Trimetazidine protects against myocardial ischemia/reperfusion injury by inhibiting excessive autophagy
Trimetazidine (TMZ) has been demonstrated to have protective effects against myocardial ischemia/reperfusion (MI/R) injury. In the present study, we investigated the effects and the underlying mechanisms of TMZ on autophagy during MI/R in vivo and in vitro. In the in vivo study, an animal model of MI/R was induced by coronary occlusion. TMZ (20 mg/kg/day) protected the rat hearts from MI/R-induced heart failure by increasing ejection fraction and fractional shortening and decreasing end-systolic volume, end-diastolic volume, left ventricular (LV) internal diameter at systole, and LV internal diameter at diastole; it alleviated myocardial injury and oxidative stress by decreasing LDH, creatine kinase MB isoenzyme, ROS, and MDA levels and increasing SOD and glutathione peroxidase levels in plasma. TMZ also reduced myocardial infarct size and apoptosis. Moreover, TMZ markedly inhibited MI/R-induced autophagy by decreasing the protein and messenger RNA levels of LC3-II, Beclin1, ATG5, and ATG7 and the number of autophagosomes and by involving the AKT/mTOR pathway. Further, in the in vitro experiments, H9c2 cells were incubated with TMZ (40 μM) to explore the direct effects of TMZ following exposure to hypoxia and reoxygenation (H/R). TMZ increased cell viability and the concentration of intracellular SOD and inhibited H/R-induced cell apoptosis and ROS production. Moreover, TMZ decreased the number of autophagosomes and autophagy-related protein expression; it also upregulated p-AKT and p-mTOR expression. In addition, TMZ augmented Bcl-2 protein expression and diminished Bax protein expression, the Bax/Bcl-2 rate, and cleaved caspase-3 level. However, these effects on H9c2 cells were notably abolished by the PI3K inhibitor LY294002. In conclusion, our results showed that TMZ inhibited I/R-induced excessive autophagy and apoptosis, which was, at least partly, mediated by activating the AKT/mTOR pathway.
TMZ improved cardiac function, alleviated myocardial injury and oxidative stress, and reduced the myocardial infarct area and apoptosis.
TMZ inhibited MI/R-induced myocardial autophagy, H/R-induced H9c2 cell apoptosis, and autophagy flux.
The effect of TMZ on autophagy was repressed by LY294002.
TMZ protected against MI/R injury by inhibiting excessive autophagy via activating the AKT/mTOR pathway.
KeywordsTrimetazidine Autophagy Ischemia/reperfusion Hypoxia/reoxygenation H9c2 cell
We sincerely thank Lixue Chen and Guangcheng Qin of the Central Laboratory and Qian Dong of the Department of Cardiology of the First Affiliated Hospital of Chongqing Medical University for their assistance with these experiments.
This work was supported by the National Natural Science Fund of China (Grant No. 81570212), the Cardiac Rehabilitation and Metabolic Therapy Research Fund (Grant No. ky_2016_12_20), the Science and Technology Plan Project of Chongqing Yuzhong District (Grant No. 20140111), the Chinese Medicine Science and Technology Project of Chongqing Health and Family Planning Commission (Grant No. ZY201702073), the Postgraduate Research and Innovation Project of Chongqing (Grant No. CYB15093), and the “Advanced” Research Foundation Project of Cardiovascular Health Institute of China Cardiovascular Health Alliance (Grant No. ky_2017_07_08).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no competing interests.
- 4.Bourke LT, McDonnell T, McCormick J, Pericleous C, Ripoll VM, Giles I, Rahman A, Stephanou A, Ioannou Y (2017) Antiphospholipid antibodies enhance rat neonatal cardiomyocyte apoptosis in an in vitro hypoxia/reoxygenation injury model via p38 MAPK. Cell Death Dis 8:e2549. https://doi.org/10.1038/cddis.2016.235 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Hao M, Zhu S, Hu L, Zhu H, Wu X, Li Q (2017) Myocardial ischemic postconditioning promotes autophagy against ischemia reperfusion injury via the activation of the nNOS/AMPK/mTOR pathway. Int J Mol Sci 18. https://doi.org/10.3390/ijms18030614
- 17.Di Napoli P, Di Giovanni P, Gaeta MA, D’Apolito G, Barsotti A (2007) Beneficial effects of trimetazidine treatment on exercise tolerance and B-type natriuretic peptide and troponin T plasma levels in patients with stable ischemic cardiomyopathy. Am Heart J 154:602.e601–602.e605CrossRefGoogle Scholar
- 19.Ramezani-Aliakbari F, Badavi M, Dianat M, Mard SA, Ahangarpour A (2018) The beneficial effects of trimetazidine on reperfusion-induced arrhythmia in diabetic rats. Exp Clin Endocrinol Diabetes. https://doi.org/10.1055/s-0043-122881
- 21.Wu Q, Qi B, Liu Y, Cheng B, Liu L, Li Y, Wang Q (2013) Mechanisms underlying protective effects of trimetazidine on endothelial progenitor cells biological functions against H2O2-induced injury: involvement of antioxidation and Akt/eNOS signaling pathways. Eur J Pharmacol 707:87–94CrossRefPubMedGoogle Scholar
- 23.Khan M, Meduru S, Mostafa M, Khan S, Hideg K, Kuppusamy P (2010) Trimetazidine, administered at the onset of reperfusion, ameliorates myocardial dysfunction and injury by activation of p38 mitogen-activated protein kinase and Akt signaling. J Pharmacol Exp Ther 333:421–429CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Zaouali MA, Boncompagni E, Reiter RJ, Bejaoui M, Freitas I, Pantazi E, Folch-Puy E, Abdennebi HB, Garcia-Gil FA, Rosello-Catafau J (2013) AMPK involvement in endoplasmic reticulum stress and autophagy modulation after fatty liver graft preservation: a role for melatonin and trimetazidine cocktail. J Pineal Res 55:65–78CrossRefPubMedGoogle Scholar
- 31.Pantos C, Bescond-Jacquet A, Tzeis S, Paizis I, Mourouzis I, Moraitis P, Malliopoulou V, Politi ED, Karageorgiou H, Varonos D et al (2005) Trimetazidine protects isolated rat hearts against ischemia-reperfusion injury in an experimental timing-dependent manner. Basic Res Cardiol 100:154–160CrossRefPubMedGoogle Scholar
- 33.Dehina L, Vaillant F, Tabib A, Bui-Xuan B, Chevalier P, Dizerens N, Bui-Xuan C, Descotes J, Blanc-Guillemaud V, Lerond L et al (2013) Trimetazidine demonstrated cardioprotective effects through mitochondrial pathway in a model of acute coronary ischemia. Naunyn Schmiedeberg’s Arch Pharmacol 386:205–215CrossRefGoogle Scholar