Exercise training reverses cardiac aging phenotypes associated with heart failure with preserved ejection fraction in male mice

Heart failure with preserved ejection fraction (HFpEF) is the most common type of HF in older adults. Although no pharmacological therapy has yet improved survival in HFpEF, exercise training (ExT) has emerged as the most effective intervention to improving functional outcomes in this age‐related disease. The molecular mechanisms by which ExT induces its beneficial effects in HFpEF, however, remain largely unknown. Given the strong association between aging and HFpEF, we hypothesized that ExT might reverse cardiac aging phenotypes that contribute to HFpEF pathophysiology and additionally provide a platform for novel mechanistic and therapeutic discovery. Here, we show that aged (24–30 months) C57BL/6 male mice recapitulate many of the hallmark features of HFpEF, including preserved left ventricular ejection fraction, subclinical systolic dysfunction, diastolic dysfunction, impaired cardiac reserves, exercise intolerance, and pathologic cardiac hypertrophy. Similar to older humans, ExT in old mice improved exercise capacity, diastolic function, and contractile reserves, while reducing pulmonary congestion. Interestingly, RNAseq of explanted hearts showed that ExT did not significantly modulate biological pathways targeted by conventional HF medications. However, it reversed multiple age‐related pathways, including the global downregulation of cell cycle pathways seen in aged hearts, which was associated with increased capillary density, but no effects on cardiac mass or fibrosis. Taken together, these data demonstrate that the aged C57BL/6 male mouse is a valuable model for studying the role of aging biology in HFpEF pathophysiology, and provide a molecular framework for how ExT potentially reverses cardiac aging phenotypes in HFpEF.     

Nimbolide prevents myocardial damage by regulating cardiac biomarkers,antioxidant level,and apoptosis signaling against doxorubicin‐induced cardiotoxicity in rats

The current work planned to assess the protecting properties of nimbolide against doxorubicin (DOX)‐treated myocardial damage. Myocardial damage was produced with 2.5 mg/kg of DOX given on alternative days (14 days). Thiobarbituric acid reactive substances (TBARS) levels of a lipid peroxidative marker were elevated, whereas reduced body weight, heart weight, blood pressure indices and reduced levels of antioxidants like glutathione‐S‐transferase, superoxide dismutase, catalase, glutathione peroxidase, glutathione, and glutathione reductase were observed in the heart tissue of DOX‐treated animals. DOX‐treated animals showed augmented levels of cardiac markers likes monocyte chemotactic protein‐1, interferon‐gamma, aspartate transferase, creatine kinase, lactate dehydrogenase, creatine kinase‐muscle/brain, heart‐type fatty acid‐binding protein, glycogen phosphorylase isoenzyme BB, transforming growth factor‐β, brain natriuretic peptide, myoglobin, and cTnI in serum. Histopathological assessment confirmed the DOX‐induced cardiotoxicity. Furthermore, DOX‐induced rats showed augmented inflammatory mediators (nuclear factor‐κB [NF‐kB], tumor necrosis factor‐α [TNF‐α], and interleukin‐1β [IL‐1β]) and increased PI3K/Akt signaling proteins (PI3K, p‐Bad/Bad, caspase‐3, and p‐Akt), whereas decreased oxidative markers (HO‐1 and NQO‐1) and p‐PTEN were observed. Nimbolide‐supplemented rats showed reduced activity/levels of cardiac markers and TBARS levels in serum and heart tissue. Levels of enzymatic and nonenzymatic antioxidants were augmented in the heart tissue of nimbolide‐supplemented rats. Nimbolide influence decreased apoptosis, inflammation, and enhanced antioxidant markers through the modulation of p‐Bad/Bad, caspase‐3, PI3K, p‐Akt, TNF‐α, NF‐kB, IL‐1β, HO‐1, NQO‐1, and p‐PTEN markers. The histopathological explanations were observed to be in line with biochemical analysis. Therefore, the finding of current work was that nimbolide has a defensive effect on the myocardium against DOX‐induced cardiac tissue damage.     

LncRNA SNHG1 exerts a protective role in cardiomyocytes hypertrophy via targeting miR‐15a‐5p/HMGA1 axis

Heart failure preceded by pathological cardiac hypertrophy is a leading cause of death. Long noncoding RNA small nucleolar RNA host gene 1 (SNHG1) was reported to inhibit cardiomyocytes apoptosis, but the role and underlying mechanism of SNHG1 in pathological cardiac hypertrophy have not yet been understood. This study was designed to investigate the role and molecular mechanism of SNHG1 in regulating cardiac hypertrophy. We found that SNHG1 was upregulated during cardiac hypertrophy both in vivo (transverse aortic constriction treatment) and in vitro (phenylephrine [PE] treatment). SNHG1 overexpression attenuated the cardiomyocytes hypertrophy induced by PE, while SNHG1 inhibition promoted hypertrophic response of cardiomyocytes. Furthermore, SNHG1 and high‐mobility group AT‐hook 1 (HMGA1) were confirmed to be targets of miR‐15a‐5p. SNHG1 promoted HMGA1 expression by sponging miR‐15a‐5p, eventually attenuating cardiomyocytes hypertrophy. There data revealed a novel protective mechanism of SNHG1 in cardiomyocytes hypertrophy. Thus, targeting of SNHG1‐related pathway may be therapeutically harnessed to treat cardiac hypertrophy.     

Role of B lymphocytes in the infarcted mass in patients with acute myocardial infarction

Despite early reperfusion, patients with ST segment elevation myocardial infarction (STEMI) may present large myocardial necrosis and significant impairment of ventricular function. The present study aimed to evaluate the role of subtypes of B lymphocytes and related cytokines in the infarcted mass and left ventricular ejection fraction obtained by cardiac magnetic resonance imaging performed after 30 days of STEMI. This prospective study included 120 subjects with STEMI submitted to pharmacoinvasive strategy. Blood samples were collected in subjects in the first (D1) and 30th (D30) days post STEMI. The amount of CD11b+ B1 lymphocytes (cells/ml) at D1 were related to the infarcted mass (rho = 0.43; P=0.033), measured by cardiac MRI at D30. These B1 cells were associated with CD4+ T lymphocytes at D1 and D30, while B2 classic lymphocytes at day 30 were related to left ventricular ejection fraction (LVEF). Higher titers of circulating IL-4 and IL-10 were observed at D30 versus D1 (P=0.013 and P<0.001, respectively). Titers of IL-6 at D1 were associated with infarcted mass (rho = 0.41, P<0.001) and inversely related to LVEF (rho = −0.38, P<0.001). After multiple linear regression analysis, high-sensitivity troponin T and IL-6 collected at day 1 were independent predictors of infarcted mass and, at day 30, only HDL-C. Regarding LVEF, high-sensitivity troponin T and high-sensitivity C-reactive protein were independent predictors at day 1, and B2 classic lymphocytes, at day 30. In subjects with STEMI, despite early reperfusion, the amount of infarcted mass and ventricular performance were related to inflammatory responses triggered by circulating B lymphocytes.     

个体化精准运动为核心的整体康复方案对冠心病介入治疗术后患者整体功能再提高的临床研究*

目的: 探讨个体化精准运动为核心的整体康复方案对冠心病介入治疗术后患者整体功能再提高的作用。方法: 选择2016 年6 月至2019 年12 月间在北京康复医院临床诊断为冠心病稳定性心绞痛患者20 例,随机分为对照组（n=10）和运动组（n=10）。全部患者择期行冠状动脉介入治疗,术后对照组患者仅进行除运动康复之外的常规治疗指导;运动组患者进行12周个体化运动为核心的心脏康复,介入前、介入后2周、康复后12周分别评估患者标准化症状限制性极限运动的心肺运动试验（CPET）指标、心脏超声、6 min步行距离（6MWD）等。结果: 所有患者均安全无并发症完成症状限制性CPET,运动组患者完成12周全程运动康复治疗。组间比较显示,介入前和介入后2周,对照组和运动组患者CPET指标以及左心室射血分数、6MWD等均无明显差异（P>0.05）。康复12周后,运动组患者无氧阈（ml/min、ml/（min·kg））、峰值摄氧量（ml/（min·kg））、氧脉搏（ml/beat）和6MWD较对照组明显升高,差异有统计学意义（P<0.05）。组内比较显示,康复治疗12周后,运动组患者无氧阈（ml/min、ml/（min·kg）、%pred）、峰值摄氧量（ml/min、ml/（min·kg）、%pred）、峰值氧脉搏（ml/beat）和6MWD均较介入前明显改善,差异有统计学意义（P<0.05）;而且与介入后2周比较,无氧阈（ml/（min·kg））和峰值摄氧量（ml/（min·kg））均明显升高,差异有统计学意义（P<0.05）。对照组患者在康复12周后无氧阈（ml/min）和峰值氧脉搏（ml/beat）较介入前改善,差异有统计学意义（P<0.05）,但CPET指标与介入后2周比较无明显差异。结论: 冠状动脉介入术后进行个体化运动康复为核心的整体管理可进一步提高冠心病稳定性心绞痛患者运动心肺功能和运动耐力。运动康复是介入术后患者二级预防的重要内容,需要大量推广。     

Exosomes from neuronal stem cells may protect the heart from ischaemia/reperfusion injury via JAK1/2 and gp130

Myocardial infarction requires urgent reperfusion to salvage viable heart tissue. However, reperfusion increases infarct size further by promoting mitochondrial damage in cardiomyocytes. Exosomes from a wide range of different cell sources have been shown to activate cardioprotective pathways in cardiomyocytes, thereby reducing infarct size. Yet, it is currently challenging to obtain highly pure exosomes in quantities enough for clinical studies. To overcome this problem, we used exosomes isolated from CTX0E03 neuronal stem cells, which are genetically stable, conditionally inducible and can be produced on an industrial scale. However, it is unknown whether exosomes from neuronal stem cells may reduce cardiac ischaemia/reperfusion injury. In this study, we demonstrate that exosomes from differentiating CTX0E03 cells can reduce infarct size in mice. In an in vitro assay, these exosomes delayed cardiomyocyte mitochondrial permeability transition pore opening, which is responsible for cardiomyocyte death after reperfusion. The mechanism of MPTP inhibition was via gp130 signalling and the downstream JAK/STAT pathway. Our results support previous findings that exosomes from non-cardiomyocyte-related cells produce exosomes capable of protecting cardiomyocytes from myocardial infarction. We anticipate our findings may encourage scientists to use exosomes obtained from reproducible clinical-grade stocks of cells for their ischaemia/reperfusion studies.     

Performance of a simplified HEART score and HEART-GP score for evaluating chest pain in urgent primary care

BackgroundChest pain is a common symptom in urgent primary care. The distinction between urgent and non-urgent causes can be challenging. A modified version of the HEART score, in which troponin is omitted (‘simplified HEART’) or replaced by the so-called ‘sense of alarm’ (HEART-GP), may aid in risk stratification.MethodThis study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale, out-of-hours, regional primary care facility in the Netherlands, with 6‑week follow-up for major adverse cardiac events (MACEs). The outcome of interest is diagnostic accuracy, including positive predictive value (PPV) and negative predictive value (NPV).ResultsWe included 664 patients; MACEs occurred in 4.8% (n = 32). For  simplified HEART and HEART-GP, we found C‑statistics of 0.86 (95% confidence interval (CI) 0.80–0.91) and 0.90 (95% CI 0.85–0.95), respectively. Optimal diagnostic accuracy was found for a simplified HEART score ≥2 (PPV 9%, NPV 99.7%), HEART-GP score ≥3 (PPV 11%, NPV 99.7%) and HEART-GP score ≥4 (PPV 16%, NPV 99.4%). Physicians referred 157 patients (23.6%) and missed 6 MACEs. A simplified HEART score ≥2 would have picked up 5 cases, at the expense of 332 referrals (50.0%, p < 0.001). A HEART-GP score of ≥3 and ≥4 would have detected 5 and 3 MACEs and led to 293 (44.1%, p < 0.001) and 186 (28.0%, p = 0.18) referrals, respectively.ConclusionHEART-score modifications including the physicians’ ‘sense of alarm’ may be used as a risk stratification tool for chest pain in primary care in the absence of routine access to troponin assays. Further validation is warranted.Supplementary InformationThe online version of this article (10.1007/s12471-020-01529-4) contains supplementary material, which is available to authorized users.     

Reviewing the role of cardiac exosomes in myocardial repair at a glance

Exosome-based therapy is an emerging novel approach for myocardial infarction (MI) treatment. Exosomes are identified as extracellular vesicles that are produced within multivesicular bodies in the cells' cytosols and then are secreted from the cells. Exosomes are 30–100 nm in diameter that are released from viable cells and are different from other secreted vesicles such as apoptotic bodies and microvesicles in their origin and contents such as RNAs, proteins, and nucleic acid. The recent advances in exosome research have demonstrated the role of these bionanovesicles in the physiological, pathological, and molecular aspects of the heart. The results of in vitro and preclinical models have shown that exosomes from different cardiac cells can improve cardiac function following MI. For example, mesenchymal stem cells (MSCs) and cardiac progenitor cells (CPCs) containing exosomes can affect the proliferation, survival, and differentiation of cardiac fibroblasts and cardiomyocytes. Moreover, MSCs- and CPCs-derived exosomes can enhance the migration of endothelial cells. Exosome-based therapy approaches augment the cardiac function by multiple means, such as reducing fibrosis, stimulation of vascular angiogenesis, and proliferation of cardiomyocytes that result in replacing damaged heart tissue with newly generated functional myocytes. This review article aims to briefly discuss the recent advancements in the role of secreted exosomes in myocardial repair by focusing on cardiac cells-derived exosomes.     

人成体心源间充质样细胞表型分析及向心脏谱系诱导分化潜能的研究

目的探讨成人心源性间充质样细胞 (CDMCs)的分子表型及向心脏谱系的分化潜能。方法实验分为:不同培养时间CDMCs (第3、5、7代),并以脐带间充质干细胞 (UCMSCs)为对照。分析各细胞分子表型并向心脏谱系诱导分化。显微镜观察细胞形态;计算生长倍增时间并绘制细胞生长曲线;流式细胞术分析表面标志抗原表达;实时定量PCR和Western blot分别测干细胞多能分子及组织特异性分子mRNA和蛋白表达。结果采用重复测量资料方差分析、单因素方差分析和配对t检验。结果 CDMCs具有UCMSCs形态特征与增殖能力,体外培养1 ~ 7 d,与UCMSCs比较,P3、5、7代CDMCs增殖能力差异无统计学意义 (P> 0.05)。与UCMSCs相比,不同培养时间CDMCs表面标志抗原 (CD90)表达 (冻存前:97.13%±2.00%比59.87%±34.14%、38.83%±11.04%、34.77±14.78%;冻存后:99.83%±0.17%比56.00%±19.47%、47.48±11.88%、41.15±8.68%)降低(P< 0.05)。与UCMSCs相比,不同培养时间CDMCs中Rex1 (0.00±0.00比0.68±0.50、0.29±0.17、0.38±0.50)、Oct3/4 (1.00±0.02比5.28±0.78、3.88±0.95、3.63±0.34)、Nanog(1.00±0.16比7.57±4.69、5.40±3.58、5.34±0.76)以及心脏特异转录因子Nkx2.5 (1.00±0.12比30.60±22.43、19.69±9.65、8.82±4.94)、Gata4 (1.00±0.85比60467±25266、44350±25800、35067±23113)表达均增高,差异有统计学意义 (P均< 0.05)。与诱导前比较,向心肌诱导分化15 d后,不同培养时间CDMCs中cTnT蛋白表达水平 (0.40±0.13比0.98±0.16、0.38±0.18 比0.69±0.15、0.17±0.11比0.70±0.17)增高 (P< 0.05)。结论 CDMCs不仅具备部分干细胞和间充质细胞表型,还具有心脏组织特异性。其具备心脏谱系分化潜能,心肌细胞分化能力可能优于UCMSCs。     

An orthotropic viscoelastic material model for passive myocardium: theory and algorithmic treatment

This contribution presents a novel constitutive model in order to simulate an orthotropic rate-dependent behaviour of the passive myocardium at finite strains. The motivation for the consideration of orthotropic viscous effects in a constitutive level lies in the disagreement between theoretical predictions and experimentally observed results. In view of experimental observations, the material is deemed as nearly incompressible, hyperelastic, orthotropic and viscous. The viscoelastic response is formulated by means of a rheological model consisting of a spring coupled with a Maxwell element in parallel. In this context, the isochoric free energy function is decomposed into elastic equilibrium and viscous non-equilibrium parts. The baseline elastic response is modelled by the orthotropic model of Holzapfel and Ogden [Holzapfel GA, Ogden RW. 2009. Constitutive modelling of passive myocardium: a structurally based framework for material characterization. Philos Trans Roy Soc A Math Phys Eng Sci. 367:3445–3475]. The essential aspect of the proposed model is the account of distinct relaxation mechanisms for each orientation direction. To this end, the non-equilibrium response of the free energy function is constructed in the logarithmic strain space and additively decomposed into three anisotropic parts, denoting fibre, sheet and normal directions each accompanied by a distinct dissipation potential governing the evolution of viscous strains associated with each orientation direction. The evolution equations governing the viscous flow have an energy-activated nonlinear form. The energy storage in the Maxwell branches has a quadratic form leading to a linear stress–strain response in the logarithmic strain space. On the numerical side, the algorithmic aspects suitable for the implicit finite element method are discussed in a Lagrangian setting. The model shows excellent agreement compared to experimental data obtained from the literature. Furthermore, the finite element simulations of a heart cycle carried out with the proposed model show significant deviations in the strain field relative to the elastic solution.