Attenuation of myocardial reperfusion injury by reducing intracellular calcium overloading with dihydropyridines

Gram-Scale Total Synthesis of TAB with Cardioprotective Activity and the Structure-Activity Relationship of Its Analogs

Traditional Chinese medicine has been proven to be of great significance in cardioprotective effects. Clinopodium chinense (Lamiaceae) has unique advantages in the treatment and prevention of cardiovascular diseases. Tournefolic acid B (TAB) was proven to be a potent component against myocardial ischemia reperfusion injury (MIRI) from Clinopodium chinense (Lamiaceae). This article will attempt to establish a gram-scale synthesis method of TAB and discuss the structure-activity relationship of its analogs. The total synthesis of TAB was completed in 10 steps with an overall yield of 13%. In addition, analogs were synthesized, and their cardioprotective activity was evaluated on the hypoxia/reoxygenation of H9c2 cells. Amidation of the acid position is helpful to the activity, while methylation of phenolic hydroxyl groups greatly decreased the cardioprotective activity. The easily prepared azxepin analogs also showed cardioprotective activity. Most of the clogP values calculated by Molinspiration ranged from 2.5 to 5, which is in accordance with Lipinski's rule of 5. These findings represent a novel kind of cardioprotective agent that is worthy of further study.

Glutathionylation of the L-type Ca2+ channel in oxidative stress-induced pathology of the heart

There is mounting evidence to suggest that protein glutathionylation is a key process contributing to the development of pathology. Glutathionylation occurs as a result of posttranslational modification of a protein and involves the addition of a glutathione moiety at cysteine residues. Such modification can occur on a number of proteins, and exerts a variety of functional consequences. The L-type Ca2+ channel has been identified as a glutathionylation target that participates in the development of cardiac pathology. Ca2+ influx via the L-type Ca2+ channel increases production of mitochondrial reactive oxygen species (ROS) in cardiomyocytes during periods of oxidative stress. This induces a persistent increase in channel open probability, and the resulting constitutive increase in Ca2+ influx amplifies the cross-talk between the mitochondria and the channel. Novel strategies utilising targeted peptide delivery to uncouple mitochondrial ROS and Ca2+ flux via the L-type Ca2+ channel following ischemia-reperfusion have delivered promising results, and have proven capable of restoring appropriate mitochondrial function in myocytes and in vivo.

Cardioprotection by kappa-opioid receptor agonist U50488H is mediated by opioidergic regulation but not by calcium current modulation

Background

Because the κ-opioid receptor (OR) agonist U50488H stimulates opioidergic regulation and inhibits L-type Ca²⁺ channels, this study was aimed at assessing the roles of OR and L-type Ca²⁺ channels on U50488H-induced cardioprotection.

Methods

Langendorff-perfused rat hearts were subjected to 30 min of regional ischemia and 2 h of reperfusion. Isolated hearts were treated with U50488H with or without the κ-OR antagonist nor-binaltorphimine (nor-BNI) or the Ca²⁺ channels activator BAY K 8644. Infarct size was measured with 2,3,5-triphenyltetrazolium chloride staining.

Results

U50488H treatment at reperfusion: (1) significantly reduced infarct size (11.3 ± 1.3%) compared to control hearts (27.7 ± 1.1%, P < 0.001), an effect that was completely blocked by nor-BNI (24.0 ± 0.9%, P < 0.001 vs. U50488H) but not by BAY K 8644 (7.1 ± 1.7%, P > 0.05 vs. U50488H); (2) significantly increased left ventricular developed pressure (65.3 ± 4.8%) after 2 h of reperfusion compared to control hearts (44.8 ± 3.6%, P < 0.05), an effect that was abrogated by nor-BNI (40.5 ± 4.5%, P > 0.05 vs. control) but not by BAY K 8644 (64.3 ± 5.6%, P < 0.01 vs. control); and (3) significantly decreased heart rate (P < 0.01 vs. control), an effect that was completely abrogated by both nor-BNI and BAY K 8644.

Conclusions

U50488H significantly limits myocardial infarction and stunning in isolated rat hearts after ischemia-reperfusion induction. The infarct size limitation and contractility improvement observed with U50488H treatment during reperfusion are entirely mediated by OR stimulation and not by Ca²⁺ channel modulation.

Defective calcium handling in cardiomyocytes isolated from hearts subjected to ischemia-reperfusion

Although ischemia-reperfusion (I/R) has been shown to affect subcellular organelles that regulate the intracellular Ca2+concentration ([Ca2+]i), very little information regarding the Ca2+handling ability of cardiomyocytes obtained from I/R hearts is available. To investigate changes in [Ca2+]idue to I/R, rat hearts in vitro were subjected to 10–30 min of ischemia followed by 5–30 min of reperfusion. Cardiomyocytes from these hearts were isolated and purified; [Ca2+]iwas measured by employing fura-2 microfluorometry. Reperfusion for 30 min of the 20-min ischemic hearts showed attenuated cardiac performance, whereas basal [Ca2+]ias well as the KCl-induced increase in [Ca2+]iand isoproterenol (Iso)-induced increase in [Ca2+]iin cardiomyocytes remained unaltered. On the other hand, reperfusion of the 30-min ischemic hearts for different periods revealed marked changes in cardiac function, basal [Ca2+]i, and Iso-induced increase in [Ca2+]iwithout any alterations in the KCl-induced increase in [Ca2+]ior S(−)-BAY K 8644-induced increase in [Ca2+]i. The I/R-induced alterations in cardiac function, basal [Ca2+]i, and Iso-induced increase in [Ca2+]iin cardiomyocytes were attenuated by an antioxidant mixture containing superoxide dismutase and catalase as well as by ischemic preconditioning. The observed changes due to I/R were simulated in hearts perfused with H2O2for 30 min. These results suggest that abnormalities in basal [Ca2+]ias well as mobilization of [Ca2+]iupon β-adrenoceptor stimulation in cardiomyocytes are dependent on the duration of ischemic injury to the myocardium. Furthermore, Ca2+handling defects in cardiomyocytes appear to be mediated through oxidative stress in I/R hearts.

Mitochondrial function in cardiomyocytes: target for cardioprotection

PURPOSE OF REVIEW

Cardiac diseases including ischemic heart disease, cardiomyopathy, hypertension, atherosclerosis and congestive heart failure are associated with cardiac cell death as a result of both necrosis and apoptosis. Mitochondria play an essential role in deciding whether a cell lives or dies. This review summarizes current knowledge on the mechanisms by which mitochondria exert such decision-making power.

RECENT FINDINGS

A wide variety of factors, either directly or indirectly, function in a synchronized manner to regulate the death versus survival signals. Mitochondrial bioenergetics and permeability transition pore plays a crucial role in this process, although several redox-sensitive genes, proteins and transcription factors, such as Bcl-2, Bax, nuclear factor kappa B, regulate the decision-making power of mitochondria, which have the final authority to decide whether a cell lives or dies. Mitochondrially generated reactive oxygen species are critically involved in the decision-making process, by functioning both as executioner by damaging the biomolecules, or as savior by virtue of their ability to perform redox signaling.

SUMMARY

It appears that mitochondria regulate the life and death of cardiac cells by manipulating several factors, including bioenergetics, mitochondrial permeability transition pore and redox-sensing genes. Redox signaling is likely to be critically involved in this process.

Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage

OBJECTIVES

We studied the incidence of myocardial injury in aneurysmal subarachnoid hemorrhage (SAH) using the more sensitive cardiac troponin I (cTnI) assay, correlated changes in cTnI with creatine kinase, MB fraction (CK-MB), myoglobin, and catecholamine metabolite assays, and examined the predictive value of changes in cTnI for myocardial dysfunction.

BACKGROUND

Myocardial injury in aneurysmal SAH as evidenced by elevated CK-MB fraction has been reported. Little published data exist on the value of cTnI measurements in aneurysmal SAH.

METHODS

Thirty-nine patients were studied for seven days. Clinical cardiovascular assessment, electrocardiographic (ECG), echocardiography, cTnI, CK, CK-MB and CK-MB index, myoglobin and 24-h urinary catecholamine assays were performed in all patients. The ECG abnormalities were defined by the presence of ST-T changes, prolonged QT intervals, and arrhythmias. An abnormal echocardiogram was defined by the presence of wall-motion abnormalities and a reduced ejection fraction. The severity of SAH was graded clinically and radiologically.

RESULTS

Eight patients demonstrated elevations in cTnI (upper limit of normal is 0.1 microg/liter with the immunoenzymatic assay and 0.4 microg/liter with the sandwich immunoassay), while five had abnormal CK-MB levels (upper limit of normal is 8 microg/liter). Patients with more severe grades of SAH were more likely to develop a cTnI leak (p < 0.05). Patients with cTnI elevations were more likely to demonstrate ECG abnormalities (p < 0.01) and manifest clinical myocardial dysfunction (p < 0.01) as evidenced by the presence of a gallop rhythm on auscultation and clinical or radiological evidence of pulmonary edema as compared to those with CK-MB elevations. The sensitivity and specificity of cTnI to predict myocardial dysfunction were 100% and 91%, respectively, whereas the corresponding figures for CK-MB were 60% and 94%, respectively. Elevations in myoglobin levels (upper limit of normal <70 microg/liter) and urinary catecholamine metabolites (urinary vanilmandelate/creatinine ratio upper limit of normal, 2.6) are a nonspecific finding.

CONCLUSIONS

Measurements of cTnI reveal a higher incidence of myocardial injury than predicted by CK-MB in aneurysmal SAH, and elevations of cTnI are associated with a higher incidence of myocardial dysfunction. Thus, cTnI is a highly sensitive and specific indicator of myocardial dysfunction in aneurysmal SAH.

Tetrandrine ameliorates ischaemia-reperfusion injury of rat myocardium through inhibition of neutrophil priming and activation

1. We have previously shown that tetrandrine (TTD), a bisbenzyltetrahydroiosquinoline isolated from the Chinese herb Stephania tetrandra, inhibits neutrophil adhesion, Mac-1 expression, and reactive oxygen species (ROS) production. To examine whether inhibition of neutrophil function may confer upon TTD the ability to prevent myocardial ischaemia-reperfusion (MI/R) injury, experiments were performed on rats subjected to coronary ligation followed by reperfusion for induction of MI/R injury. 2. Intravenous administration of TTD (0.1 and 1.0 mg kg-1) 15 min prior to coronary ligation completely prevented MI/R-associated mortality. TTD pretreatment also significantly reduced MI/R-induced ventricular tachyarrhythmia, myocardial infarct size, and neutrophil infiltration. 3. However, TTD pretreatment did not influence mean arterial blood pressure, heart rate, or product of pressure-rate, indicating that TTD extenuated MI/R through mechanisms independent of modulating haemodynamics or myocardial oxygen demand. 4. Peripheral blood neutrophils were isolated for ex vivo examination of shape change and Mac-1 upregulation of neutrophils, two sensitive indicators of proinflammatory priming, as well as N-formyl-methionyl-leucyl-phenylalanine (fMLP)-induced adhesion and ROS production, parameters commonly used for the assessment of neutrophil activation. 5. Neutrophils from MI/R animals showed significant shape change and Mac-1 upregulation, both of which were prevented by TTD-pretreatments. On the other hand, fMLP-induced adhesion and ROS production of neutrophils were markedly enhanced by MI/R but diminished in TTD-pretreated animals. 6. These data suggest that the protective effect of TTD against MI/R injury can be accounted for by inhibition of neutrophil priming and activation, thereby abolishing subsequent infiltration and ROS production that cause MI/R injury.

Role of angiotensin II in sympathetic nervous system induced left ventricular dysfunction

Experiments were undertaken to determine whether angiotensin (Ang) II concentration increases during massive sympathetic nervous system (SNS) activation and whether such an increase plays a role in the pathogenesis of SNS-induced left ventricular (LV) dysfunction. We also sought to determine whether excessive Ca2+ uptake through L-type channels due to intense adrenoceptor activation is responsible for the LV dysfunction. AngII concentration was measured in the plasma and myocardium before and after massively activating the SNS with an intracisternal injection of veratrine. In separate experiments, rabbits were given losartan, enalaprilat, enalaprilat plus HOE-140, nifedipine, -Bay K 4866, or saline before massively activating the SNS. LV function was evaluated 2.5 h later. The intense SNS activity caused plasma and myocardial AngII to increase by 400 and 437%, respectively. AngII receptor blockade did not prevent LV dysfunction. In contrast, enalaprilat reduced the degree of dysfunction, but its cardioprotection was abolished by HOE-140. Although nifedipine prevented SNS-induced LV dysfunction, administration of the Ca2+ channel opener, -Bay K 4866, did not increase its severity. Our results indicate that AngII is not involved in the pathogenesis of SNS-induced LV dysfunction and that the cardioprotection provided by angiotensin converting enzyme (ACE) inhibition is due to activation of a bradykinin pathway. Furthermore, the finding that the magnitude of the LV dysfunction was reduced by enalaprilat, and not increased by -Bay K 4866, suggests that intense adrenoceptor activation of L-type Ca2+ channels is not the primary pathogenetic mechanism.Key words: converting-enzyme inhibitor, calcium channel opener-blocker, myocardial contractility, catecholamines, rabbits.

The effects of verapamil and nimodipine on bupivacaine-induced cardiotoxicity in rats: an in vivo and in vitro study

The purpose of this in vivo and in vitro study was to compare the effects of verapamil or nimodipine pretreatment on bupivacaine-induced cardiotoxicity. In the in vivo study, the dose-response curve for the 50% lethal dose (LD50) of bupivacaine was determined for rats. Two separate groups of rats were pretreated with i.v. verapamil 150 microg/kg (n = 35) or i.v. nimodipine 200 microg/kg (n = 35). Each pretreatment group was then subdivided into four groups of at least four rats each. Three minutes after pretreatment, bupivacaine was administered to each of four groups in doses of 2.5, 3.0, 3.25, and 3.5 mg/kg, respectively. Both verapamil and nimodipine pretreatment increased the LD50 and 95% confidence intervals for bupivacaine and increased survival. In the in vitro study, the effects of verapamil or nimodipine perfusion on bupivacaine cardiotoxicity (negative chronotropic, negative inotropic, and arrhythmogenic effects) and coronary perfusion pressure (CPP) were investigated in isolated, perfused rat heart preparations. Depression of heart rate, contractile force, and CPP, and the incidence of arrhythmias caused by bupivacaine alone were similar to those caused by bupivacaine after verapamil pretreatment. In contrast, bupivacaine induced less negative chronotropic effects (P < 0.05, paired t-test) and arrhythmias (P < 0.05, chi2 analysis) after nimodipine pretreatment. The results of this study demonstrate that both verapamil and nimodipine pretreatment decrease bupivacaine-induced cardiotoxicity in vivo, whereas only nimodipine pretreatment decreased bupivacaine-induced cardiotoxicity and arrhythmias in vitro.

IMPLICATIONS

In this experimental study consisting of two stages (in vivo and in vitro), we compared the effects of two calcium channel-blocking drugs (verapamil and nimodipine) on bupivacaine toxicity. Bupivacaine is a local anesthetic frequently used in clinical practice, and cardiotoxicity is one of its severe side effects. Verapamil and nimodipine were both effective in decreasing bupivacaine cardiotoxicity in this rat model.

Interrelationship between cellular calcium homeostasis and free radical generation in myocardial reperfusion injury

This review describes the interrelationship between two important biological factors, intracellular calcium overloading and oxygen-derived free radicals, which play a crucial role in the pathogenesis of myocardial ischemic reperfusion injury. Free radicals are generated during the reperfusion of ischemic myocardium, and polyunsaturated fatty acids in the membrane phospholipids are the likely targets of the free radical attack. On the other hand, activation of phospholipases can provoke the breakdown of membrane phospholipids which results in the activation of arachidonate cascade leading to the generation of prostaglandins, and oxygen free radicals can be produced during the interconversion of the prostaglandins. In conclusion, it has been emphasized that the two seemingly different causative factors of reperfusion injury, intracellular calcium overloading and free radical generation are, in fact, highly interrelated.

Developmental differences in cytosolic calcium accumulation associated with surgically induced global ischemia: optimization of cardioplegic protection and mechanism of action

OBJECTIVE

The effect of cardioplegic solutions with high concentrations of potassium or magnesium (or both) on cytosolic calcium accumulation was investigated with fura-2 in isolated perfused mature (n = 24) and aged (n = 24) rabbit hearts.

METHODS

We compared cytosolic calcium accumulation before ischemia (control), during 30 minutes of ischemia and 30 minutes of reperfusion under global ischemia, or after treatment with potassium (20 mmol/L), magnesium (20 mmol/L), or both.

RESULTS

Cytosolic calcium accumulation was increased during global ischemia in the mature heart (from 178.7 +/- 24.2 in the control group to 393.6 +/- 25.5 nmol/L; p < 0.005) and in the aged heart (from 187.4 +/- 18.7 in the control group to 501.0 +/- 46.1 nmol/L; p < 0.005). Potassium reduced cytosolic calcium accumulation during ischemia in both the mature and aged hearts (300.9 +/- 23.2 and 365.2 +/- 27.7 nmol/L, respectively; p < 0.05 vs global ischemia). Magnesium and potassium/magnesium completely controlled cytosolic calcium accumulation in the mature heart (198.7 +/- 27.5 nmol/L; p < 0.01 vs global ischemia and p < 0.05 vs potassium: 182.3 +/- 22.7 nmol/L; p < 0.05 vs global ischemia and potassium, respectively). Magnesium and potassium/magnesium attenuated cytosolic calcium accumulation in the aged heart (261.3 +/- 26.7, 262.3 +/- 25.2 nmol/L, respectively; p < 0.01 vs global ischemia). These changes in cytosolic calcium accumulation correlated with improved post-ischemic ventricular function. To investigate the mechanism(s) of magnesium-supplemented cardioplegic inhibition of cytosolic calcium accumulation, we performed parallel studies (n = 43) using nifedipine, ryanodine, and dimethylthiourea. Nifedipine with or without ryanodine reduced cytosolic calcium accumulation. Dimethylthiourea did not alter cytosolic calcium accumulation during global ischemia. Our results suggest that cytosolic calcium accumulation during global ischemia was mainly increased via the sarcolemmal 1-type calcium channel and the sarcoplasmic reticulum calcium-release channel. The modulating action of potassium/magnesium cardioplegia on cytosolic calcium accumulation during ischemia would appear to act through the inhibition of the myocardial 1-type calcium channel and the sarcoplasmic reticulum calcium-release channel.

CONCLUSION

Senescent cardiac dysfunction correlates with increased ischemia-induced cytosolic calcium accumulation. Magnesium-supplemented potassium cardioplegia ameliorates this age-related phenomenon at normothermia and may have important implications in myocardial protection in the elderly population.

Antioxidant properties of dihydropyridines in isolated rat hearts

Isolated Sprague-Dawley rat hearts were perfused under constant flow conditions. Hearts were treated with vehicle or treatment buffers, including nisoldipine, nifedipine, or the optical isomers (+)- or (-)-nisoldipine. H2O2 (500-600 microM) was then added to the treatment buffer for 12 min. H2O2 was removed and perfusion continued with treatment buffers (10 min) followed by control buffer (20 min). Contractile function decreased following perfusion with H2O2. Contractile function was protected was protected in a concentration-dependent manner (nisoldipine=19,26,50,63 and 78%; nifedipine = 23, 37, 55,61, and 63% of pre-peroxide function, 0, 0.1, 0.5 1.0, and 5 microliter, respectively). There were no significant differences between equal concentrations of nisoldipine and nifedipine. Contractile function was equally protected by both (+)- and (-)-nisoldipine compared with vehicle-treated hearts (56, 67, and 16%, of pre-peroxide function, respectively). Biochemical analyses indicated that H2O2 damaged plasma membranes (increased lactate dehydrogenase leak) and caused lipid peroxidation (elevated tissue thiobarbituric acid reactive substances). Biochemical changes were equally reduced by nisoldipine and nifedipine treatments and by (+)- and (-)-nisoldipine. The treatment groups have widely differing IC50 values as calcium channel antagonists, yet they had equal effects in reducing oxidative injury, suggesting that this beneficial effect is not mediated by calcium antagonism.

Prazosin reduces myocardial ischemia/reperfusion-induced Ca2+ overloading in rat heart by inhibiting phosphoinositide signaling

The aim of this study was to establish whether or not alpha 1-adrenergic receptors are implicated in triggering phosphoinositide hydrolysis and intracellular Ca2+ accumulation during myocardial ischemia and reperfusion. In isolated perfused rat hearts, the selective alpha 1-receptor antagonist prazosin abolished the increase in radioactivity incorporation into cellular inositol phosphates induced by 30 min ischemia followed by 30 min reperfusion, and selectively blocked the degradation of phosphoinositides; only minor changes in the ischemia/reperfusion-induced loss of other classes of phospholipids were seen. In addition, a prazosin-induced decrease of ischemia/reperfusion Ca2+ overloading was documented in real-time recordings of epicardial cytosolic free Ca2+ in fura 2-loaded hearts. An inhibition of early ischemic Ca2+ rise was observed, as well as a lower peak of cytosolic free Ca2+ and a more rapid reversal to normal values during reperfusion. Moreover, alpha 1-adrenergic blockade resulted in a significant improvement in the recovery of myocardial function during reperfusion: an increased left ventricular developed pressure and maximum rate of rise of systolic pressure paralleled the decrease in time-averaged cytosolic Ca2+ and the increase in amplitude of Ca2+ transients, respectively. It is concluded that myocardial Ca2+ overloading during ischemia and reperfusion may be triggered by alpha 1-adrenergic receptor-induced polyphosphoinositide hydrolysis.