AFRICA CARDIOVASCULAR JOURNAL of AFRICA • Volume 28, No 6, November/December 2017 389

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AFRICA CARDIOVASCULAR JOURNAL of AFRICA • Volume 28, No 6, November/December 2017 389 AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017 389 The effect of iloprost and sildenafil, alone and in combination, on myocardial ischaemia and nitric oxide and irisin levels Suna Aydin, Tuncay Kuloglu, Suleyman Aydin, Meltem Yardim, Davut Azboy, Zeki Temizturk, Ali Kemal Kalkan, Mehmet Nesimi Eren Abstract sacrificed after 24 hours, and their heart, liver and kidney tissues and blood samples were collected for analyses. An Aim: Insufficient oxygen supply to organs and tissues due to immunohistochemical method was used to measure the change reduced arterial or venous blood flow results in ischaemia, in irisin levels, the ELISA method to quantify blood irisin during which, although ATP production stops, AMP and levels, and Griess’ assay to determine nitric oxide (NO) levels adenosine continue to be produced from ATP. The fate of in the serum and tissue. Myocardial ischaemia was confirmed irisin, which causes the production of heat instead of ATP based on the results of Masson’s trichrome staining, as well as during ischaemia, is unknown. Iloprost and sildenafil are levels of troponin and creatine kinase MB. two pharmaceutical agents that mediate the resumption of Results: Irisin levels in biological tissue and serum dropped reperfusion (blood supply) via vasodilatation during ischae- statistically significantly in the ischaemic group (MI), but mic conditions. Our study aimed to explore the effects of were restored with ILO and SIL administration. Individual iloprost and sildenafil on irisin levels in the heart, liver and SIL administration was more potently restorative than indi- kidney tissues and whether these pharmaceutical agents had vidual ILO administration or the combined administration any impact on serum irisin and nitric oxide levels in rats with of the two agents. NO level, on the other hand, showed the induced experimental myocardial ischaemia. opposite tendency, reaching the highest level in the MI group, Methods: The study included adult male Sprague-Dawley rats and falling with the use of pharmaceutical agents. aged 10 months and weighing between 250 and 280 g. The Conclusions: Individual or combined administration of ILO animals were randomly allocated to eight groups, with five rats and SIL reduced myocardial ischaemia and NO levels, and in each group. The groups were: sham (control), iloprost (ILO), increased irisin levels. Elevated levels of irisin obtained by sildenafil (SIL), ILO + SIL, myocardial ischaemia (MI), MI + drug administration could possibly contribute to accelerated ILO, MI + SIL and MI + ILO + SIL. The treatment protocols wound recovery by local heat production. Sildenafil was more were implemented before inducing ischaemia, which was done effective than iloprost in eliminating ischaemia and may be the by occluding the left coronary artery with a plastic ligature for first choice in offsetting the effects of ischaemia in the future. 30 minutes. Following the reperfusion procedure, all rats were Keywords: iloprost, sildenafil, nitric oxide, irisin, myocardial Department of Cardiovascular Surgery, Elazig Education ischaemia–reperfusion and Research Hospital, Health Science University, Elazig, Turkey Submitted 2/11/16, accepted 25/4/17 Suna Aydin, MD, [email protected] Published online 31/8/17 Davut Azboy, MD Cardiovasc J Afr 2017; 28: 389–396 www.cvja.co.za Zeki Temizturk, MD Department of Anatomy, School of Medicine, Firat DOI: 10.5830/CVJA-2017-025 University, Elazig, Turkey Suna Aydin, MD Myocardial ischaemia impairs the function and survival of Department of Histology and Embryology, School of cardiac myocytes. Current treatment for this condition is Medicine, Firat University, Elazig, Turkey elimination of ischaemia.1 Although the use of coronary dilator Tuncay Kuloglu, MD anti-aggregatory medications to various degrees is the treatment 2,3 Department of Medical Biochemistry (Firat Hormones of choice in the elimination of ischaemia, surgical coronary Research Group), School of Medicine, Firat University, bypass methods are also used, as laid down in treatment Elazig, Turkey guidelines.4-6 Additionally, iloprost is the first line of treatment in Suleyman Aydin, PhD occlusions seen in peripheral artery disease.7 Meltem Yardim, MD Iloprost (ILO) is an eicosanoid pharmaceutical agent from Department of Cardiology, Education and Research the prostacyclin group.8 Currently, it is clinically used to unblock Hospital, Istanbul, Turkey occluded vessels.9,10 ILO exercises its vasodilatory effect by Ali Kemal Kalkan, MD preventing platelet aggregation.8,11 Another vasodilatory agent 12 Department of Cardiovascular Surgery, School of that acts via nitric oxide (NO) is sildenafil (SIL). NO levels 13 Medicine, Dicle University, Diyarbakir, Turkey increase during ischaemia. During reperfusion, NO levels Mehmet Nesimi Eren, MD are elevated,13 caused by the vasodilator effect of SIL.14 The - increased NO levels combine with a superoxide radical (O2 ) to 390 CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017 AFRICA form a toxic oxygen metabolite, peroxynitrite (ONOO-), which ILO in the 0.2–2-μg/kg range.26,27 In this study, 2 mg/kg sildenafil causes damage in the tissues.15,16 Therefore, elucidation of the citrate was administered to the SIL group and 1 μg/kg to the changes in NO levels caused by the administration of ILO and ILO group via the intraperitoneal route before the induction of SIL, which were used for the reperfusion of tissues, could help ischaemia–reperfusion, as described previously by Harada et al.28 explain the mechanisms underlying this process. A 30-minute occlusion was then induced using a plastic ligature, At present, sildenafil is employed to correct erectile dysfunction.12 as described previously.29 After the ligature was released, blood Since it acts as a vasodilator, it can serve as a therapeutic agent flow was visually confirmed. All rats were sacrificed at 24 hours during ischaemia.14 Vasodilatation enhances oxygenation and following the reperfusion procedure. therefore mediates in the elimination of ischaemia and increases Blood samples were collected as described for previous adenosine triphosphate (ATP) formation. It is established that experiments,30 centrifuged at 4 000 rpm and stored at –80°C until the aerobic ATP formation is blocked in hypoxic states. Therefore, irisin analysis. Glucose, creatine kinase (CK), creatine kinase MB ischaemia leads to a decrease in ATP production.17 Another (CKMB) and troponin I on the other hand, were analysed without molecule that causes a reduction in ATP levels is irisin.18,19 By delay on an auto-analyser. Heart, liver and kidney tissue was fixed increasing the amount of uncoupling proteins, this molecule leads in 10% formaldehyde solution and stored for immunohistochemical to the release of heat rather than ATP from molecules.18 analysis. The remaining heart, liver and kidney tissue, after the wet Since ILO,7 used in ischaemic peripheral artery disease, and weight was determined, were homogenised and the supernatants SIL,12 used in erectile dysfunction, increase oxygenation through were stored at –80°C for NO analysis. vasodilatation, the tissues recovered from ischaemia would As its half life is short, it is difficult to directly analyse NO. For theoretically be expected to have elevated ATP levels. On the NO measurements, its stable end-products, nitrite and nitrate, other hand, in the presence of irisin, heat production would are quantified in tissues with a spectrophotometric method. This increase through uncoupling of proteins and cause a decrease method is based on the principle of measuring the absorbance at in ATP production.18,19 Therefore there seems to be an obvious 545 nm of the complex formed when nitrate is reduced to nitrite correlation between the treatment of ischaemic tissue with ILO in the presence of nitrate reductase enzyme, and the resulting and SIL, and irisin levels. nitrite reacts with sulfanylamide and N-ethylendiamin.31 Furthermore, myocardial ischaemia does not only affect Serum irisin levels were determined using the ELISA method, heart tissue. It was reported in previous studies that myocardial following the catalogue guidelines provided by the manufacturing ischaemia could directly impact on kidney tissue,20 which is an firm.32 The kit was reported to have a minimum irisin detection excretory organ, and the liver,21 where glycogenesis takes place. limit of 1.29 ng/ml and minimal cross-reactivity (~9%) with In addition, there is an increased need for energy (glucose) fibronectin type III domain-containing protein 5 (FNDC5). In during ischaemic conditions. It was reported that irisin inhibited our laboratory results, we found an intra-assay value of 8% and glycogenesis, or impeded the production of glucose.22 inter-assay value of 10%. Therefore the aim of this study was to determine the change in Histopathological examinations were carried out using the irisin level in tissues with increased energy needs under ischaemic triphenyl tetrazolium chloride method to identify the damage conditions. Our principal objectives were to explore (1) whether to the myocardium and other tissues, as described previously.23 ILO and SIL played a part in recovery after myocardial injury Myocardial injury was assessed according to the semi-quantitative and how they changed irisin expression in experimentally induced method of Miller et al.33 The Abc immunohistochemical method myocardial ischaemia–reperfusion; (2) whether ILO, SIL, or of Hsu et al.34 was used to determine the distribution of irisin a combination of both were more efficient in the treatment of expression in the myocardium and other tissues.34 ischaemic injury; (3) how NO levels were altered in response to these therapeutic agents; (4) whether irisin, which causes metabolisation of ATP, was down- or upregulated in tissues with Statistical analysis an increased need for ATP, as in the case of ischaemia; and (5) The extent of the damage in the myocardium and other tissues how ILO and SIL treatment affected irisin expression in heart, was determined using the Student’s t-test. SPSS 22 software liver and kidney tissues under ischaemic conditions. was employed in all statistical analyses.
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