Zhou Ting, Liu Yong, Zhu Lijun, Jiang Jian, Chen Qijiang, Li Lulu, Wu Xianlong, Xu Jiefeng, Fang Jianjiang
Department of Emergency Medicine, Ningbo Medical Center Lihuili Hospital, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
Department of Intensive Care Medicine, The First Hospital of Ninghai, Ningbo, China.
Shock. 2025 Apr 1;63(4):614-621. doi: 10.1097/SHK.0000000000002539. Epub 2024 Dec 19.
Introduction: Dl-3-n-butylphthalide (NBP), a small molecular compound extracted from celery seeds, has been shown to exhibit diverse pharmacological activities, including anti-inflammatory, antioxidative, and anti-apoptotic effects. Recent studies have highlighted its efficacy in treating various cardiovascular conditions, such as myocardial infarction, hypertrophy, heart failure, and cardiotoxicity. This study aimed to investigate whether NBP could alleviate cardiac dysfunction and injury following hemorrhage-induced cardiac arrest (HCA) in a porcine model and elucidate its potential mechanisms. Methods: Seventeen pigs were randomized into three groups: sham (n = 5), HCA + vehicle (n = 5), and HCA + NBP (n = 7). In the HCA + vehicle and HCA + NBP groups, the HCA model was established by continuous bleeding at a rate of 2 mL/kg/min to induce cardiac arrest. Cardiac arrest was maintained for 7 min, followed by the reinfusion of 50% of the shed blood at a rate of 5 mL/kg/min. After successful resuscitation, the HCA + NBP group received an intravenous dose of 2.5 mg/kg of NBP within 120 min. Post-resuscitation cardiac function (stroke volume, global ejection fraction) and injury biomarkers (cardiac troponin I, creatine kinase-MB) were assessed at regular intervals. At the end of the post-resuscitation observation, cardiac tissue samples were collected to assess: histopathological injury; cellular apoptosis; levels of pro-inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-18 (IL-18); the expression levels of NOD-like receptor pyrin domain 3 (NLRP3), caspase 1, gasdermin D (GSDMD), cyclic-GMP-AMP synthase (cGAS), stimulator of interferon genes (STING), and tank-binding kinase 1 (TBK1); and the integrated optical density (IOD) of GSDMD N-terminal (GSDMD-N), phosphorylated STING (p-STING), and phosphorylated TBK1 (p-TBK1). Results: Following resuscitation, both stroke volume and global ejection fraction were significantly reduced, while serum levels of cardiac troponin I and creatine kinase-MB were markedly elevated in the HCA + vehicle and HCA + NBP groups compared with the sham group. However, the extent of cardiac dysfunction and injury was significantly attenuated in the HCA + NBP group relative to the HCA + vehicle group. At 24 h post-resuscitation, substantial cardiac pathological injury and apoptosis were observed. Additionally, pyroptosis-related proteins (NLRP3, caspase-1, GSDMD, GSDMD-N) were upregulated, inflammatory markers (TNF-α, IL-1β, IL-6, IL-18) were elevated, and the activation of the cGAS-STING-TBK1 pathway (cGAS, STING, TBK1, p-STING, p-TBK1) were noted in both the HCA + vehicle and HCA + NBP groups compared with the sham group. Notably, these pathological changes were significantly attenuated in the HCA + NBP group compared with the HCA + vehicle group. Conclusions: NBP provided substantial cardiac protection following HCA and resuscitation in pigs. This protective effect was likely mediated through the inhibition of cell pyroptosis and inflammation by suppressing the cGAS-STING-TBK1 signaling pathway.
丁苯酞(NBP)是一种从芹菜籽中提取的小分子化合物,已被证明具有多种药理活性,包括抗炎、抗氧化和抗凋亡作用。最近的研究强调了其在治疗各种心血管疾病方面的疗效,如心肌梗死、肥大、心力衰竭和心脏毒性。本研究旨在探讨NBP是否能减轻猪模型中出血性心脏骤停(HCA)后的心脏功能障碍和损伤,并阐明其潜在机制。
17头猪被随机分为三组:假手术组(n = 5)、HCA + 溶剂组(n = 5)和HCA + NBP组(n = 7)。在HCA + 溶剂组和HCA + NBP组中,通过以2 mL/kg/min的速率持续出血诱导心脏骤停建立HCA模型。心脏骤停维持7分钟,然后以5 mL/kg/min的速率回输50%的失血。成功复苏后,HCA + NBP组在120分钟内静脉注射2.5 mg/kg的NBP。定期评估复苏后心脏功能(每搏输出量、整体射血分数)和损伤生物标志物(心肌肌钙蛋白I、肌酸激酶同工酶MB)。在复苏后观察结束时,收集心脏组织样本以评估:组织病理学损伤;细胞凋亡;促炎细胞因子水平,包括肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和白细胞介素-18(IL-18);NOD样受体吡咯结构域3(NLRP3)、半胱天冬酶1、gasdermin D(GSDMD)、环磷酸鸟苷-腺苷酸合酶(cGAS)、干扰素基因刺激物(STING)和TANK结合激酶1(TBK1)的表达水平;以及GSDMD N端(GSDMD-N)、磷酸化STING(p-STING)和磷酸化TBK1(p-TBK1)的积分光密度(IOD)。
复苏后,与假手术组相比,HCA + 溶剂组和HCA + NBP组的每搏输出量和整体射血分数均显著降低,而血清心肌肌钙蛋白I和肌酸激酶同工酶MB水平显著升高。然而,与HCA + 溶剂组相比,HCA + NBP组的心脏功能障碍和损伤程度显著减轻。复苏后24小时,观察到明显的心脏病理损伤和凋亡。此外,与假手术组相比,HCA + 溶剂组和HCA + NBP组中焦亡相关蛋白(NLRP3、半胱天冬酶-1、GSDMD、GSDMD-N)上调,炎症标志物(TNF-α、IL-1β、IL-6、IL-18)升高,cGAS-STING-TBK1通路(cGAS、STING、TBK1、p-STING、p-TBK1)激活。值得注意的是,与HCA + 溶剂组相比,HCA + NBP组的这些病理变化显著减轻。
NBP在猪HCA及复苏后提供了显著的心脏保护作用。这种保护作用可能是通过抑制cGAS-STING-TBK1信号通路来抑制细胞焦亡和炎症介导的。