The influence of age and type 2 diabetes on cardioprotective interventions against myocardial ischaemia-reperfusion injury.

The background of the thesis is based on the conflicting results between bench and bedside regarding the susceptibility to myocardial infarction with old age and diabetes. In laboratories all over the world, strategies have been developed to protect the myocardium from this insult, including the use of ischaemic conditioning (short periods of ischaemia and reperfusion prior to or following lethal ischaemia) or the use of a variety of pharmacological agents. However, surprisingly, translating these effective cardioprotective treatments into the clinic has proved problematic. The main issue seems to be the fact that the experimental investigations have mainly used young, healthy animals while the human patients present often with a number of other risk factors, or comorbidities, such as type 2 diabetes and old age. Therefore the aim of this thesis was to investigate the susceptibility to ischaemia-reperfusion injury and the proficiency of cardioprotective strategies to protect the heart in the setting of ageing and type 2 diabetes. Utilizing a model of type 2 diabetes, the Goto-Kakizaki rat and its normoglycaemic control Wistar rat, within the range of 3 to 18 months of age, the Langendorff isolated heart model and in vivo coronary artery occlusion and reperfusion were employed to investigate the susceptibility to ischaemia-reperfusion injury. Mechanical or pharmacological cardioprotective strategies were also investigated in this setting and the mechanisms of the failed cardioprotection were examined further using in vitro techniques focusing on known pro survival signalling pathways within the myocardium. The ageing diabetic heart demonstrated an increased vulnerability to injury and was less amenable to protection by ischaemic conditioning. Pharmacological agents namely, metformin and sitagliptin appear to differentially protect the diabetic and non-diabetic heart, and this could be due to the underlying intracellular changes associated with ageing and diabetes

Chronic Metformin Associated Cardioprotection Against Infarction: Not Just a Glucose Lowering Phenomenon

Purpose: Clinical and experimental investigations demonstrated that metformin, a widely used anti-diabetic drug, exhibits cardioprotective properties against myocardial infarction. Interestingly, metformin was previously shown to increase the expression of PGC-1α a key controller of energy metabolism in skeletal muscle, which is down-regulated in diabetic conditions. We hypothesized that chronic treatment with metformin could protect the aged, diabetic heart against ischemia-reperfusion injury (IRI) by up-regulating PGC-1α and improving the impaired functionality of diabetic mitochondria. / Methods: Following 4 weeks of metformin (300 mg/kg) administered in the drinking water, 12 month-old diabetic Goto Kakizaki and non-diabetic Wistar rat hearts were assigned for infarct measurement following 35 min ischemia and 60 min reperfusion or for electron microscopy (EM) and Western blotting (WB) investigations. / Results: Metformin elicited a cardioprotective effect in both non-diabetic and diabetic hearts. In contrast with the diabetic non-treated hearts, the diabetic hearts treated with metformin showed more organized and elongated mitochondria and demonstrated a significant increase in phosphorylated AMPK and in PGC-1α expression. / Conclusions: In summary these results show for the first time that chronic metformin treatment augments myocardial resistance to ischemia-reperfusion injury, by an alternative mechanism in addition to the lowering of blood glucose. This consisted of a positive effect on mitochondrial structure possibly via a pathway involving AMPK activation and PGC-1α. Thus, metformin prescribed chronically to patients may lead to a basal state of cardioprotection thereby potentially limiting the occurrence of myocardial damage by cardiovascular events

Resolving Fine Cardiac Structures in Rats with High-Resolution Diffusion Tensor Imaging

Cardiac architecture is fundamental to cardiac function and can be assessed non-invasively with diffusion tensor imaging (DTI). Here, we aimed to overcome technical challenges in ex vivo DTI in order to extract fine anatomical details and to provide novel insights in the 3D structure of the heart. An integrated set of methods was implemented in ex vivo rat hearts, including dynamic receiver gain adjustment, gradient system scaling calibration, prospective adjustment of diffusion gradients, and interleaving of diffusion-weighted and non-diffusion-weighted scans. Together, these methods enhanced SNR and spatial resolution, minimised orientation bias in diffusion-weighting, and reduced temperature variation, enabling detection of tissue structures such as cell alignment in atria, valves and vessels at an unprecedented level of detail. Improved confidence in eigenvector reproducibility enabled tracking of myolaminar structures as a basis for segmentation of functional groups of cardiomyocytes. Ex vivo DTI facilitates acquisition of high quality structural data that complements readily available in vivo cardiac functional and anatomical MRI. The improvements presented here will facilitate next generation virtual models integrating micro-structural and electro-mechanical properties of the heart

Evaluation of non‐Gaussian diffusion in cardiac MRI

Purpose: The diffusion tensor model assumes Gaussian diffusion and is widely applied in cardiac diffusion MRI. However, diffusion in biological tissue deviates from a Gaussian profile as a result of hindrance and restriction from cell and tissue microstructure, and may be quantified better by non‐Gaussian modeling. The aim of this study was to investigate non‐Gaussian diffusion in healthy and hypertrophic hearts. Methods: Thirteen rat hearts (five healthy, four sham, four hypertrophic) were imaged ex vivo. Diffusion‐weighted images were acquired at b‐values up to 10,000 s/mm2. Models of diffusion were fit to the data and ranked based on the Akaike information criterion. Results: The diffusion tensor was ranked best at b‐values up to 2000 s/mm2 but reflected the signal poorly in the high b‐value regime, in which the best model was a non‐Gaussian “beta distribution” model. Although there was considerable overlap in apparent diffusivities between the healthy, sham, and hypertrophic hearts, diffusion kurtosis and skewness in the hypertrophic hearts were more than 20% higher in the sheetlet and sheetlet‐normal directions. Conclusion: Non‐Gaussian diffusion models have a higher sensitivity for the detection of hypertrophy compared with the Gaussian model. In particular, diffusion kurtosis may serve as a useful biomarker for characterization of disease and remodeling in the heart

Trends in Depression and Antidepressant Prescribing in Children and Adolescents: A Cohort Study in The Health Improvement Network (THIN)

In 2003, the Committee on Safety of Medicines (CSM) advised against treatment with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine in children, due to a possible increased risk of suicidal behaviour. This study examined the effects of this safety warning on general practitioners' depression diagnosing and prescription behaviour in children

Does Pathogen Spillover from Commercially Reared Bumble Bees Threaten Wild Pollinators?

The conservation of insect pollinators is drawing attention because of reported declines in bee species and the ‘ecosystem services’ they provide. This issue has been brought to a head by recent devastating losses of honey bees throughout North America (so called, ‘Colony Collapse Disorder’); yet, we still have little understanding of the cause(s) of bee declines. Wild bumble bees (Bombus spp.) have also suffered serious declines and circumstantial evidence suggests that pathogen ‘spillover’ from commercially reared bumble bees, which are used extensively to pollinate greenhouse crops, is a possible cause. We constructed a spatially explicit model of pathogen spillover in bumble bees and, using laboratory experiments and the literature, estimated parameter values for the spillover of Crithidia bombi, a destructive pathogen commonly found in commercial Bombus. We also monitored wild bumble bee populations near greenhouses for evidence of pathogen spillover, and compared the fit of our model to patterns of C. bombi infection observed in the field. Our model predicts that, during the first three months of spillover, transmission from commercial hives would infect up to 20% of wild bumble bees within 2 km of the greenhouse. However, a travelling wave of disease is predicted to form suddenly, infecting up to 35–100% of wild Bombus, and spread away from the greenhouse at a rate of 2 km/wk. In the field, although we did not observe a large epizootic wave of infection, the prevalences of C. bombi near greenhouses were consistent with our model. Indeed, we found that spillover has allowed C. bombi to invade several wild bumble bee species near greenhouses. Given the available evidence, it is likely that pathogen spillover from commercial bees is contributing to the ongoing decline of wild Bombus in North America. Improved management of domestic bees, for example by reducing their parasite loads and their overlap with wild congeners, could diminish or even eliminate pathogen spillover

How do things become strategic? ‘Strategifying’ corporate social responsibility

How do things become ‘strategic’? Despite the development of strategy-as-practice studies and the recognized institutional importance of strategy as a social practice, little is known about how strategy boundaries change within organizations. This article focuses on this gap by conceptualizing ‘strategifying’ – or making something strategic – as a type of institutional work that builds on the institution of strategy to change the boundaries of what is regarded as strategy within organizations. We empirically investigate how corporate social responsibility has been turned into strategy at a UK electricity company, EnergyCorp. Our findings reveal the practices that constitute three types of strategifying work – cognitive coupling, relational coupling and material coupling – and show how, together and over time, these types of work changed the boundaries of strategy so that corporate social responsibility became included in EnergyCorp’s official strategy, became explicitly attended to by strategists and corporate executives and became inscribed within strategy devices. By disambiguating the notions of strategifying and strategizing, our study introduces new perspectives for analysing the institutional implications of the practice of strategy

Exploring the Zoonotic Potential of Mycobacterium avium Subspecies paratuberculosis through Comparative Genomics

A comparative genomics approach was utilised to compare the genomes of Mycobacterium avium subspecies paratuberculosis (MAP) isolated from early onset paediatric Crohn's disease (CD) patients as well as Johne's diseased animals. Draft genome sequences were produced for MAP isolates derived from four CD patients, one ulcerative colitis (UC) patient, and two non-inflammatory bowel disease (IBD) control individuals using Illumina sequencing, complemented by comparative genome hybridisation (CGH). MAP isolates derived from two bovine and one ovine host were also subjected to whole genome sequencing and CGH. All seven human derived MAP isolates were highly genetically similar and clustered together with one bovine type isolate following phylogenetic analysis. Three other sequenced isolates (including the reference bovine derived isolate K10) were genetically distinct. The human isolates contained two large tandem duplications, the organisations of which were confirmed by PCR. Designated vGI-17 and vGI-18 these duplications spanned 63 and 109 open reading frames, respectively. PCR screening of over 30 additional MAP isolates (3 human derived, 27 animal derived and one environmental isolate) confirmed that vGI-17 and vGI-18 are common across many isolates. Quantitative real-time PCR of vGI-17 demonstrated that the proportion of cells containing the vGI-17 duplication varied between 0.01 to 15% amongst isolates with human isolates containing a higher proportion of vGI-17 compared to most animal isolates. These findings suggest these duplications are transient genomic rearrangements. We hypothesise that the over-representation of vGI-17 in human derived MAP strains may enhance their ability to infect or persist within a human host by increasing genome redundancy and conferring crude regulation of protein expression across biologically important regions

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyse