Ning-Ping Wang

Progressively developed myocardial apoptotic cell death during late phase of reperfusion

Myocardial apoptosis is primarily triggered during reperfusion (R). The aim of this study was to test the hypothesis that R-induced apoptosis develops progressively during the late phase of R, and that R-induced apoptosis is associated with changes in expression of anti- and pro-apoptotic proteins and infiltrated inflammatory cells. Thirty-one dogs were subjected to 60 min of left anterior descending coronary occlusion followed by 6, 24, 48, and 72 h R, respectively. There was no group difference in collateral blood flow, measured by colored microspheres during ischemia. Necrotic cell death (TTC staining) was significantly increased during R, starting at 27 ± 2% at 6 h R and increasing to 41 ± 2%† at 24 h R. There was no further change at 48 (37 ± 3%†) and 72 (36 ± 6%†) h R, respectively. TUNEL positive cells (% total normal nuclei) in the peri-necrotic zone progressively increased from 6 (26 ± 2*) to 24 (38 ± 1*†), 48 (48 ± 3*†) and 72 (59 ± 4*†) h R, respectively. The number of detected TUNEL positive cells at these time points was consistent with an increased intensity of DNA ladders, identified by agarose gel electrophoresis. Compared with normal tissue, western blot analysis showed persistent reduction in expression of anti-apoptotic protein Bcl-2 from 6 (16 ± 0.8%*) to 72 h R (78 ± 2%*†), and increase in expression of pro-apoptotic proteins including Bax from 6 (30 ± 3%*) to 72 h R (66 ± 3%*†), and p53 from 6 (12 ± 1%*) to 72 h R (91 ± 2%*†), respectively. Immunohistochemical staining revealed that infiltrated neutrophils (mm2 myocardium) were significantly correlated with development of necrotic and apoptotic cell death from 6 to 24 h R, respectively (P < 0.05), while large macrophage infiltration seen during 48 to 72 h R were correlated with apoptotic cell death (P < 0.05). These results indicate that 1) necrosis peaked at 24 h R when apoptosis was still progressively developing during later R; 2) changes in Bcl-2 family and p53 proteins may participate in R-induced myocardial apoptosis; 3) inflammatory cells may play a role in triggering cell death during R. *P < 0.05 vs. normal nuclei and tissue; †P < 0.01 vs. 6 h R.

Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis

BACKGROUND Multiple organ failure after deep hypothermic circulatory arrest (DHCA) may occur secondary to endothelial dysfunction and apoptosis. We sought to determine if DHCA causes endothelial dysfunction and apoptosis in brain, kidney, lungs, and other tissues. METHODS Anesthetized pigs on cardiopulmonary bypass were: (1) cooled to 18 degrees C, and had their circulation arrested (60 minutes) and reperfused at 37 degrees C for 90 minutes (DHCA, n = 8); or (2) time-matched normothermic controls on bypass (CPB, n = 6). Endothelial function in cerebral, pulmonary, and renal vessels was assessed by vasorelaxation responses to endothelial-specific bradykinin (BK) or acetylcholine (ACh), and smooth muscle-specific nitroprusside. RESULTS In vivo transcranial vasorelaxation responses to ACh were similar between the two groups. In small-caliber cerebral arteries, endothelial relaxation (BK) was impaired in CPB vs DHCA (maximal 55% +/- 2% [p < 0.05] vs 100% +/- 6%). Pulmonary artery ACh responses were comparable between CPB (110% +/- 10%) and DHCA (83% +/- 6%), but responses in pulmonary vein were impaired in DHCA (109% +/- 3%, p < 0.05) relative to CPB (137% +/- 6%). In renal arteries, endothelial (ACh) responses were impaired in DHCA (71% +/- 13%) relative to CPB (129% +/- 14%). Apoptosis (DNA laddering) occurred primarily in duodenal tissue, with a greater frequency in DHCA (56%, p < 0.05) compared with normothermic CPB (17%) and nonbypass controls (0%). CONCLUSIONS DHCA is associated with endothelial dysfunction in cerebral microvessels but not in the in vivo transcranial vasculature; in addition, endothelial dysfunction was noted in large-caliber renal arteries and pulmonary veins. DHCA is also associated with duodenal apoptosis. Vascular endothelial dysfunction and apoptosis may be involved in the pathophysiology of multisystem organ failure after DHCA.

Preconditioning decreases Bax expression, PMN accumulation and apoptosis in reperfused rat heart.

OBJECTIVE Recent studies suggest that ischemic preconditioning (IPC) inhibits myocardial apoptosis after ischemia and reperfusion. This study tested the hypothesis that IPC reduces ischemia/reperfusion-induced myocardial apoptosis by inhibiting neutrophil (PMN) accumulation and altering expression of Bcl-2 and Bax proteins. METHODS Eighteen rats were subjected to 30 min of left coronary artery occlusion followed by 180 min of reperfusion with IPC (5 min ischemia and 10 min of reperfusion, n = 10) or without IPC (n = 8). Myocardial apoptosis was detected histologically using the terminal transferase UTP nick end labeling (TUNEL) assay and confirmed by DNA ladder on agarose gel electrophoresis. PMN accumulation was detected immunohistochemically with anti-rat CD18 antibody (WT3) and expression of Bcl-2 and Bax proteins was analyzed using Western blot assay. RESULTS IPC significantly decreased TUNEL positive cells (% total nuclei) in the ischemic zone from 28.6 +/- 2.8 to 3.4 +/- 0.9 (P < 0.05), consistent with the absence of DNA ladders in the IPC group. IPC significantly attenuated PMN accumulation (cells/mm2 myocardium) in the ischemic zone from 243 +/- 19 to 118 +/- 19 (P < 0.05). By regression analysis, there was a significant correlation between TUNEL positive cells and accumulated CD18 positive PMNs in the ischemic zone (r = 0.8, P < 0.001), which was shifted downward by IPC. Densitometrically, IPC significantly attenuated the ischemia/reperfusion-upregulated expression of Bax protein in the ischemic zone from 204 +/- 57% in the control group to 76 +/- 7% (P < 0.05), while the expression of Bcl-2 was not different from the non-ischemic zone in either group. CONCLUSION These data suggest that ischemic preconditioning may reduce myocardial apoptosis by inhibiting PMN accumulation and down-regulating expression of Bax.

Evidence that cardioprotection by postconditioning involves preservation of myocardial opioid content and selective opioid receptor activation

Opioids introduced at reperfusion (R) following ischemia (I) reduce infarct size much like postconditioning, suggesting the hypothesis that postconditioning increases cardiac opioids and activates local opioid receptors. Anesthetized male rats subjected to 30 min regional I and 3 h R were postconditioned with three cycles of 10 s R and 10 s reocclusion at onset of R. Naloxone (NL), its peripherally restricted analog naloxone methiodide, delta-opioid receptor (DOR) antagonist naltrindole (NTI), kappa-opioid receptor antagonist norbinaltorphimine (NorBNI), and mu-opioid receptor (MOR) antagonist H-D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Pen-Thr-NH2 (CTAP) were administered intravenously 5 min before R. The area at risk (AAR) was comparable among groups, and postconditioning reduced infarct size from 57 +/- 2 to 42 +/- 2% (P < 0.05). None of the antagonists alone altered infarct size. All antagonists abrogated postconditioning protection at higher doses. However, blockade of infarct sparing by postconditioning was lost, since tested doses of NL, NTI, NorBNI, and CTAP were lowered. The efficacy of NorBNI declined first at 3.4 micromol/kg, followed sequentially by NTI (1.1), NL (0.37), and CTAP (0.09), suggesting likely MOR and perhaps DOR participation. Representative small, intermediate, and large enkephalins in the AAR were quantified (fmol/mg protein; mean +/- SE). I/R reduced proenkephalin (58 +/- 9 vs. 33 +/- 4; P < 0.05) and sum total of measured enkephalins, including proenkephalin, peptide B, methionine-enkephalin, and methionine-enkephalin-arginine-phenylalanine (139 +/- 17 vs. 104 +/- 7; P < 0.05) compared with shams. Postconditioning increased total enkephalins (89 +/- 8 vs. 135 +/- 5; P < 0.05) largely by increasing proenkephalin (33 +/- 4 vs. 96 +/- 7; P < 0.05). Thus the infarct-sparing effect of postconditioning appeared to involve endogenously activated MORs and possibly DORs, and preservation of enkephalin precursor synthesis in the AAR.

Administration of adenosine during reperfusion reduces injury of vascular endothelium and death of myocytes.

INTRODUCTION To test the hypothesis that administration of adenosine during reperfusion attenuates endothelial dysfunction and extension of infarct size by inhibiting polymorphonuclear neutrophil (PMN)-mediated events and apoptosis. METHODS Anesthetized dogs were subjected to 1 h coronary artery occlusion and 6 h of reperfusion with infusion of saline (vehicle, n = 8) or 140 micrograms/kg per min adenosine, n = 8) continuously into the left atrium starting 5 min before reperfusion and continuing for 2 h. RESULTS There was no intergroup difference in collateral myocardial blood flow measured by using colored microspheres in the area at risk during ischemia. Infusion of adenosine transiently improved segmental shortening (4.1 +/- 3.1% versus -2.5 +/- 2.3%, P < 0.05) and segmental work (41.4 +/- 22 versus 15 +/- 13 mmHg/mm, P < 0.05) after 4 h of reperfusion. Infusion of adenosine reduced size of infarct (determined by staining with triphenyltetrazolium chloride) from 27 +/- 2% with vehicle to 14 +/- 1%, (P < 0.05). This was confirmed by measuring that it lowered activity of plasma creatine kinase (from 19 +/- 2 versus 8 +/- 1 IU/g protein, P < 0.05). It also reduced the proportion of terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling-positive nuclei in the perinecrotic zone from 17.3 +/- 1.6 to 10.3 +/- 1.0% (P < 0.05) and reduced the appearance of DNA ladders in gel electrophoresis. In addition, it significantly decreased accumulation of PMN in the ischemic area (determined by immunohistochemistry with anti-CD18 antibody) and activity of cardiac myeloperoxidase compared with vehicle (439 +/- 52 versus 183 +/- 20 PMN/mm2 myocardium and 1.1 +/- 0.1 versus 2.4 +/- 0.2 U/100 mg tissue, P < 0.05, respectively). Furthermore, infusion of adenosine during reperfusion preserved vascular endothelial function expressed in terms of a decrease in adherence of PMN to postischemic coronary artery endothelium (63 +/- 3 versus 36 +/- 4 PMN/mm2 endothelium, P < 0.05, basal function) and agonist (acetylcholine)-induced endothelium-dependent relaxation (negative logarithm to base 10 of concentration (mol/l) for half-maximal effect 7.7 +/- 0.1 versus 7.2 +/- 0.1, P < 0.05, stimulated function). Infusion of adenosine directly inhibited generation of superoxide radical from canine PMN in vitro dose dependently from 27.8 +/- 6.3 to 5.8 +/- 2.1 nmol/l/5 x 10(6) PMN (P < 0.05). CONCLUSION Intra-atrial infusion of adenosine during reperfusion reduced accumulation of PMN in area at risk, preserved vascular endothelial function after ischemia-reperfusion by inhibiting interaction between PMN and endothelial cells, and decreased extension of infarct, possibly by limiting apoptosis.

Reduction of infarct size and preservation of endothelial function by multidose intravenous adenosine during extended reperfusion

It has been proposed that infarct extension is developed from the early to the late phase of reperfusion (R). This study compares the protective effect of single or multidose administration of adenosine (Ado) on infarct size during early and late phases of R by attenuating neutrophil (PMN) recruitment. Forty-one dogs underwent 60-min left anterior descending artery (LAD) ischemia followed by 6, 24, and 48 h of R, respectively. Infarct size (%) increased over 6 to 24 h (27 +/- 2 to 38 +/- 4; P < 0.05 24 h versus 6 h group), with a corresponding increase in creatine kinase activity. Transmural myocardial blood flow (mL/min/g) decreased from 6 to 24 h (0.47 +/- 0.02 to 0.29 +/- 0.02; P < 0.05 24 h versus 6 h group). PMN localization (mm(2) myocardium) in the perinecrotic tissue detected by immunohistochemistry with anti-CD18 antibody, and accumulation detected by myeloperoxidase (MPO, DeltaAbs/min/g) increased from 6 to 24 h (292 +/- 25 to 605 +/- 44; P < 0.05 24 h versus 6 h group; and 55 +/- 7 to 96 +/- 5; P < 0.05 24 h versus 6 h group), respectively. In in vitro analysis, PMN adherence (mm(2) endothelium) to postischemic LAD increased from 98 +/- 2 to 125 +/- 3 (P < 0.05 24 h versus 6 h group) and maximal LAD endothelium-dependent relaxation (%) impaired from 6 to 24 h (74 +/- 7 to 42 +/- 10; P < 0.05 24 h versus 6 h group). Intravenous Ado (140 microg/kg/min) for 2 h at R reduced infarct size (17 +/- 2; P < 0.05 Ado versus 6 h group), CD18 positive cells (130 +/- 10; P < 0.05 Ado versus 6 h group), MPO (14 +/- 3; P < 0.05 Ado versus 6 h group), PMN adherence (57 +/- 2; P < 0.05 Ado versus 6 h group), and augmented LAD vascular relaxation (102 +/- 5 versus 74 +/- 7; P < 0.05 Ado versus 6 h group). However, this protection by Ado was lost when R was extended to 24 h. Treatment with multiple infusion of Ado at 2, 6, 12, and 18 h R significantly preserved protective effects seen at 6 h R in the Ado group. Protection by multidose Ado was still preserved when R was extended to an additional 24 h. These data suggest that interventions aiming at permanently reducing R injury may thus need to be administered not only at early R, but also during late phase. A slow wave of PMN accumulation at late R may be involved in the extension of infarction and endothelial dysfunction.

Comparison of AMP579 and adenosine in inhibition of cell-cell interaction between human neutrophil and vascular endothelial cell

The purpose of the present study was to compare inhibitory effects between AMP579 (a new adenosine analog) and adenosine (Ado) in attenuating an interaction between human neutrophils (PMNs) and cultured human umbilical vein endothelial cells (HUVECs). PMN activation was determined by superoxide anion (O2–) production and degranulation (myeloperoxidase release). Cell–cell interaction was quantitated by adherence of fluorescent labeled PMNs to HUVECs. AMP579 inhibited O2– (nM/5 × 106 PMN) from fMLP‐activated human PMNs (55.3 ± 3.1) in a concentration‐dependent manner ranging from 31.1 ± 2.9 at 10 nM to 11.7 ± 0.9 at 10 ± μM, all P < 0.01 vs. fMLP group. In the same dose range, however, Ado showed significant inhibition only at 1 μM (30.3 ± 4.1) and 10 ± μM (27.5 ± 4.3) vs. the fMLP group. The calculated IC50 value (0.11 ± 0.05 μM) in AMP579 group was significantly less than that in the Ado group (4.1 ± 1.2 μM). Although there was no group difference on PMN myeloperoxidase release (percent inhibition from fMLP) between AMP579 and Ado at concentrations greater than 1 μM (52.9 ± 5.2 vs. 46.4 ± 5.9), AMP579 showed significant attenuation of degranulation compared with Ado at 10 nM (31.7 ± 2.5 vs. 11.6 ± 1.9) and 100 nM (48.2 ± 4.6 vs. 25.6 ± 3.8), respectively, suggesting that AMP579 is more potent in inhibiting PMN activation. AMP579 reduced PMN adherence to TNFα‐stimulated HUVEC (fluorescent units/well) in a concentration‐dependent manner from 472 ± 32 at 10 nM to 214 ± 15 at 10 μM vs. 675 ± 54 in the TNFα group. At 10 nM and 100 nM, adenosine did not attenuate PMN adherence, while it showed significant inhibition at 1 (504 ± 45) and 10 μM (435 ± 50), respectively. The IC50 value (2.8 ± 1 μM) for AMP579 was significantly lower than that (41 ± 8 μM) in the Ado group. The results from the present study suggest that 1) AMP579 directly inhibits adherence‐independent superoxide radical generation and degranulation from activated PMNs and attenuates cell–cell interaction between PMNs and vascular endothelial cells by preventing damage on endothelial cells. 2) AMP579 exerts more potent protective effect compared with adenosine at a lower dose range, indicating its prospect for clinical application. Drug Dev. Res. 49:266–272, 2000.