Egr-1 functions as a master switch regulator of remote ischemic preconditioning-induced cardioprotection

  • M. BillahEmail author
  • A. Ridiandries
  • B. S. Rayner
  • U. K. Allahwala
  • A. Dona
  • L. M. Khachigian
  • R. Bhindi
Original Contribution


Despite improved treatment options myocardial infarction (MI) is still a leading cause of mortality and morbidity worldwide. Remote ischemic preconditioning (RIPC) is a mechanistic process that reduces myocardial infarction size and protects against ischemia reperfusion (I/R) injury. The zinc finger transcription factor early growth response-1 (Egr-1) is integral to the biological response to I/R, as its upregulation mediates the increased expression of inflammatory and prothrombotic processes. We aimed to determine the association and/or role of Egr-1 expression with the molecular mechanisms controlling the cardioprotective effects of RIPC. This study used H9C2 cells in vitro and a rat model of cardiac ischemia reperfusion (I/R) injury. We silenced Egr-1 with DNAzyme (ED5) in vitro and in vivo, before three cycles of RIPC consisting of alternating 5 min hypoxia and normoxia in cells or hind-limb ligation and release in the rat, followed by hypoxic challenge in vitro and I/R injury in vivo. Post-procedure, ED5 administration led to a significant increase in infarct size compared to controls (65.90 ± 2.38% vs. 41.00 ± 2.83%, p < 0.0001) following administration prior to RIPC in vivo, concurrent with decreased plasma IL-6 levels (118.30 ± 4.30 pg/ml vs. 130.50 ± 1.29 pg/ml, p < 0.05), downregulation of the cardioprotective JAK–STAT pathway, and elevated myocardial endothelial dysfunction. In vitro, ED5 administration abrogated IL-6 mRNA expression in H9C2 cells subjected to RIPC (0.95 ± 0.20 vs. 6.08 ± 1.40-fold relative to the control group, p < 0.05), resulting in increase in apoptosis (4.76 ± 0.70% vs. 2.23 ± 0.34%, p < 0.05) and loss of mitochondrial membrane potential (0.57 ± 0.11% vs. 1.0 ± 0.14%-fold relative to control, p < 0.05) in recipient cells receiving preconditioned media from the DNAzyme treated donor cells. This study suggests that Egr-1 functions as a master regulator of remote preconditioning inducing a protective effect against myocardial I/R injury through IL-6-dependent JAK–STAT signaling.


Myocardial Infarction Remote preconditioning JAK–STAT Egr-1 Interleukin-6 


Author contributions

All authors take responsibility for all aspects of the reliability and freedom of bias of the data presented and their discussed interpretation


This work was supported by Heart Research Australia. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of CardiologyKolling Institute, Northern Sydney Local Health DistrictSt LeonardsAustralia
  2. 2.Sydney Medical School NorthernUniversity of SydneySydneyAustralia
  3. 3.Vascular Biology and Translational Research, School of Medical SciencesUniversity of New South WalesSydneyAustralia
  4. 4.Inflammation Group, Heart Research InstituteUniversity of SydneySydneyAustralia
  5. 5.School of Life SciencesIndependent University BangladeshDhakaBangladesh

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