Distribution and function of recombinant endothelial nitric oxide synthase in transplanted hearts

Nitric oxide synthases in heart failure

SIGNIFICANCE

The regulation of myocardial function by constitutive nitric oxide synthases (NOS) is important for the maintenance of myocardial Ca(2+) homeostasis, relaxation and distensibility, and protection from arrhythmia and abnormal stress stimuli. However, sustained insults such as diabetes, hypertension, hemodynamic overload, and atrial fibrillation lead to dysfunctional NOS activity with superoxide produced instead of NO and worse pathophysiology.

RECENT ADVANCES

Major strides in understanding the role of normal and abnormal constitutive NOS in the heart have revealed molecular targets by which NO modulates myocyte function and morphology, the role and nature of post-translational modifications of NOS, and factors controlling nitroso-redox balance. Localized and differential signaling from NOS1 (neuronal) versus NOS3 (endothelial) isoforms are being identified, as are methods to restore NOS function in heart disease.

CRITICAL ISSUES

Abnormal NOS signaling plays a key role in many cardiac disorders, while targeted modulation may potentially reverse this pathogenic source of oxidative stress.

FUTURE DIRECTIONS

Improvements in the clinical translation of potent modulators of NOS function/dysfunction may ultimately provide a powerful new treatment for many hearts diseases that are fueled by nitroso-redox imbalance.

The complex role of iNOS in acutely rejecting cardiac transplants

This review summarizes the evidence for a detrimental role of nitric oxide (NO) derived from inducible NO synthase (iNOS) and/or reactive nitrogen species such as peroxynitrite in acutely rejecting cardiac transplants. In chronic cardiac transplant rejection, iNOS may have an opposing beneficial component. The purpose of this review is primarily to address issues related to acute rejection, which is a recognized risk factor for chronic rejection. The evidence for a detrimental role is based upon strategies involving nonselective NOS inhibitors, NO neutralizers, selective iNOS inhibitors, and iNOS gene deletion in rodent models of cardiac rejection. The review is presented in the context of the impact on various components, including graft survival, histological rejection, and cardiac function, which may contribute to the process of graft rejection in toto. Possible limitations of each strategy are discussed in order to understand better the variance in published findings, including issues related to the potential importance of cell localization of iNOS expression. Finally, the concept of a dual role for NO and its downstream product, peroxynitrite, in rejection vs immune regulation is discussed.

Prolonging organ allograft survival: potential role of nitric oxide scavengers

A growing number of studies suggest a key role of nitric oxide (NO) derived from the inducible NO synthase (iNOS) isoform as a signalling molecule leading to acute organ transplant rejection. Current theory suggests that NO targets certain tissue proteins for nitrosylation or nitration leading to inhibition of enzyme/protein function and to cell death via apoptosis. Gene expression of iNOS and formation of nitrotyrosine residues have been confirmed in biopsies of rejecting grafts in humans. Experimental attempts to delay graft rejection by treatment with iNOS enzyme inhibitors have yielded conflicting results. An alternative strategy to alter rejection mediated by NO is to scavenge and/or neutralise the actions of excess NO, thereby by-passing the inhibition of iNOS enzyme activity. This review summarises recent laboratory evidence that new experimental NO scavengers/neutralisers have potential value to prolong graft survival. To date, various metal-based NO scavenging/neutralising compounds have been shown to enhance cardiac allograft survival in the absence of immunosuppression. When used in combination with low-dose cyclosporin, these agents produce a synergistic action to enhance graft survival or even to produce "permanent graft survival" under certain prolonged drug regimens. A portion of this benefit may be accounted for by the property of some of these compounds to display immunosuppressant and anti-inflammatory activity in vivo. These properties are based on findings including the following: (i) attenuating cell infiltration into the graft; (ii) attenuating activation of NFkappaB (a transcription factor important for upregulation of various inflammatory genes); (iii) attenuating cyclin D3 gene expression (a marker of cell proliferation; (iv) antagonising autoimmune activation (as determined by attenuated cytokine gene expression in splenocytes isolated from treated animals but stimulated for several days ex vivo in mixed lymphocyte cultures).

Development of an in vivo ischemia-reperfusion model in heterotopically transplanted rat hearts

BACKGROUND

Heart transplantation has been extensively used in animal models, including studies on gene therapy for myocardial preservation. We investigated the feasibility of in situ left coronary artery (LCA) ligation as a physiological system for the examination of strategies to modulate myocardial tolerance against ischemia-reperfusion injury, such as gene therapy, using heterotopically transplanted rat hearts.

METHODS

Lewis rat hearts that had been transplanted into syngeneic recipients' abdomens were subjected to 30-min ischemia, by occluding the LCA, and subsequent blood reperfusion by releasing the suture in situ (I/R group). Transplanted hearts in the sham group underwent laparotomy only.

RESULTS

At 24 hr of reperfusion, the size of the ischemic region was 40.1+/-3.1% of the total left ventricular mass, and the infarct size was 47.5+/-3.3% of the area at risk in the I/R group. Cardiac function was reduced in the I/R group compared with the sham group, associated with higher myeloperoxidase activity (5.12+/-1.35 vs. 0.97+/-0.33 U/g wt) and higher incidence of apoptosis as defined by TUNEL (29.8+/-3.2 vs. 3.8+/-0.7%) and DNA ladder. In the I/R group, up-regulation of Bax, Bak, and caspase-3 was observed.

CONCLUSIONS

These data on myocardial damage of transplanted hearts are consistent and equivalent to those of the usual LCA occlusion model, suggesting that this method is useful to investigate strategies for modulating myocardial tolerance against ischemia-reperfusion injury using heterotopically transplanted rat hearts in a more physiological blood-perfused model.