心肌细胞过表达miR-27b导致小鼠发生心肌纤维化和线粒体损伤

以往的miRNA芯片研究结果显示, miR-27b在人类心脏疾病标本和压力负荷引起的小鼠心肌肥厚模型中表达水平明显升高, 提示其在心脏疾病发生过程中发挥了重要功能。为研究miR-27b在心脏组织中的功能, 文章建立了在心肌细胞特异性 a-肌球蛋白重链(a-MHC)启动子(5.5 kb)控制下过表达miR-27b的转基因小鼠。通过Real-time PCR检测, 发现miR-27b前体和成熟体表达水平在转基因小鼠心脏组织中明显升高。miR-27b转基因小鼠不仅出现心肌肥厚, 还表现出明显的心肌纤维化。进一步研究表明心肌纤维化的关键调节分子金属基质蛋白酶13(MMP13)是miR-27b的靶分子, 在miR-27b转基因小鼠中MMP13显著下调, 胶原分子I和 III则显著上调。此外, 还发现miR-27b转基因小鼠会出现心脏超微结构的损伤。以上研究结果表明, miR-27b可能通过抑制MMP13促进心肌纤维化。     

Mitochondria and Neuronal Death/Survival Signaling Pathways in Cerebral Ischemia

Apoptotic cell death pathways have been implicated in acute brain injuries, including cerebral ischemia, brain trauma, and spinal cord injury, and in chronic neurodegenerative diseases. Experimental ischemia and reperfusion models, such as transient focal/global ischemia in rodents, have been thoroughly studied and suggest the involvement of mitochondria and the cell survival/death signaling pathways in cell death/survival cascades. Recent studies have implicated mitochondria-dependent apoptosis involving pro- and anti-apoptotic protein binding, the release of cytochrome c and second mitochondria-derived activator of caspase, the activation of downstream caspases-9 and –3, and DNA fragmentation. Reactive oxygen species are known to be significantly generated in the mitochondrial electron transport chain in the dysfunctional mitochondria during reperfusion after ischemia, and are also implicated in the survival signaling pathway that involves phosphatidylinositol-3-kinase (PI3-K), Akt, and downstream signaling molecules, like Bad, 14-3-3, and the proline-rich Akt substrate (PRAS), and their bindings. Further studies of these survival pathways may provide novel therapeutic strategies for clinical stroke.Special issue dedicated to Lawrence F. Eng.     

Calcium Antagonist Isradipine Reduces Metabolic Alterations in Acute Cerebral Ischemia in Spontaneously Hypertensive Rats

The present study was designed to examine the effect of a calcium antagonist isradipine (PN200-110: PN) on local cerebral blood flow and brain tissue metabolism after 1-hour supratentorial ischemia induced by bilateral carotid artery ligation (BCL) in spontaneously hypertensive rats (SHR). PN, dissolved in ethanol plus polyethylene glycol 400, diluted with saline to make the final concentration of 0.25mg/ml and 2.5mg/ml, was administered subcutaneously either 30 min prior to BCL or just after the induction of incomplete cerebral ischemia (n = 7 in each group). Vehicle injection was served as a control group (n = 7). Cerebral blood flow in the parietal cortex (CBF) and the cerebellar cortex (CeBF) was measured by hydrogen clearance technique, and the supra- and infratentorial metabolites of the brain frozen in situ were determined by the enzymatic method. Blood pressure was lowered, but CBF was increased by PN administration in pre-BCL treatment study. After 1 hour of BCL, CBF decreased to around 10% or less of the resting value, being insignificant among the groups. Brain adenosine triphosphate was better preserved in PN-administered groups. The increase in lactate level tended to reduce dose dependently by PN treatment. PN also reduced the metabolic alterations in brain tissue with significance, even when administered just after the induction of forebrain ischemia. It is considered that pre- as well as post-BCL administration of PN is beneficial to attenuate the metabolic alterations in incomplete forebrain ischemia in SHR.     

Risk stratification for sudden cardiac death

Recent advances in pharmacological and device-based therapies have provided a range of management options for patients at risk of sudden cardiac death (SCD). Since all such interventions come with their attendant risks, however, stratification procedures aimed at identifying those who stand to benefit overall have gained a new degree of importance. This review assesses the value of risk stratification measures currently available in clinical practice, as well as of others that may soon enter the market. Parameters that may be obtained only by performing invasive cardiac catheterisation procedures are considered separately from those that may be derived using more readily available non-invasive techniques. It is concluded that effective stratification is likely to require the use of composite parameters and that invasive procedures might only be justified in specific sub-groups of patients.     

Current perspectives in pulmonary surfactant — Inhibition, enhancement and evaluation

Pulmonary surfactant (PS) is a complicated mixture of approximately 90% lipids and 10% proteins. It plays an important role in maintaining normal respiratory mechanics by reducing alveolar surface tension to near-zero values. Supplementing exogenous surfactant to newborns suffering from respiratory distress syndrome (RDS), a leading cause of perinatal mortality, has completely altered neonatal care in industrialized countries. Surfactant therapy has also been applied to the acute respiratory distress syndrome (ARDS) but with only limited success. Biophysical studies suggest that surfactant inhibition is partially responsible for this unsatisfactory performance. This paper reviews the biophysical properties of functional and dysfunctional PS. The biophysical properties of PS are further limited to surface activity, i.e., properties related to highly dynamic and very low surface tensions. Three main perspectives are reviewed. (1) How does PS permit both rapid adsorption and the ability to reach very low surface tensions? (2) How is PS inactivated by different inhibitory substances and how can this inhibition be counteracted? A recent research focus of using water-soluble polymers as additives to enhance the surface activity of clinical PS and to overcome inhibition is extensively discussed. (3) Which in vivo, in situ, and in vitro methods are available for evaluating the surface activity of PS and what are their relative merits? A better understanding of the biophysical properties of functional and dysfunctional PS is important for the further development of surfactant therapy, especially for its potential application in ARDS.     

地高辛抗血清阻断内洋地黄素对心肌缺血/再灌注损伤的影响

目的：探讨地高辛抗血清对大鼠实验性心肌缺血／再灌注损伤（MI／R）的心肌氧化应激的影响。方法：采用左冠状动脉前降支结扎30min,复灌45min建立在体大鼠MI／R模型。SD大鼠随机分成假手术组、缺血／再灌注模型组、生理盐水组、维拉帕米组、小、中、大剂量地高辛抗血清组：于再灌注45min后检测左室心尖部缺血区心肌中内洋地黄素含量、心肌细胞膜Na^＋,K^＋-ATP酶和SOD活性以及MDA含量,光镜下观察心肌组织形态学变化。结果：MI／R组和生理盐水组大鼠心肌组织内洋地黄素水平明显升高,细胞膜Na^＋,K^＋-ATP酶活性明显下降,心肌组织SOD活性降低,MDA水平升高。治疗组包括维拉帕米组均能减轻心肌组织结构损伤,降低MDA水平,部分恢复SOD活性;但只有地高辛抗血清能降低心肌组织内洋地黄素水平,恢复心肌细胞膜Na^＋,K^＋-ATP酶活性。结论：地高辛抗血清通过拮抗内洋地黄素,恢复心肌细胞膜Na^＋,K^＋-ATP酶活性,从而减轻缺血／再灌注时的氧自由基损伤。     

常见血清酶测定在急性心肌梗塞诊断中的应用

对1992年6月至1993年4月入院诊断为急性心肌梗塞(AMI)患者在发病后即时至48 h分三个阶段进行连续取血样测定4种血清酶（AST、CK、LDH、CKMB）的含量,且与心电图作比较.结果表明,在AMI过程中酶异常检出率最高可达到90%（AST、CK-MB）,最低为70%（LDH）.若以异常Q波为AMI确诊,其不能检出率为40%;提示在AMI早期作血清酶检测有助于进一步确诊及减少漏诊率.若AMI患者已下降的CK-MB再度上升,提示可能有新的梗死灶发生;AMI患者在发病6 h内,血清酶显著升高,提示预后不佳.     

不同质子泵抑制剂对冠脉支架植入术后氯吡格雷联合阿司匹林抗血小板作用的研究

目的:通过比较奥美拉唑和泮托拉唑对冠状动脉支架术(PCI)后患者血小板功能指标和主要不良心血管事件与出血并发症发生情况,探讨不同质子泵抑制剂对PCI后氯吡格雷联合阿司匹林抗血小板作用的影响。方法:60例实施PCI后常规联合抗血小板治疗(氯吡格雷75mg/d+阿司匹林100mg/d)患者随机分为奥美拉唑组(40mg/d,20例),泮托拉唑组(40mg/d,20例)和对照组(20例),连续用药30d。分别在服药前1d及服药15d,30d用血栓弹力图检测ADP途径诱导的血小板抑制率值和比浊法检测ADP途径诱导的血小板最大聚集率(MPAR)。并观察30d各组主要不良心血管事件和出血并发症的发生情况。结果:①奥美拉唑组和泮托拉唑组与对照组相比,服药前1d及服药15d,30d用血栓弹力图检测的血小板抑制率和比浊法检测的血小板最大聚集率(MPAR)均无明显变化;奥美拉唑与泮托拉唑组间比较,差异也无统计学意义。服药15d,30d与服药前1d相比,每组血小板抑制率明显升高,血小板最大聚集率明显下降,差异有统计学意义(P0.05);但15d和30d相比较,差异无统计学意义。②三组比较心血管事件发生率相近,差异无统计学意义(P0.05);奥美拉唑组和泮托拉唑组比较,心血管事件发生率也无统计学差异(P0.05)。③与对照组比较,奥美拉唑组和泮托拉唑组胃肠道出血发生率均明显减少,有统计学意义(P0.05),但两服药组间比较,出血发生率无明显区别,差异无统计学意义(P0.05)。结论:氯吡格雷联合阿司匹林具有增强血小板抑制,降低血小板凝聚的作用,而不同机制质子泵抑制剂奥美拉唑与泮托拉唑对PCI术后氯吡格雷联合阿司匹林抗血小板治疗患者的血小板功能无明显影响,不降低对心血管事件的预防效果,同时明显降低患者胃肠出血事件的发生率。     

普伐他汀对心脏成纤维细胞转化生长因子-β1合成的影响

目的:探讨普伐他汀对醛固酮诱导新生大鼠心脏成纤维细胞转化生长因子-β1(TGF-β1)的影响。方法:采用胰酶消化法和差速贴壁分离法获取和培养心脏成纤维细胞,应用ELISA、Western-blot、RT-PCR的方法分别测定醛固酮、普伐他汀以及甲羟戊酸对心脏成纤维细胞培养液中TGF-β1水平和心脏成纤维细胞TGF-β1mRNA和蛋白质的表达。结果:与正常对照组相比,醛固酮(10-7mol/L)可促进心脏成纤维细胞培养液中TGF-β1水平和心脏成纤维细胞TGFβ-1mRNA和蛋白质的表达,提前给予普伐他汀(10-5,10-4,10-3mol/L)能剂量依赖性地抑制醛固酮的上述作用,同时这种抑制作用可被甲羟戊酸所逆转。结论:普伐他汀可抑制醛固酮诱导的心脏成纤维细胞TGF-β1mRNA表达以及蛋白质的合成和分泌,其机制可能与甲羟戊酸代谢途径有关。