Depuis plus de 30 ans, les progrès thérapeutiques ont permis de réduire la morbi-mortalité liée à l’infarctus du myocarde. La reperfusion est une étape essentielle dans la prise en charge des patients, mais est également à l’origine de lésions tissulaires cardiaques. Plusieurs travaux ont montré que le conditionnement ischémique ou pharmacologique du coeur permet de réduire ces lésions de reperfusion, mais que cet effet bénéfique reste limité dans un contexte de diabète.Dans ce travail, nous avons tout d’abord étudié l’impact du diabète de type 2 sur la fonction mitochondriale. Les études ont été réalisées sur des trabécules d’oreillette humaine, et dans deux sous-populations mitochondriales, les mitochondries sous-sarcolemmales (SSM) et interfibrillaires (IFM), par des approches polarographique, spectrophotométrique et protéomique. Alors que des différences sont observées en termes d’activité enzymatique et d’expression protéique entre SSM et IFM, nous n’avons pas observé d’effet lié au diabète sur la fonction mitochondriale.Dans un second temps, nous avons développé un modèle d’étude des lésions d’ischémie reperfusion chez la souris en utilisant la technique de Langendorff. Nous avons étudié les effets sur la fonction cardiaque et sur le volume de nécrose, du post-conditionnement pharmacologique par différents agonistes et antagonistes opioïdes (morphine, [D-Pen2,D-Pen5]-enkephaline (DPDPE), naloxone, naltrindole) après une ischémie globale. Chacune des molécules testées réduit le volume de nécrose. La fonction cardiaque était également améliorée après 60 minutes de reperfusion en présence de morphine seule, de naloxone seule, et des associations morphine-naloxone et DPDPE-naltrindole. Les mécanismes moléculaires impliqués dans ces effets cardioprotecteurs nécessitent d’être mieux compris avant d'envisager une application chez l’Homme, en particulier chez le patient diabétique, afin de limiter les lésions de reperfusion dans un contexte d’infarctus du myocarde. / The morbidity and the mortality of the heart stroke have been reduced over the last 30 years and it was related to an improvement of patient care. The early reperfusion of the heart is an essential step, but is responsible for ischemia-reperfusion injuries. Both ischemic and pharmacological conditionings were shown to increase heart function, but these beneficial effects are reduced in a context of diabetes mellitus.First, we studied the effect of type 2 diabetes mellitus on mitochondrial function. Studies were performed on heart trabeculae, and in subsarcolemmal (SSM) or interfibrillar (IFM) mitochondria extracted from human atrial appendages using polarographic, spectrophotometric and proteomic analyses. Whereas differences on enzymatic activities and in protein expression were observed between SSM and IFM, we did not find any deleterious effect of diabetes mellitus on mitochondrial function. Second, using a Langendorff’s apparatus, we developed an experimental model in mouse to study ischemia-reperfusion injuries. Pharmacological post-conditioning was tested by using various opioid agonists and antagonists, including morphine, [D-Pen2,D-Pen5]-enkephalin (DPDPE), naloxone, and naltrindole. The effects were observed on heart function and the volume of necrosis. All treatments were effective to reduce the necrosis in the heart compared to control condition. After 60 minutes of reperfusion, cardiac function was also improved with morphine, naloxone, and the association of morphine-naloxone, and DPDPE-naltrindole. A better understanding of the molecular mechanisms is needed to improve pharmacological post-conditioning in patients, particularly in diabetics, presenting with heart stroke.

Cardiovascular intervention studies are a very important issue given that the ischaemic heart disease is one of the main mortality and morbidity causes in the Western world. Cardioprotection is mediated through a variety of signalling pathways in the cell that may directly or indirectly affect energy metabolism and mitochondria. Ischaemia-reperfusion injury of the heart significantly affect mitochondrial function revealing a potential therapeutic target. The role of mitochondria in the myocardium is not only in the field of energy homeostasis, but also in mediating the cellular response to reduced oxygen supply and in apoptosis regulation. This thesis aims to elucidate the response of the hypertrophied heart of the spontaneously hypertensive rat (SHR) and the derived conplastic strain with mitochondrial genome of normotensive Brown Norway (SHR-mtBN ) to the cardioprotective regime of adaptation to chronic normobaric hypoxia (CNH, Fi 0.1). The adaptive changes were studied at the cellular, protein and gene levels using Real-time RT-PCR, Biomark Chip Analysis, Western Blot, spectrophotometric measurements of enzyme activity and quantitative immunofluorescence analyses. The present thesis was based on a different cardioprotective phenotype between SHR and SHR-mtBN strains, i.e. a significantly smaller...

Cardiovascular diseases (CVDs) are the most widely spread diseases of modern civilization. Mechanisms involved in the protection of myocardial tissue are for that very reason in the focus of cardiovascular research. The adaptation to chronic hypoxia has been studied for many years in the context of its positive effects on heart function and its increased tolerance to ischemia-reperfusion (I/R) injury. This Master thesis describes the role of Akt kinase in the mechanisms leading to myocardial protection against I/R injury using the model of adaptation to chronic normobaric hypoxia (CNH). The hearts from male Wistar rats, that were kept in normoxic or hypoxic conditions (O2 0.1) for the period of 3 weeks, were retrogradely perfused by oxygenated Krebs-Henseleit solution and then subjected to 10 min of ischemia and 10 min of reperfusion. Samples prepared from left ventricles (LV) of experimental hearts were later used for protein analyses. The adaptation to CNH leads to increased phosphorylation of Akt kinase on Ser473, but it did not affect the phosphorylation on Thr308 nor the total protein level of Akt. A significant increase in Bcl-2/Bax ratio was also observed in hearts adapted to CNH. This Master thesis further elucidates, how Akt signaling pathway and its activation are affected by short...

Malgré de très nombreuses études expérimentales et cliniques dans le domaine de l'arrêt circulatoire, seulement 2% à 12% des patients quittent l'hôpital avec une bonne récupération neurologique. Il est donc nécessaire de proposer de nouvelles thérapeutiques pour tenter d'augmenter la survie après un arrêt circulatoire. Pour atteindre ce but il semble indispensable d'améliorer la qualité du massage cardiaque durant la réanimation et de protéger le myocarde et le cerveau contre les phénomènes d'ischémie-reperfusion. Dans la première partie de ce travail, nous avons évalués dans une étude pré hospitalière l'utilisation d'un dispositif innovant de massage cardiaque interne par minithoracotomie et montré une amélioration de l'hémodynamique en comparaison avec le massage cardiaque standard. Dans la deuxième partie, nous avons testés les possibles effets protecteurs de l'EPO (érythropoïétine) dans deux types d'arrêt circulatoire. Dans un modèle d'arrêt cardiaque expérimental chez le rat nous avons démontré que lorsque l'EPO était injectée avant l'arrêt cardiaque, la réanimation initiale était améliorée et la survie des animaux augmentée ce qui pouvaient suggérer un effet cardio et/ou neuroprotecteur de l'EPO contre les effets délétères de l'ischémie reperfusion. Dans une étude clinique en chirurgie cardiaque sous circulation extra corporelle, nous n'avons pas pu démontré d'effet bénéfique de l'EPO ni sur l'ischémie myocardique, ni sur l'ischémie cérébrale ni sur les paramètres de l'inflammation. Sur la base de ces deux études, il est donc difficile de conclure sur le potentiel rôle bénéfique de l'EPO dans l'arrêt circulatoire. Néanmoins, sur la seule base des résultats expérimentaux, l'EPO pourrait faire partie de l'arsenal thérapeutique pour mieux protéger le myocarde et le cerveau contre les effets délétères de l'ischémie reperfusion après un arrêt cardiaque. / Despite extensive experimental and clinical research on cardiac arrest, only 2-12% of resuscitated patients are discharged from hospital in good neurological conditions. There is, therefore, a dear need for new therapies that improve survival after cardiac arrest. It ‘s necessary to improve the quality of cardiac massage and to protect against cardiac and cerebral ischemia occurring during cardiac arrest. In a first part, we evaluated the prehospital feasibility of performing a new method of minimally invasive direct cardiac massage (MID-CM®) and we suggested that better haemodynamic results can be obtained than with standard cardiopulmonary resuscitation. In a second part, we tested erythropoietin (EPO) against placebo in two model of cardiac arrest. In an experimental model of cardiac arrest, we demonstrated that EPO, when administrated before cardiac arrest, improved initial resuscitation and increased the duration of post-resuscitation survival. In a second model of circulatory arrest during cardiac surgery with cardiopulmonary bypass, EPO administration did not protect against cerebral ischemia and inflammatory response occurring during cardiac surgery with CPB. It is difficult to make definitive conclusion on the potential role of EPO in myocardial and cerebral protection after circulatory arrest. We can hope that EPO administration will represent pharmacological approach in upcoming years to additional myocardial salvage of the reperfused myocardium after cardiac arrest.

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Biochemical Sciences Candidate: Bc. Pavla Martinková Supervisor: PharmDr. Anna Jirkovská, PhD. Title of diploma thesis: Antiproliferative activity of novel dexrazoxane analogues and their effect on antitumor effectiveness of anthracyclines Athracycline antibiotics (such as daunorubicin, doxorubicin or epirubicin) belong to the most common terapeutics of both solid tumors and hematological malignities. Unfortunately the serious and life-threatening adverse effect cardiotoxicity compromises their clinical usefulness. The only approved protection against anthracycline cardiotoxicity so far is dexrazoxane. Despite the outstanding cardioprotective ability, dexrazoxane use is very limited mainly due to its possible side effects. So we were directed towards synthesis of dexrazoxane analogues with better pharmacological properties. The aim of this diploma thesis was to assess the antiproliferative activity of novel analogues of both dexrazoxane (MK-15 and ES-5) and ADR-925 (JR-159 and KH- TA4) and their influence on the antiproliferative effectiveness of anthracyclines. Moreover, we aimed to study their chelating properties and their inhibition of the topoisomerase II in solution. We tested the antiproliferative activity of...

Eicosapentaenoic acid (EPA) is a polyunsaturated fatty acid (PUFA) with neuroprotective and cardioprotective properties. It is thought that some of the actions of EPA may be attributed to its elongated metabolite, the PUFA docosapentaenoic acid (DPA). Docosahexaenoic acid (DHA) and arachidonic acid (AA) are bioactive PUFA ubiquitously expressed in neural tissues. EPA and AA can be converted by cyclooxygenase (COX) to prostanoids and by lipoxygenase (LOX) to hydroxy fatty acids. PUFA can also be converted to ethanolamides in the brain. These mediators are involved in physiological and pathological processes in many bodily systems. The purpose of this study was to examine the production of eicosanoids, hydroxy fatty acids and fatty acid ethanolamides in young and aged rat brain following EPA or DPA enriched diets. The effects of specific PUFA on human platelet eicosanoid production were also investigated as these mediators play a role in adhesion and aggregation. Liquid chromatography coupled to tandem mass spectrometry (LC/ESI-MS/MS) assays were developed and used to measure lipid mediators in rat brain and human platelets. Ageing in rat brain was accompanied with several changes in the prostanoid and hydroxy fatty acid profiles. Supplementing the diet with EPA or DPA at a daily dose of 200 mg/kg for 8 weeks prevented these changes and decreased levels of PGE2. DPA changed the profile of hydroxy fatty acids synthesised in the brain tissue of young animals. This study has shown that levels of eicosapentaenoylethanolamide (EPA-EA) increase in the brain as a result of ageing and that this is accompanied by an increase in levels of anandamide. Feeding aged animals EPA or DPA further increased the levels of EPA-EA but prevented any change in the level of anandamide. Niacin is used to treat hypercholesterolaemia although it is associated with an unpleasant PGD2 mediated skin flush. This exploratory study has shown that human platelets treated with niacin did not show any changes in their prostanoid and hydroxy fatty acid profiles. Platelets treated with EPA showed increased production of TXB3 and 12-HEPE. Niacin augmented the effects of EPA on human platelet mediator synthesis. Overall, this study has demonstrated that EPA can change brain and platelet lipid mediator synthesis and has provided evidence that could explain some of the neuroprotective and cardioprotective actions of this PUFA.

Background: Surgical procedures are invariably accompanied by the use of inhalational and intravenous anesthetics. Both groups have strong influence on cardiovascular system by the interaction with myocardial oxygen supply/demand ratio and cardiomyocyte functions at the level of cell membranes, ion channels and regulatory enzymes. Aims: 1. To examine the effects of different isoflurane concentrations on the left ventricular (LV) dimensions and systolic function in the rat. 2. To examine the effects of isoflurane-induced myocardial preconditioning (APC) on the cardiac tolerance to ischemia- reperfusion (I-R) injury. 3. To compare the influence of anesthesia, based on ketamine- dexmedetomidine (KET-DEX), on the release of biochemical markers of myocardial injury and the early postoperative course with the anesthesia, based on sevoflurane-sufentanil (SEVO), in the patients undergoing coronary artery bypass grafting (CABG). Methods: 1. We carried out transthoracic echocardiographic examination in the rats immobilized by 1.5-3% concentration of isoflurane. 2. After inducing APC by isoflurane (0.5 and 1 MAC), we evaluated ventricular arrhythmias during regional ischemia (45 min), induced by the occlusion of the left anterior descending artery, and subsequent reperfusion (60 min), using the model of...

Background: Surgical procedures are invariably accompanied by the use of inhalational and intravenous anesthetics. Both groups have strong influence on cardiovascular system by the interaction with myocardial oxygen supply/demand ratio and cardiomyocyte functions at the level of cell membranes, ion channels and regulatory enzymes. Aims: 1. To examine the effects of different isoflurane concentrations on the left ventricular (LV) dimensions and systolic function in the rat. 2. To examine the effects of isoflurane-induced myocardial preconditioning (APC) on the cardiac tolerance to ischemia- reperfusion (I-R) injury. 3. To compare the influence of anesthesia, based on ketamine- dexmedetomidine (KET-DEX), on the release of biochemical markers of myocardial injury and the early postoperative course with the anesthesia, based on sevoflurane-sufentanil (SEVO), in the patients undergoing coronary artery bypass grafting (CABG). Methods: 1. We carried out transthoracic echocardiographic examination in the rats immobilized by 1.5-3% concentration of isoflurane. 2. After inducing APC by isoflurane (0.5 and 1 MAC), we evaluated ventricular arrhythmias during regional ischemia (45 min), induced by the occlusion of the left anterior descending artery, and subsequent reperfusion (60 min), using the model of...

Eicosapentaenoic acid (EPA) is a polyunsaturated fatty acid (PUFA) with neuroprotective and cardioprotective properties. It is thought that some of the actions of EPA may be attributed to its elongated metabolite, the PUFA docosapentaenoic acid (DPA). Docosahexaenoic acid (DHA) and arachidonic acid (AA) are bioactive PUFA ubiquitously expressed in neural tissues. EPA and AA can be converted by cyclooxygenase (COX) to prostanoids and by lipoxygenase (LOX) to hydroxy fatty acids. PUFA can also be converted to ethanolamides in the brain. These mediators are involved in physiological and pathological processes in many bodily systems. The purpose of this study was to examine the production of eicosanoids, hydroxy fatty acids and fatty acid ethanolamides in young and aged rat brain following EPA or DPA enriched diets. The effects of specific PUFA on human platelet eicosanoid production were also investigated as these mediators play a role in adhesion and aggregation. Liquid chromatography coupled to tandem mass spectrometry (LC/ESI-MS/MS) assays were developed and used to measure lipid mediators in rat brain and human platelets. Ageing in rat brain was accompanied with several changes in the prostanoid and hydroxy fatty acid profiles. Supplementing the diet with EPA or DPA at a daily dose of 200 mg/kg for 8 weeks prevented these changes and decreased levels of PGE2. DPA changed the profile of hydroxy fatty acids synthesised in the brain tissue of young animals. This study has shown that levels of eicosapentaenoylethanolamide (EPA-EA) increase in the brain as a result of ageing and that this is accompanied by an increase in levels of anandamide. Feeding aged animals EPA or DPA further increased the levels of EPA-EA but prevented any change in the level of anandamide. Niacin is used to treat hypercholesterolaemia although it is associated with an unpleasant PGD2 mediated skin flush. This exploratory study has shown that human platelets treated with niacin did not show any changes in their prostanoid and hydroxy fatty acid profiles. Platelets treated with EPA showed increased production of TXB3 and 12-HEPE. Niacin augmented the effects of EPA on human platelet mediator synthesis. Overall, this study has demonstrated that EPA can change brain and platelet lipid mediator synthesis and has provided evidence that could explain some of the neuroprotective and cardioprotective actions of this PUFA.