Non-invasive technology that improves cardiac function after experimental myocardial infarction: Whole Body Periodic Acceleration (pGz)

Arkady Uryash, Jorge Bassuk, Paul Kurlansky, Francisco Altamirano, Jose R Lopez, Jose A Adams, Arkady Uryash, Jorge Bassuk, Paul Kurlansky, Francisco Altamirano, Jose R Lopez, Jose A Adams

Abstract

Myocardial infarction (MI) may produce significant inflammatory changes and adverse ventricular remodeling leading to heart failure and premature death. Pharmacologic, stem cell transplantation, and exercise have not halted the inexorable rise in the prevalence and great economic costs of heart failure despite extensive investigations of such treatments. New therapeutic modalities are needed. Whole Body Periodic Acceleration (pGz) is a non-invasive technology that increases pulsatile shear stress to the endothelium thereby producing several beneficial cardiovascular effects as demonstrated in animal models, normal humans and patients with heart disease. pGz upregulates endothelial derived nitric oxide synthase (eNOS) and its phosphorylation (p-eNOS) to improve myocardial function in models of myocardial stunning and preconditioning. Here we test whether pGz applied chronically after focal myocardial infarction in rats improves functional outcomes from MI. Focal MI was produced by left coronary artery ligation. One day after ligation animals were randomized to receive daily treatments of pGz for four weeks (MI-pGz) or serve as controls (MI-CONT), with an additional group as non-infarction controls (Sham). Echocardiograms and invasive pressure volume loop analysis were carried out. Infarct transmurality, myocardial fibrosis, and markers of inflammatory and anti-inflammatory cytokines were determined along with protein analysis of eNOS, p-eNOS and inducible nitric oxide synthase (iNOS).At four weeks, survival was 80% in MI-pGz vs 50% in MI-CONT (p< 0.01). Ejection fraction and fractional shortening and invasive pressure volume relation indices of afterload and contractility were significantly better in MI-pGz. The latter where associated with decreased infarct transmurality and decreased fibrosis along with increased eNOS, p-eNOS. Additionally, MI-pGz had significantly lower levels of iNOS, inflammatory cytokines (IL-6, TNF-α), and higher level of anti-inflammatory cytokine (IL-10). pGz improved survival and contractile performance, associated with improved myocardial remodeling. pGz may serve as a simple, safe, non-invasive therapeutic modality to improve myocardial function after MI.

Conflict of interest statement

Competing Interests: Jose A. Adams has read the journal’s policy and the authors of this manuscript have the following competing interests: the following authors AU, JB, PK, FA, and JRL have declared that no competing interests exist. JAA owns minimal number of stocks in Noninvasive Monitoring Systems (NIMS), a company which manufactures a platform similar to the one described in this study. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Myocardial Infarction Protocol Schematic.
Fig 1. Myocardial Infarction Protocol Schematic.
Permanent ligation of left coronary artery without reperfusion was done. pGz or Control were begun 24 hr after MI, and continued for four weeks. Post-MI echocardiograms (Echo) were done immediately post MI, at 1,3,4 weeks. Invasive Pressure Volume Loops were collected at end of study.
Fig 2. pGz Improves Survival After Myocardial…
Fig 2. pGz Improves Survival After Myocardial Infarction.
Kaplan-Meir Survival Curves. Survival during the four weeks after myocardial infarction in MI-pGz and MI-CONT groups. † p< 0.01.
Fig 3. pGz Reduced Infarct Size, Transmurality…
Fig 3. pGz Reduced Infarct Size, Transmurality and Fibrosis.
A. The ratio of left ventricular wall to myocardial infarct length in MI-CONT and MI-pGz, with representative microscopic findings. †p

Fig 4. Ejection Fraction and Fractional Shortening.

Fig 4. Ejection Fraction and Fractional Shortening.

A. Ejection Fraction (EF %) determined by echocardiogram…

Fig 4. Ejection Fraction and Fractional Shortening.
A. Ejection Fraction (EF %) determined by echocardiogram immediately after MI (Post-MI) and at 1,3,4 weeks. * p

Fig 5. Invasive Pressure Volume Relationship.

Representative…

Fig 5. Invasive Pressure Volume Relationship.

Representative loops for the pressure volume relationship of the…

Fig 5. Invasive Pressure Volume Relationship.
Representative loops for the pressure volume relationship of the left ventricle four weeks after myocardial infarction determined at baseline, and after reduction of preload via occlusion in Sham, MI-CONT and MI-pGz.

Fig 6. pGz Increases eNOS Signaling and…

Fig 6. pGz Increases eNOS Signaling and IL-10 Expression, whereas it Reduces iNOS, TNF-α and…

Fig 6. pGz Increases eNOS Signaling and IL-10 Expression, whereas it Reduces iNOS, TNF-α and IL-6 Expression.
A. Left ventricular protein content of endothelial derived nitric oxide synthase (eNOS) and phosphorylated eNOS (p-eNOS) as well as inducible nitric oxide synthase (iNOS), for Sham, MI-CONT and MI-pGz with representative immune blots for each group.* p
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References
    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–e292. 10.1161/01.cir.0000441139.02102.80 - DOI - PMC - PubMed
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    1. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circulation Heart failure. 2013;6(3):606–19. 10.1161/HHF.0b013e318291329a - DOI - PMC - PubMed
    1. Adams JA, Mangino MJ, Bassuk J, Kurlansky P, Sackner MA. Regional blood flow during periodic acceleration. Critical care medicine. 2001;29(10):1983–8. - PubMed
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Fig 4. Ejection Fraction and Fractional Shortening.
Fig 4. Ejection Fraction and Fractional Shortening.
A. Ejection Fraction (EF %) determined by echocardiogram immediately after MI (Post-MI) and at 1,3,4 weeks. * p

Fig 5. Invasive Pressure Volume Relationship.

Representative…

Fig 5. Invasive Pressure Volume Relationship.

Representative loops for the pressure volume relationship of the…

Fig 5. Invasive Pressure Volume Relationship.
Representative loops for the pressure volume relationship of the left ventricle four weeks after myocardial infarction determined at baseline, and after reduction of preload via occlusion in Sham, MI-CONT and MI-pGz.

Fig 6. pGz Increases eNOS Signaling and…

Fig 6. pGz Increases eNOS Signaling and IL-10 Expression, whereas it Reduces iNOS, TNF-α and…

Fig 6. pGz Increases eNOS Signaling and IL-10 Expression, whereas it Reduces iNOS, TNF-α and IL-6 Expression.
A. Left ventricular protein content of endothelial derived nitric oxide synthase (eNOS) and phosphorylated eNOS (p-eNOS) as well as inducible nitric oxide synthase (iNOS), for Sham, MI-CONT and MI-pGz with representative immune blots for each group.* p
Similar articles
Cited by
References
    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–e292. 10.1161/01.cir.0000441139.02102.80 - DOI - PMC - PubMed
    1. Seferovic PM, Stoerk S, Filippatos G, Mareev V, Kavoliuniene A, Ristic AD, et al. Organization of heart failure management in European Society of Cardiology member countries: survey of the Heart Failure Association of the European Society of Cardiology in collaboration with the Heart Failure National Societies/Working Groups. Eur J Heart Fail. 2013;15(9):947–59. 10.1093/eurjhf/hft092 - DOI - PubMed
    1. Guha K, McDonagh T. Heart failure epidemiology: European perspective. Current cardiology reviews. 2013;9(2):123–7. - PMC - PubMed
    1. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circulation Heart failure. 2013;6(3):606–19. 10.1161/HHF.0b013e318291329a - DOI - PMC - PubMed
    1. Adams JA, Mangino MJ, Bassuk J, Kurlansky P, Sackner MA. Regional blood flow during periodic acceleration. Critical care medicine. 2001;29(10):1983–8. - PubMed
Show all 85 references
Publication types
MeSH terms
Substances
Related information
Grant support
This work was funded by a grant from the Florida Heart Research Institute (http://www.floridaheart.org). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Fig 5. Invasive Pressure Volume Relationship.
Fig 5. Invasive Pressure Volume Relationship.
Representative loops for the pressure volume relationship of the left ventricle four weeks after myocardial infarction determined at baseline, and after reduction of preload via occlusion in Sham, MI-CONT and MI-pGz.
Fig 6. pGz Increases eNOS Signaling and…
Fig 6. pGz Increases eNOS Signaling and IL-10 Expression, whereas it Reduces iNOS, TNF-α and IL-6 Expression.
A. Left ventricular protein content of endothelial derived nitric oxide synthase (eNOS) and phosphorylated eNOS (p-eNOS) as well as inducible nitric oxide synthase (iNOS), for Sham, MI-CONT and MI-pGz with representative immune blots for each group.* p

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Source: PubMed

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