1
|
Lee WE, Genetzakis E, Figtree GA. Novel Strategies in the Early Detection and Treatment of Endothelial Cell-Specific Mitochondrial Dysfunction in Coronary Artery Disease. Antioxidants (Basel) 2023; 12:1359. [PMID: 37507899 PMCID: PMC10376062 DOI: 10.3390/antiox12071359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Although elevated cholesterol and other recognised cardiovascular risk factors are important in the development of coronary artery disease (CAD) and heart attack, the susceptibility of humans to this fatal process is distinct from other animals. Mitochondrial dysfunction of cells in the arterial wall, particularly the endothelium, has been strongly implicated in the pathogenesis of CAD. In this manuscript, we review the established evidence and mechanisms in detail and explore the potential opportunities arising from analysing mitochondrial function in patient-derived cells such as endothelial colony-forming cells easily cultured from venous blood. We discuss how emerging technology and knowledge may allow us to measure mitochondrial dysfunction as a potential biomarker for diagnosis and risk management. We also discuss the "pros and cons" of animal models of atherosclerosis, and how patient-derived cell models may provide opportunities to develop novel therapies relevant for humans. Finally, we review several targets that potentially alleviate mitochondrial dysfunction working both via direct and indirect mechanisms and evaluate the effect of several classes of compounds in the cardiovascular context.
Collapse
Affiliation(s)
- Weiqian E. Lee
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (W.E.L.); (E.G.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Elijah Genetzakis
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (W.E.L.); (E.G.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Gemma A. Figtree
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (W.E.L.); (E.G.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW 2065, Australia
| |
Collapse
|
2
|
Ait-Aissa K, Norwood-Toro LE, Terwoord J, Young M, Paniagua LA, Hader SN, Hughes WE, Hockenberry JC, Beare JE, Linn J, Kohmoto T, Kim J, Betts DH, LeBlanc AJ, Gutterman DD, Beyer AM. Noncanonical Role of Telomerase in Regulation of Microvascular Redox Environment With Implications for Coronary Artery Disease. FUNCTION (OXFORD, ENGLAND) 2022; 3:zqac043. [PMID: 36168588 PMCID: PMC9508843 DOI: 10.1093/function/zqac043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 01/28/2023]
Abstract
Telomerase reverse transcriptase (TERT) (catalytic subunit of telomerase) is linked to the development of coronary artery disease (CAD); however, whether the role of nuclear vs. mitchondrial actions of TERT is involved is not determined. Dominant-negative TERT splice variants contribute to decreased mitochondrial integrity and promote elevated reactive oxygen species production. We hypothesize that a decrease in mitochondrial TERT would increase mtDNA damage, promoting a pro-oxidative redox environment. The goal of this study is to define whether mitochondrial TERT is sufficient to maintain nitric oxide as the underlying mechanism of flow-mediated dilation by preserving mtDNA integrity.Immunoblots and quantitative polymerase chain reaction were used to show elevated levels of splice variants α- and β-deletion TERT tissue from subjects with and without CAD. Genetic, pharmacological, and molecular tools were used to manipulate TERT localization. Isolated vessel preparations and fluorescence-based quantification of mtH2O2 and NO showed that reduction of TERT in the nucleus increased flow induced NO and decreased mtH2O2 levels, while prevention of mitochondrial import of TERT augmented pathological effects. Further elevated mtDNA damage was observed in tissue from subjects with CAD and initiation of mtDNA repair mechanisms was sufficient to restore NO-mediated dilation in vessels from patients with CAD. The work presented is the first evidence that catalytically active mitochondrial TERT, independent of its nuclear functions, plays a critical physiological role in preserving NO-mediated vasodilation and the balance of mitochondrial to nuclear TERT is fundamentally altered in states of human disease that are driven by increased expression of dominant negative splice variants.
Collapse
Affiliation(s)
- K Ait-Aissa
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - L E Norwood-Toro
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - J Terwoord
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - M Young
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - L A Paniagua
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Cardiovascular Innovation Institute, University of Louisville, Louisville, KY 40292, USA
| | - S N Hader
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - W E Hughes
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - J C Hockenberry
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - J E Beare
- Cardiovascular Innovation Institute, University of Louisville, Louisville, KY 40292, USA,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40292, USA
| | - J Linn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - T Kohmoto
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - J Kim
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
| | - D H Betts
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
| | - A J LeBlanc
- Cardiovascular Innovation Institute, University of Louisville, Louisville, KY 40292, USA,Department of Cardiovascular and Thoracic Surgery, School of Medicine, University of Louisville, Louisville, KY 40292, USA
| | - D D Gutterman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - A M Beyer
- Address correspondence to A.M.B. (e-mail: )
| |
Collapse
|
3
|
Avram VF, Merce AP, Hâncu IM, Bătrân AD, Kennedy G, Rosca MG, Muntean DM. Impairment of Mitochondrial Respiration in Metabolic Diseases: An Overview. Int J Mol Sci 2022; 23:ijms23168852. [PMID: 36012137 PMCID: PMC9408127 DOI: 10.3390/ijms23168852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
Mitochondrial dysfunction has emerged as a central pathomechanism in the setting of obesity and diabetes mellitus, linking these intertwined pathologies that share insulin resistance as a common denominator. High-resolution respirometry (HRR) is a state-of-the-art research method currently used to study mitochondrial respiration and its impairment in health and disease. Tissue samples, cells or isolated mitochondria are exposed to various substrate-uncoupler-inhibitor-titration protocols, which allows the measurement and calculation of several parameters of mitochondrial respiration. In this review, we discuss the alterations of mitochondrial bioenergetics in the main dysfunctional organs that contribute to the development of the obese and diabetic phenotypes in both animal models and human subjects. Herein we review data regarding the impairment of oxidative phosphorylation as integrated mitochondrial function assessed by means of HRR. We acknowledge the critical role of this method in determining the alterations in oxidative phosphorylation occurring in the early stages of metabolic pathologies. We conclude that there is a mutual two-way relationship between mitochondrial dysfunction and insulin insensitivity that characterizes these diseases.
Collapse
Affiliation(s)
- Vlad Florian Avram
- Department VII Internal Medicine—Diabetes, Nutrition and Metabolic Diseases, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Center for Molecular Research in Nephrology and Vascular Disease, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Adrian Petru Merce
- Doctoral School Medicine—Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Iasmina Maria Hâncu
- Doctoral School Medicine—Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Alina Doruța Bătrân
- Doctoral School Medicine—Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Gabrielle Kennedy
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mount Pleasant, MI 48858, USA
| | - Mariana Georgeta Rosca
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mount Pleasant, MI 48858, USA
- Correspondence: (M.G.R.); (D.M.M.)
| | - Danina Mirela Muntean
- Center for Translational Research and Systems Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Department III Functional Sciences—Pathophysiology, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
- Correspondence: (M.G.R.); (D.M.M.)
| |
Collapse
|
4
|
Kiyooka T, Ohanyan V, Yin L, Pung YF, Chen YR, Chen CL, Kang PT, Hardwick JP, Yun J, Janota D, Peng J, Kolz C, Guarini G, Wilson G, Shokolenko I, Stevens DA, Chilian WM. Mitochondrial DNA integrity and function are critical for endothelium-dependent vasodilation in rats with metabolic syndrome. Basic Res Cardiol 2022; 117:3. [PMID: 35039940 PMCID: PMC9030679 DOI: 10.1007/s00395-021-00908-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 01/31/2023]
Abstract
Endothelial dysfunction in diabetes is generally attributed to oxidative stress, but this view is challenged by observations showing antioxidants do not eliminate diabetic vasculopathy. As an alternative to oxidative stress-induced dysfunction, we interrogated if impaired mitochondrial function in endothelial cells is central to endothelial dysfunction in the metabolic syndrome. We observed reduced coronary arteriolar vasodilation to the endothelium-dependent dilator, acetylcholine (Ach), in Zucker Obese Fatty rats (ZOF, 34 ± 15% [mean ± standard deviation] 10-3 M) compared to Zucker Lean rats (ZLN, 98 ± 11%). This reduction in dilation occurred concomitantly with mitochondrial DNA (mtDNA) strand lesions and reduced mitochondrial complex activities in the endothelium of ZOF versus ZLN. To demonstrate endothelial dysfunction is linked to impaired mitochondrial function, administration of a cell-permeable, mitochondria-directed endonuclease (mt-tat-EndoIII), to repair oxidatively modified DNA in ZOF, restored mitochondrial function and vasodilation to Ach (94 ± 13%). Conversely, administration of a cell-permeable, mitochondria-directed exonuclease (mt-tat-ExoIII) produced mtDNA strand breaks in ZLN, reduced mitochondrial complex activities and vasodilation to Ach in ZLN (42 ± 16%). To demonstrate that mitochondrial function is central to endothelium-dependent vasodilation, we introduced (via electroporation) liver mitochondria (from ZLN) into the endothelium of a mesenteric vessel from ZOF and restored endothelium-dependent dilation to vasoactive intestinal peptide (VIP at 10-5 M, 4 ± 3% vasodilation before mitochondrial transfer and 48 ± 36% after transfer). Finally, to demonstrate mitochondrial function is key to endothelium-dependent dilation, we administered oligomycin (mitochondrial ATP synthase inhibitor) and observed a reduction in endothelium-dependent dilation. We conclude that mitochondrial function is critical for endothelium-dependent vasodilation.
Collapse
Affiliation(s)
- Takahiko Kiyooka
- Division of Cardiology, Tokai University Oiso Hospital, Kanagawa Japan
| | - Vahagn Ohanyan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - Liya Yin
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - Yuh Fen Pung
- Division of Biomedical Sciences, University of Nottingham, Malaysia Campus
| | - Yeong-Renn Chen
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - Chwen-Lih Chen
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - Patrick T. Kang
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - James P. Hardwick
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - June Yun
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - Danielle Janota
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - Joanna Peng
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | - Christopher Kolz
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| | | | - Glenn Wilson
- Department of Biomedical Science, University of South Alabama
| | - Inna Shokolenko
- Department of Biomedical Science, University of South Alabama
| | - Donte A. Stevens
- Division of Biological Sciences, University of California-San Diego
| | - William M. Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University
| |
Collapse
|
5
|
Wu L, Sowers JR, Zhang Y, Ren J. OUP accepted manuscript. Cardiovasc Res 2022; 119:691-709. [PMID: 35576480 DOI: 10.1093/cvr/cvac080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular diseases (CVDs) arise from a complex interplay among genomic, proteomic, and metabolomic abnormalities. Emerging evidence has recently consolidated the presence of robust DNA damage in a variety of cardiovascular disorders. DNA damage triggers a series of cellular responses termed DNA damage response (DDR) including detection of DNA lesions, cell cycle arrest, DNA repair, cellular senescence, and apoptosis, in all organ systems including hearts and vasculature. Although transient DDR in response to temporary DNA damage can be beneficial for cardiovascular function, persistent activation of DDR promotes the onset and development of CVDs. Moreover, therapeutic interventions that target DNA damage and DDR have the potential to attenuate cardiovascular dysfunction and improve disease outcome. In this review, we will discuss molecular mechanisms of DNA damage and repair in the onset and development of CVDs, and explore how DDR in specific cardiac cell types contributes to CVDs. Moreover, we will highlight the latest advances regarding the potential therapeutic strategies targeting DNA damage signalling in CVDs.
Collapse
Affiliation(s)
- Lin Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - James R Sowers
- Diabetes and Cardiovascular Research Center, University of Missouri Columbia, Columbia, MO 65212, USA
| | - Yingmei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Jun Ren
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai 200032, China
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
6
|
Cao W, Gao J, Zhang Y, Li A, Yu P, Cao N, Liang J, Tang X. Autophagy up-regulated by MEK/ERK promotes the repair of DNA damage caused by aflatoxin B1. Toxicol Mech Methods 2021; 32:87-96. [PMID: 34396909 DOI: 10.1080/15376516.2021.1968985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aflatoxin B1 (AFB1), a kind of mycotoxin, exerts its cytotoxicity by increasing the oxidative damage of target organs, especially the liver. In vivo and in vitro experiments were carried out to elucidate the toxic mechanism of AFB1. The results of MTT, cloning-formation, flow cytometry, immunocytochemistry, Reverse transcription PCR (RT-PCR) and western blot showed that AFB1 activated NOX2 gp91 phox, inhibited proliferation and migration, and blocked cell cycle at G0/G1 period of HHL-5 cells. Autophagy promoted the repair of NOX2-dependent DNA damage. NOX2/gp91 phox mainly activates MEK/ERK pathway and then up-regulates autophagy. In vivo experiments have shown that AFB1 (0.75 mg/kg daily orally, 4 weeks) had no significant changes in the size and shape of the liver in mice. However, these treatments lead to structural abnormalities of hepatocytes and DNA damage. In summary, AFB1 caused intracellular oxidative stress and DNA damage, NOX2/gp91-phox activates the MEK/ERK pathway, and upregulated autophagy to promote the repair of DNA damage. We concluded that by increasing the level of autophagy, the ability of anti-AFB1 toxicity of liver can be increased.
Collapse
Affiliation(s)
- Weiya Cao
- Medical School, Anhui University of Science and Technology, Huainan, China.,Institute of Environment-friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Jiafeng Gao
- Medical School, Anhui University of Science and Technology, Huainan, China.,Institute of Environment-friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Yinci Zhang
- Medical School, Anhui University of Science and Technology, Huainan, China.,Institute of Environment-friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Amin Li
- Medical School, Anhui University of Science and Technology, Huainan, China.,Institute of Environment-friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Pan Yu
- Medical School, Anhui University of Science and Technology, Huainan, China.,Institute of Environment-friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Niandie Cao
- Medical School, Anhui University of Science and Technology, Huainan, China.,Institute of Environment-friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Jiaojiao Liang
- Medical School, Anhui University of Science and Technology, Huainan, China.,Institute of Environment-friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| | - Xiaolong Tang
- Medical School, Anhui University of Science and Technology, Huainan, China.,Institute of Environment-friendly Materials and Occupational Health, Anhui University of Science and Technology, Wuhu, China
| |
Collapse
|
7
|
Severino P, D’Amato A, Pucci M, Infusino F, Birtolo LI, Mariani MV, Lavalle C, Maestrini V, Mancone M, Fedele F. Ischemic Heart Disease and Heart Failure: Role of Coronary Ion Channels. Int J Mol Sci 2020; 21:E3167. [PMID: 32365863 PMCID: PMC7246492 DOI: 10.3390/ijms21093167] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 01/09/2023] Open
Abstract
Heart failure is a complex syndrome responsible for high rates of death and hospitalization. Ischemic heart disease is one of the most frequent causes of heart failure and it is normally attributed to coronary artery disease, defined by the presence of one or more obstructive plaques, which determine a reduced coronary blood flow, causing myocardial ischemia and consequent heart failure. However, coronary obstruction is only an element of a complex pathophysiological process that leads to myocardial ischemia. In the literature, attention paid to the role of microcirculation, in the pathophysiology of ischemic heart disease and heart failure, is growing. Coronary microvascular dysfunction determines an inability of coronary circulation to satisfy myocardial metabolic demands, due to the imbalance of coronary blood flow regulatory mechanisms, including ion channels, leading to the development of hypoxia, fibrosis and tissue death, which may determine a loss of myocardial function, even beyond the presence of atherosclerotic epicardial plaques. For this reason, ion channels may represent the link among coronary microvascular dysfunction, ischemic heart disease and consequent heart failure.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155-00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (L.I.B.); (M.V.M.); (C.L.); (V.M.); (M.M.)
| |
Collapse
|
8
|
Sorop O, van de Wouw J, Chandler S, Ohanyan V, Tune JD, Chilian WM, Merkus D, Bender SB, Duncker DJ. Experimental animal models of coronary microvascular dysfunction. Cardiovasc Res 2020; 116:756-770. [PMID: 31926020 PMCID: PMC7061277 DOI: 10.1093/cvr/cvaa002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/25/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022] Open
Abstract
Coronary microvascular dysfunction (CMD) is commonly present in patients with metabolic derangements and is increasingly recognized as an important contributor to myocardial ischaemia, both in the presence and absence of epicardial coronary atherosclerosis. The latter condition is termed 'ischaemia and no obstructive coronary artery disease' (INOCA). Notwithstanding the high prevalence of INOCA, effective treatment remains elusive. Although to date there is no animal model for INOCA, animal models of CMD, one of the hallmarks of INOCA, offer excellent test models for enhancing our understanding of the pathophysiology of CMD and for investigating novel therapies. This article presents an overview of currently available experimental models of CMD-with an emphasis on metabolic derangements as risk factors-in dogs, swine, rabbits, rats, and mice. In all available animal models, metabolic derangements are most often induced by a high-fat diet (HFD) and/or diabetes mellitus via injection of alloxan or streptozotocin, but there is also a wide variety of spontaneous as well as transgenic animal models which develop metabolic derangements. Depending on the number, severity, and duration of exposure to risk factors-all these animal models show perturbations in coronary microvascular (endothelial) function and structure, similar to what has been observed in patients with INOCA and comorbid conditions. The use of these animal models will be instrumental in identifying novel therapeutic targets and for the subsequent development and testing of novel therapeutic interventions to combat ischaemic heart disease, the number one cause of death worldwide.
Collapse
Affiliation(s)
- Oana Sorop
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jens van de Wouw
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Selena Chandler
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Vahagn Ohanyan
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Johnathan D Tune
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, USA
| | - William M Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- Walter Brendel Centre of Experimental Medicine, University Hospital, LMU Munich, Marchioninistr. 27, 81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), 81377 Munich, Germany
| | - Shawn B Bender
- Department of Biomedical Sciences, University of Missouri, Columbia, MO, USA
- Research Service, Harry S Truman Memorial Veterans Hospital, Columbia, MO, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
9
|
van de Wouw J, Sorop O, van Drie RWA, van Duin RWB, Nguyen ITN, Joles JA, Verhaar MC, Merkus D, Duncker DJ. Perturbations in myocardial perfusion and oxygen balance in swine with multiple risk factors: a novel model of ischemia and no obstructive coronary artery disease. Basic Res Cardiol 2020; 115:21. [PMID: 32100119 PMCID: PMC7042191 DOI: 10.1007/s00395-020-0778-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
Comorbidities of ischemic heart disease, including diabetes mellitus (DM), hypercholesterolemia (HC) and chronic kidney disease (CKD), are associated with coronary microvascular dysfunction (CMD). Increasing evidence suggests that CMD may contribute to myocardial ‘Ischemia and No Obstructive Coronary Artery disease’ (INOCA). In the present study, we tested the hypothesis that CMD results in perturbations in myocardial perfusion and oxygen delivery using a novel swine model with multiple comorbidities. DM (streptozotocin), HC (high-fat diet) and CKD (renal embolization) were induced in 10 female swine (DM + HC + CKD), while 12 healthy female swine on a normal diet served as controls (Normal). After 5 months, at a time when coronary atherosclerosis was still negligible, myocardial perfusion, metabolism, and function were studied at rest and during treadmill exercise. DM + HC + CKD animals showed hyperglycemia, hypercholesterolemia, and impaired kidney function. During exercise, DM + HC + CKD swine demonstrated perturbations in myocardial blood flow and oxygen delivery, necessitating a higher myocardial oxygen extraction—achieved despite reduced capillary density—resulting in lower coronary venous oxygen levels. Moreover, myocardial efficiency was lower, requiring higher oxygen consumption for a given level of myocardial work. These perturbations in myocardial oxygen balance were associated with lower myocardial lactate consumption, stroke volume, and LVdP/dtmax, suggestive of myocardial ischemia and dysfunction. Further analyses showed a reduction in adenosine-recruitable coronary flow reserve, but this was exclusively the result of an increase in basal coronary blood flow, while maximal coronary flow per gram of myocardium was maintained; the latter was consistent with the unchanged arteriolar wall/lumen ratio, arteriolar density and peri-arteriolar collagen content. However, isolated small arteries displayed selective blunting of endothelium-dependent vasodilation in response to bradykinin in DM + HC + CKD swine, suggesting that changes in coronary microvascular function rather than in structure contributed to the perturbations in myocardial oxygen delivery. In conclusion, common comorbidities in swine result in CMD, in the absence of appreciable atherosclerosis, which is severe enough to produce perturbations in myocardial oxygen balance, particularly during exercise, resembling key features of INOCA.
Collapse
Affiliation(s)
- Jens van de Wouw
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oana Sorop
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ruben W A van Drie
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Richard W B van Duin
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Isabel T N Nguyen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daphne Merkus
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Walter Brendel Center of Experimental Medicine (WBex), LMU Munich, 81377, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance (MHA), 81377, Munich, Germany
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| |
Collapse
|
10
|
Badimon L, Bugiardini R, Cenko E, Cubedo J, Dorobantu M, Duncker DJ, Estruch R, Milicic D, Tousoulis D, Vasiljevic Z, Vilahur G, de Wit C, Koller A. Position paper of the European Society of Cardiology-working group of coronary pathophysiology and microcirculation: obesity and heart disease. Eur Heart J 2019; 38:1951-1958. [PMID: 28873951 DOI: 10.1093/eurheartj/ehx181] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/28/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Lina Badimon
- Cardiovascular Research Center (CSIC-ICCC), CIBERCV, and Biomedical Research Institute Sant Pau (IIB-Sant Pau), c/Sant Antoni M Claret 167, 08025 Barcelona, Spain.,Cardiovascular Research Chair UAB, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Judit Cubedo
- Cardiovascular Research Center (CSIC-ICCC), CIBERCV, and Biomedical Research Institute Sant Pau (IIB-Sant Pau), c/Sant Antoni MaClaret 167, 08025 Barcelona, Spain
| | - Maria Dorobantu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila" of Bucharest, Emergency Clinical Hospital of Bucharest, 8, Calea Floreasca, Sector 1, 014461 Bucuresti, Romania
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus University Medical Center, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Ramón Estruch
- Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel, 170, 08036 Barcelona, Spain.,CIBER Obesity and Nutrition, Instituto de Salud Carlos III, Spain
| | - Davor Milicic
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, HR-10000 Zagreb, Croatia
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Vasilissis Sofias 114, TK 115 28 Athens, Greece
| | - Zorana Vasiljevic
- Clinical Center of Serbia, University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia
| | - Gemma Vilahur
- Cardiovascular Research Center (CSIC-ICCC), CIBERCV, and Biomedical Research Institute Sant Pau (IIB-Sant Pau), c/Sant Antoni MaClaret 167, 08025 Barcelona, Spain
| | - Cor de Wit
- Institut für Physiologie, Universität zu Lübeck and Deutsches Zentrumfür Herz-Kreislauf-Forschung (DZHK) e.V., partner site: Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Alkotas street, 44, 1123 Budapest, Hungary.,Department of Physiology, New York Medical College, Valhalla, NY 10595, USA
| |
Collapse
|
11
|
Jamaiyar A, Juguilon C, Dong F, Cumpston D, Enrick M, Chilian WM, Yin L. Cardioprotection during ischemia by coronary collateral growth. Am J Physiol Heart Circ Physiol 2018; 316:H1-H9. [PMID: 30379567 DOI: 10.1152/ajpheart.00145.2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ischemic heart diseases (IHD) cause millions of deaths around the world annually. While surgical and pharmacological interventions are commonly used to treat patients with IHD, their efficacy varies from patient to patient and is limited by the severity of the disease. One promising, at least theoretically, approach for treating IHD is induction of coronary collateral growth (CCG). Coronary collaterals are arteriole-to-arteriole anastomoses that can undergo expansion and remodeling in the setting of coronary disease when the disease elicits myocardial ischemia and creates a pressure difference across the collateral vessel that creates unidirectional flow. Well-developed collaterals can restore blood flow in the ischemic area of the myocardium and protect the myocardium at risk. Moreover, such collaterals are correlated to reduced mortality and infarct size and better cardiac function during occlusion of coronary arteries. Therefore, understanding the process of CCG is highly important as a potentially viable treatment of IHD. While there are several excellent review articles on this topic, this review will provide a unified overview of the various aspects related to CCG as well as an update of the advancements in the field. We also call for more detailed studies with an interdisciplinary approach to advance our knowledge of CCG. In this review, we will describe growth of coronary collaterals, the various factors that contribute to CCG, animal models used to study CCG, and the cardioprotective effects of coronary collaterals during ischemia. We will also discuss the impairment of CCG in metabolic syndrome and the therapeutic potentials of CCG in IHD.
Collapse
Affiliation(s)
- Anurag Jamaiyar
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio.,School of Biomedical Sciences, Kent State University , Kent, Ohio
| | - Cody Juguilon
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Feng Dong
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Devan Cumpston
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Molly Enrick
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - William M Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| | - Liya Yin
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, Ohio
| |
Collapse
|
12
|
Zhou H, Wang J, Zhu P, Zhu H, Toan S, Hu S, Ren J, Chen Y. NR4A1 aggravates the cardiac microvascular ischemia reperfusion injury through suppressing FUNDC1-mediated mitophagy and promoting Mff-required mitochondrial fission by CK2α. Basic Res Cardiol 2018; 113:23. [DOI: 10.1007/s00395-018-0682-1] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/09/2018] [Accepted: 04/30/2018] [Indexed: 12/22/2022]
|
13
|
Chemotherapeutic-Induced Cardiovascular Dysfunction: Physiological Effects, Early Detection-The Role of Telomerase to Counteract Mitochondrial Defects and Oxidative Stress. Int J Mol Sci 2018. [PMID: 29534446 PMCID: PMC5877658 DOI: 10.3390/ijms19030797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Although chemotherapeutics can be highly effective at targeting malignancies, their ability to trigger cardiovascular morbidity is clinically significant. Chemotherapy can adversely affect cardiovascular physiology, resulting in the development of cardiomyopathy, heart failure and microvascular defects. Specifically, anthracyclines are known to cause an excessive buildup of free radical species and mitochondrial DNA damage (mtDNA) that can lead to oxidative stress-induced cardiovascular apoptosis. Therefore, oncologists and cardiologists maintain a network of communication when dealing with patients during treatment in order to treat and prevent chemotherapy-induced cardiovascular damage; however, there is a need to discover more accurate biomarkers and therapeutics to combat and predict the onset of cardiovascular side effects. Telomerase, originally discovered to promote cellular proliferation, has recently emerged as a potential mechanism to counteract mitochondrial defects and restore healthy mitochondrial vascular phenotypes. This review details mechanisms currently used to assess cardiovascular damage, such as C-reactive protein (CRP) and troponin levels, while also unearthing recently researched biomarkers, including circulating mtDNA, telomere length and telomerase activity. Further, we explore a potential role of telomerase in the mitigation of mitochondrial reactive oxygen species and maintenance of mtDNA integrity. Telomerase activity presents a promising indicator for the early detection and treatment of chemotherapy-derived cardiac damage.
Collapse
|
14
|
Ma C, Beyer AM, Durand M, Clough AV, Zhu D, Norwood Toro L, Terashvili M, Ebben JD, Hill RB, Audi SH, Medhora M, Jacobs ER. Hyperoxia Causes Mitochondrial Fragmentation in Pulmonary Endothelial Cells by Increasing Expression of Pro-Fission Proteins. Arterioscler Thromb Vasc Biol 2018; 38:622-635. [PMID: 29419407 DOI: 10.1161/atvbaha.117.310605] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/15/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We explored mechanisms that alter mitochondrial structure and function in pulmonary endothelial cells (PEC) function after hyperoxia. APPROACH AND RESULTS Mitochondrial structures of PECs exposed to hyperoxia or normoxia were visualized and mitochondrial fragmentation quantified. Expression of pro-fission or fusion proteins or autophagy-related proteins were assessed by Western blot. Mitochondrial oxidative state was determined using mito-roGFP. Tetramethylrhodamine methyl ester estimated mitochondrial polarization in treatment groups. The role of mitochondrially derived reactive oxygen species in mt-fragmentation was investigated with mito-TEMPOL and mitochondrial DNA (mtDNA) damage studied by using ENDO III (mt-tat-endonuclease III), a protein that repairs mDNA damage. Drp-1 (dynamin-related protein 1) was overexpressed or silenced to test the role of this protein in cell survival or transwell resistance. Hyperoxia increased fragmentation of PEC mitochondria in a time-dependent manner through 48 hours of exposure. Hyperoxic PECs exhibited increased phosphorylation of Drp-1 (serine 616), decreases in Mfn1 (mitofusion protein 1), but increases in OPA-1 (optic atrophy 1). Pro-autophagy proteins p62 (LC3 adapter-binding protein SQSTM1/p62), PINK-1 (PTEN-induced putative kinase 1), and LC3B (microtubule-associated protein 1A/1B-light chain 3) were increased. Returning cells to normoxia for 24 hours reversed the increased mt-fragmentation and changes in expression of pro-fission proteins. Hyperoxia-induced changes in mitochondrial structure or cell survival were mitigated by antioxidants mito-TEMPOL, Drp-1 silencing, or inhibition or protection by the mitochondrial endonuclease ENDO III. Hyperoxia induced oxidation and mitochondrial depolarization and impaired transwell resistance. Decrease in resistance was mitigated by mito-TEMPOL or ENDO III and reproduced by overexpression of Drp-1. CONCLUSIONS Because hyperoxia evoked mt-fragmentation, cell survival and transwell resistance are prevented by ENDO III and mito-TEMPOL and Drp-1 silencing, and these data link hyperoxia-induced mt-DNA damage, Drp-1 expression, mt-fragmentation, and PEC dysfunction.
Collapse
Affiliation(s)
- Cui Ma
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Andreas M Beyer
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Matthew Durand
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Anne V Clough
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Daling Zhu
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Laura Norwood Toro
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Maia Terashvili
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Johnathan D Ebben
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - R Blake Hill
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Said H Audi
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Meetha Medhora
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.)
| | - Elizabeth R Jacobs
- From the College of Medical Laboratory Science and Technology, Harbin Medical University, Daqing, China (C.M., D.Z., M.M., E.R.J.); Department of Medicine (C.M., A.M.B., A.C., L.N., J.E., M.M., E.R.J.), Department of Physical Medicine and Rehabilitation (M.D.), Department of Physiology (A.M.B., M.M., E.R.J.), Department of Biochemistry (B.H.), Department of Radiation Oncology (M.M.), Department of Biophysics (N.H.), and Cardiovascular Center (M.T., C.M., A.B., M.D., M.M., E.R.J.), Medical College of Wisconsin, Milwaukee; Research Service, Zablocki Veterans Affairs Medical Center, Milwaukee (A.C., S.H.A., M.M., E.R.J.); Department of Biomedical Engineering, Marquette University, Milwaukee (S.H.A.); and Department of Mathematics, Statistics and Computer Science, Marquette University, Milwaukee (A.C.).
| |
Collapse
|
15
|
Kiel AM, Goodwill AG, Noblet JN, Barnard AL, Sassoon DJ, Tune JD. Regulation of myocardial oxygen delivery in response to graded reductions in hematocrit: role of K + channels. Basic Res Cardiol 2017; 112:65. [PMID: 28965130 DOI: 10.1007/s00395-017-0654-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/25/2017] [Indexed: 01/10/2023]
Abstract
This study was designed to identify mechanisms responsible for coronary vasodilation in response to progressive decreases in hematocrit. Isovolemic hemodilution was produced in open-chest, anesthetized swine via concurrent removal of 500 ml of arterial blood and the addition of 500 ml of 37 °C saline or synthetic plasma expander (Hespan, 6% hetastarch in 0.9% sodium chloride). Progressive hemodilution with Hespan resulted in an increase in coronary flow from 0.39 ± 0.05 to 1.63 ± 0.16 ml/min/g (P < 0.001) as hematocrit was reduced from 32 ± 1 to 10 ± 1% (P < 0.001). Overall, coronary flow corresponded with the level of myocardial oxygen consumption, was dependent on arterial pressures ≥ ~ 60 mmHg, and occurred with little/no change in coronary venous PO2. Anemic coronary vasodilation was unaffected by the inhibition of nitric oxide synthase (L-NAME: 25 mg/kg iv; P = 0.92) or voltage-dependent K+ (K V) channels (4-aminopyridine: 0.3 mg/kg iv; P = 0.52). However, administration of the K ATP channel antagonist (glibenclamide: 3.6 mg/kg iv) resulted in an ~ 40% decrease in coronary blood flow (P < 0.001) as hematocrit was reduced to ~ 10%. These reductions in coronary blood flow corresponded with significant reductions in myocardial oxygen delivery at baseline and throughout isovolemic anemia (P < 0.001). These data indicate that vasodilator factors produced in response to isovolemic hemodilution converge on vascular smooth muscle glibenclamide-sensitive (K ATP) channels to maintain myocardial oxygen delivery and that this response is not dependent on endothelial-derived nitric oxide production or pathways that mediate dilation via K V channels.
Collapse
Affiliation(s)
- Alexander M Kiel
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Adam G Goodwill
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Jillian N Noblet
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - April L Barnard
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Daniel J Sassoon
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Johnathan D Tune
- Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA.
| |
Collapse
|
16
|
Influence of increased heart rate and aortic pressure on resting indices of functional coronary stenosis severity. Basic Res Cardiol 2017; 112:61. [PMID: 28905113 PMCID: PMC5597688 DOI: 10.1007/s00395-017-0651-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Abstract
Baseline assessment of functional stenosis severity has been proposed as a practical alternative to hyperemic indices. However, intact autoregulation mechanisms may affect intracoronary hemodynamics. The aim of this study was to investigate the effect of changes in aortic pressure (Pa) and heart rate (HR) on baseline coronary hemodynamics and functional stenosis assessment. In 15 patients (55 ± 3% diameter stenosis) Pa, intracoronary pressure (Pd) and flow velocity were obtained at control, and during atrial pacing at 120 bpm, increased Pa (+30 mmHg) with intravenous phenylephrine (PE), and elevated Pa while pacing at sinus heart rate (PE + sHR). We derived rate pressure product (RPP = systolic Pa × HR), baseline microvascular resistance (BMR = Pd/velocity), and stenosis resistance [BSR = (Pa − Pd)/velocity] as well as whole-cycle Pd/Pa. Tachycardia (120 ± 1 bpm) raised RPP by 74% vs. control. Accordingly, BMR decreased by 27% (p < 0.01) and velocity increased by 36% (p < 0.05), while Pd/Pa decreased by 0.05 ± 0.02 (p < 0.05) and BSR remained similar to control. Raising Pa to 121 ± 3 mmHg (PE) with concomitant reflex bradycardia increased BMR by 26% (p < 0.001) at essentially unchanged RPP and velocity. Consequently, BSR and Pd/Pa were only marginally affected. During PE + sHR, velocity increased by 21% (p < 0.01) attributable to a 46% higher RPP (p < 0.001). However, BMR, BSR, and Pd/Pa remained statistically unaffected. Nonetheless, the interventions tended to increase functional stenosis severity, causing Pd/Pa and BSR of borderline lesions to cross the diagnostic threshold. In conclusion, coronary microvascular adaptation to physiological conditions affecting metabolic demand at rest influences intracoronary hemodynamics, which may lead to altered basal stenosis indices used for clinical decision-making.
Collapse
|
17
|
Cao J, Singh SP, McClung JA, Joseph G, Vanella L, Barbagallo I, Jiang H, Falck JR, Arad M, Shapiro JI, Abraham NG. EET intervention on Wnt1, NOV, and HO-1 signaling prevents obesity-induced cardiomyopathy in obese mice. Am J Physiol Heart Circ Physiol 2017; 313:H368-H380. [PMID: 28576832 PMCID: PMC5582926 DOI: 10.1152/ajpheart.00093.2017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 01/15/2023]
Abstract
We have previously reported that epoxyeicosatrienoic acid (EET) has multiple beneficial effects on vascular function; in addition to its antiapoptotic action, it increases insulin sensitivity and inhibits inflammation. To uncover the signaling mechanisms by which EET reduces cardiomyopathy, we hypothesized that EET infusion might ameliorate obesity-induced cardiomyopathy by improving heme oxygenase (HO)-1, Wnt1, thermogenic gene levels, and mitochondrial integrity in cardiac tissues and improved pericardial fat phenotype. EET reduced levels of fasting blood glucose and proinflammatory adipokines, including nephroblastoma overexpressed (NOV) signaling, while increasing echocardiographic fractional shortening and O2 consumption. Of interest, we also noted a marked improvement in mitochondrial integrity, thermogenic genes, and Wnt 1 and HO-1 signaling mechanisms. Knockout of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) in EET-treated mice resulted in a reversal of these beneficial effects including a decrease in myocardial Wnt1 and HO-1 expression and an increase in NOV. To further elucidate the effects of EET on pericardial adipose tissues, we observed EET treatment increases in adiponectin, PGC-1α, phospho-AMP-activated protein kinase, insulin receptor phosphorylation, and thermogenic genes, resulting in a "browning" pericardial adipose phenotype under high-fat diets. Collectively, these experiments demonstrate that an EET agonist increased Wnt1 and HO-1 signaling while decreasing NOV pathways and the progression of cardiomyopathy. Furthermore, this report presents a portal into potential therapeutic approaches for the treatment of heart failure and metabolic syndrome.NEW & NOTEWORTHY The mechanism by which EET acts on obesity-induced cardiomyopathy is unknown. Here, we describe a previously unrecognized function of EET infusion that inhibits nephroblastoma overexpressed (NOV) levels and activates Wnt1, hence identifying NOV inhibition and enhanced Wnt1 expression as novel pharmacological targets for the prevention and treatment of cardiomyopathy and heart failure.Listen to this article's corresponding podcast at http://ajpheart.physiology.org/content/early/2017/05/31/ajpheart.00093.2017.
Collapse
Affiliation(s)
- Jian Cao
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York.,Chinese PLA General Hospital, Beijing, China
| | - Shailendra P Singh
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York
| | - John A McClung
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York
| | - Gregory Joseph
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York
| | - Luca Vanella
- Department of Drug Science/Section of Biochemistry, University of Catania, Catania, Italy
| | - Ignazio Barbagallo
- Department of Drug Science/Section of Biochemistry, University of Catania, Catania, Italy
| | - Houli Jiang
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York
| | - John R Falck
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Arad
- Leviev Heart Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel; and
| | - Joseph I Shapiro
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Nader G Abraham
- Departments of Medicine and Pharmacology, New York Medical College, Valhalla, New York; .,Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| |
Collapse
|
18
|
Abstract
The atherosclerotic coronary vasculature is not only the culprit but also a victim of myocardial ischemia/reperfusion injury. Manifestations of such injury are increased vascular permeability and edema, endothelial dysfunction and impaired vasomotion, microembolization of atherothrombotic debris, stasis with intravascular cell aggregates, and finally, in its most severe form, capillary destruction with hemorrhage. In animal experiments, local and remote ischemic pre- and postconditioning not only reduce infarct size but also these manifestations of coronary vascular injury, as do drugs which recruit signal transduction steps of conditioning. Clinically, no-reflow is frequently seen after interventional reperfusion, and it carries an adverse prognosis. The translation of cardioprotective interventions to clinical practice has been difficult to date. Only 4 drugs (brain natriuretic peptide, exenatide, metoprolol, and esmolol) stand unchallenged to date in reducing infarct size in patients with reperfused acute myocardial infarction; unfortunately, for these drugs, no information on their impact on the ischemic/reperfused coronary circulation is available.
Collapse
Affiliation(s)
- Gerd Heusch
- From the Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, University of Essen, Essen, Germany.
| |
Collapse
|
19
|
Lemaster K, Jackson D, Goldman D, Frisbee JC. Insidious incrementalism: The silent failure of the microcirculation with increasing peripheral vascular disease risk. Microcirculation 2017; 24. [DOI: 10.1111/micc.12332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/02/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Kent Lemaster
- Department of Physiology and Pharmacology; Schulich School of Medicine and Dentistry; University of Western Ontario; London ON Canada
| | - Dwayne Jackson
- Department of Medical Biophysics; Schulich School of Medicine and Dentistry; University of Western Ontario; London ON Canada
| | - Daniel Goldman
- Department of Medical Biophysics; Schulich School of Medicine and Dentistry; University of Western Ontario; London ON Canada
| | - Jefferson C. Frisbee
- Department of Medical Biophysics; Schulich School of Medicine and Dentistry; University of Western Ontario; London ON Canada
| |
Collapse
|
20
|
Transition in the mechanism of flow-mediated dilation with aging and development of coronary artery disease. Basic Res Cardiol 2016; 112:5. [PMID: 27995364 DOI: 10.1007/s00395-016-0594-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/01/2016] [Indexed: 01/07/2023]
Abstract
In microvessels of patients with coronary artery disease (CAD), flow-mediated dilation (FMD) is largely dependent upon the endothelium-derived hyperpolarizing factor H2O2. The goal of this study is to examine the influence of age and presence or absence of disease on the mechanism of FMD. Human coronary or adipose arterioles (~150 µm diameter) were prepared for videomicroscopy. The effect of inhibiting COX [indomethacin (Indo) or NOS (L-NAME), eliminating H2O2 (polyethylene glycol-catalase (PEG-CAT)] or targeting a reduction in mitochondrial ROS with scavengers/inhibitors [Vitamin E (mtVitamin E); phenylboronic acid (mtPBA)] was determined in children aged 0-18 years; young adults 19-55 years; older adults >55 years without CAD, and similarly aged adults with CAD. Indo eliminated FMD in children and reduced FMD in younger adults. This response was mediated mainly by PGI2, as the prostacyclin-synthase-inhibitor trans-2-phenyl cyclopropylamine reduced FMD in children and young adults. L-NAME attenuated dilation in children and younger adults and eliminated FMD in older adults without CAD, but had no effect on vessels from those with CAD, where mitochondria-derived H2O2 was the primary mediator. The magnitude of dilation was reduced in older compared to younger adults independent of CAD. Exogenous treatment with a sub-dilator dose of NO blocked FMD in vessels from subjects with CAD, while prolonged inhibition of NOS in young adults resulted in a phenotype similar to that observed in disease. The mediator of coronary arteriolar FMD evolves throughout life from prostacyclin in youth, to NO in adulthood. With the onset of CAD, NO-inhibitable release of H2O2 emerges as the exclusive mediator of FMD. These findings have implications for use of pharmacological agents, such as nonsteroidal anti-inflammatory agents in children and the role of microvascular endothelium in cardiovascular health.
Collapse
|
21
|
Severe familial hypercholesterolemia impairs the regulation of coronary blood flow and oxygen supply during exercise. Basic Res Cardiol 2016; 111:61. [PMID: 27624732 DOI: 10.1007/s00395-016-0579-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/02/2016] [Indexed: 01/25/2023]
Abstract
Accelerated development of coronary atherosclerosis is a defining characteristic of familial hypercholesterolemia (FH). However, the recent data highlight a significant cardiovascular risk prior to the development of critical coronary stenosis. We, therefore, examined the hypothesis that FH produces coronary microvascular dysfunction and impairs coronary vascular control at rest and during exercise in a swine model of FH. Coronary vascular responses to drug infusions and exercise were examined in chronically instrumented control and FH swine. FH swine exhibited ~tenfold elevation of plasma cholesterol and diffuse coronary atherosclerosis (20-60 % plaque burden). Similar to our recent findings in the systemic vasculature in FH swine, coronary smooth muscle nitric oxide sensitivity was increased in vivo and in vitro with maintained endothelium-dependent vasodilation in vivo in FH. At rest and during exercise, FH swine exhibited increased myocardial O2 extraction resulting in reduced coronary venous SO2 and PO2 versus control. During exercise in FH swine, the transmural distribution of coronary blood flow was unchanged; however, a shift toward anaerobic cardiac metabolism was revealed by increased coronary arteriovenous H(+) concentration gradient. This shift was associated with a worsening of cardiac efficiency (relationship between cardiac work and O2 consumption) in FH during exercise owing, in part, to a generalized reduction in stroke volume which was associated with increased left atrial pressure in FH. Our data highlight a critical role for coronary microvascular dysfunction as a contributor to impaired myocardial O2 balance, cardiac ischemia, and impaired cardiac function prior to the development of critical coronary stenosis in FH.
Collapse
|
22
|
Mikhed Y, Fahrer J, Oelze M, Kröller-Schön S, Steven S, Welschof P, Zinßius E, Stamm P, Kashani F, Roohani S, Kress JM, Ullmann E, Tran LP, Schulz E, Epe B, Kaina B, Münzel T, Daiber A. Nitroglycerin induces DNA damage and vascular cell death in the setting of nitrate tolerance. Basic Res Cardiol 2016; 111:52. [DOI: 10.1007/s00395-016-0571-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 12/13/2022]
|