Matot Idit, Weiniger Carolyn F, Zeira Evelyne, Galun Eithan, Joshi Bhalchandra V, Jacobson Kenneth A
Department of Anesthesiology & Critical Care Medicine, Hadassah University Medical Center, The Hebrew University, Jerusalem, Israel.
Crit Care. 2006;10(2):R65. doi: 10.1186/cc4893.
Although activation of A3 adenosine receptors attenuates reperfusion lung injury and associated apoptosis, the signaling pathway that mediates this protection remains unclear. Adenosine agonists activate mitogen-activated protein kinases, and these kinases have been implicated in ischemia/reperfusion injury; the purpose of this study was therefore to determine whether A3 adenosine receptor stimulation with reperfusion modulates expression of the different mitogen-activated protein kinases. In addition, we compared the effect of the A3 adenosine agonist IB-MECA with the newly synthesized, highly selective A3 adenosine receptor agonist MRS3558 on injury in reperfused lung.
Studies were performed in an in vivo spontaneously breathing cat model, in which the left lower lobe of the lung was isolated and subjected to 2 hours of ischemia and 3 hours of reperfusion. The selective A3 adenosine receptor agonists IB-MECA (0.05 mg/kg, 0.1 mg/kg, or 0.3 mg/kg) and MRS3558 (0.05 mg/kg or 0.1 mg/kg) were administered before reperfusion.
Both A3 adenosine receptor agonists administered before reperfusion markedly (P < 0.01) attenuated indices of injury and apoptosis, including the percentage of injured alveoli, wet/dry weight ratio, myeloperoxidase activity, TUNEL (in situ TdT-mediated dUTP nick end labeling)-positive cells, and caspase 3 activity and expression. The more pronounced effects at low doses were observed with MRS3558. Increases in phosphorylated c-Jun amino-terminal protein kinase (JNK), p38, and extracellular signal-regulated kinase (ERK)1/2 levels were observed by the end of reperfusion compared with controls. Pretreatment with the A3 agonists upregulated phosphorylated ERK1/2 levels but did not modify phosphorylated JNK and p38 levels.
The protective effects of A3 adenosine receptor activation are mediated in part through upregulation of phosphorylated ERK. Also, MRS3558 was found to be more potent than IB-MECA in attenuating reperfusion lung injury. The results suggest not only that enhancement of the ERK pathway may shift the balance between cell death and survival toward cell survival, but also that A3 agonists have potential as an effective therapy for ischemia/reperfusion-induced lung injury.
尽管A3腺苷受体的激活可减轻再灌注肺损伤及相关凋亡,但介导这种保护作用的信号通路仍不清楚。腺苷激动剂可激活丝裂原活化蛋白激酶,而这些激酶与缺血/再灌注损伤有关;因此,本研究的目的是确定再灌注时刺激A3腺苷受体是否会调节不同丝裂原活化蛋白激酶的表达。此外,我们比较了A3腺苷激动剂IB-MECA与新合成的、高度选择性的A3腺苷受体激动剂MRS3558对再灌注肺损伤的影响。
在体内自主呼吸的猫模型中进行研究,其中分离出左下肺叶,使其经历2小时缺血和3小时再灌注。在再灌注前给予选择性A3腺苷受体激动剂IB-MECA(0.05mg/kg、0.1mg/kg或0.3mg/kg)和MRS3558(0.05mg/kg或0.1mg/kg)。
再灌注前给予的两种A3腺苷受体激动剂均显著(P<0.01)减轻了损伤和凋亡指标,包括损伤肺泡百分比、湿/干重比、髓过氧化物酶活性、TUNEL(原位TdT介导的dUTP缺口末端标记)阳性细胞以及半胱天冬酶3活性和表达。MRS3558在低剂量时观察到更明显的效果。与对照组相比,再灌注结束时观察到磷酸化c-Jun氨基末端蛋白激酶(JNK)、p38和细胞外信号调节激酶(ERK)1/2水平升高。用A3激动剂预处理可上调磷酸化ERK1/2水平,但不改变磷酸化JNK和p38水平。
A3腺苷受体激活的保护作用部分是通过上调磷酸化ERK介导的。此外,发现MRS3558在减轻再灌注肺损伤方面比IB-MECA更有效。结果表明,不仅ERK途径增强可能使细胞死亡和存活之间的平衡向细胞存活方向转变,而且A3激动剂有潜力作为缺血/再灌注诱导的肺损伤的有效治疗方法。