Leistner Marcus, Sommer Stefanie, Kanofsky Peer, Leyh Rainer, Sommer Sebastian-Patrick
Department of Thoracic, Cardiac and Vascular Surgery, University Medical Center Goettingen, Goettingen, Germany.
Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
J Cardiothorac Surg. 2019 May 14;14(1):92. doi: 10.1186/s13019-019-0911-1.
Mitochondrial impairment can result from myocardial ischemia reperfusion injury (IR). Despite cardioplegic arrest, IR-associated cardiodepression is a major problem in heart surgery. We determined the effect of increasing ischemia time on the respiratory chain (RC) function, the inner membrane polarization and Ca homeostasis of rat cardiac subsarcolemmal mitochondria (SSM).
Wistar rat hearts were divided into 4 groups of stop-flow induced warm global IR using a pressure-controlled Langendorff system: 0, 15, 30 and 40 min of ischemia with 30 min of reperfusion, respectively. Myocardial contractility was determined from left ventricular pressure records (dP/dt, dPmax) with an intraventricular balloon. Following reperfusion, SSM were isolated and analyzed regarding electron transport chain (ETC) coupling by polarography (Clark-Type electrode), membrane polarization (JC1 fluorescence) and Ca-handling in terms of Ca-induced swelling and Ca-uptake/release (Calcium Green-5 N® fluorescence).
LV contractility and systolic pressure during reperfusion were impaired by increasing ischemic times. Ischemia reduced ETC oxygen consumption in IR40/30 compared to IR0/30 at complex I-V (8.1 ± 1.2 vs. 18.2 ± 2.0 nmol/min) and II-IV/V (16.4 ± 2.6/14.8 ± 2.3 vs. 2.3 ± 0.6 nmol/min) in state 3 respiration (p < 0.01). Relative membrane potential revealed a distinct hyperpolarization in IR30/30 and IR40/30 (171.5 ± 17.4% and 170.9 ± 13.5%) compared to IR0/30 (p < 0.01), wearing off swiftly after CCCP-induced uncoupling. Excess mitochondrial permeability transition pore (mPTP)-gated Ca-induced swelling was recorded in all groups and was most pronounced in IR40/30. Pyruvate addition for mPTP blocking strongly reduced SSM swelling in IR40/30 (relative AUC, ± pyruvate; IR0/30: 1.00 vs. 0.61, IR15/30: 1.68 vs. 1.00, IR30/30: 1.42 vs. 0.75, IR40/30: 1.97 vs. 0.85; p < 0.01). Ca-uptake remained unaffected by previous IR. Though Ca-release was delayed for ≥30 min of ischemia (p < 0.01), Ca retention was highest in IR15/30 (RFU; IR0/30: 6.3 ± 3.6, IR 15/30 42.9 ± 5.0, IR30/30 15.9 ± 3.8, IR40/30 11.5 ± 6.6; p ≤ 0.01 for IR15/30 against all other groups).
Ischemia prolongation in IR injury gradually impaired SSM in terms of respiratory chain function and Ca-homeostasis. Membrane hyperpolarization appears to be responsible for impaired Ca-cycling and ETC function. Ischemia time should be considered an important factor influencing IR experimental data on subsarcolemmal mitochondria. Periods of warm global ischemia should be minimized during cardiac surgery to avoid excessive damage to SSMs.
线粒体功能障碍可由心肌缺血再灌注损伤(IR)引起。尽管有心脏停搏,但IR相关的心脏抑制仍是心脏手术中的一个主要问题。我们确定了增加缺血时间对大鼠心内膜下线粒体(SSM)呼吸链(RC)功能、内膜极化和钙稳态的影响。
使用压力控制的Langendorff系统将Wistar大鼠心脏分为4组,进行停流诱导的温性全心IR:分别缺血0、15、30和40分钟,再灌注30分钟。通过心室内球囊从左心室压力记录(dP/dt,dPmax)确定心肌收缩力。再灌注后,分离SSM,并通过极谱法(Clark型电极)分析电子传递链(ETC)偶联、膜极化(JC1荧光)以及钙处理方面的钙诱导肿胀和钙摄取/释放(钙绿-5N®荧光)。
随着缺血时间增加,再灌注期间左心室收缩力和收缩压受损。与IR0/30相比,缺血使IR40/30中复合体I-V(8.1±1.2对18.2±2.0 nmol/min)和II-IV/V(16.4±2.6/14.8±2.3对2.3±0.6 nmol/min)在状态3呼吸时的ETC氧消耗减少(p<0.01)。相对膜电位显示,与IR0/30相比,IR30/30和IR40/30中出现明显的超极化(171.5±17.4%和170.9±13.5%)(p<0.01),在CCCP诱导解偶联后迅速消失。所有组均记录到过量线粒体通透性转换孔(mPTP)门控的钙诱导肿胀,在IR40/30中最为明显。添加丙酮酸阻断mPTP可显著降低IR40/30中SSM的肿胀(相对AUC,±丙酮酸;IR0/30:1.00对0.61,IR15/30:1.68对1.00,IR30/30:1.42对0.75,IR40/