Acute myocardial infarction (AMI) is one of the main causes of mortality among the able-bodied population in Russia and the population of economically developed countries. In recent years, deaths from AMI in the USA and Europe have not decreased. This is due to the lack of highly effective drugs for the treatment of AMI. One of the promising drugs to improve the survival of patients with AMI is erythropoietin. We searched for full-text publications in the PubMed database and on the website of the journal Nature. In studies performed on animals, it was shown that erythropoietin (5000 U/kg) is able to increase cardiac tolerance to ischemia and reperfusion due to activation of a number of kinases (PKC, ERK1/2, Akt, JAK2, PI3K) and due to GSK-3β kinase inactivation. Erythropoietin prevents post-infarction remodeling of the heart and enhances the process of myocardial neovascularization in rats and dogs. Erythropoietin in used doses (on the average 1000 U/kg) does not affect infarct size in patients with AMI and does not have an effect on post-infarction ventricular remodeling in humans. The reason for this discrepancy between experimental and clinical data remains unclear. It is possible that the use of large doses of erythropoietin or the use of its analogues that do not affect erythropoiesis can prevent the development of post-infarction cardiac remodeling in humans.
Author's summary High mortality among people with acute myocardial infarction is one of the most urgent problems of modern cardiology. And in recent years, much attention has been paid to the search for pharmacological approaches to prevent heart damage. In this review, we tried to analyze data on the effect of P2Y 12 receptor antagonists on the ischemia/reperfusion tolerance of the heart.
Remote postconditioning of the heart (RPost) – performed several periods of short-term ischemia-reperfusion of an remote organ after a long period of ischemia immediately before the resumption or in the early reperfusion, which leads to a reduction in the size at the subsequently formed infarction – represents a great therapeutic potential for clinical practice. The mechanism of remote postconditioning includes a trigger that can be played by adenosine, opioids, cannabinoids, bradykinin, CGRP, and substance P. Protein kinase C, PI3 kinase, Akt kinase, and JAK play an important role in the signaling mechanism of remote postconditioning. Experimental studies found that genetically determined or diet-induced metabolic changes reduce the effectiveness of cardioprotection in RPost. As possible mechanisms of cardioprotection inefficiency, we can suggest a decrease in the release of humoral factors, dysfunction of the receptor and signaling link of RPost, the effect of metabolic disorders on the functioning of KATP channel, mPTP, and on the state of mitochondrial respiration. However, these assumptions need experimental substantiation. The results of clinical studies show both the antinecrotizing and infarct-limiting effect of RPost in AMI and cardiac surgery, and the lack of its effectiveness. The role of metabolic disorders in the absence of the effectiveness of RPost in patients requires substantiation.
Microvascular obstruction (MVO) of coronary arteries increases the mortality rate and major adverse cardiac events in patients with acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). According to preliminary data platelets, inflammation, Ca2+ overload, neuropeptide Y, and endothelin-1 could be involved in the pathogenesis of MVO. Many questions related to the pathogenesis of MVO remain unanswered. The role of endothelial cell damage in the formation of MVO in patients with AMI and PCI is unknown. It is unclear whether nitric oxide (NO) production reduces or decreases sensitivity of smooth muscle cells of coronary arteries to NO in patients with MVO. It was obtained only indirect evidence on the involvement of inflammation in the development of MVO. The role of ROS in the pathogenesis of MVO is not studied. The role of necroptosis and pyroptosis in the pathogenesis of MVO in patients with AMI and PCI is also not studied.The significance of thromboxane A, vasopressin, angiotensin II, and prostacyclin in the formation of MVO is unknown before. It was not obtained conclusive evidence on the involvement of coronary artery spasm in the development of MVO. Correlation analysis of the neuropeptide Y, endothelin-1 levels and the MVO size in patients with AMI and PCI was not performed. It is not clear whether endogenous adrenaline exacerbates MVO or, conversely, prevents MVO.
Background. Mortality from acute myocardial infarction with ST-segment elevation in cardiac hospitals ranges from 4.5 to 7 %, and these data has not decreased in recent years. The most common cause of death in patients is cardiogenic shock, the likelihood of which directly depends on infarct size. It is quite clear that there is an urgent need to create drugs to limit the size of infarction and prevent the occurrence of cardiogenic shock.The aim. To evaluate the role of reactive oxygen species and redox-sensitive protein kinases in the infarction-limiting effect of opioid peptide deltorphin II in cardiac reperfusion in rats.Materials and methods. Coronary occlusion (45 min) and reperfusion (120 min) were performed in rats anesthetized with α-chloralose. The selective δ2-opioid receptor agonist deltorphin II, a hydroxyl radical scavenger 2-mercaptoprpionyl glycine (2-MPG), a superoxide radical scavenger tempol, the protein kinase Cδ (PKCδ) inhibitor rottlerin, the PI3-kinase inhibitor wortmannin, the inhibitor of ERK1/2 kinase PD98059 were injected before of reperfusion of the heart.Results. Deltorphin II contributed to a two-fold decrease in infarction size. Injection of 2-MPG, tempol, rottlerin, wortmannin, PD98059 alone had no effect on infarction size in rats. 2-MPG and tempol did not affect the infarction-reducing effect of deltorphin II. Rottlerin, wortmannin, and PD98059 eliminated the cardioprotective effect of deltorphin II.Conclusion. The infarction-reducing effect of deltorphin II does not depend on the production of superoxide radical and hydroxyl radical. Superoxide radical and hydroxyl radical do not play a significant role in reperfusion injury of the heart after coronary occlusion (45 min). PKCδ, PI3-kinase, and ERK1/2 kinase are involved in the infarction-limiting effect of deltorphin II in myocardial reperfusion.
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