Insights of Chinese Medicine on Ventricular Remodeling:Multiple-Targets,Individualized-Treatment

Ventricular remodeling(VR) can be induced by myocardial injury, leading to progressive cardiac dysfunction and heart failure, and is associated with high morbidity and mortality. Despite being studied for more than 3 decades, current therapeutic strategies still remain unsatisfactory in efficacy, expensive, and with side effects and drug resistances. Chinese medicine(CM) has been used to treat heart diseases for thousands of years. This article reviews the published studies on the mechanisms and therapeutic applications of CM in VR. The major aspects include: mechanistic studies of VR, molecular biology and myocardial functional studies of CM therapies on VR, and mechanism of CM therapies on VR.

Protective Mechanisms of Suxiao Jiuxin Pills(速效救心丸) on Myocardial Ischemia-Reperfusion Injury in vivo and in vitro

Objective:To study the protective mechanism of Chinese medicine Suxiao Jiuxin Pills(速效救心丸,SXJ)on myocardial ischemia and reperfusion(I/R)injury.Methods:Mouse myocardial I/R injury model was created by 30-min coronary artery occlusion followed by 24-h reperfusion,the mice were then divided into the sham group(n=7),the I/R group(n=13),the tirofiban group(TIR,positive drug treatment,n=9),and the SXJ group(n=11).Infarct size(IS),risk region(RR),and left ventricle(LV)were analyzed with double staining methods.In addition,H9C2 rat cardiomyocytes were cultured with Na2S2O4 to simulate I/R in vitro.The phosphorylation of extracellular regulated protein kinases1/2(ERK1/2),protein kinase B(AKT),glycogen synthase kinase-3β(GSK3β),and protein expression of GATA4 in nucleus were detected with Western blot assay.Results:The ratio of IS/RR in SXJ and TIR groups were lower than that in I/R group(SXJ,22.4%±6.6%;TIR,20.8%±3.3%;vs.I/R,35.4%±3.7%,P<0.05,respectively).In vitro experiments showed that SXJ increased the Na2S2O4-enhanced phosphorylation of AKT/GSK3βand nuclear expression of GATA4.Conclusion:SXJ prevents myocardial I/R injury in mice by activating AKT/GSK3βand GATA4 signaling pathways.

Shexiang Tongxin Dropping Pill Allieviates Heart Failure via Extracellula Matrix-Receptor Interaction Pathways Based on RNA-Seq Transcriptomics and Experimental Studies

Objective:To investigate the protective mechanisms of Chinese medicine Shexiang Tongxin Dropping Pills(STDP) on heart failure(HF).Methods:Isoproterenol(ISO)-induced HF rat model and angiotensin Ⅱ(Ang Ⅱ)-induced neonatal rat cardiac fibroblast(CFs) model were used in the present study.HF rats were treated with and without STDP(3 g/kg).RNA-seq was performed to identify differentially expressed genes(DEGs).Cardiac function was evaluated by echocardiography.Hematoxylin and eosin and Masson’s stainings were taken to assess cardiac fibrosis.The levels of collagen Ⅰ(Col Ⅰ) and collagen Ⅲ(Col Ⅲ) were detected by immunohistochemical staining.CCK8 kit and transwell assay were implemented to test the CFs’ proliferative and migratory activity,respectively.The protein expressions of α-smooth muscle actin(α-SMA),matrix metalloproteinase-2(MMP-2),MMP-9,Col I,and Col Ⅲ were detected by Western blotting.Results:The results of RNA-seq analysis showed that STDP exerted its pharmacological effects on HF via multiple signaling pathways,such as the extracellular matrix(ECM)-receptor interaction,cell cycle,and B cell receptor interaction.Results from in vivo experiments demonstrated that STDP treatment reversed declines in cardiac function,inhibiting myocardial fibrosis,and reversing increases in Col Ⅰ and Col Ⅱ expression levels in the hearts of HF rats.Moreover,STDP(6,9 mg/mL) inhibited the proliferation and migration of CFs exposed to Ang Ⅱin vitro(P<0.05).The activation of collagen synthesis and myofibroblast generation were markedly suppressed by STDP,also the synthesis of MMP-2 and MMR-9,as well as ECM components Col Ⅰ,Col Ⅲ,and α-SMA were decreased in Ang Ⅱ-induced neonatal rats’ CFs.Conclusions:STDP had anti-fibrotic effects in HF,which might be caused by the modulation of ECM-receptor interaction pathways.Through the management of cardiac fibrosis,STOP may be a compelling candidate for improving prognosis of HF.

Suxiao Jiuxin Pills Prevent Ventricular Fibrillation from Inhibiting L-type Calcium Currents CaV1.2 in vivo and in vitro

Objective: To investigate whether Suxiao Jiuxin Pills(SJP), a Chinese herbal remedy, is an anti-ventricular fibrillation(VF) agent. Methods: VF was induced by isoproterenolol(ISO) intraperitoneal injection followed by electrical pacing in mice and rabbits. The effects of SJP on the L-type calcium channel current(CaV1.2), voltage-dependent sodium channel current(INa), rapid and slow delayed rectifier potassium channel current(IKr and IKs, respectively) were studied by whole-cell patch-clamp method. Computer simulation was implemented to incorporate the experimental data of SJP effects on the CaV1.2 current into the action potential(AP) and pseudo-electrocardiography(pseudo-ECG) models. Results: SJP prevented VF induction and reduced VF durations significantly in mice and rabbits. Patch-clamp experiments revealed that SJP decreased the peak amplitude of the CaV1.2 current with a half maximal concentration(IC50) value of 16.9 mg/L(SJP-30 mg/L, –32.8±6.1 pA;Verapamil, –16.2±1.8 pA;vs. control, –234.5±16.7 pA, P<0.01, respectively).The steady-state activation curve, inactivation curve, and the recovery from inactivation of the CaV1.2 current were not shifted significantly. Specifically, SJP did not altered INa, IKr, and IKs currents significantly(SJP vs.control, P>0.05). Computer simulation showed that SJP-reduced CaV1.2 current shortened the AP duration,transiting VF into sinus rhythm in pseudo-ECG. Conclusion: SJP reduced VF via inhibiting the CaV1.2 current with in vivo, in vitro, and in silico studies, which provide experimental basis for SJP anti-VF clinical application.

Astragaloside IV Attenuates Polymicrobial Sepsis-Induced Cardiac Dysfunction in Rats via IKK/NF-κB Pathway

Objective To evaluate the protective effects of Astragaloside IV(AST)in a rat model of myocardial injury induced by cecal ligation and puncture(CLP).Methods The model of sepsis-induced cardiac dysfunction was induced by CLP.Using a random number table,50 specific pathogen free grade of Sprague Dawley rats were randomized into 5 groups:the sham group(sham),the model group(CLP,18 h/72 h)and AST group(18 h/72 h).Except the sham group,the rats in other groups received CLP surgery to induce sepsis.CLP groups received intragastric administration with normal saline after CLP.AST groups received intragastric administration with AST solution(40 mg/kg)once a day.The levels of inflammatory mediators and oxidative stress markers in the serum of the septic rats were determined via enzyme-linked immunosorbent assay(ELISA)at different time point,such as interleukin 6(IL-6),IL-10,high mobility group box-1 protein B1(HMGB-1),superoxide dismutase(SOD),and malondialdehyde(MDA).Cardiac function was determined by echocardiography.Moreover,changes in myocardial pathology were evaluated using hematoxylin and eosin staining.The levels of lactate dehydrogenase(LDH)and creatine kinase-MB(CK-MB)were analysed to determine the status of CLP-induced myocardium.In addition,the apotosis of myocardial cells was analysed by terminal-deoxynucleoitidyl transferase mediated nick end labeling(TUNEL).The protein levels of B-cell lymphoma-2(Bcl-2),Bcl-2-associated X(Bax),IκB kinaseα(IKKα),nuclear factor kappa B p65(NF-κB p65)were detected by Western blot analysis.Moreover,survival rate was investigated.Results AST improved the survival rate of CLP-induced rats by up to 33.3%(P<0.05).The cardioprotective effect of AST was observed by increased ejection fraction,fractional shortening and left ventricular internal diameter in diastole respectively(P<0.01 or P<0.05).Subsequently,AST attenuated CLP-induced myocardial apoptosis and the ratio of Bcl-2/Bax in the myocardium,as well as the histological alterations of myocardium(P<0.01 or P<0.05);the generation of inflammatory cytokines(IL-6,IL-10,HMGB-1)and oxidative stress markers(SOD,MDA)in the serum was significantly alleviated(P<0.01 or P<0.05).On the other hand,AST markedly suppressed CLP-induced accumulation of IKK-αand NF-κB p65 subunit phosphorylation(P<0.01 or P<0.05).Conclusions AST plays a significant protective role in sepsis-induced cardiac dysfunction and survival outcome.The possible mechanism of cardioprotection is dependent on the activation of the IKK/NF-κB pathway in cardiomyocytes.