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(Circulation. 2009;120:677-686.)
© 2009 American Heart Association, Inc.

Molecular Cardiology

Pharmacological Activation of Soluble Guanylate Cyclase Protects the Heart Against Ischemic Injury

Sevil Korkmaz, PhD^*; Tamás Radovits, MD, PhD^*; Enik Barnucz, MD; Kristóf Hirschberg, MD; Philipp Neugebauer; Sivakkanan Loganathan; Gábor Veres, MD; Szabolcs Páli; Beatrice Seidel; Stefan Zöllner; Matthias Karck, MD; Gábor Szabó, MD, PhD

From the Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany (S.K., T.R., E.B., K.H., P.N., S.L., S.P., B.S., S.Z., M.K., G.S.), and Heart Center (T.R., K.H., S.P.) and Department of Cardiovascular Surgery (G.V.), Semmelweis University, Budapest, Hungary.

Correspondence to Dr Sevil Korkmaz, Department of Cardiac Surgery, University of Heidelberg, INF326 OG2, 69120 Heidelberg, Germany. E-mail korkmaz_sevil{at}hotmail.com

Received February 23, 2009; accepted June 19, 2009.

Background— The role of the nitric oxide/cGMP/cGMP–dependent protein kinase G pathway in myocardial protection and preconditioning has been the object of intensive investigations. The novel soluble guanylate cyclase activator cinaciguat has been reported to elevate intracellular [cGMP] and activate the nitric oxide/cGMP/cGMP–dependent protein kinase G pathway in vivo. We investigated the effects of cinaciguat on myocardial infarction induced by isoproterenol in rats.

Methods and Results— Rats were treated orally twice a day for 4 days with vehicle or cinaciguat (10 mg/kg). Isoproterenol (85 mg/kg) was injected subcutaneously 2 days after the first treatment at an interval of 24 hours for 2 days to produce myocardial infarction. After 17 hours, histopathological observations and left ventricular pressure-volume analysis to assess cardiac function with a Millar microtip pressure-volume conductance catheter were performed, and levels of biochemicals of the heart tissues were measured. Gene expression analysis was performed by quantitative real-time polymerase chain reaction. Isolated canine coronary arterial rings exposed to peroxynitrite were investigated for vasomotor function, and immunohistochemistry was performed for cGMP and nitrotyrosine. The present results show that cinaciguat treatment improves histopathological lesions, improves cardiac performance, improves impaired cardiac relaxation, reduces oxidative stress, ameliorates intracellular enzyme release, and decreases cyclooxygenase 2, transforming growth factor-β, and β-actin mRNA expression in experimentally induced myocardial infarction in rats. In vitro exposure of coronary arteries to peroxynitrite resulted in an impairment of endothelium-dependent vasorelaxation, increased nitro-oxidative stress, and reduced intracellular cGMP levels, which were all improved by cinaciguat. A cardioprotective effect of postischemic cinaciguat treatment was shown in a canine model of global ischemia/reperfusion.

Conclusion— Pharmacological soluble guanylate cyclase activation could be a novel approach for the prevention and treatment of ischemic heart disease.

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Clinical Summaries
Circulation 2009 120: 647-648. [Extract] [Full Text]