Diabetic hearts have lower basal urocortin levels that fail to increase after cardioplegic arrest: Association with increased apoptosis and postsurgical.

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Diabetic hearts have lower basal urocortin levels that fail to increase after cardioplegic arrest: Association with increased apoptosis and postsurgical cardiac dysfunction Carol Chen-Scarabelli, MSc, PhD, FAHA, Richard Knight, MD, PhD, Anastasis Stephanou, PhD, Gabriele Scarabelli, MD, Francesco Onorati, MD, PhD, Maddalena Tessari, MSc, PhD, Alessio Rungatscher, MD, Jagat Narula, MD, PhD, FAHA, MACC, Louis Saravolatz, MD, MACP, Alessandro Mazzucco, MD, Giuseppe Faggian, MD, Tiziano M. Scarabelli, MD, PhD, FAHA The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 5, Pages 2296-2308 (November 2014) DOI: 10.1016/j.jtcvs.2014.05.018 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Quantitative polymerase chain reaction of urocortin messenger RNA (mRNA) levels in cardiac samples collected before and after cardioplegic (CP) arrest from patients without diabetes mellitus (NDMPs) and patients with diabetes mellitus (DMPs). **P < .01 and *P < .05. B, Expression of the urocortin protein, as determined by Western blotting of extracts from pre- and post-CP atrial tissues. A total of 54 samples from DMPs (27 taken before cardioplegia and 27 after release of aortic crossclamping) and 44 samples from NDMPs (22 obtained before cardioplegia and 22 after release of aortic crossclamping) were processed. To obtain adequate amounts of protein and mRNA, the pre- and post-CP samples collected from 3 patients were combined and processed together, with the exception of 1 pre- and post-CP batch from NDMPs composed of 4 samples. The blot shown is representative of 3 different blots. Marker proteins with the indicated molecular masses were also used. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2296-2308DOI: (10.1016/j.jtcvs.2014.05.018) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Quantitative polymerase chain reaction of protein kinase C (PKC)ε urocortin messenger RNA (mRNA) levels from pre- and postcardioplegic (CP) myocardial samples from patients without (NDMPs) and with (DMPs) diabetes mellitus. **P < .01 and *P < .05. B, Expression of total and phosphorylated PKCε protein, as determined by Western blotting of extracts from nondiabetic and diabetic human hearts before and after CP arrest. A total of 54 samples from DMPs (27 taken before cardioplegia and 27 after release of aortic crossclamping) and 44 samples from NDMPs (22 obtained before cardioplegia and 22 after release of aortic crossclamping) were processed. To obtain adequate amounts of proteins and mRNA, pre- and post-CP samples collected from 3 different patients were combined and processed together, with the exception of 1 pre- and post-CP batch from NDMPs composed of 4 samples. The data shown are representative of 3 different experiments. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2296-2308DOI: (10.1016/j.jtcvs.2014.05.018) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Quantitative polymerase chain reaction of protein kinase C (PKC)δ urocortin messenger RNA (mRNA) levels from pre- and post-cardioplegic (CP) myocardial samples of patients without (NDMPs) and with (DMPs) diabetes mellitus. **P < .01 and *P < .05. B, Western blotting of extracts from nondiabetic and diabetic human hearts before and after cardioplegic arrest showing expression of total and phosphorylated PKCδ protein. A total of 54 samples from DMPs (27 taken before cardioplegia and 27 after release of aortic crossclamping) and 44 samples from NDMPs (22 obtained before cardioplegia and 22 after release of aortic crossclamping) were processed. To obtain adequate amounts of proteins and mRNA, pre- and postcardioplegic samples collected from 3 different patients were combined and processed together, with exception of 1 pre- and postcardioplegic batch from NDMPs composed of 4 samples. The data shown are representative of 3 different experiments. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2296-2308DOI: (10.1016/j.jtcvs.2014.05.018) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Occurrence of apoptotic cell death as assessed by terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL) staining at the end of cardioplegic (CP) arrest in myocardial sections from the hearts of patients without (NDMPs) and with (DMPs) diabetes mellitus. A total of 5 different sections for each collected sample were analyzed. Data are expressed as the mean ± standard deviation of 12 to 15 high-power fields. B, Nuclear and mitochondrial translocation of protein kinase C (PKC)δ in the human heart exposed to CP arrest as assessed by Western blotting in protein extracts from cardiac samples of NDMPs and DMPs collected before and after CP. Matrix protein p84, cytochrome oxidase subunit IV (COX IV), and actin were used as specific markers of the nuclear, mitochondrial, and cytosolic fractions, respectively. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2296-2308DOI: (10.1016/j.jtcvs.2014.05.018) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Two adjacent 5-μm myocardial sections serially cut from the same postcardioplegic wax block of a patient with diabetes. The sections were stained with (A) an antibody against urocortin (white asterisk) and rhodamine-based terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL) reagents (white arrow) or (B) an antibody against phosphorylated protein kinase C (PKC)δ (yellow arrow). Secondary antibodies conjugated with fluorescein were used to label the primary antibody against urocortin (A, bright green cytosol) and phosphorylated PKCδ (B, bright green nuclei). A, Urocortin-negative cells were TUNEL negative, but, (B) adjacent urocortin-negative cells with apoptotic nuclei stained red by TUNEL reagents also exhibited nuclear translocation of PKCδ. A total of 54 samples from diabetic patients (27 taken before cardioplegia and 27 after release of aortic crossclamping) and 44 samples from nondiabetic patients (22 obtained before cardioplegia and 22 after release of aortic crossclamping) were processed. Five different sections for each collected sample were analyzed. A and B, The images depicted were representative of 27 myocardial samples harvested from diabetic patients after cardioplegic arrest. Data are expressed as the mean ± standard deviation of 12 to 15 high-power fields. Myocardial sections from atrial tissues collected from a nondiabetic patient after cardioplegic arrest. C, The first section was stained with primary antibody against urocortin and a secondary antibody conjugated with fluorescein. Positive cells appear bright green. D, The second section was stained with 2 different primary antibodies (anti-cytochrome oxidase subunit IV [COX IV], a specific mitochondrial marker, and anti-phosphorylated PKCε) and finally counterstained with the nuclear marker TOPRO-3 (blue staining). COX IV stained bright red by a secondary antibody conjugated with rhodamine. E, PKCε stained bright green by a secondary antibody conjugated with fluorescein. F, An overlay of the 3 stains is shown. The percentage of co-localization of phosphorylated PKCε and mitochondria was digitally quantified using image analyzer software. D, Visually, an overlap of “green” phosphorylated PKCε and “red” mitochondria resulted in a bright orange fluorescent signal that could be observed in the merged images. Five different sections for each collected sample were analyzed. C-F, Representative images of 22 myocardial samples harvested from nondiabetic patients after cardioplegic arrest. Data are expressed as the mean ± standard deviation of 12 to 15 high-power fields. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 2296-2308DOI: (10.1016/j.jtcvs.2014.05.018) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions