1
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Vite A, Matsuura TR, Bedi KC, Flam EL, Arany Z, Kelly DP, Margulies KB. Functional Impact of Alternative Metabolic Substrates in Failing Human Cardiomyocytes. JACC Basic Transl Sci 2024; 9:1-15. [PMID: 38362346 PMCID: PMC10864907 DOI: 10.1016/j.jacbts.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 02/17/2024]
Abstract
Recent studies suggest that metabolic dysregulation in patients with heart failure might contribute to myocardial contractile dysfunction. To understand the correlation between function and energy metabolism, we studied the impact of different fuel substrates on human nonfailing or failing cardiomyocytes. Consistent with the concept of metabolic flexibility, nonfailing myocytes exhibited excellent contractility in all fuels provided. However, impaired contractility was observed in failing myocytes when carbohydrates alone were used but was improved when additional substrates were added. This study demonstrates the functional significance of fuel utilization shifts in failing human cardiomyocytes.
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Affiliation(s)
- Alexia Vite
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy R. Matsuura
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth C. Bedi
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily L. Flam
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zoltan Arany
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel P. Kelly
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth B. Margulies
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Abstract
The ketone bodies beta-hydroxybutyrate and acetoacetate are hepatically produced metabolites catabolized in extrahepatic organs. Ketone bodies are a critical cardiac fuel and have diverse roles in the regulation of cellular processes such as metabolism, inflammation, and cellular crosstalk in multiple organs that mediate disease. This review focuses on the role of cardiac ketone metabolism in health and disease with an emphasis on the therapeutic potential of ketosis as a treatment for heart failure (HF). Cardiac metabolic reprogramming, characterized by diminished mitochondrial oxidative metabolism, contributes to cardiac dysfunction and pathologic remodeling during the development of HF. Growing evidence supports an adaptive role for ketone metabolism in HF to promote normal cardiac function and attenuate disease progression. Enhanced cardiac ketone utilization during HF is mediated by increased availability due to systemic ketosis and a cardiac autonomous upregulation of ketolytic enzymes. Therapeutic strategies designed to restore high-capacity fuel metabolism in the heart show promise to address fuel metabolic deficits that underpin the progression of HF. However, the mechanisms involved in the beneficial effects of ketone bodies in HF have yet to be defined and represent important future lines of inquiry. In addition to use as an energy substrate for cardiac mitochondrial oxidation, ketone bodies modulate myocardial utilization of glucose and fatty acids, two vital energy substrates that regulate cardiac function and hypertrophy. The salutary effects of ketone bodies during HF may also include extra-cardiac roles in modulating immune responses, reducing fibrosis, and promoting angiogenesis and vasodilation. Additional pleotropic signaling properties of beta-hydroxybutyrate and AcAc are discussed including epigenetic regulation and protection against oxidative stress. Evidence for the benefit and feasibility of therapeutic ketosis is examined in preclinical and clinical studies. Finally, ongoing clinical trials are reviewed for perspective on translation of ketone therapeutics for the treatment of HF.
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Affiliation(s)
- Timothy R. Matsuura
- Cardiovascular Institute and Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Patrycja Puchalska
- Department of Medicine, Division of Molecular Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Peter A. Crawford
- Department of Medicine, Division of Molecular Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Daniel P. Kelly
- Cardiovascular Institute and Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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3
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Sharp TE, Scarborough AL, Li Z, Polhemus DJ, Hidalgo HA, Schumacher JD, Matsuura TR, Jenkins JS, Kelly DP, Goodchild TT, Lefer DJ. Novel Göttingen Miniswine Model of Heart Failure With Preserved Ejection Fraction Integrating Multiple Comorbidities. JACC Basic Transl Sci 2021; 6:154-170. [PMID: 33665515 PMCID: PMC7907541 DOI: 10.1016/j.jacbts.2020.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 01/07/2023]
Abstract
A lack of preclinical large animal models of heart failure with preserved ejection fraction (HFpEF) that recapitulate this comorbid-laden syndrome has led to the inability to tease out mechanistic insights and to test novel therapeutic strategies. This study developed a large animal model that integrated multiple comorbid determinants of HFpEF in a miniswine breed that exhibited sensitivity to obesity, metabolic syndrome, and vascular disease with overt clinical signs of heart failure. The combination of a Western diet and 11-deoxycorticosterone acetate salt-induced hypertension in the Göttingen miniswine led to the development of a novel large animal model of HFpEF that exhibited multiorgan involvement and a full spectrum of comorbidities associated with human HFpEF.
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Key Words
- DBP, diastolic blood pressure
- DOCA, 11-deoxycorticosterone acetate
- EC50, half-maximal effective concentration
- EF, ejection fraction
- HDL, high-density lipoprotein
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- IVGTT, intravenous glucose tolerance test
- LDL, low-density lipoprotein
- LV, left ventricle
- PCWP, pulmonary capillary wedge pressure
- SBP, systolic blood pressure
- TC, total cholesterol
- WD, Western diet
- animal models of human disease
- heart failure with preserved ejection fraction
- hypertension
- metabolic syndrome
- obesity
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Affiliation(s)
- Thomas E Sharp
- Cardiovascular Center of Excellence, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Amy L Scarborough
- Cardiovascular Center of Excellence, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Zhen Li
- Cardiovascular Center of Excellence, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - David J Polhemus
- Cardiovascular Center of Excellence, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Hunter A Hidalgo
- Cardiovascular Center of Excellence, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA.,Department of Pharmacology and Experimental Therapeutics, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Jeffery D Schumacher
- Department of Animal Care, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - Timothy R Matsuura
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Stephen Jenkins
- Department of Cardiology, Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Daniel P Kelly
- Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Traci T Goodchild
- Cardiovascular Center of Excellence, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA.,Department of Pharmacology and Experimental Therapeutics, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
| | - David J Lefer
- Cardiovascular Center of Excellence, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA.,Department of Pharmacology and Experimental Therapeutics, School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
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4
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Yurista SR, Matsuura TR, Silljé HHW, Nijholt KT, McDaid KS, Shewale SV, Leone TC, Newman JC, Verdin E, van Veldhuisen DJ, de Boer RA, Kelly DP, Westenbrink BD. Ketone Ester Treatment Improves Cardiac Function and Reduces Pathologic Remodeling in Preclinical Models of Heart Failure. Circ Heart Fail 2020; 14:e007684. [PMID: 33356362 PMCID: PMC7819534 DOI: 10.1161/circheartfailure.120.007684] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Supplemental Digital Content is available in the text. Accumulating evidence suggests that the failing heart reprograms fuel metabolism toward increased utilization of ketone bodies and that increasing cardiac ketone delivery ameliorates cardiac dysfunction. As an initial step toward development of ketone therapies, we investigated the effect of chronic oral ketone ester (KE) supplementation as a prevention or treatment strategy in rodent heart failure models.
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Affiliation(s)
- Salva R Yurista
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (S.R.Y., H.H.W.S., K.T.N., D.J.v.V., R.A.d.B., B.D.W.)
| | - Timothy R Matsuura
- Department of Medicine, Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (T.R.M., K.S.M., S.V.S., T.C.L., D.P.K.)
| | - Herman H W Silljé
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (S.R.Y., H.H.W.S., K.T.N., D.J.v.V., R.A.d.B., B.D.W.)
| | - Kirsten T Nijholt
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (S.R.Y., H.H.W.S., K.T.N., D.J.v.V., R.A.d.B., B.D.W.)
| | - Kendra S McDaid
- Department of Medicine, Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (T.R.M., K.S.M., S.V.S., T.C.L., D.P.K.)
| | - Swapnil V Shewale
- Department of Medicine, Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (T.R.M., K.S.M., S.V.S., T.C.L., D.P.K.)
| | - Teresa C Leone
- Department of Medicine, Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (T.R.M., K.S.M., S.V.S., T.C.L., D.P.K.)
| | - John C Newman
- Division of Geriatrics, Buck Institute for Research on Aging, University of California, San Francisco (J.C.N., E.V.)
| | - Eric Verdin
- Division of Geriatrics, Buck Institute for Research on Aging, University of California, San Francisco (J.C.N., E.V.)
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (S.R.Y., H.H.W.S., K.T.N., D.J.v.V., R.A.d.B., B.D.W.)
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (S.R.Y., H.H.W.S., K.T.N., D.J.v.V., R.A.d.B., B.D.W.)
| | - Daniel P Kelly
- Department of Medicine, Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (T.R.M., K.S.M., S.V.S., T.C.L., D.P.K.)
| | - B Daan Westenbrink
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (S.R.Y., H.H.W.S., K.T.N., D.J.v.V., R.A.d.B., B.D.W.)
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5
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Sakamoto T, Matsuura TR, Wan S, Ryba DM, Kim J, Won KJ, Lai L, Petucci C, Petrenko N, Musunuru K, Vega RB, Kelly DP. A Critical Role for Estrogen-Related Receptor Signaling in Cardiac Maturation. Circ Res 2020; 126:1685-1702. [PMID: 32212902 PMCID: PMC7274895 DOI: 10.1161/circresaha.119.316100] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
RATIONALE The heart undergoes dramatic developmental changes during the prenatal to postnatal transition, including maturation of cardiac myocyte energy metabolic and contractile machinery. Delineation of the mechanisms involved in cardiac postnatal development could provide new insight into the fetal shifts that occur in the diseased heart and unveil strategies for driving maturation of stem cell-derived cardiac myocytes. OBJECTIVE To delineate transcriptional drivers of cardiac maturation. METHODS AND RESULTS We hypothesized that ERR (estrogen-related receptor) α and γ, known transcriptional regulators of postnatal mitochondrial biogenesis and function, serve a role in the broader cardiac maturation program. We devised a strategy to knockdown the expression of ERRα and γ in heart after birth (pn-csERRα/γ [postnatal cardiac-specific ERRα/γ]) in mice. With high levels of knockdown, pn-csERRα/γ knockdown mice exhibited cardiomyopathy with an arrest in mitochondrial maturation. RNA sequence analysis of pn-csERRα/γ knockdown hearts at 5 weeks of age combined with chromatin immunoprecipitation with deep sequencing and functional characterization conducted in human induced pluripotent stem cell-derived cardiac myocytes (hiPSC-CM) demonstrated that ERRγ activates transcription of genes involved in virtually all aspects of postnatal developmental maturation, including mitochondrial energy transduction, contractile function, and ion transport. In addition, ERRγ was found to suppress genes involved in fibroblast activation in hearts of pn-csERRα/γ knockdown mice. Disruption of Esrra and Esrrg in mice during fetal development resulted in perinatal lethality associated with structural and genomic evidence of an arrest in cardiac maturation, including persistent expression of early developmental and noncardiac lineage gene markers including cardiac fibroblast signatures. Lastly, targeted deletion of ESRRA and ESRRG in hiPSC-CM derepressed expression of early (transcription factor 21 or TCF21) and mature (periostin, collagen type III) fibroblast gene signatures. CONCLUSIONS ERRα and γ are critical regulators of cardiac myocyte maturation, serving as transcriptional activators of adult cardiac metabolic and structural genes, an.d suppressors of noncardiac lineages including fibroblast determination.
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Affiliation(s)
| | | | - Shibiao Wan
- Institute for Diabetes, Obesity and Metabolism, Dept. Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Center for Applied Bioinformatics, St. Jude Children’s Research Hospital, Memphis, TN 38105
| | | | - Junil Kim
- Institute for Diabetes, Obesity and Metabolism, Dept. Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Kyoung Jae Won
- Institute for Diabetes, Obesity and Metabolism, Dept. Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Rick B. Vega
- Center for Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery Institute at Lake Nona, Orlando, Florida, 32827, USA
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6
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Affiliation(s)
- Timothy R Matsuura
- From the Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Teresa C Leone
- From the Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daniel P Kelly
- From the Cardiovascular Institute, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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7
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Horton JL, Davidson MT, Kurishima C, Vega RB, Powers JC, Matsuura TR, Petucci C, Lewandowski ED, Crawford PA, Muoio DM, Recchia FA, Kelly DP. The failing heart utilizes 3-hydroxybutyrate as a metabolic stress defense. JCI Insight 2019; 4:124079. [PMID: 30668551 DOI: 10.1172/jci.insight.124079] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/16/2019] [Indexed: 12/18/2022] Open
Abstract
Evidence has emerged that the failing heart increases utilization of ketone bodies. We sought to determine whether this fuel shift is adaptive. Mice rendered incapable of oxidizing the ketone body 3-hydroxybutyrate (3OHB) in the heart exhibited worsened heart failure in response to fasting or a pressure overload/ischemic insult compared with WT controls. Increased delivery of 3OHB ameliorated pathologic cardiac remodeling and dysfunction in mice and in a canine pacing model of progressive heart failure. 3OHB was shown to enhance bioenergetic thermodynamics of isolated mitochondria in the context of limiting levels of fatty acids. These results indicate that the heart utilizes 3OHB as a metabolic stress defense and suggest that strategies aimed at increasing ketone delivery to the heart could prove useful in the treatment of heart failure.
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Affiliation(s)
- Julie L Horton
- Center for Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery Institute at Lake Nona (SBP-LN), Orlando, Florida, USA
| | - Michael T Davidson
- Departments of Medicine and Pharmacology, and Cancer Biology, and Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - Clara Kurishima
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Rick B Vega
- Center for Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery Institute at Lake Nona (SBP-LN), Orlando, Florida, USA
| | - Jeffery C Powers
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Timothy R Matsuura
- Cardiovascular Institute and Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Petucci
- Center for Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery Institute at Lake Nona (SBP-LN), Orlando, Florida, USA.,Cardiovascular Institute and Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - E Douglas Lewandowski
- Center for Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery Institute at Lake Nona (SBP-LN), Orlando, Florida, USA.,Davis Heart and Lung Research Institute and Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Peter A Crawford
- Center for Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery Institute at Lake Nona (SBP-LN), Orlando, Florida, USA.,Departments of Medicine and Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Deborah M Muoio
- Departments of Medicine and Pharmacology, and Cancer Biology, and Duke Molecular Physiology Institute, Duke University, Durham, North Carolina, USA
| | - Fabio A Recchia
- Department of Physiology, Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.,Institute of Life Sciences, Scuola Superiore Sant'Anna Pisa, Fondazione G. Monasterio, Pisa, Italy
| | - Daniel P Kelly
- Center for Metabolic Origins of Disease, Sanford Burnham Prebys Medical Discovery Institute at Lake Nona (SBP-LN), Orlando, Florida, USA.,Cardiovascular Institute and Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Matsuura TR, Bartos JA, Tsangaris A, Shekar KC, Olson MD, Riess ML, Bienengraeber M, Aufderheide TP, Neumar RW, Rees JN, McKnite SH, Dikalova AE, Dikalov SI, Douglas HF, Yannopoulos D. Early Effects of Prolonged Cardiac Arrest and Ischemic Postconditioning during Cardiopulmonary Resuscitation on Cardiac and Brain Mitochondrial Function in Pigs. Resuscitation 2017; 116:8-15. [PMID: 28408349 PMCID: PMC5552370 DOI: 10.1016/j.resuscitation.2017.03.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (CA) is a prevalent medical crisis resulting in severe injury to the heart and brain and an overall survival of less than 10%. Mitochondrial dysfunction is predicted to be a key determinant of poor outcomes following prolonged CA. However, the onset and severity of mitochondrial dysfunction during CA and cardiopulmonary resuscitation (CPR) is not fully understood. Ischemic postconditioning (IPC), controlled pauses during the initiation of CPR, has been shown to improve cardiac function and neurologically favorable outcomes after 15min of CA. We tested the hypothesis that mitochondrial dysfunction develops during prolonged CA and can be rescued with IPC during CPR (IPC-CPR). METHODS A total of 63 swine were randomized to no ischemia (Naïve), 19min of ventricular fibrillation (VF) CA without CPR (Untreated VF), or 15min of CA with 4min of reperfusion with either standard CPR (S-CPR) or IPC-CPR. Mitochondria were isolated from the heart and brain to quantify respiration, rate of ATP synthesis, and calcium retention capacity (CRC). Reactive oxygen species (ROS) production was quantified from fresh frozen heart and brain tissue. RESULTS Compared to Naïve, Untreated VF induced cardiac and brain ROS overproduction concurrent with decreased mitochondrial respiratory coupling and CRC, as well as decreased cardiac ATP synthesis. Compared to Untreated VF, S-CPR attenuated brain ROS overproduction but had no other effect on mitochondrial function in the heart or brain. Compared to Untreated VF, IPC-CPR improved cardiac mitochondrial respiratory coupling and rate of ATP synthesis, and decreased ROS overproduction in the heart and brain. CONCLUSIONS Fifteen minutes of VF CA results in diminished mitochondrial respiration, ATP synthesis, CRC, and increased ROS production in the heart and brain. IPC-CPR attenuates cardiac mitochondrial dysfunction caused by prolonged VF CA after only 4min of reperfusion, suggesting that IPC-CPR is an effective intervention to reduce cardiac injury. However, reperfusion with both CPR methods had limited effect on mitochondrial function in the brain, emphasizing an important physiological divergence in post-arrest recovery between those two vital organs.
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Affiliation(s)
- Timothy R Matsuura
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
| | - Jason A Bartos
- Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Adamantios Tsangaris
- Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | | | - Matthew D Olson
- Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Matthias L Riess
- Department of Anesthesiology, TVHS VA Medical Center, Nashville, TN, USA; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin Bienengraeber
- Departments of Anesthesiology and Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer N Rees
- Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Scott H McKnite
- Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Anna E Dikalova
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sergey I Dikalov
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hunter F Douglas
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Demetris Yannopoulos
- Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
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9
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Bartos JA, Voicu S, Matsuura TR, Tsangaris A, Sideris G, Oestreich BA, George SA, Olson M, Shekar KC, Rees JN, Carlson K, Sebastian P, McKnite S, Raveendran G, Aufderheide TP, Yannopoulos D. Role of epinephrine and extracorporeal membrane oxygenation in the management of ischemic refractory ventricular fibrillation: a randomized trial in pigs. JACC Basic Transl Sci 2017; 2:244-253. [PMID: 29152600 PMCID: PMC5693223 DOI: 10.1016/j.jacbts.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Minnesota Resuscitation Consortium has established a protocol for rapid transport of patients with refractory out-of-hospital VF cardiac arrest to the cardiac catheterization laboratory for rapid evaluation and stabilization often requiring ECMO. This protocol provides new challenges to treatment paradigms that were created to rapidly achieve return of spontaneous circulation in the field. A porcine model of refractory VF cardiac arrest was developed, including initiation of VF using endovascular occlusion of the proximal LAD followed by 5 min of untreated VF. Resuscitation begins with 10 min of high-quality CPR followed by 35 min of ACLS and reconstitution of coronary flow. A 2 × 2 study design was used with animals randomized to use of epinephrine or placebo during ACLS and then again randomized to ECMO or no ECMO at the time of reinitiation of coronary flow. ECMO-facilitated coronary reperfusion and hemodynamic stabilization improved 4-h survival compared with CPR-facilitated reperfusion and standard ACLS in a porcine model of refractory VF cardiac arrest. Repeated epinephrine boluses provided in accordance with standard ACLS protocols increased systemic blood pressure and coronary perfusion pressure but provided no benefit in survival compared with placebo. Over 50% of the animals receiving ECMO met criteria for decannulation at 4 h, suggesting that rapid cardiac and hemodynamic recovery is possible in severely injured animals treated with ECMO.
Extracorporeal membrane oxygenation (ECMO) is used in cardiopulmonary resuscitation (CPR) of refractory cardiac arrest. The authors used a 2 × 2 study design to compare ECMO versus CPR and epinephrine versus placebo in a porcine model of ischemic refractory ventricular fibrillation (VF). Pigs underwent 5 min of untreated VF and 10 min of CPR, and were randomized to receive epinephrine versus placebo for another 35 min. Animals were further randomized to left anterior descending artery (LAD) reperfusion at minute 45 with ongoing CPR versus venoarterial ECMO cannulation at minute 45 of CPR and subsequent LAD reperfusion. Four-hour survival was improved with ECMO whereas epinephrine showed no effect.
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Affiliation(s)
- Jason A Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Sebastian Voicu
- Medical and Toxicological Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 2 rue Ambroise Paré, 75475 Paris, France
| | - Timothy R Matsuura
- Department of Integrated Biology & Physiology, University of Minnesota, Minneapolis, MN
| | - Adamantios Tsangaris
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Georgios Sideris
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Brett A Oestreich
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Stephen A George
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Matthew Olson
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | | | - Jennifer N Rees
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Kathleen Carlson
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Pierre Sebastian
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Scott McKnite
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Ganesh Raveendran
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
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10
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Bartos JA, Matsuura TR, Sarraf M, Youngquist ST, McKnite SH, Rees JN, Sloper DT, Bates FS, Segal N, Debaty G, Lurie KG, Neumar RW, Metzger JM, Riess ML, Yannopoulos D. Bundled postconditioning therapies improve hemodynamics and neurologic recovery after 17 min of untreated cardiac arrest. Resuscitation 2014; 87:7-13. [PMID: 25447036 DOI: 10.1016/j.resuscitation.2014.10.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/04/2014] [Accepted: 10/14/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Ischemic postconditioning (stutter CPR) and sevoflurane have been shown to mitigate the effects of reperfusion injury in cardiac tissue after 15min of ventricular fibrillation (VF) cardiac arrest. Poloxamer 188 (P188) has also proven beneficial to neuronal and cardiac tissue during reperfusion injury in human and animal models. We hypothesized that the use of stutter CPR, sevoflurane, and P188 combined with standard advanced life support would improve post-resuscitation cardiac and neurologic function after prolonged VF arrest. METHODS Following 17min of untreated VF, 20 pigs were randomized to Control treatment with active compression/decompression (ACD) CPR and impedance threshold device (ITD) (n=8) or Bundle therapy with stutter ACD CPR+ITD+sevoflurane+P188 (n=12). Epinephrine and post-resuscitation hypothermia were given in both groups per standard protocol. Animals that achieved return of spontaneous circulation (ROSC) were evaluated with echocardiography, biomarkers, and a blinded neurologic assessment with a cerebral performance category score. RESULTS Bundle therapy improved hemodynamics during resuscitation, reduced need for epinephrine and repeated defibrillation, reduced biomarkers of cardiac injury and end-organ dysfunction, and increased left ventricular ejection fraction compared to Controls. Bundle therapy also improved rates of ROSC (100% vs. 50%), freedom from major adverse events (50% vs. 0% at 48h), and neurologic function (42% with mild or no neurologic deficit and 17% achieving normal function at 48h). CONCLUSIONS Bundle therapy with a combination of stutter ACD CPR, ITD, sevoflurane, and P188 improved cardiac and neurologic function after 17min of untreated cardiac arrest in pigs. All studies were performed with approval from the Institutional Animal Care Committee of the Minneapolis Medical Research Foundation (protocol #12-11).
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Affiliation(s)
- Jason A Bartos
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States
| | - Timothy R Matsuura
- Department of Integrative Biology and Physiology, University of Minnesota, United States
| | - Mohammad Sarraf
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States
| | | | - Scott H McKnite
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States
| | - Jennifer N Rees
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States
| | - Daniel T Sloper
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States
| | - Frank S Bates
- Department of Chemical Engineering and Materials Science, University of Minnesota, United States
| | - Nicolas Segal
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States
| | - Guillaume Debaty
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States; UJF-Grenoble 1/CNRS/CHU de Grenoble/TIMC-IMAG UMR 5525, Grenoble F-38041, France
| | - Keith G Lurie
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, United States
| | - Joseph M Metzger
- Department of Integrative Biology and Physiology, University of Minnesota, United States
| | - Matthias L Riess
- Department of Anesthesiology, TVHS VA Medical Center, Nashville, TN, United States; Department of Anesthesiology, Vanderbilt University, Nashville, TN, United States
| | - Demetris Yannopoulos
- Department of Medicine-Cardiovascular Division, University of Minnesota, United States.
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11
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Riess ML, Matsuura TR, Bartos JA, Bienengraeber M, Aldakkak M, McKnite SH, Rees JN, Aufderheide TP, Sarraf M, Neumar RW, Yannopoulos D. Anaesthetic Postconditioning at the Initiation of CPR Improves Myocardial and Mitochondrial Function in a Pig Model of Prolonged Untreated Ventricular Fibrillation. Resuscitation 2014; 85:1745-51. [PMID: 25281906 DOI: 10.1016/j.resuscitation.2014.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Anaesthetic postconditioning (APoC) attenuates myocardial injury following coronary ischaemia/reperfusion. We hypothesised that APoC at the initiation of cardiopulmonary resuscitation (CPR) will improve post resuscitation myocardial function along with improved mitochondrial function in a pig model of prolonged untreated ventricular fibrillation. METHODS In 32 pigs isoflurane anaesthesia was discontinued prior to induction of ventricular fibrillation that was left untreated for 15 min. At the initiation of CPR, 15 animals were randomised to controls (CON), and 17 to APoC with 2 vol% sevoflurane during the first 3 min CPR. Pigs were defibrillated after 4 min of CPR. After return of spontaneous circulation (ROSC), isoflurane was restarted at 0.8-1.5 vol% in both groups. Systolic and diastolic blood pressures were measured continuously. Of the animals that achieved ROSC, eight CON and eight APoC animals were randomised to have their left ventricular ejection fraction (LVEF%) assessed by echocardiography at 4h. Seven CON and nine APoC were randomised to euthanasia 15 min after ROSC to isolate mitochondria from the left ventricle for bioenergetic studies. RESULTS ROSC was achieved in 10/15 CON and 15/17 APoC animals. APoC improved haemodynamics during CPR and post-CPR LVEF%. Mitochondrial ATP synthesis, coupling of oxidative phosphorylation and calcium retention capacity were improved in cardiac mitochondria isolated after APoC. CONCLUSIONS In a porcine model of prolonged untreated cardiac arrest, APoC with inhaled sevoflurane at the initiation of CPR, is associated with preserved mitochondrial function and improved post resuscitation myocardial dysfunction. Approved by the Institutional Animal Care Committee of the Minneapolis Medical Research Foundation of Hennepin County Medical Center (protocol number 11-05).
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Affiliation(s)
- Matthias L Riess
- TVHS VA Medical Center, Nashville, TN, United States; Department of Anesthesiology, Vanderbilt University, Nashville, TN, United States.
| | - Timothy R Matsuura
- Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, United States
| | - Jason A Bartos
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Martin Bienengraeber
- Departments of Anesthesiology and Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mohammed Aldakkak
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Scott H McKnite
- Minneapolis Medical Research Foundation, Minneapolis, MN, United States
| | - Jennifer N Rees
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Mohammad Sarraf
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, United States
| | - Demetris Yannopoulos
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States
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