Artemisinin is herbal drug with a wide range of biological and physiological function. It is currently administered in the treatment against uncomplicated F.Palcifarum infections. It has also been shown to be cytotoxic against a variety of cancer cells. Despite the promise of many anti cancer drugs, drug induced cardiotoxicity has constantly threatened drug applicability especially in patients with co-morbities. Artemisinin has been shown to be cardioprotective, although the intracellular pathways remain to be elucidated. In this study, isolated perfused rat hearts were subjected to 35 minutes of ischaemia and 120 minutes reperfusion or primary cardiac myocytes subjected to 120 minutes hypoxia and 120 minutes reoxygenation where artemisinin (4.3μM) was administered in presence and absence of the PI3K inhibitor (wortmannin) (0.1μM), p70S6K inhibitor (rapamycin) (0.1μM), non selective nitric oxide synthase inhibitor (L-NAME) (100μM) and inducible nitric oxide synthase inhibitor (aminoguanidine) (100μM). At the end of the experiment, hearts underwent infarct size to risk ratio assessment via tri-phenyltetrazolium chloride staining or western blot analysis for p-Akt and p70S6K. Cardiac myocytes were assessed for either MTT analysis, cleaved-caspase 3 or for eNOS/iNOS or p-BAD activity using flow cytometry. In isolated hearts, artemisinin (0.1μM-100μM) showed a significant dose dependent decrease in infarct size (P<0.01-0.001 vs. I/R control). It was also shown to significantly improve cellular viability (66.5±6.3% vs. 29.3±6.1% in H/R, P<0.01) and decrease the levels of cleaved caspase-3 compared to the H/R control group (17.1±2.0% vs. 26.8±2.0% in H/R, P<0.001). Artemisinin was shown to confer protection via the activation of the PI3K-Akt-p70S6k cell survival pathway and presented an upregulation in p-eNOS and iNOS expression. Furthermore, co-administering artemisinin with doxorubicin showed artemisinin reverses I/R or H/R injury as well as doxorubicin-induced injury via the nitric oxide signalling pathway. Additionally, in HL-60 cells, the co-administration doubled artemisinins cytotoxicity while also implicating the nitric oxide pathway. This is the first study to shows that artemisinin ameliorates doxorubicin mediated cardiac injury whilst enhancing its cytotoxicity in HL-60 in a nitric oxide dependent manner. This study concluded that artemisinin was both anti apoptotic and protective against myocardial I/R injury via the PI3K-Akt-BAD/P70S6K and via the nitric oxide cell survival pathway as well as pro-apoptotic against HL-60 in a nitric oxide dependent manner.

Myocardial reperfusion injury is thought to be caused by reperfusion induced i) cytosolic Ca²⁺ overload and/or, ii) the formation of oxygen derived freeradicals. At the start of this study, data implicating cytosolic Ca²⁺ overload in the genesis of reversible reperfusion injury were inconclusive. Although several workers have approached this problem by measurements of cytosolic calcium ions, it was my aim to examine the potential sources of such calcium overload. The experiments reported in this thesis were therefore designed to examine the role of altered intracellular and transsarcolemmal Ca²⁺ fluxes in the genesis of reperfusion stunning and arrhythmias. The study was also aimed at elucidating the possible sources and entry pathways contributing to this proposed cytosolic Ca²⁺ overload. In order to investigate the possible role of altered reperfusion Ca²⁺ fluxes in reperfusion injury, we exposed the isolated working, and Langendorff perfused rat heart model to ischaemia and reperfusion to induce reperfusion stunning and arrhythmias. Hearts were pre-treated (before ischaemia) or reperfused with pharmacological compounds, or by interventions known to enhance or inhibit intracellular or transsarcolemmal Ca²⁺ fluxes. The severity of reperfusion stunning (mechanical dysfunction) was measured by reperfusion aortic output, coronary flow and left ventricular pressure. The incidence of reperfusion ventricular arrhythmias was measured by the incidence of ventricular tachycardia and/ or fibrillation. In selected studies, the metabolic status of hearts was evaluated using biochemical assays performed on myocardial tissue samples. Data obtained in these studies indicate that increased Ca²⁺ fluxes through sarcolemmal L-type Ca²⁺ channels during early reperfusion exacerbate stunning, while inhibition of these fluxes with the Ca²⁺ antagonist drug nisoldipine or by Mg²⁺ or Mn²⁺ improve reperfusion function. These data also suggest that although interventions increasing Ca²⁺ fluxes early in reperfusion exacerbate reperfusion stunning, these same interventions improve reperfusion function when performed later. The data also indicate that Ca²⁺ may enter the myocyte indirectly via activation of the Na⁺/H⁺ and Na⁺/Ca²⁺ exchanger during reperfusion. Inhibition of Na⁺/H⁺ exchange activity by HOE 694 during reperfusion attenuated reperfusion stunning and arrhythmias. Both activation of the Na⁺/H⁺ (and Na⁺/Ca²⁺) exchanger and Ca²⁺ influx via the Ca²⁺ channel could contribute to reperfusion induced Ca²⁺ overload and subsequent injury. The study also showed that altered intracellular Ca²⁺ oscillations play a role in reperfusion stunning and arrhythmias as shown by the use of the SR Ca²⁺ release channel blocker, ryanodine. Inhibition of the sarcoplasmic reticulum Ca²⁺ A TP-ase pump by two novel inhibitors, thapsigargin and cyclopiazonic acid, during ischaemia and early reperfusion improved reperfusion function and reduced the incidence of ventricular arrhythmias. function when unphysiologically high concentrations of the peptide were infused into the heart during reperfusion. Taken together, these data suggest that: 1) Ca²⁺ fluxes during early reperfusion (intracellular and transsarcolemmal) play a role in reperfusion injury, 2) that both the Ca²⁺ channel and Na⁺/H⁺ exchange activity contribute to reperfusion injury by possibly contributing to cytosolic Ca²⁺ overload and that, 3) altered intracellular Ca²⁺ oscillations through the SR play a role in both stunning and arrhythmias. Thus the proposal is that modulation of Ca²⁺ fluxes through either the sarcolemma or the sarcoplasmic reticulum, lessen reperfusion injury (stunning and arrhythmias). Although these data do not provide direct evidence of reperfusion Ca²⁺ overload, they support the concept that calcium ions play a role in the genesis of reversible reperfusion injury.

To test whether the antiapoptotic protein Bcl-2 prevents apoptosis and injury of cardiomyocytes after ischemia-reperfusion (I/R), we generated a line of transgenic mice that carried a human Bcl-2 transgene under the control of a mouse α-myosin heavy chain promoter. High levels of human Bcl-2 transcripts and 26-kDa Bcl-2 protein were expressed in the hearts of transgenic mice. Functional recovery of the transgenic hearts significantly improved when they were perfused as Langendorff preparations. This protection was accompanied by a threefold decrease in lactate dehydrogenase (LDH) released from the transgenic hearts. The transgenic mice were subjected to 50 min of ligation of the left descending anterior coronary artery followed by reperfusion. The infarct sizes, expressed as a percentage of the area at risk, were significantly smaller in the transgenic mice than in the nontransgenic mice (36.6 ± 5 vs 69.9 ± 7.3%, respectively). In hearts subjected to 30 min of coronary artery occlusion followed by 3 h of reperfusion, Bcl-2 transgenic hearts had significantly fewer terminal deoxynucleodidyl-transferase nick-end labeling-positive or in situ oligo ligation-positive myocytes and a less prominent DNA fragmentation pattern: Our results demonstrate that overexpression of Bcl-2 renders the heart more resistant to apoptosis and I/R injury.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18865号 / 医博第3976号 / 新制||医||1008(附属図書館) / 31816 / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 坂井 義治, 教授 福田 和彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21627号 / 医博第4433号 / 新制||医||1033(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 平井 豊博, 教授 松原 和夫, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Thesis (Ph.D.)--University of Alabama at Birmingham, 2007. / Title from PDF title page (viewed on Feb. 4, 2010). Includes bibliographical references (p. 120-131).

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed June 5, 2008). Includes bibliographical references.

Thesis (doctoral)--Lund University, 1994.

published_or_final_version / Physiology / Doctoral / Doctor of Philosophy

In rats anaesthetised with enflurane, Iexamined.the response of coccygeal primary afferents fibres to noxious thermal and mechanical stimulation and to innocuous brushing, during transient ischaemia and reperfusion of their receptive fields on the tail. Ischaemia was induced by occluding the blood supply to the tail for 30 min using a tourniquet. I discovered four different groups of afferent fibres, distinguished by conduction velocity and modality, A{3fibres responding to both brush and pinch of their receptive fields showed decreased sensitivity to brush during both ischaemia and reperfusion; Ao fibres responding to pinch were unaffected by either ischaemia or reperfusion, C fibres responding to noxious heat (49· C) and pinch showed hypersensitivity during reperfusion, especially immediately after release of the tourniquet. Another group of C fibres, presumably chemosensitive, became more actiVA during ischaemia and exhibited a 7-fold increase in firing rate during receptive field reperfuslon in the absence of obvious stimuli. These results indicate that during reperfuslon of the rat tail following transient ischaemia, myelinated fibres do not increase their input to the CNS, while C fibres became more active and showed sensitization to noxious stimulation of their receptive fields. The enhanced CNS nociceptive activity which occurs during reperfusion consequently results from both peripheral and. central sensitization. / GR2017