post-MI Heart Research Articles

EphrinB2-mediated CDK5/ISL1 pathway enhances cardiac lymphangiogenesis and alleviates ischemic injury by resolving post-MI inflammation

EphrinB2 (erythropoietin-producing hepatoma interactor B2) is a key Eph/ephrin family member, promoting angiogenesis, vasculogenesis, and lymphangiogenesis during embryonic development. However, the role of EphrinB2 in cardiac lymphangiogenesis following myocardial infarction (MI) and the potential molecular mechanism remains to be demonstrated. This study revealed that EphrinB2 prevented ischemic heart post-MI from remodeling and dysfunction by activating the cardiac lymphangiogenesis signaling pathway. Deletion of EphrinB2 impaired cardiac lymphangiogenesis and aggravated adverse cardiac remodeling and ventricular dysfunction post-MI. At the same time, overexpression of EphrinB2 stimulated cardiac lymphangiogenesis which facilitated cardiac infiltrating macrophage drainage and reduced inflammation in the ischemic heart. The beneficial effects of EphrinB2 on improving clearance of inflammatory response and cardiac function were abolished in Lyve1 knockout mice. Mechanistically, EphrinB2 accelerated cell cycling and lymphatic endothelial cell proliferation and migration by activating CDK5 and CDK5-dependent ISL1 nuclear translocation. EphrinB2 enhanced the transcriptional activity of ISL1 at the VEGFR3 (FLT4) promoter, and VEGFR3 inhibitor MAZ51 significantly diminished the EphrinB2-mediated lymphangiogenesis and deteriorated the ischemic cardiac function. We uncovered a novel mechanism of EphrinB2-driven cardiac lymphangiogenesis in improving myocardial remodeling and function after MI.

The effects of acetylated cordycepin derivatives on promoting vascular angiogenesis and attenuating myocardial ischemic injury

BackgroundEnhanced angiogenesis following myocardial infarction (MI) is beneficial to preserve cardiac function. The present study aimed to investigate whether acetylated derivatives of cordycepin altered its original antitumor properties and exerted cardioprotective effects by promoting angiogenesis in vitro and in vivo. MethodsCordycepin and its derivatives with single (DA), double (DAA), and triple acetyl groups (DAAA) were assessed. The cell viability of leukemia U937 cells, malignant hepatoma Huh-7 cells, and human umbilical vascular endothelial cells (HUVECs) treated with cordycepin, DA, DAA, and DAAA were determined. The expression of β-catenin in U937 cells, as well as the expression of p65, p38 and other related signal regulators in HUVECs elicited by lipopolysaccharides (LPS) were also observed. Angiogenesis was determined by tube formation in HUVECs and Matrigel plug assay in mice. Cardiac function following administration of DAAA was evaluated in mice MI model simulated by coronary artery ligation. ResultsThe inhibitory effects of cordycepin and its acetylated derivatives on U937 cells, Huh-7 cells, HUVECs, and the expression of β-catenin in U937 cells were mitigated with increasing acetylation. Intriguingly, DAAA preserved the cell viability of HUVECs compared to other acetylated derivatives. Although DAAA had a significantly diminished antitumor effect compared to cordycepin, it promoted angiogenesis in mice and tube formation in HUVECs and attenuated LPS-induced phosphorylation of p65 and p38. Additionally, administration of DAAA improved cardiac function following coronary artery ligation in mice. ConclusionDAAA could be considered a promising adjunctive therapy to prevent post-MI heart failure through promoting angiogenesis.

Bnip3 promotes the release of mitochondria-derived extracellular vesicles in cardiac fibroblasts to exacerbate inflammation response after myocardial infarction

Abstract Background Cardiac fibroblasts (CFs) play a crucial role in tissue repair and remodeling following myocardial infarction (MI). Furthermore, CFs possess the ability to sense signals of myocardial injury and secrete cytokines, thereby eliciting a pro-inflammatory response during the early post-MI phase. Our previous studies have demonstrated that CFs located in the infarcted region release small extracellular vesicles (sEVs) abundant in damaged mitochondria, termed "mt-sEVs". These mt-sEVs are internalized by macrophages, prompting the secretion of IL-6 and IL-1β via NLRP3/Caspase-1 pathway. Nonetheless, the precise mechanisms underlying the promotion of mt-sEVs release remain elusive. Objective This study aimed to investigate the pivotal genes involved in mediating the release of CFs-derived mt-sEVs, with potential implications for post-MI therapeutic strategies. Methods Primary CFs were cultured for 24 hours in sugar-free medium with 1% oxygen (OGD) in vitro. Conditioned medium was subjected to ultracentrifugation to isolate sEVs. The presence of damaged mitochondrial components within the sEVs was confirmed using Mito-tracker and nanoflowmetry. Subcellular structures were visualized via transmission electron microscopy (TEM). Protein interactions were validated through co-immunoprecipitation (co-IP) assays. CF-specific gene knockout mice were generated and subjected to MI surgery. The proportion of F4/80+/CD86+ cells was quantified using flow cytometry. Cardiac function was evaluated using echocardiography, and the extent of cardiac fibrosis was assessed via Masson staining. Results Re-analysis of single-cell RNA sequencing data (GSE153480) unveiled a significant upregulation of the mitophagy receptor Bnip3 in CF sub-populations following MI, and the up-regulated trend was also observed in OGD-CFs. Deletion of Bnip3 hindered the expression of LC3 and its co-localization with mitochondria. TEM observed extensive fusion of mitophagosomes with multivesicular bodies in OGD-CFs. Fluorescence signal detected by nano flowmetry significantly decreased in Bnip3 knockdown sEVs incubated with Mito-tracker. Bnip3 deletion in CFs resulted in a significant downregulation of the sEVs release key factor Rab27a, concomitant with a striking increase in Rab27a ubiquitination. Predicted binding sites of both Bnip3 and Rab27a with the deubiquitinase Usp7 were validated through co-IP assays. Immunofluorescence staining demonstrated the co-localization of Usp7 with Bnip3 in OGD-CFs. CF-specific deletion of Bnip3 reduced the proportion of M1 macrophages, reversed left ventricular dysfunction, and mitigated myocardial fibrosis in post-MI hearts. Conclusion Collectively, our study reveals that Bnip3-mediated mitochondrial secretory autophagy in CFs was significantly activated to drive the release of mt-sEVs. Additionally, Bnip3 interacts with Usp7 to deubiquitinate Rab27a, promoting the release of mt-sEVs in CFs, exacerbating the inflammatory response after MI.Graphical abstract

Collagen VI and endotrophin: potential extracellular matrix targets to attenuate adverse cardiac remodeling post-infarction

Abstract Background The extracellular matrix (ECM) is a key component of cardiac repair after myocardial infarction (post-MI). After tissue damage following myocardial ischaemia, the ECM becomes enriched in proteases that are known to induce partial enzymatic cleavage and fragmentation of native structural and fibrillar macromolecules such as collagens. While some of the resulting protein fragments (matrikines) may have beneficial effects by mediating an active scar formation, other such as the collagen VI (COL6) proteolytic component "endothrophin" has been related to deleterious evolution and fibrosis, particularly in the presence of cardiovascular risk factors. Purpose We aimed to investigate the collagen profile in the structural fraction of ECM (enriched in fibrillar and structural proteins) of post-MI hearts at late evolution stages after MI. Methods The ECM protein profile was investigated in the ischemic (ISCH) and non-ischemic (NISCH) zones of the post-MI myocardium in pigs. MI was induced by closed-chest balloon occlusion of the LAD for 90 minutes. Studies were performed in normo- and hypercholesterolemic (diet induced) animals. Myocardial tissue was obtained 30d after MI. ECM proteins were selectively extracted, identified by LC/MS-MS and validated by Western Blot. Plasma levels of endothrophin were quantified by ELISA. Myocardial tissue from the same areas was characterized by immunohistochemistry. Results The ECM in the ISCH zone showed a differential signature of 39 proteins (14 upregulated / 25 downregulated) 30 days after MI compared to the NISCH area of the same animals. In the ISCH region, significant changes in collagen referring to COL6A3 and COL6A1 (increase) and COL6A2 and COL6A6 (decrease) were detected. COL6A3 protein content was 1.8fold higher (p=0.01) in the ISCH-ECM. A similar increase was found in normo- and hypercholesterolemic animals. A higher trend in COL6A3 levels was found in the ISCH- vs, the NISCH-zone in the myocardial cellular fraction suggesting that the COL6 ECM-related increase in ISCH is produced at a transcript level. Importantly, the COL6A3 found in the ECM did not contain the protein peptide (C5 domain) corresponding to endotrophin matrikine, suggesting its cleavage and release. Using a specific ELISA, hypercholesterolemic animals showed significantly higher endothrophin plasma levels than normolipemic controls (p=0.003) even in the absence of MI. Conclusion Our results evidence an increase in COL6A3 content in the ECM of the ischemic myocardium at 30 days post-MI. COL6A3 is depleted in a peptide of the C5 domain corresponding to endotrophin, found to be enhanced in hypercholesterolemia. These findings support a role for collagen type VI in adverse cardiac remodeling post-MI.

A humanized monoclonal antibody targeting an ectonucleotidase rescues cardiac metabolism and heart function after myocardial infarction

Myocardial infarction (MI) results in aberrant cardiac metabolism, but no therapeutics have been designed to target cardiac metabolism to enhance heart repair. We engineer a humanized monoclonal antibody against the ectonucleotidase ENPP1 (hENPP1mAb) that targets metabolic crosstalk in the infarcted heart. In mice expressing human ENPP1, systemic administration of hENPP1mAb metabolically reprograms myocytes and non-myocytes and leads to a significant rescue of post-MI heart dysfunction. Using metabolomics, single-nuclear transcriptomics, and cellular respiration studies, we show that the administration of the hENPP1mAb induces organ-wide metabolic and transcriptional reprogramming of the heart that enhances myocyte cellular respiration and decreases cell death and fibrosis in the infarcted heart. Biodistribution and safety studies showed specific organ-wide distribution with the antibody being well tolerated. In humanized animals, with drug clearance kinetics similar to humans, we demonstrate that a single "shot" of the hENPP1mAb after MI is sufficient to rescue cardiac dysfunction.

Advancing Human iPSC-Derived Cardiomyocyte Hypoxia Resistance for Cardiac Regenerative Therapies through a Systematic Assessment of In Vitro Conditioning.

Acute myocardial infarction (MI) is a sudden, severe cardiac ischemic event that results in the death of up to one billion cardiomyocytes (CMs) and subsequent decrease in cardiac function. Engineered cardiac tissues (ECTs) are a promising approach to deliver the necessary mass of CMs to remuscularize the heart. However, the hypoxic environment of the heart post-MI presents a critical challenge for CM engraftment. Here, we present a high-throughput, systematic study targeting several physiological features of human induced pluripotent stem cell-derived CMs (hiPSC-CMs), including metabolism, Wnt signaling, substrate, heat shock, apoptosis, and mitochondrial stabilization, to assess their efficacy in promoting ischemia resistance in hiPSC-CMs. The results of 2D experiments identify hypoxia preconditioning (HPC) and metabolic conditioning as having a significant influence on hiPSC-CM function in normoxia and hypoxia. Within 3D engineered cardiac tissues (ECTs), metabolic conditioning with maturation media (MM), featuring high fatty acid and calcium concentration, results in a 1.5-fold increase in active stress generation as compared to RPMI/B27 control ECTs in normoxic conditions. Yet, this functional improvement is lost after hypoxia treatment. Interestingly, HPC can partially rescue the function of MM-treated ECTs after hypoxia. Our systematic and iterative approach provides a strong foundation for assessing and leveraging in vitro culture conditions to enhance the hypoxia resistance, and thus the successful clinical translation, of hiPSC-CMs in cardiac regenerative therapies.

Abstract Tu075: Cardiac macrophages expressing CD206 and IL-4Ra are required for adverse LV remodeling in HF

Cardiac macrophages significantly expand in chronic heart failure (HF). We tested the hypothesis that CD206 + macrophages expressing interleukin (IL)-4Ra in the failing heart are key drivers of left ventricular (LV) remodeling and ischemic cardiomyopathy. Cardiac macrophages were profiled using flow cytometry in adult male C57BL/6 (WT) mice following non-reperfused myocardial infarction (MI) to induce HF or sham operation. CD206 + macrophages progressively expanded in post-MI hearts during the progression of LV remodeling and comprised ~85% of macrophages at 8 w. These macrophages were exclusively proliferative and predominantly C-C motif chemokine receptor (CCR2) – and major histocompatibility complex (MHC)II hi in failing hearts, with the majority (92%) of CD206 + CCR2 – macrophages expressing LYVE-1, an embryonically-derived resident macrophage marker. Nearly half of cardiac CD206 + macrophages expressed IL-4Ra; the abundance of CD206 + IL-4Ra + directly correlated with LV dysfunction and fibrosis. Intramyocardial adoptive transfer of IL-4-polarized bone marrow derived CD206 + macrophages induced progressive LV dilation, dysfunction and fibrosis over 4 w in naïve recipient mice. To evaluate the role of CD206 + IL-4Ra + macrophages in LV remodeling, we used male and female LysM CreERT2 ;IL-4Ra F/F mice that allow for inducible myeloid-specific IL-4Ra gene deletion. Administration of tamoxifen from at 4 to 10 w post-MI (in established HF), effectively deleted IL-4Ra in cardiac macrophages and significantly reduced CD206 + macrophage abundance and proliferation in the remodeling heart. Myeloid-specific IL-4Ra deletion further prevented LV remodeling progression, improved fibrosis and neovascularization, and alleviated LV systolic dysfunction, while suppressing expansion of cardiac immune cells and blood Ly6C high monocytosis. We conclude that an expanded and proliferative population of CD206 + IL-4Ra + macrophages primarily derived from resident macrophages are key mediators of pathological LV remodeling and fibrosis. Inhibition of CD206 + macrophage IL-4Ra signaling may be a fruitful therapeutic approach to alleviate disease progression in HF.

Abstract Tu139: Ferroptotic Cardiomyocytes Support Angiogenesis in the Infarcted Myocardium

Introduction: Mammalian cardiomyocytes have a low turnover rate which is insufficient to repopulate the damaged myocardium after injury caused by myocardial infarction (MI). Previously, we reported that ferroptosis is the main mechanism of cardiomyocyte death in the infarcted neonatal heart. We hypothesized that ferroptotic cardiomyocytes play a beneficial role during the wound healing process. Aims: In this study, we aim to characterize the role of ferroptotic cardiomyocytes by investigating their influence on non-cardiomyocyte populations in the heart post-MI. Methods: Left anterior descending artery occlusion (LAD-O) was performed on wild type (C 5 7BL/6J x FVB) mice at P1. Ferroptosis inhibitor ferrostatin-1 (Fer-1) was delivered at a 2mg/kg dose via subcutaneous injection immediately following LAD-O procedure and again daily until P4. Histology and immunofluorescence were performed to assess myocardial regeneration. iPSC-derived cardiomyocytes (iCMs) were treated with Erastin, Staurosporine, or vehicle control to generate conditioned media. HUVECs were treated with iCM conditioned media for tube formation assays. Results: The infarcts of Fer-1 treated animals show decreased total macrophages from 5.5% to 0.16% (P < 0.05, N = 6 per group, S.E.M. = 1.2%) and those present were less polarized towards the M2 phenotype, decreased from 62.5% to 7.9% (N = 6 per group, P < 0.001, S.E.M. = 9.6%). This trend was confirmed via flow cytometry. The number of Emcn + cells in the infarct was significantly reduced in Fer-1 treated mice, decreasing from 17% to 10% (S.E.M. = 1.7%, N = 4 per group, P < 0.01). HUVECs treated with conditioned media generated by treating iPSC-derived cardiomyocytes with Staurosporine, but not Erastin or DMSO, showed reduced mesh area (fold change from 0.94 to.0 24, N = 5 per group, P < 0.01. S.EM. = .128). Other tube formation endpoints such as extremities, junctions, and branching followed this trend. Conclusions: Our analysis revealed that ferroptotic cardiomyocytes play a supportive role in the wound healing and tissue remodeling environment by directly supporting angiogenesis and polarizing the cardiac macrophages towards a more pro-angiogenic state.

Abstract We145: δ-catenin mRNA m 6 A Methylation Promotes Cardiac Fibrosis following Acute Myocardial Infarction

Background: Cardiac fibrosis is pivotal in heart failure progression, where excessive extracellular matrix (ECM) secretion by activated fibroblasts leads to adverse remodeling and dysfunction. While Wnt/β-catenin signaling influences fibroblast activation and cardiac fibrosis post-MI, its precise regulation remains unclear. Emerging evidence suggests N6-methyladenosine (m 6 A) mRNA methylation's role in disease pathology, yet its specific contribution to post-MI cardiac fibrosis is not well understood. Thus, we hypothesized that “ MI-induced METTL3 (a Key m6A mRNA methyltransferase) activation stabilizes δ-catenin mRNA, facilitating cardiac fibrosis and adverse remodeling ”. Methods: The mice underwent sham/MI surgeries for 4 weeks, after which heart tissues were collected for biochemical and histological analysis following heart function measurements. Additionally, methyl-immunoprecipitation followed by RNA sequencing (MeRIP-sequencing) was performed on the heart tissue post-surgery, and the data were analyzed to identify fibrosis-associated targets. Results: Ischemic injury significant increase in m6A mRNA methylation in heart tissues. This increase in m 6 A RNA was also observed in adult cardiac fibroblasts (AMFs) following TGFb treatment. Interestingly, METTL3 inhibition (METTL3 siRNA) resulted in a significant reduction in TGFb-induced periostin and fibronectin gene expression, while METTL3 overexpression enhanced the expression of fibrotic genes in AMFs. To identify differentially regulated m6A target genes, MeRIP-seq was performed on RNA isolated from mice hearts post-MI. The sequencing data suggested hypermethylation of fibrosis-associated genes, including δ-catenin, post-MI. Notably, TGFb-induced increased δ-catenin mRNA methylation led to δ-catenin mRNA stabilization. In contrast, METTL3 inhibition using siMETTL3 in AMFs and in METTL3 KO mice significantly reduced fibroblast activation and cardiac fibrosis. Conclusion: Our data suggests that hypermethylation of δ-catenin mRNA plays a significant role in the progression of cardiac fibrosis following AMI. Therefore, regulating METTL3 could be a potential therapeutic target for attenuating cardiac fibrosis.

Abstract We024: Spatial Transcriptomics Identifies a Regeneration-Permissive Microenvironment in the Neonatal Mammalian Heart

Ischemic heart disease is the leading cause of death globally, largely driven by inability of the adult heart to restore tissue structure and function after injury. However, the neonatal mouse heart is able to regenerate up to one week after birth, circumventing scarring and functional impairment. Neonatal heart regeneration is a spatially and temporally regulated process, involving coordinated communication of different cardiac cell types. Our previous work identified a regenerative cardiomyocyte population (CM4) that proliferates after myocardial infarction (MI), but the intercellular communication that induces their regenerative response is not fully understood. To study the cellular environment of CM4 cells during neonatal heart regeneration, we profiled spatial transcriptomes of regenerative P1 hearts at 3 days and 7 days after MI and compared them to nonregenerative P8 hearts. We identified unique spatial regions with distinct gene expression signatures, that we refer to as “molecular niches”, in the ischemic and border zones (IZ, BZ) of the P1 heart post-MI compared to P8 hearts. Cell type deconvolution of molecular niches showed a distinct temporal change of fibroblast and macrophage abundance in the IZ of P1 hearts compared to P8 hearts and also showed the localization of CM4 cells to the BZ of P1 hearts at 7 days post-MI. To identify intercellular communication that contributes to the differential injury response in P1 and P8 hearts, we analyzed ligand-receptor pairs that were expressed at higher levels in the IZ and BZ of P1 compared to P8 hearts. Among the nearly 50 signaling pairs identified, OSM and SLIT signaling have been previously implicated in heart regeneration. Notably, many of these signaling factors, including cytokines, chemokines and growth factors, have receptors expressed in multiple cardiac cell types. Thus, ongoing studies are systematically distilling the effect of each secreted factor on individual cell types in the heart using a cardiac cell co-culture and multiplexed single-cell RNA sequencing approach. In summary, our study provides insight into the spatial organization and tissue microenvironment of neonatal heart regeneration and identifies a number of candidate signaling pathways that potentially mediate critical intercellular communication during neonatal heart regeneration.

SGLT2 inhibitor Dapagliflozin alleviates cardiac dysfunction and fibrosis after myocardial infarction by activating PXR and promoting angiogenesis

BackgroundMyocardial infarction (MI) has emerged as the primary cause of global mortality. Managing blood sugar levels could play a vital role in the treatment of MI. Dapagliflozin (DPG), a commonly used hypoglycemic drug, has demonstrated efficacy in treating heart failure. However, the impact of DPG on MI remains unclear. We aimed to investigate the effects and mechanisms of DPG in relation to MI. Methods and resultsDPG administration alleviated MI-induced cardiac dysfunction and myocardial fibrosis. We also found that DPG administration mitigated cardiomyocyte apoptosis through TUNEL staining. CD31 and α-Sma staining revealed that DPG promotes post-MI angiogenesis in mice. In vitro, using scratch assays, transwell assays, and tube formation assays, we discovered that DPG enhanced HUVEC proliferation capacity. Mechanistically, DPG promoted the expression of extracellular matrix genes and mitochondrial function-related genes. Additionally, molecular docking identified the interaction between DPG and PXR, which activated PXR and recruited it to the promoters of Pgam2 and Tcap, promoting their expressions, thus facilitating angiogenesis and post-MI heart repair. ConclusionsDPG promotes angiogenesis by activating PXR, thereby alleviating cardiac dysfunction and fibrosis after myocardial infarction. This study provides new strategies and targets for the treatment of ischemic disease.

Excessive autophagy of myocardial cells promotes ferroptosis and exacerbates heart failure in the state of myocardial infarction

IntroductionThis study investigates the molecular mechanisms by which excessive autophagy exacerbates post-myocardial infarction heart failure(post-MI HF) through nuclear receptor coactivator 4 (NCOA4)-mediated ferritinophagy and ferroptosis.Material and methodsWe developed a post-MI heart failure model in Sprague-Dawley rats via coronary artery ligation, alongside an in vitro heart failure model using hypoxia/reoxygenation-stimulated H9C2 cells. Intervention with rapamycin (autophagy activator), 3-methyladenine (autophagy inhibitor), desferrioxamine, and ferredoxin-1(ferroptosis inhibitors). Various techniques, including echocardiography, immunofluorescence colocalization, C11 BODIPY 581/591 staining, flow cytometry, transmission electron microscopy, western blotting, and RT-qPCR, were employed.ResultsIn vivo analyses revealed that NCOA4-mediated ferritinophagy and ferroptosis are significant in post-MI HF. Manipulating autophagy through rapamycin and 3-methyladenine influenced the expression of NCOA4 and glutathione peroxidase 4 (GPX4), subsequently affecting ferroptosis and modulating heart failure severity. Our in vitro experiments corroborated these findings, demonstrating that heightened autophagy amplifies NCOA4 expression, which in turn fosters ferroptosis and exacerbates myocardial injury. Interestingly, silencing of NCOA4 partially mitigated autophagy-induced iron deficiency, indicating a crucial intersection between autophagy and iron metabolism. Moreover, the cardioprotective effects observed following NCOA4 silencing were negated by concurrent GPX4 silencing.ConclusionsOur findings elucidate that autophagy precedes NCOA4 in its regulatory pathway and directly influences ferritinophagy. Enhanced autophagy augments intracellular free iron and unstable iron pools, triggering lipid peroxidation through ferritinophagy, which promotes ferroptosis and impairs cardiac function. These insights offer a novel scientific basis for developing therapeutic strategies for heart failure post-MI HF.

Malonate given at reperfusion prevents post-myocardial infarction heart failure by decreasing ischemia/reperfusion injury

The mitochondrial metabolite succinate is a key driver of ischemia/reperfusion injury (IRI). Targeting succinate metabolism by inhibiting succinate dehydrogenase (SDH) upon reperfusion using malonate is an effective therapeutic strategy to achieve cardioprotection in the short term (< 24 h reperfusion) in mouse and pig in vivo myocardial infarction (MI) models. We aimed to assess whether inhibiting IRI with malonate given upon reperfusion could prevent post-MI heart failure (HF) assessed after 28 days. Male C57BL/6 J mice were subjected to 30 min left anterior coronary artery (LAD) occlusion, before reperfusion for 28 days. Malonate or without-malonate control was infused as a single dose upon reperfusion. Cardiac function was assessed by echocardiography and fibrosis by Masson’s trichrome staining. Reperfusion without malonate significantly reduced ejection fraction (~ 47%), fractional shortening (~ 23%) and elevated collagen deposition 28 days post-MI. Malonate, administered as a single infusion (16 mg/kg/min for 10 min) upon reperfusion, gave a significant cardioprotective effect, with ejection fraction (~ 60%) and fractional shortening (~ 30%) preserved and less collagen deposition. Using an acidified malonate formulation, to enhance its uptake into cardiomyocytes via the monocarboxylate transporter 1, both 1.6 and 16 mg/kg/min 10 min infusion led to robust long-term cardioprotection with preserved ejection fraction (> 60%) and fractional shortening (~ 30%), as well as significantly less collagen deposition than control hearts. Malonate administration upon reperfusion prevents post-MI HF. Acidification of malonate enables lower doses of malonate to also achieve long-term cardioprotection post-MI. Therefore, the administration of acidified malonate upon reperfusion is a promising therapeutic strategy to prevent IRI and post-MI HF.

Persistent transcriptional changes in cardiac adaptive immune cells following myocardial infarction: New evidence from the re-analysis of publicly available single cell and nuclei RNA-sequencing data sets

IntroductionChronic immunopathology contributes to the development of heart failure after a myocardial infarction. Both T and B cells of the adaptive immune system are present in the myocardium and have been suggested to be involved in post-MI immunopathology. MethodsWe analyzed the B and T cell populations isolated from previously published single cell RNA-sequencing data sets (PMID: 32130914, PMID: 35948637, PMID: 32971526 and PMID: 35926050), of the mouse and human heart, using differential expression analysis, functional enrichment analysis, gene regulatory inferences, and integration with autoimmune and cardiovascular GWAS. ResultsAlready at baseline, mature effector B and T cells are present in the human and mouse heart, having increased activity in transcription factors maintaining tolerance (e.g. DEAF1, JDP2, SPI-B). Following MI, T cells upregulate pro-inflammatory transcript levels (e.g. Cd11, Gzmk, Prf1), while B cells upregulate activation markers (e.g. Il6, Il1rn, Ccl6) and collagen (e.g. Col5a2, Col4a1, Col1a2). Importantly, pro-inflammatory and fibrotic transcription factors (e.g. NFKB1, CREM, REL) remain active in T cells, while B cells maintain elevated activity in transcription factors related to immunoglobulin production (e.g. ERG, REL) in both mouse and human post-MI hearts. Notably, genes differentially expressed in post-MI T and B cells are associated with cardiovascular and autoimmune disease. ConclusionThese findings highlight the varied and time-dependent dynamic roles of post-MI T and B cells. They appear ready-to-go and are activated immediately after MI, thus participate in the acute wound healing response. However, they subsequently remain in a state of pro-inflammatory activation contributing to persistent immunopathology.

Macrophage GPR18 signaling activation by Resolvin D2 mediates metabolic switch and cardiac repair after myocardial infarction.

Abstract Higher inflammatory response is a major cause of heart failure and mortality post myocardial infarction (MI), a major health problem worldwide. Resolution of inflammation, well established as an actively orchestrated programmed response, is mediated by specialized pro-resolving lipid mediators (SPM) and cellular processes like efferocytosis. Resolvin D2 (RvD2), one such potent SPM, is expressed in leukocytes and stimulates the resolution of inflammation through signaling by its receptor GPR18. RvD2 signaling attenuates inflammation in immune-related conditions through macrophage (Mφ) cell-intrinsic and extrinsic mechanisms. The therapeutic potential of SPM has been demonstrated in treatment of sepsis and arthritis. However, the role of Mφ RvD2-GPR18 signaling in heart post-MI has not been elucidated. Here, we demonstrate (i) induction of GPR18 receptor on cardiac Mφ, (ii) &amp;gt;50% reduction in survival of myeloid- and Mφ-specific GPR18-/- mice, (iii) reduced heart function in GPR18-/- mice post-MI, (iv) a GPR18-dependent suppression of TLR4 signaling cytokines, and (v) suppression of TLR4-induced glycolytic metabolism by RvD2-GPR18 signaling in vitro in Mφ from human GPR18 chimeric adult mice. To summarize, our data suggest GPR18-dependent metabolic and phenotype switch to anti-inflammatory Mφ and cardiac repair post-MI. Further interrogation will delineate the intracellular pathways downstream of GPR18 and demonstrate the potential of RvD2 in reducing mortality post-MI.

FBXL8 inhibits post-myocardial infarction cardiac fibrosis by targeting Snail1 for ubiquitin-proteasome degradation

Abnormal cardiac fibrosis is the main pathological change of post-myocardial infarction (MI) heart failure. Although the E3 ubiquitin ligase FBXL8 is a key regulator in the cell cycle, cell proliferation, and inflammation, its role in post-MI ventricular fibrosis and heart failure remains unknown. FBXL8 was primarily expressed in cardiac fibroblasts (CFs) and remarkably decreased in CFs treated by TGFβ and heart subjected to MI. The echocardiography and histology data suggested that adeno-associated viruses (AAV9)-mediated FBXL8 overexpression had improved cardiac function and ameliorated post-MI cardiac fibrosis. In vitro, FBXL8 overexpression prevented TGFβ-induced proliferation, migration, contraction, and collagen secretion in CFs, while knockdown of FBXL8 demonstrated opposite effects. Mechanistically, FBXL8 interacted with Snail1 to promote Snail1 degradation through the ubiquitin–proteasome system and decreased the activation of RhoA. Moreover, the FBXL8ΔC3 binding domain was indispensable for Snail1 interaction and degradation. Ectopic Snail1 expression partly abolished the effects mediated by FBXL8 overexpression in CFs treated by TGFβ. These results characterized the role of FBXL8 in regulating the ubiquitin-mediated degradation of Snail1 and revealed the underlying molecular mechanism of how MI up-regulated the myofibroblasts differentiation-inducer Snail1 and suggested that FBXL8 may be a potential curative target for improving post-MI cardiac function.

THE ROLE OF NEUTROPHILS TO LYMPHOCYTES RATIO AS PREDICTIVE BIOMARKER IN ACUTE MYOCARDIAL INFARCTION PATIENTS AT AL-GAMHURIA MODERN GENERAL HOSPITAL – ADEN-YEMEN

Inflammation plays a fundamental role in the development of atherosclerosis and in the pathogenesis of acute myocardial infarction (AMI). Neutrophils to lymphocytes ratio (NLR) was recognized as important inflammatory marker in predicting the severity and prognosis of AMI. The aim of this study is to determine the role of NLR as predictive biomarker in AMI patients at Al-Gamhuria Modern General Hospital. This study was considered a descriptive cross-sectional study, which was conducted in Al-Gamhuria Modern General Hospital from March through August 2022. The study includes 124 patients diagnosed as AMI and classified into two groups: 70 patients with low NLR and 54 patients with high NLR. Out of 124 patients, 56.5% of patients had low NLR and 43.5% had high NLR. Patients with high NLR were older (62.31 ± 7.30 vs. 57.80 ± 5.17 years), had higher prevalence of D.M., hyperlipidemia, more smokers and Khat chewers compared to patients with low NLR. High NLR group had more elevated CK-MB and Troponin T, more reduced ejection fraction (EF) and fractional shortening (FS) compared to low NLR group (P &lt; 0.001). High NLR group also had poorer Killip class (P &lt; 0.001), and were more prone to death inside the hospital compared to low NLR group (11.1% vs. 1.4%), (P= 0.042). As conclusion, NLR is a strong predictor of myocardial damage, myocardial dysfunction as well as in-hospital mortality in patients with AMI. NLR as an inflammatory marker can also predict the consequences on the heart post-MI.

Proteomic study of left ventricle and cortex in rats after myocardial infarction

Myocardial infarction (MI) induces neuroinflammation indirectly, chronic neuroinflammation may cause neurodegenerative diseases. Changes in the proteomics of heart and brain tissue after MI may shed new light on the mechanisms involved in neuroinflammation. This study explored brain and heart protein changes after MI with a data-independent acquisition (DIA) mode proteomics approach. Permanent ligation of the left anterior descending coronary artery (LAD) was performed in the heart of rats, and the immunofluorescence of microglia in the brain cortex was performed at 1d, 3d, 5d, and 7d after MI to detect the neuroinflammation. Then proteomics was accomplished to obtain the vital proteins in the heart and brain post-MI. The results show that the number of microglia was significantly increased in the Model-1d group, the Model-3d group, the Model-5d group, and the Model-7d group compared to the Sham group. Various proteins were obtained through DIA proteomics. Linking to key targets of brain disease, 14 proteins were obtained in the brain cortex. Among them, elongation of very long chain fatty acids protein 5 (ELOVL5) and ATP-binding cassette subfamily G member 4 (ABCG4) were verified through western blotting (WB). The results of WB were consistent with the proteomics results. Therefore, these proteins may be related to the pathogenesis of neuroinflammation after MI.

Small Extracellular Vesicles From Infarcted and Failing Heart Accelerate Tumor Growth.

Myocardial infarction (MI) and heart failure are associated with an increased incidence of cancer. However, the mechanism is complex and unclear. Here, we aimed to test our hypothesis that cardiac small extracellular vesicles (sEVs), particularly cardiac mesenchymal stromal cell-derived sEVs (cMSC-sEVs), contribute to the link between post-MI left ventricular dysfunction (LVD) and cancer. We purified and characterized sEVs from post-MI hearts and cultured cMSCs. Then, we analyzed cMSC-EV cargo and proneoplastic effects on several lines of cancer cells, macrophages, and endothelial cells. Next, we modeled heterotopic and orthotopic lung and breast cancer tumors in mice with post-MI LVD. We transferred cMSC-sEVs to assess sEV biodistribution and its effect on tumor growth. Finally, we tested the effects of sEV depletion and spironolactone treatment on cMSC-EV release and tumor growth. Post-MI hearts, particularly cMSCs, produced more sEVs with proneoplastic cargo than nonfailing hearts did. Proteomic analysis revealed unique protein profiles and higher quantities of tumor-promoting cytokines, proteins, and microRNAs in cMSC-sEVs from post-MI hearts. The proneoplastic effects of cMSC-sEVs varied with different types of cancer, with lung and colon cancers being more affected than melanoma and breast cancer cell lines. Post-MI cMSC-sEVs also activated resting macrophages into proangiogenic and protumorigenic states in vitro. At 28-day follow-up, mice with post-MI LVD developed larger heterotopic and orthotopic lung tumors than did sham-MI mice. Adoptive transfer of cMSC-sEVs from post-MI hearts accelerated the growth of heterotopic and orthotopic lung tumors, and biodistribution analysis revealed accumulating cMSC-sEVs in tumor cells along with accelerated tumor cell proliferation. sEV depletion reduced the tumor-promoting effects of MI, and adoptive transfer of cMSC-sEVs from post-MI hearts partially restored these effects. Finally, spironolactone treatment reduced the number of cMSC-sEVs and suppressed tumor growth during post-MI LVD. Cardiac sEVs, specifically cMSC-sEVs from post-MI hearts, carry multiple protumorigenic factors. Uptake of cMSC-sEVs by cancer cells accelerates tumor growth. Treatment with spironolactone significantly reduces accelerated tumor growth after MI. Our results provide new insight into the mechanism connecting post-MI LVD to cancer and propose a translational option to mitigate this deadly association.

One-Year Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction Patients Undergoing Optical Coherence Tomography-Guided Primary Percutaneous Coronary Intervention: A Comparative Study.

BACKGROUND Percutaneous coronary intervention (PCI) with angiography guidance is a common procedure. Optical coherence tomography (OCT) is a non-invasive imaging method that uses light waves. This study from a single center aimed to compare 1-year outcomes in 75 patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent OCT-guided primary PCI, with 163 patients with acute STEMI who underwent PCI without OCT guidance from February 2019 to July 2021. MATERIAL AND METHODS Patients with acute STEMI were enrolled from February 2019 to July 2021. Seventy-five patients underwent OCT-guided PCI (OCT group), while 163 underwent PCI without OCT (control group). Baseline characteristics, in-hospital mortality, target lesion revascularization, post-MI heart failure, and 1-year all-cause mortality were compared between groups. RESULTS The OCT group had lower diabetes mellitus and hyperlipidemia prevalence. Additionally, they experienced longer procedures (OCT: 50.45&plusmn;21.75 min; control: 33.80&plusmn;14.44 min; P<0.001). After PCI, the control group had lower left ventricular ejection fractions (OCT: 53.4%&plusmn;10.5%; control: 47.8%&plusmn;12.4%; P<0.001) and higher post-MI heart failure rates (OCT: 2.7%; control: 11.0%; P=0.030). Notably, the 1-year all-cause mortality rate was significantly lower in the OCT group (OCT: 1.3%; control: 8.0%; P=0.043). CONCLUSIONS During the 1-year follow-up, patients who received OCT-guided primary PCI experienced a notably lower rate of post-MI heart failure than did those who underwent primary PCI without OCT guidance. Importantly, the application of OCT in primary PCI procedures did not result in a higher incidence of distal embolism, even in cases with a significant thrombus burden.