Orientador: Kleber Gomes Franchini / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T04:16:59Z (GMT). No. of bitstreams: 1 Deckmann_AnaCarolina_D.pdf: 7310325 bytes, checksum: 97d12a5e15b0b17033701d84779632e1 (MD5) Previous issue date: 2008 / Resumo: O termo síndrome coronária aguda compreende a angina instável e o infarto do miocárdio, entidades clínicas freqüentes e potencialmente letais. Ambas as situações caracterizam-se por um desbalanço entre a oferta e a demanda de oxigênio no miocárdio, freqüentemente desencadeadas pela diminuição da perfusão resultante de estreitamento ou oclusão de artérias coronárias em conseqüência de aterosclerose. As elevadas taxas de morbidade e mortalidade destas condições são atribuídas, principalmente, à perda de massa miocárdica e instabilidades elétricas decorrentes não apenas da isquemia, mas também da reperfusão espontânea ou induzida de áreas do miocárdio isquêmico. Desta forma, é intensa a busca por estratégias e agentes farmacológicos que possam reduzir os danos miocárdicos provocados tanto pela isquemia como pela reperfusão. Evidências experimentais e algumas evidências clínicas indicam que a adenosina (Ado) administrada sistemicamente é capaz de proteger o miocárdio dos efeitos da isquemia/reperfusão. A proteção conferida pela Ado ocorre tanto aguda (1-6 horas) como tardiamente (1-3 dias) após a administração em dose única. Enquanto a proteção aguda depende da ativação de vias de sinalização que mobilizam efetores constitutivamente expressos nas células, a proteção tardia parece depender da alteração da expressão de genes envolvidos em múltiplas funções celulares. No entanto, algumas características da ação sistêmica da Ado, tais como a meia-vida curta e seus efeitos cardiovasculares (i.e. bradicardia e hipotensão), são barreiras importantes para seu uso clínico nas síndromes coronárias agudas. Uma das maneiras de evitar estes efeitos indesejáveis é utilizar agentes farmacológicos que aumentam a biodisponibilidade de Ado, como antagonistas de seus transportadores ou inibidores da adenosina quinase, uma enzima-chave no metabolismo de purinas que fosforila a adenosina em AMP através de hidrólise do ATP. Neste contexto, demonstramos anteriormente que compostos derivados de anilinoquinazolinas são inibidores de adenosina quinase e induzem a proteção miocárdica tanto aguda como tardia em modelo de coração isolado. Tendo em vista que a proteção tardia depende da expressão diferencial de genes, o presente estudo foi planejado para investigar as respostas transcricionais envolvidas na cardioproteção induzida tardiamente após a administração do composto quinazolínico líder inibidor de adenosina quinase, DMA. Para tanto, foram utilizados lâminas de oligonucleotídeos contendo as sequências referentes a todos os genes de camundongo (~35 mil genes). As sondas de RNA foram sintetizadas a partir de corações de camundongos tratados com dose única de DMA O termo síndrome coronária aguda compreende a angina instável e o infarto do miocárdio, entidades clínicas freqüentes e potencialmente letais. Ambas as situações caracterizam-se por um desbalanço entre a oferta e a demanda de oxigênio no miocárdio, freqüentemente desencadeadas pela diminuição da perfusão resultante de estreitamento ou oclusão de artérias coronárias em conseqüência de aterosclerose. As elevadas taxas de morbidade e mortalidade destas condições são atribuídas, principalmente, à perda de massa miocárdica e instabilidades elétricas decorrentes não apenas da isquemia, mas também da reperfusão espontânea ou induzida de áreas do miocárdio isquêmico. Desta forma, é intensa a busca por estratégias e agentes farmacológicos que possam reduzir os danos miocárdicos provocados tanto pela isquemia como pela reperfusão. Evidências experimentais e algumas evidências clínicas indicam que a adenosina (Ado) administrada sistemicamente é capaz de proteger o miocárdio dos efeitos da isquemia/reperfusão. A proteção conferida pela Ado ocorre tanto aguda (1-6 horas) como tardiamente (1-3 dias) após a administração em dose única. Enquanto a proteção aguda depende da ativação de vias de sinalização que mobilizam efetores constitutivamente expressos nas células, a proteção tardia parece depender da alteração da expressão de genes envolvidos em múltiplas funções celulares. No entanto, algumas características da ação sistêmica da Ado, tais como a meia-vida curta e seus efeitos cardiovasculares (i.e. bradicardia e hipotensão), são barreiras importantes para seu uso clínico nas síndromes coronárias agudas. Uma das maneiras de evitar estes efeitos indesejáveis é utilizar agentes farmacológicos que aumentam a biodisponibilidade de Ado, como antagonistas de seus transportadores ou inibidores da adenosina quinase, uma enzima-chave no metabolismo de purinas que fosforila a adenosina em AMP através de hidrólise do ATP. Neste contexto, demonstramos anteriormente que compostos derivados de anilinoquinazolinas são inibidores de adenosina quinase e induzem a proteção miocárdica tanto aguda como tardia em modelo de coração isolado. Tendo em vista que a proteção tardia depende da expressão diferencial de genes, o presente estudo foi planejado para investigar as respostas transcricionais envolvidas na cardioproteção induzida tardiamente após a administração do composto quinazolínico líder inibidor de adenosina quinase, DMA. Para tanto, foram utilizados lâminas de oligonucleotídeos contendo as sequências referentes a todos os genes de camundongo (~35 mil genes). As sondas de RNA foram sintetizadas a partir de corações de camundongos tratados com dose única de DMA / Abstract: The term acute coronary syndrome includes unstable angina and myocardial infarction, which are frequent and potentially lethal clinical entities. Both situations are characterized by an imbalance between myocardial oxygen supply and demand, often triggered by the reduced perfusion caused by narrowing or occlusion of coronary arteries due to atherosclerosis. The high morbidity and mortality rates determined by these conditions are attributed mainly to loss of myocardial and electrical instabilities, arising not only from ischemia, but also from spontaneous or induced reperfusion of the ischemic regions. Thus, there is much interest in the development of strategies and pharmacological agents able to minimize the injuries caused not only by myocardial ischemia but also by reperfusion. Experimental and clinical data indicate that systemically administered adenosine (Ado) is able to protect the myocardium from ischemia/reperfusion injuries. The protection induced by Ado occurs in two phases, an acute (1-6 hours) and a late (1-3 days) phase after a single dose administration. While acute protection depends on activation of signaling pathways that mobilize end-effectors constitutively expressed in the cells, the late protection depends on the alterations of the expression of genes involved in multiple cellular functions. However, some characteristics of the systemic action of Ado, such as its short half-life and cardiovascular side effects (i.e. bradycardia and hypotension), are major barriers to its clinical use in acute coronary syndromes. One way to circumvent these undesirable effects is to use pharmacological agents that increase Ado bioavailability, as antagonists of its transporters or adenosine kinase (ADK) inhibitors. ADK is a key enzyme in the metabolism of purines that phosphorilates adenosine to AMP by ATP hydrolysis. In this context, we have previously demonstrated that derivatives of anilinoquinazolines are potent inhibitors of adenosine kinase and induce both acute and late phases of cardioprotection, as showed in isolated heart model. The present study was designed to investigate the transcriptional responses involved in late cardioprotection induced by administration of the anilinoquinazoline DMA. We used oligonucleotide microarrays containing representative sequences of all genes from mouse genome (~35 thousand genes). The RNA probes were synthesized from hearts of mice treated with DMA (30 mg/kg, single dose) ou vehicle (DMSO), 24 and 48 hours prior to tissue excision. We considered differentially expressed (fold change>[2.0], p<0.1) a total of 1061 genes in 24-hour and 844 genes in 48-hour groups, in comparison to vehicle treated samples. Most of these transcripts were unknown genes (ESTs-Expressed Sequence Tags; 63% at 24 hours, 76% in 48 hours). In 24h transcriptome, most of the genes (75% of the known genes and 62% of ESTs) were upregulated, while in 48h transcriptome 56% of the known genes and 58% of ESTs were upregulated. The functional analysis of known genes showed large representation of classes associated with cell adhesion, signaling, transport and metabolism in 24 hours, and cell adhesion, development of multicellular organism and metabolism in 48 hours. The analysis of gene identities revealed few coincidences between the two transcriptomes, and clustering analysis performed to study the gene profile transition from 24 to 48h revealed that most genes presents transitory regulation of its expression (i.e., tendency of upregulation at 24h followed by downregulation at 48h and vice-versa). Analysis of differentially expressed genes in terms of metabolic and signaling pathways in which they are inserted allowed us to assess a putative metabolome of myocardial cells treated by the quinazoline DMA. Results indicated that the most affected pathways are glucose and lipids metabolism, PPAR-? and adipocytokines, angiogenic responses, among others. Among these results, we confirmed experimentally the angiogenic effect of DMA and also the expression of genes and proteins associated with modifications in cardiac energy metabolism. Our results indicate that various cellular responses, including the energetic metabolism, ion homeostasis and changes in cell osmolarity, must cooperate to induce the cardioprotection phenotype after DMA administration. Studies focusing the mechanistic modifications of these groups of genes will contribute to elucidate their involvement in the protection induced by treatment with quinazolines, and will provide clues to comprehend myocardial protection phenomenon. Keywords: cardioprotection, quinazolinic compounds, gene expression, oligonucleotide microarrays, Mus musculus / Doutorado / Medicina Experimental / Doutor em Clínica Médica

Introdução: O aumento da tolerância do miocárdio isquêmico observado durante o segundo de dois testes de esforços seqüenciais, o fenômeno do pré-aquecimento, foi proposto como um modelo clínico do pré-condicionamento isquêmico. Bloqueadores dos canais de K-ATP dependentes, tais como as sulfoniluréias, podem induzir a perda do pré-condicionamento isquêmico, o qual poderia estar envolvido no aumento dos eventos cardiovasculares. A repaglinida é um agente hipoglicemiante oral, pertencente à família da meglitinida e supostamente dotada de menor efeito no pré-condicionamento isquêmico, ainda que o fármaco tenha seu principal mecanismo de ação nos canais de K-ATP dependentes. Objetivos e Métodos: O objetivo foi investigar os efeitos da repaglinida no fenômeno do pré-condicionamento isquêmico em pacientes diabéticos com doença coronariana estável. Foram estudados 42 pacientes diabéticos tipo 2, com angina estável e doença arterial documentada. Todos os pacientes tinham testes ergométricos positivos para isquemia. Na primeira fase do teste, a sulfoniluréia e os betabloqueadores foram suspensos por trinta dias e sete dias, respectivamente. Os pacientes foram submetidos a dois testes ergométricos seqüenciais, com intervalo de trinta minutos (testes 1 e 2). Na segunda fase, os pacientes receberam repaglinida por sete dias e mais dois testes ergométricos foram repetidos (testes 3 e 4). Resultados: Todos os pacientes alcançaram ST >1 mm na primeira fase (Teste 1 e 2). O tempo alcançado no teste 2 foi maior que aquele alcançado no teste 1 (4:44s. x 5:37s. p=0,001), como também foi maior a duração do exercício (6:15s x 6:29s. p=0,008), denotando pré-condicionamento isquêmico. Após o uso da repaglinida, nos testes 3 e 4, observou-se menor tempo alcançado para atingir isquemia no teste 4 (5:37s. x 4:58s. p=0,001). Observou-se, ainda, menor tempo de tolerância ao exercício na fase 2 (6:57s x 6:34s. p=0,007). Em relação ao surgimento de angina, não se constataram diferenças estatísticas entre as duas fases. Conclusão: Nos pacientes diabéticos com doença coronariana estável, a repaglinida bloqueou o pré-condicionamento isquêmico. / Background: The increase of tolerance to myocardial ischemia observed during the second of two sequential exercise tests, the warm-up phenomenon, has been proposed as a clinical model of ischemic preconditioning. Blockers of K-ATP channels, such as the Sulfonylurea drugs, can induce loss of ischemic preconditioning, what could be involved in an increase of cardiac events. Repaglinide is a hypoglycemic agent with supposedly lower influence on ischemic preconditioning, despite acting in K-ATP channels. Objectives and Methods: This study investigated the effects of repaglinide on the ischemic preconditioning in diabetic patients with CAD. There were 42 patients and inclusion criteria were positive treadmill test for myocardial ischemia. Sulphonylureas and beta-blocking agents were withdrawn 30 and 7 days respectively before phase 1 of the study. In this phase, the patients underwent two consecutive treadmill exercise tests at 30 minute intervals (test 1 and test 2). In phase 2 of the study, all patients received repaglinide 2 mg three times daily during 7 days before treadmill exercise test (test 3 and test 4). Results: All patients achieved 1.0 mm ST-segment depression during phase 1. The time achieved to ST depression during test 2 was greater than that during test 1 (4:44s vs. 5:37s. p=0.001) as well as the duration of the exercise (6:15s vs.6: 29s. p=0.008), suggesting a higher ischemic threshold. In phase 2 after repaglinide, all patients achieved 1 mm ST-segment depression. However, the time achieved to ST depression, as well as the duration of the exercise, was lower in test 4 comparing with test 3. There were no statistical differences regarding angina episodes in phase 1 or phase 2. Conclusions: In diabetic patients with stable coronary disease, the oral hypoglycemic agent repaglinide abolished the myocardial ischemic preconditioning.

Orientador: Heitor Moreno Júnior / Texto em português e inglês / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T06:24:55Z (GMT). No. of bitstreams: 1 Modolo_RodrigoGimenezPissutti_D.pdf: 4167862 bytes, checksum: c8c13bab82be7254e6f029089b1c79b3 (MD5) Previous issue date: 2014 / Resumo: INTRODUÇÃO: A hipertensão arterial é o mais prevalente e significante fator de risco modificável para doença arterial coronariana (DAC). Uma parte destes pacientes com hipertensão descontrolada é classificada como sendo portadora da Hipertensão Arterial Resistente (HAR). A incidência da isquemia miocárdica e da DAC aumenta juntamente com a ascensão dos níveis pressóricos. No entanto, a prevalência de isquemia miocárdica em pacientes com HAR é desconhecida, bem como os fatores associados à primeira. MÉTODOS: Analisamos 129 pacientes com HAR verdadeira, seguidos regularmente em nosso ambulatório especializado. Foram realizados cintilografia de perfusão miocárdica em repouso e após stress farmacológico por dipiridamol nestes indivíduos. Os pacientes eram então divididos em dois grupos: com (I-HAR, n=36) e sem (SI-HAR, n=93) isquemia miocárdica. Ecocardiograma, MAPA-24h (para inclusive análise de efeito do jaleco branco), e vasodilatação mediada por fluxo (VMF) também foram realizados. RESULTADOS: Trinta e seis pacientes (28%) tinham isquemia miocárdica e 49% apresentavam o efeito do jaleco branco (EJB). O EJB esteve associado com alta prevalência de isquemia miocárdica (49,2% vs. 7,6%, p<0,001). Não houve diferença entre os grupos no que concerne à idade, sexo, parâmetros bioquímicos, pressão arterial de consultório e na MAPA. Pacientes no grupo I-HAR eram mais diabéticos (31 vs. 11%, p<0,05) e obesos (75 vs. 40%, p<0,001). Ajustando-se para idade e IMC, a regressão logística múltipla mostrou que diabetes (OR 6,5; 95%CI: 1,06-40,1, p=0,04), VMF (OR 0,18; 95%CI: 0,07-0,41, p<0,001), frequência cardíaca (OR 1,23; 95%CI: 1,11-1,36, p<0,001), índice de massa ventricular esquerda (OR 1,02; 95%CI: 1,01-1,04, p=0,04), e microalbuminúria (OR 1,02; 95%CI: 1,01-1,04, p=0,002) foram considerados preditores independentes de isquemia. Em outro modelo de regressão logística, ajustando-se para as mesmas variáveis, ainda tendo isquemia miocárdica como variável dependente, o EJB também foi considerado preditor independente de isquemia (OR=14,7, CI95% 4,8-44,8; p<0,001). CONCLUSÃO: Há uma alta prevalência de isquemia miocárdica em pacientes com HAR. Microalbuminúria, frequência cardíaca, disfunção endotelial, massa ventricular esquerda e a presença do efeito do jaleco branco podem ser úteis para guiar a investigação de isquemia miocárdica em pacientes assintomáticos para DAC, neste grupo de pacientes de alto risco ¿ HAR / Abstract: BACKGROUND: Hypertension is the most prevalent and significant modifiable risk factor for coronary heart disease. A portion of patients with uncontrolled hypertension is considered to have resistant hypertension (RHTN). Myocardial ischemia incidence increases along with blood pressure (BP) levels. However, the prevalence of myocardial ischemia in patients with RHTN is unknown, as well as the factors associated with it. METHODS: We enrolled 129 patients with true RHTN regularly followed in our specialty hypertension clinic and evaluated then by resting and dipyridamole pharmacological stress myocardial perfusion scintigraphy. Patients were then divided in two groups: with (I-RHTN, n=36) and without (NI-RHTN, n=93) myocardial ischemia. Echocardiography, 24h-ABPM (for analysis of white-coat effect -WCE) and flow-mediated dilation (FMD) were also evaluated. RESULTS: Thirty-six (28%) patients had myocardial ischemia and 49% presented the WCE. WCE was associated with higher prevalence of myocardial ischemia (49.2% vs. 7.6%, p<0.001) There was no difference between groups regarding age, gender, biochemical parameters, office and 24h-ABPM levels. Patients in the I-RHTN group were more likely diabetic (31 vs. 11%, p<0.05) and obese (75 vs. 40%, p<0.001). Adjusting for age and BMI, multiple logistic regression showed that diabetes (OR 6.5; 95%CI: 1.06-40.1, p=0.04), FMD (OR 0.18; 95%CI: 0.07-0.41, p<0.001), heart rate (OR 1.23; 95%CI: 1.11-1.36, p<0.001), left ventricular mass index (OR 1.02; 95%CI: 1.01-1.04, p=0.04), and microalbuminuria (OR 1.02; 95%CI: 1.01-1.04, p=0.002) were independent predictors of ischemia. On another model of logistic regression, using the same adjustments and myocardial ischemia as dependent variable, the WCE was considered an independent predictor of ischemia as well (OR=14.7, CI95% 4.8-44.8; p<0.001). CONCLUSIONS: In conclusion, there is a high prevalence of myocardial ischemia in patients with RHTN. Increased microalbuminuria, heart rate, endothelial dysfunction, LV mass and the presence of the white-coat phenomenon can be useful to guide the investigation for myocardial ischemia in these high risk patients / Doutorado / Farmacologia / Doutor em Farmacologia

Dans le cadre du développement d’une stratégie clinique de diminution de l’invasivité de l’acte de Chirurgie cardiaque, axée à la fois sur la réduction du traumatisme de la paroi thoracique, de l’ischémie myocardique peropératoire, et de l’agressivité de la CEC, une étude prospective randomisée a été réalisée pour comparer l’impact sur le métabolisme myocardique en peropératoire de l’utilisation de la cardioplégie cristalloïde Custodiol® versus la solution de cardioplégie de St Thomas au cours de la chirurgie coronarienne. L’objectif de cette étude est de comparer les modifications periopératoire de la concentration dans l’espace interstitiel de lactate, pyruvate, glycérol et glucose dans les deux groupes de cardioplégie et ceci depuis le déclampage jusqu'à 24h en post-opératoire. Matériels et méthodes. Vingt-huit patients ont pu être inclus dans l’étude. Le monitorage a été pratiqué avec la technique de microdialyse (cathéter CMA 70, Analyseur CMA 600, CMA Microdialysis,Sweden), avec une mesure toutes les 10 minutes pendant le temps du clampage et la première heure post déclampage, puis toutes les heures, des concentrations interstitielles des métabolites. Les concentrations plasmatiques des troponines à la sortie du bloc opératoire et à H +12 ont été également évaluées dans les deux groupes. Résultats : Des 28 patients inclus et randomisés, 22 ont pu bénéficier d’un monitorage complet (12 pour le groupe Custodiol® et 10 pour le groupe St Thomas). Six ont été exclus pour des raisons techniques (1 arrachement, 3 plicatures, 1 chute du cathéter et 1 dysfonctionnement de l’analyseur). Une analyse comparative entre les patients inclus et exclus de l’étude ne montre pas de différences significatives pour les facteurs de risque cardiovasculaires, la FEVG, l’âge, le genre. Les valeurs moyennes des concentrations +/- écart type de lactate, pyruvate, glucose et glycérol au déclampage (T0,) sont les suivants : groupe Custodiol® : 2.77+/-1.81 mmol l-1 ; 13.74+/-20.87 μmol l-1 ; 0.46+/-0.84 mmol l-1 ; 196.99+/-122.22 mmol l-1 ; groupe St Thomas : 0.89+/-0.64 mmol l-1 ; 6.49+/-9.10 μmol l-1 ; 0.19+/-0.18 mmol l-1 ; 73.17+/-72.11 mmol l-1. Les temps de CEC et de clampage ont été respectivement dans le groupe Custodiol® de : 94.2+/-14 min et 59.8+/-15 min, et, dans le groupe St Thomas de 82.6+/-15.9 min et 55.8+/-16.29 et min (p=ns). Les concentrations post-opératoires en troponine T (sortie de bloc et H+12) ont été respectivement de 2.8+/-1.8 et 7.4+/-5.3 μmol/L pour le groupe Custodiol® et de 3.3+/-4.0 et 5.0+/-3.6 μmol/L (p=ns) pour le groupe Saint Thomas. Aucun évènement clinique ou électrocardiographique n’a eu lieu en post opératoire dans les deux groupes. Conclusion. Le monitorage de l’état redox myocardique interstitiel a été possible dans les deux groupes de façon sûre et efficace et a permis de déceler des variations des concentrations en métabolites dans les deux groupes en l’absence d’évènements cliniques. Les résultats de ces analyses retrouvent, au déclampage, des concentrations significativement plus hautes de lactate et glycérol dans le groupe Custodiol®. Ces différences s’effacent rapidement pendant la phase de reperfusion avec une tendance (non significative) à une concentration de lactates plus basse dans le groupe de patients du groupe Custodiol®. Des études multicentriques ciblées sur des clampages longs supérieurs à 90 min nous semblent nécessaires pour définir si une différence à la fois métabolique et clinique peut exister entre les différentes solutions de protection cardiaque / In our unit, the challenge is to develop a clinical strategy of reduction of the invasiveness of the “On pump procedure” of cardiac surgery: that means a reduction of the chest wall trauma, of the cross clamping perioperative myocardial ischemia, and of the invasiveness of the extra-corporeal circulation. In this background, we organized a randomized perspective study in order to assess the impact of the perioperative myocardial redox metabolism during the on pump coronary surgery protected with Custodiol® versus St Thomas crystalloid cardioplegias. Objectives: To assess the presence and the severity of the perioperative myocardial ischemia in the Custodiol® versus St Thomas group, defined as the interstitial myocardial concentrations of lactate, pyruvate, glycerol and glucose, at the time of the removal of the aortic clamp. Materials and methods : Twenty height patients could be enrolled in the study and were randomized in the Custodiol® and in the St-Thomas group. Monitoring was assessed with the technique of the cardiac microdialysis (CMA 70 probe, CMA 600 analyzer, CMA Microdialysis, Sweden), by dosing every ten minutes during the aortic cross clamping period and every hour out of the operating room, up to 24 hours, the interstitial myocardial concentrations of Lactate, pyruvate, glycerol and glucose. The Lactate/pyruvate ratio and glucose/lactate ratios and 12 hours post-operative troponin plasmatic concentrations were also assessed. Statistical analysis comparing the Custodiol® versus ST Thomas group were performed via a t-test. Results: Out of the 28 enrolled patients, twenty-two (12 of the Custodiol® group and 10 of the St Thomas group) could be successfully monitored with the microdialysis technique. Six were excluded because of technical reasons (one intempestive ablation, 3 iatrogenic plication of the tube, 1 felled out of the table, one due to a dysfunction of the analyzer). The comparative analysis between included and excluded patients did not prove any statistical result in terms of cardiovascular risk factors, EF, age and gender. At declamping time (T0), mean values of concentrations of lactate, pyruvate, glucose and glycerol were the following: Custodiol® group: 2.77+-1.81 mmol l-1;13.74+-20.87 μmol l-1;0.46+-0. mmol l-1;196.99+-122.22 mmol l-1 ; St Thomas : 0.89+-0.64 mmol l-1 ; 6.49+-9.10 μmol l-1; 0.19+-0.18 mmol l-1; 73.17+-72.11 mmol l-1. Cross clamping and CPB times were respectively 94.2+/-14 et 59.8+/-15 min (Custodiol®), and 82.6+/-15.9 et 55.8+/-16.29 et minutes (St-Thomas) (p=ns) . Post operative plasmatic levels of Troponin (arrival in the ICU and 12 H+12) were respectively de 2.8+/-1.8 and 7.4+/-5.3 (pour le groupe Custodiol®) et de 3.3+/-4.0 et 5.0+/-3.6 μmol/L (Saint Thomas) (ns). Conclusion: Monitoring of the interstitial myocardial redox state was safely possible in both groups and allowed to assess metabolic different findings in the two cardioprotective methods that were not enhanced by perioperative clinical ischemic events. Microdialysis assessed, at the time of aorta declamping, significantly higher concentrations of lactate and Glycerol in the Custodiol® group. That difference regressed during the reperfusion phase with a tendency for a lower lactate level in the Custodiol® group. Multicentric studies focused on cross clamping time longer than 90 minutes seem necessary to enhance metabolic interstitial and clinical superiority between cardioprotective solutions

Background: Myocardial apoptosis plays an important role in myocardial ischemia/reperfusion (I/R) injury. Activation of PI3K/Akt signaling protects the myocardium from I/R injury. This study investigated the role of miR-214 in hypoxia/ reoxygenation (H/R)-induced cell damage in vitro and myocardial I/R injury in vivo. Methods and Results: H9C2 cardiomyoblasts were transfected with lentivirus expressing miR-214 (LmiR-214) or lentivirus expressing scrambled miR-control (LmiR-control) respectively, to establish cell lines of LmiR-214 and LmiR-control. The cells were subjected to hypoxia for 4 h followed by reoxygenation for 24 h. Transfection of LmiR-214 suppresses PTEN expression, significantly increases the levels of Akt phosphorylation, markedly attenuates LDH release, and enhances the viability of the cells subjected to H/R. In vivo transfection of mouse hearts with LmiR-214 significantly attenuates I/R induced cardiac dysfunction and reduces I/Rinduced myocardial infarct size. LmiR-214 transfection significantly attenuates I/Rinduced myocardial apoptosis and caspase-3/7 and caspase-8 activity. Increased expression of miR-214 by transfection of LmiR-214 suppresses PTEN expression, increases the levels of phosphorylated Akt, represses Bim1 expression and induces Bad phosphorylation in the myocardium. In addition, in vitro data shows transfection of miR-214 mimics to H9C2 cells suppresses the expression and translocation of Bim1 from cytosol to mitochondria and induces Bad phosphorylation. Conclusions: Our in vitro and in vivo data suggests that miR-214 protects cells from H/R induced damage and attenuates I/R induced myocardial injury. The mechanisms involve activation of PI3K/Akt signaling by targeting PTEN expression, induction of Bad phosphorylation, and suppression of Bim1 expression, resulting in decreases in I/R-induced myocardial apoptosis.

Substance P and neurokinin A are tachykinins that are co-localized with calcitonin gene-related peptide (CGRP) in a unique subpopulation of cardiac afferent nerve fibers. These neurons are activated by nociceptive stimuli and exhibit both sensory and motor functions that are mediated by the tachykinins and/or CGRP. Sensory signals (e.g., cardiac pain) are transmitted by peptides released at central processes of these neurons, whereas motor functions are produced by the same peptides released from peripheral nerve processes. This review summarizes our current understanding of intracardiac actions of the tachykinins. The major targets for the tachykinins within the heart are the intrinsic cardiac ganglia and coronary arteries. Intrinsic cardiac ganglia contain cholinergic neurons that innervate the heart and coronary vasculature. Tachykinins can stimulate NK3 receptors on these neurons to increase their excitability and evoke spontaneous firing of action potentials. This action provides a mechanism whereby tachykinins can indirectly influence cardiac function and coronary tone. Tachykinins also have direct effects on coronary arteries to decrease or increase tone. Stimulation of NK1 receptors on the endothelium causes vasodilation mediated by nitric oxide. This effect is normally dominant, but NK2 receptor-mediated vasoconstriction can also occur and is augmented when NK1 receptors are blocked. It is proposed that these ganglion stimulant and vascular actions are manifest by endogenous tachykinins during myocardial ischemia.

Objective: The mechanisms by which lipopolysaccharide (LPS) pretreatment induces cardioprotection following ischaemia/reperfusion (I/R) have not been fully elucidated. We hypothesized that activation of phosphoinositide 3-kinase (PI3K)/Akt and high mobility group box 1 (HMGBx1) signaling plays an important role in LPS-induced cardioprotection. Methods: In in vivo experiments, age- and weight-matched male C57BL/10Sc wild type mice were pretreated with LPS before ligation of the left anterior descending coronary followed by reperfusion. Infarction size was examined by triphenyltetrazolium chloride (TTC) staining. Akt, phospho-Akt, and HMGBx1 were assessed by immunoblotting with appropriate primary antibodies. In situ cardiac myocyte apoptosis was examined by the TdT-mediated dUTP nick-end labeling (TUNEL) assay. In an in vitro study, rat cardiac myoblasts (H9c2) were subdivided into two groups, and only one was pretreated with LPS. After pretreatment, the cells were transferred into a hypoxic chamber under 0.5% O2. Levels of HMGBx1 were assessed by immunoblot. Results: In the in vivo experiment, pretreatment with LPS reduced the at risk infarct size by 70.6% and the left ventricle infarct size by 64.93% respectively. Pretreatment with LPS also reduced cardiac myocytes apoptosis by 39.1% after ischemia and reperfusion. The mechanisms of LPS induced cardioprotection involved increasing PI3K/Akt activity and decreasing expression of HMGBx1. In the in vitro study, pretreatment with LPS reduced the level of HMGBx1 in H9c2 cell cytoplasm following hypoxia. Conclusion: The results suggest that the cardioprotection following I/R induced by LPS pretreatment involves PI3K/Akt and HMGBx1 pathways.

To quantify the concurrent transduction capabilities of spatially distributed intrinsic cardiac neurons, the activities generated by atrial vs. ventricular intrinsic cardiac neurons were recorded simultaneously in 12 anesthetized dogs at baseline and during alterations in the cardiac milieu. Few (3%) identified atrial and ventricular neurons (2 of 72 characterized neurons) responded solely to regional mechanical deformation, doing so in a tightly coupled fashion (cross-correlation coefficient r = 0.63). The remaining (97%) atrial and ventricular neurons transduced multimodal stimuli to display stochastic behavior. Specifically, ventricular chemosensory inputs modified these populations such that they generated no short-term coherence among their activities (cross-correlation coefficient r = 0.21 ± 0.07). Regional ventricular ischemia activated most atrial and ventricular neurons in a noncoupled fashion. Nicotinic activation of atrial neurons enhanced ventricular neuronal activity. Acute decentralization of the intrinsic cardiac nervous system obtunded its neuron responsiveness to cardiac sensory stimuli. Most atrial and ventricular intrinsic cardiac neurons generate concurrent stochastic activity that is predicated primarily upon their cardiac chemotransduction. As a consequence, they display relative independent short-term (beat-to-beat) control over regional cardiac indexes. Over longer time scales, their functional interdependence is manifest as the result of interganglionic interconnections and descending inputs.

We examined whether blocking the MyD88 mediated pathway could protect myocardium from ischemia/reperfusion (I/R) injury by transfecting Ad5-dnMyD88 into the myocardium of rats (n = 8) 3 days before the hearts were subjected to ischemia (45 min) and reperfusion (4 h). Ad5-GFP served as control (n = 8). One group of rats was (n = 8) subjected to I/R without transfection. Transfection of Ad5-dnMyD88 significantly reduced infarct size by 53.6% compared with the I/R group (15.1 ± 3.02 vs 32.5 ± 2.59) while transfection of Ad5-GFP did not affect I/R induced myocardial injury (35.4 ± 2.59 vs 32.5 ± 2.59). Transfection of Ad5-dnMyD88 significantly inhibited I/R-enhanced NFκB activity by 50% and increased the levels of phospho-Akt by 35.6% and BCL-2 by 81%, respectively. Cardiac myocyte apoptosis after I/R was significantly reduced by 59% in the Ad5-dnMyD88 group. The results demonstrate that both inhibition of the NFκB activation pathway and activation of the Akt signaling pathway may be responsible for the protective effect of transfection of dominant negative MyD88.

Aberrant afferent signaling drives adverse remodeling of the cardiac nervous system in ischemic heart disease. The study objective was to determine whether thoracic spinal dorsal column stimulation (SCS) modulates cardiac afferent sensory transduction of the ischemic ventricle. In anesthetized canines (n = 16), extracellular activity generated by 62 dorsal root ganglia (DRG) soma (T1-T3), with verified myocardial ischemic (MI) sensitivity, were evaluated with and without 20-min preemptive SCS (T1-T3 spinal level; 50 Hz, 90% motor threshold). Transient MI was induced by 1-min coronary artery occlusion (CAO) of the left anterior descending (LAD) or circumflex (LCX) artery, randomized as to sequence. LAD and LCX CAO activated cardiac-related DRG neurons (LAD: 0.15 ± 0.04-1.05 ± 0.20 Hz, P < 0.00002; LCX: 0.08 ± 0.02-1.90 ± 0.45 Hz, P < 0.0003). SCS decreased basal neuronal activity of neurons that responded to LAD (0.15 ± 0.04 to 0.02 ± 0.01 Hz, P < 0.006) and LCX (0.08 ± 0.02 to 0.02 ± 0.01 Hz, P < 0.003). SCS suppressed responsiveness to transient MI (LAD: 1.05 ± 0.20-0.03 ± 0.01 Hz; P < 0.0001; LCX: 1.90 ± 0.45-0.03 ± 0.01 Hz; P < 0.001). Suprathreshold SCS (1 Hz) did not activate DRG neurons antidromically (n = 10 animals). Ventricular fibrillation (VF) was associated with a rapid increase in DRG activity to a maximum of 4.39 ± 1.07 Hz at 20 s after VF induction and a return to 90% of baseline within 10 s thereafter. SCS obtunds the capacity of DRG ventricular neurites to transduce the ischemic myocardium to second-order spinal neurons, a mechanism that would blunt reflex sympathoexcitation to myocardial ischemic stress, thereby contributing to its capacity to cardioprotect.NEW & NOTEWORTHY Aberrant afferent signaling drives adverse remodeling of the cardiac nervous system in ischemic heart disease. This study determined that thoracic spinal column stimulation (SCS) obtunds the capacity of dorsal root ganglia ventricular afferent neurons to transduce the ischemic myocardium to second-order spinal neurons, a mechanism that would blunt reflex sympathoexcitation to myocardial ischemic stress. This modulation does not reflect antidromic actions of SCS but likely reflects efferent-mediated changes at the myocyte-sensory neurite interface.