Access Type
Open Access Dissertation
Date of Award
January 2017
Degree Type
Dissertation
Degree Name
Ph.D.
Department
Physiology
First Advisor
Karin Przyklenk
Abstract
Remote preconditioning is a promising and robust treatment for myocardial
ischemia/reperfusion injury that evokes cardioprotection through endogenous neural
and/or humoral signaling. A recent study has reported that protective signaling is
mediated by exosomes through the circulation; however this concept is supported by
limited and inconsistent evidence. Despite overwhelming success in preclinical studies,
the efficacy of remote preconditioning in human studies is inconclusive. Importantly, the
majority of remote preconditioning studies use healthy animal models despite growing
evidence that comorbidities, such as type-2 diabetes, may negatively influence
outcomes. Nonetheless, the efficacy of remote preconditioning in the setting of type-2
diabetes has not been investigated.
Using an established model of myocardial ischemia/reperfusion in the Zucker
model of type-2 diabetes and a model of hypoxia/reoxygenation in cultured HL-1
cardiomyocytes we tested four hypotheses:
i. remote preconditioning is ineffective in early-stage type-2 diabetes in vivo;
ii. the traditional ultracentrifugation technique for exosomes isolating is inadequate
to isolate protective factor(s) from remote preconditioning;
iii. enhanced ultracentrifugation technique for exosome isolation sequesters a
protective fraction of serum;
iv. the humoral component of remote preconditioning is defective in type-2 diabetes.
In support of Hypothesis I, we demonstrate that remote preconditioning failed to
reduce infarct size caused by ischemia/reperfusion in the Zucker model of early-stage
type-2 diabetes. Our results illustrate that the loss in efficacy is not the result of
hyperglycemia per se nor sensitization of the myocardium to ischemia/reperfusion.
Subsequently, we sought to isolate a subfraction of serum from remote preconditioned
rats which contained exosomes that could communicate protection and render HL-1
cardiomyocytes resistant to hypoxia/reoxygenation-induced cell death. In agreement
with Hypothesis II, we report that the traditional ultracentrifugation isolation technique
(100,000 xg for 2 hr) did not isolate the protective component with the exosome-rich
pellet from serum, suggesting that the protective component remained in the
supernatant. In accordance with these observations, we enhanced the
ultracentrifugation technique to improve exosome sedimentation and obtain a protective
sub-fraction of serum. In agreement with Hypothesis III, the enhanced
ultracentrifugation technique (300,000 xg for 12 hr) isolated a protective exosome-rich
supernatant fraction from remote preconditioned serum. However, our enhanced
ultracentrifugation technique also yielded an additional, exosome-rich pellet and an
exosome-depleted fraction, neither of which evoked protection. Lastly, in support of
Hypothesis IV, we demonstrate that unfractionated serum and the exosome-rich
supernatant fraction obtained from remote preconditioned diabetic Zucker Fatty rats did
not protect HL-1 cardiomyocytes from hypoxia/reoxygenation. In conclusion, our results
illustrate for the first time that the infarct-sparing efficacy of remote preconditioning is
abolished in the setting of early-stage type-2 diabetes. We demonstrate that exosomes,
although not sufficient for protection, may be requisite in the humoral component of
remote preconditioning. Finally, we report that the humoral component of remote
preconditioning is defective in the setting of type-2 diabetes – a defect that may
contribute to the failure of remote conditioning to limit infarct size in this comorbid
model.
Recommended Citation
Wider, Joseph Michael, "Remote Preconditioning: Evaluating The Efficacy Of Cardioprotection In Type-2 Diabetes And Exploring The Mechanistic Role Of Exosomes" (2017). Wayne State University Dissertations. 1754.
https://digitalcommons.wayne.edu/oa_dissertations/1754