Pyruvate-fortified cardioplegia evokes myocardial erythropoietin signaling in swine undergoing cardiopulmonary bypass

Am J Physiol Heart Circ Physiol. 2009 Nov;297(5):H1914-22. doi: 10.1152/ajpheart.01213.2008. Epub 2009 Sep 18.

Abstract

Pyruvate-fortified cardioplegia protects myocardium and hastens postsurgical recovery of patients undergoing cardiopulmonary bypass (CPB). Pyruvate reportedly suppresses degradation of the alpha-subunit of hypoxia-inducible factor-1 (HIF-1), an activator of the gene encoding the cardioprotective cytokine erythropoietin (EPO). This study tested the hypothesis that pyruvate-enriched cardioplegia evoked EPO expression and mobilized EPO signaling mechanisms in myocardium. Hearts of pigs maintained on CPB were arrested for 60 min with 4:1 blood-crystalloid cardioplegia. The crystalloid component contained 188 mM glucose + or - 24 mM pyruvate. After 30-min cardiac reperfusion with cardioplegia-free blood, the pigs were weaned from CPB. Left ventricular myocardium was sampled 4 h after CPB for immunoblot assessment of HIF-1alpha, EPO and its receptor, the signaling kinases Akt and ERK, and endothelial nitric oxide synthase (eNOS), an effector of EPO signaling. Pyruvate-fortified cardioplegia stabilized arterial pressure post-CPB, induced myocardial EPO mRNA expression, and increased HIF-1alpha, EPO, and EPO-R protein contents by 60, 58, and 123%, respectively, vs. control cardioplegia (P < 0.05). Pyruvate cardioplegia also increased ERK phosphorylation by 61 and 118%, respectively, vs. control cardioplegia-treated and non-CPB sham myocardium (P < 0.01), but did not alter Akt phosphorylation. Nitric oxide synthase (NOS) activity and eNOS content fell 32% following control CPB vs. sham, but pyruvate cardioplegia prevented these declines, yielding 49 and 80% greater NOS activity and eNOS content vs. respective control values (P < 0.01). Pyruvate-fortified cardioplegia induced myocardial EPO expression and mobilized the EPO-ERK-eNOS mechanism. By stabilizing HIF-1alpha, pyruvate-fortified cardioplegia may evoke sustained activation of EPO's cardioprotective signaling cascade in myocardium.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Blood Pressure / drug effects
  • Cardioplegic Solutions / metabolism
  • Cardioplegic Solutions / pharmacology*
  • Cardiopulmonary Bypass* / adverse effects
  • Edema, Cardiac / etiology
  • Edema, Cardiac / metabolism
  • Edema, Cardiac / prevention & control
  • Energy Metabolism
  • Erythropoietin / genetics
  • Erythropoietin / metabolism*
  • Extracellular Signal-Regulated MAP Kinases / metabolism
  • Female
  • Glutathione / metabolism
  • Heart Arrest, Induced / adverse effects
  • Heart Arrest, Induced / methods*
  • Heart Diseases / etiology
  • Heart Diseases / metabolism
  • Heart Diseases / physiopathology
  • Heart Diseases / prevention & control*
  • Heart Rate / drug effects
  • Heart Ventricles / drug effects
  • Heart Ventricles / metabolism
  • Hypoxia-Inducible Factor 1, alpha Subunit / genetics
  • Hypoxia-Inducible Factor 1, alpha Subunit / metabolism
  • Male
  • Models, Animal
  • Myocardium / metabolism*
  • Nitric Oxide Synthase Type III / metabolism
  • Oxidation-Reduction
  • Phosphorylation
  • Proto-Oncogene Proteins c-akt / metabolism
  • Pyruvic Acid / metabolism
  • Pyruvic Acid / pharmacology*
  • RNA, Messenger / metabolism
  • Receptors, Erythropoietin / metabolism
  • Signal Transduction / drug effects*
  • Swine
  • Time Factors
  • Up-Regulation

Substances

  • Cardioplegic Solutions
  • Hypoxia-Inducible Factor 1, alpha Subunit
  • RNA, Messenger
  • Receptors, Erythropoietin
  • Erythropoietin
  • Pyruvic Acid
  • Nitric Oxide Synthase Type III
  • Proto-Oncogene Proteins c-akt
  • Extracellular Signal-Regulated MAP Kinases
  • Glutathione