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      Phosphatidylserine Supplementation as a Novel Strategy for Reducing Myocardial Infarct Size and Preventing Adverse Left Ventricular Remodeling

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          Abstract

          Phosphatidylserines are known to sustain skeletal muscle activity during intense activity or hypoxic conditions, as well as preserve neurocognitive function in older patients. Our previous studies pointed out a potential cardioprotective role of phosphatidylserine in heart ischemia. Therefore, we investigated the effects of phosphatidylserine oral supplementation in a mouse model of acute myocardial infarction (AMI). We found out that phosphatidylserine increases, significantly, the cardiomyocyte survival by 50% in an acute model of myocardial ischemia-reperfusion. Similar, phosphatidylserine reduced significantly the infarcted size by 30% and improved heart function by 25% in a chronic model of AMI. The main responsible mechanism seems to be up-regulation of protein kinase C epsilon (PKC-ε), the main player of cardio-protection during pre-conditioning. Interestingly, if the phosphatidylserine supplementation is started before induction of AMI, but not after, it selectively inhibits neutrophil’s activation, such as Interleukin 1 beta (IL-1β) expression, without affecting the healing and fibrosis. Thus, phosphatidylserine supplementation may represent a simple way to activate a pre-conditioning mechanism and may be a promising novel strategy to reduce infarct size following AMI and to prevent myocardial injury during myocardial infarction or cardiac surgery. Due to the minimal adverse effects, further investigation in large animals or in human are soon possible to establish the exact role of phosphatidylserine in cardiac diseases.

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          Most cited references72

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          Epidemiology and risk profile of heart failure.

          Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. HF represents a considerable burden to the health-care system, responsible for costs of more than $39 billion annually in the USA alone, and high rates of hospitalizations, readmissions, and outpatient visits. HF is not a single entity, but a clinical syndrome that may have different characteristics depending on age, sex, race or ethnicity, left ventricular ejection fraction (LVEF) status, and HF etiology. Furthermore, pathophysiological differences are observed among patients diagnosed with HF and reduced LVEF compared with HF and preserved LVEF, which are beginning to be better appreciated in epidemiological studies. A number of risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes, among others, have been identified that both predict the incidence of HF as well as its severity. In this Review, we discuss key features of the epidemiology and risk profile of HF.
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            Postnatal isl1+ cardioblasts enter fully differentiated cardiomyocyte lineages.

            The purification, renewal and differentiation of native cardiac progenitors would form a mechanistic underpinning for unravelling steps for cardiac cell lineage formation, and their links to forms of congenital and adult cardiac diseases. Until now there has been little evidence for native cardiac precursor cells in the postnatal heart. Herein, we report the identification of isl1+ cardiac progenitors in postnatal rat, mouse and human myocardium. A cardiac mesenchymal feeder layer allows renewal of the isolated progenitor cells with maintenance of their capability to adopt a fully differentiated cardiomyocyte phenotype. Tamoxifen-inducible Cre/lox technology enables selective marking of this progenitor cell population including its progeny, at a defined time, and purification to relative homogeneity. Co-culture studies with neonatal myocytes indicate that isl1+ cells represent authentic, endogenous cardiac progenitors (cardioblasts) that display highly efficient conversion to a mature cardiac phenotype with stable expression of myocytic markers (25%) in the absence of cell fusion, intact Ca2+-cycling, and the generation of action potentials. The discovery of native cardioblasts represents a genetically based system to identify steps in cardiac cell lineage formation and maturation in development and disease.
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              Multitarget Strategies to Reduce Myocardial Ischemia/Reperfusion Injury

              Many treatments have been identified that confer robust cardioprotection in experimental animal models of acute ischemia and reperfusion injury. However, translation of these cardioprotective therapies into the clinical setting of acute myocardial infarction (AMI) for patient benefit has been disappointing. One important reason might be that AMI is multifactorial, causing cardiomyocyte death via multiple mechanisms, as well as affecting other cell types, including platelets, fibroblasts, endothelial and smooth muscle cells, and immune cells. Many cardioprotective strategies act through common end-effectors and may be suboptimal in patients with comorbidities. In this regard, emerging data suggest that optimal cardioprotection may require the combination of additive or synergistic multitarget therapies. This review will present an overview of the state of cardioprotection today and provide a roadmap for how we might progress towards successful clinical use of cardioprotective therapies following AMI, focusing on the rational combination of judiciously selected, multitarget therapies. This paper emerged as part of the discussions of the European Union (EU)-CARDIOPROTECTION Cooperation in Science and Technology (COST) Action, CA16225.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Int J Mol Sci
                Int J Mol Sci
                ijms
                International Journal of Molecular Sciences
                MDPI
                1422-0067
                22 April 2021
                May 2021
                : 22
                : 9
                : 4401
                Affiliations
                [1 ]Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, 52074 Aachen, Germany; dschumacher@ 123456ukaachen.de (D.S.); acuraj@ 123456ukaachen.de (A.C.); mstaudt@ 123456ukaachen.de (M.S.); franziska.neweling@ 123456uk-koeln.de (F.C.); dumitrascu.andre@ 123456yahoo.com (A.R.D.); jsoppert@ 123456ukaachen.de (J.S.); mrusu@ 123456ukaachen.de (M.R.); sakine@ 123456gmx.de (S.S.)
                [2 ]Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, 52074 Aachen, Germany
                [3 ]Department of Anesthesiology, University Hospital, RWTH Aachen University, 52074 Aachen, Germany
                [4 ]Department of Geriatric Medicine, University Hospital, RWTH Aachen University, 52074 Aachen, Germany
                [5 ]Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; brolles@ 123456ukaachen.de
                [6 ]Institute of Immunology, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
                [7 ]Department of Intensive Care and Intermediate Care, University Hospital, RWTH Aachen University, 52074 Aachen, Germany; cbeckers@ 123456ukaachen.de
                [8 ]Department of Cardiology, Angiology and Intensive Medicine, University Hospital Aachen, 52074 Aachen, Germany; kkneizeh@ 123456ukaachen.de
                [9 ]Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore; chrishan.ramachandra@ 123456nhcs.com.sg (C.J.A.R.); derek.hausenloy@ 123456duke-nus.edu.sg (D.J.H.)
                [10 ]National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore 169609, Singapore
                [11 ]Yong Loo Lin School of Medicine, National University Singapore, Singapore 169857, Singapore
                [12 ]The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK
                [13 ]Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung 41354, Taiwan
                [14 ]Human Genetic Laboratory, University for Medicine and Pharmacy, 200642 Craiova, Romania
                Author notes
                [* ]Correspondence: eliehn@ 123456ukaachen.de ; Tel.: +49-241-803-5983; Fax: +49-241-808-2716
                Author information
                https://orcid.org/0000-0002-2308-6543
                https://orcid.org/0000-0001-5593-3623
                https://orcid.org/0000-0002-7393-861X
                https://orcid.org/0000-0003-0729-4956
                https://orcid.org/0000-0002-1253-3272
                Article
                ijms-22-04401
                10.3390/ijms22094401
                8122843
                33922385
                dea0bd0a-fbae-48b1-b107-77f31ac0f4b1
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 30 March 2021
                : 21 April 2021
                Categories
                Article

                Molecular biology
                l-α-phosphatidyl-l-serine,phosphatidylserine,myocardial infarction,cardio-protection,preconditioning,inflammation

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