花生四烯酸细胞色素P450表氧化酶代谢物EETs的内源性心血管保护作用

花生四烯酸(arachidonic acid, AA)是生物体内最丰富的多不饱和脂肪酸,其代谢产物具有广泛的生物学活性。环氧二十碳三烯酸(epoxyeicosatrienoic acids, EETs)是AA经细胞色素P450表氧化酶(cytochrome P450 epoxygenase, CYP450)代谢产生的内源性小分子化合物,近20年的研究表明EETs具有广泛的心血管保护作用,是重要的内源性心血管保护因子。EETs不仅可以改善不同病因导致的心脏重构,抑制心肌肥厚,减轻不同因素导致的心肌损伤,还能明显改善上述病理过程所导致的血流动力学紊乱和心功能损害。在血管保护方面,最早的研究证明EETs是一种内皮来源的超极化因子,可以通过作用于内皮细胞和平滑肌上的钙离子敏感通道而发挥血管舒张作用,随后研究发现,EETs可能有更多非超极化效应而产生降压、改善冠状动脉血供、调节肺动脉压力等作用。此外,EETs还具有显著的内皮保护效应,可以抑制内皮细胞的炎症反应和黏附作用,抑制血小板聚集,促进纤溶和血管的新生。EETs还能改善主动脉重构,包括抑制动脉粥样硬化、主动脉外膜纤维化和主动脉钙化。EETs心血管保护作用的分子机制是多方面的,EETs可通过调控多个信号通路从而调节不同病理生理环节,是一种多靶点内源性心血管保护因子。因此研究EETs在心血管系统中的生理和病理生理作用有利于阐明心血管疾病的内源性保护机制,为心血管疾病的防治提供新策略。本文综述了EETs的内源性心血管保护作用和机制,以期为该领域的转化研究提供新的思路。     

2型糖尿病的系统性血管保护治疗策略

在最新研究发现的系统性血管保护的优化治疗策略表明,血管损伤机制与胰岛素抵抗、糖尿病肾病及外周动脉疾病(PAD)的发病机理相关。胰岛素抵抗机制在血管损伤方面主要表现为大血管和微血管病变。系统性动脉硬化性疾病的及时诊断和干预是至关重要的。并且,治疗方面不仅仅是改善现有疾病状况,也应注意减少心血管事件的风险。这些努力有助于降低心血管事件的风险和死亡率。PAD的治疗包括药物治疗、血管内治疗和血管重建,以及运动疗法。经典治疗药物包括血管舒张剂,如贝前列素和抗血小板药物。值得注意的是,贝前列素除血管舒张活性外还有几个其他治疗作用,包括保护血管内皮、抗血小板和抗炎作用。最近的前期临床研究表明,贝前列素不仅通过其舒张血管活性改善四肢缺血,同时改善了影响血管内皮功能的胰岛素抵抗。贝列前素的应用,在早期疾病阶段维持血管内皮功能,减少血管事件的发生率,发挥其系统性血管保护作用。这样,贝列前素最终将有助于改善患者的生存质量并可能增加PAD患者的寿命。     

Kappa 阿片受体的抗缺血性心脏保护作用--信息机制

有证据表明,心脏细胞产生强腓肽和强腓肽类多肽,它们是kappa阿片受体(κ-0R)的激动剂。κ-0R是心脏一种优势的阿片受体,其激活可改变在体和离体心脏的功能。在正常和病理情况下,内源性κ-阿片肽可能通过自分泌或旁分泌的方式调节心脏功能。心肌缺血是导致心脏功能紊乱的一个常见原因,主要表现为心肌功能减弱,心律失常及心肌梗塞等。心肌缺血时,交感神经发放增强,从而增加作功负荷及氧消耗量;而这又使缺血引发的状况更为恶化。机体抵抗缺血引发心肌损害／心律失常的保护机制之一是抑制β-肾上腺素受体(β—AR)的兴奋。κ-0R确实能抑制β-AR的激动。这种抑制主要是由于GS蛋白受到抑制,也在较小程度上由于信息通路的腺苷酸环化酶的抑制。因为该种酶能通过对百日咳毒素敏感的G蛋白转导β—AR的激动。另一保护心肌对抗缺血性损害的机制是预处理。预处理是指预先受到缺血等损伤使心脏对随后更严重的损伤产生较强的耐受能力。这种保护作用可以在预处理后即时产生,也可延至预处理后1—3天。在采用缺血或其产生的后果之一——代谢抑制作为预处理而致的心脏保护中,κ-OR参与媒介预处理的作用。用κ—OR的特异性激动剂U50488H激活κ—OR(U50488H药理性预处理,UP)可激活蛋白激酶C(PKC),开放ATY敏感的钾通道(KATP channels)及增加热休克蛋白(HSP)的产生。阻断PKC的作用,关闭KATP通道或抑制HSP的合成,均可消除UP的心脏保护作用。这些发现表明,PKC、KATP通道和HSP在UP的心脏保护中均具重要作用。此外,UP也能减低缺血造成心肌损害的因素之一,即Ca^2 的超负荷。这个事实表明UP发挥心脏保护作用至少部分地是通过减低Ca^2 的超负荷。最有趣的是,以阻断剂阻塞KATP通道,在消除UP的延迟性心脏保护作用的同时也降低了UP对Ca^2 超负荷的抑制作用。这个事实揭示了KATP通道开放所致的心脏保护作用至少部分地可能是由于防止或减低了Ca^2 的超负荷。     

SGLT2抑制剂治疗心力衰竭的机制

钠-葡萄糖协同转运蛋白2(sodium-glucose cotransport protein 2,SGLT2)抑制剂是一种新型口服降糖药。临床研究证实,无论是否患有2型糖尿病,SGLT2抑制剂都可以改善心力衰竭患者的预后,但其机制尚不明确。SGLT2抑制剂可能通过改善心脏的收缩和舒张功能、改善心脏重构、降低心脏前后负荷、改善心肌能量代谢、调控神经-体液调节以及控制心血管危险因素等方式直接发挥心血管保护作用。此外,心力衰竭患者通常合并肾功能不全,SGLT2抑制剂可改善肾功能发挥间接心血管保护作用。本文对目前报道的SGLT2抑制剂改善心力衰竭可能的多效作用机制进行总结。     

二苯乙烯苷抗动脉粥样硬化的作用和机制

二苯乙烯苷是中药何首乌中主要的水溶性生物活性成分。大量研究表明,二苯乙烯苷能够通过调脂、抗氧化、抗炎、舒张血管及增强免疫力等作用而抑制动脉粥样硬化的发生和发展,作为抗动脉粥样硬化的一种有效成分极具研究价值。但目前对其抗动脉粥样硬化的潜在作用机制还不完全清楚,本文就二苯乙烯苷在调节脂质、抗氧化、降低炎性反应等方面作用和机制作一综述。     

干细胞的旁分泌和自分泌功能——基础与临床研究的新视角

近年发现干细胞具有很强的旁/自分泌功能,本文综述干细胞所分泌的生长因子、细胞因子、调节肽、细胞信号分子等生物活性因子,以及缺血、缺氧、生长因子、性别和其它激素对干细胞分泌功能的调节;并分析干细胞分泌功能在血管生成、心脏、肝脏、肾脏和神经系统保护中的作用,认为干细胞可通过其分泌功能影响靶器官结构、功能状态及其病理状态下的修复,是干细胞治疗改善靶器官功能、抗凋亡、抗炎等作用的机制之一.     

免疫系统在病毒性心肌炎发病中的作用

心肌炎通常由病毒感染引起,有证据表明心肌炎最终发展成扩张性心肌病,是发达国家主要致死的原因,越来越多的人认为细胞因子在心肌炎和心肌病发病中起重要作用,心力衰竭病人血循环中细胞因子水平较正常人高。已证明多种细胞因子能在体内外抑制心肌收缩,细胞因子由活化的免疫细胞产生,它可诱生NO合酶,继而产生NO,已证明NO既有利又有害,关键在于产生NO量的多少,NO能抑制病毒复制,而保护心脏抗柯萨奇B病毒感染,无论是病毒感染对心脏的直接作用,还是免疫应答的利弊平衡,对此两者分子机制的了解都将是掌握人类心肌炎发病的关键。     

葛根素对糖尿病视网膜细胞凋亡作用的研究进展

糖尿病的发病率逐年上升,其并发症的严重性日趋明显,特别是糖尿病视网膜病变导致视力下降和丧失已经引起了广泛关注,所以研究糖尿病视网膜病变的发病机制及其防治是必要的。糖尿病视网膜病变是一种多种机制共同作用的复杂性疾病,而细胞凋亡在糖尿病视网膜病变的发生和发展中起着重要的作用,所以研究细胞凋亡对糖尿病视网膜病变的治疗有着重要意义。由于细胞凋亡研究的深入,人们将注意力集中于糖尿病视网膜细胞凋亡能否得到抑制和逆转的问题上。研究发现,糖尿病视网膜病变细胞凋亡可能与视网膜新生血管形成、VEGF水平增高等因素有关。当前对葛根素的研究表明,葛根素能有效抑制视网膜新生血管形成,并且对于缺血、缺氧等因素引起的损害有很强的改善作用,葛根素还可以降低糖尿病糖基化终产物水平,甚至对视网膜超微结构的损害具有一定的保护作用,所以葛根素可能是治疗糖尿病性视网膜病变的新策略。本文就近期糖尿病视网膜病变中细胞凋亡的有关研究和葛根素的抗细胞凋亡作用做一综述,提示在糖尿病视网膜病变中葛根素的不可忽视的作用。     

降钙素基因相关肽与动脉粥样硬化

动脉粥样硬化是心血管疾病中最常见的一种血管病变,影响着血管、免疫、代谢等系统。动脉粥样硬化发生发展是一个复杂的过程,它损伤血管内皮,平滑肌等细胞,涉及到多种细胞因子的相互作用。而CGRP具有抑制血管平滑肌增值作用,对预防血管术后再狭窄有重要意义,CGRP能舒张血管,对防治氧化应激引起的内皮损伤具有保护作用,但其机制还不完全清楚。     

降钙素基因相关肽与动脉粥样硬化

动脉粥样硬化是心血管疾病中最常见的一种血管病变,影响着血管、免疫、代谢等系统。动脉粥样硬化发生发展是一个复杂的过程,它损伤血管内皮,平滑肌等细胞,涉及到多种细胞因子的相互作用。而CGRP具有抑制血管平滑肌增值作用,对预防血管术后再狭窄有重要意义,CGRP能舒张血管,对防治氧化应激引起的内皮损伤具有保护作用,但其机制还不完全清楚。     

Therapeutic potential of vitamin E against myocardial ischemic-reperfusion injury.

Myocardial ischemia is a disease process characterized by reduced coronary flow such that the supply of nutritive blood to heart muscle (myocardium) is insufficient for normal myocardial aerobic metabolism. Prompt reestablishment of coronary flow by invasive and noninvasive clinical procedures is the most direct and effective means of limiting myocardial damage in ischemic heart disease patients, although reperfusion carries with it an injury component which may reflect, at least to some degree, the toxic effects of partially reduced oxygen species and their participation in degenerative cellular processes such as membrane lipid peroxidation. Vitamin E, a lipophilic, chain-breaking antioxidant, is a prominent membrane constituent in heart muscle, where it modulates/regulates various aspects of heart muscle-cell metabolism and function. Vitamin E's beneficial effects against experimentally induced oxidative damage to the heart, along with inverse epidemiological correlations between plasma vitamin E level and either anginal pain or mortality due to ischemic heart disease, suggest that vitamin E might have protective and therapeutic roles against myocardial ischemic-reperfusion injury. Laboratory investigations aimed at addressing this possibility have demonstrated that vitamin E supplementation protects isolated hearts against ischemic-reperfusion injury, and relatively more inconsistent and limited data document cardioprotective effects of vitamin E in some animal models of myocardial ischemia-reperfusion, especially when administered prior to the ischemic period. Clinical attempts to establish whether vitamin E has therapeutic benefit in ischemic heart disease patients remain inconclusive, having relied upon a variety of nonuniformly controlled protocols and a single, rather subjective endpoint (anginal pain). Consequently, although laboratory data constitute a conceptual context for and indirect support of the idea that vitamin E could be a cardioprotectant against ischemic-reperfusion injury, compelling clinical evidence regarding vitamin E's therapeutic potential in the ischemic heart-disease patient is lacking. Elective coronary revascularization would appear to provide an attractive clinical setting for evaluating the therapeutic efficacy of vitamin E in the context of cardiac ischemia-reperfusion. Further biochemical work would still be required to define how vitamin E exerts any cardioprotective effect observed in these patients.     

Protective roles of puerarin and Danshensu on acute ischemic myocardial injury in rats

Ischemic heart diseases have been the leading cause of death in both developed and developing countries over the past decades. The aim of this study was to investigate the cardioprotective effects of the complex preparation (called Shenge), made of puerarin (isolated from Pueraria lobata Ohwi., also called Kudzu) and Danshensu (isolated from the Chinese herb, Salvia miltiorrhiza), on acute ischemic myocardial injury in rats and its underlying mechanisms. The left anterior descending (LAD) coronary artery was occluded to induce myocardial ischemia in the hearts of SD rats. Shenge was injected into the tail vein 15 min after occlusion at doses of 0, 30, 60, or 120 mg/kg body wt. ST elevation was then measured at 60, 120, and 240 min after Shenge administration. The ischemic size, serum levels of creatine kinase isoenzyme-MB (CK-MB), lactate dehydrogenase (LDH), superoxide dismutase (SOD) and malondialdehyde (MDA), and ST elevation were measured after the rats were sacrificed. Shenge decreased ST elevation induced by acute myocardial ischemia, reduced ischemic size, serum levels of CK-MB, LDH and MDA, and increased serum activity of SOD in a dose-dependent manner. The combined use of puerarin and Danshensu at a ratio of 1:1 showed the most effective activity. In conclusion, Shenge exerts significant cardioprotective effects against acute ischemic myocardial injury in rats, likely through its antioxidant and anti-lipid peroxidation properties, and thus may be an effective and promising medicine for both prophylaxis and treatment of ischemic heart disease.     

Disorders of cardiac contractile function in ischemic shock; the protective effect of antioxidants and liposomes made from egg phospholipids

Experiments were made on Wistar rats with 6h tourniqueting of the hind limbs to study animal survival rate, myocardial contractile function and protective action of antioxidants and egg phospholipid liposomes during ischemic shock. It has been shown that reperfusion of the limbs leads to a high animal lethality, make lower myocardial contractile function and coronary flow of the hearts isolated from rats following a 6h reperfusion of the limbs. Well-known antioxidant butylated hydroxytoluene and a new antioxidant tetramethylpiperidine derivative bring animal lethality down and improve coronary flow and contractile function of the isolated heart. Phospholipid liposomes increase survival rate moderately but have no any effect on the heart contractile function. It has been deduced that lipid peroxidation takes part in the disturbance of heart contractile function and genesis of the death within ischemic shock.     

The Effect of Euryale Ferox (Makhana), an Herb of Aquatic Origin, on Myocardial Ischemic Reperfusion Injury

Fox nut or gorgon nut (Euryale ferox – Family Nymphaeaceae), popularly known as Makhana, has been widely used in traditional oriental medicine to cure a variety of diseases including kidney problems, chronic diarrhea, excessive leucorrhea and hypofunction of the spleen. Based on the recent studies revealing antioxidant activities of Euryale ferox and its glucosides composition, we sought to determine if Euryale ferox seeds (Makhana) could reduce myocardial ischemic reperfusion injury. Two different models were used: acute model, where isolated rat hearts were preperfused for 15 min with Krebs Henseleit bicarbonate (KHB) buffer containing three different doses of makhana (25, 125 or 250 μg/ml) followed by 30 min of ischemia and 2 h of reperfusion; and chronic model, where rats were given two different doses of makhana (250 and 500 mg/kg/day) for 21 days, after which isolated hearts were subjected to 30 min of ischemia followed by 2 h of reperfusion. In both cases, the hearts of the Makhana treated rats were resistant to ischemic reperfusion injury as evidenced by their improved post-ischemic ventricular function and reduced myocardial infarct size. Antibody array technique was used to identify the cardioprotective proteins. The Makhana-treated hearts had increased amounts of thioredoxin-1 (Trx–1) and thioredoxin-related protein-32 (TRP32) compared to the control hearts. Western blot analysis confirmed increased expression of TRP32 and thioredoxin proteins. In vitro studies revealed that Makhana extracts had potent reactive oxygen species scavenging activities. Taken together, the results of this study demonstrate cardioprotective properties of Makhana and suggest that such cardioprotective properties may be linked with the ability of makhana to induce TRP32 and Trx-1 proteins and to scavenge ROS.This study was partially supported by NIH HL22559 and HL 33889. Excellent technical assistance of Praveer Mathur for antibody array is acknowledged.     

Chinese medicinal formula Guan-Xin-Er-Hao protects the heart against oxidative stress induced by acute ischemic myocardial injury in rats

Guan-Xin-Er-Hao (GXEH) is a Chinese medicine formula for treating ischemic heart diseases (IHD) and has a favorable effect. Our aim was to examine whether or not acute oral GXEH could protect the heart against myocardial infarction and apoptosis in acute myocardial ischemic rats. If so, we would explain the antioxidative mechanism involved. The left anterior descending coronary artery was occluded to induce myocardial ischemia in hearts of Sprague-Dawley rats. At the end of the 3 h ischemic period (or 24 h for infarct size), we measured the myocardial infarct size, myocardial apoptosis and the activities of antioxidative enzymes. GXEH reduced infarct size, myocardial apoptosis and the serum level of malondialdehyde (MDA), increased the activities of total antioxidant capacity (T-AOC), superoxide dismutase (SOD) and GSH-peroxidase (GPX) activities and the serum level of glutathione (GSH). GXEH exerts significant cardioprotective effects against acute ischemic myocardial injury in rats, likely through its antioxidation and antilipid peroxidative properties, and thus may be used as a promising agent for both prophylaxis and treatment of IHD.     

Preconditioning the hyperlipidemic myocardium: fact or fantasy?

Ischemic heart disease is a leading cause of death worldwide. Myocardial ischemia results in reduced coronary flow, followed by diminished oxygen and nutrient supply to the heart. Reperfusion to an ischemic myocardium often augments the ischemic damage, known as ischemia-reperfusion (I/R) injury. Number of studies demonstrated that the hyperlipidemic myocardium is rather sensitive and more vulnerable to I/R-induced myocardial injury. Repeated brief ischemia and reperfusion cycles, termed as ischemic preconditioning, given before a sustained ischemia is known to reduce myocardial damage occur as a result of I/R. A plethora of evidence supports the fact that preconditioning is one of the promising interventional strategies having an ability to limit I/R-induced myocardial injury. Despite this fact, the preconditioning-mediated cardioprotection is blunted in chronic hyperlipidemic condition. This suggests that preconditioning is moderately a ‘healthy heart protective phenomenon’. The mechanisms by which chronic hyperlipidemia abrogates cardioprotective effects of preconditioning are uncertain and are not completely understood. The impaired opening of mitochondrial-K_ATP channels, eNOS uncoupling and excessive generation of superoxides in the hyperlipidemic myocardium could play a role in attenuating preconditioning-mediated myocardial protection against I/R injury. Moreover, hyperlipidemia-induced loss of cardioprotective effect of preconditioning is associated with redistribution of both sarcolemmal and mitochondrial Connexin 43. We addressed, in this review, the potential mechanisms involved in hyperlipidemia-induced impairment of myocardial preconditioning. Additionally, novel pharmacologic interventions to attenuate hyperlipidemia-associated exaggerated I/R-induced myocardial injury have been discussed.     

Anti-oxidative stress effects of Herba leonuri on ischemic rat hearts

Our current study was to test the hypothesis that the extract of Herba leonuri (HL) would have antioxidant and cardioprotective effects on ischemic myocardium. The extract of HL (400 mg/kg/day) was administered orally (daily) starting from 1 week before and continuing until 3 weeks after myocardial infarction (MI). Surviving rats were sacrificed at different time points to obtain left ventricles for biochemical assays. Our study demonstrates for the first time that HL does have antioxidant effects both in vitro and in vivo. The antioxidant effects of HL are exerted only under the condition of oxidative stress, by selectively preserving the activities of superoxide dismutase and glutathione peroxidase, as well as depressing the formation of malondialdehyde, especially in the acute phase of acute MI. Its effects of scavenging free radicals and inhibiting the formation of reactive oxygen species may play a key role in protecting the endogenous antioxidant system from oxidative stress in vivo.     

Healing the diabetic heart: does myocardial preconditioning work?

Diabetes mellitus-associated ischemic heart disease is a major public burden in industrialized countries. Reperfusion to a previously ischemic myocardium is obligatory to reinstate its function prior to irreversible damage. However, reperfusion is considered ‘a double-edged sword’ as reperfusion per se could augment myocardial ischemic damage, known as myocardial ischemia-reperfusion (I/R) injury. The brief and repeated cycles of I/R given before a sustained ischemia and reperfusion are represented as ischemic preconditioning, which protects the heart from lethal I/R injury. Few studies have demonstrated preconditioning-mediated cardioprotection in the diabetic heart. In contrast, considerable number of studies suggests that myocardial defensive effects of preconditioning are abolished in the presence of chronic diabetes mellitus that raised questions over preconditioning effects in the diabetic heart. It is evidenced that chronic diabetes mellitus-associated deficit in survival pathways, impaired function of mito-K_ATP channels, MPTP opening and high oxidative stress play key roles in paradoxically suppressed cardioprotective effects of preconditioning in the diabetic heart. These controversial results open up a new area of research to identify potential mechanisms influencing disparities on preconditioning effects in diabetic hearts. In this review, we discussed first the discrepancies on the modulatory role of diabetes mellitus in I/R-induced myocardial injury. Following this, we addressed whether preconditioning could protect the diabetic heart against I/R-induced myocardial injury. Moreover, potential mechanisms pertaining to the attenuated cardioprotective effects of preconditioning in the diabetic heart have been delineated. These are important to be understood for better exploitation of preconditioning strategies in limiting I/R-induced myocardial injury in the diabetic heart.     

Cardioprotective effect of intermittent fasting is associated with an elevation of adiponectin levels in rats

It has been reported that dietary energy restriction, including intermittent fasting (IF), can protect heart and brain cells against injury and improve functional outcome in animal models of myocardial infarction (MI) and stroke. Here we report that IF improves glycemic control and protects the myocardium against ischemia-induced cell damage and inflammation in rats. Echocardiographic analysis of heart structural and functional variables revealed that IF attenuates the growth-related increase in posterior ventricular wall thickness, end systolic and diastolic volumes, and reduces the ejection fraction. The size of the ischemic infarct 24 h following permanent ligation of a coronary artery was significantly smaller, and markers of inflammation (infiltration of leukocytes in the area at risk and plasma IL-6 levels) were less, in IF rats compared to rats on the control diet. IF resulted in increased levels of circulating adiponectin prior to and after MI. Because recent studies have shown that adiponectin can protect the heart against ischemic injury, our findings suggest a potential role for adiponectin as a mediator of the cardioprotective effect of IF.     

Is oxytocin a therapeutic factor for ischemic heart disease?

Ischemic heart disease (IHD) is among the most important and top ranked causes of death in the world, and its preventive and interventional mechanisms are actively being investigated. Preconditioning may still be beneficial in some situations such as IHD. Development of cardioprotective agents to improve myocardial function, to decrease the incidence of arrhythmias, to delay the onset of necrosis, and to limit the total extent of infarction during IHD is of great clinical importance. In order to reduce morbidity, a new treatment modality must be developed, and oxytocin may indeed be one of the candidates. There is increasing experimental evidence indicating that oxytocin may have cardioprotective effects either by decreasing the extent of reperfusion injury or by pharmacologic preconditioning activity. This review shows that in the presence of oxytocin, the cardioprotective effects may be increased to some extent. The presented board of evidence focuses on the valuable effects of oxytocin on myocardial function and candidates it for future clinical studies in the realm of ischemic heart diseases.