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Circulation Research. 2004
Published online before print July 8, 2004, doi: 10.1161/01.RES.0000138301.42713.18
A more recent version of this article appeared on August 20, 2004
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Submitted on September 17, 2003
Revised on June 25, 2004
Accepted on June 28, 2004

Program of Cell Survival Underlying Human and Experimental Hibernating Myocardium

Christophe Depre ; Song-Jung Kim ; Anna S. John ; Yan Hong Huang ; Ornella E. Rimoldi ; John R. Pepper ; Gilles D. Dreyfus ; Vinciane Gaussin ; Dudley J. Pennell ; Dorothy E. Vatner ; Paolo G. Camici ; and Stephen F. Vatner *

From the Department of Cell Biology and Molecular Medicine and the Cardiovascular Research Institute (C.D., S.-J.K., Y.H.H., V.G., D.E.V., S.F.V.), University of Medicine and Dentistry New Jersey, Newark; National Heart and Lung Institute (A.S.J., O.E.R., J.R.P., G.D.D., D.J.P., P.G.C.), Imperial College, London, UK; and Medical Research Council Clinical Sciences Centre (O.E.R., P.G.C.), London, UK.

* To whom correspondence should be addressed. E-mail: vatnersf{at}umdnj.edu.

Hibernating myocardium refers to chronically dysfunctional myocardium in patients with coronary artery disease in which cardiac viability is maintained and whose function improves after coronary revascularization. It is our hypothesis that long-term adaptive genomic mechanisms subtend the survival capacity of this ischemic myocardium. Therefore, the goal of this study was to determine whether chronic repetitive ischemia elicits a gene program of survival protecting hibernating myocardium against cell death. Accordingly, we measured the expression of survival genes in hibernating myocardium, both in patients surgically treated for hibernation and in a chronic swine model of repetitive ischemia reproducing the features of hibernation. Human hibernating myocardium was characterized by an upregulation of genes and corresponding proteins involved in anti-apoptosis (IAP), growth (VEGF, H11 kinase), and cytoprotection (HSP70, HIF-1{alpha}, GLUT1). In the swine model, the same genes and proteins were upregulated after repetitive ischemia, which was accompanied by a concomitant decrease in myocyte apoptosis. These changes characterize viable tissue, because they were not found in irreversibly injured myocardium. Our report demonstrates a novel mechanism by which the activation of an endogenous gene program of cell survival underlies the sustained viability of the hibernating heart. Potentially, promoting such a program offers a novel opportunity to salvage postmitotic tissues in conditions of ischemia.


Key words: gene expression • coronary artery disease • ischemia • stunning • hibernation




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