Work, stress and cardiovascular diseases

Classical risk factors such as smoking, hypertension or elevated plasma levels of cholesterol account only for part of the variance in the probability of cardiovascular disease. Work related psychosocial factors such as high job demands, low decision latitude or lack of social support often pertain during extended periods. Such work related stressors may modulate biological risk factors (e.g. by increasing the risk of hypertension) or may elicit adverse health behaviour (increased tobacco consumption). Several longitudinal cohort studies indeed support the notion of an association between work related stressors and the risk of cardiovascular disease. However, the exact biological mechanisms conferring this risk remain in part elusive. The general stress model of allostasis and allostatic load may allow studying possible pathways in more detail and within a common conceptual framework. Allostasis refers to the often useful acute stress reaction that prepares the organism for flight or fight threatening situations. Allostatic load summarizes the wear and tear inflicted upon the organism after repeated or dysregulated allostatic efforts. The framework of allostasis and allostatic load permits to investigate the direct effect of work related stressors on the primary stress reaction (reduced vagal tone, increased sympathetic tone and increased activity of the hypothalamic-pituitary-adrenal axis) as well as the effect on biological process, which are regulated by the acute stress reaction. Longitudinal studies have shown an inverse association between a score operationalizing allostatic load by means of 10 biological measures and functional status/mortality. These studies in elderly individuals remain to be replicated using the same framework for working age populations.     

AMP-activated protein kinase signaling in metabolic regulation

AMP-activated protein kinase (AMPK) is an energy sensor that regulates cellular metabolism. When activated by a deficit in nutrient status, AMPK stimulates glucose uptake and lipid oxidation to produce energy, while turning off energy-consuming processes including glucose and lipid production to restore energy balance. AMPK controls whole-body glucose homeostasis by regulating metabolism in multiple peripheral tissues, such as skeletal muscle, liver, adipose tissues, and pancreatic beta cells--key tissues in the pathogenesis of type 2 diabetes. By responding to diverse hormonal signals including leptin and adiponectin, AMPK serves as an intertissue signal integrator among peripheral tissues, as well as the hypothalamus, in the control of whole-body energy balance.     

磷酸腺苷活化蛋白激酶在内毒素血症大鼠蛋白调节中的作用

内毒素血症是现代临床危重病医学面临的棘手问题,也是导致危重症的常见原因和对预后产生严重影响的重要因素,内毒素血症患者往往因为严重感染和应激,处于一个高分解、高消耗的状态.这种能量消耗增加的高分解代谢状态和对代谢底物利用的改变共同构成了此类患者的代谢特征.蛋白质是人体三大能量物质之一,也是各种代谢活动的基础和构成人体的最重要的物质之一.     

NADPH oxidase CYBA polymorphisms, oxidative stress and cardiovascular diseases

Oxidative stress plays a key role in the pathophysiology of several major cardiovascular diseases, including atherosclerosis, hypertension, heart failure, stroke and diabetes. ROS (reactive oxygen species) affect multiple tissues either directly or through NO depletion. ROS induce cardiovascular dysfunction by modulating cell contraction/dilation, migration, growth/apoptosis and extracellular matrix protein turnover, which contribute to vascular and cardiac remodelling. Of the several sources of ROS within the cardiovascular system, a family of multisubunit NADPH oxidases appears to be a predominant contributor of superoxide anion. Recent findings suggest a significant role of the genetic background in NADPH oxidase regulation. Common genetic polymorphisms within the promoter and exonic sequences of CYBA, the gene that encodes the p22(phox) subunit of NADPH oxidase, have been characterized in the context of cardiovascular diseases. This review aims to present the current state of research into these polymorphisms in their relationship to cardiovascular diseases.     

AMP-activated protein kinase: the guardian of cardiac energy status

Several years ago it was proposed that the AMP-activated protein kinase cascade might protect cells against stresses that deplete cellular ATP. Young et al. have now directly tested this by studying the effects of ischemia and reperfusion in perfused hearts from mice expressing a dominant-negative mutant that suppresses the kinase activity in cardiac muscle. Compared with control hearts, the mutant hearts showed clear evidence for increased necrotic damage and increased apoptosis. These findings may have implications for the treatment of ischemic heart disease.     

AMP-activated protein kinase mediates ischemic glucose uptake and prevents postischemic cardiac dysfunction, apoptosis, and injury

AMP-activated protein kinase (AMPK) is an important regulator of diverse cellular pathways in the setting of energetic stress. Whether AMPK plays a critical role in the metabolic and functional responses to myocardial ischemia and reperfusion remains uncertain. We examined the cardiac consequences of long-term inhibition of AMPK activity in transgenic mice expressing a kinase dead (KD) form of the enzyme. The KD mice had normal fractional shortening and no heart failure, cardiac hypertrophy, or fibrosis, although the in vivo left ventricular (LV) dP/dt was lower than that in WT hearts. During low-flow ischemia and postischemic reperfusion in vitro, KD hearts failed to augment glucose uptake and glycolysis, although glucose transporter content and insulin-stimulated glucose uptake were normal. KD hearts also failed to increase fatty acid oxidation during reperfusion. Furthermore, KD hearts demonstrated significantly impaired recovery of LV contractile function during postischemic reperfusion that was associated with a lower ATP content and increased injury compared with WT hearts. Caspase-3 activity and TUNEL-staining were increased in KD hearts after ischemia and reperfusion. Thus, AMPK is responsible for activation of glucose uptake and glycolysis during low-flow ischemia and plays an important protective role in limiting damage and apoptotic activity associated with ischemia and reperfusion in the heart.     

腺嘌呤核苷酸活化蛋白激酶与哺乳动物雷帕霉素靶蛋白信号转导通路的相互作用

背景:腺嘌呤核苷酸活化蛋白激酶的下游靶分子哺乳动物雷帕霉素靶蛋白对细胞生长、分裂和蛋白质合成有重要意义.目的:综述腺嘌呤核苷酸活化蛋白激酶与哺乳动物雷帕霉素靶蛋白信号转导相互调节的最新研究进展,以期揭示腺嘌呤核苷酸活化蛋白激酶和哺乳动物雷帕霉素靶蛋白信号转导的交互作用对蛋白质合成的影响.方法:以"(mammalian target of rapamycin OR mTOR) AND (AMP activated protein kinase OR AMPK) AND signal transduction"为检索式,计算机检索PubMed数据库相关内容的文献,最终纳入30篇可反映腺嘌呤核苷酸活化蛋白激酶与哺乳动物雷帕霉素靶蛋白信号转导通路相互作用的文献,并进行归纳总结.结果与结论:腺嘌呤核苷酸活化蛋白激酶活化导致哺乳动物雷帕霉素靶蛋白信号转导减弱一定程度上抑制蛋白质合成,腺嘌呤核苷酸活化蛋白激酶通过多个位点磷酸化和活化而调节哺乳动物雷帕霉素靶蛋白信号转导.腺嘌呤核苷酸活化蛋白激酶磷酸化马铃薯球蛋白会抑制Akt,ERK1/ERK2和p90rsk等其他蛋白激酶的作用.明确腺嘌呤核苷酸活化蛋白激酶对哺乳动物雷帕霉素靶蛋白的调节过程所起的作用,对揭示腺嘌呤核苷酸活化蛋白激酶-哺乳动物雷帕霉素靶蛋白途径调控能量代谢和蛋白合成方面有重要意义.     

腺嘌呤核苷酸活化蛋白激酶与哺乳动物雷帕霉素靶蛋白信号转导通路的相互作用

背景：腺嘌呤核苷酸活化蛋白激酶的下游靶分子哺乳动物雷帕霉素靶蛋白对细胞生长、分裂和蛋白质合成有重要意义。目的：综述腺嘌呤核苷酸活化蛋白激酶与哺乳动物雷帕霉素靶蛋白信号转导相互调节的最新研究进展,以期揭示腺嘌呤核苷酸活化蛋白激酶和哺乳动物雷帕霉素靶蛋白信号转导的交互作用对蛋白质合成的影响。方法：以＂（mammalian target of rapamycin OR mTOR）AND（AMP activated protein kinase OR AMPK）AND signal transduction＂为检索式,计算机检索PubMed数据库相关内容的文献,最终纳入30篇可反映腺嘌呤核苷酸活化蛋白激酶与哺乳动物雷帕霉素靶蛋白信号转导通路相互作用的文献,并进行归纳总结。结果与结论：腺嘌呤核苷酸活化蛋白激酶活化导致哺乳动物雷帕霉素靶蛋白信号转导减弱一定程度上抑制蛋白质合成,腺嘌呤核苷酸活化蛋白激酶通过多个位点磷酸化和活化而调节哺乳动物雷帕霉素靶蛋白信号转导。腺嘌呤核苷酸活化蛋白激酶磷酸化马铃薯球蛋白会抑制Akt,ERK1/ERK2和p90rsk等其他蛋白激酶的作用。明确腺嘌呤核苷酸活化蛋白激酶对哺乳动物雷帕霉素靶蛋白的调节过程所起的作用,对揭示腺嘌呤核苷酸活化蛋白激酶-哺乳动物雷帕霉素靶蛋白途径调控能量代谢和蛋白合成方面有重要意义。     

The AMP-activated protein kinase alpha2 catalytic subunit controls whole-body insulin sensitivity

AMP-activated protein kinase (AMPK) is viewed as a fuel sensor for glucose and lipid metabolism. To better understand the physiological role of AMPK, we generated a knockout mouse model in which the AMPKalpha2 catalytic subunit gene was inactivated. AMPKalpha2(-/-) mice presented high glucose levels in the fed period and during an oral glucose challenge associated with low insulin plasma levels. However, in isolated AMPKalpha2(-/-) pancreatic islets, glucose- and L-arginine-stimulated insulin secretion were not affected. AMPKalpha2(-/-) mice have reduced insulin-stimulated whole-body glucose utilization and muscle glycogen synthesis rates assessed in vivo by the hyperinsulinemic euglycemic clamp technique. Surprisingly, both parameters were not altered in mice expressing a dominant-negative mutant of AMPK in skeletal muscle. Furthermore, glucose transport was normal in incubated isolated AMPKalpha2(-/-) muscles. These data indicate that AMPKalpha2 in tissues other than skeletal muscles regulates insulin action. Concordantly, we found an increased daily urinary catecholamine excretion in AMPKalpha2(-/-) mice, suggesting altered function of the autonomic nervous system that could explain both the impaired insulin secretion and insulin sensitivity observed in vivo. Therefore, extramuscular AMPKalpha2 catalytic subunit is important for whole-body insulin action in vivo, probably through modulation of sympathetic nervous activity.     

Past strategies and future directions for identifying AMP-activated protein kinase (AMPK) modulators

AMP-activated protein kinase (AMPK) is a promising therapeutic target for cancer, type II diabetes, and other illnesses characterized by abnormal energy utilization. During the last decade, numerous labs have published a range of methods for identifying novel AMPK modulators. The current understanding of AMPK structure and regulation, however, has propelled a paradigm shift in which many researchers now consider ADP to be an additional regulatory nucleotide of AMPK. How can the AMPK community apply this new understanding of AMPK signaling to translational research? Recent insights into AMPK structure, regulation, and holoenzyme-sensitive signaling may provide the hindsight needed to clearly evaluate the strengths and weaknesses of past AMPK drug discovery efforts. Improving future strategies for AMPK drug discovery will require pairing the current understanding of AMPK signaling with improved experimental designs.     

Elimination of endoplasmic reticulum stress and cardiovascular,type 2 diabetic,and other metabolic diseases

Abstract

Multiple factors including unhealthy living habits influence the life-maintaining functions of the endoplasmic reticulum (ER) and induce ER stress and metabolic abnormalities. The ER responds to the disturbances by activating mechanisms that increase the capacity to eliminate ER stress. This article elucidates the effects of ER activation that eliminates both ER stress and associated cardiovascular, type 2 diabetic (DM2), and other metabolic diseases. ER-activating compounds eliminate ER stress by lowering elevated cholesterol, regress atherosclerosis, decrease cardiovascular mortality, reduce blood glucose and insulin, and, together with the normalization of glucose–insulin homeostasis, remove insulin resistance, pancreatic β-cell failure, and DM2. A deficient cytochrome P450 activity in hepatic ER leads to cholesterol accumulation that induces stress and xanthoma formation, whereas P450-activating therapy up-regulates apolipoprotein AI and LDLR genes, down-regulates apolipoprotein B gene, and produces an antiatherogenic plasma lipoprotein profile. The ER activation reduces the stress also by eliminating hepatic fat and converting saturated fatty acids (FAs) to unsaturated FAs. Cognitive processes require gene expression modification, and preclinical studies indicate that ER-activating therapy improves cognition. Promotion of healthy lifestyle choices and indicated therapies are key factors in the prevention and elimination of ER stress and associated global health problems.     

Effects of triglycyl-lysine-vasopressin on cardiovascular responses to orthostatic stress

Summary. The influence of triglycyl-lysine-vasopressin (TGLVP) on cardiovascular responses to orthostatic stress was studied. Arterial pressures, heart rate (HR) and stroke volume (SV) were measured in eight healthy males subjected to 20 min 70° head-up tilt. On different days they received either 0·01 mg/kg b.w. of TGLVP or a corresponding volume of 0·9% saline i.v. after 15 min supine rest. After the drug injection, in supine subjects, HR had decreased from 58 to 50 beats min^-1, total peripheral resistance (TPR) was elevated by 29%, systolic (SAP) and diastolic pressure (DAP) had increased by 7 and 8 mmHg, respectively. During tilt, values for HR and SAP were similar with and without TGLVP whereas DAP and MAP were elevated 8 and 7 mmHg, respectively, by the drug. 4–8 min into the tilt, TGLVP caused an 8% sustained curtailment of SV. Both with and without the drug TPR increased by about 30% in response to head-up tilt. Thus, the marked peripheral arteriolar constriction after vasopressin in the supine position was not affected by head-up tilt. Tilting also abolished the drug-induced elevation in SAP, most likely explained by the reduction in SV. Although TPR was markedly increased by TGLVP during head-up tilt, reflected in the behaviour of DAP, the response of SV speaks against any beneficial effect of this drug on orthostatic tolerance in healthy subjects.     

C-reactive protein: the harbinger of cardiovascular diseases

Coronary heart disease remains the major cause of mortality and morbidity in the United States and other western countries despite major advances in its treatment. During the last decades, many markers of coronary artery disease have been found which help predict future risk of cardiovascular events. High-sensitivity C-reactive protein has been studied extensively and was seen to be associated with a higher risk of cardiovascular events in patients with acute coronary syndromes and/or peripheral artery disease. Discussed in this review is the latest literature about this marker and its association with cardiovascular disease, as well as the latest therapeutic options available.     

高敏C反应蛋白与心血管疾病的关系

对C反应蛋白 (CRP)这个古老项目的新认识、新理论及用途在概述动脉粥样硬化中的作用 ,预测非冠心病 (CHD)患者未来心血管事件发生率及未来心血管事件的可能性研究 ,高敏感性C反应蛋白 (Hs CRP)与传统CHD危险因素的关系和检测应用前景几方面进行扼要综述。Hs CRP与传统检测方法不同的是检测正常范围低水平的CRP微小变化 ,它不仅可能是一种轻度慢性全身性炎症的标志物 ,而且直接参与了动脉粥样硬化的过程 ,可以增强预测预后和治疗的能力 ,hs CRP的预测价值显著高于与传统危险因素有关的生化指标或其他新发现的指标     

心型脂肪酸结合蛋白在心血管疾病中作用研究进展

心型脂肪酸结合蛋白是一种小型细胞质蛋白,主要在心肌组织表达。心肌受损时,心型脂肪酸结合蛋白快速释放入血,胸痛发作1 h时血液中心型脂肪酸结合蛋白表达明显升高。心型脂肪酸结合蛋白与心血管疾病关系密切。本文就心型脂肪酸结合蛋白在急性冠状动脉综合征、心力衰竭、心房颤动中作用的研究进展作一综述。     

Aberrant activation of AMP-activated protein kinase remodels metabolic network in favor of cardiac glycogen storage

AMP-activated protein kinase (AMPK) responds to impaired cellular energy status by stimulating substrate metabolism for ATP generation. Mutation of the gamma2 regulatory subunit of AMPK in humans renders the kinase insensitive to energy status and causes glycogen storage cardiomyopathy via unknown mechanisms. Using transgenic mice expressing one of the mutant gamma2 subunits (N488I) in the heart, we found that aberrant high activity of AMPK in the absence of energy deficit caused extensive remodeling of the substrate metabolism pathways to accommodate increases in both glucose uptake and fatty acid oxidation in the hearts of gamma2 mutant mice via distinct, yet synergistic mechanisms resulting in selective fuel storage as glycogen. Increased glucose entry in the gamma2 mutant mouse hearts was directed through the remodeled metabolic network toward glycogen synthesis and, at a substantially higher glycogen level, recycled through the glycogen pool to enter glycolysis. Thus, the metabolic consequences of chronic activation of AMPK in the absence of energy deficiency is distinct from those previously reported during stress conditions. These findings are of particular importance in considering AMPK as a target for the treatment of metabolic diseases.     

Maternal antioxidant blocks programmed cardiovascular and behavioural stress responses in adult mice

Intra-uterine growth restriction is an independent risk factor for adult psychiatric and cardiovascular diseases. In humans, intra-uterine growth restriction is associated with increased placental and fetal oxidative stress, as well as down-regulation of placental 11β-HSD (11β-hydroxysteroid dehydrogenase). Decreased placental 11β-HSD activity increases fetal exposure to maternal glucocorticoids, further increasing fetal oxidative stress. To explore the developmental origins of co-morbid hypertension and anxiety disorders, we increased fetal glucocorticoid exposure by administering the 11β-HSD inhibitor CBX (carbenoxolone; 12?mg·kg-1 of body weight·day-1) during the final week of murine gestation. We hypothesized that maternal antioxidant (tempol throughout pregnancy) would block glucocorticoid-programmed anxiety, vascular dysfunction and hypertension. Anxiety-related behaviour (conditioned fear) and the haemodynamic response to stress were measured in adult mice. Maternal CBX administration significantly increased conditioned fear responses of adult females. Among the offspring of CBX-injected dams, maternal tempol markedly attenuated the behavioural and cardiovascular responses to psychological stress. Compared with offspring of undisturbed dams, male offspring of dams that received daily third trimester saline injections had increased stress-evoked pressure responses that were blocked by maternal tempol. In contrast, tempol did not block CBX-induced aortic dysfunction in female mice (measured by myography and lucigenin-enhanced chemiluminescence). We conclude that maternal stress and exaggerated fetal glucocorticoid exposure enhance sex-specific stress responses, as well as alterations in aortic reactivity. Because concurrent tempol attenuated conditioned fear and stress reactivity even among the offspring of saline-injected dams, we speculate that antenatal stressors programme offspring stress reactivity in a cycle that may be broken by antenatal antioxidant therapy.