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Wang J, Zou J, Shi Y, Zeng N, Guo D, Wang H, Zhao C, Luan F, Zhang X, Sun J. Traditional Chinese medicine and mitophagy: A novel approach for cardiovascular disease management. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 128:155472. [PMID: 38461630 DOI: 10.1016/j.phymed.2024.155472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, imposing an enormous economic burden on individuals and human society. Laboratory studies have identified several drugs that target mitophagy for the prevention and treatment of CVD. Only a few of these drugs have been successful in clinical trials, and most studies have been limited to animal and cellular models. Furthermore, conventional drugs used to treat CVD, such as antiplatelet agents, statins, and diuretics, often result in adverse effects on patients' cardiovascular, metabolic, and respiratory systems. In contrast, traditional Chinese medicine (TCM) has gained significant attention for its unique theoretical basis and clinical efficacy in treating CVD. PURPOSE This paper systematically summarizes all the herbal compounds, extracts, and active monomers used to target mitophagy for the treatment of CVD in the last five years. It provides valuable information for researchers in the field of basic cardiovascular research, pharmacologists, and clinicians developing herbal medicines with fewer side effects, as well as a useful reference for future mitophagy research. METHODS The search terms "cardiovascular disease," "mitophagy," "herbal preparations," "active monomers," and "cardiac disease pathogenesis" in combination with "natural products" and "diseases" were used to search for studies published in the past five years until January 2024. RESULTS Studies have shown that mitophagy plays a significant role in the progression and development of CVD, such as atherosclerosis (AS), heart failure (HF), myocardial infarction (MI), myocardial ischemia/reperfusion injury (MI/RI), cardiac hypertrophy, cardiomyopathy, and arrhythmia. Herbal compound preparations, crude extracts, and active monomers have shown potential as effective treatments for these conditions. These substances protect cardiomyocytes by inducing mitophagy, scavenging damaged mitochondria, and maintaining mitochondrial homeostasis. They display notable efficacy in combating CVD. CONCLUSION TCM (including herbal compound preparations, extracts, and active monomers) can treat CVD through various pharmacological mechanisms and signaling pathways by inducing mitophagy. They represent a hotspot for future cardiovascular basic research and a promising candidate for the development of future cardiovascular drugs with fewer side effects and better therapeutic efficacy.
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Affiliation(s)
- Jinhui Wang
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China
| | - Junbo Zou
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China
| | - Yajun Shi
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China
| | - Nan Zeng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan, PR China
| | - Dongyan Guo
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China
| | - He Wang
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China
| | - Chongbo Zhao
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China
| | - Fei Luan
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China.
| | - Xiaofei Zhang
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China.
| | - Jing Sun
- Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, School of Pharmacy, Shaanxi University of Chinese Medicine, Xi'an 712046, Shaanxi, PR China.
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Liu Y, Wei H, Li J. A review on SIRT3 and its natural small molecule activators as a potential Preventive and therapeutic target. Eur J Pharmacol 2024; 963:176155. [PMID: 37914065 DOI: 10.1016/j.ejphar.2023.176155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
Sirtuins (SIRTs) were originally characterized by yeast Sir2 as a lifespan regulator that is conserved in all three structural domains of bacteria, archaea and eukaryotes and belong to histone deacetylases consisting of seven members (SIRT1-SIRT7). Surprisingly, SIRTs have been shown to play important regulatory roles in almost all cellular functions, including mitochondrial biogenesis, oxidative stress, inflammation, cell growth, energy metabolism, neural function, and stress resistance. Among the SIRT members, sirtuin 3 (SIRT3) is one of the most important deacetylases that regulates the mitochondrial acetylation and plays a role in pathological processes, such as metabolism, DNA repair, oxidative stress, apoptosis and ferroptosis. Therefore, SIRT3 is considered as a potential target for the treatment of a variety of pathological diseases, including metabolic diseases, neurodegenerative diseases, age-related diseases and others. Furthermore, the isolation, screening, and development of SIRT3 signaling agonists, especially from natural products, have become a widely investigated objective. This paper describes the structure of SIRT3 protein, discusses the pathological process of SIRT3-mediated acetylation modification, and reviews the role of SIRT3 in diseases, SIRT3 activators and its related disease studies.
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Affiliation(s)
- Yuanyuan Liu
- College of Life Science, Northeast Agricultural University, Harbin, 150030, China
| | - Haidong Wei
- College of Life Science, Northeast Agricultural University, Harbin, 150030, China.
| | - Jianhong Li
- College of Life Science, Northeast Agricultural University, Harbin, 150030, China; Key Laboratory of Chicken Genetics and Breeding, Ministry of Agriculture and Rural Affairs, Harbin, 150030, China.
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Bergman I, Boyle D, Braver O, Gelikas S, Wexler Y, Omelchenko A, Assali A, Nussinovitch U. Ischemic Postconditioning Confers No Benefit to Left Ventricular Systolic Function: A Meta-Analysis of Cardiac Magnetic Resonance Imaging Results. Am J Cardiol 2023; 208:126-133. [PMID: 37837795 DOI: 10.1016/j.amjcard.2023.09.039] [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: 07/10/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/16/2023]
Abstract
Ischemic postconditioning (IPoC) is a technique suggested to reduce reperfusion injury in patients suffering acute ST-elevation myocardial infarction (STEMI), although its use is highly controversial. This meta-analysis aimed to evaluate the effect of IPoC with percutaneous coronary intervention in patients with acute STEMI, as measured by follow-up left ventricular ejection fraction (LVEF) on cardiac magnetic resonance imaging. The investigators searched PubMed, Embase, and Web of Science for all randomized controlled trials published during the last 2 decades. After the removal of duplicates, 2,021 articles from online databases had been identified using relevant search criteria. The included randomized controlled trials had studied patients with acute STEMI and Thrombolysis in Myocardial Infarction flow 0 to 1 at presentation and had measured follow-up LVEF using cardiac magnetic resonance imaging. Overall, 11 studies (n = 1,339 patients) qualified for inclusion. In each study, the control group did not differ significantly from the experimental group. The pooled data from included studies were analyzed using standardized mean difference between IPoC and control groups, and the 95% confidence interval for LVEF; the results were visualized using a forest plot. Bivariate regression analyses and 1-way analyses of LVEF coefficient ratios were done to isolate for various clinical and procedural parameters. An analysis of pooled data of the IPoC (n = 674) and control (n = 665) groups showed that IPoC did not significantly impact follow-up LVEF (using standardized mean difference 0.10, 95% confidence interval 0.00 to 0.21). Further analysis showed that IPoC did not improve follow-up LVEF when isolating for relevant clinical and procedural parameters. In conclusion, the use of IPoC as an adjunctive therapy to percutaneous coronary intervention seemingly provides no benefit to left ventricular systolic function, as quantified with cardiac magnetic resonance imaging, in patients with acute STEMI with Thrombolysis in Myocardial Infarction flow 0 to 1.
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Affiliation(s)
- Idan Bergman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rabin Medical Center, Petach Tikva, Israel
| | | | - Omri Braver
- Department of Cardiology, Barzilai Medical Center, Ashkelon, Israel
| | - Shaul Gelikas
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Yehuda Wexler
- Rappaport Faculty of Medicine and Research Institute, Technion - Israel Institute of Technology, Haifa, Israel
| | - Alexander Omelchenko
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - Abid Assali
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - Udi Nussinovitch
- Heart Institute at the Edith Wolfson Medical Center, Holon, Israel.
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Zhang J, Hu Y, Wang H, Hou J, Xiao W, Wen X, Wang T, Long P, Jiang H, Wang Z, Liu H, Chen X. Advances in research on the protective mechanisms of traditional Chinese medicine (TCM) in myocardial ischaemia-reperfusion injury. PHARMACEUTICAL BIOLOGY 2022; 60:931-948. [PMID: 35587352 PMCID: PMC9132412 DOI: 10.1080/13880209.2022.2063342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/31/2022] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT Developing effective drugs to treat myocardial ischaemia-reperfusion (MI/R) injury is imperative. Traditional Chinese medicines (TCMs) have had considerable success in the treatment of cardiovascular diseases. Elucidating the mechanisms by which TCMs improve MI/R injury can supplement the literature on MI/R prevention and treatment. OBJECTIVE To summarise TCMs and their main protective mechanisms against MI/R injury reported over the past 40 years. METHODS Relevant literature published between 1980 and 2020 in Chinese and English was retrieved from the Web of Science, PubMed, SpringerLink, PubMed Central, Scopus, and Chinese National Knowledge Infrastructure (CNKI) databases. Search terms included 'medicinal plants', 'myocardial ischaemia reperfusion injury', 'Chinese medicine prescriptions', 'mechanisms', 'prevention', 'treatment' and 'protection'. For inclusion in the analysis, medicinal plants had to be searchable in the China Medical Information Platform and Plant Database. RESULTS We found 71 medicinal species (from 40 families) that have been used to prevent MI/R injury, of which Compositae species (8 species) and Leguminosae species (7 species) made up the majority. Most of the effects associated with these plants are described as antioxidant and anti-inflammatory. Furthermore, we summarised 18 kinds of Chinese compound prescriptions, including the compound Danshen tablet and Baoxin pill, which mainly reduce oxidative stress and regulate mitochondrial energy metabolism. DISCUSSION AND CONCLUSIONS We summarised TCMs that protect against MI/R injury and their pharmacological mechanisms. This in-depth explanation of the roles of TCMs in MI/R injury protection provides a theoretical basis for the research and development of TCM-based treatment drugs.
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Affiliation(s)
- Jiexin Zhang
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu/Affiliated Hospital of Southwest, Jiaotong University, Chengdu, Sichuan, China
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yonghe Hu
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Han Wang
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu/Affiliated Hospital of Southwest, Jiaotong University, Chengdu, Sichuan, China
| | - Jun Hou
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Wenjing Xiao
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Xudong Wen
- Department of Gastroenterology, The First People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Tingting Wang
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Pan Long
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Hezhong Jiang
- Faculty of Life Sciences and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Zhanhao Wang
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu/Affiliated Hospital of Southwest, Jiaotong University, Chengdu, Sichuan, China
| | - Huawei Liu
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu/Affiliated Hospital of Southwest, Jiaotong University, Chengdu, Sichuan, China
| | - Xin Chen
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu/Affiliated Hospital of Southwest, Jiaotong University, Chengdu, Sichuan, China
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Resveratrol Reestablishes Mitochondrial Quality Control in Myocardial Ischemia/Reperfusion Injury through Sirt1/Sirt3-Mfn2-Parkin-PGC-1α Pathway. Molecules 2022; 27:molecules27175545. [PMID: 36080311 PMCID: PMC9457908 DOI: 10.3390/molecules27175545] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023] Open
Abstract
Resveratrol is a natural polyphenol found in various plants. It has been widely studied on cardiovascular disorders. It is known that resveratrol can activate Sirtuin proteins and participate in cellular energy metabolism through a Sirtuin-dependent pathway. Here, we hypothesized that resveratrol may protect against myocardial ischemia/reperfusion injury (MIRI) through the target of Sirt1/Sirt3 on mitochondrial dynamics, cardiac autophagy, bioenergetics and oxidative damage in hypoxia/reoxygenation (H/R)-induced neonatal rat cardiomyocytes. We observed that resveratrol could activate the Sirt1/Sirt3-FoxO pathway on myocardial mitochondria in H/R cardiomyocytes. Subsequently, we found that resveratrol repaired the fission–fusion balance, autophagic flux and mitochondrial biosynthesis compared by H/R group. These changes were followed by increased functional mitochondrial number, mitochondrial bioenergetics and a better mitochondrial antioxidant enzyme system. Meanwhile, these effects were antagonized by co-treatment with Selisistat (Ex527), a Sirtuin inhibitor. Together, our findings uncover the potential contribution of resveratrol in reestablishing a mitochondrial quality control network with Parkin, Mfn2 and PGC-1α as the key nodes.
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Fabris E, Selvarajah A, Tavenier A, Hermanides R, Kedhi E, Sinagra G, van’t Hof A. Complementary Pharmacotherapy for STEMI Undergoing Primary PCI: An Evidence-Based Clinical Approach. Am J Cardiovasc Drugs 2022; 22:463-474. [PMID: 35316483 PMCID: PMC9468081 DOI: 10.1007/s40256-022-00531-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
Antithrombotic therapy is the cornerstone of pharmacological treatment in patients undergoing primary percutaneous coronary intervention (PCI). However, the acute management of ST elevation myocardial infarction (STEMI) patients includes therapy for pain relief and potential additional strategies for cardioprotection. The safety and efficacy of some commonly used treatments have been questioned by recent evidence. Indeed a concern about morphine use is the interaction between opioids and oral P2Y12 inhibitors; early beta-blocker treatment has shown conflicting results for the improvement of clinical outcomes; and supplemental oxygen therapy lacks benefit in patients without hypoxia and may be of potential harm. Other additional strategies remain disappointing; however, some treatments may be selectively used. Therefore, we intend to present a critical updated review of complementary pharmacotherapy for a modern treatment approach for STEMI patients undergoing primary PCI.
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Kang IS, Kwon K. Potential application of biomimetic exosomes in cardiovascular disease: focused on ischemic heart disease. BMB Rep 2022. [PMID: 34903320 PMCID: PMC8810547 DOI: 10.5483/bmbrep.2022.55.1.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease, especially ischemic heart disease, is a major cause of mortality worldwide. Cardiac repair is one of the most promising strategies to address advanced cardiovascular diseases. Despite moderate improvement in heart function via stem cell therapy, there is no evidence of significant improvement in mortality and morbidity beyond standard therapy. The most salutary effect of stem cell therapy are attributed to the paracrine effects and the stem cell-derived exosomes are known as a major contributor. Hence, exosomes are emerging as a promising therapeutic agent and potent biomarkers of cardiovascular disease. Furthermore, they play a role as cellular cargo and facilitate intercellular communication. However, the clinical use of exosomes is hindered by the absence of a standard operating procedures for exosome isolation and characterization, problems related to yield, and heterogeneity. In addition, the successful clinical application of exosomes requires strategies to optimize cargo, improve targeted delivery, and reduce the elimination of exosomes. In this review, we discuss the basic concept of exosomes and stem cell-derived exosomes in cardiovascular disease, and introduce current efforts to overcome the limitations and maximize the benefit of exosomes including engineered biomimetic exosomes.
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Affiliation(s)
- In Sook Kang
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul 07804, Korea
| | - Kihwan Kwon
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul 07804, Korea
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Chelluboina B, Vemuganti R. Therapeutic potential of nutraceuticals to protect brain after stroke. Neurochem Int 2020; 142:104908. [PMID: 33220386 DOI: 10.1016/j.neuint.2020.104908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
Stroke leads to significant neuronal death and long-term neurological disability due to synergistic pathogenic mechanisms. Stroke induces a change in eating habits and in many cases, leads to undernutrition that aggravates the post-stroke pathology. Proper nutritional regimen remains a major strategy to control the modifiable risk factors for cardiovascular and cerebrovascular diseases including stroke. Studies indicate that nutraceuticals (isolated and concentrated form of high-potency natural bioactive substances present in dietary nutritional components) can act as prophylactic as well as adjuvant therapeutic agents to prevent stroke risk, to promote ischemic tolerance and to reduce post-stroke consequences. Nutraceuticals are also thought to regulate blood pressure, delay neurodegeneration and improve overall vascular health. Nutraceuticals potentially mediate these effects by their powerful antioxidant and anti-inflammatory properties. This review discusses the studies that have highlighted the translational potential of nutraceuticals as stroke therapies.
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Affiliation(s)
- Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA; William S. Middleton Veterans Administration Hospital, Madison, WI, USA.
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Comparison of infarction size, complete ST-segment resolution incidence, mortality and re-infarction and target vessel revascularization between remote ischemic conditioning and ischemic postconditioning in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:278-286. [PMID: 33597992 PMCID: PMC7863805 DOI: 10.5114/aic.2020.99262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Due to higher morbidity and mortality, ST-segment elevation myocardial infarction (STEMI) causes many public health problems. Aim To observe effects of remote ischemic conditioning (RIC) and ischemic postconditioning (IPC) on patients diagnosed as STEMI undergoing primary percutaneous coronary intervention (pPCI). Material and methods This meta-analysis was conducted using indirect comparison by conducting a network meta-analysis (NMA). We conducted searches by utilizing PubMed and the other databases to identify randomized controlled trials (RCTs) that described IPC or RIC treated patients diagnosed with STEMI during processes of pPCI. Enzymatic infarct size and infarction size were evaluated and cardiac events were assessed during the follow-up. Results Pooled results showed that lower enzymatic infarction size was associated with the RIC group compared to the IPC group (IPC vs. RIC: standardized mean difference (SMD) = 1.126; 95% confidence interval (CI): 0.756–1.677). Compared with IPC, RIC significantly reduced infarction size, which was assessed using cardiac magnetic resonance (CMR) (SMD = 1.113; 95% CI: 0.674–1.837). We noted a potential toward greater complete ST-segment resolution in RIC patients compared with IPC patients (odds ratio (OR) = 0.821; 95% CI: 0.166–4.051). No significant difference existed in all-cause mortality (OR = 2.211; 95% CI: 0.845–5.784), Target vessel revascularization (TVR) (OR = 0.045; 95% CI: 0.001–.662) or re-infarction (OR = 1.763; 95% CI: 0.741–4.193). Conclusions This meta-analysis suggested RIC was correlated with significantly smaller infarction size compared to IPC. No significant superiority between RIC and IPC has been observed in this study on cSTR incidence, mortality and re-infarction or TVR.
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Wang Y, Zhang K, Qi X, Yang G, Wang H, Zhang Z, Yang B. Effects of propofol on LC3II and mTOR/p-mTOR expression during ischemia-reperfusion myocardium injury in rats with type 2 diabetes mellitus. Exp Ther Med 2020; 19:2441-2448. [PMID: 32256720 PMCID: PMC7098214 DOI: 10.3892/etm.2020.8499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 11/05/2019] [Indexed: 01/11/2023] Open
Abstract
To investigate the effects of propofol on myocardial ischemia reperfusion in rats with type 2 diabetes, male adult rats were divided into five groups: Sham-operation (CC), ischemia-reperfusion (CI), low-dose propofol (LP), moderate-dose propofol (MP) and high-dose propofol (HP). The LP, MP and HP groups were administered with 6, 12 and 24 mg/kg/h propofol, respectively, prior to occlusion. Heart rate (HR), left ventricular systolic pressure (LVSP) and the rate (dp/dt max) of left ventricular pressure rise in early systole (±dp/dt max) were recorded. The role of autophagy was also studied by measuring the levels of superoxide dismutase (SOD), malondialdehyde (MDA), autophagy marker protein LC3II, mammalian target of rapamycin (mTOR)/phosphorylate (p)-mTOR and cardiac troponin T (cTnT). The myocardial morphological features were assessed using light and electron microscopy. The present results demonstrated that the HR, LVSP, +dp/dt and -dp/dt levels in the propofol groups (LP, MP and HP) were significantly increased (P<0.05) when compared with the CI group. The myocardial cells in the MP group showed mild edematous changes and partially dissolved mitochondrial cristae and membrane rupture. SOD, cTnT and MDA levels were significantly decreased (P<0.05), mTOR expression decreased significantly (P<0.05) and p-mTOR expression increased significantly in the MP group (P<0.05). The present study demonstrated the protective effects of propofol in T2DM rats exhibiting MIRI, with an optimal protective effect at an infusion rate of 12 mg/kg/h. Additionally, the results revealed that propofol led to significant reductions in LC3II and mTOR serum levels and the inhibition of autophagy in myocardial cells.
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Affiliation(s)
- Ying Wang
- Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Kecheng Zhang
- Department of Medicine, Hebei University, Baoding, Hebei 071000, P.R. China
| | - Xiuru Qi
- Department of Medicine, Hebei University, Baoding, Hebei 071000, P.R. China
| | - Guang Yang
- Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Hongjie Wang
- Department of Medicine, Hebei University, Baoding, Hebei 071000, P.R. China
| | - Zhe Zhang
- Hebei Medical Science and Technology Development Research Center, Shijiazhuang, Hebei 051000, P.R. China
| | - Baofeng Yang
- Health and Family Planning Commission of Hebei, Shijiazhuang, Hebei 050000, P.R. China
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Nickolay T, Nichols S, Ingle L, Hoye A. Exercise Training as a Mediator for Enhancing Coronary Collateral Circulation: A Review of the Evidence. Curr Cardiol Rev 2019; 16:212-220. [PMID: 31424373 PMCID: PMC7536817 DOI: 10.2174/1573403x15666190819144336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022] Open
Abstract
Coronary collateral vessels supply blood to areas of myocardium at risk after arterial occlusion. Flow through these channels is driven by a pressure gradient between the donor and the occluded artery. Concomitant with increased collateral flow is an increase in shear force, a potent stimulus for collateral development (arteriogenesis). Arteriogenesis is self-limiting, often ceasing prematurely when the pressure gradient is reduced by the expanding lumen of the collateral vessel. After the collateral has reached its self-limited maximal conductance, the only way to drive further increases is to re-establish the pressure gradient. During exercise, the myocardial oxygen demand is increased, subsequently increasing coronary flow. Therefore, exercise may represent a means of driving augmented arteriogenesis in patients with stable coronary artery disease. Studies investigating the ability of exercise to drive collateral development in humans are inconsistent. However, these inconsistencies may be due to the heterogeneity of assessment methods used to quantify change. This article summarises current evidence pertaining to the role of exercise in the development of coronary collaterals, highlighting areas of future research.
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Affiliation(s)
- Thomas Nickolay
- Hull York Medical School, University of Hull, Hull, HU6 7RX, United Kingdom
| | - Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
| | - Lee Ingle
- Sports Health and Exercise Science, University of Hull, Hull, HU6 7RX, United Kingdom
| | - Angela Hoye
- Hull York Medical School, University of Hull, Hull, HU6 7RX, United Kingdom
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Recent Advances in Pharmacological and Non-Pharmacological Strategies of Cardioprotection. Int J Mol Sci 2019; 20:ijms20164002. [PMID: 31426434 PMCID: PMC6720817 DOI: 10.3390/ijms20164002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 02/08/2023] Open
Abstract
Ischemic heart diseases (IHD) are the leading cause of death worldwide. Although the principal form of treatment of IHD is myocardial reperfusion, the recovery of coronary blood flow after ischemia can cause severe and fatal cardiac dysfunctions, mainly due to the abrupt entry of oxygen and ionic deregulation in cardiac cells. The ability of these cells to protect themselves against injury including ischemia and reperfusion (I/R), has been termed “cardioprotection”. This protective response can be stimulated by pharmacological agents (adenosine, catecholamines and others) and non-pharmacological procedures (conditioning, hypoxia and others). Several intracellular signaling pathways mediated by chemical messengers (enzymes, protein kinases, transcription factors and others) and cytoplasmic organelles (mitochondria, sarcoplasmic reticulum, nucleus and sarcolemma) are involved in cardioprotective responses. Therefore, advancement in understanding the cellular and molecular mechanisms involved in the cardioprotective response can lead to the development of new pharmacological and non-pharmacological strategies for cardioprotection, thus contributing to increasing the efficacy of IHD treatment. In this work, we analyze the recent advances in pharmacological and non-pharmacological strategies of cardioprotection.
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Huang L, Liu Z, Wang L. Effects of Ischemic Post-Conditioning on the Expressions of LC3-II and Beclin-1 in the Hippocampus of Rats After Cerebral Ischemia and Reperfusion. Open Life Sci 2019; 14:179-190. [PMID: 33817150 PMCID: PMC7874818 DOI: 10.1515/biol-2019-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/06/2018] [Indexed: 12/26/2022] Open
Abstract
Objective To investigate the effects of postconditioning ischemia on the expressions of the hippocampus neuron autophagy-related proteins LC3-II and Beclin-1 in rats following cerebral ischemia reperfusion. Methods A total of 128 male Sprague-Dawley rats were randomly divided into 4 groups: control, cerebral ischemia-reperfusion (IR), cerebral ischemia post-conditioning group (IP), and PI3K/Akt inhibitor (LY294002). The rat cerebral ischemia model was established by the improved Pulsinelli four vessel occlusion method. The durations across the platform and escape latent period were recorded using the water maze experiment. The changes in cell morphology and the number of surviving hippocampal neurons were detected by hematoxylin-eosin (HE) staining. The cells with Beclin-1 and LC3-II in the hippocampal region were detected by immunohistochemical staining and Western blotting. Results When compared with the IR at 48 and 72 h, the number of platform passes increased and the escape latency time was shortened. Consequently, the HE staining detected positive cells with LC3-II and Beclin-1 increased in number at each time point in immunohistochemistry and the expressions of the LC3-II and Beclin-1 proteins were improved in the IP (P < 0.05). Conclusions Cerebral ischemic post-conditioning promoted the expressions of autophagy-related proteins LC3-II and Beclin-1 while relieving the injuries caused by cerebral ischemia reperfusion.
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Affiliation(s)
- Liquan Huang
- Department ICU of the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Zizhuo Liu
- Department emergency of Tianjin medical university general hospital, Tianjin, China
| | - Lingcong Wang
- Department ICU of the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
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Mattlage AE, Sutter EN, Bland MD, Surkar SM, Gidday JM, Lee JM, Hershey T, Chen L, Lang CE. Dose of remote limb ischemic conditioning for enhancing learning in healthy young adults. Exp Brain Res 2019; 237:1493-1502. [PMID: 30915491 DOI: 10.1007/s00221-019-05519-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
Remote limb ischemic conditioning (RLIC) is a technique in which tissues distant from the target organ are exposed to brief, sub-lethal bouts of ischemia. The effects of remotely applied ischemic conditioning are systemically transferred to the target organ, and typically manifested as protection from subsequent ischemic injury. Previous studies in our lab have found and confirmed that RLIC enhances learning and retention during motor training on a balance task. The current study tested the effect of RLIC dose (number of cycles) on learning enhancement in young, healthy adults. Forty healthy participants age 18-40 years were randomized to receive 5 cycles of sham conditioning (n = 9), 3 cycles of RLIC (n = 11), 4 cycles of RLIC (n = 10), or 5 cycles of RLIC (n = 10) using a blood pressure cuff around the upper arm once a day for 7 consecutive weekdays (Days 1-7). Participants concurrently trained on a balance task, bimanual cup stacking task, and a discrete sequence production task on Days 3-7. Change in performance on each of the three tasks was compared across groups. Participants in all four groups improved their performance on each of the three tasks over time. However, RLIC at any dose did not enhance learning on any of the three tasks. While RLIC is safe, inexpensive, and clinically feasible, reproducibility may be challenged by unidentified factors, raising critical challenges to the straightforward translation of RLIC for improving rehabilitation outcomes in individuals recovering from neurological injury.
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Affiliation(s)
- Anna E Mattlage
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
| | - Ellen N Sutter
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Marghuretta D Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Swati M Surkar
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey M Gidday
- Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Neuroscience, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
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Tavares JGP, Errante PR, Govato TCP, Vasques ÊR, Ferraz RRN, Taha MO, Menezes-Rodrigues FS, Caricati-Neto A. Cardioprotective effect of preconditioning is more efficient than postconditioning in rats submitted to cardiac ischemia and reperfusion1. Acta Cir Bras 2018; 33:588-596. [PMID: 30110060 DOI: 10.1590/s0102-865020180070000004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/24/2018] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To investigate the cardioprotective effects of ischemic preconditioning (preIC) and postconditioning (postIC) in animal model of cardiac ischemia/reperfusion. METHODS Adult rats were submitted to protocol of cardiac ischemia/reperfusion (I/R) and randomized into three experimental groups: cardiac I/R (n=33), preCI + cardiac I/R (n=7) and postCI + cardiac I/R (n=8). After this I/R protocol, the incidence of ventricular arrhythmia (VA), atrioventricular block (AVB) and lethality (LET) was evaluated using the electrocardiogram (ECG) analysis. RESULTS After reestablishment of coronary blood flow, we observed variations of the ECG trace with increased incidence of ventricular arrhythmia (VA) (85%), atrioventricular block (AVB) (79%), and increase of lethality (70%) in cardiac I/R group. The comparison between I/R + preIC group with I/R group demonstrated significant reduction in VA incidence to 28%, AVB to 0% and lethality to 14%. The comparison of I/R + postIC group with I/R group was observed significance reduction in AVB incidence to 25% and lethality to 25%. CONCLUSION The preconditioning strategies produce cardioprotection more efficient that postconditioning against myocardial dysfunctions and lethality by cardiac ischemia and reperfusion.
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Affiliation(s)
- José Gustavo Padrão Tavares
- Fellow PhD degree, Postgraduate Program in Pharmacology, Universidade Federal de São Paulo (UNIFESP), Brazil. Conception and design of the study, analysis and interpretation of data, manuscript writing
| | - Paolo Ruggero Errante
- Fellow PhD degree, Postgraduate Program in Pharmacology, UNIFESP, Sao Paulo-SP, Brazil. Analysis and interpretation of data, manuscript writing
| | - Tânia Carmem Peñaranda Govato
- Assistant Professor, Department of Pharmacology, Faculdade de Medicina do ABC (FMABC), Santo Andre-SP, Brazil. Statistical analysis
| | - Ênio Rodrigues Vasques
- Fellow PhD degree, Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo (USP), Brazil. Interpretation of electrocardiogram
| | - Renato Ribeiro Nogueira Ferraz
- Full Professor, Program in Management of Health System (PMPA-GSS), Universidade Nove de Julho (UNINOVE), Sao Paulo-SP, Brazil. Critical revision
| | - Murched Omar Taha
- Associate Professor, Department of Surgery, UNIFESP, Sao Paulo-SP, Brazil. Technical procedures
| | | | - Afonso Caricati-Neto
- Associate Professor, Department of Pharmacology, UNIFESP, Sao Paulo-SP, Brazil. Conception and design of the study, critical revision
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Wang W, Huang X, Sun Y, Zhang J. Blood rheology of angina pectoris patients with myocardial injury after ischemia reperfusion and its effect on thromboxane B 2 levels. Exp Ther Med 2018; 15:769-772. [PMID: 29399084 PMCID: PMC5772472 DOI: 10.3892/etm.2017.5449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/24/2017] [Indexed: 11/08/2022] Open
Abstract
This study investigated the changes in the blood rheology of patients with angina pectoris and ischemia reperfusion injury and their effect on thromboxane B2 (TXB2) levels to examine their relationship. Forty patients with unstable angina pectoris who underwent elective percutaneous coronary intervention (PCI) were selected for the unstable angina group (UA group) and forty patients deemed free of coronary heart disease by coronary angiography were selected for the control group. Venous blood samples were drawn from all participants; patients in the UA group had blood drawn 1 day before and 1 day after the PCI procedure. Blood samples were used to analyze blood rheology and examine hemodynamic parameters, at the same time radioimmunoassay was applied to measure the concentrations of serum endothelin-1 (ET-1) and TXB2, and an automatic biochemical analyzer was used to detect the content of superoxide dismutase (SOD) and malondialdehyde (MDA). Our results showed the patients in the UA group all presented hyperviscosity; however the levels were higher for the patients in the UA group (after surgery) than for those in the UA group (before surgery). Patients in the control group exhibited normal levels, and the differences among groups were significant in pairwise comparisons (P<0.05). The levels of ET-1 and TXB2 in the UA group were increased compared with those in control group and they were highest after surgery (P<0.05). For the patients in the UA group, the serum TXB2 concentration increased gradually along with the increase in risk stratification. There were significant differences in comparisons between different strata and between UA patients and those in the control group (P<0.05). The serum SOD activity levels were lowest in the UA group (after surgery), higher in the UA group (before surgery) and highest in the control group. Conversely, the MDA content was highest in the UA group (after surgery), lower in the UA group (before surgery) and smallest in the control group; there were significant differences in pairwise comparisons. Based on our findings, a hyperviscosity syndrome was manifested in the blood rheology of patients with angina pectoris and ischemia reperfusion injury. The higher than normal TXB2 levels can be used as a marker of platelet activation and a reference for clinical risk stratification, thus having great significance for the prevention and treatment of ischemia reperfusion injury and assessment of disease progression.
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Affiliation(s)
- Wenlong Wang
- Department of Emergency, Beijing Shijitan Hospital, Beijing 100038, P.R. China
| | - Xiaohui Huang
- Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yiyong Sun
- Department of Respiratory Medicine, People's Hospital of Zhangqiu, Jinan, Shandong 250200, P.R. China
| | - Jinying Zhang
- Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
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Tauskela JS, Bourourou M, Blondeau N. Tackling issues in the path toward clinical translation in brain conditioning: Potential offered by nutraceuticals. Brain Circ 2017; 3:78-86. [PMID: 30276308 PMCID: PMC6126266 DOI: 10.4103/bc.bc_8_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/23/2017] [Accepted: 05/31/2017] [Indexed: 11/21/2022] Open
Abstract
Brief periods of ischemia have been shown in many experimental setups to provide tolerance against ischemia in multiple organs including the brain, when administered before (preconditioning) or even after (postconditioning) the normally lethal ischemia. In addition to these so-called ischemic conditionings, many pharmacological and natural agents (e.g., chemicals and nutraceuticals) can also act as potent pre- and post-conditioners. Deriving from the original concept of ischemic preconditioning, these various conditioning paradigms may be promising as clinical-stage therapies for prevention of ischemic-related injury, especially stroke. As no proven experimentally identified strategy has translated into clinical success, the experimental induction of neuroprotection using these various conditioning paradigms has raised several questions, even before considering translation to clinical studies in humans. The first aim of the review is to consider key questions on preclinical studies of pre- or post-conditioning modalities including those induced by chemical or nutraceuticals. Second, we make the argument that several key issues can be addressed by a novel concept, nutraceutical preconditioning. Specifically, α-linolenic acid (alpha-linolenic acid [ALA] an omega-3 polyunsaturated fatty acid), contained in plant-derived edible products, is essential in the daily diet, and a body of work has identified ALA as a pre- and post-conditioner of the brain. Nutritional intervention and functional food development are an emerging direction for preventing stroke damage, offering the potential to improving clinical outcomes through activation of the endogenous protective mechanisms known collectively as conditioning.
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Affiliation(s)
- Joseph S Tauskela
- Department of Translational Bioscience, Human Health Therapeutics, National Research Council Canada, Ottawa, Ontario, Canada K1A 0R6
| | - Miled Bourourou
- University of Côte d'Azur, Centre National de la Recherche Scientifique, IPMC, UMR7275 Sophia Antipolis, F-06560, France
| | - Nicolas Blondeau
- University of Côte d'Azur, Centre National de la Recherche Scientifique, IPMC, UMR7275 Sophia Antipolis, F-06560, France
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Mentias A, Mahmoud AN, Elgendy IY, Elgendy AY, Barakat AF, Abuzaid AS, Saad M, Kapadia SR. Ischemic postconditioning during primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 90:1059-1067. [PMID: 28296005 DOI: 10.1002/ccd.26965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/10/2016] [Accepted: 01/16/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although some studies have shown potential benefit for ischemic postconditioning (IPoC) during primary percutaneous coronary intervention (PCI) in improving surrogate markers of reperfusion and infarction size, the benefit of this approach on clinical outcomes remains unknown. METHODS AND RESULTS Electronic databases were searched for randomized clinical trials that compared IPoC versus conventional treatment during primary PCI. Random effects DerSimonian-Laird risk ratios (RR) were calculated for different clinical and surrogate outcomes. The main outcome of this analysis was all-cause mortality. A total of 25 trials involving 3,619 patients were included in the analysis. At a mean follow up of 14 months (95% confidence interval (CI) 8.6-19.4 months), the incidence of all-cause mortality was 4.9% [95% CI 3.8-6.0%] in the IPoC group versus 3.8% [95% CI 1.9-5.7%] in the control group (RR 0.92, 95% CI 0.68-1.24, P = 0.74). The risk of reinfarction (2.7% [95% CI 1.1-4.3%] vs. 2.3% [0.6-4.0%]; RR 1.29, 95% CI 0.62-2.68, P = 0.72), heart failure (3.6% [95% CI 2.0-5.1%] vs. 5.7% [95% CI 3.3-8.2%]; RR 0.77, 95% CI 0.58-1.06, P = 0.24), target vessel revascularization (3.2% [95% CI 1.7-4.7%] vs. 2.4% [95% CI 1.4-3.3%]; RR 1.40, 95% CI 0.90-2.20, P = 0.20), and stent thrombosis (2.4% [95% CI 1.1-3.8%] vs. 1.8% [95% CI 0.5-3.2%]); RR 1.50, 95% CI 0.60-3.70, P = 0.40) was similar in both groups. CONCLUSIONS IPoC does not appear to reduce the risk of clinical adverse events in patients with ST-elevation myocardial infarction undergoing primary PCI. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Amgad Mentias
- Department of Medicine, Division of Cardiovascular Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ahmed N Mahmoud
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Islam Y Elgendy
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Akram Y Elgendy
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Amr F Barakat
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - A Sami Abuzaid
- Division of Cardiovascular medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, Delaware
| | - Marwan Saad
- Department of Medicine, Division of cardiovascular diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Samir R Kapadia
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio
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19
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Ma J, Luo Y, Sevag Packard RR, Ma T, Ding Y, Abiri P, Tai YC, Zhou Q, Shung KK, Li R, Hsiai T. Ultrasonic Transducer-Guided Electrochemical Impedance Spectroscopy to Assess Lipid-Laden Plaques. SENSORS AND ACTUATORS. B, CHEMICAL 2016; 235:154-161. [PMID: 27773967 PMCID: PMC5068578 DOI: 10.1016/j.snb.2016.04.179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Plaque rupture causes acute coronary syndromes and stroke. Intraplaque oxidized low density lipoprotein (oxLDL) is metabolically unstable and prone to induce rupture. We designed an intravascular ultrasound (IVUS)-guided electrochemical impedance spectroscopy (EIS) sensor to enhance the detection reproducibility of oxLDL-laden plaques. The flexible 2-point micro-electrode array for EIS was affixed to an inflatable balloon anchored onto a co-axial double layer catheter (outer diameter = 2 mm). The mechanically scanning-driven IVUS transducer (45 MHz) was deployed through the inner catheter (diameter = 1.3 mm) to the acoustic impedance matched-imaging window. Water filled the inner catheter to match acoustic impedance and air was pumped between the inner and outer catheters to inflate the balloon. The integrated EIS and IVUS sensor was deployed into the ex vivo aortas dissected from the fat-fed New Zealand White (NZW) rabbits (n=3 for fat-fed, n= 5 normal diet). IVUS imaging was able to guide the 2-point electrode to align with the plaque for EIS measurement upon balloon inflation. IVUS-guided EIS signal demonstrated reduced variability and increased reproducibility (p < 0.0001 for magnitude, p < 0.05 for phase at < 15 kHz) as compared to EIS sensor alone (p < 0.07 for impedance, p < 0.4 for phase at < 15 kHz). Thus, we enhanced topographic and EIS detection of oxLDL-laden plaques via a catheter-based integrated sensor design to enhance clinical assessment for unstable plaque.
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Affiliation(s)
- Jianguo Ma
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Yuan Luo
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - René R. Sevag Packard
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Teng Ma
- Department of Biomedical Engineering and Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Yichen Ding
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Parinaz Abiri
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Yu-Chong Tai
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Qifa Zhou
- Department of Biomedical Engineering and Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Kirk K. Shung
- Department of Biomedical Engineering and Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Rongsong Li
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Tzung Hsiai
- Department of Bioengineering, School of Engineering and Applied Sciences, University of California, Los Angeles, CA 90095, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Electrical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
- Corresponding Author: Tzung K. Hsiai, M.D., Ph.D., Department of Medicine (Cardiology) and Bioengineering, University of California, Los Angeles, 10833 Le Conte Ave., CHS17-054A, Los Angeles, CA 90095-1679, , Telephone: 310-268-3839
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Belardi JA, Albertal M. Ischemic Postconditioning: Not Giving Up Yet. Catheter Cardiovasc Interv 2016; 88:514-515. [PMID: 27759929 DOI: 10.1002/ccd.26788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/31/2015] [Accepted: 08/24/2015] [Indexed: 11/10/2022]
Abstract
Ischemic postconditioning protects against reperfusion injury. Adjunctive use of manual thrombus aspiration improves reperfusion results in patients undergoing primary angioplasty. Combining both strategies (ischemic postconditioning and thrombus aspiration) may have additive effects in terms of myocardial salvage. The PORT trial will study the role of ischemic postconditioning in patients undergoing primary angioplasty with thrombus aspiration.
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Affiliation(s)
- Jorge A Belardi
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Mariano Albertal
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Vanezis AP, Rodrigo GC, Squire IB, Samani NJ. Remote ischaemic conditioning and remodelling following myocardial infarction: current evidence and future perspectives. Heart Fail Rev 2016; 21:635-43. [PMID: 27177446 PMCID: PMC4983281 DOI: 10.1007/s10741-016-9560-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Remote ischaemic conditioning (rIC) has demonstrated its effectiveness as a powerful cardioprotective tool in number of preclinical and limited clinical settings. More recently, ischaemic postconditioning given after an ischaemic event such as a myocardial infarction (MI) has shown not only to reduce infarct size but also to have beneficial effects on acute remodelling post-MI and to reduce the burden of heart failure and other detrimental outcomes. Building on this platform, repeated rIC over a number of days has the potential to augment the protective process even further. This review considers the current evidence base from which the concept of rIC in the setting of post-MI remodelling has grown. It also discusses the ongoing and planned clinical trials which are attempting to elucidate whether the protection imparted by rIC in the preclinical setting can be translated to the clinic and become a realistic weapon in the clinician’s armoury to tackle acute remodelling and heart failure post-MI.
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Affiliation(s)
- A P Vanezis
- Department of Cardiovascular Sciences, Glenfield General Hospital, University of Leicester, Leicester, LE3 9QP, UK.
| | - G C Rodrigo
- Department of Cardiovascular Sciences, Glenfield General Hospital, University of Leicester, Leicester, LE3 9QP, UK
| | - I B Squire
- Department of Cardiovascular Sciences, Glenfield General Hospital, University of Leicester, Leicester, LE3 9QP, UK
| | - N J Samani
- Department of Cardiovascular Sciences, Glenfield General Hospital, University of Leicester, Leicester, LE3 9QP, UK
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Gao J, Luo J, Liu F, Zheng Y, Chen B, Chen Q, Yang Y. Short-and long-term effects of ischemic postconditioning in STEMI patients: a meta-analysis. Lipids Health Dis 2015; 14:147. [PMID: 26573572 PMCID: PMC4647593 DOI: 10.1186/s12944-015-0151-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/06/2015] [Indexed: 01/28/2023] Open
Abstract
Background Compelling evidence from large randomized trials demonstrates the salutary effects of ischemic postconditioning on cardioprotection against ischemic/reperfusion injury. However, some studies appear negative findings. This study was designed to assess the short-and long-term effects of postconditioning (Poc) in studies including evolving ST-elevation myocardial infarction (STEMI). Methods Relevant studies were identified through an electronic literature search from the PubMed, Library of Congress, Embase, Cochrane Central Register of Controlled Trials, and ISI Web of Science. Studies published up to December 2014 were eligible for inclusion. Patients older than 18 years presenting within 12 h of the first STEMI and eligible for angioplasty were considered for the study. Results The 25 trials allocated 1136 patients to perform locational postconditioning cycles at the onset of reperfusion and 1153 patients to usual percutaneous coronary intervention (PCI). Ischemic postconditioning demonstrated a decrease in serum cardiac enzymes creatine kinase (CK) and CK-MB (P < 0.00001 and P =0.25, respectively) in the subgroup analysis based on direct stenting. Reduction in infarct size by imaging was showed during7 days after myocardial infarction (P =0.01), but not in the longterm (P = 0.08). The wall motion score index was improved in both the short term within 7 days (P = 0.009) and the long term over 6 months after receiving Poc (P = 0.02). All included studies were limited by the high risk of performance and publication bias. Conclusions Ischemic postconditioning by brief interruptions of coronary blood flow at the onset of reperfusion after PCI appears to be superior to PCI alone in reducing myocardial injury and improving left ventricular function, especially in patients who have received direct stenting in PCI.
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Affiliation(s)
- Jing Gao
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R., China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, 830054, P.R., China.,Department of endocrinology, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, P.R.China
| | - Junyi Luo
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R., China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, 830054, P.R., China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, 830054, P.R., China
| | - Yingying Zheng
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R., China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, 830054, P.R., China
| | - Bangdang Chen
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, 830054, P.R., China
| | - Qingjie Chen
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R., China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, 830054, P.R., China
| | - Yining Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P.R., China. .,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, 830054, P.R., China.
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Yetgin T, van Kranenburg M, Ten Cate T, Duncker DJ, de Boer MJ, Diletti R, van Geuns RJM, Zijlstra F, Manintveld OC. Ischemic Postconditioning After Routine Thrombus Aspiration During Primary Percutaneous Coronary Intervention: Rationale and Design of the POstconditioning Rotterdam Trial. Catheter Cardiovasc Interv 2015; 88:508-514. [PMID: 27022882 DOI: 10.1002/ccd.26239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/31/2015] [Accepted: 08/24/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Whether ischemic postconditioning (IPOC) immediately after routine thrombus aspiration (TA) reduces infarct size (IS) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) has not been established. STUDY DESIGN The POstconditioning Rotterdam Trial (PORT) is a dual-center, prospective, open-label, randomized trial with blinded endpoint evaluation enrolling 72 subjects with first-time STEMI, and an occluded infarct-related artery (IRA) without collaterals undergoing PPCI. Subjects are randomized 1:1 to a strategy of IPOC immediately after TA followed by stenting of the IRA or to conventional percutaneous coronary intervention (PCI), including TA followed by stenting of the IRA (controls). Cardiac magnetic resonance imaging (MRI) is performed at 3-5 days after STEMI and at 3 months. The primary endpoint is IS at 3 months measured by delayed enhancement MRI. Other secondary endpoints include MRI-derived microvascular obstruction (MVO), left ventricular ejection fraction, myocardial salvage index, enzymatic IS, ST-segment resolution, myocardial blush grade, microcirculatory resistance, inflammation markers, and clinical events through 3-month follow-up. CONCLUSIONS PORT is testing the hypothesis that adding IPOC (against lethal reperfusion injury) to TA (against distal embolization and MVO) is cardioprotective and reduces ultimate IS in STEMI patients undergoing PPCI (Dutch Trial Register identifier: NTR4040). © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Tuncay Yetgin
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.,Interuniversity Cardiology Institute of the Netherlands, ICIN-KNAW, Utrecht, the Netherlands
| | | | - Tim Ten Cate
- Department of Cardiology, UMC St. Radboud, Nijmegen, the Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.,Interuniversity Cardiology Institute of the Netherlands, ICIN-KNAW, Utrecht, the Netherlands
| | - Menko-Jan de Boer
- Department of Cardiology, UMC St. Radboud, Nijmegen, the Netherlands
| | - Roberto Diletti
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
| | - Robert-Jan M van Geuns
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.,Interuniversity Cardiology Institute of the Netherlands, ICIN-KNAW, Utrecht, the Netherlands
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TRPV1 activation is involved in the cardioprotection of remote limb ischemic postconditioning in ischemia-reperfusion injury rats. Biochem Biophys Res Commun 2015; 463:1034-9. [PMID: 26079883 DOI: 10.1016/j.bbrc.2015.06.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022]
Abstract
Limb remote ischemic postconditioning (RIPostC) has been proved to be a safe and effective measurement of cardioprotection against ischemia-reperfusion injury. But what bridges the remote organ insult and the cardioprotective effect in heart remains to be elucidated. This study aimed to found that whether TRPV1 may mediate the cardioprotective effect from remote organ to heart and the role of CGRP and SP in this process. We found that RIPostC effectively ameliorated cardiac ischemia/reperfusion injury in terms of limiting infarct size, lowering CK and cTnI release and improving cardiac function. In addition, these cardioprotective effects could be significantly abolished by inhibition of either CGRP or SP receptors with corresponding antagonists (CGRP8-37 for CGRP and RP-67580 for SP) injected before reperfusion. Besides, RIPostC resulted in significantly increase in the levels of CGRP and SP in plasma and hearts, as well as the levels and mRNA expression of CGRP and SP in DRG. The increase in CGRP and SP levels in plasma and hearts were markedly inhibited by TRPV1 receptor antagonist capsazepine. These findings indicate that limb remote ischemic postconditioning could attenuate cardiac ischemia/reperfusion injury in rats, and the cardioprotective mechanism is via TRPV1-mediated upregulation of CGRP and SP, which could subsequently act on their corresponding receptors in heart tissue.
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25
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Doul J, Charvátová Z, Ošťádalová I, Kohutiar M, Maxová H, Ošťádal B. Neonatal rat hearts cannot be protected by ischemic postconditioning. Physiol Res 2015; 64:789-94. [PMID: 26047384 DOI: 10.33549/physiolres.932981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although there are abundant data on ischemic postconditioning (IPoC) in the adult myocardium, this phenomenon has not yet been investigated in neonatal hearts. To examine possible protective effects of IPoC, rat hearts isolated on days 1, 4, 7 and 10 of postnatal life were perfused according to Langendorff. Developed force (DF) of contraction was measured by an isometric force transducer. Hearts were exposed to 40 or 60 min of global ischemia followed by reperfusion up to the maximum recovery of DF. IPoC was induced by three cycles of 10, 30 or 60 s periods of global ischemia/reperfusion. To further determine the extent of ischemic injury, lactate dehydrogenase (LDH) release was measured in the coronary effluent. Tolerance to ischemia did not change from day 1 to day 4 but decreased to days 7 and 10. None of the postconditioning protocols tested led to significant protection on the day 10. Prolonging the period of sustained ischemia to 60 min on day 10 did not lead to better protection. The 3x30 s protocol was then evaluated on days 1, 4 and 7 without any significant effects. There were no significant differences in LDH release between postconditioned and control groups. It can be concluded that neonatal hearts cannot be protected by ischemic postconditioning during first 10 days of postnatal life.
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Affiliation(s)
- J Doul
- Department of Pathophysiology, Second Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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26
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Cherry-Allen KM, Gidday JM, Lee JM, Hershey T, Lang CE. Remote limb ischemic conditioning enhances motor learning in healthy humans. J Neurophysiol 2015; 113:3708-19. [PMID: 25867743 DOI: 10.1152/jn.01028.2014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/27/2015] [Indexed: 12/19/2022] Open
Abstract
Brief bouts of sublethal ischemia have been shown to protect exposed tissue (ischemic conditioning) and tissues at remote sites (remote ischemic conditioning) against subsequent ischemic challenges. Given that the mechanisms of this protective phenomenon are multifactorial and epigenetic, we postulated that remote limb ischemic conditioning (RLIC) might enhance mechanisms responsible for neural plasticity, and thereby facilitate learning. Specifically, we hypothesized that conditioning of the nervous system with RLIC, achieved through brief repetitive limb ischemia prior to training, would facilitate the neurophysiological processes of learning, thus making training more effective and more long-lasting. Eighteen healthy adults participated in this study; nine were randomly allocated to RLIC and nine to sham conditioning. All subjects underwent seven consecutive weekday sessions and 2-wk and 4-wk follow-up sessions. We found that RLIC resulted in significantly greater motor learning and longer retention of motor performance gains in healthy adults. Changes in motor performance do not appear to be due to a generalized increase in muscle activation or muscle strength and were not associated with changes in serum brain-derived neurotrophic factor (BDNF) concentration. Of note, RLIC did not enhance cognitive learning on a hippocampus-dependent task. While future research is needed to establish optimal conditioning and training parameters, this inexpensive, clinically feasible paradigm might ultimately be implemented to enhance motor learning in individuals undergoing neuromuscular rehabilitation for brain injury and other pathological conditions.
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Affiliation(s)
- Kendra M Cherry-Allen
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Jeff M Gidday
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri; Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Tamara Hershey
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri; Department of Neurology, Washington University School of Medicine, St. Louis, Missouri; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
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27
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Luz A, Santos M, Magalhães R, Silveira J, Cabral S, Dias V, Oliveira F, Pereira S, Leite-Moreira A, Carvalho H, Torres S. Lack of Benefit of Ischemic Postconditioning After Routine Thrombus Aspiration During Reperfusion. J Cardiovasc Pharmacol Ther 2015; 20:523-31. [DOI: 10.1177/1074248415578171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/02/2015] [Indexed: 11/16/2022]
Abstract
Objectives: The underutilization of manual thrombus aspiration (MTA) may have reduced the benefits of ischemic postconditioning (PostCon), as it reduces thrombus embolization. We aimed to assess the benefits of PostCon in patients with ST-segment elevation myocardial infarction (STEMI) after the systematic utilization of MTA. Methods: A total of 87 patients were enrolled in a prospective, randomized trial (43 PostCon and 44 controls). After MTA, PostCon was performed on the treatment group by applying 4 cycles of alternate reperfusion and reocclusion (60 seconds each) using the angioplasty balloon. The primary end point was infarct size assessed by the area under the curve (AUC) of troponin T (TnT) activity. The secondary end points were left ventricle ejection fraction (LVEF) and major cardiac events (new myocardial infarction or cardiac death) both at discharge and at follow-up. Results: The AUC for TnT was no different with respect to study arms (median [interquartile range]): PostCon = 8.9 (10.6) versus control = 8.2 (10.6), P = .68. Left ventricle ejection fraction improved from in-hospital to follow-up (9 ± 3 months) for the entire cohort (46.3% ± 7.3% vs 52.2% ± 10.7%, P < .001), with no differences between PostCon and controls (51.6% ± 9.5% vs 52.7% ± 11.9%, P = .89); major cardiac events at 14 ± 4 months of follow-up were also no different (PostCon = 1.0 (2.3%) vs control = 0, P = .49). Conclusion: In patients with STEMI treated with MTA, PostCon offered no benefits to infarct size, LVEF, or major cardiac events.
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Affiliation(s)
- André Luz
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
| | - Mário Santos
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
- Department of Physiology and Cardio-Thoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Magalhães
- Institute of Biomedical Sciences “Abel Salazar,” University of Porto, Porto, Portugal
| | - João Silveira
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
- Institute of Biomedical Sciences “Abel Salazar,” University of Porto, Porto, Portugal
| | - Sofia Cabral
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
| | - Vasco Dias
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
| | | | - Sousa Pereira
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Physiology and Cardio-Thoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Carvalho
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
- Institute of Biomedical Sciences “Abel Salazar,” University of Porto, Porto, Portugal
| | - Severo Torres
- Cardiology Department, Porto Hospital Centre, Porto, Portugal
- Institute of Biomedical Sciences “Abel Salazar,” University of Porto, Porto, Portugal
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Hu XQ, Cheng J, Tang B, Zhang ZH, Huang K, Yang YP, Mao YY, Zhong M, Fu SW. Clinical effect of postconditioning in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials. J Zhejiang Univ Sci B 2015; 16:198-207. [PMID: 25743121 PMCID: PMC4357369 DOI: 10.1631/jzus.b1400237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the clinical effect of postconditioning on patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). METHODS Randomized controlled trials were identified by searching relevant databases published up to April 2nd, 2014. A meta-analysis of eligible studies was performed by Stata 12.0 and Review Manager 5.2 with a fixed-effect model. RESULTS Ten studies providing adverse cardiac events in a total of 1346 STEMI patients treated with primary PCI were identified. The occurrence of heart failure was significantly reduced in patients treated with postconditioning compared with usual care (risk ratio (RR) 0.533; 95% confidence intervals (CI) 0.368-0.770), whereas non-fatal reinfarction slightly increased in the postconditioning group (RR 2.746; 95% CI 1.007-7.488). No significant difference in total major adverse cardiac events (MACEs) was observed between the two groups (RR 0.876; 95% CI 0.671-1.144). CONCLUSIONS Postconditioning in STEMI patients undergoing primary PCI significantly reduces the risk of heart failure, but fails to decrease the incidence of total MACEs and the risk of non-fatal reinfarction.
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Affiliation(s)
- Xian-qing Hu
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Jian Cheng
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Biao Tang
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Zhong-heng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Ke Huang
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Yi-ping Yang
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Yan-yan Mao
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Ming Zhong
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Shen-wen Fu
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
- †E-mail:
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Pagliaro P, Penna C. Redox signalling and cardioprotection: translatability and mechanism. Br J Pharmacol 2015; 172:1974-95. [PMID: 25303224 DOI: 10.1111/bph.12975] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/24/2014] [Accepted: 09/30/2014] [Indexed: 12/13/2022] Open
Abstract
The morbidity and mortality from coronary artery disease (CAD) remain significant worldwide. The treatment for acute myocardial infarction has improved over the past decades, including early reperfusion of culprit coronary arteries. Although it is mandatory to reperfuse the ischaemic territory as soon as possible, paradoxically this leads to additional myocardial injury, namely ischaemia/reperfusion (I/R) injury, in which redox stress plays a pivotal role and for which no effective therapy is currently available. In this review, we report evidence that the redox environment plays a pivotal role not only in I/R injury but also in cardioprotection. In fact, cardioprotective strategies, such as pre- and post-conditioning, result in a robust reduction in infarct size in animals and the role of redox signalling is of paramount importance in these conditioning strategies. Nitrosative signalling and cysteine redox modifications, such as S-nitrosation/S-nitrosylation, are also emerging as very important mechanisms in conditioning cardioprotection. The reasons for the switch from protective oxidative/nitrosative signalling to deleterious oxidative/nitrosative/nitrative stress are not fully understood. The complex regulation of this switch is, at least in part, responsible for the diminished or lack of cardioprotection induced by conditioning protocols observed in ageing animals and with co-morbidities as well as in humans. Therefore, it is important to understand at a mechanistic level the reasons for these differences before proposing a safe and useful transition of ischaemic or pharmacological conditioning. Indeed, more mechanistic novel therapeutic strategies are required to protect the heart from I/R injury and to improve clinical outcomes in patients with CAD.
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Affiliation(s)
- P Pagliaro
- Department of Clinical and Biological Sciences, University of Torino, 10043, Orbassano, Turin, Italy
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30
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Bice JS, Baxter GF. Postconditioning signalling in the heart: mechanisms and translatability. Br J Pharmacol 2014; 172:1933-46. [PMID: 25303373 DOI: 10.1111/bph.12976] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/29/2014] [Accepted: 10/05/2014] [Indexed: 12/15/2022] Open
Abstract
The protective effect of ischaemic postconditioning (short cycles of reperfusion and reocclusion of a previously occluded vessel) was identified over a decade ago commanding intense interest as an approach for modifying reperfusion injury which contributes to infarct size in acute myocardial infarction. Elucidation of the major mechanisms of postconditioning has identified potential pharmacological targets for limitation of reperfusion injury. These include ligands for membrane-associated receptors, activators of phosphokinase survival signalling pathways and inhibitors of the mitochondrial permeability transition pore. In experimental models, numerous agents that target these mechanisms have shown promise as postconditioning mimetics. Nevertheless, clinical studies of ischaemic postconditioning and pharmacological postconditioning mimetics are equivocal. The majority of experimental research is conducted in animal models which do not fully portray the complexity of risk factors and comorbidities with which patients present and which we now know modify the signalling pathways recruited in postconditioning. Cohort size and power, patient selection, and deficiencies in clinical infarct size estimation may all represent major obstacles to assessing the therapeutic efficacy of postconditioning. Furthermore, chronic treatment of these patients with drugs like ACE inhibitors, statins and nitrates may modify signalling, inhibiting the protective effect of postconditioning mimetics, or conversely induce a maximally protected state wherein no further benefit can be demonstrated. Arguably, successful translation of postconditioning cannot occur until all of these issues are addressed, that is, experimental investigation requires more complex models that better reflect the clinical setting, while clinical investigation requires bigger trials with appropriate patient selection and standardization of clinical infarct size measurements.
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Affiliation(s)
- Justin S Bice
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
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Araszkiewicz A, Grygier M, Pyda M, Rajewska J, Michalak M, Lesiak M, Grajek S. Postconditioning Reduces Enzymatic Infarct Size and Improves Microvascular Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction. Cardiology 2014; 129:250-7. [DOI: 10.1159/000367965] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022]
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Favaretto E, Roffi M, Frigo AC, Lee MS, Marra MP, Napodano M, Tarantini G. Meta-analysis of randomized trials of postconditioning in ST-elevation myocardial infarction. Am J Cardiol 2014; 114:946-52. [PMID: 25108303 DOI: 10.1016/j.amjcard.2014.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 11/27/2022]
Abstract
Clinical benefit of postconditioning in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention is still controversial. We performed a meta-analysis of available randomized clinical trials (RCTs) to define the role of postconditioning in STEMI. Fourteen RCTs evaluating postconditioning in a total of 778 patients with STEMI were identified in PubMed, EMBase, and Cochrane databases from January 1998 to February 2014. Overall, postconditioning was found to be cardioprotective in term of infarct size reduction (weighted standardized mean differences -0.5837, 95% confidence interval -0.9609 to -0.2066, p <0.05), but significant heterogeneity across the trials was detected (I(2) = 84%). Univariate meta-regression analysis did not identify clinical or procedural variables associated with a more pronounced effect of postconditioning effects on infarct size with the exception of using cardiac magnetic resonance (CMR) to evaluate infarct size (p <0.01). Restricting the analysis to 6 RCTs including a total of 448 patients and evaluating the postconditioning effect on infarct size by means of CMR led to the disappearance of benefit of postconditioning on infarct size. In conclusion, the results of this meta-analysis of RCTs suggested that postconditioning reduces infarct size, as expressed by weighted standardized mean differences. However, if the analysis was limited to trials with a more accurate quantification of infarct size reduction, namely by CMR, the benefit was lost. More data are required before adoption of postconditioning in clinical practice.
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Abdelnoor M, Sandven I, Limalanathan S, Eritsland J. Postconditioning in ST-elevation myocardial infarction: a systematic review, critical appraisal, and meta-analysis of randomized clinical trials. Vasc Health Risk Manag 2014; 10:477-91. [PMID: 25143742 PMCID: PMC4134024 DOI: 10.2147/vhrm.s67154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective We aimed to summarize the evidence from randomized clinical trials studies examining the efficacy of ischemic postconditioning (IPost) in ST-elevation myocardial infarction. Design The study was a systematic review and critical appraisal, with meta-analysis of randomized clinical trials. Materials and methods We searched the literature. A total of 21 randomized clinical trials were identified. Both fixed effect and random effects models were used to synthesize the results of individual studies. Heterogeneity between studies was examined by subgroup and random effects meta-regression analyses, considering ptient-related and study-level variables. Publication bias, or “small-study effect”, was evaluated. Results Substantial heterogeneity was present. The random effects model pooled estimate for the outcome infarct size assessed by cardiac magnetic resonance was estimated by the standardized mean difference (SMD) =−0.06, 95% confidence interval (CI): −0.34 to 0.21, ie, no effect of IPost. For the end point infarct size, estimated by biomarkers of myocardial necrosis, an overall pooled effect was SMD =−0.58, 95% CI: −0.96 to −0.19. This effect disappeared in powered and nonbiased studies (SMD =0.03, 95% CI: −0.48 to 0.55). Finally, for the outcome left ventricular ejection fraction, SMD =0.47 95% CI: 0.20 to 0.74. Unfortunately, selection bias (small-study effect) was present. For this outcome, the meta-regression showed that both presence of hypertension and the inclusion of nonbiased studies explained 28.3% of the heterogeneity among the studies. Simulation by the “trim and fill” method, which controlled for selection bias using random effects model, diluted the effect (SMD =0.17 95% CI: −0.13 to 0.48). No effects by IPost on ST-segment resolution or on the majority of adverse clinical events were observed during follow up, except the incidence of congestive heart failure was found. Conclusion Evidence from this study suggests no cardioprotection from IPost, on surrogate and the majority of clinical end points. A possible beneficial effect on the incidence of congestive heart failure needs to be replicated by a large clinical trial.
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Affiliation(s)
- M Abdelnoor
- Centre of Epidemiology and Biostatistics, Oslo University Hospital, Ullevål, Norway ; Centre of Clinical Heart Research, Oslo University Hospital, Ullevål, Norway
| | - I Sandven
- Centre of Epidemiology and Biostatistics, Oslo University Hospital, Ullevål, Norway
| | - S Limalanathan
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - J Eritsland
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
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Diletti R, Yetgin T, Manintveld OC, Ligthart JM, Zivelonghi C, Zijlstra F, Ribichini F. Percutaneous coronary interventions during ST-segment elevation myocardial infarction: current status and future perspectives. EUROINTERVENTION 2014; 10 Suppl T:T13-22. [DOI: 10.4244/eijv10sta4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Khalili H, Patel VG, Mayo HG, de Lemos JA, Brilakis ES, Banerjee S, Bavry AA, Bhatt DL, Kumbhani DJ. Surrogate and clinical outcomes following ischemic postconditioning during primary percutaneous coronary intervention of ST--segment elevation myocardial infarction: a meta-analysis of 15 randomized trials. Catheter Cardiovasc Interv 2014; 84:978-86. [PMID: 24948465 DOI: 10.1002/ccd.25581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/05/2014] [Accepted: 06/14/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To conduct a meta-analysis on surrogate and clinical outcomes with myocardial ischemic postconditioning (IPoC) following revascularization with primary percutaneous intervention (PPCI) for ST-segment myocardial infarction (STEMI) compared with PPCI alone. BACKGROUND Reperfusion injury remains an important problem following PPCI for STEMI. Trials of IPoC have mainly focused on cardiac biomarkers; the impact on clinical outcomes is unknown. METHODS Clinical trials that randomized STEMI patients to IPoC as compared with conventional PPCI were included for analysis. RESULTS A total of 15 randomized trials with 1,545 patients met our selection criteria (785 underwent IPoC + PPCI, 760 PPCI alone). Mean follow-up for clinical outcomes was 4.7 months. The mean ischemic time was 225 min. ST-segment resolution (Relative Risk [RR] = 0.98; 95% Confidence Intervals [CI] 0.85-1.13; P = 0.75) and infarct size (Weighted mean difference [WMD] = -2.53%, 95% CI -6.10 to 1.05; P = 0.17) were similar between the IPoC + PPCI vs. PPCI arms. Left ventricular ejection fraction at follow-up was marginally higher in the IPoC (WMD = 4.15%, 95% CI 0.19-8.12%, P = 0.04). No differences were noted in any of the clinical outcomes studied, including mortality (RR = 1.52; 95% CI 0.77-2.99; P = 0.23), recurrent MI (RR = 3.04; 95% CI 0.74-12.54; P = 0.12); stent thrombosis (RR = 1.24, 95% CI 0.51-3.04; P = 0.83) or the composite MACE outcome (RR = 1.53; 95% CI 0.89-2.63; P = 0.13). CONCLUSIONS IPoC following PPCI is not associated with improvements in surrogate or clinical outcomes at 5 months as compared with PPCI alone. Our findings indicate no role for IPoC in the routine management of patients with STEMI.
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Affiliation(s)
- Houman Khalili
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
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Gulati P, Singh N. Tadalafil enhances the neuroprotective effects of ischemic postconditioning in mice, probably in a nitric oxide associated manner. Can J Physiol Pharmacol 2014; 92:418-26. [DOI: 10.1139/cjpp-2013-0428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study investigates the modulatory effect of tadalafil, a selective phosphodiesterase (PDE-5) inhibitor, on the neuroprotective effects of ischemic postconditioning (iPoCo) in mice. Bilateral carotid artery occlusion (BCAO) for 12 min followed by reperfusion for 24 h was employed to produce ischemia and reperfusion induced cerebral injury. Cerebral infarct size was measured using TTC staining. Memory was assessed using the Morris water maze test. Degree of motor incoordination was evaluated using inclined beam-walking, rota-rod, and lateral push tests. Brain nitrite/nitrate, acetylcholinesterase activity, TBARS, and glutathione levels were also estimated. BCAO followed by reperfusion produced a significant increase in cerebral infarct size, brain nitrite/nitrate and TBARS levels, and acetylcholinesterase activity along with a reduction in glutathione. Marked impairment of memory and motor coordination was also noted. iPoCo consisting of 3 episodes of 10 s carotid artery occlusion and reperfusion instituted immediately after BCAO significantly decreased infarct size, memory impairment, motor incoordination, and altered biochemistry. Pretreatment with tadalafil mimicked the neuroprotective effects of iPoCo. The tadalafil-induced neuroprotective effects were significantly attenuated by l-NAME, a nonselective NOS inhibitor. We concluded that tadalafil mimics the neuroprotective effects of iPoCo, probably through a nitric oxide dependent pathway, and PDE-5 could be a target of interest with respect to the neuroprotective mechanism of iPoCo.
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Affiliation(s)
- Puja Gulati
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | - Nirmal Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
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Bainey KR, Armstrong PW. Clinical perspectives on reperfusion injury in acute myocardial infarction. Am Heart J 2014; 167:637-45. [PMID: 24766972 DOI: 10.1016/j.ahj.2014.01.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/24/2014] [Indexed: 12/31/2022]
Abstract
Prompt reperfusion therapy in acute myocardial infarction enhances clinical outcome. However, reperfusion itself may contribute to myocardial cell death. The current review outlines the multifocal mechanisms of reperfusion injury and focuses on understanding the potential role of each element and its contribution to the injury pattern inflicted upon the myocardium. We evaluate the spectrum of contemporary therapies that have been tested in an attempt to reduce myocardial injury. Finally, we explore promising innovative strategies targeting novel reperfusion injury pathways to protect ischemic myocardium during reperfusion.
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X'avia Chan CY, Wang D, Cadeiras M, Deng MC, Ping P. S-nitrosylation of TRIM72 mends the broken heart: a molecular modifier-mediated cardioprotection. J Mol Cell Cardiol 2014; 72:292-5. [PMID: 24735828 DOI: 10.1016/j.yjmcc.2014.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 04/01/2014] [Accepted: 04/04/2014] [Indexed: 11/16/2022]
Affiliation(s)
- C Y X'avia Chan
- NHLBI Proteomics Center at UCLA, Department of Physiology, David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA; Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA.
| | - Ding Wang
- NHLBI Proteomics Center at UCLA, Department of Physiology, David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA; Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA.
| | - Martin Cadeiras
- Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, USA.
| | - Mario C Deng
- Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, USA.
| | - Peipei Ping
- NHLBI Proteomics Center at UCLA, Department of Physiology, David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA; Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA 90095, USA.
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Brooks MJ, Andrews DT. Molecular mechanisms of ischemic conditioning: translation into patient outcomes. Future Cardiol 2014; 9:549-68. [PMID: 23834695 DOI: 10.2217/fca.13.30] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Following the initiation of an ischemic insult, reperfusion injury (RI) can result in numerous deleterious cardiac effects, including cardiomyocyte death. Experimental data have suggested that ischemic conditioning, when delivered either before or after the ischemic event, can provide considerable cardioprotection against RI. Ischemic conditioning involves delivering brief repetitive cycles of ischemia to the myocardium (local) or to another distal organ or structure (remote). This review will discuss recent advances in the molecular mechanisms involved in RI, the signaling pathways recruited by ischemic conditioning and conclude with an appraisal of the evidence for the use of ischemic conditioning in current clinical practice.
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Affiliation(s)
- Matthew J Brooks
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
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40
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Sadat U, Walsh SR, Varty K. Cardioprotection by ischemic postconditioning during surgical procedures. Expert Rev Cardiovasc Ther 2014; 6:999-1006. [DOI: 10.1586/14779072.6.7.999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Effect of Remote Ischemic Preconditioning on Platelet Activation and Reactivity Induced by Ablation for Atrial Fibrillation. Circulation 2014; 129:11-7. [DOI: 10.1161/circulationaha.113.005336] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Radiofrequency ablation of atrial fibrillation has been associated with some risk of thromboembolic events. Previous studies showed that preventive short episodes of forearm ischemia (remote ischemic preconditioning [IPC]) reduce exercise-induced platelet reactivity. In this study, we assessed whether remote IPC has any effect on platelet activation induced by radiofrequency ablation of atrial fibrillation.
Methods and Results—
We randomized 19 patients (age, 54.7±11 years; 17 male) undergoing radiofrequency catheter ablation of paroxysmal atrial fibrillation to receive remote IPC or sham intermittent forearm ischemia (control subjects) before the procedure. Blood venous samples were collected before and after remote IPC/sham ischemia, at the end of the ablation procedure, and 24 hours later. Platelet activation and reactivity were assessed by flow cytometry by measuring monocyte-platelet aggregate formation, platelet CD41 in the monocyte-platelet aggregate gate, and platelet CD41 and CD62 in the platelet gate in the absence and presence of ADP stimulation. At baseline, there were no differences between groups in platelet variables. Radiofrequency ablation induced platelet activation in both groups, which persisted after 24 hours. However, compared with control subjects, remote IPC patients showed a lower increase in all platelet variables, including monocyte-platelet aggregate formation (
P
<0.0001), CD41 in the monocyte-platelet aggregate gate (
P
=0.002), and CD41 (
P
<0.0001) and CD62 (
P
=0.002) in the platelet gate. Compared with control subjects, remote IPC was also associated with a significantly lower ADP-induced increase in all platelet markers.
Conclusions—
Our data show that remote IPC before radiofrequency catheter ablation for paroxysmal atrial fibrillation significantly reduces the increased platelet activation and reactivity associated with the procedure.
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Dong M, Mu N, Guo F, Zhang C, Ren F, Li J, Tao Z, Yang J, Li G. The beneficial effects of postconditioning on no-reflow phenomenon after percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction. J Thromb Thrombolysis 2013; 38:208-14. [DOI: 10.1007/s11239-013-1010-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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DWYER NATHANB, MIKAMI YOKO, HILLAND DARLENE, ALJIZEERI AHMED, FRIEDRICH MATTHIASG, TRABOULSI MOUHIEDDIN, ANDERSON TODDJ. No Cardioprotective Benefit of Ischemic Postconditioning in Patients With ST-Segment Elevation Myocardial Infarction. J Interv Cardiol 2013; 26:482-90. [DOI: 10.1111/joic.12064] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- NATHAN B. DWYER
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Alberta Canada
| | - YOKO MIKAMI
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Alberta Canada
| | - DARLENE HILLAND
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Alberta Canada
| | - AHMED ALJIZEERI
- Division of Cardiology; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - MATTHIAS G. FRIEDRICH
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Alberta Canada
| | - MOUHIEDDIN TRABOULSI
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Alberta Canada
| | - TODD J. ANDERSON
- Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Alberta Canada
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Hausenloy DJ. Conditioning the heart to prevent myocardial reperfusion injury during PPCI. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:13-32. [PMID: 24062884 DOI: 10.1177/2048872612438805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 01/22/2012] [Indexed: 11/15/2022]
Abstract
For patients presenting with a ST-segment elevation myocardial infarction (STEMI), early myocardial reperfusion by primary percutaneous coronary intervention (PPCI) remains the most effective treatment strategy for limiting myocardial infarct size, preserving left ventricular systolic function, and preventing the onset of heart failure. Recent advances in PCI technology to improve myocardial reperfusion and the introduction of novel anti-platelet and anti-thrombotic agents to maintain the patency of the infarct-related coronary artery continue to optimize PPCI procedure. However, despite these improvements, STEMI patients still experience significant major adverse cardiovascular events. One major contributing factor has been the inability to protect the heart against the lethal myocardial reperfusion injury, which accompanies PPCI. Past attempts to translate cardioprotective strategies, discovered in experimental studies to prevent lethal myocardial reperfusion injury, into the clinical setting of PPCI have been disappointing. However, a number of recent proof-of-concept clinical studies suggest that the heart can be 'conditioned' to protect itself against lethal myocardial reperfusion injury, as evidenced by a reduction in myocardial infarct size. This can be achieved using either mechanical (such as ischaemic postconditioning, remote ischaemic preconditioning, therapeutic hypothermia, or hyperoxaemia) or pharmacological (such as cyclosporin-A, natriuretic peptide, exenatide) 'conditioning' strategies as adjuncts to PPCI. Furthermore, recent developments in cardiac magnetic resonance (CMR) imaging can provide a non-invasive imaging strategy for assessing the efficacy of these novel adjunctive therapies to PPCI in terms of key surrogate clinical endpoints such as myocardial infarct size, myocardial salvage, left ventricular ejection fraction, and the presence of microvascular obstruction or intramyocardial haemorrhage. In this article, we review the therapeutic potential of 'conditioning' to protect the heart against lethal myocardial reperfusion injury in STEMI patients undergoing PPCI.
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The impact of ischemia-reperfusion injury on the effectiveness of primary angioplasty in ST-segment elevation myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2013; 9:275-81. [PMID: 24570732 PMCID: PMC3915986 DOI: 10.5114/pwki.2013.37509] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 07/12/2013] [Accepted: 08/16/2013] [Indexed: 01/16/2023] Open
Abstract
The most effective method of reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PCI), assisted by aspiration thrombectomy and administration of antiplatelet agents and anticoagulants. However, effective restoration of blood flow in the infarct-related artery may paradoxically result in further damage to the heart muscle. This phenomenon, called ischemia-reperfusion injury (IRI), can significantly reduce the beneficial effects of reperfusion therapy. The rapid restoration of blood flow to the previously ischemic area causes a number of pathophysiological mechanisms leading to increased necrosis of myocytes still viable at the end of the ischemic period. It has been postulated that there are several strategies that can reduce damage to the heart muscle. Attempts to translate the results of experimental trials has been disappointing. More recently, however, some of the clinical benefits of ischemic postconditioning in which reperfusion in patients with STEMI who are undergoing PCI is interrupted with short episodes of ischemia were demonstrated. This renewed the interest in the reperfusion phase as a target for cardioprotective therapy. Research in this field has also been reinforced by the discovery of new potential targets for treatment that protects against IRI, such as the kinase pathway to protect against damage (reperfusion injury salvage kinases – RISK) and mitochondrial permeability transition pore. It seems that these findings will help to develop strategies that will improve the efficiency of mechanical reperfusion and may translate into long-term clinical effects.
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Affiliation(s)
- Alex Schevchuck
- From the Division of Cardiology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Warren K. Laskey
- From the Division of Cardiology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
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Zhong H, Gao Z, Chen M, Zhao J, Wang F, Li L, Dong H, Liu L, Wang Q, Xiong L. Cardioprotective effect of remote ischemic postconditioning on children undergoing cardiac surgery: a randomized controlled trial. Paediatr Anaesth 2013; 23:726-33. [PMID: 23668330 DOI: 10.1111/pan.12181] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Remote ischemic postconditioning (RPostC) is a noninvasive intervention that has demonstrated cardioprotection and neuroprotection in animal studies. OBJECTIVE Our goal was to investigate the cardio-cerebral protective effects of RPostC on children undergoing open-heart surgery for repair of congenital heart defects (CHD). METHODS Children undergoing open-heart repair of CHD were randomly assigned to a RPostC or control group. RPostC was induced by three 5-min cycles of lower limb ischemia and reperfusion using a blood pressure cuff (200 mmHg) at the onset of aortic unclamping. Serum cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), neuron-specific enolase (NSE), S100β, cytokines, and clinical outcomes were assessed. RESULTS There were 35 children in the control group and 34 in the RPostC group. The mean age (3.64 ± 1.95 years vs. 3.45 ± 3.02 years, P = 0.80), weight (15.11 ± 6.91 kg vs. 13.40 ± 6.33 kg, P = 0.37), surgical time (144.82 ± 38.51 min vs. 129.92 ± 30.76 min, P = 0.15), and bypass time (78.01 ± 27.22 min vs. 72.52 ± 26.05 min, P = 0.49) were not different. Compared with the control group, the postoperative levels of cTnI (P = 0.037) and CK-MB (P = 0.046) were significantly reduced in the RPostC group. Furthermore, the MAP was higher (P = 0.008), and ICU stay (36.87 ± 3.30 h vs. 60.57 ± 7.35 h, P = 0.006) and postoperative hospital stay (8.56 ± 1.50 days vs. 10.06 ± 2.41 days, P = 0.048) were shorter in the RPostC group than in the control group. However, the postoperative CVP and the concentrations of NSE, S100β, CRP, TNF-α, IL-1β, IL-6, and IL-10 were not significantly different. CONCLUSION RPostC significantly alleviates cardiac injury in children undergoing open-heart repair of CHD and may also reduce cerebral injury.
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Affiliation(s)
- Haixing Zhong
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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48
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Wang L, Wang J, Xu H, Li B. Postconditioning in patients treated with primary percutaneous coronary intervention: An updated meta-analysis. Catheter Cardiovasc Interv 2013; 82:E662-71. [PMID: 23804529 DOI: 10.1002/ccd.25095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/01/2013] [Accepted: 06/16/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Lei Wang
- Graduate School; Shanxi Medical University; Taiyuan Shanxi People's Republic of China
| | - Jingping Wang
- Department of Cardiology; Shanxi Cardiovascular Hospital; Taiyuan Shanxi People's Republic of China
| | - Huiyu Xu
- Department of Cardiology; Shanxi Cardiovascular Hospital; Taiyuan Shanxi People's Republic of China
| | - Bao Li
- Department of Cardiology; Shanxi Cardiovascular Hospital; Taiyuan Shanxi People's Republic of China
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Zhang R, Shen L, Xie Y, Gen L, Li X, Ji Q. Effect of morphine-induced postconditioning in corrections of tetralogy of fallot. J Cardiothorac Surg 2013; 8:76. [PMID: 23577699 PMCID: PMC3666925 DOI: 10.1186/1749-8090-8-76] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/26/2013] [Indexed: 12/04/2022] Open
Abstract
Background Results of previous reports on ischemic postconditioning in animals and humans were very encouraging. Although ischemic postconditioning possessed a wide prospect of clinical application, debates on the precise ischemic postconditioning algorithm to use in clinical settings were ongoing. In this regard, pharmacological strategies were possible alternative methods. Accumulating data demonstrated that pharmacological postconditioning with morphine conferred cardioprotection in animals. This trial aimed to evaluate the effect of morphine-induced postconditioning on protection against myocardial ischemia/reperfusion injury in patients undergoing corrections of Tetralogy of Fallot (TOF). Methods Eight-nine consecutive children scheduled for corrections of TOF were enrolled and randomly assigned to either a postconditioning group (patients received a dose of morphine (0.1 mg/kg) injected via a cardioplegia needle into the aortic root for direct and focused delivery to the heart within 1 minute starting at 3 min before aorta cross-clamp removal, n=44) or a control group (the same protocol was performed as in the postconditioning group except that patients received the same volume of saline instead, n=45). The peri-operative relevant data were investigated and analyzed, and the cardiac troponin I (cTnI) was assayed preoperatively, and then 4 h, 8 h, 12 h, 24 h and 48 h after reperfusion. Results Morphine-induced postconditioning reduced postoperative peak cTnI release as compared to the control group (0.57 ± 0.15 versus 0.75 ± 0.20 ng/mL, p<0.0001). Morphine-induced postconditioned patients had lower peak inotropic score (5.7 ± 2.4 versus 8.4 ± 3.6, p<0.0001) and shorter duration of mechanical ventilation as well as ICU stay (20.6 ± 6.8 versus 28.5 ± 8.3 hours, p<0.0001 and 40.4 ± 10.3 versus 57.8 ± 15.2 hours, p<0.0001, respectively), while higher left ventricular ejection fraction as well as cardiac output (0.57±0.15 versus 0.51±0.13, p=0.0467 and 1.39 ± 0.25 versus 1.24 ± 0.21 L/min, p=0.0029, respectively) as compared to the control group during the first postoperative 24 hours. Conclusions Morphine-induced postconditioning may provide enhanced cardioprotection against ischemia/reperfusion injury in children undergoing corrections of TOF.
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Affiliation(s)
- Rufang Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, 1400 Western Beijing Rd, Shanghai 200040, PR China.
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Tarantini G, Favaretto E, Marra MP, Frigo AC, Napodano M, Cacciavillani L, Giovagnoni A, Renda P, De Biasio V, Plebani M, Mion M, Zaninotto M, Isabella G, Bilato C, Iliceto S. Postconditioning during coronary angioplasty in acute myocardial infarction: the POST-AMI trial. Int J Cardiol 2012; 162:33-8. [DOI: 10.1016/j.ijcard.2012.03.136] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/02/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
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