Mitochondrial Apoptotic Pathway Induced by Myocardial Ischemia-Reperfusion Injury in Human

Ischemic Postconditioning Clinical Trial

Official title:

Mitochondrial Apoptotic Pathway Induced by Myocardial Ischemia-Reperfusion Injury in Human

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT02430116
• Other study ID #: wangyanbin123
• Status: Recruiting
• Phase: N/A
• First received: April 20, 2015
• Last updated: April 29, 2015
• Start date: June 2014

Study information

• Verified date: April 2015
• Source: Shenzhen Sun Yat-sen Cardiovascular Hospital
• Contact: n/a
• Is FDA regulated: No
• Health authority: China: National Health Commission
• Study type: Interventional

Clinical Trial Summary

Background: The cardiomyocytes apoptosis induced by ischemia-reperfusion(I/R) is one of the most important factors in the myocardial I/R injury(MIRI) undergoing cardiac valve replacement with cardiopulmonary bypass(CVRCPB),and Ischemic postconditioning (I-postC) can inhibit apoptosis of myocardial cells. Consequently, this study investigated the key genes and apoptosis signaling pathways of myocardium in patients undergoing CVRCPB.

Methods: A total of 36 New York Heart Association class II or III patients with rheumatic heart disease (RHD) of both sexes, aged 21-59 years, who were scheduled for first cardiac valve replacement with CPB in the investigators' hospital from February 2014 to May 2015, were randomly divided into the following three groups (n=12 each): negative control group (NEG group); I/R group (POS group); and I-postC group (Treat group). In the Treat group, the procedure involved 5 min before opening the ascending aorta, aortic unclamping for 30 s, and cross-clamping for 30 s for three cycles, after which the ascending aorta was completely opened. The NEG and Treat groups were not treated. Thirty-six patients were assessed for arrhythmia and recovery of myocardial contractile function after reperfusion by electrocardiograms and degree of dependence on vasoactive drugs. The myocardial tissues of the right atrial appendage were obtained at 3 min before CPB was established in the NEG group, and at 45 min after opening the aorta in the POS and Treat groups. In all three groups, the myocardial tissues of the right atrial appendage were obtained and preserved at −80°C for further experiments. The right atrial appendage of three patients randomly selected in each group was fixed with RNA later (Qiagen, Hilden, Germany) in a centrifuge tube overnight at 4°C, and then preserved at −20°C for RNA extraction. Human 12×135K Gene Array profiling of mRNA expressions was undertaken in human cardiac muscle cells. Differentially expressed mRNAs verified by quantitative real-time RT-PCR were subjected to pathway analysis. The mRNA expressions of AIF, APAF1, CYCS, Bax, caspase-3, caspase-9, caspase-6, caspase-7, BCL2, BAG1, and PI3K were assessed by real-time RT-PCR and western blot analysis. The levels of myocardial apoptosis induced by I/R were investigated by TUNEL assays. The changes in MIRI induced by myocardial apoptosis were investigated by pathologic examination of the myocardium.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 40
• Est. primary completion date: May 2015
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 21 Years to 59 Years

Eligibility

Inclusion Criteria:

• New York Heart Association class II or III

• aged 21-59 years

• scheduled for first cardiac valve replacement with CPB

Exclusion Criteria:

• The patient with a history of heart operation or diabetes,

• with a history of liver and/or kidney dysfunction,

• with a history of coronary heart disease and the left ventricular ejection fraction(LVEF)<0.4, receiving drugs with pretreatment effectssuchas hormones, ATP-sensitive potassium (KATP) channel openers,insulin,et al. within preoperative one week,

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Prevention

Related Conditions & MeSH terms

• Cardiopulmonarybypass
• Coronary Artery Disease
• Ischemia
• Ischemia-reperfusion(I/R)
• Ischemic Postconditioning
• Myocardial Ischemia
• Reperfusion Injury
• the Mitochondrial Pathway

Intervention

Procedure:
• Ischemic postconditioning
In the Treat group, the procedure involved 5 min before opening the ascending aorta, aortic unclamping for 30 s, and cross-clamping for 30 s for three cycles, after which the ascending aorta was completely opened.

Locations

Country	Name	City	State
China	Shenzhen SUN Yat-Sen Cardiovascular hospital	Shenzhen

Sponsors (1)

Lead Sponsor	Collaborator
WANG Yan-bin

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	recovery of myocardial contractile function after reperfusion		1 day	Yes
Primary	degree of dependence on vasoactive drugs		1 day	Yes
Primary	number of participants with postoperative arrhythmia		1 day	Yes