Cardioprotective effect of electroacupuncture in cardiopulmonary bypass through apelin/APJ signaling

Chronic CNT Fiber Interface With Median Nerve at Acupoint PC6 for Rat's Myocardial Ischemia Control

Myocardial ischemia is one of the most prevalent cardiovascular diseases, underscoring the need for safer and effective therapeutic approaches. Peripheral nerve stimulation, particularly vagus nerve stimulation has emerged as a promising non-pharmaceutical therapy for managing myocardial ischemia. However, vagus nerve stimulation carries risks, such as off-target effects and adverse cardiac events due to its extensive innervation and mixed afferent/efferent fiber composition. Therefore, it is crucial to explore a safer and more user-friendly peripheral nerve interface. In this work, we developed a novel chronic median nerve interface using carbon nanotube fibers as electrodes to stimulate the median nerve at the acupoint PC6 for myocardial ischemia control. Carbon nanotube fibers exhibited excellent biocompatibility, flexibility, conductivity, and charge storage capacity, making them ideal for reliable and prolonged median nerve stimulation. Our results demonstrated that median nerve stimulation at the acupoint PC6 achieved therapeutic effects comparable to electroacupuncture, including improvement in S-T segment values, LF/HF ratios, cardiac index and cardiac troponin T, while being safer and easier to operate than vagus nerve stimulation. Moreover, median nerve stimulation exhibited superior transient and residual effects compared to electroacupuncture, despite a slower response time. Additionally, histological and fluorescence analyses confirmed the safety of the CNTF-based interface over time. These findings suggested that median nerve stimulation at the acupoint PC6 combined the efficacy of nerve stimulation with the safety of acupuncture, offering a promising approach for myocardial ischemia control, particularly in chronic and repeated treatment scenarios. Further researches are warranted to optimize CNTF properties, elucidate the underlying mechanisms of median nerve stimulation, and explore its potential in clinical applications.

Protective effect of apelin-13 in lens epithelial cells via inhibiting oxidative stress-induced apoptosis

BACKGROUND

It is widely accepted that glaucoma-induced oxidative stress expedites cataracts' process. Therefore, we examined the effects of apelin-13 against oxidative stress-induced damage in human lens epithelial cells (HLECs) and investigated the potential pathogenic mechanism of acute primary angle-closure glaucoma.

METHODS

This experiment included five groups: control, H2O2, apelin-13 + H2O2, ML221 + H2O2, and apelin-13 + ML221 + H2O2. ML221 was employed in rescue experiments as an APJ antagonist. HLECs were pretreated with or without apelin-13 and subsequently exposed to H2O2. HLECs' viability was assessed by CCK8. Cell apoptosis was determined using Annexin V-FITC/PI staining. The mitochondrial membrane potential was assessed by fluorescent probe JC-1. Intracellular G6PD activity, NADPH/NADP+, and GSH/GSSG ratios were detected to assess the cells' oxidative damage.

RESULT

Apelin-13 reversed the H2O2-induced decrease in cell viability. The increased expression of G6PD and GLTU1, the G6PD, GSH/GSSG and NADPH/NADP + levels showed that apelin-13 can mitigate the H2O2-induced inhibition of the pentose phosphate pathway and dysregulation of cell redox status in the apelin-13 + H2O2 group compared with the H2O2 group. In H2O2-treated HLECs, apelin-13 can mitigate cell apoptosis, promote Bcl-2 expression, and suppress the Bax and Caspase-3 expression. In addition, H2O2 substantially reduced the mitochondrial membrane potential in HLECs, which was reversed by apelin-13. Notably, the inhibition of APJ intensified oxidative damage in H2O2-induced HLECs, demonstrating that the effects of apelin-13 were hindered by ML221.

CONCLUTIONS

Apelin-13 reduced oxidative damage and apoptosis in HLECs through APJ. These results demonstrate that apelin-13 can be employed as a potential drug for glaucoma with cataracts to delay the progression of cataracts.

Overview of mechanism of electroacupuncture pretreatment for prevention and treatment of cardiovascular and cerebrovascular diseases

Cardio-cerebrovascular disease (CCVD) is a serious threat to huma strategy to prevent the occurrence and development of disease by giving electroacupuncture intervention before the disease occurs. EAP has been shown in many preclinical studies to relieve ischemic symptoms and improve damage from ischemia-reperfusion, with no comprehensive review of its mechanisms in cardiovascular disease yet. In this paper, we first systematically discussed the meridian and acupoint selection law of EAP for CCVD and focused on the progress of the mechanism of action of EAP for the prevention and treatment of CCVD. As a result, in preclinical studies, AMI and MCAO models are commonly used to simulate ischemic injury in CCVD, while MIRI and CI/RI models are used to simulate reperfusion injury caused by blood flow recovery after focal tissue ischemia. According to the meridian matching rules of EAP for CCVD, PC6 in the pericardial meridian is the most commonly used acupoint in cardiovascular diseases, while GV20 in the Du meridian is the most commonly used acupoint in cerebrovascular diseases. In terms of intervention parameters, EAP intervention generally lasts for 30 min, with acupuncture depths mostly between 1.5 and 5 mm, stimulation intensities mostly at 1 mA, and commonly used frequencies being low frequencies. In terms of molecular mechanisms, the key pathways of EAP in preventing and treating cardiovascular and cerebrovascular diseases are partially similar. EAP can play a protective role in cardiovascular and cerebrovascular diseases by promoting autophagy, regulating Ca2+ overload, and promoting vascular regeneration through anti-inflammatory reactions, antioxidant stress, and anti-apoptosis. Of course, both pathways involved have their corresponding specificities. When using EAP to prevent and treat cardiovascular diseases, it involves the metabolic pathway of glutamate, while when using EAP to prevent and treat cerebrovascular diseases, it involves the homeostasis of the blood-brain barrier and the release of neurotransmitters and nutritional factors. I hope these data can provide experimental basis and reference for the clinical promotion and application of EAP in CCVD treatment.

Effects of transcutaneous electrical nerve stimulation on myocardial protection in patients undergoing aortic valve replacement: a randomized clinical trial

Background

Cardiopulmonary bypass-related myocardial ischemia-reperfusion injury is a major contributor to postoperative morbidity. Although transcutaneous electrical nerve stimulation (TENS) has been found to have cardioprotective effects in animal studies and healthy volunteers, its effects on cardiac surgery under cardiopulmonary bypass patients have not been evaluated. We investigated the effects of TENS on myocardial protection in patients undergoing aortic valve replacement surgery using cardiopulmonary bypass.

Methods

Thirty patients were randomized to receive TENS or sham in three different anesthetic states – pre-anesthesia, sevoflurane, or propofol (each n = 5). TENS was applied with a pulse width of 385 μs and a frequency of 10 Hz using two surface electrodes at the upper arm for 30 min. Sham treatment was provided without stimulation. The primary outcome was the difference in myocardial infarct size following ischemia-reperfusion injury in rat hearts perfused with pre- and post-TENS plasma dialysate obtained from the patients using Langendorff perfusion system. The cardioprotective effects of TENS were determined by assessing reduction in infarct size following treatment.

Results

There were no differences in myocardial infarct size between pre- and post-treatment in any group (41.4 ± 4.3% vs. 36.7 ± 5.3%, 39.8 ± 7.3% vs. 27.8 ± 12.0%, and 41.6 ± 2.2% vs. 37.8 ± 7.6%; p = 0.080, 0.152, and 0.353 in the pre-anesthesia, sevoflurane, and propofol groups, respectively).

Conclusions

In our study, TENS did not show a cardioprotective effect in patients undergoing aortic valve replacement surgery.

Trial registration

This study was registered at clinicaltrials.gov (NCT03859115, on March 1, 2019).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-022-01611-x.