Alterations of β-adrenoceptor-G-protein-regulated adenylyl cyclase in heart failure

Alterations of receptor-G-protein-regulated adenylyl cyclase activity have been suggested to represent an important alteration leading to contractile dysfunction in the failing human heart. Recent experiments suggest that the ₁-adrenoceptor(₁AR) density and mRNA levels are reduced, while ₂-adrenoceptors and stimulatory G-proteins are unchanged (mRNA and protein level). Functional assays demonstrated that the catalyst of the adenylyl cyclase is not different between failing and nonfailing myocardium. Inhibitory G-proteins are increased (pertussis toxin substrates, protein and mRNA) and correlate to the reduced inotropic effects of -adrenoceptor agonists and of CAMP-PDE inhibitors. Gi-coupled m-cholinoceptors and A₁-adrenergic receptors are unchanged in density and affinity. Stimulation of these receptors resulted in an unchanged antiadrenergic effect on force of contraction. In conclusion, a downregulation of ₁-AR and an increase of Gi have been observed as signal transduction alteration in failing human myocardium. These alterations are due to alterations of gene expression in the failing heart and are related to a defective regulation of force of contraction in heart failure.     

Etiologic factors and pathologic alterations in selenium-vitamin E deficiency and excess in animals and humans

The etiology of selenium-vitamin E (Se-E) deficiency diseases may be complex. Many of the syndromes involve combined deficiency of selenium and vitamin E. Selenium moves into the animal and human food chain from soil and plants, which may contain inadequate amounts of the nutrient in many areas of the world. Vitamin E may be in low concentration in many animal feeds unless supplements are added. Some syndromes, such as steatitis in cats, result from an increased requirement of vitamin E in diets that contain large amounts of polyunsaturated fatty acids, and these diseases will only respond to vitamin E administration. Deficiency syndromes in animals owing to pure Se deficiency are infrequent and have been produced mainly by laboratory studies utilizing extreme deficiency conditions. Other factors that may affect the occurrence of these deficiency diseases are concurrent dietary deficiency of S-containing amino acids, bioavailability of different forms of dietary Se, intake of compounds that antagonize Se (e.g., silver salts), and exposure to various prooxidant substances (e.g., iron compounds, oxygen, ozone, and various drugs). A wide variety of pathologic alterations occur in animals and humans with Se-E deficiency. Myocardial lesions are seen most frequently in calves, lambs, pigs, turkey poults, and ducklings. In humans, Keshan disease, an endemic cardiomyopathy in China, is attributed to Se deficiency. Necrosis of skeletal muscle is the most frequent lesion observed in animal species. Necrosis of smooth muscle of the gizzard and intestine may be a prominent lesion in turkey poults, ducklings, and quail. Other Se-E deficiency lesions include hepatic necrosis, gastric ulceration, intestinal and uterine lipofuscinosis, pancreatic damage, steatitis, exudative diathesis, encephalomalacia, and testicular necrosis. Selenium toxicosis is well characterized in animals and humans by neurological, hoof, and hair alterations.     

The role of SIRT2 in vascular-related and heart-related diseases: A review

At present, cardiovascular disease is one of the important factors of human death, and there are many kinds of proteins involved. Sirtuins family proteins are involved in various physiological and pathological activities of the human body. Among them, there are more and more studies on the relationship between sirtuin2 (SIRT2) protein and cardiovascular diseases. SIRT2 can effectively inhibit pathological cardiac hypertrophy. The effect of SIRT2 on ischaemia-reperfusion injury has different effects under different conditions. SIRT2 can reduce the level of reactive oxygen species (ROS), which may help to reduce the severity of diabetic cardiomyopathy. SIRT2 can affect a variety of cardiovascular diseases, energy metabolism and the ageing of cardiomyocytes, thereby affecting heart failure. SIRT2 also plays an important role in vascular disease. For endothelial cell damage used by oxidative stress, the role of SIRT2 is bidirectional, which is related to the degree of oxidative stress stimulation. When the degree of stimulation is small, SIRT2 plays a protective role, and when the degree of stimulation increases to a certain level, SIRT2 plays a negative role. In addition, SIRT2 is also involved in the remodelling of blood vessels and the repair of skin damage.     

Allopurinol reduces oxidative stress and activates Nrf2/p62 to attenuate diabetic cardiomyopathy in rats

Allopurinol (ALP) attenuates oxidative stress and diabetic cardiomyopathy (DCM), but the mechanism is unclear. Activation of nuclear factor erythroid 2‐related factor 2 (Nrf2) following the disassociation with its repressor Keap1 under oxidative stress can maintain inner redox homeostasis and attenuate DCM with concomitant attenuation of autophagy. We postulated that ALP treatment may activate Nrf2 to mitigate autophagy over‐activation and consequently attenuate DCM. Streptozotocin‐induced type 1 diabetic rats were untreated or treated with ALP (100 mg/kg/d) for 4 weeks and terminated after heart function measurements by echocardiography and pressure‐volume conductance system. Cardiomyocyte H9C2 cells infected with Nrf2 siRNA or not were incubated with high glucose (HG, 25 mmol/L) concomitantly with ALP treatment. Cell viability, lactate dehydrogenase, 15‐F2t‐Isoprostane and superoxide dismutase (SOD) were measured with colorimetric enzyme‐linked immunosorbent assays. ROS, apoptosis, was assessed by dihydroethidium staining and TUNEL, respectively. The Western blot and qRT‐PCR were used to assess protein and mRNA variations. Diabetic rats showed significant reductions in heart rate (HR), left ventricular eject fraction (LVEF), stroke work (SW) and cardiac output (CO), left ventricular end‐systolic volume (LVVs) as compared to non‐diabetic control and ALP improved or normalized HR, LVEF, SW, CO and LVVs in diabetic rats (all P < .05). Hearts of diabetic rats displayed excessive oxidative stress manifested as increased levels of 15‐F2t‐Isoprostane and superoxide anion production, increased apoptotic cell death and cardiomyocytes autophagy that were concomitant with reduced expressions of Nrf2, heme oxygenase‐1 (HO‐1) and Keap1. ALP reverted all the above‐mentioned diabetes‐induced biochemical changes except that it did not affect the levels of Keap1. In vitro, ALP increased Nrf2 and reduced the hyperglycaemia‐induced increases of H9C2 cardiomyocyte hypertrophy, oxidative stress, apoptosis and autophagy, and enhanced cellular viability. Nrf2 gene silence cancelled these protective effects of ALP in H9C2 cells. Activation of Nrf2 subsequent to the suppression of Keap1 and the mitigation of autophagy over‐activation may represent major mechanisms whereby ALP attenuates DCM.     

MMF联合泼尼松治疗成人特发性膜性肾病的疗效及安全性研究

目的:探究吗替麦考酚酯(MMF)联合泼尼松(Pre)治疗成人特发性膜性肾病(IMN)的疗效及安全性。方法:选取2015.06-2017.06我院收治的102例行IMN患者列为研究对象,将患者按随机数字表法以1:1比例分为对照组与观察组,每组各51例,对照组患者使用Pre进行治疗,观察组患者使用MMF+Pre进行治疗,治疗12个月。比较两组治疗12个月后疗效,治疗前、治疗后6个月及12个月后肾功能相关指标[24 h尿蛋白定量(24 h UP)、血清胱抑素C(CysC)、血清尿素氮(BUN)、血清肌酐(Scr)、血清白蛋白(Alb)]、脂代谢指标[总胆固醇(TC)、甘油三酯(TG)],并记录用药间期出现的药物不良反应。结果:治疗12个月后,研究组患者总有效率为90.20%,显著高对照组74.51%(P0.05);治疗6个月、12个月后,两组患者24 h UP、Cys C、TC、TG水平较治疗前均依次显著下降而Alb水平显著上升(P0.05),且观察组上述指标与同期对照组对比差异显著(P0.05);而两组BUN和Scr水平较治疗前差异不显著(P0.05),两组对比无统计学意义(P0.05)。治疗期间,观察组患者药物不良反应率为11.76%,显著低于对照组27.45%(P0.05)。结论:应用MMF联合泼尼松治疗成人IMN疗效更佳,可显著改善患者肾功能,并改善患者脂代谢,药物方案安全性较高,具有较高应用价值。     

特发性膜性肾病患者外周血中性粒细胞-淋巴细胞比值的临床与病理价值分析

摘要 目的：探讨外周血中性粒细胞与淋巴细胞比值（NLR）在特发性膜性肾病（IMN）中的临床及病理价值。方法：收集2017年1月至2019年12月确诊为IMN患者221例作为IMN组,将2019年7月至2019年9月体检且尿常规和肾功能指标正常的87例健康体检者作为正常对照组,计算每个研究对象的NLR值,比较两组间NLR值的差异。记录IMN患者的血生化指标及患者的肾脏病理分期及纤维化程度,并且根据MDRD公式计算肾小球滤过率(eGFR),分析NLR与IMN患者的血生化指标及病理特征的相关性。ROC曲线分析外周血NLR评估IMN患者肾间质纤维化的敏感性和特异性。结果：IMN组外周血NLR值高于对照组,差异有统计学意义（P<0.05）。外周血NLR值与IMN患者年龄和肾间质纤维化有关联（P均<0.05）,但与IMN患者性别及肾脏病理分期无关联（P均>0.05）。IMN外周血NLR值与IMN患者hs-CRP、SCr、BUN呈正相关（P<0.05）,与eGFR呈负相关（P<0.05）,与ESR、UA、TP、Alb、24小时蛋白尿定量均无相关性（P均>0.05）。不同程度肾间质纤维化的IMN患者外周血NLR值不同,差异有统计学意义（P<0.05）,且肾间质纤维化程度在1、2、3级时,纤维化程度越重,NLR值越大;3个级别间两两比较,差异均有统计学意义（P均<0.05）。外周血NLR值预测IMN患者肾间质纤维化的ROC曲线下面积为0.715[95%CI(0.626,0.803)],其截断值为1.858时,灵敏度为68.6%,特异度为66.7%。结论：外周血NLR可作为IMN肾脏功能水平的一个有效评价指标,且与IMN患者肾间质纤维化有关,可作为判断肾间质纤维化的参考指标。     

Phenotyping of hypertensive heart disease and hypertrophic cardiomyopathy using personalized 3D modelling and cardiac cine MRI

Differential diagnosis of hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) is clinically challenging but important for treatment management. This study aims to phenotype HHD and HCM in 3D + time domain by using a multiparametric motion-corrected personalized modeling algorithm and cardiac magnetic resonance (CMR). 44 CMR data, including 12 healthy, 16 HHD and 16 HCM cases, were examined. Multiple CMR phenotype data consisting of geometric and dynamic variables were extracted globally and regionally from the models over a full cardiac cycle for comparison against healthy models and clinical reports. Statistical classifications were used to identify the distinctive characteristics and disease subtypes with overlapping functional data, providing insights into the challenges for differential diagnosis of both types of disease. While HCM is characterized by localized extreme hypertrophy of the LV, wall thickening/contraction/strain was found to be normal and in sync, though it was occasionally exaggerated at normotrophic/less severely hypertrophic regions during systole to preserve the overall ejection fraction (EF) and systolic functionality. Additionally, we observed that hypertrophy in HHD could also be localized, although at less extreme conditions (i.e. more concentric). While fibrosis occurs mostly in those HCM cases with aortic obstruction, only minority of HHD patients were found affected by fibrosis. We demonstrate that subgroups of HHD (i.e. preserved and reduced EF: HHDpEF & HHDrEF) have different 3D + time CMR characteristics. While HHDpEF has cardiac functions in normal range, dilation and heart failure are indicated in HHDrEF as reflected by low LV wall thickening/contraction/strain and synchrony, as well as much reduced EF.     

格列齐特对糖尿病大鼠心肌的保护作用及其机制*

目的: 观察格列齐特对糖尿病大鼠心肌保护作用及其可能的机制。方法: 将60只健康SD大鼠随机分为正常组(NC,n=10),造模组(n=50)给予高糖高脂饲料4周后,腹腔注射STZ(45 mg/kg)建立糖尿病大鼠模型,随机抽取以FBG≥16.7 mmol/L作为糖尿病模型建立成功。将造模成功的38只糖尿病大鼠随机分为模型组(MC,n=9)、格列齐特组(Glic,80 mg/kg,n=10)、格列本脲组(Glib,2.5 mg/kg,n=10)、法舒地尔组(Fas,10 mg/kg,n=9);NC组和MC组灌胃等容积蒸馏水,Glic组和Glib组灌胃给药,Fas组采用腹腔注射。各组大鼠每天给药一次,每周记录体质量及空腹血糖(FBG),持续8周。实验结束时取血并测定心脏质量,计算心脏质量指数(HWI);测定各组糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)含量以及血清丙二醛(MDA)水平和超氧化物歧化酶(SOD)活性;通过HE和Masson染色,观察心肌病理变化和组织胶原纤维水平;TUNEL染色观察并计算心肌细胞凋亡率;Western blot法检测心肌组织中RhoA、ROCK1、eNOS、Bcl-2和Bax蛋白表达。结果: 与NC组比较,MC组FBG、HWI、HbA1c、TC、TG、LDL-C、MDA水平,心肌组织胶原沉积和心肌细胞凋亡率以及心肌组织中RhoA、ROCK1、Bax蛋白明显升高,SOD活性及HDL-C、eNOS、Bcl-2和体重显著降低(P＜0.01);与MC组相比,Glic组FBG、HWI、HbA1c、TC、TG、LDL-C和MDA等指标明显下降,心肌组织胶原沉积及心肌细胞凋亡减轻,心肌组织RhoA、ROCK1、Bax蛋白表达下调(P＜0.01或P＜0.05),大鼠体重和血清中SOD活性,HDL-C升高,eNOS、Bcl-2蛋白水平升高(P＜0.01或P＜0.05)。与Glic组相比,Glib组与Fas组体重、血脂、FBG、HWI、MDA以及心肌纤维化和心肌细胞凋亡水平升高,SOD和Bcl-2降低,Glib组心肌组织RhoA、ROCK1、Bax蛋白表达上调(P＜0.01或P＜0.05)。结论: 格列齐特可改善糖尿病大鼠心肌损伤并减轻心肌细胞凋亡水平,其机制可能与降低血糖,改善氧化应激状态,调控RhoA/ROCK1/eNOS信号通路有关。