Administration of small interfering RNA (siRNA) specific for prolyl-4 hydroxylase-2 (PHD2) results in PHD2 inhibition, Hypoxia Inducible Factor-I (HIF-1) activation, and cardioprotection versus Ischemia Reperfusion (IR). This study observes the effects of siRNA-mediated PHD2 inhibition on the distribution of cardioprotective proteins by immunofluorescence and basic histology. Fifteen mice were divided into 5 groups: PHD2 Control, Non-Targeting scramble (NTS) Control, IR Control, PHD2 IR, and NTS IR. Histologically, tissue damage was reduced dramatically in the PHD2 IR group compared to the NTS IR and IR control groups. From confocal images, total fluorescent pixels and intensities were quantified. The PHD2 IR group yielded the highest pixel quantity and intensity for HIF-1 and possessed increased pixels and intensity for Inducible Nitric Oxide Synthase, another cardioprotective protein. These results further demonstrate the cardioprotection and HIF-1 activation conferred by PHD2 siRNA administration and supports its role as a potential therapy to alleviate cardiac IR injury.

Recent studies have shown that the potent phosphodiesterase-5 (PDE-5) inhibitor, sildenafil citrate, induces a powerful cardioprotective effect against ischemia-reperfusion (I/R) injury in rabbit and mouse hearts. However, the effect of this drug in inducing long-term protection against I/R injury remains unknown. The goal of this study was to identify the duration of the protective window of sildenafil citrate as well as vardenafil, a more potent PDE-5 inhibitor. Rabbits were treated with sildenafil (0.7 mg/kg, iv), vardenafil (0.143 mg/kg), or an equivalent volume of saline. After 24 hrs, 48 hrs, 96 hrs, or 7 days of sildenafil treatment, the hearts were subjected to I/R. In the vardenafil groups, the hearts were subjected to I/R at 24 hrs and 7 days after administration of the drug. To evaluate the role of nitric oxide (NO) in cardioprotection, a non-selective blocker of nitric oxide synthase, L-NAME (15 mg/kg, iv) was administered 10 minutes prior to I/R. The results show significant reductions in infarct size in hearts treated with sildenafil and vardenafil as compared to the corresponding saline controls at all time points. The protective effects of sildenafil and vardenafil were abrogated in animals treated with L-NAME. L-NAME had no effect on infarct size in saline treated control rabbits. These data suggest that both sildenafil and vardenafil induce a long-term protective effect against myocardial infarction which is mediated via a NO-dependent pathway. These studies are important in exploiting the clinical potential of PDE-5 inhibitors in terms of protection against ischemia/reperfusion injury in patients with coronary artery disease.

Cardiac injury is increased following ischemia-reperfusion. Mitochondria are the “effector organelles” that are damaged during ischemia (ISC) when there is no blood flow. Resumption of metabolism by damaged mitochondria during reperfusion (REP) results in increased cell injury. Current therapeutic interventions to pre-condition and post-condition the heart during ISC are ineffective during certain conditions like aging and diabetes due to defects in the signaling cascades. In contrast, mitochondrial-based strategies are effective in protecting the heart during ISC-REP. Hence direct therapeutic targeting of dysfunctional mitochondria will provide the potential to bypass the upstream signaling defects and intervene directly upon the effector organelle. Novel mitochondrial-targeted therapy relies on understanding the sites in the electron transport chain (ETC) that are damaged by ISC and produce cell-injury during REP. This project identifies a novel pathological role of cytochrome c in depleting cardiolipin during ischemia after which the mitochondria are in a defective condition that leads to additional cell death during reperfusion. During ischemia oxidants from complex III oxidize cytochrome c, forming a peroxidase, which causes oxidative damage and depletion of cardiolipin. Depletion of cardiolipin disrupts normal physiology and augments cell death. Identification of the innovative pathobiology during ISC-REP recognizes a novel therapeutic target, cytochrome c peroxidase, which can be a focal point for new therapeutic interventions to decrease cardiac injury. In order to maintain homeostatis, living organisms have the methionine sulfoxide reductase system, which reduce both free and protein bound Met(O) back to methionine (Met) in the presence of thioredoxin. Oxidized Trx is inactive and unable to bind to ASK1 thereby activating ASK1 and causing cell death via p38/JNK pathways thereby contributing to the pathogenesis of myocardial ISC-REP injury. In this study we have shown that inhibition of ASK1 protects the heart during REP via the modulation of mitochondria that sustained damage during ISC. The mitochondrial-based mechanism of cardioprotection with ASK1 inhibition enhanced the functional integrity of the inner mitochondrial membrane retaining cytochrome c thereby decreasing cell death. This therapeutic intervention is a key step to achieve the ultimate goal to improve clinical outcomes in patients that suffer an acute myocardial infarction.

In resting muscle, blood flow is regulated to meet the demand for O2 by the tissue. A modified ischemia (I)/reperfusion(R) investigation was systematically run and PISFO2, PaO2, Q and VO2 were observed. Twenty-nine spinotrapezius muscles from male Sprague-Dawley rats (284±20 grams) were surgically exteriorized for intravital microscopy to test a model relating blood flow, O2 supply and O2 demand. The model can aid in the understanding of the regulation of tissue PO2. The interstitial PO2 (PISFO2) and perivascular PO2 (PaO2) measurements were made using phosphorescence quenching microscopy (PQM). O2 consumption (VO2) values were obtained with a quasi-continuous, flash-synchronized, pressurized airbag to initiate ischemia and sample the rate of O¬2 change (dPO2/dt). Centerline red blood cell velocity was measured with an Optical Doppler Velocimeter and converted to flow using vessel diameter. 5-, 15-, 30-, 60-, 300- and 600-second ischemic durations were used to observe changes in PISFO2, Q, and VO2. A critical point was observed following 30 seconds of (I) where dPISFO2/dt during recovery was the fastest (4.25±0.72 mmHg/s) and was 1.00±0.16 mmHg/s following 600 seconds. Flow recovery, dQ/dt, peaked to 3.88±0.64 (µl•min-1)/s after 60 seconds of (I) but significantly dropped to 2.83±0.55 (µl•min-1)/s following 300 seconds of (I) but increased to 2.92±0.45 (µl•min-1)/s following 600 seconds. This gives evidence to a no-reflow phenomenon occurring in the extended periods of ischemia. A peak in VO¬2 to 309.2±45.0 nl O2/cm3•s with a time course of 160 seconds occurred following 600 seconds of ischemia. As the ischemic duration decreased, the time course and peak VO2 also decreased. VO2 following 300 seconds of (I) was significantly higher than 5-60 seconds of (I) (p <0.05) but was not significantly different from 600 seconds of (I). The information collected during the Q and VO2 studies can be incorporated into a factor, M, that relates VO2, Q and ∆PO2. M calculated for the recovery of 5- through 60-second (I) groups reasonably relates the three variables due to consistency and little variability. However, recovery in 600- and especially 300-second (I) groups showed higher variability in M which requires more consideration.

Acute myocardial infarction (AMI) is the leading cause of death worldwide. Currently, the best method of treating cardiac ischemia is early reperfusion which, itself, induces myocardial damage. The mTOR complex is a key regulator of cardioprotection against cell stressors. We hypothesized that reperfusion therapy with Rapamycin, a potent mTOR inhibitor, would reduce infarct size in adult mouse hearts. Rapamycin was administered at the onset of reperfusion following 30 min in situ LAD ligation. After 24 hours of reperfusion, myocardial infarct size and apoptosis were significantly reduced in rapamycin-treated mice compared to control. Rapamycin inhibited pro-apoptotic protein Bax and phosphorylation of ribosomal protein S6 (target of mTORC1), while it induced phosphorylation of AKT (target of mTORC2). Rapamycin also induced phosphorylation of ERK, while significantly reduced phosphorylation of p38. Thus, our study shows that reperfusion therapy with Rapamycin provides cardioprotection through induction of the phosphorylation of Akt and ERK.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

L'infarctus du myocarde (IDM) est consécutif à une occlusion coronaire provoquant une ischémie prolongée. La taille de l'infarctus est le déterminant majeur de la récupération du myocarde et de la survie du patient. La reperfusion coronaire la plus précoce (par thrombolyse ou angioplastie) est reconnue comme étant le seul traitement recommandé. Cependant, malgré les effets bénéfiques, la reperfusion s'accompagne d'effets délétères appelés « lésions de reperfusion ». Récemment, l'efficacité du postconditionnement ischémique (PostC) a été démontrée en clinique. Il permet, lorsqu'il est utilisé au cours de l'angioplastie primaire ou de sauvetage, de réduire significativement la taille de l'infarctus. L'application du protocole de PostC reste cependant limitée aux patients admis dans les centres d'angioplastie, ce qui exclut tous les patients thrombolysés. Afin d'améliorer la cardioprotection, il est nécessaire de déterminer la fenêtre thérapeutique temporelle optimale d'administration du PostC. De plus, il est nécessaire de développer des stratégies thérapeutiques nouvelles, adjuvants de la reperfusion, qui pourront être administrées dès que le diagnostic d'IDM est posé. L'objectif de notre travail a donc été d'étudier l'influence du délai d'application du PostC sur l'efficacité de cardioprotection dans un modèle murin d'ischémie-reperfusion et de rechercher des substances pharmacologiques cardioprotectrices. Nos travaux révèlent que l'efficacité du PostC est maintenue s'il est appliqué les 30 premières minutes après le début de la reperfusion. D'autre part, nous avons évalué le potentiel thérapeutique de peptides inhibiteurs ciblant l'apoptose responsable de la mort cellulaire au cours de l'ischémie-reperfusion. L'utilisation de peptides Tat-BH4 et Pip2b-BH4 pour le traitement des lésions d'ischémie-reperfusion myocardique a fait l'objet d'une étude preuve-de-concept in vivo. Les constructions peptidiques inhibant l'interaction FAS-DAXX, injectées en intraveineuse au moment de la reperfusion, induisent une diminution de 50% de la taille d'infarctus et de l'apoptose. Ils ont fait l'objet d'un dépôt de brevet car ils constituent des outils pharmacologiques à haut potentiel thérapeutique. / Myocardial infarction (MI) results from a coronary occlusion leading to severe ischemia. Infarct size is a major determinant of myocardial salvage and mortality. Prompt revascularization (either by thrombolysis or primary angioplasty) is recommended for AMI patients but leads to deleterious effects called "reperfusion injury". Recently, ischemic postconditioning (PostC) efficiency has been reported in patients. However, its application during primary angioplasty is limited to patients admitted in angioplasty centers thereby excluding thrombolysed patients. In order to improve cardioprotection, it is necessary to define the time window for optimal cardioprotection and to develop new pharmacological strategies for AMI patients. Our work, using an in vivo mouse model of ischemia-reperfusion, shows that PostC efficiency is maintained if applied the first 30 minutes after the onset of reperfusion. Furthermore, we evaluated the therapeutic potential of peptide inhibitors targeting apoptosis, which is responsible for cell death during ischemia-reperfusion. As a proof-of-concept study, the cardioprotective effects of Tat-BH4 and Pip2b-BH4 peptidic constructs have been revealed in vitro and in vivo. The peptidic constructs targeting FAS-DAXX interaction, injected intravenously as a single bolus at the time of reperfusion, reduced by 50% both infarct size and apoptosis. These pharmacological tools have been patented due to their high therapeutic potential.

Adaptation to chronic hypoxia increases myocardial resistance to acute ischemia/reperfusion (I/R) injury, similarly to application of exogenous erythropoietin (EPO). Nevertheless, it is not known if EPO induced by chronic hypoxia plays a role in its cardioprotective mechanism. The aim of this study was to find out if protective effect of exogenous EPO adds up to protection offered by chronic hypoxia. Adult male mice (ICR) were adapted to intermittent hypobaric hypoxia 8 hours per day, 5 days per week for 5 weeks. The degree of hypoxia corresponded to 7000 metres. Control animals were housed for the same time in normoxic environment. Resistance to I/R injury was assessed according to size of myocardial infarction induced by 45-min global ischemia and 1-h reperfusion of the heart in vitro. Animals were treated 24 h before the experiment with 200 or 5000 U/kg EPO. Treatment with 200 U/kg EPO was sufficient to significantly limit infarct size in normoxic animals (33,56 ± 2,93 % vs. 25,71 ± 2,29 %). Hypoxic adaptation decreased infarct area to 23,49 ± 2,30%, but additive effect of EPO in hypoxic group was not detected. The results indicate that exogenous EPO employs the same cardioprotective mechanisms as adaptation to chronic intermittent hypoxia. Preliminary results indicate that repeated application of EPO...

Le système kallicréine-kinines (SKK) est un système peptidique vasodilatateur. Les métabolites actifs du système, les kinines, sont produites par la kallicréine tissulaire (TK), et agissent via leurs deux récepteurs, B2 et B1. Le SKK a été impliqué dans les processus physiopathologiques conduisant au diabète de type 2. Son rôle est bien établi dans la protection des complications cardiovasculaires et rénales du diabète. Nous avons étudié le rôle du SKK dans le développement des anomalies métaboliques liées à l'obésité en utilisant des souris déficientes en TK dans deux modèles d'obésité (mutation ob/ob et régime gras). Nous n'avons pas mis en évidence d'effet de la déficience en TK sur les anomalies glucidiques dans ces deux modèles. Chez l'homme, nous avons étudié l'effet d'un polymorphisme génétique de la TK dans une cohorte de 4843 sujets de la population générale suivi pendant 9 ans. Nous n'avons pas observé d'effet d'un déficit partiel en activité TK sur l'apparition des troubles glucidiques.Ensuite, nous avons étudié l'effet de la stimulation du SKK par des agonistes spécifiques de chaque récepteur lors d'une ischémie reperfusion cardiaque. Chez les souris non diabétiques, l'agoniste B2 réduit la taille de l'infarctus. L'agoniste B1 n'a pas d'effet. Chez les souris diabétiques, l'agoniste B2 n'a pas d'effet. En revanche, l'agoniste B1 diminue la taille de l'infarctus. On observe une induction de la synthèse du B1R dans le c¿ur diabétique.Nos travaux clarifient le rôle du SKK dans le développement du diabète et de ses complications cardiaques. L'effet des agonistes ouvre une nouvelle piste thérapeutique dans la prise en charge des du syndrome coronarien aigu. / Kallikrein-kinin system (KKS) is a vasodilator peptide system. Kinins, the active peptides, are produced by tissue kallikrein (TK), and act via their two receptors, B1 and B2. KKS was involved in the pathophysiological process leading to type 2 diabetes. Its role is well established in the protection of cardiovascular and renal complications of diabetes. We studied the role of SKK in the development of metabolic abnormalities associated with obesity using TK deficient mice in two models of obesity (Ob/Ob and high fat diet). We did not observed any effect of TK deficiency on metabolic parameters in these two models. In humans, we studied the effect of a polymorphism of TK in a population-based cohort of 4843 subjects followed for 9 years. We did not observe any effect of a partial deficiency in TK on the occurrence of metabolic disorders. Next, we studied the effect of specific agonists of B1 and B2 receptors in cardiac ischemia reperfusion injury. In non-diabetic mice, the B2 agonist reduces infarct size. Agonist B1 has no effect. In diabetic mice, B2 agonist had no effect. In contrast, B1 agonist reduces infarct size. Overexpression of B1R is observed in the diabetic heart. Our work clarifies the role of SKK in the development of diabetes and its cardiac complications. Agonists of kinins receptors could be a new therapeutic approach in the management of acute coronary syndrome.

L’infarctus du myocarde (IDM) est une cause majeure de mortalité dans le monde. La stratégie thérapeutique actuelle repose sur la reperfusion précoce du myocarde qui contribue largement à l’amélioration du pronostic des malades. Les investigations menées chez des modèles d’ischémie/reperfusion (I/R) cardiaque ont montré que l’apoptose des cardiomyocytes était contrôlée en partie par les protéines de type Bcl-2. La production de radicaux libres (RL), en particulier par la nicotinamide adénine dinucléotide phosphate (NADPH) oxydase, contribue aussi à l’altération de la fonction cardiaque. Récemment, les effets observés de l’érythropoïétine (Epo) sur l’I/R, sont principalement liés à ses effets anti-apoptotiques, anti-inflammatoires et à son rôle dans l’angiogénèse et le remodelage vasculaire. Ces propriétés suggèrent le potentiel de l’Epo dans la cardioprotection suite à un IDM. Dès lors, les objectifs de cette thèse ont été : 1) de confirmer les effets cardioprotecteurs d’un analogue de l’Epo, la darbepoétine-a (DA), chez un modèle d’I/R chez le rat; 2) d’étudier les voies de signalisation impliquées dans ses effets anti-apoptotiques et ; 3) de caractériser les effets antioxydants de la DA médiée par l’hème-oxygénase-1 (HO-1), et ; d’étudier le rôle de la NADPH oxydase. Dans la 1ère étude, le traitement par DA a permis de diminuer significativement la taille de l’infarctus, la production de RL et l’apoptose. La DA a activé la voie des protéines Jak2/Akt, augmenté l’expression des protéines P-Bad et P-GSK3ß et anti-apoptotiques, Bcl-2 et Bcl-xL. Ces mêmes effets bénéfiques ont été confirmés à plus long terme avec la réduction des lésions fibrotiques et l’augmentation du nombre da capillaires sanguins, suggérant une meilleure perfusion du ventricule gauche. La seconde étude, a confirmé les effets cardioprotecteurs de la DA. Parallèlement, la DA a induit l’expression et l’activité de l’HO-1 et régulé l’expression des sous-unités p47phox et Rac1 nécessaires à l’activation de la NADPH oxydase. Ces résultats sont concordants avec la baisse de la production des RL observés dans le groupe DA. Les effets bénéfiques de la DA ont été annihilés en présence de ZnPP, inhibiteur de l’HO-1. Des essais cliniques sont actuellement en cours pour démontrer que les bénéfices observés chez l’animal, peuvent être retrouvés chez l’homme. / Cardiovascular disease remains a leading cause of mortality in industrialized countries. Loss of cardiomyocytes via apoptosis is believed to contribute to the continuous decline of the ventricular function in heart failure. Several investigations revealed that following ischemia-reperfusion (I/R), cardiomyocytes apoptosis is controlled, at least, by the Bcl-2 proteins family members. The excessive reactive oxygen species (ROS) production, through NADPH oxidase, contributes also to cellular damages and death. Recently, erythropoietin (EPO), a hematopoietic cytokine, has been shown to protect heart exposed to ischemia or ischemia-reperfusion, limiting infarct size and cardiac remodeling. However, to date the precise cellular mechanism of DA-induced cardioprotection remains incompletely understood. Thus, the aims of this work were 1) to assess the short and long term cardioprotective effects of darbepoetin-a (DA), an Epo analog, in an in vivo rat model of I/R ; 2) to investigate the signaling pathway through which DA potentially limits apoptosis and ; 3) to elucidate whether its cardioprotective effect, and more particularly its antioxidative effect, is linked to an HO-1-dependent inhibition of the NADPH activity. In the first study, left ventricle infarct size (LV) was smaller than that in the control rats, in agreement with echocardiographics parameters. DA-treatment activated the JAK2/Akt signaling pathway, lowered cleaved caspase-3 and increased both P-Bad and P-GSK-3ß proteins. This was consistent with the decrease of ROS production and the lowered binding of Bad to Bcl-xL and Bcl-. Similarly, in long term study, histology alterations implicated lower LV cardiac fibrosis and greater capillary density; furthermore both Bcl-xL and Bcl-2 were upregulated. In the second study, both LVSF and LVEF were higher versus control and DA+ZnPP, a heme-oxygenase-1 (HO-1) inhibitor, matching with the decreased LV infarct size in DA rats. DA induced HO-1 and down regulated the expression of p47phox and the activation of Rac1, both regulatory subunits of the NADPH-oxidase. This was consistent with the decrease of ROS production and these DA effects were inhibited by ZnPP. Further experiments in humans are now required to prove benefits effects of DA and to promote the use of EPO as therapeutics in heart infarction.