Pre-conditioning and postconditioning to limit ischemia-reperfusion-induced myocardial injury: what could be the next footstep?

Myocardial ischemia is a condition in which the coronary blood flow to the heart is reduced, which results in deficient oxygen and nutrients supply to the heart. Reperfusion to an ischemic myocardium often results in lethal myocardial injury. The brief episodes of ischemia and reperfusion given before prolonged ischemia and reperfusion denote pre-conditioning. On the other hand, brief episodes of ischemia and reperfusion given after prolonged ischemia and at the onset of reperfusion denotes postconditioning. Pre- and postconditioning are anti-jeopardized phenomenons in which both forms have been shown to protect the myocardium from lethal ischemia-reperfusion injury. However, numerous experimental studies reveal that the cardioprotective effects of these phenomenons have been suppressed in presence of some pathological factors such as hyperglycemia, obesity, hypercholesterolemia, etc. In this review, we have critically discussed the mechanisms involved in the cardioprotective effects of pre- and postconditioning to limit ischemia-reperfusion-induced myocardial injury. Moreover, the clinical relevance and factors affecting the cardioprotective potentials of pre- and postconditioning have been delineated.     

Simvastatin acutely reduces myocardial reperfusion injury in vivo by activating the phosphatidylinositide 3-kinase/Akt pathway

Long-term pretreatment with statins reduces myocardial injury after acute ischemia and reperfusion by increasing the expression of endothelial nitric oxide synthase (eNOS). We hypothesized that statins may act rapidly enough to protect the myocardium from ischemia/reperfusion injury when given right at the beginning of the reperfusion period and tried to delineate the role of PI 3-kinase/Akt pathway in early eNOS activation. Activated simvastatin was given intravenously 3 minutes before starting the reperfusion after temporary coronary artery occlusion (CAO) in anaesthetized rats. Simvastatin significantly increased myocardial PI 3-kinase activity, AktSer473, and eNOSSer1177 phosphorylation and reduced infarct size by 42%. Infarct size reduction as well as activation of PI 3-kinase/Akt/eNOS pathway were not observed in rats co-treated with the PI 3-kinase inhibitor wortmannin. Contribution of eNOS was further delineated using the NOS inhibitor L-NAME, which could completely block cardioprotection by the statin. In summary, simvastatin acutely reduces the extent of myocardial necrosis in normocholesterolemic rats in an NO- dependent manner by activating the PI 3-kinase/Akt pathway. This is the first study demonstrating short-term cardioprotective effects of simvastatin in an in vivo model of ischemia/reperfusion.     

天山花楸叶总黄酮对大鼠心肌缺血/再灌注损伤的保护作用

目的观察天山花楸叶总黄酮对大鼠心肌缺血/再灌注(I/R)损伤的保护作用,探讨其作用机制。方法采用改良的Langendorff逆行恒压灌流方法,建立大鼠离体心脏I/R损伤模型,观察天山花楸叶总黄酮(4.0、6.0mg·L-1)对心脏I/R损伤后心功能、心肌组织中超氧岐化酶(SOD)活性和丙二醛(MDA)含量变化的影响。利用DPPH、羟自由基、超氧阴离子、脂质过氧化反应体系,检测了天山花楸叶总黄酮(6.25、12.5、25、50、100mg·L-1)体外抗氧化能力。结果天山花楸叶总黄酮(6.0mg·L-1)可明显改善离体心脏I/R损伤后左心室发展压(LVDP)和左室压力升高或降低最大速率(±dp/dtmax),明显增加冠脉流量;天山花楸叶总黄酮(6.0mg·L-1)处理后I/R损伤心肌组织中SOD活性升高,MDA含量减少。天山花楸叶总黄酮(6.25～100mg.L-1)可浓度依赖性地清除DPPH自由基、羟自由基和超氧阴离子自由基,并抑制脂质过氧化反应。结论天山花楸叶总黄酮对心肌缺血/再灌注损伤具有明显保护作用,与其具有较强的抗氧化活性有关。     

Magnolol reduces myocardial ischemia/reperfusion injury via neutrophil inhibition in rats.

The accumulation of oxygen-free radicals and activation of neutrophils are strongly implicated as important pathophysiological mechanisms mediating myocardial ischemia/reperfusion injury. It has been proven that various antioxidants have cardioprotective effects. Magnolol, an active component extracted from the Chinese medicinal herb Magnolia officinalis, possesses potent antioxidant and free radical scavenging activities. In this study, the cardioprotective activity of magnolol was evaluated in an open-chest anesthetized rat model of myocardial ischemia/reperfusion injury. The results demonstrated that pretreatment with magnolol (0.2 and 0.5 microg/kg, i.v. bolus) at 10 min before 45 min of left coronary artery occlusion, significantly suppressed the incidence of ventricular fibrillation and mortality when compared with the control group. Magnolol (0.2 and 0.5 microg/kg) also significantly reduced the total duration of ventricular tachycardia and ventricular fibrillation. After 1 h of reperfusion, pretreatment with magnolol (0.2 and 0.5 microg/kg) caused a significant reduction in infarct size. In addition, magnolol (0.2 microg/kg) significantly reduced superoxide anion production and myeloperoxidase activity, an index of neutrophil infiltration in the ischemic myocardium. In addition, pretreatment with magnolol (0.2 and 0.5 microg/kg) suppressed ventricular arrhythmias elicited by reperfusion following 5 min of ischemia. In vitro studies of magnolol (5, 20 and 50 microM) significantly suppressed N-formylmethionyl-leucyl-phenylalanine (fMLP; 25 nM)-activated human neutrophil migration in a concentration-dependent manner. It is concluded that magnolol suppresses ischemia- and reperfusion-induced ventricular arrhythmias and reduces the size of the infarct resulting from ischemia/reperfusion injury. This pronounced cardioprotective activity of magnolol may be mediated by its antioxidant activity and by its capacity for neutrophil inhibition in myocardial ischemia/reperfusion.     

Myocardial postconditioning: Next step to cardioprotection

Myocardial ischemia is a condition in which lack of blood flow to the cardiac muscle occurs resulting in deficient oxygen and nutrient supply to the heart. The restoration of blood flow to an organ or tissue is termed reperfusion. Brief episodes of ischemia and reperfusion given after prolonged ischemia and at the onset of reperfusion denotes postconditioning. Myocardial postconditioning is a phenomenon in which myocardium from lethal ischemia-reperfusion injury is protected. However, numerous experimental studies reveal that the cardioprotective effects of postconditioning are suppressed in various pathological states. This review critically discusses the mechanisms involved in the cardioprotective effects of postconditioning and factors affecting the cardioprotective potential of myocardial postconditioning.     

Wogonin suppresses arrhythmias, inflammatory responses, and apoptosis induced by myocardial ischemia/reperfusion in rats

Wogonin is a flavonoid isolated from Scutellaria baicalensis Georgi, a traditional Chinese medicine, and it possesses antioxidant and anti-inflammatory effects. The aim of this study is to investigate the in vivo effect of wogonin on myocardial ischemia/reperfusion injury in an open-chest anesthetized rat model, which was induced by 45-minute left coronary artery occlusion and 2-hour reperfusion. Rats were treated with wogonin (5, 10, and 20 mg/kg, intraperitoneal) 40 minutes before ischemia or treatment with 10 mg/kg of wogonin 15 minutes after occlusion. Pretreatment with 10 mg/kg of wogonin significantly delayed the occurrence of ventricular premature contractions and tachycardia, and it suppressed the incidence of ventricular tachycardia and ventricular fibrillation, and mortality elicited by ischemia when compared with that in the control group, accompanied by reducing the arrhythmia scores. After 2-hour reperfusion, pretreatment and posttreatment with wogonin significantly reduced the infarct size and plasma levels of creatine kinase muscle-brain fraction and lactate dehydrogenase. Wogonin also significantly reduced the elevation of plasma tissue necrosis factor-α and superoxide anion production in the myocardium with ischemia/reperfusion. The expression of monocyte chemoattractant protein-1, phosphorylated p38 mitogen-activated protein kinase, p65 and IκBα, and active caspase-3 in ischemic myocardium pronouncedly increased in the control group; these were significantly attenuated by treatment with wogonin. In conclusion, wogonin demonstrated in vivo cardioprotective effects by the attenuation of the severity of ischemia-induced arrhythmias and irreversible ischemia/reperfusion injury, which is associated with its antioxidant capacity and anti-inflammatory effects. The suppression of nuclear factor-κB and p38 mitogen-activated protein kinase activation and the inhibition of monocyte chemoattractant protein-1 expression contribute to the beneficial effects of wogonin.     

新型NO供体SP/W-5186在兔心肌缺血/再灌注损伤中的作用和机制

目的：研究一种结构中含有半胱氨酸的新型一氧化氮供体ＳＰ／Ｗ＝－５１８６，在新西兰兔缺血／再灌注心肌损伤中的作用和机制。方法：兔缺血４５ｍｉｎ继之再灌注１８０ｍｉｎ。再灌注前５ｍｉｎ，通过静脉单剂量给予低剂量（０．３μｍｏｌ／ｋｇ）或高剂量（１μｍｏｌ／ｋｇ）的ＳＰ／Ｗ０５１８６。结果：给予０．３μｊｏｌ／ｋｇＷＰ／Ｗ０－５１８６对平均动脉压、心率等心功能指标没有影响，可显著地降低血小板聚集，减少白     

葡萄糖酸镁对大鼠心肌缺血再灌注损伤的保护作用

目的:观察葡萄糖酸镁对心肌缺血再灌注损伤的影响,探讨葡萄糖酸镁心肌保护作用及其机理。方法:采用改进了的整体大鼠急性心肌缺血再灌注损伤模型,检测组织内Na+- K+- ATPase活力及丙二醛(MDA)和Ca2 +含量,并测定由ADP诱导的血小板5min最大聚集率AGG (M )。结果:与假手术组相比,缺血再灌注组心肌组织内Na+-K+ -ATPase活力显著下降(P <0 .0 1) ,MDA和Ca2 +含量明显升高(P<0 .0 1) ,AGG(M)升高(P <0 .0 5 )。与缺血再灌注组比较,葡萄糖酸镁3个不同剂量保护组心肌组织内Na+ -K+ -ATPase活力明显升高(P <0 .0 1) ,MDA和Ca2 +含量明显降低(P <0 .0 5或P <0 .0 1) ,AGG(M)也明显降低(P <0 .0 1) ,且各作用均随用药剂量的增加而更加显著。结论:葡萄糖酸镁对心肌缺血再灌注损伤有保护作用,其保护作用机制与增加Na+ -K+- ATPase活性、减轻钙超载和抑制脂质过氧化反应以及血小板聚集有关。     

参麦注射液预处理对大鼠心肌缺血-再灌注损伤中胰岛素抵抗的影响

目的探讨参麦注射液(SM)对胰岛素(Ins)抵抗是否有改善作用。方法 SD雄性大鼠24只随机均分为两组:A组每天腹腔注射SM 10ml/kg,连续3d;B组注射等量生理盐水。末次给药后30min采用冠脉结扎15min后再松开45min的办法制备大鼠心肌缺血-再灌注(I-R)损伤模型。放射免疫法检测血糖(Glu)、Ins和C肽的浓度,ELISA法检测血浆抵抗素和游离脂肪酸(FFA)含量。结果 A组血浆Glu[(3.64±0.53)mmol/L vs.(4.29±0.62)mmol/L]、Ins[(31.68±0.21)μU/ml vs.(39.17±0.69)μU/ml]、C肽[(9.26±1.87)ng/ml vs.(13.05±2.56)ng/ml]的浓度以及血浆FFA[(326.40±35.63)μmol/L vs.(429.30±29.64)μmol/L]和抵抗素[(13.29±1.16)ng/mlvs.(16.32±1.52)ng/ml](P<0.05)的含量均明显低于B组(P<0.05)。结论 SM预处理能减轻大鼠心肌I-R损伤过程中的Ins抵抗,对心肌产生一定的保护作用。     

Vitexin protects against myocardial ischemia/reperfusion injury in Langendorff-perfused rat hearts by attenuating inflammatory response and apoptosis

The aim of the present study is to investigate the effects and its possible underlying mechanisms of vitexin on myocardial ischemia/reperfusion (I/R) injury in isolated rat hearts. Isolated rat hearts were perfused with Langendorff apparatus, which subjected to 30 min ischemia and then followed by 60 min reperfusion. In the isolated rat heart subjected to I/R injury, treatment of vitexin (50, 100, 200 μmol/L) significantly enhanced coronary flow, and decreased the pathological scores of myocardium. 50, 100, 200 μmol/L vitexin significantly attenuated I/R-induced increases of myocardial TNF-α and IL-1β, and 25, 50, 100, 200 μmol/L vitexin significantly reduced apoptosis index of cardiac muscle cell of rat isolated heart subjected to I/R injury. Vitexin significantly inhibited I/R-induced increase of myocardial Bax protein expression; however, 100, 200 μmol/L vitexin markedly increased myocardial Bcl-2 protein expression. Furthermore, vitexin at concentrations of 50, 100, 200 μmol/L significantly reduced expression of myocardial NF-κBp65 protein. Therefore, these results demonstrate that vitexin exhibits significant protective effect against myocardial I/R injury in isolated rat heart, which is related to inhibition of the release of inflammatory cytokines and the apoptosis of cardiac muscle cell via up-regulating protein expression of Bcl-2 as well as down-regulating Bax and NF-κBp65.     

Protective effect of a novel thromboxane antagonist, BAY-U3405, on canine myocardial damage after coronary artery occlusion and reperfusion

The effects of a novel thromboxane antagonist, (3R)-3-(4-fluorophenylsulfonmido)-1,2,3,4-tetrahydro-9-carbazol epropanoic acid (BAY-U3405), on myocardial damage due to ischemia and reperfusion (added to accelerate the initiated injury) were studied in anesthetized dogs. The left anterior descending (LAD) coronary artery was occluded for 6 hours and reperfused for 30 minutes. BAY-U3405, 1 mg/kg, was injected intravenously 15 minutes after LAD occlusion, followed by continuous infusion of 10 mg/kg/hour starting at 30 minutes after occlusion. The drug had no hemodynamic effects. During the experiments 6 of 14 animals died of ventricular fibrillation (VF) in the placebo-vehicle controls (3 during occlusion and 3 during reperfusion); in the drug-treated group 5 of 13 dogs died of VF (all during occlusion none during reperfusion). This difference in total mortality and cause was not statistically significant. Reperfusion arrhythmias were largely suppressed by BAY-U3405: 201 +/- 43 versus 689 +/- 98 irregular beats during 30 minutes (p less than 0.001) in the experimental and control groups, respectively. Coronary collateral flow, obtained from a load-line analysis by measurement of retrograde coronary flow, and collateral index were similar in both groups. Therefore, BAY-U3405 did not alter collateral blood supply to the ischemic myocardium. Infarct size, determined with tetrazolium staining, was reduced by 65% (p less than 0.01) after its administration. These results suggest that thromboxane antagonism by BAY-U3405 may delay infarct expansion and reduce the frequency of ventricular arrhythmias during reperfusion of previously ischemic myocardium.     

丹参酮、纳络酮对缺血再灌注心肌局部血流量的影响

目的：观察丹参酮、纳络酮对缺血再灌注心肌局部血流量的影响。方法：用结扎冠状动脉左前降支的方法复制犬心肌缺血再灌注模型，心肌局部血流量用氢气清除法测定。结果：丹参酮、纳络酮均能明显增加正常及部分再灌注心肌血流量，丹参酮主要增加缺血周围区血流量，纳络酮可增加缺血中心区及周围区血流量。结论：丹参酮、纳络酮均能缩小缺血区范围，纳络酮还能减轻缺血程度。     

再灌注早期给予5-N,N二甲基氨氯吡咪对心肌缺血再灌注损伤的保护作用机制研究

目的探讨再灌注早期给予20μmol/L5-N,N二甲基氨氯吡咪(DMA)减轻心肌缺血再灌注损伤的作用机制。方法采用Langendorff法建立离体大鼠心肌缺血再灌注模型,全心缺血45min后,再灌注30min,在再灌注初始5min期间给予药物干预[空白对照;20μmol/LDMA组;低浓度(0.5mmol/L)氨氯吡咪组;高浓度(2.0mmol/L)氨氯吡咪组],其中20μmol/LDMA可以抑制Na+/H+交换,激动Na+/Ca2+交换;低浓度氨氯吡咪主要抑制Na+/H+交换;高浓度氨氯吡咪同时抑制Na+/H+交换和Na+/Ca2+交换。观察不同的药物对离体灌流心脏再灌注期间血流动力学指标(LVSP-LVDP,+dp/dtmax,-dp/dtmax)的影响,同时观察再灌注期间冠状动脉流出液中肌酸激酶(CK)的活性变化。结果与对照组相比,3个药物干预组对再灌后各项血流动力学指标的恢复均有明显的促进作用;流出液中CK的活性较对照组也明显下降。但是再灌注30min后3个给药组血流动力学指标以及流出液中CK的活性差异无统计学意义。结论20μmol/LDMA可明显减轻心肌缺血再灌注损伤,其机制主要是通过抑制Na+/H+交换来发挥其作用,与它对Na+/Ca2+交换的激动作用关系不大。     

新化合物TG6对心肌缺血/再灌注损伤的影响及机制研究

目的研究TG6对心肌缺血/再灌注损伤的保护作用及机制。方法采用整体大鼠心肌缺血/再灌注（I/R）实验,离体大鼠心脏低灌复灌实验和乳鼠心肌细胞缺氧/复氧损伤（H/R）实验等模型,以血清CK、LDH、T-SOD、MDA等为指标,研究TG6对心肌缺血再灌注损伤的保护作用。结果在整体大鼠心肌缺血再灌注损伤实验中,TG6显著减少I/R损伤后心肌梗死面积,减少血清中CK活力和MDA含量,减少LDH活力,增加T-SOD活力;在离体大鼠心脏低灌复灌实验中,TG6显著增加低灌复灌后心肌冠脉流量,减少心肌组织中MDA含量和CK、LDH外漏,提高心肌组织中T-SOD活力;在乳鼠心肌细胞H/R损伤实验中,TG6对正常生长条件下的细胞没有明显影响,提高Na2S2O4制备的心肌细胞H/R模型下细胞的存活率、降低细胞CK的释放率及细胞[Ca^2＋]i的含量。结论 TG6对心肌I/R损伤有一定的保护作用。     

Effects of SEA0400, a novel inhibitor of the Na+/Ca2+ exchanger, on myocardial stunning in anesthetized dogs

Activation of the Na+/Ca2+ exchanger may contribute to Ca2+ overload during reperfusion after transient ischemia. We examined the effects of 2-[4-[(2,5-difluorophenyl) methoxy]phenoxy]-5-ethoxyaniline (SEA0400), a selective inhibitor of Na+/Ca2+ exchange, on a canine model of ischemia/reperfusion injury (myocardial stunning). Myocardial stunning was induced by a 15-min occlusion of the left anterior descending coronary artery followed by a 4-h reperfusion in anesthetized open-chest dogs. Reperfusion gradually restored myocardial percent segment shortening but remained depressed during a 4-h reperfusion period. A bolus intravenous injection of SEA0400 (0.3 or 1.0 mg/kg), given 1 min before reperfusion, improved significantly the recovery of percent segment shortening in the ischemic/reperfused myocardium. SEA0400 did not affect the hemodynamics and electrocardiogram parameters. In addition, SEA0400 did not affect reperfusion-induced change in coronary blood flow. These results suggest that the Na+/Ca2+ exchanger is involved in the stunned myocardium of dogs after reperfusion, and that SEA0400 has a protective effect against myocardial stunning in dogs.     

Serine protease inhibitor nafamostat given before reperfusion reduces inflammatory myocardial injury by complement and neutrophil inhibition

Animal data strongly support a role for inflammation in myocardial ischemia reperfusion injury. Attempts at cardioprotection by immunomodulation (such as with the specific C5 antibody pexelizumab) in humans have been disappointing. We hypothesized that a broader spectrum antiinflammatory agent might yield successful cardioprotection. The serine protease inhibitor nafamostat (FUT-175), which is already in clinical use, is a potent antiinflammatory synthetic serine protease inhibitor with anticomplement activity that we tested in a well-established rabbit model of 1 hour of myocardial ischemia followed by 3 hours of reperfusion. Compared to vehicle-treated animals, nafamostat (1 mg/kg of body weight) administered 5 minutes before reperfusion significantly reduced myocardial injury assessed by plasma creatine kinase activity (38.1 +/- 6.0 versus 57.9 +/- 3.7I U/g protein; P < 0.05) and myocardial necrosis (23.6 +/- 3.1% versus 35.7 +/- 1.0%; P < 0.05) as well as myocardial leukocyte accumulation (P < 0.05). In parallel in vitro studies, Nafamostat was a significantly more potent broad spectrum complement suppressor than C1 inhibitor. Nafamostat appears to have capability as an inhibitor of both complement pathways and as a broad-spectrum antiinflammatory agent by virtue of its serine protease inhibition. Administration of nafamostat before myocardial reperfusion after ischemia produced significant, dose-dependent cardioprotection. Reduced leukocyte accumulation and complement activity seem involved in the mechanism of this cardioprotective effect.     

Thaliporphine protects ischemic and ischemic‐reperfused rat hearts via an NO‐dependent mechanism

In ischemia or ischemia‐reperfusion (I/R), nitric oxide (NO) can potentially exert several beneficial effects. Thaliporphine, a natural alkaloid with Ca²⁺ channel‐activating and Na⁺/K⁺ channel‐blocking activities, increased NO levels and exerted cardioprotective action in ischemic or I/R rats. The role of NO in the cardioprotective actions of thaliporphine was assessed. The severity of rhythm disturbances and mortality in anesthetized rats with either coronary artery occlusion for 30 min, or 5 min followed by 30‐min reperfusion, were monitored and compared in thaliporphine‐ vs. placebo‐treated groups. Thaliporphine treatment significantly increased NO and decreased lactate dehydrogenase (LDH) levels in the blood during the end period of ischemia or I/R. These changes in NO and LDH levels by thaliporphine were associated with a reduction in the incidence and duration of ventricular tachycardia (VT) and ventricular fibrillation (VF) during ischemic or I/R period. The mortality of animals was also completely prevented by 1 × 10^–8 moles/kg of thaliporphine. In animals subjected to 4 h of left coronary artery occlusion, 1 × 10^–7 moles/kg of thaliporphine dramatic reduced cardiac infarct zone from 46 ± 6% to 7.1 ± 1.9%. Inhibition of NO synthesis with 3.7 × 10^–6 moles/kg of N^ω ‐nitro‐L‐arginine methyl ester (L‐NAME) abolished the beneficial effects of thaliporphine during 30 min or 4 h myocardial ischemia. However, the antiarrhythmic activity and mortality reduction efficacy of thaliporphine during reperfusion after 5 min of ischemia was only partially antagonized by L‐NAME. These results showed that thaliporphine efficiently exerted the cardioprotections either in acute or prolonged coronary artery occlusion or occlusion‐reperfusion situations. The fact that thaliporphine induced cardioprotective effects were abrogated by L‐NAME indicates that NO is an important mediator for the cardioprotective effects of thaliporphine in acute or prolonged ischemia, whereas antioxidant activities may contribute to the protection of I/R injury. Drug Dev. Res. 52:446–453, 2001. © 2001 Wiley‐Liss, Inc.     

San酮对大鼠缺血再灌注损伤心肌的保护作用

AIM: To investigate the protective effect of xanthones against myocardial ischemia-reperfusion injury in rats. METHODS: Ischemia-reperfusion injury was induced by 20 min of global ischemia and 40 min of reperfusion in isolated rat hearts or 60-min coronary artery occlusion and 180-min reperfusion in vivo, respectively. Heart rate, coronary flow, left ventricular pressure (LVP), and its first derivative (+/- dp/dtmax) were recorded, and the activity of creatine kinase in coronary effluent and malondialdehyde contents in myocardial tissues were measured in vitro. The activity of serum creatine kinase and myocardium infarct size were measured in vivo. RESULTS: Xanthones (90 or 300 microg/L) caused a significant improvement of cardiac function (LVP and +/- dp/dtmax) and a decrease in the release of creatine kinase in coronary effluent as well as the level of malondialdehyde in myocardial tissues. Xanthones (0.5 or 1.0 mg/kg) also markedly decreased infarct size and the release of creatine kinase in vivo. CONCLUSION: Xanthones protect the myocardium against the damages induced by ischemia-reperfusion in rats, and the effect of xanthones may be related to the inhibition of lipid peroxidation.