Resumo: O hábito de fumar apresenta importante impacto na saúde da população. A associação entre fumo e doença cardiovascular tem sido amplamente explorada em relação à aterosclerose. Recentemente, evidências clínicas e experimentais sugerem que a exposição ao cigarro pode modular o processo de remodelação ventricular. O objetivo desse estudo foi avaliar o papel do inibidor da enzima conversora da angiotensina no processo de remodelação induzido pela exposição à fumaça do cigarro. Ratos Wistar foram distribuídos em três grupos: 1) grupo controle (C, n=8); 2) grupo exposto à fumaça do cigarro (EFC, n=8); 3) grupo exposto à fumaça do cigarro e recebendo 20 mg/kg/dia de lisinopril (EFC-LIS, n=8). Após dois meses os animais foram submetidos ao estudo funcional, morfométrico, e bioquímico. Para a análise estatística foi utilizado o teste de variância ANOVA complementado por Holm-Sidak, o teste Kruskal-Wallis complementado por Tukey e o teste Mann-Whitney. O nível de significância foi 5%. A pressão sistólica caudal foi menor no grupo EFC-LIS (C = 116 ± 27, EFC = 126 ± 16, EFC-LIS = 89 ± 12 mmHg; p = 0,003) em relação aos grupos C e EFC; o grupo EFC apresentou maior valor do diâmetro sistólico do ventrículo esquerdo, corrigido pelo peso (C = 8,25 ± 2,16, EFC = 11,76 ± 1,20, EFC-LIS = 9,27 ± 2,00 mm/kg; p = 0,003), em comparação aos grupos C e EFC-LIS; o diâmetro diastólico do ventrículo esquerdo ajustado pelo peso foi maior nos grupos EFC e EFC-LIS... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The habit of smoking has important impact on population health. The association between tobacco and cardiovascular disease has been widely explored in relation to atherosclerosis. Recently, clinical and experimental evidences suggest that the exposure to tobacco smoke can modulate the process of ventricular remodeling. The objective of that study was to evaluate the role of the angiotensin-converting enzyme inhibitor on cardiac remodeling induced by tobacco smoke exposure. Wistar rats were allocated in three groups: 1) group control (C, n=8); 2) group exposed to tobacco smoke (EFC, n=8); 3) group exposed to tobacco smoke and treated with lisinopril 20mg/kg/day (EFC-LIS, n=8). After two months the animals were submitted to the functional study, morphometric, and biochemical. For the statistical analysis was used the ANOVA test of variance complemented by Holm-Sidak, the test Kruskal-Wallis complemented by Tukey and the test the Mann-Whitney. The significance level was 5%. Results: the caudal systolic pressure was smaller in the group EFC-LIS (C = 116 ± 27, EFC = 126 ± 16, EFC-LIS = 89 ± 12 mmHg; p = 0,003) in relation to the groups C and EFC; the group EFC presented higher value of the systolic diameter of the left ventricle, corrected by body weight (BW) (C = 8,25 ± 2,16, EFC = 11,76 ± 1,20, EFC-LIS = 9,27 ± 2,00 mm/kg; p = 0,003), in comparison with the groups C and EFC-LIS; the diastolic diameter of the left ventricle, adjusted by BW was higher in the groups EFC e EFC-LIS (C = 18,42 ± 3,57, EFC = 22,94 ± 1,98, EFC-LIS = 22,05 ± 1,30 mm/kg; p = 0,003); the relationship EPP/DDVE was smaller in the group EFC-LIS in relation to the control (C = 0,20 (0,18-0,23), EFC = 0,15 (0,14-0,18), EFC-LIS = 0,14 (0,14-0,18); p = 0,026). The group EFC presented smaller ejection fraction... (Complete abstract click electronic access below) / Orientador: Leonardo Antonio Mamede Zornoff / Coorientador: Sergio Alberto Rupp Paiva / Banca: Fernanda M. Cosolim-Colombo / Banca: Wilson Natrus / Banca: Beatriz B. Matsubara / Banca: Katashi Okoshi / Doutor

Das Chemokine SDF-1α und sein Rezeptor CXCR4 sind in eine Vielzahl biologischer Prozesse, wie der Organogenese, der Hämatopoese und der Immunantwort involviert. Die Entdeckung des alternativen SDF-1α-Rezeptors CXCR7 bewirkte eine erneute Untersuchung der Funktion des SDF-1-Systems in diesen Vorgängen. CXCR7 ist in der Lage, je nach Gewebe- oder Zelltyp, als \'Scavenger\'-Rezeptor, Modulator des CXCR4 oder selbstständig aktiver Rezeptor zu agieren. In dieser Arbeit wurde untersucht, inwiefern beide Rezeptoren im Verlauf der Entwicklung der Muskulatur exprimiert werden, welche Aufgabe sie dabei übernehmen und ob sich Rückschlüsse auf die Muskelregeneration daraus ableiten lassen. Hierfür erfolgten in vitro-Untersuchungen an C2C12-Zellen und die anschließende Analyse der Expression von CXCR4, CXCR7 und SDF-1α in der sich entwickelnden Gliedmaßenmuskulatur von Wildtyp- und mdx-Mäusen. Die Untersuchung von C2C12-Zellen zeigte in allen Differenzierungsstadien eine detektierbare Menge von CXCR4 und eine zunehmende Expression des CXCR7. Die Behandlung der Zellen mit SDF-1α führte zu einer Phosphorylierung von Erk1/2 und PKCζ/λ und hemmte gleichzeitig deren Differenzierung. Nach einer Blockierung des CXCR4 mit seinem pharmakologischen Antagonist AMD3100 oder nach Hemmung der Expression durch spezifische siRNA blieb die Aktivierung des Signalweges aus und der hemmende Einfluss des SDF-1α auf die Differenzierung verschwand vollständig. Im Gegensatz dazu blieben nach der pharmakologischen Blockierung oder durch siRNA vermittelten Expressionshemmung des CXCR7 alle SDF-1α induzierten Effekte vollständig erhalten. Eine Untersuchung des Signalweges am dritten Tag der Differenzierung zeigte keine Aktivierung von Erk1/2. Ebenso blieb Erk1/2 nach einer Hemmung der Expression des CXCR4 unphosphoryliert. Im Gegensatz dazu fand nach einer Hemmung der Expression des CXCR7 mit spezifischer siRNA erneut eine Aktivierung des Signalweges statt. Weiterhin konnte in vivo festgestellt werden, dass die Expression des CXCR4 in der Muskulatur während der embryonalen Entwicklung am höchsten ist und bereits kurz nach der Geburt stark abnimmt, wenn die sekundäre Muskelentwicklung abgeschlossen ist. Die Expression des CXCR7 hingegen steigt perinatal an und bleibt bis zum Erwachsenenalter bestehen. Zusammengefasst zeigen diese Ergebnisse, dass CXCR4 aktiv das Signalgeschehen von SDF-1α in der Myogenese vermittelt und somit zur Differenzierungshemmung von Myoblasten beiträgt. CXCR7 hingegen wirkt als passiver SDF-1α-Scavenger und induziert somit durch eine Modulierung der extrazellulären SDF-1α-Konzentration die Differenzierung. In Übereinstimmung mit der Rolle des SDF-1α-Systems bei der Muskelentwicklung, konnte eine kontinuierliche SDF-1α- Expression im Bindegewebe um pränatale und im Endomysium von postnatalen und adulten Muskelfasern festgestellt werden. Diese SDF-1α-Expression stieg ebenso wie die CXCR4-Expression bei der Analyse der Muskulatur von dystrophin-defizienten Mäusen an und zeigte somit, dass dieses System auch für die Proliferation von Muskelvorläuferzellen in der regenerativen Muskulatur eine wichtige Rolle spielt. Bemerkenswerter Weise hatte diese Muskeldystrophie keinen Einfluss auf die Expression des CXCR7 und beeinflusst vermutlich dessen Funktion über einen anderen Mechanismus. Durch die offensichtlich enge Kontrolle von Muskelentwicklung und Regeneration durch CXCR4, CXCR7 und deren Liganden SDF-1α, bilden diese ein vielversprechendes therapeutisches Ziel für bestimmte Muskelerkrankungen. / The chemokine, SDF-1α, and its receptor, CXCR4, are assumed to control a multitude of biological processes such as organogenesis, haematopoesis, and immune responses. The previous demonstration that SDF-1α additionally binds to the chemokine receptor, CXCR7, currently urges a re-evaluation of the function of the SDF-1 system in these processes. In fact, depending on the tissue and cell type, CXCR7 either acts as a scavenger receptor, a modulator of CXCR4 or an independent active receptor. This thesis is dedicated to answer the following questions: Are both SDF-1α receptors expressed during muscle development? What is the actual function of these receptors during myogenesis? Is there a role of the SDF-1 system in muscle regeneration? To adress these issues both in vitro studies with the myoblast cell line, C2C12, as well as in vivo analyses on the expression of CXCR4, CXCR7 and SDF-1α in developing and regenerating limb muscles have been performed. At all stages of differentiation, C2C12 cells exhibited measurable amounts of CXCR4. In addition, in the course of differentiation C2C12 cells showed increasing expression levels of CXCR7. Treatment of the cells with SDF-1α resulted in the phosphorylation of Erk1/2 and PKCζ/λ and subsequently blocked their myogenic differentiation. Following inactivation of CXCR4 either by its antagonist, AMD3100, or by specific siRNA, SDF-1α failed to activate both pathways and in addition no longer inhibited the myogenic differentiation of C2C12 cells. By contrast, inactivation of CXCR7 remained without effects on SDF-1α-induced cell signalling and resulting inhibitory effects on myogenic differentiation. Interestingly, SDF-1α also failed to activate Erk1/2 signalling in differentiated C2C12 cells. Cell signalling in differentiated C2C12 cells was, however, restored following inhibition of CXCR7 expression, but not following inhibition of CXCR4 expression. The in vivo analysis further revealed that in limb muscles expression of the CXCR4 is highest during embryonic development with a decrease in expression levels shortly after birth when secondary muscle development is completed. Vice versa, expression levels of CXCR7 increased perinatally and remained high into adulthood. In summary, these findings unravel that CXCR4 actively mediates SDF-1α-signalling during myogenesis. The findings further provide evidence that CXCR7 acts as a scavenger receptor during myogenesis which controls myogenic differentiation by modulating extracellular SDF-1α concentration. In further agreement with a major role of SDF-1α in muscle development, SDF-1α is continously expressed by the endomysium of postnatal and adult muscle fibers. Moreover, expression of SDF-1α as well as CXCR4 is massively increased in muscles of dystrophin-deficient mice further implying that the SDF-1 system plays an equally important role during muscle development and regeneration. The pivotal role of SDF-1α in muscle development and regeneration points to the SDF-1 system as a promising therapeutical target for certain muscle diseases.

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O treinamento por natação leva a uma sobrecarga de volume no coração, que induz a hipertrofia cardíaca (HC) excêntrica, com aumento da massa e do diâmetro cardíaco. Neste trabalho foram investigadas as adaptações no sistema cardiovascular e na expressão de genes relacionados à HC patológica, na gênese da HC por treinamento de natação. 42 ratas wistar foram divididas em grupos: sedentário controle (SC) treinado protocolo 1 (P1) e treinado protocolo 2 (P2). O treinamento de P1 foi de 1x60min/dia, 5x/semana, por 10 semanas. O de P2 foi igual ao P1 até a 8ª semana. Na 9ª semana 2x/dia e na 10ª semana 3x/dia. Os grupos treinados, em relação ao SC, apresentaram bradicardia de repouso, melhora no desempenho físico do teste máximo e do consumo máximo de oxigênio e HC, sem alterar a pressão arterial média e a expressão dos genes do fator natriurético atrial e da alfa actina esquelética. O grupo P2 apresentou aumento no diâmetro cardíaco e redução da expressão do gene da beta miosina de cadeia pesada. Este último resultado é contrário à literatura para a HC patológica, que mostra o aumento não só da expressão deste gene como a dos outros genes estudados. Os resultados de HC de P2 assemelham-se aos encontrados em estudos recentes com atletas de modalidades de maior componente aeróbio, sendo este um bom modelo para investigação dos mecanismos envolvidos na HC destes atleta / Swimming training leads to a cardiac volume overload that induces excentric cardiac hypertrophy (CH) with an increase in cardiac mass and diameter. Cardiovascular system adaptations and expression of genes relatated with pathological CH were investigated in swimming training CH. We studied 42 wistar females, divided in sedentary control (SC) group, protocol 1 trained group (P1) and protocol 2 trained group (P2). The P1 training program was once a day for 5 times/week for 10 weeks. P2 was the same as P1 until 8th week. In 9th week it was twice a day and in 10th week 3 times a day. Trained groups, in contrast with SC, showed rest bradycardia, improvement in physical performance, maximum oxygen uptake and CH, with no alteration in the medium arterial pressure and in the expression of atrial natriuretic factor and skeletal alpha actin genes. Moreover, P2 showed an increase in cardiac diameter and decrease in the expression of beta myosin heavy chain gene. This expression result is different of patological CH literature wich shows an increase of this gene expression and also in the others genes we had investigated. P2 CH results were similar to those recently found in endurance-type athletes, sugesting this is a good model to investigate mechanisms involved in endurance-type athletes CH

Die ersten identifizierten Krankheitsgene der dilatativen Kardiomyopathie (DCM) kodierten alle für Proteine des Zytoskeletts. Deshalb wurde DCM als Erkrankung des Zytoskeletts bezeichnet. Bei der hypertrophen Kardiomyopathie (HCM) wurden bisher mehr als 250 Mutationen in neun Sarkomerprotein-Genen beschrieben. Deshalb wurde HCM als Erkrankung des Sarkomers bezeichnet. In den letzten Jahren wurde dieses Konzept durch Entdeckung von Mutationen in Sarkomerprotein-Genen bei DCM jedoch in Frage gestellt. Vor diesem Hintergrund haben wir die Sarkomerprotein-Gene beta-MHC und Troponin T bei 46 nicht verwandten DCM-Patienten untersucht. Das systematische Mutationsscreening wurde mit Hilfe von SSCP-Analyse und DNA-Sequenzierung durchgeführt. Im beta-MHC-Gen konnten wir die zwei Missense-Mutationen Ala223Thr und Ser642Leu bei zwei jungen Patienten identifizieren. Beide Mutationen wurden weder bei 136 HCM-Patienten noch bei 88 Kontrollen gefunden. Mit dem Editor for Structural Alignment of Proteins (STRAP) wurden die Mutationen auf die Proteinstruktur des Myosins projiziert. Hier ist erkennbar, dass Ala223Thr in der oberen 50 kDa Domäne und Ser642Leu in der Aktin-Myosin-Bindungsregion liegt. Der Austausch von Alanin zu Threonin könnte die Raumstruktur des Proteins verändern, Thermostabilität verringern und die Proteinfaltung und somit die Proteinmotilität beeinträchtigen. In der Aktin-Myosin-Bindungsregion liegt neben Ser642Leu die bereits bekannte DCM-assoziierte Mutation Ser532Pro. Durch eine Verminderung der Krafterzeugung könnten die beiden Mutationen zu DCM führen. Ferner wurden die zwei stummen Mutationen IVS11+23A>T und Asp376Asp und sechs Polymorphismen identifiziert. Im Troponin T-Gen wurden keine Mutationen, jedoch sechs Polymorphismen beobachtet. Es ergab sich kein Anhaltspunkt auf eine funktionelle Relevanz der stummen Mutationen oder Polymorphismen. Wir konnten also bestätigen, dass Mutationen in Sarkomerprotein-Genen sowohl zu HCM als auch zu DCM führen können. / All of the initially identified disease-causing genes in dilated cardiomyopathy (DCM) encoded proteins of the cytoskeleton. Therefore DCM has been termed a disease of the cytoskeleton. In hypertrophic cardiomyopathy (HCM) more than 250 mutations in nine sarcomeric protein genes have been identified so far. Therefore HCM has been termed a disease of the sarcomere. However, in the last few years this concept has been queried by findings of mutations in sarcomeric protein genes in DCM. According to this consideration we screened the sarcomeric protein genes beta-MHC and troponin T in 46 patients with DCM. Systematic mutation screening was done using SSCP analysis and DNA sequencing. In the beta-MHC gene we identified the two missense mutations Ala223Thr and Ser642Leu in two young patients. Both mutations were neither found in 136 HCM patients nor in 88 controls. Using the Editor for Structural Alignment of Proteins (STRAP) the mutations were projected onto the protein structure of myosin. Ala223Thr turned out to be localized in the upper 50 kDa domain and Ser642Leu in the actin-myosin-interface region. The exchange from alanine to threonine might alter the spatial structure of the protein, decrease its thermostability and affect the protein folding and thus the protein motility. Closely to Ser642Leu the DCM-associated mutation Ser532Pro is located in the actin-myosin-interface region. By a decrease in force production both mutations might cause DCM. Furthermore we identified the two silent mutations IVS11+23A>T and Asp376Asp and six polymorphisms. In the troponin T gene no mutations but six polymorphisms were detected. No evidence was found for functional relevance of the silent variants or polymorphisms. Thus, we could confirm that mutations in sarcomeric protein genes can lead to both HCM and DCM.

The cytokine TRAIL is a promising cancer therapeutic candidate as it induces apoptosis selectively in transformed cells. TRAIL-induced clustering of its receptors (DR) is essential for the DISC complex formation, which induces cell death. The mechanism for TRAIL's tumour selective effect is largely unknown. We identified the cytoskeleton proteins non-muscle myosin heavy chain IIa, IIb (NMHCIIa, NMHCIIb), myosin regulatory light chain (MLC2) and ß-actin as novel DR-interactors. An initially weak and TRAIL-induced abrogation of NMHCII/DR interaction correlated with efficient DISC formation in tumour cells. In contrast, a robust NMHCII/DR interaction that was sustained upon TRAIL stimulus was accompanied by incomplete DISC arrangement. Weakening the NMHCII/DR interaction in normal cells using chemical inhibitors enhanced TRAIL-induced apoptosis. Intriguingly, siRNA-mediated NMHCIIa- but not NMHCIIb depletion potently released TRAIL resistance in normal cells and influenced DISC composition. Reduced NMHCII/DR interaction in transformed cells was characterised by diminished MLC2 phosphorylation and altered protein expression of upstream regulatory kinases. Our results suggest that normal cell resistance to TRAIL-apoptosis is based on the interaction of cytoskeleton components with DR that is impaired upon transformation. Since NMHCII function in cell adhesion and migration, it will be interesting to study possible roles of the interaction in cell detachment and altered TRAIL sensitivity; moreover this link may provide clues as to the cause of TRAIL resistance in some cancers.

O treinamento por natação leva a uma sobrecarga de volume no coração, que induz a hipertrofia cardíaca (HC) excêntrica, com aumento da massa e do diâmetro cardíaco. Neste trabalho foram investigadas as adaptações no sistema cardiovascular e na expressão de genes relacionados à HC patológica, na gênese da HC por treinamento de natação. 42 ratas wistar foram divididas em grupos: sedentário controle (SC) treinado protocolo 1 (P1) e treinado protocolo 2 (P2). O treinamento de P1 foi de 1x60min/dia, 5x/semana, por 10 semanas. O de P2 foi igual ao P1 até a 8ª semana. Na 9ª semana 2x/dia e na 10ª semana 3x/dia. Os grupos treinados, em relação ao SC, apresentaram bradicardia de repouso, melhora no desempenho físico do teste máximo e do consumo máximo de oxigênio e HC, sem alterar a pressão arterial média e a expressão dos genes do fator natriurético atrial e da alfa actina esquelética. O grupo P2 apresentou aumento no diâmetro cardíaco e redução da expressão do gene da beta miosina de cadeia pesada. Este último resultado é contrário à literatura para a HC patológica, que mostra o aumento não só da expressão deste gene como a dos outros genes estudados. Os resultados de HC de P2 assemelham-se aos encontrados em estudos recentes com atletas de modalidades de maior componente aeróbio, sendo este um bom modelo para investigação dos mecanismos envolvidos na HC destes atleta / Swimming training leads to a cardiac volume overload that induces excentric cardiac hypertrophy (CH) with an increase in cardiac mass and diameter. Cardiovascular system adaptations and expression of genes relatated with pathological CH were investigated in swimming training CH. We studied 42 wistar females, divided in sedentary control (SC) group, protocol 1 trained group (P1) and protocol 2 trained group (P2). The P1 training program was once a day for 5 times/week for 10 weeks. P2 was the same as P1 until 8th week. In 9th week it was twice a day and in 10th week 3 times a day. Trained groups, in contrast with SC, showed rest bradycardia, improvement in physical performance, maximum oxygen uptake and CH, with no alteration in the medium arterial pressure and in the expression of atrial natriuretic factor and skeletal alpha actin genes. Moreover, P2 showed an increase in cardiac diameter and decrease in the expression of beta myosin heavy chain gene. This expression result is different of patological CH literature wich shows an increase of this gene expression and also in the others genes we had investigated. P2 CH results were similar to those recently found in endurance-type athletes, sugesting this is a good model to investigate mechanisms involved in endurance-type athletes CH

Cardiovascular diseases are among the leading causes of death worldwide and particularly in the developed World. The search for new therapeutic approaches for improving the functions of the damaged heart is therefore a critical endeavour. Myocardial infarction, which can lead to heart failure, is associated with irreversible loss of functional cardiomyocytes. The loss of cardiomyocytes poses a major difficulty for treating the damaged heart since terminally differentiated cardiomyocytes have very limited regeneration potential. Currently, the only effective treatment for severe heart failure is heart transplantation but this option is limited by the acute shortage of donor hearts. The high incidence of heart diseases and the scarcity donor hearts underline the urgent need to find alternative therapeutic approaches for treating cardiovascular diseases. Pluripotent embryonic stem (ES) cells can differentiate into functional cardiomyocytes. Therefore the engraftment of ES cell-derived functional cardiomyocytes or cardiac progenitor cells into the damaged heart to regenerate healthy myocardial tissues may be used to treat damaged hearts. Stem cell-based therapy therefore holds a great potential as a very attractive alternative to heart transplant for treating heart failure and other cardiovascular diseases. A major obstacle to the realisation of stem cell-based therapy is the lack of donor cells and this in turn is due to the fact that, currently, the molecular mechanisms or the regulatory signal transduction mechanisms that are responsible for mediating ES cell differentiation into cardiomyocytes are not well understood. Overcoming this huge scientific challenge is absolutely necessary before the use of stem cell-derived cardiomyocytes to treat the damaged heart can become a reality. Therefore the aim of this thesis was to investigate the signal transduction pathways that are involved in the differentiation of stem cells into cardiomyocytes. The first objective was the establishment and use of cardiomyocyte differentiation models using H9c2 cells and P19 stem cells to accomplish the specific objectives of the thesis. The specific objectives of the thesis were, the investigation of the roles of (i) nitric oxide (ii) protein kinase C (PKC), (iii) p38 mitogen-activated protein kinase (p38 MAPK) (vi) phosphoinositide 3-kinase (PI3K) and (vi) nuclear factor-kappa B (NF-kB) signalling pathways in the differentiation of stem cells to cardiomyocytes and, more importantly, to identify where possible any points of convergence and potential cross-talk between pathways that may be critical for differentiation to occur. P19 cells were routinely cultured in alpha minimal essential medium (α-MEM) supplemented with 100 units/ml penicillin /100 μg/ml streptomycin and 10% foetal bovine serum (FBS). P19 cell differentiation was initiated by culturing the cells in microbiological plates in medium containing 0.8 % DMSO to form embryoid bodies (EB). This was followed by transfer of EBs to cell culture grade dishes after four days. H9c2 cells were cultured in Dulbecco’s Modified Eagle’s medium (DMEM) supplemented with 10% FBS. Differentiation was initiated by incubating the cells in medium containing 1% FBS. In both models, when drugs were employed, they were added to cells for one hour prior to initiating differentiation. Cell monolayers were monitored daily over a period of 12 or 14 days. H9c2 cells were monitored for morphological changes and P19 cells were monitored for beating cardiomyocytes. Lysates were generated in parallel for western blot analysis of changes in cardiac myosin heavy chain (MHC), ventricular myosin chain light chain 1(MLC-1v) or troponin I (cTnI) using specific monoclonal antibodies. H9c2 cells cultured in 1% serum underwent differentiation as shown by the timedependent formation of myotubes, accompanied by a parallel increase in expression of both MHC and MLC-1v. These changes were however not apparent until 4 to 6 days after growth arrest and increased with time, reaching a peak at day 12 to 14. P19 stem cells cultured in DMSO containing medium differentiated as shown by the timedependent appearance of beating cardiomyocytes and this was accompanied by the expression of cTnI. The differentiation of both P19 stem cells and H9c2 into cardiomyocytes was blocked by the PI3K inhibitor LY294002, PKC inhibitor BIM-I and the p38 MAPK inhibitor SB2035800. However when LY294002, BIM-I or SB2035800 were added after the initiation of DMSO-induced P19 stem cell differentiation, each inhibitor failed to block the cell differentiation into beating cardiomyocytes. The NF-kB activation inhibitor, CAPE, blocked H9c2 cell differentiation into cardiomyocytes. Fast nitric oxide releasing donors (SIN-1 and NOC-5) markedly delayed the onset of differentiation of H9c2 cells into cardiomyocytes while slow nitric oxide releasing donors (SNAP and NOC-18) were less effective in delaying the onset of differentiation or long term differentiation of H9c2 cells into cardiomyocytes. Akt (protein kinase B) is the key downstream target of PI3K. Our cross-talk data also showed that PKC inhibition and p38 MAPK inhibition respectively enhanced and reduced the activation of Akt, as determined by the phosphorylation of Akt at serine residue 473. In conclusion, PKC, PI3K, p38 MAPK and NF-kB are relevant for the differentiation of stem cells into cardiomyocytes. Our data also show that the PKC, PI3K and p38 MAPK signalling pathways are activated as very early events during the differentiation of stem cells into cardiomyocytes. Our data also suggest that PKC may negatively regulate Akt activation while p38 MAPK inhibition inhibits Akt activation. Our fast NO releasing donor data suggest that nitric oxide may negatively regulate H9c2 cell differentiation.