One-year outcome of the sevoflurane in acute myocardial infarction randomized trial

Cardioprotective Effect of Anesthetics: Translating Science to Practice

Cardiovascular diseases are the number one cause of mortality in the world, particularly among the aging population. Major adverse cardiac events are also a major contributor to perioperative complications, affecting 2.6% of noncardiac surgeries and up to 18% of cardiac surgeries. Cardioprotective effects of volatile anesthetics and certain intravenous anesthetics have been well-documented in preclinical studies; however, their clinical application has yielded conflicting results in terms of their efficacy. Therefore, better understanding of the underlying mechanisms and developing effective ways to translate these insights into clinical practice remain significant challenges and unmet needs in the area. Several recent reviews have focused on mechanistic dissection of anesthetic-mediated cardioprotection. The present review focuses on recent clinical trials investigating the cardioprotective effects of anesthetics in the past five years. In addition to highlighting the main outcomes of these trials, the authors provide their perspectives about the current gap in the field and potential directions for future investigations.

Silencing of PTEN inhibits the oxidative stress damage and hippocampal cell apoptosis induced by Sevoflurane through activating MEK1/ERK signaling pathway in infant rats

Phosphatase and tensin homolog (PTEN) is a suppressive player in tumor but its concrete role in oxidative stress (OS) damage and cell apoptosis remains much exploration. Thus, this study is conducted to explore the participation of PTEN and its mechanisms in OS damage and cell apoptosis in hippocampal cells.Infant rats were grouped into normal, Sevo, Sevo + si-negative control (NC), Sevo + si-PTEN and Sevo + si-PTEN + PD (MEK1/ERK signaling pathway inhibitor) groups. Infant hippocampal cells were grouped into blank, Sevo, Sevo + si-NC, Sevo + si-PTEN and Sevo + si-PTEN + PD groups. The expressions of PTEN and MEK1/ERK signaling pathway-related proteins were determined. OS-related indices in hippocampal tissues and cells were detected. Cell apoptosis was detected by flow cytometry.Sevoflurane up-regulated PTEN expression and silencing of PTEN activates MEK1/ERK signaling pathway in hippocampal tissues and cells of infant rats. Silencing of PTEN alleviated hippocampal tissue pathological status and inhibited sevoflurane-induced cell apoptosis in hippocampal tissues of infant rats. Silencing of PTEN alleviated OS damage in hippocampal tissues of infant rats. Silencing of PTEN inhibited sevoflurane-induced apoptosis after OS damage in hippocampal cells of infant rats. Silencing of PTEN reduced sevoflurane-induced OS damage in hippocampal cells of infant rats.Our study demonstrates that PTEN silencing inhibits the OS damage and cell apoptosis in hippocampal cells induced by Sevoflurane through activating MEK1/ERK signaling pathway in infant rats.

MicroRNA-146b induces the PI3K/Akt/NF-κB signaling pathway to reduce vascular inflammation and apoptosis in myocardial infarction by targeting PTEN

The aim of the present study was to investigate the function of microRNA-146b on myocardial infarction and the mechanism. An MTT assay, Annexin V/propidium iodide (PI) apoptosis assay, ELISA kits, western blot analysis and a caspase-3/8 activity assay were used to measure cell growth, vascular apoptosis inflammatory factors, and the B-cell lymphoma 2-associated X protein (Bax), phosphatase and tensin homolog (PTEN), phosphoinositide 3-kinase (PI3K)/Akt/nuclear factor (NF)-κB signaling pathway. The expression of microRNA-146b was downregulated in the myocardial infarction rat model, compared with the control group. In an in vitro model of myocardial infarction, the downregulation of microRNA-146b increased inflammatory factors, vascular apoptosis, caspase-3/8 activity and the protein expression of Bax. MicroRNA-146b reduced vascular apoptosis, caspase-3/8 activity and the protein expression of Bax. MicroRNA-146b also regulated the PI3K/Akt/NF-κB signaling pathway to mediate vascular inflammation and apoptosis in myocardial infarction by PTEN. A PI3K inhibitor decreased the effect of microRNA-146b on vascular inflammation and apoptosis following myocardial infarction. In conclusion, microRNA-146b mediated vascular inflammation and apoptosis in patients with myocardial infarction, which may be associated with activation of the PI3K/Akt/NF-κB signaling pathway by PTEN.

Cellular and molecular approaches to enhance myocardial recovery after myocardial infarction

Reperfusion therapy has resulted in significant improvement in post-myocardial infarction morbidity and mortality in over the last 4 decades. Nonetheless, it is well recognized that simply restoring patency of the epicardial artery may not stop or reverse damage at microvascular level, and myocardial salvage is often suboptimal. Numerous efforts have been undertaken to elucidate the mechanisms underlying extensive myonecrosis to facilitate the discovery of therapies to provide additional and incremental benefits over current therapeutic pathways. To date, conclusively effective strategies to promote myocardial recovery have not yet been established. Novel approaches are investigating the foundational cellular and molecular bases of myocardial ischemia and irreversible injury. Herein, we review the emerging concepts and proposed therapies that may improve myocardial protection and reduce infarct size. We examine the preclinical and clinical evidence for reduced infarct size with these strategies, including anti-inflammatory agents, intracellular ion channel modulators, agents affecting the reperfusion injury salvage kinase (RISK) and nitric oxide signaling pathways, modulators of mitochondrial function, anti-apoptotic agents, and stem cell and gene therapy. We review the potential reasons of failures to date and the potential for new strategies to further promote myocardial recovery and improve prognosis.