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Randhawa PK, Bali A, Virdi JK, Jaggi AS. Conditioning-induced cardioprotection: Aging as a confounding factor. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2018; 22:467-479. [PMID: 30181694 PMCID: PMC6115349 DOI: 10.4196/kjpp.2018.22.5.467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/28/2018] [Accepted: 05/15/2018] [Indexed: 01/15/2023]
Abstract
The aging process induces a plethora of changes in the body including alterations in hormonal regulation and metabolism in various organs including the heart. Aging is associated with marked increase in the vulnerability of the heart to ischemia-reperfusion injury. Furthermore, it significantly hampers the development of adaptive response to various forms of conditioning stimuli (pre/post/remote conditioning). Aging significantly impairs the activation of signaling pathways that mediate preconditioning-induced cardioprotection. It possibly impairs the uptake and release of adenosine, decreases the number of adenosine transporter sites and down-regulates the transcription of adenosine receptors in the myocardium to attenuate adenosine-mediated cardioprotection. Furthermore, aging decreases the expression of peroxisome proliferator-activated receptor gamma co-activator 1-alpha (PGC-1α) and subsequent transcription of catalase enzyme which subsequently increases the oxidative stress and decreases the responsiveness to preconditioning stimuli in the senescent diabetic hearts. In addition, in the aged rat hearts, the conditioning stimulus fails to phosphorylate Akt kinase that is required for mediating cardioprotective signaling in the heart. Moreover, aging increases the concentration of Na+ and K+, connexin expression and caveolin abundance in the myocardium and increases the susceptibility to ischemia-reperfusion injury. In addition, aging also reduces the responsiveness to conditioning stimuli possibly due to reduced kinase signaling and reduced STAT-3 phosphorylation. However, aging is associated with an increase in MKP-1 phosphorylation, which dephosphorylates (deactivates) mitogen activated protein kinase that is involved in cardioprotective signaling. The present review describes aging as one of the major confounding factors in attenuating remote ischemic preconditioning-induced cardioprotection along with the possible mechanisms.
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Affiliation(s)
- Puneet Kaur Randhawa
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | - Anjana Bali
- Akal College of Pharmacy and Technical Education, Mastuana Sahib, Sangrur 148002, India
| | - Jasleen Kaur Virdi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | - Amteshwar Singh Jaggi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
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Shahvazian N, Rafiee M, Rahmanian M, Razavi-Ratki SK, Farahzadi MH. Repeated Remote Ischemic Conditioning Effect on Ankle-brachial Index in Diabetic Patients - A Randomized Control Trial. Adv Biomed Res 2017; 6:28. [PMID: 28401075 PMCID: PMC5360001 DOI: 10.4103/2277-9175.201685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Remote ischemic preconditioning (RIPC) is a phenomenon where a short period of ischemia in one organ protects against further ischemia in the other organs. We hypothesized that RIPC occurring in diabetic patients with ankle brachial index (ABI) between 0.70 and 0.90 were included with peripheral arterial disease, would make the better coronary flow resulted in the increasing ABI. Materials and Methods: This randomized clinical trial study was done in the Afshar Cardiovascular Hospital in Yazd between 2013 and 2014. Sixty participants were randomly divided into two groups (intervention and control groups). The intervention group was undergoing RIPC, and the control group was tested without RIPC. RIPC was stimulated by giving three cycles of 5 min of ischemia followed by 5 min of reperfusion of both upper arms using a blood pressure cuff inflated to 200 mm Hg (n = 30). This was compared with no RIPC group which consisted of placing a deflated blood pressure cuff on the upper limbs (n = 30). Results: The mean of ABI level before intervention in the RIPC and control group group was 0.82 ± 0.055 and 0.83 ± 0.0603 (P = 0.347) respectively, with no significant difference. It was 0.86 ± 0.066 in the RIPC group compared the control 0.83 ± 0.0603 (P = 0.046). So levels of ABI were greater after intervention in the RIPC group. The mean of ABI level increase from 0.82 ± 0.05 to 0.86 ± 0.06 in RIPC group (P = 0.008). So the intervention group showed a significant increase in ABI. Conclusions: RIPC through using a simple, noninvasive technique, composing three cycles of 5 min-ischemia of both upper arms, showing a significant increase in ABI level in diabetic patients.
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Affiliation(s)
- Najmeh Shahvazian
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mansour Rafiee
- Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Masoud Rahmanian
- Department of Endocrinology and Metabolism, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Seyed Kazem Razavi-Ratki
- Department of Nuclear Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mohammad Hadi Farahzadi
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Saes GF, Zerati AE, Wolosker N, Ragazzo L, Rosoky RMA, Ritti-Dias RM, Cucato GG, Chehuen M, Farah BQ, Puech-Leão P. Remote ischemic preconditioning in patients with intermittent claudication. Clinics (Sao Paulo) 2013; 68:495-9. [PMID: 23778346 PMCID: PMC3634960 DOI: 10.6061/clinics/2013(04)10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/19/2012] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Remote ischemic preconditioning (RIPC) is a phenomenon in which a short period of sub-lethal ischemia in one organ protects against subsequent bouts of ischemia in another organ. We hypothesized that RIPC in patients with intermittent claudication would increase muscle tissue resistance to ischemia, thereby resulting in an increased ability to walk. METHODS In a claudication clinic, 52 ambulatory patients who presented with complaints of intermittent claudication in the lower limbs associated with an absent or reduced arterial pulse in the symptomatic limb and/or an ankle-brachial index <0.90 were recruited for this study. The patients were randomly divided into three groups (A, B and C). All of the patients underwent two tests on a treadmill according to the Gardener protocol. Group A was tested first without RIPC. Group A was subjected to RIPC prior to the second treadmill test. Group B was subjected to RIPC prior to the first treadmill test and then was subjected to a treadmill test without RIPC. In Group C (control group), both treadmill tests were performed without RIPC. The first and second tests were conducted seven days apart. Brazilian Clinical Trials: RBR-7TF6TM. RESULTS Group A showed a significant increase in the initial claudication distance in the second test compared to the first test. CONCLUSION RIPC increased the initial claudication distance in patients with intermittent claudication; however, RIPC did not affect the total walking distance of the patients.
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Affiliation(s)
- Glauco Fernandes Saes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Disciplina de Cirurgia Vascular, Ambulatório de Claudicação, São Paulo/SP, Brasil.
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Johnston-Cox HA, Ravid K. Adenosine and blood platelets. Purinergic Signal 2011; 7:357-65. [PMID: 21484090 DOI: 10.1007/s11302-011-9220-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 01/19/2011] [Indexed: 02/07/2023] Open
Abstract
Adenosine is an important regulatory metabolite and an inhibitor of platelet activation. Adenosine released from different cells or generated through the activity of cell-surface ectoenzymes exerts its effects through the binding of four different G-protein-coupled adenosine receptors. In platelets, binding of A(2) subtypes (A(2A) or A(2B)) leads to consequent elevation of intracellular cyclic adenosine monophosphate, an inhibitor of platelet activation. The significance of this ligand and its receptors for platelet activation is addressed in this review, including how adenosine metabolism and its A(2) subtype receptors impact the expression and activity of adenosine diphosphate receptors. The expression of A(2) adenosine receptors is induced by conditions such as oxidative stress, a hallmark of aging. The effect of adenosine receptors on platelet activation during aging is also discussed, as well as potential therapeutic applications.
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Affiliation(s)
- Hillary A Johnston-Cox
- Departments of Medicine and Biochemistry, Whitaker Cardiovascular Institute, and Evans Center for Interdisciplinary Biomedical Research, Boston University School of Medicine, CVI, 700 Albany St., Boston, MA, 02118, USA
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Johnston-Cox HA, Yang D, Ravid K. Physiological implications of adenosine receptor-mediated platelet aggregation. J Cell Physiol 2010; 226:46-51. [PMID: 20717958 DOI: 10.1002/jcp.22379] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adenosine is an important mediator of inhibition of platelet activation. This metabolite is released from various cells, as well as generated via activity of ecto-enzymes on the cell surface. Binding of adenosine to A(2) subtypes (A(2A) or A(2B)), G-protein coupled adenosine receptors, results in increased levels of intracellular cyclic adenosine monophosphate (cAMP), a strong inhibitor of platelet activation. The role and importance of adenosine and its receptors in platelet physiology are addressed in this review, including recently identified roles for the A(2B) adenosine receptor as a modulator of platelet activation through its newly described role in the control of expression of adenosine diphosphate (ADP) receptors.
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Affiliation(s)
- Hillary A Johnston-Cox
- Departments of Medicine and Biochemistry, Whitaker Cardiovascular Institute, Evans Center for Interdisciplinary Biomedical Research, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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Peart JN, Headrick JP. Clinical cardioprotection and the value of conditioning responses. Am J Physiol Heart Circ Physiol 2009; 296:H1705-20. [PMID: 19363132 DOI: 10.1152/ajpheart.00162.2009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adjunctive cardioprotective strategies for ameliorating the reversible and irreversible injuries with ischemia-reperfusion (I/R) are highly desirable. However, after decades of research, the promise of clinical cardioprotection from I/R injury remains poorly realized. This may arise from the challenges of trialing and effectively translating experimental findings from laboratory models to patients. One can additionally consider whether features of the more heavily focused upon candidates could limit or preclude therapeutic utility and thus whether we might shift attention to alternate strategies. The phenomena of preconditioning and postconditioning have proven fertile in identification of experimental means of cardioprotection and are the most intensely interrogated responses in the field. However, there is evidence these processes, which share common molecular signaling elements and end effectors, may be poor choices for clinical exploitation. This includes evidence of age dependence, limiting efficacy in target aged or senescent hearts; refractoriness to conditioning stimuli in diseased myocardium; interference from a variety of relevant pharmaceuticals; inadvertent induction of these responses by prior ischemia or commonly used drugs, precluding further benefit; and sex dependence of protective signaling. This review focuses on these features, raising questions about current research strategies, and the suitability of these widely studied phenomena as rational candidates for clinical translation.
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Affiliation(s)
- Jason N Peart
- Heart Foundation Research Centre, Griffith University, Queensland, 9726, Australia.
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Peart JN, Headrick JP. Sustained cardioprotection: exploring unconventional modalities. Vascul Pharmacol 2008; 49:63-70. [PMID: 18675381 DOI: 10.1016/j.vph.2008.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 06/27/2008] [Accepted: 07/08/2008] [Indexed: 01/18/2023]
Abstract
Since Murry et al. [Murry, C.E., Jennings, R.B., Reimer, K.A., 1986. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 74, 1124-36.] initially reported on the powerful protective effects of ischemic preconditioning (PC), a plethora of experimental investigations have identified varied preconditioning protocols or mimetics to achieve cardioprotection. These stimuli predominantly act via archetypal mediators identified in associated signalling studies (including PI3-K, Akt, PKC, mitochondrial K(ATP) channels). Despite an intense research effort over the last 20 years, there remains a paucity of evidence that this protective paradigm is clinically exploitable. This may arise due to a number of drawbacks to conventional protection, including effects of age, disease, and interactions with other pharmacological agents. This encourages investigation of alternate strategies that trigger protection via unconventional signalling (distinct from conventional PC) and/or mediate sustained shifts in ischemic tolerance in hearts of varying age and disease status. This review considers briefly drawbacks to conventional PC, and focuses on alternate strategies for generating prolonged states of cardiac protection.
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Affiliation(s)
- Jason N Peart
- Heart Foundation Research Centre, Griffith University, Australia.
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Linden MD, Barnard MR, Frelinger A, Michelson AD, Przyklenk K. Effect of adenosine A2 receptor stimulation on platelet activation-aggregation: differences between canine and human models. Thromb Res 2007; 121:689-98. [PMID: 17727923 PMCID: PMC2346597 DOI: 10.1016/j.thromres.2007.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 06/11/2007] [Accepted: 07/01/2007] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Adenosine A(2) agonists improve arterial patency in experimental models of recurrent thrombosis, an effect purportedly triggered by stimulation of platelet A(2) receptors and subsequent down-regulation of platelet function. However: (i) there is no direct evidence to substantiate this premise; and (ii) given the recognized differences among species in platelet signaling, it is possible that the mechanisms of A(2) receptor stimulation may be model-dependent. Accordingly, we applied an integrated in vivo and in vitro approach, using both canine and human models, to test the hypothesis that the anti-thrombotic effects of A(2) agonist treatment are due in part to inhibition of platelet activation. METHODS In Protocol 1, recurrent coronary thrombosis was triggered in anesthetized dogs by application of a stenosis at a site of arterial injury. Coronary patency and flow cytometric indices of platelet activation (P-selectin expression; formation of heterotypic aggregates) were compared in dogs pre-treated with the A(2) agonist CGS 21680 versus controls. In Protocols 2 and 3, blood samples were obtained from dogs and human volunteers. In vitro aggregation and platelet activation (assessed by impedance aggregometry and flow cytometry, respectively) were quantified in paired aliquots pre-incubated with CGS versus vehicle. RESULTS In the canine models, CGS improved in vivo coronary patency and attenuated in vitro aggregation but, contrary to our hypothesis, did not evoke a down-regulation in platelet activation. In contrast, in human blood samples, CGS attenuated both in vitro aggregation and flow cytometric markers of platelet activation-aggregation. CONCLUSION The mechanisms contributing to the anti-thrombotic effect of A(2) agonist treatment are species-dependent: adenosine A(2) receptor stimulation inhibits platelet activation in human, but not canine, models.
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Affiliation(s)
- Matthew D. Linden
- Center for Platelet Function Studies, University of Massachusetts Medical School, Worcester MA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester MA
| | - Marc R. Barnard
- Center for Platelet Function Studies, University of Massachusetts Medical School, Worcester MA
| | - A.L. Frelinger
- Center for Platelet Function Studies, University of Massachusetts Medical School, Worcester MA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester MA
| | - Alan D. Michelson
- Center for Platelet Function Studies, University of Massachusetts Medical School, Worcester MA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester MA
| | - Karin Przyklenk
- Center for Platelet Function Studies, University of Massachusetts Medical School, Worcester MA
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester MA
- Department of Anesthesiology, University of Massachusetts Medical School, Worcester MA
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