Étude expérimentale de l'hypothermie ultra-rapide par ventilation liquide totale au cours de situations critiques d'ischémie-reperfusionL’ischémie-reperfusion est une situation rencontrée de façon pluri-quotidienne en anesthésie-réanimation. Sa prise en charge thérapeutique est limitée au traitement de la pathologie causale et à la suppléance des organes défaillants. Dans ce contexte, l’hypothermie possède des effets cyto- et organo-protecteurs pléiotropes, dont les bénéfices pourraient être pénalisés par des délais d’application trop longs. La ventilation liquide totale (VLT) hypotherme est une approche émergente, permettant de refroidir très rapidement un organisme. Elle consiste à ventiler les poumons avec des perfluorocarbones liquides, permettant d’assurer les échanges gazeux, tout en faisant varier la température de ces perfluorocarbones, et en utilisant le poumon comme bio-échangeur thermique.L’objectif de cette thèse était d’investiguer les effets de la VLT hypotherme au cours de la défaillance multi-viscérale dans des modèles d’ischémie-reperfusion systémique chez le lapin.Dans un premier travail, nous avons étudié un modèle d’ischémie-reperfusion par clampage de 30 minutes de l’aorte abdominale supra-cœliaque, suivi par 5 heures de reperfusion. Les animaux témoins développaient une défaillance multi-viscérale d’expression clinico-biologique sévère. Dans le groupe soumis à la VLT, cette stratégie permettait d’abaisser la température à 33°C en moins de 15 minutes, cible thermique maintenue pendant 75 minutes avant réchauffement. Les défaillances cardio-circulatoires, rénales et hépato-splanchniques étaient atténuées de façon pérenne, avec une protection d’autant plus puissante que la VLT était initiée tôt par rapport au clampage.Dans un second travail, nous nous sommes appuyés sur un modèle d’arrêt cardiaque en rythme non choquable par asphyxie, à l’origine d’une mortalité majeure de cause neurologique, et d’un syndrome post-arrêt cardiaque sévère. La VLT hypotherme offrait une neuro- et cardio-protection puissante, et une réduction du syndrome inflammatoire. L’hyperhémie cérébrale, la production d’espèces réactives de l’oxygène et l’augmentation de la perméabilité de la barrière hémato-encéphalique étaient également significativement réduits.Ces travaux démontrent qu’une hypothermie systémique ultra-rapide par VLT hypotherme atténue les effets délétères multi-viscéraux de l’ischémie-reperfusion. La brièveté de la fenêtre temporelle de protection suggère que la rapidité d’obtention de la cible thermique est un élément clef dans le bénéfice permis par cette approche. / Ultra-fast cooling with total liquid ventilation and ischemia-induced multi-organ failureIschemia and reperfusion injury is a major challenge in anesthesiology and critical care. Resolution of the underlying condition and organ replacement therapies are the cornerstone of the treatment. Hypothermia exhibits a myriad of protective effects, but delays of application may blunt its benefits. Ultra-fast cooling with total liquid ventilation (TLV) is an emerging strategy, which consists in lung ventilation with cold perflurocarbons and uses the lungs as a heat exchanger while maintaining normal gas exchanges. Our objective was to investigate the effects of TLV-induced cooling during multiorgan failure caused by systemic ischemia-reperfusion in rabbits.In a first study, the application of 30 minutes of supraceliac aortic cross-clamping followed by 300 minutes of reperfusion led to severe multiorgan failure in control animals. On the contrary, animals submitted to hypothermic TLV reached the temperature of 33°C within less than 15 minutes. Hypothermia was maintained during 75 minutes before rewarming. This brief period of hypothermic TLV attenuated biochemical and histological markers of multiorgan failure. Cardiovascular and liver dysfunctions were limited by this short period of hypothermic TLV, even when started after reperfusion. Conversely, acute kidney injury was limited only when hypothermia was started before reperfusion.In a second study, non-shockable cardiac arrest from respiratory cause was responsible for a high rate of mortality and a severe post-cardiac arrest syndrome. Hypothermic TLV had potent neuro- and cardio-protective effects, as well as reduced inflammatory syndrome. Early preservation of the blood-brain barrier integrity and cerebral hemodynamics as well as reduction in the immediate reactive oxygen species production in the brain, heart, and kidneys were also notable.These studies demonstrate that ultra-fast cooling by TLV alleviates the deleterious effects of ischemia-reperfusion. The optimal duration and timing of TLV-induced hypothermia for end-organ protection in hypoperfusion states remains to be determined.

Die extrakorporale Zirkulation unter Einsatz einer Herz-Lungen-Maschine kann postoperativ zu kontraktilen ventrikulären Funktionsstörungen führen, die Morbidität und Mortalität für betroffene Patienten erhöht. Diese kardiale Dysfunktion bezeichnet man als myokardiales Stunning, welche durch die globale Ischämie ausgelöst wird. Das Phänomen der reversiblen kontraktilen Dysfunktion weißt eine hohe klinische Relevanz auf und ist somit in den vergangenen Jahrzehnten sowohl klinisch als auch experimentell intensiv erforscht worden. Dabei kamen unterschiedlichste Spezies, Methoden und Modelle zum Einsatz. Ziel der vorliegenden Arbeit ist die Etablierung eines neuartigen akut instrumentierten Tiermodells, anhand dessen Folgen des kardiopulmonalen Bypasses und Wirkung des endogenen Opioidsystems auf myokardiales Stunning untersucht werden können. Mit Hilfe des entwickelten Versuchsmodells können die Auswirkungen applizierter Opioidrezeptorantagonisten und die Effekte der kardiopulmonalen Zirkulation auf die kontraktile myokardiale Dysfunktion valide untersucht werden. Als Versuchstiere wurden 50 männlich kastrierte Schweine der Rassenkreuzung „Deutsche Landrasse“ und „Yorkshireschwein“ eingesetzt. In Allgemeinanästhesie wurden die Tiere über eine Thorakotomie instrumentiert und anschließend elektrisch Kammerflimmern induziert. Nach Erreichen einer stabilen extrakorporalen Zirkulation unter der Herz-Lungen-Maschine wurde nach Ablauf der ischämischen Phase eine standardisierte Reaninmation und Weaning durchgeführt. Alle 50 Tiere konnten den Versuch erfolgreich durchlaufen. Die Analyse und Auswertung sämtlicher archivierter Daten und Proben der Versuchstiere wurde zu einem späteren Zeitpunkt durchgeführt.

La thérapie cellulaire est au centre de la médecine régénérative, une nouvelle avenue thérapeutique en constante évolution depuis les 2 dernières décennies, particulièrement pour les maladies touchant les organes avec très faible potentiel de régénération. Parmi les nombreuses populations de cellules souches identifiées jusqu’à présent, les cellules souches mésenchymateuses (MSC) offrent plusieurs avantages, notamment en cardiopathie ischémique. Les MSC originalement isolées de la moelle osseuse (MO) sont à présent isolées de plusieurs autres organes dont le tissu adipeux (cellules souches mésenchymateuses dérivées du tissu adipeux ASC), un organe facile d’accès et disponible en grande quantité chez l’humain. Les évidences précliniques et cliniques des MSC et ASC pointent vers une efficacité thérapeutique qui demeure limitée et nécessite une optimisation pour atteindre le potentiel de guérison et de réparation myocardique post injure ischémique. Malgré un potentiel de différenciation in vitro et in vivo, l’effet thérapeutique des cellules souches est lié aux nombreux médiateurs constituant leur sécrétome. Ainsi, afin d’optimiser l’impact thérapeutique, plusieurs méthodes ont été utilisées pour enrichir le sécrétome. Une de ces méthodes est la culture des cellules souches sous forme 3-D. Nous avons donc testé le potentiel thérapeutique des ASC sous forme de monocouche (ML pour Monolayer) et sous forme de sphéroïdes (SB pour spheroid bodies) dans deux modèles animaux différents. Ceci a été fait en testant l’efficacité d’une transplantation à distance sous cutanée. En utilisant un modèle de péritonite, les ASC sous forme SB et ML ont démontré un effet antiinflammatoire en réduisant l’infiltration de cellules inflammatoires, plus spécifiquement les neutrophiles et les macrophages. Dans un modèle d’ischémie reperfusion (I/R) du myocarde chez le rat, les ASC sous forme ML et SB ont diminué la cicatrice du myocarde. Les deux formes injectées ont réduit la présence de macrophages dans le myocarde, augmenté les cellules progénitrices endogènes c-kit+ ainsi que la densité vasculaire. Les SB ont démontré un impact plus significatif sur certains paramètres évalués tels la densité vasculaire et le recrutement de cellules progénitrices endogènes c-kit+. En conclusion, ces deux études ont permis de démontrer un potentiel pro-guérison des cellules souches, par l’entremise d’un effet endocrinien anti-inflammatoire. / The therapeutic potential of regenerative medicine and cell-based strategies have been in constant evolution for the last 2 decades, especially for the repair and healing of organs with minimal regenerative capacity such as the heart. Mesenchymal stem cells (MSC) represent a population of stem cells with great advantages. First isolated from bone marrow, they can now be readily isolated from different organs including adipose tissue. Adipose derived stem cells (ASC) are easily accessible, which is of great interest for clinical application. Beside their differentiation potential, the main therapeutic impact attributed to MSC and ASC has been through their secreted mediators i.e. via a paracrine phenomenon. Different strategies have been used to enhance the therapeutic impact of ASC, one of which consists of enriching the latter’s secretome by producing 3-D structures such as spheroid bodies. Monolayer (ML) and spheroid bodies (SB) were both used in two different animal models through remote (subcutaneous) transplantation. First, on a rat peritonitis model that proved that subcutaneous injection of the two forms reduced inflammation through decreased neutrophil and macrophage infiltration. Second, ML and SB were remotely transplanted on a rat myocardial ischemia reperfusion (I/R) model. The two forms reduced infarct scar, reduced macrophages, increased endogenous progenitor c-kit+ cells and enhanced vascular density in the infarct and peri-infarct area. SBs showed better impact on vascularization and endogenous progenitor cells recruitment compared to ML. Briefly, our studies demonstrated the efficacy of a remote ASC transplantation through an endocrine-like effect against inflammation, collagen deposition and vascularization.

Background: Arterial and venous thromboses associated with the coronavirus disease 2019 (COVID-19) have been well described. These events are caused by a hypercoagulable state due to endotheliopathy and infection-driven coagulopathy. There has been an ever-increasing number of documented cases of aortic thrombosis (AoT) in COVID-19 patients. We conducted a systematic review of current scientific literature to identify and consolidate evidence of AoT in COVID-19 patients. Methods: A systematic review of literature was conducted between March 15, 2020, and May 1, 2021, on PubMed and Cochrane databases. Additionally, a case from our facility was included. Results: A total of 38 studies (12 case series and 26 case reports) and a case from our facility describing AoT in 56 COVID-19 patients were included. Patients were aged 64.8 ± 10.5 years, were predominantly male (75%), and had several comorbidities. AoT was symptomatic in 82,14% of patients; however, when D dimers were reported, they were significantly elevated even in otherwise asymptomatic patients. Most patients had no previous history of aortic disease. Thrombosis was described in all parts of the aorta, with several cases reporting multiple locations. The median reported time until development of AoT was 10 days. Peripheral thrombosis occurred in 73.21% of cases, most commonly causing lower limb ischemia. Mortality rate was 30.4%. Conclusions: AoT can occur with no clinical symptoms or as a primary symptom in otherwise asymptomatic COVID-19 patients. D dimers are a highly sensitive diagnostic tool. Diagnosis of this condition prior to development of complications could be instrumental in saving many lives.

Activation of A3 adenosine receptors has been shown to protect the myocardium from ischaemia reperfusion injury in a number of animal models. The PI3K - AKT and MEK1/2 - ERK1/2 cell survival pathways have been shown to play a critical role in regulating myocardial ischaemia reperfusion injury. In this study we investigated whether the A3 adenosine receptor agonist 2-CL-IB-MECA protects the myocardium from ischaemia reperfusion injury, when administered at reperfusion or post reperfusion and whether the protection involved the PI3K – AKT or MEK 1/2 – ERK1/2 cell survival pathways. In the Langendorff model of ischaemia reperfusion injury isolated perfused rat hearts underwent 35 minutes of ischaemia and 120 minutes of reperfusion. Administration of 2-CL-IB-MECA (1nM) at reperfusion significantly decreased infarct size to risk ratio compared to non-treated ischeamic reperfused control hearts. This protection was abolished in the presence of the PI3K inhibitor Wortmannin or MEK1/2 inhibitor UO126. Western blot analysis determined that administration of 2-CL-IB-MECA (1 nM) upregulated ERK1/2 phosphorylation. In the adult rat cardiac myocyte model of hypoxia/reoxygenation cells underwent 6 hours of hypoxia and 18 hours of reoxygenation. Administration of 2-CL-IB-MECA (1 nM) at the onset of reoxygenation significantly decreased cellular apoptosis and necrosis. Administration of 2-CL-IB-MECA (1nM) in the presence of the Wortmannin or UO126 significantly reversed this anti-apoptotic effect and anti-necrotic effect. Our data further showed that 2-CL-IB-MECA protects myocytes subjected to hypoxia/reoxygenation injury via decreasing cleaved-caspase 3 activity that was abolished in presence of the PI3K inhibitor but not in the presence of the MEK1/2 inhibitor UO126. Administration of 2-CL-IB-MECA (100nM) at the onset of reperfusion also significantly decreased infarct size to risk ratio in the ischaemic reperfused rat heart compared to controls that was reversed in the presence of Wortmannin or Rapamycin. This protection was associated with an increase in PI3K-AKT / p70S6K / BAD phosphorylation. 2-CL-IB-MECA (100nM) administered at reoxygenation also significantly protected adult rat cardiac myocytes from hypoxia/reoxygenation injury 28 in an anti-apoptotic and anti-necrotic manner. This anti-apoptotic/necrotic effect of 2-CL-IB-MECA was abolished in the presence Wortmannin. Furthermore, that this protection afforded by 2-CL-IB-MECA (100nM) when administered at reoxygenation was associated with a decrease in cleaved caspase 3 activity that was abolished in the presence of the Wortmannin Interestingly, postponing the administration of 2-CL-IB-MECA to 15 or 30 minutes after the onset of reperfusion significantly protected the isolated perfused rat heart from ischaemia reperfusion injury in a Wortmannin and UO126 sensitive manner. This protection was associated with an increase in AKT and ERK1/2 phosphorylation. Administration of the A3 agonist 2-CL-IB-MECA 15 or 30 minutes after the onset of reoxygenation significantly protected isolated adult rat cardiac myocytes subjected to 6 hours of hypoxia and 18 hours of reoxygenation from injury in an anti-apoptotic/necrotic manner. This anti-apoptotic was abolished upon PI3K inhibition with Wortmannin or MEK1/2 inhibition with UO126. The anti-necrotic effect of 2-CL-IB-MECA when administered 15 or 30 minutes post-reperfusion was not abolished in the presence of the inhibitors. Delaying the administration of 2-CL-IB-MECA to 15 or 30 minutes after reoxygenation was associated with a decrease in cleaved-caspase 3 activity that was abolished in the presence of Wortmannin but not in the presence of the MEK 1/2inhibitor UO126. Collectively, we have demonstrated for the first time that administration of 2-CL-IB-MECA at the onset of reperfusion protects the ischaemic reperfused rat myocardium from lethal ischaemia reperfusion injury in a PI3K and MEK1/2 sensitive manner. Delaying the administration of 2-CL-IB-MECA to 15 or 30 minutes after the onset of reperfusion of reoxygenation also significantly protects the isolated perfused rat heart from ischaemia reperfusion injury and the adult rat cardiac myocyte from hypoxia/reoxygenation injury in an anti apoptotic / necrotic manner. Furthermore, that this protection is associated with recruitment of the PI3K-AKT and MEK1/2 – ERK1/2 cell survival pathways.

Thesis (MScMed)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: Protein kinases and phosphatases play important roles in the phosphorylation state of intracellular proteins under both physiologic and pathophysiologic conditions. Compared to the large number of studies investigating the significance of kinases, in particular the mitogen-activated protein kinases (MAPKs) in myocardial ischaemia/reperfusion and ischaemic preconditioning, relatively few studies have been done on the protein phosphatases in this scenario. Although several role players in the signal transduction cascade of ischaemia/reperfusion and ischaemic preconditioning have been identified thus far, the exact mechanism of cardioprotection still remains unclear. Previous studies from our laboratory have shown that the stress kinase, p38 MAPK, has a dual role in preconditioning: it acts as trigger of the process, while attenuation of its activation during sustained ischaemia and reperfusion is required for cardioprotection. Since the activation of p38 MAPK is dependent on both the upstream kinases for phosphorylation and phosphatases for dephosphorylation, we hypothesized that the balance between the activation state of the MAPKs and the induction of phosphatases may play a major role in determining the fate of cardiomyocytes exposed to ischaemic stress. The objectives of this study were: (i) to assess the activity of the myocardial protein phosphatases (PSPs and PP1) during sustained ischaemia and during reperfusion of non-preconditioned and ischaemic preconditioned hearts; (ii) to evaluate the significance of these phosphatases in ischaemia/reperfusion as well as in ischaemic preconditioning using available appropriate inhibitors; (iii) to give particular attention to the role of the phosphatase, mitogen-activated protein kinase phosphatase-1 (MKP-1), in ischaemia/reperfusion. MKP-1 is upregulated by stress conditions and selectively inactivates p38 MAPK by dephosphorylation of the regulatory Thr and Tyr residues. The glucocorticoid, dexamethasone which increases MKP-1 expression, was used as agonist to upregulate MKP-1 experimentally. The isolated perfused working rat heart was used as experimental model. After stabilization, hearts were subjected to either a one-cycle or multi-cycle ischaemic preconditioning protocol, followed by sustained global or regional ischaemia and reperfusion. Non-preconditioned hearts were subjected to ischaemia/reperfusion only. For Western blot analysis of MAPKs, PKB/Akt and MKP-1, hearts were freeze-clamped at different times during the perfusion protocol. Endpoints were infarct size, functional recovery and phosphorylation of the MAPKs (ERK and p38 MAPK) and PKB/Akt during reperfusion. Expression of MKP-1 was monitored. The results obtained showed that activation of PSPs and PP1 does not occur during sustained global ischaemia or reperfusion of non-preconditioned and preconditioned hearts. The role of the phosphatases was subsequently further investigated using two inhibitors namely cantharidin (5 μM, a concentration which inhibits both PP1 and PP2A) and okadaic acid (7.5 nM, a concentration which inhibits PP2A selectively). Administration of cantharidin or okadaic acid during the preconditioning phase, completely abolished preconditioning induced cardioprotection as indicated by mechanical failure during reperfusion and increased infarct size, associated with increased phosphorylation of p38 MAPK and PKB/Akt and dephosphorylation of ERK42/44. These results suggest a role for PP2A in the trigger phase of preconditioning. Administration of cantharidin or okadaic acid during early reperfusion of preconditioned hearts improved functional recovery. This was associated with increased phosphorylation of ERK42/44 and PKB, but not p38 MAPK. Dexamethasone, administered intraperitoneally to rats for 10 days (3mg/kg/day) or directly added to the perfusate (1 μM) resulted in significant cardioprotection of hearts subjected to 20 min sustained global ischaemia, followed by 30 min reperfusion. This is associated with a marked upregulation of MKP-1 and dephosphorylation of p38 MAPK during reperfusion. These studies suggest that the phosphatases are definitely involved in the phenomenon of ischaemia/reperfusion and ischaemic preconditioning. However, it also become clear that extensive further research is required to fully elucidate which phosphatases are involved and the mechanisms thereof. Due to the large size of the protein phosphatase family, this may prove to be a formidable task and far beyond the scope of this thesis. The results also suggested that pharmacological targetting of phosphatases involved in phosphorylation of the reperfusion injury salvage kinase (RISK) pathway (e.g. ERK42/44 and PKB/Akt) or dephosphorylation of pro-apoptotic kinases, such as p38 MAPK, may have significant clinical potential. / AFRIKAANSE OPSOMMING: Proteïenkinases en fosfatases speel 'n belangrike rol in die fosforileringstatus van intrasellulêre proteïene in beide fisiologiese en patofisiologiese toestande. In teenstelling met die groot aantal studies gedoen ten einde die rol van die kinases, veral die mitogeen-geaktiveerde proteïenkinases (MAPKs), in iskemie/herperfusie en iskemiese prekondisionering te ondersoek, is relatief min bekend aangaande die rol van die fosfatases in hierdie scenario. Hoewel verskeie rolspelers in die seintransduksieprosesse van iskemie/herperfusie en iskemiese prekondisionering reeds geïdentifiseer is, is die presiese meganisme van miokardiale beskerming steeds onbekend. Vroeëre studies vanuit ons laboratorium het getoon dat die streskinase, p38 MAPK, 'n tweeledige rol in prekondisionering speel: dit is 'n sneller ("trigger") van die proses, terwyl verlaagde aktivering tydens volgehoue iskemie en herperfusie, noodsaaklik vir beskerming is. Ons hipotese is dus dat die balans tussen die aktiveringstatus van die MAPKs en induksie van fosfatases die oorlewing van kardiomiosiete blootgestel aan iskemiese stres, bepaal. Die doelwitte van hierdie studie was: (1) bepaling van die aktiwiteit van miokardiale proteïen fosfatases (PSPs en PP1) tydens volgehoue iskemie en herperfusie van nie-geprekondisioneerde en iskemies-geprekondisioneerde harte; (ii) evaluering van die belang van fosfatases in iskemie/herperfusie beskadiging sowel as in iskemiese prekondisionering deur van geskikte inhibitore gebruik te maak; (iii) ondersoek na die rol van die fosfatase, mitogeen-geaktiveerde proteïen kinase fosfatase-1 (MPK-1) in iskemie/herperfusie beskadiging. Dit is bekend dat MKP-1 deur strestoestande opgereguleer word en p38 MAPK selektief deur defosforilasie van die regulatoriese Thr en Tyr residue inaktiveer word. Die glukokortikoïed, deksametasoon, wat MKP-1 uitdrukking stimuleer, is as agonis gebruik ten einde MKP-1 eksperimenteel op te reguleer. Die geïsoleerde, geperfuseerde werkende rothart is as eksperimentele model gebruik. Na stabilisasie, is die harte aan 'n enkel- of veelvuldige siklus iskemiese prekondisioneringsprotokol onderwerp, gevolg deur volgehoue globale of streeksiskemie. Nie-geprekondisioneerde harte is slegs aan iskemie/herperfusie onderwerp. Harte is op verskillende tye tydens die perfusieprotokol gevriesklamp vir Western blot analise van die MAPKs, PKB/Akt en MKP-1. Infarktgrootte en funksionele herstel tydens herperfusie is as indikators van iskemiese beskadiging gebruik. Fosforilasie van MAPKs en PKB/Akt sowel as uitdrukking van MKP-1 tydens vroeë herperfusie is gemonitor. Die resultate toon dat aktivering van PSP en PP1 tydens volgehoue iskemie en herperfusie nie plaasvind nie. Die rol van die fosfatases is verder ondersoek deur van twee inhibitore gebruik te maak, naamlik cantharidin (5 μM inhibeer beide PP1 en PP2A) en okadaic suur (7.5 nM inhibeer PP2A selektief). Toediening van of cantharidin of okadaic suur tydens die prekondisioneringsprotokol, hef prekondisionering-geïnduseerde beskerming totaal op, soos aangetoon deur hartversaking tydens herperfusie en 'n toename in infarktgrootte, tesame met 'n toename in die fosforilering van p38 MAPK en PKB/Akt en defosforilering van ERK42/44. Hierdie waarnemings dui op 'n rol vir PP2A as sneller in prekondisionering. Toediening van hierdie inhibitore tydens vroeë herperfusie het ook die miokardium beskerm, soos aangetoon deur 'n verbeterde meganiese herstel van geprekondisioneerde harte, tesame met ‘n verhoogde fosforilering van ERK42/44 en PKB (maar nie p38 MAPK nie). Deksametasoon, intraperitoneaal toegedien, vir 10 dae (3mg/kg/dag) of direk by die perfusaat gevoeg (1μM), het tot 'n hoogs beduidende beskerming teen iskemiese beskadiging gelei van harte blootgestel aan 20 min globale iskemie en 30 min herperfusie. Hierdie toename in funksionele herstel en afname in infarktgrootte het met 'n toename in MKP-1 uitdrukking en defosforilasie van p38 MAPK gepaard gegaan. Bogenoemde resultate dui op 'n definitiewe betrokkenheid van fosfatases in iskemie/herperfusie en iskemiese prekondisionering. Dit is egter ook duidelik dat intensiewe verdere navorsing benodig word om die presiese rol van die fosfatases te bepaal. Vanweë die grootte van die fosfatase familie, val dit egter buite die beskek van hierdie studie. Ten slotte, die resultate toon dat farmakologiese manipulasie van fosfatases betrokke by die fosforileringstatus van anti-apoptotiese kinases soos ERK42/44 en PKB/Akt en defosforilasie van pro-apoptotiese kinases, soos p38 MAPK, besondere kliniese toepassings mag hê.

Thesis (MScMedSc)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: It is well-established that transient activation of the β-adrenergic signalling pathway with ligands such as isoproterenol, formoterol and dobutamine, elicits cardioprotection against subsequent long periods of ischaemia. Initially the focus was on the β1- and β2-adrenergic receptors (β1-AR, β2-AR), but recently the β3-AR also emerged as a potential target in the treatment of heart disease. In heart failure, β1- and β2-AR are typically known to be down-regulated while β3-ARs, on the other hand, are up-regulated (Moniotte et al., 2001). Thus, it has become important to examine the significance of the β3-AR and its downstream signalling under similar states of stress. It has been shown that β3-AR stimulation is resistant to short term agonist-promoted desensitization in vitro and in vivo (Liggett et al., 1993) and after being activated, this receptor is able to convey continual intracellular signals (Lafontan et al., 1994). Thus, it could be an ideal target for therapeutic intervention, also in ischaemic heart disease. We hypothesized that selective β3-AR stimulation during ischaemia / reperfusion may be cardioprotective, whereas selective inhibition of this receptor may prove useful in the end stages of sustained ischaemia and early reperfusion. Methods: The isolated working rat heart, subjected to 35 min of regional ischaemia (RI) and 60 min reperfusion was used as model. The β3-AR agonist (BRL37344) (1 μM) or antagonist (SR59230A) (0.1 μM) were applied as follows: (i) before 35 min RI (PT), (ii) during the last 10 min of RI (PerT) and /or (iii) at the onset of reperfusion (PostT) and (iv) administration of BRL37344 during the last 10 min of RI BRL37344 (PerT) was followed by SR59230A during first 10 min of reperfusion SR59230A (Post). The contribution of nitric oxide synthase (NOS) in β3-AR was assessed, using the non-specific NOS inhibitor, L-NAME (50 μM). Endpoints were functional recovery and infarct size. In another set of experiments BRL37344 and SR59230A were applied according to the same protocols, but the left ventricle was dissected from the heart and freeze clamped at 10 min reperfusion for Western blot analysis of extracellular signal-regulated kinase (ERK p44/p42), protein kinase B (PKB/Akt), glycogen synthase kinase-3β (GSK-3β), and endothelial nitric oxide synthase (eNOS). Data were analyzed with one or two-way analysis of variance (ANOVA). Results: Administration of the selective β3-AR agonist (BRL37344) (1μM) before 35 min RI (BRL37344 (PT), significantly reduced infarct size when compared to the non-pretreatment group (NPT) (21.43±2.52 vs 43.17±1.20, p < 0.001). BRL37344 had similar effects on infarct size when applied during the last 10 min of regional ischaemia BRL37344 (PerT) (14.94±2.34, vs NPT, p < 0.001) or at the onset of reperfusion BRL37344 (PostT) (19.06±1.81, vs NPT, p < 0.001). When BRL37344 was applied as a (PerT+PostT) strategy, infarct size was once again significantly reduced (20.55±2.01 vs 43.17±1.20, p <0.001). In contrast, administration of the β3-antagonist SR59230A according to the same protocol did not reduce infarct size and values similar to those of untreated hearts (NPT) were obtained. Surprisingly, when BRL37344 was applied during the last 10 min of regional ischaemia followed by the administration of the β3-AR antagonist (SR59230A) at the onset of reperfusion, [BRL37344 (PerT) & SR59230A (PostT)], infarct size was significantly reduced to 20.78±3.02 (p <0.001 vs NPT and SR59230A (PerT + PostT). Involvement of nitric oxide (NO) was shown since the reduction in infarct size elicited by BRL37344 was totally abolished by, L-NAME, when administered in combination with BRL37344 for 10 minutes prior to RI or at the onset of reperfusion for 10 minutes (% infarct size: 41.48±3.18 and 35.75±3.54, p <0.001 vs BRL37344 (PT) and BRL37344 (PostT), respectively. Western blot results show that PKB/Akt is activated by BRL37344 regardless of the time of administration. The intervention BRL37344 (PerT+PostT), exhibited the most significant phosphorylation of PKB/Akt (fold increase: 14.2±3.71, p<0.01 vs NPT and p<0.05 vs BRL37344 (PostT). In addition, BRL37344 (PT), (PerT), (PostT) and [BRL37344 (PerT) +SR59230A (PostT)] showed significant activation of this kinase (2.92±0.22, 5.54±0.43, 4.73±0.47, and 6.60±0.78, respectively). ERKp44/p42 however, was not significantly activated by any of the treatments. Phosphorylation of eNOS and GSK-3β was significant only in the BRL37344 (PerT+PostT) and [BRL37344 (PerT) + SR59230A (PostT)] groups. The activation of eNOS-S-1177 in the BRL37344 (PerT+PostT) group was (2.82±0.46, p<0.01 and 0.05 vs NPT and BRL37344 (PostT), respectively) and in the [BRL37344 (PerT) + SR59230A (PostT)] group was (2.26±0.48, p<0.05 vs NPT). A very significant increased phosphorylation of GSK-3β was seen in the same two groups (68.8±7.73, p<0.001 vs NPT and 25.5±5.42 vs NPT, p<0.05, respectively). Conclusion: β3-AR has potent cardioprotective effects when administered either before, during and after ischaemia during early reperfusion as indicated by the reduction in infarct size as well as activation of PKB, GSK-3β and eNOS. These beneficial effects can be linked to NO production through activation of eNOS. / AFRIKAANSE OPSOMMING: Dit is bekend dat verbygaande aktivering van die β-adrenerge seinpad, met ligande soos isoproterenol, formoterol en dobutamien, die hart teen daaropvolgende lang periodes van iskemie beskerm. Aanvanklik was die fokus op die β1- en β2-adrenerge reseptore (β1-AR, β2-AR); maar onlangs is ook die β3-AR as 'n potensiële teiken in die behandeling van hartsiektes ge-eien. In hartversaking, is dit bekend dat β1- en β2-AR afreguleer word, terwyl β3-ARs, aan die ander kant, opreguleer word (Moniotte et al., 2001). Dit het dus belangrik geword om die belang van die β3-AR en sy stroomaf seinpad onder soortgelyke strestoestande te ondersoek. Dit is bewys dat β3-AR stimulasie teen korttermyn agonis geïnduseerde desensitisering in vitro en in vivo bestand is (Liggett et al., 1993) en wanneer geaktiveer, is hierdie reseptor in staat om intrasellulêre seine voortdurend oor te dra (Granneman, 1995). Dit kan dus ‘n ideale teiken vir terapeutiese intervensie wees, ook in iskemiese hartsiekte. Ons hipotetiseer dat selektiewe β3-AR stimulasie tydens iskemie / reperfusie kardiobeskermende mag wees, terwyl selektiewe inhibisie van hierdie reseptor effektief kan wees in die eindstadia van volgehoue iskemie en vroeë herperfusie. Metodes: Die geïsoleerde werkende rothart, onderwerp aan 35 min van streeksiskemie (SI) en 60 min herperfusie, is as model gebruik. Die β3-AR agonis (BRL37344) (1μM) of antagonis (SR59230A) (0.1 μM), is as volg toegedien: (i) voor 35 min SI (PT), (ii) gedurende die laaste 10 min van SI (PerT) en / of (iii) tydens die aanvang van herperfusie (PostT) en (iv) gedurende die laaste 10 min van SI is BRL toediening BRL37344 (PerT) gevolg deur SR59230A tydens die eerste 10 min van herperfusie SR59230A (Post). Die rol van stikstofoksiedsintase (NOS) in β3-AR is met behulp van die nie-spesifieke NOS inhibitor, L-NAME (50 μM) ondersoek. Eindpunte was funksionele herstel tydens herperfusie en infarktgrootte. In 'n ander reeks eksperimente is BRL37344 en SR59230A volgens dieselfde protokolle toegedien, maar die linker ventrikel is uit die hart gedissekteer na 10 min herperfusie en gevriesklamp vir Western klad analise van ekstrasellulêre-sein gereguleerde kinase (ERK p44/p42), proteïen kinase B (PKB/Akt), glikogeen sintase kinase-3β (GSK-3β), en endoteel stikstofoksied- sintase (eNOS). Data is met een of twee-rigting variansie analise (ANOVA) ontleed. Resultate: Administrasie van die selektiewe β3-AR agonis (BRL37344) (1μM) voor 35 min SI BRL37344 (PT), het die infarktgrootte beduidend verminder vergeleke met die nie-behandelde groep (NPT) (21.43±2.52 vs 43.17±1.20, p<0.001). BRL37344 het ‘n soortgelyke effek op infarktgrootte wanneer dit gedurende die laaste 10 min van streeksiskemie BRL37344 (PerT) (14.94±2.34, vs NPT, p<0.001) of by die aanvang van herperfusie (BRL37344 (PostT) (19.06±1.81, vs NPT, p<0.001) toegedien word. Wanneer BRL37344 as 'n (PerT+PostT) strategie toegedien is, was infarktgrootte weereens beduidend verlaag (20.55±2.01 vs 43.17±1.20, p<0.001). In teenstelling hiermee, het administrasie van die β3-antagonis SR59230A volgens dieselfde protokol, nie infarktgrootte verminder nie en waardes soortgelyk aan dié van onbehandelde harte (NPT) is verkry. Interessant, wanneer BRL37344 gedurende die laaste 10 min van streeksiskemie toegedien is, gevolg deur die administrasie van die β3-AR antagonis (SR59230A) by die aanvang van herperfusie, [BRL37344(PerT) & SR59230A(PostT)], was infarktgrootte aansienlik verminder tot 20.78±3.02 (p<0.001 vs NPT en SR59230A (PerT+PostT). Die betrokkenheid van stikstofoksied (NO) is waargeneem deurdat die vermindering in infarktgrootte ontlok deur BRL37344, heeltemal deur L-NAME opgehef is, wanneer dit in kombinasie met BRL37344 vir 10 minute voor SI of by die aanvang van herperfusie vir 10 minute toegedien is (% infarktgrootte: 41.48±3.18 en 35.75±3.54, p<0.001 vs BRL37344 (PT) en BRL37344 (PostT) onderskeidelik). Western kladresultate toon dat PKB/Akt deur BRL37344 geaktiveer word ongeag die tyd van die administrasie. Die intervensie BRL37344 (PerT+PostT), toon die mees beduidende fosforilering van PKB/Akt (voudige toename: 14.2±3.71, p<0.01 vs NPT en p<0.05 vs BRL37344 (PostT). Daarbenewens het BRL37344 (PT), (PerT), (PostT) en [BRL37344 (PerT) + SR59230A (PostT)] ook beduidende aktivering van hierdie kinase tot gevolg gehad (2.92±0.22, 5.54±0.43, 4.73±0.47 en 6.60±0.78, onderskeidelik). ERKp44/p42 is egter nie deur enige van die behandelings geaktiveer nie. Fosforilering van eNOS en GSK-3β was net beduidend in die BRL37344 (PerT+PostT) en [BRL37344 (PerT) + SR59230A (PostT)] groepe. Die aktivering van eNOS-S-1177 was beduidend in die BRL37344 (PerT+PostT) en [BRL37344 (PerT) + SR59230A (PostT)] groepe. 'n Baie beduidende toename in fosforilering van GSK-3β is in dieselfde twee groepe (68.8±7.73, p<0.001 en 25.5±5.42, p<0.05 vs NPT onderskeidelik) waargeneem. Gevolgtrekking: β3-AR het kragtige kardiobeskermende effekte wanneer dit, hetsy voor, tydens en na iskemie gedurende vroeë herperfusie toegedien word, soos deur die vermindering in infarktgrootte sowel as die aktivering van PKB, GSK-3β en eNOS aangedui is. Hierdie voordelige effekte kan aan NO produksie deur aktivering van eNOS gekoppel word.

Thesis (MSc)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Background: Athletes use androgenic anabolic steroids (AAS) to enhance their physical performance. The abuse of AAS is however associated with a host of side effects including sudden death due to cardiac arrest. The use of AAS leads to myocardial hypertrophy, which possibly makes the heart more prone to ischaemia/reperfusion injury, since it often develops in the absence of proper vasculature development. Chronic AAS use also disrupts myocardial p-adrenoreceptor function and possibly cAMP, signalling in the heart. Drugs increasing cAMP and decreasing cGMP levels in the ischaemic myocardium exacerbate myocardial ischaemia/reperfusion injury. We also know that AAS causes coronary artery disease secondary to the deleterious alteration of lipid profiles by increasing the LOL cholesterol and decreasing the HOLcholesterol levels. AAS treatment may increase systemic TNFa levels by stimulating lymphocyte TNFa secretion that has been implicated in the depression of myocardial function, myocardial hypertrophy and the worsening of ischaemia/reperfsuion injury. Aims: To determine whether chronic AAS treatment in trained and untrained rats influences: 1) heart function and susceptibility to ischaemia/reperfusion injury, 2) myocardial cyclic nucleotide levels (cAMP and cGMP) and 3) myocardial TNFa levels. Material and methods: Male Sprague-Dawley rats (n=100) were divided into 4 groups: sedentary vehicle (placebo) treated group, sedentary AAS treated group, exercise vehicle (placebo) treated group, and exercise AAS treated group. Steroid treated animals received an intramuscular injection of nandrolone laureate (0.375 mg/kg) once a week, for six weeks. Training consisted of swim sessions 6 days a week for 6 weeks. Swim time was incrementally increased up to a maximum of 50 minutes a day. For biometric parameters heart weight and body weight were documented. Hearts were mounted on a l.anqendorff perfusion apparatus and left ventricular developed pressure (LVDP), heart rate (HR) and coronary flow (CF) was monitored. The hearts were subjected to a period of 20 minutes of global ischaemia, followed by 30 minutes of reperfusion. Functional parameters was again monitored and documented. For biochemical analysis, blood was collected for the determination of serum lipid levels and myocardial tissue samples were collected before, during and after ischaemia for the determination of myocardial TNFa, cGMP and cAMP levels and p38 activity. Conclusions: Results obtained would suggest that AAS exacerbate exercise induced myocardial hypertrophy. It also prevents the exercise-induced improvement in cardiac function. AAS use reduces reperfusion function in treated hearts, which may suggest that AAS exacerbates ischaemie and reperfusion injury. Furthermore it was seen that AAS elevates basal (preischaemie) cyclic nucleotide levels and basal (pre-ischaemic) as well as reperfusion TNFa levels. This may also contribute to the exacerbation of ischaemic and reperfusion injury. / AFRIKAANSE OPSOMMING: Agtergrond: Androgeniese anaboliese steroïede (AAS) word dikwels deur atlete gebruik om sportprestasie te verbeter. Die misbruik van AAS het egter talle newe effekte, insluitende skielike dood wat gewoonlik toegeskryf word aan hartaanvalle. Die gebruik van AAS lei onder andere tot miokardiale hipertrofie wat opsigself, as gevolg van ontoereikende vaskulêre ontwikkeling tydens die ontwikkeling van hipertrofie, die hart nog meer vatbaar vir isgemie/herperfusie skade maak. Kroniese AAS toediening versteur miokardiale beta-adtenoresepter funksie en moontlik die tweede boodskapper, sAMP, seintransduksie in die hart. Ons weet ook dat AAS koronêre hartvatsiektes veroorsaak. Laasgenoemde is sekondêr tot die nadelige lipiedprofiel verandering, wat 'n verhoging in LDL-C en 'n verlaging in HDL-C insluit. Middels wat miokardiale sAMP vlakke verhoog en sGMP vlakke in die isgemiese miokardium verlaag, vererger miokardiale isgemie/herperfusie skade. AAS behandeling kan moontlik ook sistemiese TNFa vlakke verhoog deur limfosiet TNFa sekresie te stimuleer. Die verhoogde TNFa vlakke word verbind aan die onderdrukking van miokardiale funksie, miokardiale hipertrofie en die verergering van isgemie/herperfusie skade. Doelwitte: Die doelwitte van die studie was om te bepaal of kroniese AAS toediening in geoefende en ongeoefende rotte 1) hartfunksie en die hart se vatbaarheid vir isgemie/herperfusie skade beïnvloed, 2) miokardiale sikliese nukleotiedvlakke (sAMP en sGMP) beïnvloed en 3) miokardiale TNFa-vlakke beïnvloed. Materiale en metodes: Manlike Sprague-Dawley rotte (n=100) is gebruik en in 4 groepe verdeel: 'n ongeoefende placebo groep (kontrole); 'n ongeoefende steroïedbehandelde groep; 'n geoefende placebo groep (kontrole) en 'n geoefende steroïedbehandelde groep. Steroïed behandelde diere het 'n intramuskulêre nandroloon lauraat inspuiting (0.375 mg/kg) een keer per week vir ses weke ontvang. Die oefenprogram het bestaan uit ses swemsessies 'n week vir ses weke. Die swemtyd is geleidelik weekliks verhoog tot by 'n maksimum tyd 50 min. Die waterbadtemperatuur is tussen 30 - 32 oe gehandhaaf. Vir biometriese parameters is hartgewig en liggaamsgewig genoteer. Harte is op 'n Langendorff perfusie apparaat gemonteer en linker ventrikulêre ontwikkelde druk (LVOD), koronêre vloei (KV) en harttempo (HT) is genoteer. Die harte is vervolgens blootgestel aan 20 minute van globale isgemie gevolg deur 'n 30 minute herperfusieperiode. LVOD, KV en HT is weer eens noteer. Vir biochemiese doeleindes is bloed voor perfusie versamelom serum lipied vlakke te bepaal. Miokardiale weefsel is versamel voor, tydens en na isgemie vir die bepaling van TNFa, cGMP en AMP vlakke asook p38 aktiwiteit. Gevolgtrekkings: Na aanleiding van resultate verkry wil dit voorkom asof die gebruik van steroïde oefeningsgeïnduseerde miokardiale hipertrofie vererger. Dit verhoed ook oefeningsgeïnduseerde verbetering in miokardiale funksie. AAS lei tot 'n verlaagde herperfusiefunksie in behandelde harte, wat dalk mag dui op MS verergering van isgemie en herperfusie skade. Verder was daar ook waargeneem dat MS basale (pre-isgemiese) sikliese nukleotiedvlakke en basale TNFa-vlakke sowel as herperfusie TNFa vlakke verhoog. Die verhoging in TNF-a vlakke mag dus moontlik ook bydra tot die verergering van isgemie- en herperfusieskade.

Thessis (PhD)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: Although there is evidence for a protective role of long-chain polyunsaturated fatty acids (PUFAs) in cardiovascular disease, their mechanism of action as well as their participation in intracellular signalling processes remain to be elucidated. Therefore the aims of this study were twofold: (i) to characterize the roles of the mitogen-activated protein kinases (MAPKs) and protein kinase B (PKB/Akt) in ischaemia/reperfusion-induced apoptosis of neonatal cardiomyocytes and (ii) to establish whether long-chain PUFAs protect the heart via manipulation of these kinases. Rat neonatal ventricular myocytes exposed to simulated ischaemia and reperfusion (Sl/R) were used to characterize the role(s) of extracellular signalregulated kinase (ERK), p38 and c-Jun NH2-terminal protein kinase (JNK), as well as PKB/Akt in apoptosis. The effects of an omega-3 fatty acid (eicosapentaenoic acid - EPA) and an omega-6 fatty acid (arachidonic acid - ARA) on the response of neonatal rat cardiomyocytes to Sl/R with regard to the above parameters were determined. Exposure of the myocytes to SI (energy depletion induced by KCN and 2- deoxy-D-glucose) reduced cell viability, as measured by the 3-[4,5- dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay, and stimulated apoptosis (increased caspase-3 activation and poly(ADP-ribose) polymerase (PARP) cleavage). However, morphological evidence of increased apoptosis (Hoechst 33342 staining) occurred only after reperfusion. A rapid activation of p38 and PKB/Akt Ser473 occurred during SI, while significant activation of ERK and JNK was observed during reperfusion only. Myocytes pre-treated with SB203580, a p38-inhibitor, displayed a significant increase in cell viability and attenuation of apoptosis during Sl/R, while SP600125, a specific JNK inhibitor, significantly increased both caspase-3 activation and the apoptotic index. However, PD98059, an ERK inhibitor, was without effect. Wortmannin, a PI3-kinase inhibitor, reduced PKB/Akt Thr308 but not Ser473 phosphorylation during Sl/R and caused a significant increase in Although there is evidence for a protective role of long-chain polyunsaturated fatty acids (PUFAs) in cardiovascular disease, their mechanism of action as well as their participation in intracellular signalling processes remain to be elucidated. Therefore the aims of this study were twofold: (i) to characterize the roles of the mitogen-activated protein kinases (MAPKs) and protein kinase B (PKB/Akt) in ischaemia/reperfusion-induced apoptosis of neonatal cardiomyocytes and (ii) to establish whether long-chain PUFAs protect the heart via manipulation of these kinases. Rat neonatal ventricular myocytes exposed to simulated ischaemia and reperfusion (Sl/R) were used to characterize the role(s) of extracellular signalregulated kinase (ERK), p38 and c-Jun NH2-terminal protein kinase (JNK), as well as PKB/Akt in apoptosis. The effects of an omega-3 fatty acid (eicosapentaenoic acid - EPA) and an omega-6 fatty acid (arachidonic acid - ARA) on the response of neonatal rat cardiomyocytes to Sl/R with regard to the above parameters were determined. Exposure of the myocytes to SI (energy depletion induced by KCN and 2- deoxy-D-glucose) reduced cell viability, as measured by the 3-[4,5- dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay, and stimulated apoptosis (increased caspase-3 activation and poly(ADP-ribose) polymerase (PARP) cleavage). However, morphological evidence of increased apoptosis (Hoechst 33342 staining) occurred only after reperfusion. A rapid activation of p38 and PKB/Akt Ser473 occurred during SI, while significant activation of ERK and JNK was observed during reperfusion only. Myocytes pre-treated with SB203580, a p38-inhibitor, displayed a significant increase in cell viability and attenuation of apoptosis during Sl/R, while SP600125, a specific JNK inhibitor, significantly increased both caspase-3 activation and the apoptotic index. However, PD98059, an ERK inhibitor, was without effect. Wortmannin, a PI3-kinase inhibitor, reduced PKB/Akt Thr308 but not Ser473 phosphorylation during Sl/R and caused a significant increase in Although there is evidence for a protective role of long-chain polyunsaturated fatty acids (PUFAs) in cardiovascular disease, their mechanism of action as well as their participation in intracellular signalling processes remain to be elucidated. Therefore the aims of this study were twofold: (i) to characterize the roles of the mitogen-activated protein kinases (MAPKs) and protein kinase B (PKB/Akt) in ischaemia/reperfusion-induced apoptosis of neonatal cardiomyocytes and (ii) to establish whether long-chain PUFAs protect the heart via manipulation of these kinases. Rat neonatal ventricular myocytes exposed to simulated ischaemia and reperfusion (Sl/R) were used to characterize the role(s) of extracellular signalregulated kinase (ERK), p38 and c-Jun NH2-terminal protein kinase (JNK), as well as PKB/Akt in apoptosis. The effects of an omega-3 fatty acid (eicosapentaenoic acid - EPA) and an omega-6 fatty acid (arachidonic acid - ARA) on the response of neonatal rat cardiomyocytes to Sl/R with regard to the above parameters were determined. Exposure of the myocytes to SI (energy depletion induced by KCN and 2- deoxy-D-glucose) reduced cell viability, as measured by the 3-[4,5- dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay, and stimulated apoptosis (increased caspase-3 activation and poly(ADP-ribose) polymerase (PARP) cleavage). However, morphological evidence of increased apoptosis (Hoechst 33342 staining) occurred only after reperfusion. A rapid activation of p38 and PKB/Akt Ser473 occurred during SI, while significant activation of ERK and JNK was observed during reperfusion only. Myocytes pre-treated with SB203580, a p38-inhibitor, displayed a significant increase in cell viability and attenuation of apoptosis during Sl/R, while SP600125, a specific JNK inhibitor, significantly increased both caspase-3 activation and the apoptotic index. However, PD98059, an ERK inhibitor, was without effect. Wortmannin, a PI3-kinase inhibitor, reduced PKB/Akt Thr308 but not Ser473 phosphorylation during Sl/R and caused a significant increase in PARP cleavage during reperfusion, but had no effect on caspase-3 activation or the apoptotic index. EPA and ARA (20 jiM, present before and after SI) significantly reduced caspase-3 activation, PARP-cleavage and the apoptotic index during reperfusion. This was associated with increased ERK- and decreased p38 phosphorylation. Vanadate (a tyrosine phosphatase inhibitor), but not okadaic acid (a serine-threonine phosphatase inhibitor), significantly reduced ARAinduced inhibition of p38 phosphorylation, suggesting involvement of tyrosine phosphatases during Sl/R. MKP-1, a dual-specificity phosphatase, was targeted and a significant induction of MKP-1 by ARA and EPA was observed. An in vitro dephosphorylation assay confirmed that this phosphatase might be responsible for the inhibition of p38 activation. It was also demonstrated that the protective actions of ARA are PI3-K dependent. The results suggest that p38 has a pro-apoptotic role while JNK phosphorylation is protective and that these kinases act via caspase-3 to prevent or promote cell survival in response to SI/R-induced injury. It was demonstrated for the first time that EPA and ARA protect neonatal cardiac myocytes from ischaemia/reperfusion-induced apoptosis through induction of a dual-specific phosphatase, MKP-1, causing dephosphorylation of the proapoptotic kinase, p38. These beneficial effects of ARA and EPA were also reflected by improvement in functional recovery during ischaemia/reperfusion of the isolated perfused rat heart model. / AFRIKAANSE OPSOMMING: Dit word algemeen aanvaar dat lang-ketting poli-onversadigde vetsure teen kardiovaskulere siektes beskerm, maar hul meganisme van aksie sowel as hul invloed op intrasellulere seinoordragpaaie is egter onbekend. Die doelwitte van hierdie studie is dus tweevoudig: (i) om die belang van mitogeen-geaktiveerde proteien kinases (MAPKs) en protein kinase B (PKB/Akt) in isgemie/herperfusie-geinduseerde apoptose vas te stel en (ii) om te bepaal of lang-ketting poli-onversadigde vetsure die hart, deur manipulering van hierdie kinases, beskerm. Rot neonatale ventrikulere miosiete, blootgestel aan gesimuleerde isgemie en herperfusie (Sl/H), is gebruik om die aktivering van ekstrasellulere seingereguleerde kinase (ERK), p38, c-Jun NH2-terminale protein kinase (JNK) asook PKB/Akt tydens apoptose, te karakteriseer. Die effek van ‘n omega-3 vetsuur (eikosapentaenoSsuur - EPA) en ‘n omega-6 vetsuur (aragidoonsuur - ARA) op die respons van bogenoemde kinases in neonatale kardiomiosiete tydens Sl/H, is ondersoek. Blootstelling van miosiete aan SI (energie-uitputting gemduseer deur kaliumsianied en 2-deoksi-D-glukose) het ‘n afname in die vermoe van die sel om te oorleef, soos gemeet deur die MTT (3-[4,5-dimetieltiazol-2-yl]-2,5- difeniel tetrazolium bromied) bepaling, tot gevolg gehad. ‘n Toename in apoptose (kaspase-3 aktivering en poli(ADP-ribose) polimerase (PARP) kliewing) is ook waargeneem. Morfologiese bewyse van apoptose (Hoechst 33342 kleuring) was egter eers tydens herperfusie sigbaar. SI is gekenmerk deur vinnige aktivering van p38 en PKB/Akt Ser473, terwyl ERK en JNK fosforilering slegs tydens herperfusie waargeneem is. Vooraf-behandeling met SB203580, ‘n p38 inhibitor, het ‘n beduidende toename in sellewensvatbaarheid asook ‘n afname in die apoptotiese indeks tydens Sl/H teweeggebring, terwyl SP600125, ‘n spesifieke JNK inhibitor, apoptose bevorder het. PD98059, ‘n ERK inhibitor, het geen invloed op apoptose tydens Sl/H gehad nie. Wortmannin, ‘n PI3-kinase inhibitor, het Thr308 (nie Ser473) fosforilering onderdruk, gepaargaande met ‘n toename in PARP kliewing, maar dit het geen invloed op kaspase-3 aktivering of die apoptotiese indeks gehad nie. EPA en ARA (20 (iM, teenwoordig voor en na SI) het kaspase-3 aktivering en PARP kliewing asook die apoptotiese indeks tydens herperfusie beduidend verminder. Beide vetsure het ook ‘n beduidende toename in ERK en afname in p38 fosforilering veroorsaak. Vanadaat (‘n serien-threonien fosfatase inhibitor), maar nie “okadaic” suur (‘n tirosien fosfatase inhibitor), kon die ARA-gemduseerde inhibisie van p38 ophef nie. Induksie van MKP-1, ‘n tweeledige-spesifieke fosfatase, is beduidend deur ARA en EPA tydens herperfusie verhoog. 'n In vitro defosforileringbepaling het bevestig dat hierdie fosfatase wel betrokke by die inhibisie van p38 kan wees. Daarbenewens is gevind dat die beskermende aksie van ARA PI3-K afhanklik is. Hierdie resultate wys dat fosforilering van p38 pro-apoptoties is, terwyl JNK beskermend is en dat hierdie kinases via kaspase-3 seldood of oorlewing tydens SI/H-geinduseerde beskadiging bemiddel. In hierdie model is daar vir die eerste keer getoon dat EPA en ARA neonatale kardiale miosiete teen isgemie/herperfusie-geinduseerde apoptose beskerm deur induksie van MKP- 1, wat defosforilering van die pro-apoptotiese kinase, p38 teweegbring. Hierdie voordelige effekte van EPA en ARA is ook sigbaar in die funksionele herstel tydens isgemie/herperfusie van die geisoleerde rothart model.

published_or_final_version / abstract / Anaesthesiology / Master / Master of Philosophy