Intracellular sodium elevation reprograms cardiac metabolism

Intracellular Na elevation in the heart is a hallmark of pathologies where both acute and chronic metabolic remodeling occurs. We assessed whether acute (75μM ouabain 100nM blebbistatin) and chronic myocardial Naiload (PLM3SA mouse) are causally linked to metabolic remodeling and whether the hypertrophied failing heart shares a common Na-mediated metabolic ‘fingerprint’. Control (PLMWT), transgenic (PLM3SA), ouabain treated and hypertrophied Langendorff-perfused mouse hearts were studied by 23Na, 31P, 13C NMR followed by 1H NMR metabolomic profiling. Elevated Nai leads to common adaptive metabolic alterations preceding energetic impairment: a switch from fatty acid to carbohydrate metabolism and changes in steady-state metabolite concentrations (glycolytic, anaplerotic, Krebs cycle intermediates). Inhibition of mitochondrial Na/Ca exchanger by CGP37157 ameliorated the metabolic changes. In silico modelling indicated altered metabolic fluxes (Krebs cycle, fatty acid, carbohydrate, amino acid metabolism). Prevention of Nai overload or inhibition of Na/Camitomay be a new approach to ameliorate metabolic dysregulation in heart failure

Glucagon-like peptide-1 (GLP-1) receptor activation dilates cerebral arterioles, increases cerebral blood flow, and mediates remote (pre)conditioning neuroprotection against ischaemic stroke.

Stroke remains one of the most common causes of death and disability worldwide. Several preclinical studies demonstrated that the brain can be effectively protected against ischaemic stroke by two seemingly distinct treatments: remote ischaemic conditioning (RIC), involving cycles of ischaemia/reperfusion applied to a peripheral organ or tissue, or by systemic administration of glucagon-like-peptide-1 (GLP-1) receptor (GLP-1R) agonists. The mechanisms underlying RIC- and GLP-1-induced neuroprotection are not completely understood. In this study, we tested the hypothesis that GLP-1 mediates neuroprotection induced by RIC and investigated the effect of GLP-1R activation on cerebral blood vessels, as a potential mechanism of GLP-1-induced protection against ischaemic stroke. A rat model of ischaemic stroke (90 min of middle cerebral artery occlusion followed by 24-h reperfusion) was used. RIC was induced by 4 cycles of 5 min left hind limb ischaemia interleaved with 5-min reperfusion periods. RIC markedly (by ~ 80%) reduced the cerebral infarct size and improved the neurological score. The neuroprotection established by RIC was abolished by systemic blockade of GLP-1R with a specific antagonist Exendin(9-39). In the cerebral cortex of GLP-1R reporter mice, ~ 70% of cortical arterioles displayed GLP-1R expression. In acute brain slices of the rat cerebral cortex, activation of GLP-1R with an agonist Exendin-4 had a strong dilatory effect on cortical arterioles and effectively reversed arteriolar constrictions induced by metabolite lactate or oxygen and glucose deprivation, as an ex vivo model of ischaemic stroke. In anaesthetised rats, Exendin-4 induced lasting increases in brain tissue PO2, indicative of increased cerebral blood flow. These results demonstrate that neuroprotection against ischaemic stroke established by remote ischaemic conditioning is mediated by a mechanism involving GLP-1R signalling. Potent dilatory effect of GLP-1R activation on cortical arterioles suggests that the neuroprotection in this model is mediated via modulation of cerebral blood flow and improved brain perfusion

Glucagon-like peptide-1 (GLP-1) mediates cardioprotection by remote ischaemic conditioning

This work was supported by the British Heart Foundation (Ref: RG/14/4/30736), Medical Research Council (MR/N02589X/1) and The Wellcome Trust (Ref: 200893/Z/16/Z). A.V.G. is a Wellcome Trust Senior Research Fellow. S.M. is a Marie Skłodowska-Curie Research Fellow (Ref: 654691)

Distinct cardioprotective mechanisms of immediate, early and delayed ischaemic postconditioning

Cardioprotection against ischaemia/reperfusion injury in mice can be achieved by delayed ischaemic postconditioning (IPost) applied as late as 30 min after the onset of reperfusion. We determined the efficacy of delayed IPost in a rat model of myocardial infarction (MI) and investigated potential underlying mechanisms of this phenomenon. Rats were subjected to 20, 30 or 45 min of coronary artery occlusion followed by 120 min of reperfusion (I/R). Immediate and early IPost included six cycles of I/R (10/10 s) applied 10 s or 10 min after reperfusion onset. In the second series of experiments, the rats were subjected to 30 min of coronary occlusion followed by IPost applied 10 s, 10, 30, 45 or 60 min after the onset of reperfusion. Immediate and early IPost (applied 10 s or 10 min of reperfusion) established cardioprotection only when applied after a period of myocardial ischaemia lasting 30 min. Delayed IPost applied after 30 or 45 min of reperfusion reduced infarct sizes by 36 and 41 %, respectively (both P < 0.01). IPost applied 60 min after reperfusion onset was ineffective. Inhibition of RISK pathway (administration of ERK1/2 inhibitor PD-98059 or PI3K inhibitor LY-294002) abolished cardioprotection established by immediate IPost but had no effect on cardioprotection conferred by early IPost. Blockade of SAFE pathway using JAK/STAT inhibitor AG490 had no effect on the immediate or early IPost cardioprotection. Blockade of mitochondrial KATP (mitoKATP) channels (with 5-Hydroxydecanoate) abolished cardioprotection achieved by immediate and early IPost, but had no effect on cardioprotection when IPost was applied 30 or 45 min into the reperfusion period. Immediate IPost increased phosphorylation of PI3K-AKT and ERK1/2. Early or delayed IPost had no effect on phosphorylation of PI3K-AKT, ERK1/2 or STAT3. These data show that in the rat model, delayed IPost confers significant cardioprotection even if applied 45 min after onset of reperfusion. Cardioprotection induced by immediate and early postconditioning involves recruitment of RISK pathway and/or mitoKATP channels, while delayed postconditioning appears to rely on a different mechanism

Identifying the Source of a Humoral Factor of Remote (Pre)Conditioning Cardioprotection.

Signalling pathways underlying the phenomenon of remote ischaemic preconditioning (RPc) cardioprotection are not completely understood. The existing evidence agrees that intact sensory innervation of the remote tissue/organ is required for the release into the systemic circulation of preconditioning factor(s) capable of protecting a transplanted or isolated heart. However, the source and molecular identities of these factors remain unknown. Since the efficacy of RPc cardioprotection is critically dependent upon vagal activity and muscarinic mechanisms, we hypothesized that the humoral RPc factor is produced by the internal organ(s), which receive rich parasympathetic innervation. In a rat model of myocardial ischaemia/reperfusion injury we determined the efficacy of limb RPc in establishing cardioprotection after denervation of various visceral organs by sectioning celiac, hepatic, anterior and posterior gastric branches of the vagus nerve. Electrical stimulation was applied to individually sectioned branches to determine whether enhanced vagal input to a particular target area is sufficient to establish cardioprotection. It was found that RPc cardioprotection is abolished in conditions of either total subdiaphragmatic vagotomy, gastric vagotomy or sectioning of the posterior gastric branch. The efficacy of RPc cardioprotection was preserved when hepatic, celiac or anterior gastric vagal branches were cut. In the absence of remote ischaemia/reperfusion, electrical stimulation of the posterior gastric branch reduced infarct size, mimicking the effect of RPc. These data suggest that the circulating factor (or factors) of RPc are produced and released into the systemic circulation by the visceral organ(s) innervated by the posterior gastric branch of the vagus nerve

Diagrammatic representation of the nervous control of hormone secretion by enteroendocrine cells of the gastrointestinal tract.

<p>Extrinsic vagal parasympathetic nerves either directly or via activation of the enteric neurones trigger release of hormones (hypothesised circulating cardioprotective factors) by releasing acetylcholine (among other transmitters). ACh, acetylcholine; AChR, acetylcholine receptor; BOM, bombesin; CCK, cholecystokinin; CGPR, calcitonin gene-related peptide; GliC, glicentin; GLP-1/2, glucagon-like peptide-1 and 2; OXM, oxyntomodulin; PYY, peptide YY; VIP, vasoactive intestinal peptide.</p

Electrical stimulation of the posterior gastric vagal branch mimics RPc cardioprotection.

<p><b>(a)</b> Illustration of the experimental protocols. Electrical stimulation (stim.) of individual vagal branches commenced 25 min before the onset of myocardial ischaemia (MI) and continued 10 min into the period of reperfusion. Sham procedure involved surgical dissection of the nerve and placing it on the electrodes without stimulation. <b>(b)</b> Electrical stimulation of the posterior gastric vagal branch reduced the extent of myocardial ischaemia/reperfusion injury, whereas stimulation of the hepatic vagal branch or sham stimulation of the posterior gastric branch had no effect. The infarct size is presented as the percentage of area at risk. Individual data and means ± SEM are shown. P-values correspond to the Dunn’s post-hoc tests.</p

Experimental interventions.

<p>Previous studies—DVMN silencing, cervical vagotomy. Six types of subdiaphragmatic vagotomy performed in the current study: total, bilateral gastric, anterior gastric, posterior gastric, hepatic and celiac, are shown on a schematic representation of typical distribution of rat abdominal vagal branches. Agb, anterior gastric branch; Avt, anterior vagal trunk; Ccb, common celiac branch; Hb, hepatic branch; Lvn, left vagus nerve; Pgb, posterior gastric branch; Pvt, posterior vagal trunk; Rvn, right vagus nerve. Brain, lungs, heart, diaphragm, liver, stomach, pancreas, small intestine and colon are depicted schematically.</p

Cardioprotection established by remote ischaemic preconditioning (RPc) requires intact parasympathetic innervation of visceral organs.

<p><b>(a)</b> Illustration of the experimental protocols. RPc was induced by 15 min occlusion of both femoral arteries, followed by 10 min reperfusion. Sham-RPc procedure involved dissection of both femoral arteries without occlusion. Arrows indicate time of total subdiaphragmatic vagotomy, selective sectioning of individual visceral branches or sham surgery. <b>(b)</b> Total subdiaphragmatic vagotomy, bilateral gastric vagotomy and selective sectioning of the posterior gastric branch abolished the cardioprotective effect of RPc, whereas sectioning of the anterior gastric, celiac or hepatic branches had no effect on RPc cardioprotection. The infarct size is presented as the percentage of the area at risk. Individual data and means ± SEM are shown. P-values correspond to the Dunn’s post-hoc tests.</p