内质网应激在心肌缺血再灌注损伤中的作用

内质网应激（ERS）是细胞对内外环境变化的一种适应性反应,有助于细胞和生命个体的存活,但持续存在或过强时则最终诱发细胞凋亡。缺血,再灌注（I／R）时,钙超载及大量自由基的生成等因素诱导过度ERS导致组织损伤。缺血预处理及稳定Ca2＋稳态可激发适当的ERS,增强细胞耐受长时间缺血刺激的能力,延缓或减轻I／R造成的组织损伤。现综述ERS在缺血再灌注损伤（IRI）中的作用,并指出ERS已成为IRI防治的新靶点。     

内质网应激参与调节心肌缺血/再灌注损伤研究的新进展

对急性心肌梗死(AMI)患者进行再灌注治疗的同时也会带来新的损伤,被称为缺血再灌注损伤(IRI)。IRI的发生机制复杂,目前针对IRI仍没有有效的治疗方法。最近研究表明内质网应激(ERS)在IRI中发挥重要的作用,ERS有望成为减轻IRI的新靶点。了解ERS在IRI中的发生发展机制以及其与心肌细胞死亡的关系对于改善AMI患者的预后有重要的意义。     

血管钠肽抑制内质网应激减轻糖尿病大鼠缺血/再灌注心肌损伤

目的 观察人工合成的钠尿肽——血管钠肽（VNP）对糖尿病（DM）大鼠心肌缺血/再灌注（MI/R）损伤的影响及机制。方法 高脂饲料喂养SD大鼠4周后,注射链脲霉素STZ（25 mg/kg,i.p.）,1周后随机血糖≥11.1 mmol/L为DM模型构建成功,常规制备MI/R（30 min/4 h）模型。将大鼠随机分为4组:假手术组、MI/R组、DM+假手术组、DM+MI/R组。多导生理记录仪检测左室压上升/下降最大速率（±LVdP/dtmax）,Evans blue-TTC双染色法检测心肌梗死面积,TUNEL法进行心肌细胞凋亡测试、试剂盒检测caspase-3活性,Western blot检测GRP78、Chop和PKG等蛋白表达。结果 与对照组相比,DM大鼠MI/R心肌损伤加重。VNP治疗（再灌前10 min,给予100 μg/kg,i.v）可显著减轻DM大鼠MI/R损伤,包括增强±LVdP/dtmax,降低心梗范围、死亡率与Caspase-3活性（n=8,P<0.05）。此外,VNP可降低内质网应激相关蛋白GRP78、CHOP表达（n=3,P<0.01）。VNP上述效应可同时被PKG阻断剂KT-5823（再灌前20 min,给予0.5 mg/kg,i.p）抑制、并被cGMP衍生物8-Br-cGMP（1 mg/kg）模拟（P<0.05,P<0.01）。用内质网应激抑制剂TUDCA（50 mg/kg）预处理DM大鼠,并不能增强VNP的心肌保护作用。结论 VNP治疗可减轻DM性MI/R损伤,其机制可能与通过cGMP-PKG信号抑制内质网应激有关,提示VNP对DM性缺血性心脏病具有潜在治疗价值。     

Interleukin 6 alleviates hepatic steatosis and ischemia/reperfusion injury in mice with fatty liver disease

Fatty liver, formerly associated predominantly with excessive alcohol intake, is now also recognized as a complication of obesity and an important precursor state to more severe forms of liver pathology including ischemia/reperfusion injury. No standard protocol for treating fatty liver exists at this time. We therefore examined the effects of 10 days of interleukin 6 (IL-6) injection in 3 murine models of fatty liver: leptin deficient ob/ob mice, ethanol-fed mice, and mice fed a high-fat diet. In all 3 models, IL-6 injection decreased steatosis and normalized serum aminotransferase. The beneficial effects of IL-6 treatment in vivo resulted in part from an increase in mitochondrial beta oxidation of fatty acid and an increase in hepatic export of triglyceride and cholesterol. However, administration of IL-6 to isolated cultured steatotic hepatocytes failed to decrease lipid contents, suggesting that the beneficial effects of IL-6 in vivo do not result from its effects on hepatocytes alone. IL-6 treatment increased hepatic peroxisome proliferator-activated receptor (PPAR) alpha and decreased liver and serum tumor necrosis factor (TNF) alpha. Finally, 10 days of treatment with IL-6 prevented the susceptibility of fatty livers to warm ischemia/reperfusion injury. In conclusion, long-term IL-6 administration ameliorates fatty livers and protects against warm ischemia/reperfusion fatty liver injury, suggesting the therapeutic potential of IL-6 in treating human fatty liver disease.     

UTP减轻大鼠心脏缺血/再灌注损伤的作用

目的:探讨P2Y受体激动剂尿苷三磷酸(UTP)对于大鼠心脏缺血/再灌注损伤(I/RI)的延迟性拮抗作用。方法:24只SD大鼠随机分为4组:实验对照组、UTP组、UTP+苏拉明(suramin,SRM)组及SRM组。所有大鼠尾静脉给药24 h后,建立Langendorff离体心脏灌流模型。平衡10 min后全心停灌,25 min后复灌,持续再灌40 min。观察心脏再灌注前后血流动力学指标及心肌超微结构,记录心脏表面心电图计算心律失常的发生率,收集冠脉流出液,用全自动生化分析仪测量乳酸脱氢酶(LDH)的水平。结果:复灌后第5 min和25 min时,UTP组的左室发展压(LVDP)、左室压力微分(±dp/dtmax)恢复率均优于实验对照组(P0.05,P0.01);冠脉流出液中LDH的水平明显值降低(P0.01);复灌第5~15 min和第25~35min时的心律失常的发生频率均显著下降(P0.05,P0.01);心肌超微结构的损伤减轻。而以SRM与UTP同时作用后,UTP对心脏的保护作用则被取消。SRM组与实验对照组相比各项指标无明显变化。结论:UTP预处理可对心脏I/RI产生延迟性拮抗作用;而P2Y受体拮抗剂SRM可取消这种作用,表明UTP对心脏的保护作用是通过P2Y受体介导的。     

地氟烷预处理对大鼠离体心脏缺血再灌注损伤的影响及作用机制

目的探讨地氟烷预处理在大鼠离体心脏缺血再灌注(IR)中的保护作用是否与单磷酸腺苷激活的蛋白激酶(AMPK)有关。方法清洁级健康雄性大鼠50只,2~3月龄,体重250~280 g,切取离体心脏并随机分为正常对照(C)组、IR组、地氟烷预处理+IR(DR)组、地氟烷预处理+AMPK抑制剂+IR(DC)组和IR+AMPK抑制剂(CR)组各10只。DR组和DC组在给予大鼠吸入1 MAC的地氟烷30 min后立即切取心脏。采用Langendorff灌注装置并以95%O_2~5%CO_2饱和的K-H液作为灌注液,在平衡灌注15 min后,停止灌注30 min后再灌注60 min建立IR模型。分别在停止灌注前和再灌注60 min时记录心率(HR)、左室发展压(LVDP)、左室内压最大上升速率(+dp/dt)和左室内压最大下降速率(-dp/dt)。采用caspase-3活性检测试剂盒测定心肌组织内caspase-3活性,酶联免疫吸附(ELISA)法检测冠脉流出液中心肌肌钙蛋白(c Tn)I浓度。采用免疫组织化学法和Western印迹法检测心肌组织内AMPK(Thr-172)的磷酸化水平。结果与C组比较,IR组离体心脏再灌注60 min时HR、LVDP、+dp/dt和-dp/dt显著降低(P<0.05),心肌组织caspase-3活性和冠脉流出液中cTnI浓度显著升高(P<0.05),而AMPK(Thr-172)的磷酸化水平无显著差异(P>0.05)。与IR组比较,DR组HR、LVDP、+dp/dt和-dp/dt显著升高(P<0.05),caspase-3活性和cTnI浓度显著降低(P<0.05),AMPK(Thr-172)的磷酸化水平显著升高(P<0.05)。而与DR组比较,DC组HR、LVDP、+dp/dt和-dp/dt显著降低(P<0.05),caspase-3活性和cTnI浓度显著升高(P<0.05),AMPK(Thr-172)的磷酸化水平显著降低(P<0.05)。结论地氟烷预处理使IR后心肌组织内AMPK(Thr-172)磷酸化水平升高而被激活,是其缓解心肌IR损伤的机制之一。     

Effect of sulfur dioxide preconditioning on rat myocardial ischemia/reperfusion injury by inducing endoplasmic reticulum stress

Sulfur dioxide has recently been found to be produced endogenously in the cardiovascular system and have important positive biological effects. However, it is unknown whether sulfur dioxide preconditioning has a protective effect on rat myocardial ischemia/reperfusion (I/R) injury and whether this process involves endoplasmic reticulum stress (ERS). In this study, we showed that preconditioning with sulfur dioxide 10 min before ischemia (with a low concentration of sulfur dioxide of 1–10 μmol/kg) could reduce myocardial infarct size and plasma activities of lactate dehydrogenase and creatine kinase in rats with I/R in vivo. Sulfur dioxide preconditioning also reduced myocardium apoptosis induced by I/R. In addition, sulfur dioxide preconditioning increased cardiac function in vitro. Sulfur dioxide preconditioning induced expression of myocardial glucose-regulated protein 78 (GRP78) and phosphorylated eukaryotic initiation of the factor 2α-subunit (p-eIF2α) prior to myocardial I/R but suppressed expression of myocardial GRP78, C/EBP homologous protein, and p-eIF2α during myocardial I/R, in association with improved myocardial injury in vivo and in vitro. Pretreatment with dithiothreitol, an ERS stimulator mimicked the above cardioprotective effect. However, pretreatment with the ERS inhibitor 4-phenylbutyrate reversed the cardioprotection provided by sulfur dioxide preconditioning. These data indicated that sulfur dioxide preconditioning reduced I/R-induced myocardial injury in vivo and in vitro, and that augmenting ERS by sulfur dioxide preconditioning prior to I/R contributed to protection against myocardial I/R injury.     

异氟烷预处理对离体大鼠心肌缺血再灌注损伤的影响

目的:采用Langendorff离体心脏灌注模型,研究异氟烷预处理对离体大鼠心肌缺血再灌注损伤的影响。方法:24只SD大鼠随机分为4组,每组6只,分别为缺血再灌注损伤组(IR组)、异氟烷预处理1组(IsoP 1组)、异氟烷预处理2组(IsoP 2组)和异氟烷预处理3组(IsoP 3组)。监测复灌后心功能恢复情况、冠脉流出液中磷酸肌酸激酶(CK)、乳酸脱氨酶(LDH)的释放量和心肌存活面积的变化。结果:复灌期间3组IsoP心脏各对应时间点的LVEDP均显著低于对照组(P<0.05~<0.01);再灌注30 min时IsoP各组LVDP的恢复均高于IR组(P<0.05),IsoP3组±dp／dtmax在再灌注30 min时的恢复百分比均高于IR组(P<0.05),IsoP1组+dp／dt max高于IR组(P<0.05);复灌后异氟烷预处理组各时间点的CK、LDH释放量均低于IR组(P<0.01);IsoP2组、IsoP1组和IsoP3组心肌存活面积百分比均高于IR组(P<0.01);预处理各组之间比较无显著性差异(P>0.05)。结论:IsoP对大鼠离体缺血再灌注心肌有保护作用,可以显著减轻心肌细胞的损伤,改善心功能,增加心肌存活面积。     

Effect of endothelin and endothelin-antiserum on ischemia/reperfusion injury in isolated rat hearts]

Reperfusion of isolated perfused rat hearts with 10(-9) mol/L endothelin (ET) significantly exacerbated the ischemia/reperfusion injury(I/R), in contrast, reperfusion with specific ET-antiserum dramatically alleviated myocardial I/R injury. The results suggest that ET may be an important factor, which contributes to the pathogenesis of myocardial I/R injury.     

Myocardial protection from ischemia/reperfusion injury by targeted deletion of matrix metalloproteinase-9

OBJECTIVE: Matrix metalloproteinase-9 (MMP-9) activity is up regulated in the heart subjected to ischemic insult. Whether increased MMP-9 activity contributes to acute myocardial injury after ischemia-reperfusion remains unknown. To investigate the role of MMP-9 in myocardial infarction, we utilized a MMP-9 knockout mouse. METHODS AND RESULTS: Standard homologous recombination in embryonic stem cells was used to generate a mouse lacking MMP-9. The left anterior descending coronary artery was occluded for 30 min followed by 24 h reperfusion, and the ischemic and infarct sizes were determined. Targeted deletion of MMP-9 protected the heart from no-flow ischemia-reperfusion-induced myocardial injury. The myocardial infarct size was reduced by 17.5% in MMP-9 heterozygotes (+/-) (P<0.01) and 35.4% in MMP-9 knockout (-/-) mice (P<0.01) versus the wild-type (+/+) mice, respectively. Analysis of MMP activity in myocardial extracts by zymography demonstrated that ischemia-reperfusion-induced expression of proMMP-9 and active MMP-9 was reduced by 77.8% (P<0.01) and 69.1% (P<0.001), respectively, in (+/-) mice compared to (+/+) mice, and was absent in (-/-) animals. The expression of TIMP-1, an endogenous inhibitor of MMP-9, was elevated 4.7-fold (P<0.05) and 21.4-fold (P<0.05) in the (+/-) and (-/-) mice, respectively, compared to (+/+) mice. Immunohistochemical analysis revealed that neutrophils were the primary cellular source of MMP-9, and less neutrophils were detected in the ischemic region of the heart following ischemia-reperfusion in (-/-) mice compared to (+/+) mice. Measurement of myeloperoxidase activity, a marker enzyme of neutrophils, demonstrated a 44% reduction in neutrophils infiltrated into the ischemic myocardium in the (-/-) mice compared to the (+/+) mice (P<0.05). CONCLUSION: These results suggest that MMP-9 plays an important role in ischemia-reperfusion-induced myocardial infarction and MMP-9 could be a target for prevention or treatment of acute ischemic myocardial injury.     

低氧习服对大鼠离体心脏缺血再灌注损伤的影响

目的研究急性低氧和间断低氧习服对大鼠离体心脏缺血/再灌注损伤的影响.方法经间断低氧习服(模拟海拔3000m,5000m低氧2周,每天4 h,最后8000m低氧4 h)和急性低氧(模拟海拔8000m低氧4 h)的大鼠,麻醉后开胸,迅速取出心脏,观察其离体心脏缺血/再灌注损伤情况.结果离体心脏缺血/再灌时的心率在第3min时最低,以后逐渐恢复,低氧习服组和急性低氧组的心率可恢复至缺血前水平,显著高于常氧对照组.反映心脏收缩功能的指标左心室收缩压(LVSP)和 dp/dtmax及反映心脏舒张功能的指标-dp/dtmax在复灌的第3～5 min时降至最低,心脏功能损伤较重,以后逐渐恢复.其中低氧习服组大鼠离体心脏的LVSP、 dp/dtmax和-dp/dtmax显著高于常氧对照组和急性低氧组.冠脉流出液中的肌酸磷酸激酶(CPK)亦在缺血/再灌后显著升高,且有不断升高的趋势,低氧习服组的CPK含量显著低于常氧对照组和急性低氧组.结论低氧习服可减轻大鼠离体心脏的缺血/再灌损伤.     

氧化应激在糖尿病所致的心肌缺血/再灌注损伤中的作用

近年来,糖尿病（DM）患病率与日俱增,且并发症多。当DM患者伴发缺血性心肌病（IHD）时极易诱发心肌缺血/再灌注损伤（MI/RI）,而氧化应激在MI/RI中发挥着关键作用。由于胰岛素抵抗诱发的脂质代谢紊乱、内皮细胞功能障碍以及脂联素抵抗会导致心肌细胞凋亡增多、细胞抗氧化防御系统减弱以及促存活细胞信号通路受损,致使糖尿病性心脏病患者更易发生MI/RI,最终导致心力衰竭。氧化应激的3个主要机制分别是:活性氧簇（ROS）和活性氮簇(RNS)以及解偶联的一氧化氮合酶（NOS）通过氧化/硝化反应干扰线粒体质量调控系统,在这篇综述中,我们将主要对氧化应激在DM发生的MI/RI中可能存在的作用机制进行探讨。     

MK2-/- gene knockout mouse hearts carry anti-apoptotic signal and are resistant to ischemia reperfusion injury

Stress-induced mitogen-activated protein (MAP) kinases have been implicated in various forms of cardiovascular diseases. Ischemia/reperfusion potentiates activation of p38 MAP kinase (p38MAPK) leading to the activation of its downstream target MAPKAP kinase 2 (MK2). While p38MAPK has been shown to induce pro-apoptotic signal, whether MK2 also generates death signal is not known. To determine if MK2 triggers death signal, the hearts of MK2-/- knockout mice and genetically matched wild-type mice were subjected to 30 min ischemia followed by 2 h of reperfusion via Langendorff mode. The results indicated that the hearts of MK2-/- mice were resistant to myocardial ischemic reperfusion injury as evidenced by enhance recovery of post-ischemic ventricular performance, reduced myocardial infarct size and diminished number of apoptotic cardiomyocytes. We conclude that MK2, similar to p38MAPK, is involved in transmitting the death signal to the ischemic myocardium.     

Protective effects of hydrogen peroxide against ischemia/reperfusion injury in perfused rat hearts.

Among the several mechanisms proposed for ischemic preconditioning (IPC), generation of reactive oxygen species (ROS) is reported to be involved in the cardioprotective effects of IPC. The present study was designed to investigate whether repetitive exposure to hydrogen peroxide (H(2)O(2)) can protect the myocardium against subsequent ischemia/reperfusion injury, and whether the H(2)O(2)-induced cardioprotection is related to the preservation of energy metabolism. Langendorff-perfused rat hearts were exposed to two, 5 min episodes of IPC or to various concentrations of H(2)O(2) twice and then to 35 min global ischemia and 40 min reperfusion. Using (31)P nuclear magnetic resonance ((31)P-NMR) spectroscopy, cardiac phosphocreatine (PCr) and ATP and intracellular pH (pH(i)) were monitored. IPC and the treatment with 2 micromol/L H(2)O(2) significantly improved the post-ischemic recovery of left ventricular developed pressure (LVDP) and the PCr and ATP compared with those of the control ischemia/reperfusion (LVDP: 36.9 +/-7.4% of baseline in control hearts, 84.0+/-3.5% in IPC, 65.4+/-3.8% in H(2)O(2); PCr: 51.1+/-5.3% in control hearts, 81.4+/-5.5% in IPC, 81.7+/-5.2% in H(2)O(2); ATP: 12.3+/-1.6% in control hearts; 30.0+/-2.8% in IPC, 28.6+/-2.3% in H(2)O(2), mean +/- SE, p<0.05). However, lower (0.5 micromol/L) or higher (10 micromol/L) concentration of H(2)O (2) had no effect. There were significant linear correlations between mean LVDP and high-energy metabolites after 40 min reperfusion in H(2)O(2)-treated hearts. In IPC-treated hearts, the mean LVDP was greater than that in the 2 micromol/L H(2)O(2)-treated hearts under similar levels of high-energy metabolites. IPC also ameliorated intracellular acidification (6.38+/-0.03 in control hearts, 6.65+/-0.04 in IPC, p<0.05), but treatment with H(2)O(2) did not affect pH(i) during ischemia (6.40+/-0.05 in H(2)O(2)). In conclusion, H(2)O(2) had protective effects against ischemia/reperfusion injury and the effects were related to the preservation of energy metabolism. IPC could have additional protective mechanisms that are associated with the amelioration of intracellular acidosis during ischemia.     

大鼠肝脏缺血再灌注损伤c-fos表达及预处理的保护作用

目的探讨预处理（preconditioningPc）对大鼠肝脏缺血再灌注（ischemia／reperfusion,I／R）损伤的影响及其机制。方法制备大鼠肝脏原位I／R损伤的模型,采用免疫组织化学技术结合图像分析方法定量检测原癌基因c-fos表达的情况和肝组织脂质过氧化产物丙二醛（MDA）的变化。结果I／R损伤早期可引起损伤区肝细胞核内原癌基因c－fos的大量表达;PC明显减少了c－fos表达的细胞数量以及减轻肝脏脂质过氧化的程度。结论PC对大鼠肝脏I／R损伤有明显的保护作用,可能的机制之一是抑制肝I／R损伤后原癌基因c-fos的表达和灭活自由基减少脂质过氧化物的生成。     

Oxidative stress and neutrophil activation--the two keystones of ischemia/reperfusion injury

The widespread introduction of fibrinolytics and recently also PTCA in the treatment of myocardial infarction has changed the picture of modern cardiology. But this therapy also raises new problems and challenges. One of them is the occurrence of extensive tissue injury caused by reperfusion. Reinstitution of oxygen to the ischemic tissues initiates various processes leading to generation of reactive oxygen species (ROSs). Acting on the plasma membrane ROS damage its organization and release various proinflammatory agents. Different proteins, including receptors, ionic channels, transporters or components of transduction pathways are substrates of oxidation by ROSs. Their changed structure results in altered functioning and disruption of vital cellular processes. Another key factor of reperfusion injury is activation and infiltration of infarcted area by polymorphonuclear leukocytes (PMNs). Multiple studies identified consecutive stages of PMN activation and substances being involved in it. Main interest lies in cellular adhesion molecules, particularly selectins and beta2 integrins, as their antagonists were repeatedly found to diminish neutrophil activation and infarct size. Nevertheless new publications strike at the foundations of the established order and confront the relation between neutrophil infiltration and infarct size. PMNs are linked by close ties to other cells involved in inflammatory response. Seemingly also in cardiac ischemia-reperfusion injury, the activity of neutrophils is modulated by lymphocytes and macrophages. The article describes mutual interactions between different factors involved in the reperfusion injury that may enable preparing new treatments, hopefully as effective and successful as reperfusion therapy.