lipid-a and Myocardial-Infarction

The phenomenon of 'ischemic preconditioning' (IP) has been vigorously investigated during the past 15 years. As our knowledge on the possible protective mechanisms of IP has been increasingly expanded, novel approaches based on preconditioning with pharmacological agents have recently emerged. Two drugs have been used to induce delayed preconditioning against myocardial infarction caused by ischemia/reperfusion. One of the drugs was monophosphoryl lipid A (MLA)--a detoxified derivative of lipopolysaccharide from gram-negative strains; and another drug was RC552--a novel synthetic glycolipid that mimics the chemical structure of MLA. We have shown that pretreatment of adult mice with MLA or RC552 (350 microg/kg) 24 h prior to the global ischemia and reperfusion in the isolated perfused heart attenuated myocardial injury. Infarct size was significantly reduced in MLA or RC552-treated groups as compared with the vehicle-treated group. The delayed cardioprotection was associated with a moderate but significant increase of nitric oxide level in the ischemic myocardium. Treatment with S-methylisothiourea (3 mg/kg), a selective inhibitor of inducible nitric oxide synthase (iNOS) abolished MLA or RC552-induced delayed protection. In addition, neither MLA nor RC552 reduced infarct size in iNOS knockout mice. Our findings suggest that both MLA and RC552 are able to induce delayed myocardial preconditioning via iNOS-dependent pathway.

Topics: Adjuvants, Immunologic; Animals; Enzyme Inhibitors; Glycolipids; Humans; In Vitro Techniques; Ischemic Preconditioning, Myocardial; Isothiuronium; Lipid A; Mice; Mice, Knockout; Myocardial Infarction; Myocardial Reperfusion Injury; Nitric Oxide; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Perfusion; Rats; Signal Transduction

Monophosphoryl Lipid A (MLA) is a detoxified derivative of endotoxin and was first derived and purified from bacterial lipopolysaccharide in 1980s. This pharmacological agent has been studied as a vaccine adjunct, anti-septic, or anti-tumor agent by means of its immunomodulatory properties. In addition, MLA is one of the most well documented protective drugs against cardiac ischemia/reperfusion injury in various animal species. Mechanisms involved with the MLA-induced cardioprotection are still not fully understood. A key role for ATP-sensitive potassium channels and inducible nitric oxide synthase (iNOS) has been proposed. This article provides a brief overview on the updated understanding of MLA-induced cardioprotection and focuses on the new evidence and insights that were brought into the field by a number of new publications during 1998-1999. Our recent study in a globally ischemic mouse heart model is particularly highlighted. An obligatory role for nitric oxide (NO) in mediating the delayed cardioprotective effect induced by MLA via induction of iNOS was double-confirmed by using S-methylisothiourea (SMT)--a specific inhibitors of iNOS as well as the iNOS gene knockout mice. A direct association of the MLA-induced infarct size reduction with increased NO production was also demonstrated in this study. Future studies should target on identifying the key type(s) of cytokine and the receptors as well as free radical-activated transcription factors that may be responsible for induction of iNOS and the subsequent anti-ischemic cardioprotection with MLA. Information gathered in the studies on MLA may eventually enhance our understanding in the mechanisms of delayed phase of myocardial preconditioning and its clinical applications.

Topics: Animals; Lipid A; Myocardial Infarction; Myocardial Reperfusion Injury; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Potassium Channels

As the mechanism of ischemic preconditioning unfolds, various strategies for inducing pharmacologic preconditioning become apparent. Adenosine receptor agonists, KATP channel activators, and endothelial-neutrophil adhesion antagonists have enjoyed cardioprotective activity against ischemia/reperfusion injury in at least some preclinical models. Monophosphoryl lipid A (MLA), a structural derivative of the pharmacophore of endotoxin, enjoys an improved therapeutic index in relation to the parent biological product. MLA has found clinical application as a vaccine adjuvant and protects from sepsis and septic shock in the preclinical setting. In animal models of myocardial ischemia/reperfusion injury, pretreatment 12-24 hours prior to ischemia with a single IV bolus injection of MLA limits infarct size 50 to 75 percent in standard canine and rabbit models at doses of 10-35 micrograms/kg. Regional myocardial stunning following multiple 5-minute ischemic episodes as assessed by segment shortening is reduced in dogs pretreated 24 but not 1 hour prior to ischemia. Global cardiac function, as evaluated by pressure-volume constructs generated in dogs being weaned from cardiopulmonary bypass, recovers more quickly in animals pretreated with MLA. Cardiac protection in various models is associated with preservation of ATP during ischemia, induction of 5' nucleotidase and enhancement of calcium reuptake by SR during reperfusion. Limitation of infarct size by MLA in dogs and rabbits can be reversed by the administration of glibenclamide just prior to ischemia, suggesting a role for KATP channel opening during the first minutes of sustained ischemia. A clinical formulation of MLA (MPL-C) is currently undergoing clinical investigation in the Phase II setting in coronary artery bypass surgical patients. MLA may represent a novel means of inducing pharmacologic preconditioning, with potential for clinical application as a pretreatment before planned myocardial ischemia.

Topics: Adjuvants, Immunologic; Animals; Dogs; Humans; Lipid A; Myocardial Infarction; Myocardial Ischemia; Myocardial Stunning; Rabbits

In order to explore whether monophosphoryl lipid A (MLA)-induced delayed cadioprotection is mediated by calcitonin gene-related peptide (CGRP) and the regulatory effect of inducible heme oxygenase isorform (HO-1)/carbon monoxide (CO) on CGRP synthesis and release, the expression of CGRP and HO-1 in dorsal root ganglia (DRG) and CGRP concentration in plasma were determined in rats. Pretreatment with MLA (500 microg/kg, i.p.) significantly reduced infarct size and creatine kinase release after the 45-min coronary artery occlusion and 180-min reperfusion. MLA caused a significant increase in the expression of CGRP and HO-1 and plasma concentrations of CGRP. The cardioprotection as well as the synthesis and release of CGRP induced by MLA were completely abolished by pretreatment with zinc protoporphrin IX (ZnPP-9), an inhibitor of HO-1, or by capsaicin (50 mg/kg, s.c.), which selectively depletes transmitters in capsaicin-sensitive sensory nerves. Pretreatment with Znpp-9 had no effect on HO-1 expression, but capsaicin abrogated the expression of HO-1 induced by MLA in DRG. These results suggest that the delayed cardioprotection afforded by MLA is mediated by CGRP via activation of the HO-1 pathway.

Topics: Adjuvants, Immunologic; Animals; Calcitonin Gene-Related Peptide; Capsaicin; Carbon Monoxide; Cardiotonic Agents; Creatine Kinase; Ganglia, Spinal; Heme Oxygenase (Decyclizing); Heme Oxygenase-1; Injections, Intraperitoneal; Ischemic Preconditioning, Myocardial; Lipid A; Male; Myocardial Infarction; Myocardium; Protoporphyrins; Rats; Rats, Sprague-Dawley; Reperfusion Injury; RNA, Messenger; Signal Transduction; Time Factors

Recent study has shown that monophosphoryl lipid A-induced delayed preconditioning enhanced preservation with cardioplegia and that the protective effects of monophosphoryl lipid A were related to stimulation of calcitonin gene-related peptide (CGRP) release. The purpose of the present study was to explore whether the elevated release of CGRP induced by monophosphoryl lipid A is secondary to stimulation of CGRP synthesis via the nitric oxide (NO) pathway and to characterize the isoform of CGRP. Sprague-Dawley rats were pretreated with monophosphoryl lipid A 24 h before the experiment, and then the left main coronary artery of rat hearts was subjected to 1 h occlusion followed by 3 h reperfusion. Infarct size, plasma creatine kinase activity, the plasma level of CGRP, and the expression of CGRP isoforms (alpha- and beta-CGRP) mRNA in lumbar dorsal root ganglia were measured. Pretreatment with monophosphoryl lipid A (500 microg/kg, i.p.) significantly reduced infarct size and creatine kinase release. Monophosphoryl lipid A caused a significant increase in the expression of alpha-CGRP mRNA, but not of beta-CGRP mRNA, concomitantly with an increase in plasma concentrations of CGRP, and the increased level of CGRP expression happened before stimulation of CGRP release. The effect of monophosphoryl lipid A was completely abolished by pretreatment with L-nitroarginine methyl ester (L-NAME, 10 mg/kg, i.p.), an inhibitor of NO synthase or capsaicin (50 mg/kg, s.c.), which selectively depletes transmitters in capsaicin-sensitive sensory nerves. The results suggest that the delayed cardioprotection afforded by monophosphoryl lipid A involves the synthesis and release of CGRP via the NO pathway, and that the protection is mainly mediated by the alpha-CGRP isoform.

Topics: Animals; Calcitonin Gene-Related Peptide; Capsaicin; Creatine Kinase; Enzyme Inhibitors; Ischemic Preconditioning, Myocardial; Lipid A; Male; Myocardial Infarction; Myocardium; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; Rats; Rats, Sprague-Dawley; RNA, Messenger

To explore whether the heme oxygenase-1 (HO-1) pathway is involved in the delayed cardioprotection induced by monophosphoryl lipid A (MLA).. Sprague-Dawley rats were pretreated with MLA 24 h before the experiment. Ischemia-reperfusion injury was induced by 60 min coronary artery occlusion followed by 3 h reperfusion. Infarct size, the serum creatine kinase (CK) activity, the serum content of nitric oxide (NO), and expression of HO-1 mRNA and protein in the heart were measured.. Pretreatment with MLA (500 microg/kg, ip) markedly reduced infarct size and CK release and increased the serum content of NO (P < 0.01). The effects of MLA were completely abolished by pretreatment with L-nitroarginine methyl ester (L-NAME 10 mg/kg, ip), an inhibitor of NO synthase (P < 0.01), or Zinc protoporphyrin IX (45 micromol/kg, ip), an inhibitor of HO (P < 0.01). MLA caused a significant increase in the expression of HO-1 mRNA and protein, an effect which was not affected by L-NAME (P > 0.05).. The results suggest that the HO-1/NO pathway is involved in the delayed cardioprotection induced by MLA.

Topics: Animals; Cardiotonic Agents; Creatine Kinase; Heme Oxygenase (Decyclizing); Heme Oxygenase-1; Lipid A; Male; Myocardial Infarction; Myocardial Reperfusion Injury; Nitric Oxide; Rats; Rats, Sprague-Dawley; RNA, Messenger

The novel glycolipid RC-552 shares common structural features with the natural products lipid A and the previously described cardioprotectant monophosphoryl lipid A. RC-552 administered to dogs as a bolus intravenous dose (35-70 microg/kg) either 24 h or 10 min prior to 60 min of regional myocardial ischemia and 3 h of reperfusion significantly (P<0.05 v control) reduced infarct size (IS) as assessed by triphenyltetrazolium staining from 27.0+/-2.3% of the area-at-risk (AAR) to 13.3+/-2.2% and 15.0+/-3.0%, respectively. Administration of the non-specific inducible nitric oxide synthase (iNOS) inhibitor aminoguanidine (30 mg/kg, subcutaneously) 1 h prior to ischemia blocked the ability of RC-552 (35 microg/kg, 24 h pretreatment) to reduce infarct size. Intravenous pretreatment with RC-552 (35 microg/kg) either 24 h or 10 min prior to five 5 min repetitive cycles of ischemia and reperfusion significantly improved regional myocardial segment shortening (percentage of control) at all time points during 2 h of reperfusion in dogs. These effects of RC-552 in either cardiac injury model occurred independent of differences in AAR, transmural blood flow during ischemia or hemodynamics throughout the experiment. In contrast with monophosphoryl lipid A (MLA), which has also been reported to be cardioprotective at similar doses in dogs, RC-552 was approximately 100 times less prone to cause fever in the USP rabbit pyrogen test. Likewise, RC-552 did not induce secretion of the proinflammatory cytokines TNF, IL-6 or IL-8 from THP-1 cells or alter the expression of adhesion molecules on human neutrophils at concentrations up to 10 microg/ml. MLA was active in these systems at concentrations in the range 0.1-1.0 microg/ml. In conclusion, RC-552 reduces myocardial infarct size and stunning in dogs in the absence of residual immunomodulatory activity.

Topics: Animals; Antibodies, Monoclonal; Blood Flow Velocity; Dogs; Dose-Response Relationship, Drug; Enzyme-Linked Immunosorbent Assay; Female; Flow Cytometry; Glycolipids; Hemodynamics; Humans; Intercellular Adhesion Molecule-1; Interleukin-6; Interleukin-8; L-Selectin; Leukocytes, Mononuclear; Lipid A; Lipopolysaccharides; Male; Myocardial Infarction; Myocardial Stunning; Neutrophils; Rabbits; Tumor Cells, Cultured; Tumor Necrosis Factor-alpha

Ischemic preconditioning has been proven to be a powerful tool for myocardial protection in the setting of ischemia and reperfusion. A new drug to provide pharmacologic preconditioning, monophosphoryl lipid A (MLA), was administered 24 hours before an acute coronary occlusion in pigs to determine the effect on pharmacologic preconditioning.. Two studies were completed. In the first, swine were distributed into five groups: group I, control; group II,. aminoguanidine (AMG) (30 mg/kg), a selective inducible nitric oxide synthase (iNOS) blocker; group III, MLA (10 microg/kg); group IV, MLA (35 microg/kg); and group V, MLA and AMG (35 microg/kg and 30 mg/kg, respectively). Twenty-four hours after administration of the MLA, AMG, or both, regional left anterior descending coronary artery ischemia was induced for 15 minutes followed by one hour of global normothermic cardioplegic arrest and three hour reperfusion. Left ventricular function, tissue injury, and percentage of myocardial infarction were measured. Left ventricular myocardium in the left anterior descending coronary artery region was sampled for iNOS messenger RNA (mRNA) during ischemia and reperfusion. In the second study, pigs were sacrificed 0, 4, 6, 8, and 24 hrs after MLA/AMG administration for iNOS mRNA determination in nonischemic myocardium.. Use of MLA significantly improved postischemic ventricular function, and reduced creatinine kinase release and percentage of infarction. Monophosphoryl lipid A induced expression of iNOS mRNA in nonischemic myocardium within four hours of administration which returned to base line by 24 hours. Normothermic regional ischemia then induced expression of iNOS mRNA, which returned to base line during reperfusion. Aminoguanidine completely abolished both MLA-induced and ischemia-induced iNOS mRNA and blocked the beneficial effects of MLA.. Use of MLA can provide myocardial preservation through enhanced expression of iNOS mRNA.

Topics: Animals; Enzyme Induction; Enzyme Inhibitors; Guanidines; Hemodynamics; Ischemic Preconditioning, Myocardial; Lipid A; Myocardial Infarction; Myocardial Reperfusion Injury; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; RNA, Messenger; Swine

Endotoxin is known to confer a delayed protection against myocardial infarction. Lipopolysaccharide (LPS) treatment also induces the de novo synthesis of kinin B(1)-receptors that are not present in normal conditions. The aim of this study was to evaluate whether LPS-induced B(1)-receptors are implicated in the reduction of infarct size brought about by LPS. Rabbits were submitted to a 30-min coronary artery occlusion and 3-h reperfusion sequence. Six groups were studied: pretreated or not (control animals) with LPS (5 microgram kg(-1) i.v.) 24 h earlier and treated 15 min before and throughout ischaemia - reperfusion with either the B(1)-antagonist R-715 (1 mg kg(-1) h(-1)), the B(1)-agonist Sar-[D-Phe(8)]-des-Arg(9)-bradykinin (15 microgram kg(-1) h(-1)) or vehicle (saline). Infarct size and area at risk were assessed by differential staining and planimetric analysis. The presence of B(1)-receptors in LPS-pretreated animals was confirmed by a decrease in mean arterial pressure in response to B(1) stimulation. LPS-pretreatment significantly reduced infarct size (6.4+/-1.7%, of area at risk vs 24.1+/-2.5% in control animals, P<0.05). This protection was not modified by B(1)-receptor antagonism (7.4+/-2.2%, NS) or stimulation (5.2+/-1.2%, NS). Neither antagonist nor agonist modified infarct size in control animals. In conclusion, these data suggest that LPS-induced myocardial protection in the rabbit is not related to concomitant de novo B(1)-receptor induction.

Topics: Animals; Heart; Hemodynamics; Lipid A; Lipopolysaccharides; Male; Myocardial Infarction; Rabbits; Receptor, Bradykinin B1; Receptors, Bradykinin

Monophosphoryl lipid A (MLA), a nontoxic analogue of endotoxin, is a pharmacological agent that is known to have anti-ischemic effects. Mechanisms involved with the cardioprotection are still unclear. A role for inducible nitric oxide synthase (iNOS) was recently proposed. We tested this hypothesis using S-methylisothiourea (SMT), one of the specific pharmacological inhibitors of iNOS, as well as iNOS gene knockout mice.. Adult male ICR or B6,129 mice were pretreated with either MLA 35 or 350 microg/kg IP (MLA35 or MLA350) or vehicle 24 hours before global ischemia/reperfusion, which was carried out in a Langendorff isolated perfused heart model (n=8 to 9 per group). Another group of MLA350 mice received SMT 3 mg/kg IP 30 minutes before heart perfusion. Ventricular contractile function and heart rate were not different between the groups during the preischemia and reperfusion periods (P>0.05). Preischemic basal coronary flow was significantly increased in all MLA350 but not MLA35 mice. Myocardial infarct size was reduced significantly, from 26.9+/-2.9% of risk area in vehicle-treated mice to 13.5+/-2.4% in the MLA350 group (mean+/-SEM, P<0.05). This reduction in infarct size was accompanied by augmented nitrite/nitrate accumulation, from 0.23+/-0. 05 nmol/mg protein in the vehicle group to 0.97+/-0.27 nmol/mg protein in MLA350 mice (P<0.01). Infarct size increased significantly, to 22.2+/-2.8% after treatment with SMT in the MLA350 group. Furthermore, MLA350 failed to reduce infarct size in iNOS knockout mice (25.5+/-3.6%).. These results demonstrate a direct association of infarct size reduction with increased NO production with MLA350. An obligatory role for iNOS in mediating the cardioprotective effect induced by MLA was confirmed with the pharmacological inhibition and gene knockout mice.

Topics: Animals; Body Weight; Cardiotonic Agents; Coronary Circulation; Enzyme Inhibitors; Heart Rate; Hemodynamics; In Vitro Techniques; Isothiuronium; Lipid A; Male; Mice; Mice, Inbred ICR; Mice, Knockout; Myocardial Contraction; Myocardial Infarction; Myocardial Ischemia; Myocardial Reperfusion; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Organ Size; Ventricular Function

1 We utilized a rat model of myocardial infarction to investigate whether cardioprotection by monophosphoryl lipid A (MLA) is provided in the early and late phases, as well as to determine whether this cardioprotection may be related to the activation of manganese superoxide dismutase (Mn-SOD), an intrinsic radical scavenger. 2 Pretreatment with MLA (0.5 or 1.0 mg kg-1, i.v.) 24 h prior to 20-min left coronary artery (LCA) occlusion and 48-h reperfusion significantly decreased the incidence of ventricular fibrillation (VF) during ischaemia, as well as infarct size. Pretreatment with lower concentrations of MLA, however, was ineffective. 3 When we examined the time course of MLA (0.5 mg kg-1)-induced cardioprotection, both infarct size and the incidence of VF were significantly reduced in rats pretreated with MLA 0.5 h and 24 h before occlusion. We observed no differences, however, 2 and 72 h after MLA treatment. 4 The activity of Mn-SOD paralleled the cardioprotective effects of MLA. Mn-SOD activity in the myocardium was significantly enhanced in rats pretreated with MLA (0.5 mg kg-1) 0.5 and 24 h before. Mn-SOD activity was not altered, however, in rats pretreated 2 or 72 h before. Lower MLA concentrations were not effective even 24 h after the treatment. 5 We conclude that MLA treatment induced a biphasic pattern of cardioprotection. The pattern of Mn-SOD activity suggests that this enzyme may play a major role in the acquisition of cardioprotection against ischaemia-reperfusion injury.

Topics: Animals; Blood Pressure; Body Temperature; Enzyme Activation; Heart; Heart Rate; Hemodynamics; Lipid A; Male; Myocardial Infarction; Myocardial Reperfusion Injury; Myocardium; Rats; Rats, Wistar; Superoxide Dismutase; Time Factors; Ventricular Fibrillation

Monophosphoryl lipid-A (MLA) has a late window (24 hours) of cardioprotection against acute myocardial infarction. It is not known whether MLA, administered, 24 hours before surgery, attenuates intraoperative ventricular dysfunction "stunning" associated with aortic cross-clamping and reperfusion during elective cardiac surgery. We determined the dose-response relationship between MLA and ventricular function in a canine model of global myocardial stunning in the absence of necrosis. The role of expression of inducible heat shock protein 70 (HSP 70i) was also investigated.. Mongrel dogs (n = 32) were intravenously injected with either a vehicle solution or 3, 5, 10, 35 ug/kg MLA. Twenty four hours later, dogs were anesthetized and instrumented, in situ, to monitor the left ventricular performance (the slope of regression between stroke-work and end diastolic length). Tissue samples were obtained to determine HSP70i using immunoblot analysis. After a period of equilibration on cardiopulmonary bypass, the aortic cross-clamp was applied at normothermia for 30 minutes followed by 60 minutes of reperfusion. ATP and catabolites were determined in transmural myocardial biopsies. Triphenyl-tetrazolium chloride (TTC) staining was used to determine myocardial necrosis.. MLA treatment did not alter myocardial contractility or ATP metabolism. Global ischemia resulted in about 50% depletion of ATP and remained depressed during reperfusion in all groups. MLA-treated hearts had improved functional recovery in a dose dependent-manner. Significant recovery was observed at the highest dose (35 ug/kg) compared to the control group. Immunoblot analysis demonstrated significant increase in HSP 70i in the MLA-treated hearts.. MLA exhibits a delayed (24 hours) window of protection against myocardial stunning associated with aortic cross-clamping. HSP70i expression may play a role in MLA-mediated cardioprotection.

Topics: Adjuvants, Immunologic; Animals; Dogs; Female; HSP70 Heat-Shock Proteins; Injections, Intravenous; Lipid A; Male; Myocardial Infarction; Myocardial Reperfusion Injury; Myocardial Stunning; Myocardium; Necrosis

A non-toxic derivative of the active lipid A component of the endotoxin molecule (monophosphoryl lipid A) when given to rats in a dose of 5 mg kg(-1) by intraperitoneal injection 24 h prior to anaesthesia and coronary artery occlusion, markedly decreased the severity of ischaemia-reduced ventricular arrhythmias (ventricular fibrillation reduced from 60 to 21%; P < 0.05) and reduced myocardial infarct size (from 35.8 +/- 1.6% of the area at risk to 22.7 +/- 2.0%; P < 0.05). It did not modify blood pressure or heart rate either before or during the period of ischaemia.

Topics: Adjuvants, Immunologic; Animals; Anti-Arrhythmia Agents; Blood Pressure; Heart Rate; Lipid A; Male; Myocardial Infarction; Myocardial Ischemia; Rats; Rats, Sprague-Dawley; Ventricular Fibrillation

We sought to determine the role of opening of adenosine triphosphate (ATP)-sensitive potassium channel (K(ATP) channel) in monophosphoryl lipid A (MLA)-induced myocardial protection after ischemia/reperfusion (I/R) in rabbit. We used 5-hydroxydecanoate (5-HD), an ischemia-selective inhibitor of K(ATP) channel, to block MLA-stimulated cardiac protection. Four groups of rabbits were studied: group I, MLA-vehicle; group II, MLA; group III, MLA + 5-HD; and group IV, 5-HD only. MLA (35 microg/kg, i.v.) or vehicle were given 24 h before I/R. 5-HD (5 mg/kg) was given 15 min before ischemia. All rabbits underwent 30-min coronary occlusion, followed by 3-h reperfusion. Area at risk was delineated by injection of Evan's blue, and infarct size was determined by tetrazolium staining. Pretreatment with MLA reduced infarct size (percentage of area at risk) from 40+/-8.6% to 15.1+/-1.5%. The infarct size increased to 51.9+/-5.8% with 5-HD in MLA-treated rabbits. 5-HD did not alter infarct size significantly when given in vehicle-treated control rabbits. These data suggest that MLA exerts its protective effect through activation of K(ATP) channel.

Topics: Adenosine Triphosphate; Animals; Decanoic Acids; Hemodynamics; Hydroxy Acids; Ischemic Preconditioning; Lipid A; Myocardial Infarction; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Potassium Channel Blockers; Rabbits

Pretreatment with monophosphoryl lipid A (MLA) can pharmacologically mimic the second window of ischemic preconditioning (SWOP) to protect the heart from prolonged ischemia and reperfusion injury. Based on the delayed time course for development of MLA associated cardioprotection, this study was designed to test if MLA's cardioprotective effect is mediated by signalling through production of inducible nitric oxide synthase (iNOS), a proposed effector of SWOP. Rabbits were assigned to one of four groups: (1) vehicle control; (2) MLA: (3) vehicle+aminoguanidine (AMG) control; or (4) MLA+AMG. Monophosphoryl lipid A (35 micrograms/kg) or vehicle was given intravenously 24 h before ischemia. The selective iNOS inhibitor AMG (300 mg/ kg) was injected subcutaneously 1 h before ischemia. All rabbits experienced 30 min coronary artery occlusion followed by 3 h of reperfusion. Infarct size was measured by triphenyltetrazolium chloride (TTC) staining. followed by 3 h of reperfusion. Infarct size was measured by triphenyltetrazolium chloride (TTC) staining. Myeloperoxidase activity, an index of neutrophil infiltration, was also quantified in heart tissue collected from the post-ischemic viable border zone surrounding the infarct area. MLA pretreatment significantly reduced infarct size and neutrophil infiltration in rabbit hearts compared to control (P < 0.05). Inhibition of iNOS activity by AMG abolished the infarct size reductive effect of MLA. Aminoguanidine also blocked the ability of MLA to significantly reduce neutrophil infiltration. Although measurement of iNOS activity did not show induction of the enzyme in normal myocardial tissue 24 h after MLA pretreatment, an increase in iNOS activity in ischemic tissue relative to non-ischemic tissue was found after either 15 or 30 min of coronary occlusion in MLA treated rabbits. These results suggest that MLA pretreatment may enhance iNOS enzyme activity by MLA during ischemia which may be responsible for the observed cardioprotection.

Topics: Adjuvants, Immunologic; Animals; Heart; Hemodynamics; Ischemic Preconditioning, Myocardial; Lipid A; Male; Myocardial Infarction; Myocardium; Nitric Oxide Synthase; Peroxidase; Rabbits

Topics: Adult; Aged; Aged, 80 and over; Apolipoproteins A; Coronary Angiography; Coronary Disease; Female; Humans; Linear Models; Lipid A; Male; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Prospective Studies

The purpose of this study was to evaluate the protective effect of a new endotoxin analogue, monophosphoryl lipid A (MLA) in a rabbit model of myocardial ischemia/reperfusion and to show if this protection was mediated via synthesis of 70 kDa heat shock protein (HSP 70). Three groups of New Zealand White rabbits underwent 30 min coronary occlusion, followed by 4 hours reperfusion. First group of rabbits (n = 6) were treated with 0.35 ml vehicle (40 % propylene glycol, 10 % ethanol in water). The second and third group of rabbits (n = 6-8) were treated with MLA (35 micrograms/kg, i.v.) 12 and 24 hours prior to ischemia and reperfusion. MLA treatment either 12 or 24 h prior to ischemia/reperfusion demonstrated significantly reduced infarct size (12.5 +/- 1.7 and 14.7 +/- 2.1% for 12 and 24 h) when compared with vehicle control (40.4 +/- 8.6%, mean +/- S.E.M, p < 0.05). No significant differences in the infarct size was observed between the 12 and 24 h MLA treated groups. The area at risk was not significantly different between the three groups. Baseline values of heart rate, systolic and diastolic blood pressure were not significantly different between the control and MLA treated groups. However, the systolic as well as diastolic blood pressure during reperfusion were significantly lower in rabbits treated with MLA. Western blot analysis of the protein extracts of the hearts (n = 2/group) demonstrated no increase in the expression of the inducible form of HSP 70 following treatment with MLA. We conclude that MLA has significant anti-infarct effect in rabbit which is not mediated by the cardioprotective protein HSP 70. The anti-infarct effect of this drug is superior to the reported protective effects of delayed ischemic or heat stress preconditioning. We hypothesize that the pharmacologic preconditioning afforded by MLA is accomplished via a unique pathway that bypasses the usual intracellular signaling pathways which lead to the myocardial protection with the expression of heat shock proteins.

Topics: Animals; Blotting, Western; Carbohydrate Conformation; Carbohydrate Sequence; Gene Expression Regulation; Heart; Hemodynamics; HSP70 Heat-Shock Proteins; Lipid A; Lipopolysaccharides; Male; Molecular Sequence Data; Muscle Proteins; Myocardial Infarction; Myocardial Reperfusion Injury; Myocardium; Rabbits; Rats; Rats, Sprague-Dawley

1. Monophosphoryl lipid A (MLA) is a non-pyrogenic derivative of Salmonella lipopolysaccharide. Administration of this agent at high doses to rats and at low doses to dogs was previously shown to confer marked protection against ischaemia-reperfusion 24 h later, although the cellular mechanisms of this delayed protection are obscure. We hypothesized that MLA pretreatment causes the induction of the 70 kDa cytoprotective stress protein HSP70i in the myocardium. If this were the case, protection against ischaemia-reperfusion injury would be observed both in vitro and in vivo. 2. Rabbits were pretreated with MLA 0.035 mg kg-1, i.v. or vehicle solution. For the in vitro study, hearts were isolated 24 h later and Langendorff-perfused with Krebs-Henseleit buffer at 37 degrees C. Global ischaemia was induced for 20 min followed by 120 min reperfusion. Recovery of post-ischaemic left ventricular function and lactate dehydrogenase efflux was similar in MLA and vehicle pretreated hearts and there was no significant difference in the percentage of infarction of the left ventricle determined by triphenyltetrazolium staining (MLA 22.4 +/- 5.2%, vehicle 24.8 +/- 5.1%). 3. When 30 min regional ischaemia and 120 min reperfusion was instituted in pentobarbitone-anaesthetized rabbits 24 h after pretreatment with MLA or vehicle, the percentage infarction within the risk zone was reduced from 42.6 +/- 5.7% in vehicle pretreated animals to 19.6 +/- 4.4% in MLA pretreated animals (P < 0.01). 4. Determination of myocardial HSP70i content by Western blot analysis showed that MLA treatment did not increase HSP70i immunoreactivity. 5. We conclude that MLA at this dose confers protection only against ischaemia-reperfusion injury in vivo and that this protection is not related to induction of HSP70i. Because protection was observed only in vivo it seems possible that the delayed protection conferred by MLA is mediated by effects on humoral or blood-borne factors.

Topics: Adjuvants, Immunologic; Animals; HSP70 Heat-Shock Proteins; In Vitro Techniques; Lipid A; Male; Myocardial Infarction; Myocardial Ischemia; Myocardial Reperfusion Injury; Myocardium; Rabbits

Monophosphoryl lipid A (MLA), a derivative of the minimal substructure of lipopolysaccharide (lipid A) possesses immunomodulatory activity of the parent lipid A yet enjoys reduced toxicity. It has previously been reported that pretreatment with MLA reduces myocardial infarct size and stunning in dogs following ischemia and reperfusion. The aim of this study was to evaluate the ability of monophosphoryl lipid A (MLA) to preserve global cardiac function and peripheral hemodynamics in a rabbit model of prolonged regional ischemia (90 min), and reperfusion (6 h). An evaluation of potential mechanisms by which MLA may preserve cardiac function was also undertaken. Single dose pretreatment with MLA (35 micrograms/kg i.v.) 24 h prior to ischemia resulted in significant improvement in left ventricular developed pressure, dP/dt, rate-pressure product and mean arterial pressure during reperfusion (P < 0.05 v control). Although in this model of prolonged ischemia MLA pretreatment did not reduce infarct size (54.5 +/- 11.4% in control v 63.3 +/- 8.3% in MLA, P = N.S.), evaluation of myocardial adenylate and adenosine catabolite pools at the end of ischemia indicated a preservation of ATP and ADP and a decreased production of downstream adenosine catabolites including inosine, xanthine and uric acid. Adenosine kinase, but not 5'-nucleotidase (5'-NTase) or adenosine deaminase activity determined following reperfusion was 76% and 60% higher (P < 0.05) in non-risk and post-ischemic myocardium of MLA pretreated rabbits compared with controls. Although there was a trend toward lower tissue myeloperoxidase activity in post-ischemic myocardium from treated rabbits, the results were not significantly different from control animals. These results suggest that a 24-h pretreatment with MLA, without further treatment during ischemia or reperfusion was associated with: (1) preservation of global myocardial function during reperfusion; (2) preservation of myocardial high energy adenylates and reduced formation of adenosine catabolites during ischemia; (3) elevated myocardial adenosine kinase activity. Increased recycling of adenosine to phosphorylated nucleotides may result from MLA's affect on adenosine kinase, which could explain the drugs effect on adenylate and adenosine metabolite pools.

Topics: 5'-Nucleotidase; Adenine Nucleotides; Adenosine Deaminase; Adenosine Kinase; Adjuvants, Immunologic; Analysis of Variance; Animals; Blood Pressure; Carbohydrate Sequence; Coronary Vessels; Energy Metabolism; Female; Heart; Heart Rate; Hemodynamics; Lipid A; Molecular Sequence Data; Myocardial Infarction; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Peroxidase; Purines; Rabbits; Reference Values; Ventricular Function, Left

The purpose of this study was to evaluate the protective effect of a new endotoxin analogue, monophosphoryl lipid A (MLA) in a rabbit model of myocardial ischemia/reperfusion and to show if this protection was mediated via synthesis of 70 kDa heat shock protein (HSP 70). Three groups of New Zealand White rabbits underwent 30 min coronary occlusion, followed by 4 hours reperfusion. First group of rabbits (n = 6) were treated with 0.35 ml vehicle (40% propylene glycol, 10% ethanol in water). The second and third group of rabbits (n = 6-8) were treated with MLA (35 micrograms/kg, i.v.) 12 and 24 hours prior to ischemia and reperfusion. MLA treatment either 12 or 24 h prior to ischemia/reperfusion demonstrated significantly reduced infarct size (12.5 +/- 1.7 and 14.7 +/- 2.1% for 12 and 24 h) when compared with vehicle control (40.4 +/- 8.6%, mean +/- S.E.M, p < 0.05). No significant differences in the infarct size was observed between the 12 and 24 h MLA treated groups. The area at risk was not significantly different between the three groups. Baseline values of heart rate, systolic and diastolic blood pressure were not significantly different between the control and MLA treated groups. However, the systolic as well as diastolic blood pressure during reperfusion were significantly lower in rabbits treated with MLA. Western blot analysis of the protein extracts of the hearts (n = 2/group) demonstrated no increase in the expression of the inducible form of HSP 70 following treatment with MLA. We conclude that MLA has significant anti-infarct effect in rabbit which is not mediated by the cardioprotective protein HSP 70. The anti-infarct effect of this drug is superior to the reported protective effects of delayed ischemic or heat stress preconditioning. We hypothesize that the pharmacologic preconditioning afforded by MLA is accomplished via a unique pathway that bypasses the usual intracellular signaling pathways which lead to the myocardial protection with the expression of heat shock proteins.

Topics: Animals; Blood Pressure; Blotting, Western; Heart Rate; HSP70 Heat-Shock Proteins; Lipid A; Male; Molecular Structure; Myocardial Infarction; Myocardial Ischemia; Myocardium; Rabbits; Reperfusion; Signal Transduction

Both ischemic preconditioning and pretreatment with the endotoxin derivative monophosphoryl lipid A (MLA) protect the heart against infarction, yet the cellular mechanisms responsible for the cardioprotection achieved with either intervention are unknown. Using pentobarbital-anesthetized dogs, we tested the hypothesis that increased activity of 5'-nucleotidase (5'-NT), the enzyme that catalyzes the formation of adenosine from AMP, may play a role. Twenty-two dogs underwent 1 h of coronary occlusion and 4 h of reperfusion: eight controls received no intervention, seven animals were preconditioned with four 5-min episodes of brief ischemia, and seven received MLA (35 micrograms/kg iv) 24 h previously. Collateral blood flow was measured by injection of radiolabeled microspheres, infarct size was delineated by tetrazolium staining, and myocardial 5'-NT activities were measured by quantifying the release of adenosine from AMP. Despite comparable values of collateral blood flow in all groups, infarct size was reduced in preconditioned and MLA-treated dogs vs. controls. In addition, 5'-NT activities were increased throughout the heart with preconditioning and MLA treatment. However, single and multivariate regression analyses revealed no correlation between infarct size and 5'-NT activities for either treatment group. In fact, in the preconditioned cohort, animals with the highest enzyme activities developed the largest infarcts. This dissociation between infarct size and 5'-NT suggests that increased activity of 5'-NT is not the mechanism by which preconditioning or MLA treatment protects the canine heart against infarction.

Topics: 5'-Nucleotidase; Adenosine; Adenosine Kinase; Adenosine Triphosphate; Adjuvants, Immunologic; Animals; Coronary Circulation; Dogs; Energy Metabolism; Enzymes; Hemodynamics; Ischemic Preconditioning, Myocardial; Lipid A; Myocardial Infarction; Myocardium; Phosphates; Regional Blood Flow

The cardioprotective effect of myocardial preconditioning (PC) to reduce infarct size has been shown to last approximately 90 min (early PC), and then a second window of protection (SWOP or late PC) appears 24 h later. Although much work has been done to characterize early PC, little has been done to investigate potential mediators of SWOP. To that end, we have used monophosphoryl lipid A (MLA), a nontoxic endotoxin derivative, to produce SWOP and have examined the role of ATP-sensitive potassium (KATP) channels in mediating its cardioprotection. Adult mongrel dogs were given MLA (3, 10, or 35 micrograms/kg i.v.) 24 h before a 60-min left anterior descending coronary artery occlusion and 3 h of reperfusion. After reperfusion, the hearts were stained for myocardial infarction with triphenyltetrazolium. MLA produced a dose-dependent reduction in infarct size that was associated with an enhanced shortening of the monophasic action potential duration during early ischemia. To further examine the role of KATP channels, animals were treated with MLA (35 micrograms/kg) and 24 h later were administered either glibenclamide (0.3 mg/kg i.v.) or 5-hydroxydecanoate (7.5 mg/kg intracoronary over 20 min), two structurally distinct KATP-channel antagonists. Both glibenclamide and 5-hydroxydecanoate abolished the cardioprotection produced by MLA. These results demonstrate that the cardioprotective effect of late PC produced by MLA is dependent on functional KATP channels and is the first study to suggest that late PC may be the result of an increased KATP current during ischemia.

Topics: Action Potentials; Adenosine Triphosphate; Animals; Collateral Circulation; Coronary Circulation; Dogs; Hemodynamics; Ischemic Preconditioning, Myocardial; Lipid A; Myocardial Infarction; Myocardium; Potassium Channels; Reaction Time

Monophosphoryl lipid A (MLA), a detoxified derivative of the lipid A portion of the endotoxin molecule, given as a pretreatment 24 h prior to cardiac ischemia/reperfusion reduces myocardial stunning and infarction in dogs. This study was undertaken to evaluate the ability of MLA pretreatment to reduce infarct size in a rabbit model of in situ regional myocardial ischemia and reperfusion. Secondly, the potential role of modulation of ATP-sensitive potassium (KATP) channel in MLA's cardioprotection was evaluated using in vivo pharmacologic antagonism with a KATP channel blocker, as was the role of tumor necrosis factor using an enzyme-linked immunosorbent assay method of serum cytokine analysis.. Rabbits were pretreated intravenously with MLA or vehicle injection 24 h prior to initiation of 30 min in situ left anterior descending coronary artery occlusion followed by 3 h reperfusion. In animals receiving glibenclamide, the potassium channel antagonist was administered 30 min prior to inducing ischemia. Animals receiving glibenclamide, which possesses hypoglycemic effects, underwent serial blood glucose evaluation prior to drug and throughout the ischemia and reperfusion periods. Hemodynamics were monitored; infarct size and area at risk were assessed by contrast dye staining (triphenyltetrazolium chloride). Serum tumor necrosis factor was measured by enzyme-linked immunosorbent method in animals administered cardioprotective doses of MLA as well as pyrogenic doses of MLA and endotoxin (positive control) to determine if elaboration of this cytokine could be associated with the cardioprotective effect of MLA.. MLA administered as a single intravenous dose 24 h prior to ischemia reduced infarct size, expressed as a percent of the area at risk, 64 and 71% at doses of 35 and 10 micrograms/kg, respectively. Lower doses of MLA (2.5 and 5 micrograms/kg) did not significantly reduce infarct size. Administration of glibenclamide (300 micrograms/kg) 30 min prior to ischemia completely blocked the ability of MLA pretreatment to limit infarct size, while MLA vehicle-glibenclamide-treated control rabbits displayed infarcts not significantly different from MLA-vehicle-treated control rabbits. A cardioprotective dose of MLA (35 micrograms/kg) did not induce the elaboration of tumor necrosis factor into rabbit serum (within the limits of assay sensitivity).. Single-dose pretreatment with MLA administered intravenously to rabbits substantially reduces infarct size when administered 24 h prior to ischemia. Pharmacologic preconditioning with MLA appears to be mediated through KATP channels as the channel blocker, glibenclamide, reversed the cardioprotective activity of MLA when administered 1 day following MLA pretreatment, yet 30 min prior to ischemia. In this model the cardioprotective does not appear to be associated with increases in serum tumor necrosis factor.

Topics: Adenosine Triphosphate; Adjuvants, Immunologic; Animals; Dose-Response Relationship, Drug; Enzyme-Linked Immunosorbent Assay; Glyburide; Ischemic Preconditioning, Myocardial; Lipid A; Male; Myocardial Infarction; Potassium Channel Blockers; Rabbits; Random Allocation; Tumor Necrosis Factor-alpha

The major objective of the present study was to determine the effects of a new endotoxin analogue, monophosphoryl lipid A (MLA), on myocardial infarct size in dogs. A second aim was to determine if potential cardioprotective effects of MLA might be mediated via an enhancement of antioxidant defence mechanisms.. Barbiturate anaesthetised dogs were subjected to 60 min left circumflex coronary artery occlusion followed by 5 h reperfusion. Either of two different doses of MLA (30 and 100 micrograms.kg-1) or an equivalent volume of vehicle were given intravenously 24 h prior to the infarct experiments. Transmural myocardial blood flow was measured at 30 min of occlusion by the radioactive microsphere technique and infarct size was determined at the end of 5 h of reperfusion by triphenyltetrazolium staining. Tissue catalase and myeloperoxidase activities were measured at 5 h of reperfusion as indices of antioxidant activity and neutrophil infiltration, respectively.. There were no significant differences between groups in systemic haemodynamic variables, myocardial oxygen demand, ischaemic bed size, or coronary and collateral blood flow to the ischaemic region. However, administration of MLA produced a marked dose dependent reduction in myocardial infarct size: 19.8(SEM 3.7)% and 14.1(2.5)%, respectively, v 32.7(2.9)% in the vehicle control group, p < 0.05. Pretreatment with either 30 or 100 micrograms.kg-1 of MLA resulted in small increases in tissue catalase activity in the non-ischaemic region of the heart: 0.169(0.033) and 0.197(0.013) K.g-1, respectively, v 0.136(0.013) K.g-1 tissue in the control; however, the increases were not statistically significant by ANOVA. Myeloperoxidase activity in the border zone immediately adjacent to the infarct was markedly decreased in both MLA treated groups: MLA 30 micrograms.kg-1, 2.69(0.82); MLA 100 micrograms.kg-1, 2.49(0.47), v control group, 5.81(1.20) units.g-1 tissue; p < 0.05.. These data are the first to show a marked cardioprotective effect of a lipid A derivative of endotoxin in an in vivo model of myocardial infarction. Although the mechanism responsible for the reduction in infarct size by MLA is unknown, a reduction in neutrophil migration at the site of ongoing tissue injury, the border zone, may be partially responsible.

Topics: Animals; Catalase; Disease Models, Animal; Dogs; Endotoxins; Female; Heart; Lipid A; Male; Myocardial Infarction; Myocardial Reperfusion Injury; Myocardium; Peroxidase