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

Die vorliegende Arbeit befasste sich daher mit dem Effekt von Acarbose auf die durch Ischämie und Reperfusion verursachten myokardialen Schäden nach Saccharosebelastung bei gesunden Mäusen in vivo. Aus den Ergebnissen dieser Arbeit lässt sich ableiten, dass eine wiederholte postprandiale Hyperglykämie bei nicht - diabetischen Tieren ausreicht, um die durch Ischämie und Reperfusion verursachten Myokardschäden signifikant zu erhöhen. Dies kann durch eine Behandlung mit dem a - Glucosidase - Hemmer Acarbose verhindert werden. / This study demonstrates exacerbated myocardial damage after ischemia/reperfusion injury in animals with repetitive postprandial hyperglycemia that could be prevented by acarbose treatment. The enhanced myocardial injury could not be attributed to altered neutrophil infiltration, but to an increased production of reactive oxygen species. These findings further support starting acarbose treatment already in patients with impaired glucose tolerance before the onset of overt diabetes mellitus.

Die Entwicklung von therapeutischen Strategien, die den infarktbedingten Untergang des Myokardgewebes minimieren und die Gewebsheilung nach abgelaufenem Myokardinfarkt unterstützen, gehört zu dem Hauptziel in der modernen Kardiologie. Bis jedoch eine spezifische Intervention als Therapieform anerkannt wird, ist ein detailliertes Entschlüsseln der zellulären und molekularen Mechanismen während und nach der Myokardschädigung notwendig. Die vorliegende Arbeit beschäftigt sich intensiv mit den Vorgängen der Stickstoffmonoxid- (NO) Produktion und der Inflammation nach Okklusion von Kranzarterien. Im ersten Teil der Dissertation steht die endotheliale NO-Synthase-Expression (eNOS) im Mittelpunkt der Untersuchung. eNOS ist als wichtiger Katalysator an der Biosynthese von Stickstoffmonoxid, das als protektiver Faktor für die Gefäßhomöostase seit Jahren bekannt ist, beteiligt. Ferner besteht experimentell sehr gute Evidenz dafür, dass der endothelialen NO-Synthase am Ausmaß des kardialen Ischämie-/ Reperfusionsschadens eine entscheidende Rolle zukommt. Folglich wurde mittels der Substanz AVE 9488 versucht, die eNOS-Expression in Mäusen zu steigern und den Effekt auf das Infarktgeschehen näher zu betrachten. Die Behandlung mit AVE 9488 erzielte einen signifikant reduzierten Ischämie-/Reperfusionsschaden. Bei anschließenden Ischämie-/Reperfusionsveruchen mit eNOS defizienten Mäusen war der protektive Effekt wieder aufgehoben. Der Erfolg dieser Substanz wird in der signifikanten Reduktion des oxidativen Stresses vermutet. Ein zusätzlicher wichtiger Parameter, der während der Ischämie/Reperfusion aktiviert wird, ist der Schlüssel-Transkriptionsfaktor Nuclear Factor kappa B (NF-kB). Durch seine Bindung an bestimmte Enhancer und Promotoren reguliert der Faktor die Entzündungsprozesse, indem er die Genexpression proinflammatorischer Marker verstärkt. Folglich wurden eine Reduktion der Inflammation sowie ein protektiver Effekt nach erfolgter ischämischer Schädigung durch Hemmung von NF-kB angenommen. Zur Prüfung dieser Hypothese wurden NF-kB-Untereinheit p50 defiziente Mäuse (p50 KO) einer Okklusion einer Herzkranzarterie unterzogen. Durch die Hemmung der NF-kB-Aktivierung kam es zu einer signifikanten Reduzierung des Infarktareals im Vergleich zu den entsprechenden Wildtyp-Mäusen. Der große Benefit konnte auf die geringere Einwanderung der neutrophilen Granulozyten in das infarzierte Gebiet zurückgeführt werden. Knochenmarktransplantationsversuche mit p50 KO- und Wildtyp-Knochenmark untermauerten die Beobachtung, dass die beeinträchtigte Aktivierung von NF-kB in p50 defizienten Leukozyten protektive Effekte in der Ischämie/Reperfusion vermittelt. Die Aktivierung der proinflammatorischen Proteine während des linksventrikulären Remodelings nach Myokardinfarkt gehört zum Fokus des dritten Teils dieser Arbeit. Dieser Teil beschäftigt sich mit der Frage, inwieweit eine hochdosierte Aspirin-Therapie die linksventrikulären Umbauprozesse günstig beeinflussen kann. Dafür wurden Mäuse für 4 Wochen mit Placebo oder Aspirin (120 mg/kg pro Tag) mittels osmotischer Mini-Pumpen, die 2 Stunden nach Ligatur der Kranzarterie implantiert wurden, behandelt. In beiden Gruppen kam es zur erwarteten linksventrikulären Dilatation nach Myokardinfarkt, jedoch ohne signifikanten Unterschied zwischen Placebo- und Aspirin-behandelten Tieren. Es kam allerdings zu einer erwarteten Reduktion proinflammatorischer Proteine durch die Aspirin-Therapie. So war die Expression von Tumor-Nekrose-Faktor-alpha; (TNF-alpha) und Interleukin-1ß (IL-ß) in der Aspirin-Gruppe signifikant reduziert. Zusammenfassend lässt sich sagen, dass durch die gezielte Beeinflussung bestimmter Faktoren in der Ischämie/Reperfusion wie z. B. die Verstärkung der eNOS-Expression oder die Hemmung der NF-kB-Aktivierung die Ischämieschädigung signifikant reduziert werden kann. / One of the major therapeutic goals of modern cardiology is to design strategies aimed at minimizing myocardial necrosis and optimizing cardiac repair following myocardial infarction. However, a sound understanding of the cellular and molecular mechanism is necessary before a specific intervention is pursued on a therapeutic basis. The present work includes important aspects of inflammation and nitric oxide (NO) production after occlusion of the coronary artery. The first part of the thesis focused on endothelial NO synthase (eNOS). eNOS is a promotor of NO biosynthesis, which regulates vascular and myocardial function. Moreover, endothelial NOS is cardioprotective in ischemia/reperfusion injury. Therefore, the effects of AVE 9488, a novel pharmacon designed to selectively increase eNOS protein expression and NO formation, was tested on cardiac ischemia/reperfusion injury in vivo. Ischemia/reperfusion damage was significantly reduced in mice treated with AVE 9488 when compared to placebo treated mice. The protective effect was blunted in eNOS knockout mice treated with the eNOS enhancer. The expression of inflammatory markers was not influenced by the therapy. Reactive oxygen species were significantly reduced in mice treated with the eNOS enhancer. In addition, the transcription factor nuclear factor kappa B (NF-kB) is important in cardiac damage. NF-kB is activated by various stimuli implicated in ischemia/reperfusion injury and increases the expression of proinflammatory markers by binding on special enhancer and promoters. Inhibition of NF-kB might therefore reduce the inflammatory response and achieve protective effects after myocardial infarction. To prove this hypothesis mice with targeted deletion of the NF-kB subunit p50 (p50 KO) underwent 30 minutes of coronary artery ligation and 24 hours of reperfusion in vivo. Ischemia/reperfusion damage was significantly reduced in the p50 KO animals when compared with matching wild-type (WT) mice. Although adhesion molecules such as intercellular adhesion molecule were up-regulated in left ventricles of p50 KO mice, fewer neutrophils infiltrated the infarct area, suggesting leukocytes as a potential mediator of the protection observed in the p50 KO. This was confirmed in adoptive transfer experiments: whereas transplantation of KO bone marrow in KO animals sustained the protective effect on ischemia/reperfusion injury, transplantation of WT bone marrow in KO animals abolished it. The last part tested the hypothesis that inhibition of the proinflammatory response to myocardial infarction could improve left ventricular remodeling. Therefore, mice were treated for 4 weeks with placebo or aspirin (120 mg/kg per day) by Alzet mini-osmotic pumps implanted 2 hours after ligation of the left anterior descending artery. On echocardiography, animals 4 weeks after myocardial infarction exhibited left ventricular dilatation as expected. However, there was no difference between the placebo and the Aspirin group. The expression of the proinflammatory cytokines tumor necrosis factor alpha; (TNF-alpha) and interleukin 1ß (IL-1ß) which were markedly upregulated in mice with myocardial infarction on placebo were significantly reduced by Aspirin treatment. However, left ventricular remodeling after myocardial infarction was not altered. In conclusion, the use of specific strategies to inhibit the NF-kB activation or to increase eNOS expression in ischemia/reperfusion constitutes a promising novel therapeutic approach to reduce ischemic damage. However, successful application of anti-inflammatory interventions in the treatment of ischemic remodeling will require a better understanding of the specific molecular steps in the regulation of cardiac injury and repair.

Einleitung: Mehrere ex vivo Studien zeigten zuletzt, dass Sphingosin-1-phosphate Schutz gegen myokardiale Ischämie/ Reperfusionsschaden verleihen [19], [20]. Der synthetische Sphingosin-1-phosphat-Rezeptoragonist FTY 720 war ebenso in der Lage, Entzündungsreaktionen in verschiedenen Krankheitsmodellen zu verringern [8]. Deshalb wollten wir die Hypothese prüfen, dass eine Behandlung mit FTY 720 zu einer Infarktgrößenreduktion nach myokardialer Ischämie/ Reperfusion in vivo führt. Methode: In männlichen Wistar Ratten wurde myokardiale Ischämie dadurch induziert, dass wir die linke Koronararterie für 45 min mittels Fadenligatur verschlossen. Nach 24 h wurde die Infarktgröße bestimmt und die Granulozyteninfiltration im Infarktgebiet festgestellt. Caspase 3 Aktivität und TNF- alpha Konzentration im Myokardgewebe wurden durch ELISA ermittelt. FTY 720 wurde vor Beginn der Reperfusion i. p. appliziert oder 24 h vor Reperfusionsbeginn und nochmals direkt vor Reperfusionsbeginn. Ergebnisse: Die einmalige Gabe von 0,5 mg/kg FTY 720 vor Reperfusion oder die zusätzliche Vorbehandlung der Tiere 24 Stunden vor der operativen Infarzierung reduzierte signifikant die periphere Lymphozytenanzahl. Sie nahm keinen Einfluss auf die Granulozytenanzahl im Blut. FTY 720 reduzierte die Granulozyteninfiltration und die TNF- alpha Konzentration der Borderzone. Es hatte aber keinen Effekt auf die myokardiale Caspase 3 Aktivität. Beide Behandlungsformen, weder die FTY 720- Gabe vor Reperfusionsbeginn noch die zweimalige FTY 720- Gabe waren in der Lage, Infarktgröße am Rattenherz zu reduzieren. FTY 720 erhöhte jedoch die Sterblichkeit der Ratten, wenn es einmalig vor Reperfusionsbeginn gegeben wurde, da es fatale myokardiale Arrhythmien induzierte. Zusammenfassung: Trotz seines antiinflammatorischen Effektes bei einmaliger Gabe von FTY 720 wurde die Sterblichkeit der Tiere durch Arrhythmieinduktion erhöht. Beide Behandlungsregimes konnten die Infarktgröße nicht reduzieren. / Objective: Several recent experiments demonstrated that the Sphingosine-1-phosphate receptor agonist FTY720 improves recovery of function after myocardial ischemia-reperfusion ex vivo. Therefore, we tested the hypothesis that pharmacological postconditioning with FTY720 reduces infarct size after myocardial ischemia-reperfusion in vivo. Methods: Myocardial ischemia was induced in Wistar rats by ligating the left coronary artery for 45 minutes. After 24 hours reperfusion, we determined infarct size by TTC staining and granulocyte infiltration by immunohistochemistry. Serum and myocardial TNF-α concentration was determined by ELISA. FTY720 (0.5 mg/ kg) was applied i.p. either once, with reperfusion, or twice, 24 hours before myocardial ischemia and before reperfusion. Results: In both groups, FTY720 significantly reduced peripheral lymphocyte count in peripheral blood. FTY720 treatment attenuated granulocyte infiltration and TNF-α protein expression in reperfused myocardium. However, both treatment regimens were not able to reduce infarct size. FTY720 increased mortality due to induction of fatal ventricular tachyarrhythmias when administered once with reperfusion, but not when given 24 hours prior to ischemia. Conclusion: Despite anti-inflammatory effects, postconditioning treatment with FTY720 does not reduce infarct size but increases mortality during myocardial ischemia-reperfusion. Pre-treatment with FTY720 before ischemia abrogated the deleterious pro-arrhythmic effects without reducing infarct size

Ischaemia-reperfusion (IR) injury is caused by the re-introduction of oxygen to organs, following periods of reduced blood flow (ischaemia). Whilst re-establishing blood flow (reperfusion) to the heart following myocardial infarction is vital for organ survival, this paradoxically leads to tissue damage. Mitochondria are at the heart of IR injury, with succinate dehydrogenase (SDH) a major player in orchestrating the damage. Succinate accumulates during ischaemia and is rapidly oxidised by SDH upon reperfusion, producing reactive oxygen species (ROS), leading to cellular death. I have investigated the development of drugs, aimed at targeting succinate metabolism to ameliorate IR injury. I firstly screened a range of compounds for their ability to inhibit SDH, having been chosen for their similar structures to succinate or the classical SDH inhibitor, malonate. Interestingly, only malonate and oxaloacetate showed potent SDH inhibition, thus were selected for further development. Malonate ester prodrugs with different properties were characterised. Hydrolysis rates of the esters differed greatly, with tuned, labile, malonate esters releasing malonate much more rapidly. Malonate esters were taken up into cells and hydrolysed to release malonate to different extents. Additionally, mitochondria-targetedmalonatemono and diesters were developed, each differing in mitochondrial and cellular uptake andmalonate release. Targeted and nontargeted malonate esters distributed into tissues in vivo, with preliminary in vivo work carried out on IR injury models, to assess for protective effects of the compounds. In addition, the physiological role of the tricarboxylic acid cycle metabolite, itaconate, was investigated. In lipopolysaccharide stimulated macrophages, itaconate has been reported to exert its effects by inhibition of SDH however, I found itaconate was a relatively poor SDH inhibitor, indicating other mechanisms of action. Current prodrugs of itaconate have many non-specific effects, not attributable to itaconate. I therefore characterised a novel itaconate prodrug and found it to be a much better surrogate, which could be subsequently used to elucidate roles for itaconate. Overall, I have shown the importance of ester selection for the prodrug delivery of dicarboxylate molecules and developed methods to improve their biological delivery.

Bien qu’il ait prouvé son efficacité dans différentes espèces (lapin, porc, souris,…) ainsi que dans différents organes (rein, foie coeur, poumon,…), le Postconditionnement (PostC) peut être limité par plusieurs facteurs. Parmi les limites du Post C, on note la nécessité de son application à l’initiation de la reperfusion. L’objectif de notre travail était d’évaluer la protection induite par la Basse pression de reperfusion (BP) après un décalage temporel de son application et d’étudier les principales fonctions mitochondriales connues pour être impliquées dans la cardioprotection. Nos résultats nous ont permis de démontrer que, contrairement au PostC, la BP pouvait s’appliquer avec succès même après un décalage temporel de 10 minutes après le début de la reperfusion. Cette protection décalée est en lien avec les fonctions mitochondriales, en particulier, l’inhibition du pore de transition de perméabilité mitochondriale (PTPm). L’utilisation de la cyclosporine A (CsA), puissant inhibiteur de l’ouverture du PTPm, permet également de décaler de 10 minutes la manœuvre de protection à la reperfusion dans le modèle de coeur isolé perfusé de rat. Le PostC, comme la BP, utilise deux sources de production de NO (NOS et Xanthine oxydase reductase) pour induire la cardioprotection. Ces résultats nous semblent importants dans le sens où ils proposent une nouvelle fenêtre thérapeutique pour combattre les dégâts liés à l’ischémie/reperfusion, la BP / Although its efficacy in various species (rabbit, pig, mouse,…) and various organs (kidney, liver heart, lung), Postconditioning (PostC) can be limited by many factors such as the necessity of its application in the initiation of the reperfusion. The objective of our work was to evaluate the protection by low pressure reperfusion (LPR) with delayed intervention at reperfusion and to study the mitochondrial functions which are known to be involved in the cardioprotection. Our results showed that, contrary to PostC, LPR can protect until 10 minutes of its delayed intervention at reperfusion. This delayed protection is in correlation with mitochondrial functions, particularly, inhibition of mitochondrial transition pore (PTPm). Cyclosporine, inhibitor of PTPm, has also shown protection until 10 minutes of delayed intervention, on isolated heart rat model. PostC, like LPR, use tow sources of prodution of NO (NOS and Xanthine oxydase reductase). These results seem, to us, very important because they propose LPR as a new therapeutic window to reduce ischemia/reperfusion injury

Obesity has reached worldwide epidemic proportions and with this increased incidence of obesity, comes an increase in incidence of the comorbidities associated with obesity such as diabetes and cardiovascular disease (CVD). The underlying mechanisms which connect these diseases are still poorly understood. One system which has been shown to be up-regulated in the setting of obesity and diabetes is that of the G-protein coupled receptor-55/Lysophosphatidylinositol (GPR55/LPI). Despite being upregulated in the setting of obesity, the function of GPR55 in obesity and other disease states remains elusive. Therefore, the present study aimed to 1) investigate the role of GPR55 in obesity by characterising the phenotype of the GPR55 knockout (GPR55-/-) mouse when challenged with a high fat diet (HFD) intervention, 2) elucidate any effect of the GPR55 knockout and HFD intervention on the myocardial infarct size sustained following a period of ischaemia/reperfusion (I/R) and 3) make use of an in vitro model to elucidate the mechanisms by which changes occur in the adipose tissue of mice fed a HFD. GPR55-/- mice fed a HFD for 12-weeks gained significantly more weight in the form of fat mass, compared to wild-type (WT) controls and consequently become obese. Obese GPR55-/- mice displayed hypertrophic adipose tissue concurrent with the significant dysregulation of plasma lipids, increases in specific circulating LPI species, increased lipid deposition within the liver and a change in adipose tissue gene expression profile. These changes were not observed in GPR55-/- mice fed a standard diet or WT mice fed a HFD. Following a period of I/R, the myocardial infarct size in hearts from WT HFD fed mice was significantly smaller than in hearts from WT standard diet fed mice. This reduction in infarct size due to HFD intervention was not dependent on RISK-pathway activation and was not observed in hearts from GPR55-/- mice, therefore demonstrating that the cardio-protective effect of a HFD on infarct size is dependent on GPR55. In vitro studies using 3T3-L1 cells determined that the changes in adipose tissue gene expression of HFD fed mice was not due to enhanced stimulation with LPI or via hypoxic mechanisms. The results of these studies demonstrate that GPR55 has an anti-obesity function in vivo and also mediates the cardio-protective effect of a HFD on myocardial infarct size, through currently unknown mechanisms.

Hydrogen sulfide (H2S) is the newest member of the gasotransmitter family and is becoming well known for its cardioprotective effects in preclinical trials. Many recent studies have shown the benefits of exogenous H2S in the setting of acute myocardial infarction (AMI) and pressure overload-induced heart failure, but current formulations are derived from inorganic salts which have shortcomings in the precision and control of release of H2S. The main objective of this thesis was to determine if the novel, orally active, slow-releasing compound, SG1002, can attenuate the severity of damage and adverse remodeling caused by ischemia/reperfusion injury through an induction of angiogenesis. A traditional sodium salt, Na2S, which has been previously shown to be cardioprotective, was used as a positive control. SG1002 improved overall left ventricular function as measured by increased ejection fraction from echocardiography and decreased QRS interval from electrocardiography compared to untreated animals following MI. SG1002 therapy was also associated with an induction of angiogenesis, which was determined through qRT-PCR, western blot, and histological methods. SG1002 increased VEGF protein levels, which was paralleled with an increase in capillary density in the infarct region. SG1002 also upregulated microRNA-126, which is thought to repress the inhibitor of VEGF, Spred-1. It is possible that this “angiomiR” plays a key role in the angiogenesis-related cardioprotection of H2S. The combination of increased pro-angiogenic factors along with greater vascular density resulting from SG1002 therapy indicates the therapeutic potential for this drug in the prevention and/or treatment of ischemic heart failure.

Der myokardiale Ischämie-Reperfusions-Schaden (IR) hat eine hohe Relevanz in der Kardiologie und Herzchirurgie. Trotz intensiver Forschung ist es bislang nicht gelungen, eine effektive Therapie des IR in den klinischen Alltag zu implementieren. Mitochondrien spielen im IR eine wichtige Rolle. Die Raman-Spektroskopie mit Laserquellen von 785 nm Wellenlänge erlaubt die nicht-invasive Analyse pathophysiologischer Prozesse in vitro in Echtzeit. Daher eignet sich die Raman-spektroskopische Analyse von Mitochondrien möglicherweise dazu, notwendige neue Einblicke in die Pathophysiologie des myokardialen IR zu gewinnen. Die vorliegende Arbeit analysierte die mitochondriale Funktion von subsarkolemmalen Mitochondrien im IR mit Hilfe bekannter Methoden. Anschließend erfolgte ein Vergleich der etablierten Methode „Clark-Elektrode“ mit der neu etablierten Raman-Spektroskopie zur Analyse der mitochondrialen Funktion im IR. / Myocardial ischemia reperfusion injury (IR) has a high relevance in cardiology and heart surgery. Despite intense research, an effective treatment of IR has to date not been implemented in clinical routine. Mitochondria play an important role in IR. Raman spectroscopy with 785 nm laser wavelength permits the non-invasive analysis of pathophysiological processes in vitro and real-time. Therefore, Raman-spectroscopic analysis of mitochondria might be able to create new necessary insights in the pathophysiology of myocardial ischemia reperfusion injury. This work analysed mitochondrial function of subsarcolemmal mitochondria in IR using well-established methods. Afterwards, a comparison of the well-established method “Clark-Elektrode” with freshly established raman spectroscopy was performed to analyse the mitochondrial function in IR.

"September 2002" Bibliography: leaves 207-230. Ch. 1. Literature review -- Ch. 2. General methods -- Ch. 3. Dietary n-3 PUFAs and reperfusion injury in isolated cardiomyocytes -- Ch. 4. The effect of dietary n-3 PUFAs on cardiomyocyte membrane fluidity, intracellular ROS and Ca 2+ levels during oxidative stress -- Ch. 5. The effect of dietary fish oil supplementation on antioxidant enzyme gene expression in rat myocardium -- Ch. 6. The effect of dietary lipids on ischaemia-reperfusion injury in rat myocardium -- Ch. 7. General discussion -- Ch. 8. Appendices. The broad aims of this thesis were to develop a cellular model for studying reperfusion injury, in order to investigate the reported protective effects of n-3 PUFAs, and to examine the underlying mechanisms associated with such protection.