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Zhang Z, Wu X, Zou Z, Shen M, Liu Q, Zhangsun Z, Zhao H, Lei W, Wang Z, Dong Y, Yang Y. Heat stroke: Pathogenesis, diagnosis, and current treatment. Ageing Res Rev 2024; 100:102409. [PMID: 38986844 DOI: 10.1016/j.arr.2024.102409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
Recently, the incidence of heat-related illnesses has exhibited a steadily upward trend, which is closely associated with several environmental factors such as climate change and air pollution. The progression of heat-related illnesses is a continuous process and can progress to the terminal period when it transforms into heat stroke, the most severe form. Heat stroke is markedly by a core body temperature above 40°C and central nervous system dysfunction. Current knowledge suggests that the pathogenesis of heat stroke is complex and varied, including inflammatory response, oxidative stress, cell death, and coagulation dysfunction. This review consolidated recent research progress on the pathophysiology and pathogenesis of heat stroke, with a focus on the related molecular mechanisms. In addition, we reviewed common strategies and sorted out the drugs in various preclinical stages for heat stroke, aiming to offer a comprehensive research roadmap for more in-depth researches into the mechanisms of heat stroke and the reduction in the mortality of heat stroke in the future.
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Affiliation(s)
- Zhe Zhang
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Xiaopeng Wu
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Zheng Zou
- Department of Neurosurgery, The General Hospital of Northern Theater Command, No. 83, Wenhua Road, Shenhe District, Shenyang, Liaoning 110016, China
| | - Mingzhi Shen
- Department of General Medicine, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Road, Hainan, 572013, China
| | - Qiong Liu
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Ziyin Zhangsun
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Huadong Zhao
- Department of General Surgery, Tangdu Hospital, The Airforce Medical University, 1 Xinsi Road, Xi'an, 710038, China
| | - Wangrui Lei
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China
| | - Zheng Wang
- Department of Cardiothoracic Surgery, Central Theater Command General Hospital of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, China
| | - Yushu Dong
- Department of Neurosurgery, The General Hospital of Northern Theater Command, No. 83, Wenhua Road, Shenhe District, Shenyang, Liaoning 110016, China.
| | - Yang Yang
- Xi'an Key Laboratory of Innovative Drug Research for Heart Failure, Northwest University First Hospital, Faculty of Life Sciences and Medicine, Northwest University, 229 Taibai North Road, Xi'an, 710069, China.
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Xia R, Sun M, Li Y, Yin J, Liu H, Yang J, Liu J, He Y, Wu B, Yang G, Li J. The pathogenesis and therapeutic strategies of heat stroke-induced myocardial injury. Front Pharmacol 2024; 14:1286556. [PMID: 38259273 PMCID: PMC10800451 DOI: 10.3389/fphar.2023.1286556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Heat stroke (HS) is a febrile illness characterized by an elevation in the core body temperature to over 40°C, accompanied by central nervous system impairment and subsequent multi-organ dysfunction syndrome. In recent years, the mortality rate from HS has been increasing as ambient temperatures continue to rise each year. The cardiovascular system plays an important role in the pathogenesis process of HS, as it functions as one of the key system for thermoregulation and its stability is associated with the severity of HS. Systemic inflammatory response and endothelial cell damage constitute pivotal attributes of HS, other factors such as ferroptosis, disturbances in myocardial metabolism and heat shock protein dysregulation are also involved in the damage to myocardial tissue in HS. In this review, a comprehensively detailed description of the pathogenesis of HS-induced myocardial injury is provided. The current treatment strategies and the promising therapeutic targets for HS are also discussed.
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Affiliation(s)
- Rui Xia
- Department of Critical Care Medicine, Chongqing University Jiangjin Hospital, Chongqing, China
| | - Meng Sun
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuling Li
- Emergency Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Yin
- Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Huan Liu
- Department of Critical Care Medicine, Chongqing University Jiangjin Hospital, Chongqing, China
| | - Jun Yang
- Department of Critical Care Medicine, Chongqing University Jiangjin Hospital, Chongqing, China
| | - Jing Liu
- Department of Critical Care Medicine, Chongqing University Jiangjin Hospital, Chongqing, China
| | - Yanyu He
- Department of Critical Care Medicine, Chongqing University Jiangjin Hospital, Chongqing, China
| | - Bing Wu
- Department of Critical Care Medicine, Chongqing University Jiangjin Hospital, Chongqing, China
| | - Guixiang Yang
- Department of Critical Care Medicine, Chongqing University Jiangjin Hospital, Chongqing, China
| | - Jianhua Li
- Department of Critical Care Medicine, Chongqing University Jiangjin Hospital, Chongqing, China
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Chao CM, Wang LY, Huang CC, Chang WT, Tang LY, Lin MT, Chang CP. Myocardial structure and functional alterations in a preclinical model of exertional heat stroke. Life Sci 2023; 323:121640. [PMID: 37004732 DOI: 10.1016/j.lfs.2023.121640] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
AIM Relatively little information is available about the effect of an acute exertional heat stroke (EHS) on myocardium structure and function. Herein, we used a survival male rat model of EHS to answer the question. MAIN METHODS Adult male Wistar rats underwent forced treadmill running at a 36 °C room temperature and 50 % relative humidity until EHS onset, characterized by hyperthermia and collapse. All rats that were followed for 14 days survived. Injury severity scores of both gastrocnemius and myocardium were determined histologically. Following an EHS event, pathological echocardiography, skeletal muscle and myocardial damage scores and indicators, myocardial fibrosis, hypertrophy, and autophagy were elucidated. KEY FINDINGS Rats with EHS onset displayed skeletal muscle damage, elevated serum levels of skeletal muscle indicators (e.g., creatinine kinase, myoglobin, and potassium) and myocardial injury indicators (e.g., cardiac troponin I, creatinine kinase, and lactate dehydrogenase) returning to homeostasis within 3 days post-EHS. However, EHS-induced myocardial damage, pathological echocardiography, myocardial fibrosis, hypertrophy, and deposited misfolded proteins lasted up to 14 days post-EHS at least. SIGNIFICANCE First, we provide evidence to confirm that despite the apparent return to homeostasis, underlying processes may still be ongoing after EHS onset. Second, we provide several key findings emphasizing the pathophysiology and risk factors of EHS, highlighting gaps in knowledge with the aim of stimulating future studies.
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Chen D, Geng Y, Deng Z, Li P, Xue S, Xu T, Li G. Inhibition of TLR4 Alleviates Heat Stroke-Induced Cardiomyocyte Injury by Down-Regulating Inflammation and Ferroptosis. Molecules 2023; 28:molecules28052297. [PMID: 36903542 PMCID: PMC10005438 DOI: 10.3390/molecules28052297] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/02/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Inflammatory response and cell death play key roles in the mechanism of myocardial cell injury induced by heat stroke (HS) in rats. Ferroptosis is a newly discovered regulatory type of cell death, which is involved in the occurrence and development of various cardiovascular diseases. However, the role of ferroptosis in the mechanism of cardiomyocyte injury caused by HS remains to be clarified. The purpose of this study was to investigate the role and potential mechanism of Toll-like receptor 4 (TLR4) in cardiomyocyte inflammation and ferroptosis under HS conditions at the cellular level. The HS cell model was established by exposing H9C2 cells at 43 °C for 2 h and then recovering at 37 °C for 3 h. The association between HS and ferroptosis was investigated by adding the ferroptosis inhibitor, liproxstatin-1, and the ferroptosis inducer, erastin. The results show that the expressions of ferroptosis-related proteins recombinant solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) were decreased, the contents of glutathione (GSH) were decreased, and the contents of malondialdehyde (MDA), reactive oxygen species (ROS), and Fe2+ were increased in H9C2 cells in the HS group. Moreover, the mitochondria of the HS group became smaller and the membrane density increased. These changes were consistent with the effects of erastin on H9C2 cells and were reversed with liproxstatin-1. The addition of TLR4 inhibitor TAK-242 or NF-κB inhibitor PDTC reduced the expressions of NF-κB and p53, increased the expressions of SLC7A11 and GPX4, reduced the contents of TNF-α, IL-6 and IL-1β, increased the content of GSH and reduced MDA, ROS, and Fe2+ levels in H9C2 cells under the HS condition. TAK-242 may improve the mitochondrial shrinkage and membrane density of H9C2 cells induced by HS. In conclusion, this study illustrated that inhibition of the TLR4/NF-κB signaling pathway can regulate the inflammatory response and ferroptosis induced by HS, which provides new information and a theoretical basis for the basic research and clinical treatment of cardiovascular injuries caused by HS.
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Affiliation(s)
- Dandan Chen
- Department of Physiology, Basic Medical School, Ningxia Medical University, Yinchuan 750004, China
| | - Yao Geng
- School of Nursing, Ningxia Medical University, Yinchuan 750004, China
| | - Ziwei Deng
- School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
| | - Peiling Li
- School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
| | - Shujing Xue
- Department of Physiology, Basic Medical School, Ningxia Medical University, Yinchuan 750004, China
| | - Tao Xu
- Department of Physiology, Basic Medical School, Ningxia Medical University, Yinchuan 750004, China
- Correspondence: (T.X.); (G.L.); Tel.: +86-138-95-103-877 (T.X.); +86-187-09-508-466 (G.L.)
| | - Guanghua Li
- Department of Physiology, Basic Medical School, Ningxia Medical University, Yinchuan 750004, China
- School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
- Correspondence: (T.X.); (G.L.); Tel.: +86-138-95-103-877 (T.X.); +86-187-09-508-466 (G.L.)
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Hu JM, Hsu CH, Lin YC, Kung CW, Chen SY, Lin WT, Cheng PY, Shen HH, Lee YM. Ethyl pyruvate ameliorates heat stroke-induced multiple organ dysfunction and inflammatory responses by induction of stress proteins and activation of autophagy in rats. Int J Hyperthermia 2021; 38:862-874. [PMID: 34078225 DOI: 10.1080/02656736.2021.1931479] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objective: Heat stroke (HS) elicits the systemic inflammatory responses that result in multiple organ dysfunction (MOD). Heat shock response and autophagy are activated during heat stress for removal of damaged organelles and proteins, emerging as a major regulator of cellular homeostasis. Ethyl pyruvate (EP) is a derivative of pyruvic acid and possesses antioxidant and anti-inflammatory effects. This study aims to investigate the effects of EP on MOD in HS rats and explore the possible mechanisms.Method: Anesthetized rats were placed in a heating chamber (42 °C) to elevate the core body temperature attaining to 42.9 °C. Rats were then moved to room temperature and monitored for 6 h. EP (60 mg/kg, i.v.) was administered 30 min prior to heat exposure.Results: Results showed that EP significantly reduced HS-induced increases in plasma levels of LDH, CPK, GPT and CK-MB, reversed the decrease of platelet counts, and alleviated intestinal mucosal and pulmonary damage. Moreover, EP reduced pro-inflammatory protein, including TNF-α, IL-6, IL-1β, HMGB1 and iNOS, and induced stress proteins, heme oxygenase-1 (HO-1), heat shock protein (HSP) 70 and HSP90 in the liver of HS rats. The levels of HS-activated autophagy-regulatory proteins were affected by EP, in which the phosphorylated mTOR and AKT were reduced, and the phosphorylated AMPK increased, accompanied with upregulation in ULK1, Atg7, Atg12 and LC3II, and downregulation of p62.Conclusion: In conclusion, EP ameliorated HS-induced inflammatory responses and MOD, and the underlying mechanism is associated with the induction of the stress proteins HO-1 and HSP70 as well as restorage of autophagy.
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Affiliation(s)
- Je-Ming Hu
- Department of Surgery, Division of Colorectal Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hsueng Hsu
- Department of Internal Medicine, Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chun Lin
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Wen Kung
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Shu-Ying Chen
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Wen-Ting Lin
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan
| | - Pao-Yun Cheng
- Department of Physiology & Biophysics, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Hsueh Shen
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Mei Lee
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan
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Effects of melatonin in wound healing of dental pulp and periodontium: Evidence from in vitro, in vivo and clinical studies. Arch Oral Biol 2021; 123:105037. [PMID: 33440268 DOI: 10.1016/j.archoralbio.2020.105037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Database research has revealed that melatonin has beneficial effects in pulpal and periodontal regeneration. Several studies reported protective effects of melatonin against inflammation in several organs including the heart, brain, and teeth. In addition to inflammation reduction, melatonin has been involved in tissue regeneration and wound healing. The aim of this review is to summarize the evidence from in vitro, in vivo and clinical studies on the effects of melatonin in wound healing of dental pulp and periodontium. This review gives a thorough summary of the possible role of melatonin in wound healing of dental pulp and periodontium in connection with anti-inflammatory and antioxidant effects, cell proliferation, and cell differentiation. Any contradictory evidence is also assessed. METHODS The PubMed database was searched for all research articles published before April 2020 with the search terms "melatonin" and "dental pulp". Articles with the search terms "melatonin", "periodontal disease" and "bone" published before October 2019 were also included. Non-English articles were excluded. RESULTS Melatonin has been shown to reduce inflammation, inhibit cell proliferation and regulate differentiation of pulp cells. Melatonin increased odontoblast activities, resulting in the differentiation in the dental pulp. However, melatonin did not initiate differentiation in undifferentiated pulp cells but seemed to have beneficial effects in periodontitis by promoting periodontium's wound healing. CONCLUSION Those findings suggest that melatonin could have beneficial effects on pulpal and periodontal cells under inflammatory conditions. However, discrepancies remain between in vitro and in vivo findings regarding the effect of melatonin on dental pulp and periodontium.
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Lin X, Lin CH, Liu R, Li C, Jiao S, Yi X, Walker MJ, Xu XM, Zhao T, Huang PC, Sun G. Myricetin against myocardial injury in rat heat stroke model. Biomed Pharmacother 2020; 127:110194. [PMID: 32371315 DOI: 10.1016/j.biopha.2020.110194] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Heat stroke-induced mortality is rising across the globe. So, the design of prophylactic and/or therapeutic modalities for heat stroke is pressing need. The common plant derived flavonoid exhibits strong anti-oxidant and anti-inflammatory activities; however, its effects in heat stroke remain unknown. The study aimed to investigate the cardioprotective effects of myricetin on heat stroke induced acute myocardial injury as well as lethality in rats and to explore the underlying mechanisms. METHODS Myocardial injury was induced by subjecting the anesthetized rats to a high ambient temperature of 43 °C for 70 min. An intragastrical dose of myricetin (5-25 mg/kg body weight) was given to rats once per day for one week prior to the start of heat stress. Heat shock protein 72 antibodies was given intraperitoneally to rats 24 h before the start of heat stress. Myocardial injury severity was estimated by determing myocardial damage scores, myocardial injury indicators, myocardial oxidative and inflammatory factors. Western blot analysis was used for cardiac expression of heat shock protein (HSP)72. RESULTS Significant (P < 0.05) up-regulation of HSP-72 after chronic administration of myricetin coincided with significant (P < 0.05) reduction in hyperthermia, hypotension, cardiac inflammatory and oxidative damage and lethality. Inhibition of HSP-72 showed a significant (P < 0.05) reversal in the cardiaprotection as well as survival. CONCLUSIONS Our results indicate that myricetin diminishes myocardial injury as well as lethality in heat stroke by up-regulating HSP-72 and show promise as a novel prevention therapeutic for heat stroke.
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Affiliation(s)
- Xiaojing Lin
- Department of Spinal Cord Injury and Repair, Trauma and Orthopedics Institute of Chinese PLA, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, China; Institute of Military Cognitive and Brain Sciences, Academy of Military Medical Sciences, Beijing, 100850, China
| | - Cheng-Hsien Lin
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
| | - Ruoxu Liu
- Institute of Military Cognitive and Brain Sciences, Academy of Military Medical Sciences, Beijing, 100850, China
| | - Chenyi Li
- Institute of Military Cognitive and Brain Sciences, Academy of Military Medical Sciences, Beijing, 100850, China
| | - Shuxin Jiao
- Department of Neuroscience, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, China
| | - Xueqing Yi
- Department of Medical Imaging, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, China
| | - M J Walker
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery and Goodman and Campbell Brain andSpine, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Xiao-Ming Xu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery and Goodman and Campbell Brain andSpine, Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tingbao Zhao
- Department of Spinal Cord Injury and Repair, Trauma and Orthopedics Institute of Chinese PLA, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, China
| | - Po-Chang Huang
- Department of Orthopaedics, Chi Mei Medical Center, Tainan, Taiwan.
| | - Gang Sun
- Department of Medical Imaging, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, China.
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