI3K/Akt en JAK/STAT seine as gevolg van ischemie-reperfusie en benfotiamienbehandeling te ondersoek. Soos met die vorige eksperimente, is benfotiamien toegedien by ‟n konsentrasie van 100 μM met die aanvang van reperfusie. Weefsel is ondersoek deur middel van Western blot analise. Resultate: 20 minute van akute benfotiamientoediening, met die aanvang van reperfusie, het tot „n verkleining in die infarkgrootte (35.6 ± 2.4% vs. 55.7 ± 5.0% [p<0.05]) gelei. Inhibering van die PI3K/Akt seinweg deur toediening van Wortmannin het die infark-beperkende effek opgehef (51.5 ± 1.3% vs. 35.6 ± 2.4% [p<0.05]). Inhibering van JAK/STAT seine het egter geen effek getoon nie. Daar was geen beduidende verskille in linkerventrikulêr-ontwikkelde druk, koronêre-vloeitempo of harttempo tydens die eksperimente nie. Verder, 20 minute van akute benfotiamientoediening met die aanvang van reperfusie het „n toename in fosfo-FOXO/FOXO in die sitosoliese-fraksie veroorsaak, maar geen beduidende verandering in fosfo-STAT3/STAT3 is in die nukleus waargeneem nie. Gevolgtrekkings: Ons resultate suggereer dat akute benfotiamientoediening met die aanvang van reperfusie moontlik die infarkgrootte via aktivering van die PI3K/Akt pro-oorlewingsein kan verklein.

Despite the development and use of specialised cardiac preservation solutions, the quality of the donor heart may still be compromised by its obligatory exposure to periods of ischaemia (both cold and warm) followed by reperfusion upon reintroduction of the recipient circulation. This is reflected in Transplant Registry data showing increased primary allograft failure as a function of increasing ischaemic time. The research described in this thesis is designed to further the understanding of the mechanisms by which the donor heart may be adapted to these prolonged periods of ischaemia and reperfusion by the activation of endogenous pro-survival signalling pathways by the addition of pharmacological agents to Celsior, a clinical preservation solution. Studies were conducted in an isolated working rat heart model of donor heart preservation. The first study investigated the cardioprotective effects of a novel inhibitor of poly(ADP-ribose) polymerase 1, INO-1153. Maximum protective effect (after a 6 hour storage period) was observed when the PARP inhibitor was administered prior to cardiac arrest and storage and when the agent was added to the Celsior cardioplegic / storage solution. This protective affect was associated with activation of the Akt signalling pathway and could be prevented by inhibition of Akt phosphorylation and activation. The second study examined functional protection and pro-survival signalling pathway activation in hearts arrested and stored for 6 hours in Celsior supplemented with glyceryl trinitrate (an exogenous source of nitric oxide) and Cariporide (an inhibitor of sodium hydrogen exchange). Here, cardiac protection was accompanied by activation of the ERK 1/2 pro-survival pathway as well as a decrease in apoptosis. The third study examined the cardioprotective effect of supplementation of Celsior with all three agents after an extended (10 hour) period of hypothermic storage. Significant recovery of function was only observed in the triply supplemented hearts, being accompanied by activation of both the Akt and ERK pathways. These studies demonstrate for the first time the feasibility of recruitment of endogenous pro-survival pathways as an approach to increasing the post-storage function of the donor heart. Importantly, for the logistics of clinical transplantation, these pathways can be recruited by addition of appropriate pharmacological agents to the arresting and storage solution.