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Corradi F, Masini G, Bucciarelli T, De Caterina R. Iron deficiency in myocardial ischaemia: molecular mechanisms and therapeutic perspectives. Cardiovasc Res 2023; 119:2405-2420. [PMID: 37722377 DOI: 10.1093/cvr/cvad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/14/2023] [Accepted: 07/10/2023] [Indexed: 09/20/2023] Open
Abstract
Systemic iron deficiency (SID), even in the absence of anaemia, worsens the prognosis and increases mortality in heart failure (HF). Recent clinical-epidemiological studies, however, have shown that a myocardial iron deficiency (MID) is frequently present in cases of severe HF, even in the absence of SID and without anaemia. In addition, experimental studies have shown a poor correlation between the state of systemic and myocardial iron. MID in animal models leads to severe mitochondrial dysfunction, alterations of mitophagy, and mitochondrial biogenesis, with profound alterations in cardiac mechanics and the occurrence of a fatal cardiomyopathy, all effects prevented by intravenous administration of iron. This shifts the focus to the myocardial state of iron, in the absence of anaemia, as an important factor in prognostic worsening and mortality in HF. There is now epidemiological evidence that SID worsens prognosis and mortality also in patients with acute and chronic coronary heart disease and experimental evidence that MID aggravates acute myocardial ischaemia as well as post-ischaemic remodelling. Intravenous administration of ferric carboxymaltose (FCM) or ferric dextrane improves post-ischaemic adverse remodelling. We here review such evidence, propose that MID worsens ischaemia/reperfusion injury, and discuss possible molecular mechanisms, such as chronic hyperactivation of HIF1-α, exacerbation of cytosolic and mitochondrial calcium overload, amplified increase of mitochondrial [NADH]/[NAD+] ratio, and depletion of energy status and NAD+ content with inhibition of sirtuin 1-3 activity. Such evidence now portrays iron metabolism as a core factor not only in HF but also in myocardial ischaemia.
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Affiliation(s)
- Francesco Corradi
- Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Gabriele Masini
- Chair and Postgraduate School of Cardiology, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Tonino Bucciarelli
- Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Raffaele De Caterina
- Chair and Postgraduate School of Cardiology, University of Pisa, Via Savi 10, 56126, Pisa, Italy
- Fondazione VillaSerena per la Ricerca, Viale L. Petruzzi 42, 65013, Città Sant'Angelo, Pescara, Italy
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Inserte J, Barrabés JA, Aluja D, Otaegui I, Bañeras J, Castellote L, Sánchez A, Rodríguez-Palomares JF, Pineda V, Miró-Casas E, Milà L, Lidón RM, Sambola A, Valente F, Rafecas A, Ruiz-Meana M, Rodríguez-Sinovas A, Benito B, Buera I, Delgado-Tomás S, Beneítez D, Ferreira-González I. Implications of Iron Deficiency in STEMI Patients and in a Murine Model of Myocardial Infarction. JACC Basic Transl Sci 2021; 6:567-580. [PMID: 34368505 PMCID: PMC8326269 DOI: 10.1016/j.jacbts.2021.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
In patients with STEMI treated with primary percutaneous coronary intervention, iron deficiency is associated with larger infarcts, more extensive microvascular obstruction, and a higher frequency of adverse left ventricular remodeling. An iron-deficient diet reduces the tolerance to ischemia/reperfusion in mice at least in part by interfering with the cardioprotective pathway eNOS/soluble guanylate cyclase/protein kinase G. An iron-deficient diet reduces eNOS activity by increasing oxidative/nitrosative stress and its proteasome-dependent degradation. Not only iron excess but also iron deficiency may have deleterious effects in the context of acute myocardial ischemia.
In patients with a first anterior ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, iron deficiency (ID) was associated with larger infarcts, more extensive microvascular obstruction, and higher frequency of adverse left ventricular remodeling as assessed by cardiac magnetic resonance imaging. In mice, an ID diet reduced the activity of the endothelial nitric oxide synthase/soluble guanylate cyclase/protein kinase G pathway in association with oxidative/nitrosative stress and increased infarct size after transient coronary occlusion. Iron supplementation or administration of an sGC activator before ischemia prevented the effects of the ID diet in mice. Not only iron excess, but also ID, may have deleterious effects in the setting of ischemia and reperfusion.
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Key Words
- CK-MB, creatine kinase-myocardial band
- CMR, cardiac magnetic resonance
- HSP90, heat-shock protein 90
- ID, iron deficiency
- LV, left ventricular
- MVO, microvascular obstruction
- PKG, protein kinase G
- STEMI, ST-segment elevation acute myocardial infarction
- STIR, short tau inversion recovery
- VASP, vasodilator-stimulated phosphoprotein
- acute myocardial infarction
- eNOS, endothelial nitric oxide synthase
- endothelial nitric oxide synthase
- iNOS, inducible nitric oxide synthase
- iron deficiency
- myocardial reperfusion
- sGC, soluble guanylyl cyclase
- soluble guanylate cyclase
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Affiliation(s)
- Javier Inserte
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José A Barrabés
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - David Aluja
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Imanol Otaegui
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jordi Bañeras
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laura Castellote
- Department of Biochemistry, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Ana Sánchez
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José F Rodríguez-Palomares
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Víctor Pineda
- Institut de Diagnòstic per la Imatge, Barcelona, Spain
| | - Elisabet Miró-Casas
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laia Milà
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rosa-Maria Lidón
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonia Sambola
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Filipa Valente
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Agnès Rafecas
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marisol Ruiz-Meana
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonio Rodríguez-Sinovas
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Begoña Benito
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Irene Buera
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sara Delgado-Tomás
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - David Beneítez
- Department of Hematology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut d'Oncologia (VHIO), Barcelona, Spain
| | - Ignacio Ferreira-González
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Abstract
Nitric oxide (NO) is synthesized from L-arginine by NO synthase (NOS). As an endothelium-derived relaxing factor, a mediator of immune responses, a neurotransmitter, a cytotoxic free radical, and a signaling molecule, NO plays crucial roles in virtually every cellular and organ function in the body. The discovery of NO synthesis has unified traditionally diverse research areas in nutrition, physiology, immunology, pathology, and neuroscience. Increasing evidence over the past decade shows that many dietary factors, including protein, amino acids, glucose, fructose, cholesterol, fatty acids, vitamins, minerals, phytoestrogens, ethanol, and polyphenols, are either beneficial to health or contribute to the pathogenesis of chronic diseases partially through modulation of NO production by inducible NOS or constitutive NOS. Although most published studies have focused on only a single nutrient and have generated new and exciting knowledge, future studies are necessary to investigate the interactions of dietary factors on NO synthesis and to define the underlying molecular mechanisms.
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Affiliation(s)
- Guoyao Wu
- Department of Animal Science and Faculty of Nutrition, Texas A&M University College Station, Texas 77843, USA.
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