Abstract

Coronary microembolization (CME) substantially reduces the clinical benefits of myocardial reperfusion therapy. Autophagy and apoptosis participate in the pathophysiological processes of almost all cardiovascular diseases, including CME-induced myocardial injury, but the precise underlying mechanisms remain unclear. In the present study, we observed that Egr-1 expression was substantially increased after CME modeling. Inhibition of Egr-1 expression through the targeted delivery of rAAV9-Egr-1-shRNA improved cardiac function and reduced myocardial injury. The microinfarct size was also significantly smaller in the Egr-1 inhibitor group than in the CME group. These benefits were partially reversed by the autophagy inhibitor 3-MA. As shown in our previous study, autophagy in the myocardium was impaired after CME. Inhibition of Egr-1 expression in vivo restored the autophagy flux and reduced myocardial apoptosis, at least partially, by inhibiting the Egr-1/Bim/Beclin-1 pathway, as evidenced by the results of the western blot, RT-qPCR, and TUNEL staining. At the same time, TEM showed a dramatic increase in the number of typical autophagic vacuoles in the Egr-1 inhibitor group compared to the CME group. Based on these findings, the Egr-1/Bim/Beclin-1 pathway may be involved in CME-induced myocardial injury by regulating myocardial autophagy and apoptosis, and this pathway represents a potential therapeutic target in CME.

Highlights

  • Coronary microembolization (CME) is a common complication in patients with acute coronary syndrome (ACS) during percutaneous coronary intervention (PCI), which could be caused by microvascular obstructions with atherosclerotic plaques, microthrombus or neutrophils-platelet aggregates [1,2,3]

  • Egr-1 inhibition significantly improved cardiac function following CME compared to the CME group (P < 0.05)

  • We investigated the activation of the Egr-1/Bim/Beclin-1 pathway after CME and its specific mechanism in mediating myocardial injury by constructing a CME model in rats

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Summary

Introduction

Coronary microembolization (CME) is a common complication in patients with acute coronary syndrome (ACS) during percutaneous coronary intervention (PCI), which could be caused by microvascular obstructions with atherosclerotic plaques, microthrombus or neutrophils-platelet aggregates [1,2,3]. CME is one of the most important causes of the no-reflow phenomenon, which is responsible for the loss of clinical benefits from myocardial reperfusion therapy [4, 5]. CME affects the long-term clinical follow-up of individuals with ACS mainly because of myocardial contractile dysfunction and notable arrhythmias [6,7,8]. The prediction and prevention of CME have been difficult challenges for cardiovascular intervention physicians. As shown in our previous study, myocardial autophagy may play regulative role in CME-induced myocardial injury [9].

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