Abstract
Objective: ST-segment Elevation Myocardial Infarction (STEMI) occurs as a result of acute occlusion of the coronary artery. Despite successful reperfusion using percutaneous coronary intervention (PCI), a large percentage of myocardial cells die after reperfusion which is recognized as ischemia/reperfusion injury (I/R). Oxidized phosphatidylcholines (OxPCs) are a group of oxidized lipids generated through non-enzymatic oxidation and have pro-inflammatory properties. This study aimed to examine the roles of OxPCs in a clinical setting of myocardial I/R.Methods: Blood samples were collected from STEMI patients at presentation prior to primary PCI (PPCI) (Isch) and at 4 time-points post-PPCI, including 2 h (R-2 h), 24 h (R-24 h), 48 h (R-48 h), and 30 days (R-30 d) post-PPCI. As controls, blood samples were collected from patients with non-obstructive coronary artery disease after diagnostic coronary angiography. Aspiration thrombectomy was also performed in selected STEMI patients. High-performance lipid chromatography-electrospray mass spectrometry (LC-MS/MS) was used for OxPCs analysis.Results: Twenty-two distinct OxPC species were identified and quantified in plasma samples in patients presenting with STEMI. These compounds were categorized as fragmented and non-fragmented species. Total levels of OxPCs did not significantly differ between Isch and control groups. However, total levels of fragmented OxPCs increased significantly in the ischemic period compared with controls (Isch: 4.79 ± 0.94, Control: 1.69 ± 0.19 ng/μl of plasma, P < 0.05). Concentrations of non-fragmented OxPCs had significant reductions during ischemia compared to the control group (Isch: 4.84 ± 0.30, Control: 6.6 ± 0.51 ng/μl, P < 0.05). Levels of total OxPCs in patients with STEMI were not significantly different during reperfusion periods. However, fragmented OxPCs levels were elevated at 48 h post-reperfusion and decreased at 30 days following MI, when compared to R-2 h and R-24 h time points (Isch: 4.79 ± 0.94, R-2 h: 5.33 ± 1.17, R-24 h: 5.20 ± 1.1, R-48 h: 4.18 ± 1.07, R-30 d: 1.87 ± 0.31 ng/μl, P < 0.05). Plasma levels of two fragmented OxPCs, namely, POVPC and PONPC were significantly correlated with peak creatine kinase (CK) levels (P < 0.05). As with plasma levels, the dominant OxPC species in coronary aspirated thrombus were fragmented OxPCs, which constituted 77% of total OxPC concentrations.Conclusion: Biologically active fragmented OxPC were elevated in patients presenting with STEMI when compared to controls. PONPC concentrations were subsequently increased after PPCI resulting in reperfusion. Moreover, levels of POVPC and PONPC were also associated with peak CK levels. Since these molecules are potent stimulators for cardiomyocyte cell death, therapeutics attenuating their activities can result in a novel therapeutic pathway for myocardial salvage for patients undergoing reperfusion therapy.
Highlights
Acute myocardial infarction (MI) is one of the leading causes of morbidity and mortality worldwide [1]
Twenty-two distinct Oxidized phosphatidylcholine (OxPC) were quantified in the plasma of ST-segment elevation myocardial infarction (STEMI) patients using LC/MS/MS, which include 8 aldehydecontaining OxPC, 6 carboxylic acid-containing OxPC and 8 non-fragmented OxPCs with hydroxyl and hydroperoxyl groups as well as isoprostanes (Table 2)
The chromatograms of POVPC, PONPC and PAPC-OH, which are among the highest OxPC species in human plasma, are presented in both ischemia and control groups as examples (Figure 2)
Summary
Acute myocardial infarction (MI) is one of the leading causes of morbidity and mortality worldwide [1]. Despite significant reductions in rates of post-MI-mortality and heart failure (HF) over the last 20 years, their incidences are still high (10 and 25%, respectively), which are attributed to ischemia-reperfusion (I/R) injury [3]. I/R injury is defined as myocardial cell death following reperfusion, which is thought to be responsible for 50% of the final infarct size [3]. Of this ongoing myocardial injury is the result of an extensive production of reactive oxygen species (ROS) and inflammation post-reperfusion. Myocardial phosphatidylcholines (PC) are susceptible to oxidation, due to having a high proportion of polyunsaturated fatty acids (PUFA) in their structures. It has been shown that only 4-h treatment of human aortic endothelial cells (HAEC) with 40 μg/ml of oxidized 1-palmitoyl-2-
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