Cardiac reserve is a widely used health indicator and prognostic tool. While it is well established how to assess cardiac reserve clinically, in preclinical models it is more challenging lacking standardization. Further, although cardiac reserve incorporates both systolic (i.e., contractile reserve) and diastolic (i.e., relaxation reserve) components of the cardiac cycle, less focus has been placed on diastolic reserve. The aim of our study was to determine which technique (i.e., echocardiography, invasive hemodynamic, Langendorff) and corresponding parameters can be used to assess the systolic and diastolic reserves in preclinical models. Healthy adult male and female CD-1 mice were administered dobutamine and evaluated by echocardiography and invasive hemodynamic, or Langendorff to establish systolic and diastolic reserves. Here we show that systolic reserve can be assessed using all techniques in vivo and in vitro. Yet, the current indices available are ineffective at capturing diastolic reserve of healthy mice in vivo. When assessing systolic reserve, sex affects the dose-response of several commonly used echocardiography parameters (i.e., FS, EF). Taken together, this study improves our understanding of how sex impacts the interpretation assessment of cardiac reserve and establishes for the first time that in healthy adult mice the diastolic reserve cannot be assessed by currently established methods in vivo.
Background In response to hypoxia, the kidney is considered the major source for erythropoietin (EPO) – a protein responsible for stimulating hematopoiesis. Interestingly, recombinant human EPO (rhEPO) also has known anti‐apoptotic, cardioprotective, and inotropic effects. Preclinically, supraphysiological concentrations of rhEPO, given at the time of permanent coronary artery occlusion, is effective at reducing apoptosis in the area‐at‐risk, infarct size, and left ventricular remodeling and functional deficits. Clinically, researchers have encountered significant translational difficulties using EPO post‐myocardial infarction, as the hematopoietic effect of chronic rhEPO dosing limits its therapeutic use in patients. Emerging findings demonstrate that EPO mRNA expression occurs in non‐renal tissues, including the liver, bone, and reproductive organs, yet the evidence is divided with regards to the heart. Our preliminary data shows that cardiac EPO expression is upregulated during embryonic development, suggesting it has a paracrine role in cardiac development. Therefore, whether the adult heart produces EPO under a stress (e.g., myocardial infarction) and has physiological relevance remains unknown. Notably, in humans, serum EPO levels are elevated at 3 days post‐myocardial infarction, which indicates that the injured/hypoxic heart may produce EPO in vivo. Accordingly, our objective was to improve our understanding of the regulation and physiological significance of cardiac‐derived EPO using a murine model of myocardial infarction. It was hypothesized that a myocardial infarction would increase cardiac EPO mRNA expression, which may serve as a paracrine factor to preserve cardiac structure and function following an ischemic injury. Methods and Results Male CD1 mice were subjected to permanent ligation of the left anterior descending coronary artery to induce a myocardial infarction. At 12 h post‐surgery, hearts were harvested for qPCR analyses, which showed a significant upregulation in EPO mRNA expression. At 2, 4, and 9 weeks post‐myocardial infarction (when hearts were anoxic), hematocrit was significantly elevated, compared to age‐matched shams, indicating that serum EPO levels were still increased at these timepoints. To investigate whether cardiac EPO is driven solely by hypoxia, we subjected mice to severe hypoxia (9% O2) for 24 h and evaluated EPO mRNA expression in the heart and kidney. Indeed, EPO expression was significantly increased in the kidney, while we observed a very modest increase in the heart. Conclusions Here we show that the heart is a significant non‐renal source of EPO post‐myocardial infarction. Further, profound hypoxia does not significantly drive cardiac‐derived EPO expression, suggesting it is regulated by a hypoxia‐independent mechanism post‐injury. Taken together, endogenous cardiac EPO production may be elevated to provide paracrine cardioprotective support following a myocardial infarction. Support or Funding Information Canadian Institutes of Health Research. Natural Sciences...
Introduction Erythropoietin (EPO), in response to hypoxia, is produced by the kidney, which stimulates erythropoiesis in the bone marrow. While the kidney is regarded as the primary source of EPO, mainly in vitro expression has been shown from cells or tissues of the brain, liver, and reproductive organs. However, whether these organs are an endogenous extra‐renal source and their physiological significance is unknown. Interestingly, recombinant human EPO (rhEPO) confers cardiac cytoprotection and increases contractility. Albeit, this occurs using supra‐physiological doses of rhEPO. Whether the kidney is responsible for these effects remains to be elucidated. Therefore, the primary objective of this research is to investigate the physiological relevance of endogenous cardiomyocyte EPO production. We hypothesized that: 1) adult cardiomyoctes are a source of EPO production and 2) the loss of cardiomyocyte EPO expression leads to a decrease in contractility and an increase in susceptibility to ischemia‐reperfusion injury. Methods Cardiomyocyte‐specific deletion of EPO (EPOfl/fl‐CM) was obtained by injecting 8‐week old α‐MHC‐MerCreMer+/−: EPO fl/fl male mice with 20 mg/kg tamoxifen daily for 5 days. Left ventricular (LV) EPO expression was determined using qPCR analysis. Cardiac structure and function were assessed by echocardiography, invasive hemodynamics and the Langendorff, respectively. Hematocrit was measured from blood collected via saphenous vein. Data was obtained 8‐weeks post‐tamoxifen. Results Paradoxically, EPOfl/fl‐CM mice exhibited a dramatic increase in whole heart EPO expression. Further, cardiac‐derived EPO confers inotropic, lusitropic and hypertrophic effects. Furthermore, in response to ischemia‐reperfusion injury, EPOfl/fl‐CM mice show profound cytoprotection. Importantly, we show that endogenous cardiac‐derived EPO is capable of improving cardiac function without affecting whole body Hct levels. Conclusion The knock‐out of EPO from the cardiomyocyte leads to a reciprocal increase in LV EPO expression, whereby an alternate cell in the heart is over‐compensating for the loss of cardiomyocyte‐derived EPO. This study furthers our fundamental understanding of EPO biology and establishes it as a novel cardiac myokine, capable of increasing cardiac function and driving hypertrophy. Support or Funding Information Heart and Stroke FoundationCanadian Institutes of Health Research
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