Fred Thoné

Ultrastructural correlates of left ventricular contraction abnormalities in patients with chronic ischemic heart disease: Determinants of reversible segmental asynergy postrevascularization surgery

The relationships between structural alterations and left ventricular (LV) contraction abnormalities were studied in patients with coronary artery disease (CAD). Transmural biopsies of the LV anterior free wall were taken during aortocoronary bypass surgery (CABG) in 62 patients. When preoperative anterior wall motion (AWM) was reduced, significant myocardial cell degeneration was found in patients with as well as without previous anterior infarction (MI). The amount of myocardial fibrosis was increased only in patients with ECG evidence of previous anterior MI (p less than 0.001). In a second series of 139 CAD patients, cineventriculograms performed before and 8 months after CABG were examined. In patients with patent grafts to the LV anterior wall not previously infarcted, reduced AWM became normal. In patients with previous anterior MI the outcome of AWM was unpredictable (usually unimproved). Thus the histologic correlate of reduced AWM in segments not previously infarcted was progressive loss of contractile material in otherwise viable myocardial cells. Some reversibility was suggested by restoration of resting function after CABG. Unpredictable results in segments associated with pathologic Q waves appear related to the fibrous component of these previously infarcted areas.

Chronic Ischemic Viable Myocardium in Man - Aspects of Dedifferentiation

Histologic analysis of biopsies derived from patients with chronic dysfunctional but viable (hibernating) myocardium showed characteristic cell alterations. These changes consisted of a partial to complete loss of sarcomeres, accumulation of glycogen, and disorganization and loss of sarcoplasmic reticulum. Most of the adaptive changes that these affected cells undergo are suggestive of dedifferentiation. In the present study the expression and organizational pattern of contractile and cytoskeletal proteins such as titin, cardiotin, and α-smooth muscle actin were assessed in hibernating and normal myocardium because the expression and organization of these constituents have been related to certain stages of cardiomyocyte differentiation. In normal cells titin shows a cross-striated staining pattern, whereas cardiotin displays a fibrillar array, parallel to the sarcomeres. α-Smooth muscle actin is not expressed in adult cardiomyocytes. The expression of titin in a punctated pattern and the marked decrease to virtual absence of cardiotin in hibernating cardiomyocytes speak in favor of an embryonic phenotype of these cells. The re-expression of α-smooth muscle actin in hibernating cells strongly supports this hypothesis. The observations on three different structural proteins of heart muscle suggest that hibernating myocardium acquired aspects of muscle cell dedifferentiation.

Cardiomyocyte remodelling during myocardial hibernation and atrial fibrillation: prelude to apoptosis

OBJECTIVE Similar structural changes in the myocardium can be observed in chronic hibernating myocardium and in myocardium taken from hearts suffering chronic atrial fibrillation. We investigated whether or not these changes are indicative of apoptosis. METHODS Myocardial biopsies from 28 strictly selected patients with chronic hibernating myocardium and heart samples from 13 goats with pacing-induced chronic atrial fibrillation were used. Special attention was paid to processing the tissues immediately (fixation/freezing) in order to prevent artificial degenerative changes, thereby excluding false positive identification of apoptosis. Infarcted areas or infarcted border zones were excluded from our study. Apoptosis was detected with light and electron microscopy and terminal deoxynucleotidyl transferase nick end-labelling. Immunohistochemistry was used for detecting Bcl-2, P53 and PCNA-proteins associated with apoptosis/DNA damage. RESULTS The results obtained for chronic hibernating left ventricular myocardium were similar to those for chronic fibrillating atrial myocardium. No apoptotic nuclei, as characterised by extensive chromatin clumping, could be observed in normal or dedifferentiated cardiomyocytes under the electron microscope. The end-labelling assay did not reveal any cardiomyocytes with damaged DNA. Nor could we find any evidence of substantial expression of Bcl-2, P53 or PCNA, a result indicative of the absence of apoptotic threat or DNA damage. CONCLUSION Cardiomyocyte dedifferentiation, but not extensive degeneration through apoptosis, can be observed in chronic hibernating myocardium and chronic fibrillating atrium. Dedifferentiation may be the best way to survive prolonged exposure to the unfavourable conditions imposed by increased wall stress, a relative lowered oxygen environment, or both.

Cytochemical and Biochemical Studies of Yeasts After In Vitro Exposure to Miconazole

Yeast cells exposed to different doses of the antimycotic agent miconazole revealed important cytochemical changes in the topographic distribution of the phosphatases. A strong effect was observed on the behavior of oxidative and peroxidative enzymes. Decreased cytochrome c oxidase and peroxidase activity and increased catalase activity were seen after treatment with a fungistatic dose of miconazole, whereas a complete disappearance of these enzymes was observed after treatment with a minimal fungicidal dose of miconazole. This was in complete agreement with the quantitative biochemical data. A hypothesis is advanced concerning the possible involvement of peroxidase and catalase in the mechanism of action of this drug. Images

Localization of calcium in skeletal and cardiac muscle

SummaryThe requirement of calcium (Ca2+) in the excitation-contraction coupling of both skeletal and cardiac muscle is well established. However, the exact location of the intracellular storage sites of Ca2+ is not firmly established. We report here on the ultrastructural distribution of Ca2+ in white and red skeletal muscle and in cardiac muscle of the rat using combined phosphate-pyroantimonate (PPA) and oxalate-pyroantimonate (OPA) procedures. The methods are based on (a) stabilization and/or trapping of Ca2+ during the primary fixation step in glutaraldehyde by potassium phosphate or oxalate; (b) subsequent wash-out of all non-trapped cations such as Na+ and Mg2+ in potassium phosphate or oxalate; (c) conversion of the complexed or trapped Ca2+ into an electron-dense calcium pyroantimonate salt in 100 μm-thick tissue sections; and (d) wash-out of the excess potassium pyroantimonate at alkaline pH.With the OPA procedure, mitochondria of all muscle types showed little precipitate. The junctional sarcoplasmic reticulum was stongly reactive in relaxed white skeletal muscle, negative in contracted white fibres and negative in red skeletal and cardiac muscle, independent of the state of relaxation-contraction. Other organelles were essentially free of deposits.With the PPA method, the precipitate was almost exclusively confined to the sarcolemma and its T-tubular invaginations in cardiac and slow skeletal muscle, and was absent in fast skeletal muscle. Apart from occasional deposits in mitochondria, all other organelles were free of precipitate. The sarcolemma-associated deposits were clearly confined to the inner leaflet of the lipid bilayer. The amount of precipitate varied within the contraction cycle, relaxed cells possessing the highest density.Exposure of the tissue to La3+ resulted in the complete absence of sarcolemma-bound precipitate suggesting that the Ca2+ is exchangeable. Furthermore, these cytological data suggest a basic difference in Ca2+ storage between white skeletal muscle on the one hand, and red skeletal and cardiac muscle on the other.

Chronic hibernating myocardium: Interstitial changes

Chronic left ventricular dysfunctional but viable myocardium of patients with chronic hibernation is characterized by structural changes, which consist of depletion of contractile elements, accumulation of glycogen, nuclear chromatin dispersion, depletion of sarcoplasmic reticulum and mitochondrial shape changes. These alterations are not reminiscent of degeneration but are interpreted as de-differentiation of the cardiomyocytes. The above mentioned changes are accompanied by a marked increase in the interstitial space. The present study describes qualitative and quantitative changes in the cellular and non-cellular compartments of the interstitial space. In chronic hibernating myocardial segments the increased extracellular matrix is filled with large amounts of type I collagen, type III collagen and fibronectin. An increase in the number of vimentin-positive cells (endothelial cells and fibroblasts) compared with normal myocardium is seen throughout the extracellular matrix.The increase in interstitial tissue is considered as one of the main determinants responsible for the lack of immediate recovery of contractile function after restoration of the blood flow to the affected myocardial segments of patients with chronic left ventricular dysfunction.

Singlet oxygen and myocardial injury: Ultrastructural, cytochemical and electrocardiographic consequences of photoactivation of rose bengal

Photoactivation of rose bengal leads to the generation of reactive oxygen intermediates (predominantly singlet oxygen with some superoxide anion) which are potentially injurious to biological systems. Isolated rat hearts were perfused aerobically at 37 degrees C with bicarbonate buffer for 10 min without rose bengal and for 10 min with rose bengal (500 nM). During the last 5 min of perfusion with rose bengal, hearts were globally illuminated (5500 lux) with light (530 to 590 nm) and electrocardiographic changes were detected within 2.7 +/- 0.3 s (approximately 15 beats) of the onset of illumination. All hearts developed ventricular premature beats, ventricular tachycardia and complete atrioventricular block after 20.2 +/- 6.6, 68.0 +/- 29.7 and 184.3 +/- 20.9 s, respectively. Photoactivation by rose bengal also resulted in severe ultrastructural damage including intracellular clarifications, swelling of mitochondria with disruption and clumping of cristae and the development of contraction band necrosis. Extensive degranulation of mast cells was also observed. These changes were most evident in myocytes adjacent to large epicardial blood vessels. Cytochemical studies demonstrated that there was a loss of the calcium which is normally localized at the inner sarcolemmal surface, and the appearance of intramitochondrial calcium precipitates. In control hearts (no illumination and/or no rose bengal), arrhythmias did not develop and tissue morphology and calcium distribution remained normal. In additional studies, rose bengal-perfused hearts were illuminated regionally for 10 min over an area (approximately 6 mm2) of the left ventricle. Extensive tissue injury and calcium overload developed in the area of maximum illumination.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardioprotective effects of lidoflazine during 1-hour normothermic global ischemia.

The cardioprotective effects of lidofiazine, a drug with calcium homeostatic properties, were investigated in dogs subjected to 1 hour of normothermic global ischemia, followed by reperfusion. None of the eight control dogs could be weaned from the extracorporeal bypass, confirming the severity of the ischemic model. All eight acutely pretreated dogs showed rapid recovery from the prolonged ischemic arrest and could support their own circulation. Recovery of preischemic values was 95% for systolic aortic pressure, 71% for diastolic aortic pressure, 99% for left ventricular dP/dt max and 80% for cardiac output. Light and electron microscopy and calcium cytochemistry were performed on left ventricular biopsies taken before, during and after ischemic arrest. In the control dogs, loss of structural integrity of the sarcolemma and mitochondria was prominent at the end of the ischemic period. Intracellular edema, hypercontraction of sarcomeres and great accumulation of calcium in severely damaged mitochondria occurred after 5 and 30 minutes of reperfusion. In the lidofiazine‐treated dogs, such lesions were largely prevented during the ischemic period and completely reversed after reperfusion. These observations suggest that the tolerance to ischemia is markedly augmented by lidoflazine.

Multivariate analysis of angiographic, histologic, and electrocardiographic data in patients with coronary heart disease

In 61 consecutive patients undergoing aortocoronary bypass grafting, angiographic and electrocardiographic (ECG) changes were studied. Histologic delineation of myocardium was obtained by analysis of transmural biopsy specimens acquired at the time of surgery. The use of principal-component analysis revealed three definite groups of patients. Group I comprised patients with histologic findings associated with severe left anterior descending coronary artery (LAD) stenosis, without abnormal wall motion or ejection fraction. ECG abnormalities were limited to ST changes. Group II comprised patients with severe myocardial cell degeneration with only modest fibrosis associated with severe LAD stenosis and severely impaired wall motion. The incidence of infarction on the ECG was low. Group III patients had important myocardial cell degeneration with severe fibrosis associated with severe LAD stenosis, severely depressed wall motion, and significantly impaired ejection fraction. In this group there was a high incidence of infarction apparent on the ECG. Postoperative follow-up (24 months) showed a total survival of 94.4% in group I, 92.8% in group II, and only 72.7% in group III. This identification of subtypes of coronary artery disease seems to be helpful in estimating patient prognosis after coronary surgery.

Mitochondrial hydrogen peroxide generation by NADH-oxidase activity following regional myocardial ischemia in the dog.

Recently, an exogenous NADH-oxidase has been shown to be a source of oxygen derived toxic species in heart mitochondria. This enzyme uses NADH and oxygen to form superoxide radicals and hydrogen peroxide. Growing evidence suggests that oxygen radicals and hydrogen peroxide may contribute to cardiac damage during ischemia or hypoxia. The activity of the enzyme NADH-oxidase could play an important role in the damage caused by oxygen derived toxic species, especially since cellular defense mechanisms against free radicals are depleted under ischemic conditions. In this study, a cytochemical method was used to visualize hydrogen peroxide, the reaction product of NADH-oxidase activity, in normal and ischemic dog myocardium. The NADH-oxidase reaction product was present in weak amounts in mitochondria from normoxic myocardium. In viable ischemic areas a high degree of activity was observed in the mitochondria. In infarcted tissue mitochondria contained few or no reaction product at all. The results support the hypothesis that hydrogen peroxide and oxygen radicals produced in the mitochondria by a high NADH-oxidase activity may contribute to the mitochondrial damage observed during ischemia when NADH is no longer oxidized by the respiratory chain and cellular defense mechanisms are impaired.