Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Abstract

Background: Extracorporeal cardiac shock waves (ECSW) have great potential in the treatment of coronary heart disease. Endothelial progenitor cells (EPCs) are a class of pluripotent progenitor cells derived from bone marrow or peripheral blood, which have the capacity to migrate to ischemic myocardium and differentiate into mature endothelial cells and play an important role in neovascularization and endothelial repair. In this study, we investigated whether ECSW therapy can improve EPCs dysfunction and apoptosis induced by hypoxia and explored the underlying mechanisms.Methods: EPCs were separated from ApoE gene knockout rat bone marrow and identified using flow cytometry and fluorescence staining. EPCs were used to produce in vitro hypoxia-injury models which were then divided into six groups: Control, Hypoxia, Hypoxia + ECSW, Hypoxia + LY294002 + ECSW, Hypoxia + MK-2206 + ECSW, and Hypoxia + L-NAME + ECSW. EPCs from the Control, Hypoxia, and Hypoxia + ECSW groups were used in mRNA sequencing reactions. mRNA and protein expression levels were analyzed using qRT-PCR and western blot analysis, respectively. Proliferation, apoptosis, adhesion, migration, and angiogenesis were measured using CCK-8, flow cytometry, gelatin, transwell, and tube formation, respectively. Nitric oxide (NO) levels were measured using an NO assay kit.Results: Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis showed that differentially expressed genes were enriched in cancer signaling, PI3K-Akt signaling, and Rap1 signaling pathways. We selected differentially expressed genes in the PI3K-Akt signaling pathway and verified them using a series of experiments. The results showed that ECSW therapy (500 shots at 0.09 mJ/mm2) significantly improved proliferation, adhesion, migration, and tube formation abilities of EPCs following hypoxic injury, accompanied by upregulation of p-PI3K, p-Akt, p-eNOS, Bcl-2 protein and NO, PI3K, and Akt mRNA expression, and downregulation of Bax and Caspase3 protein expression. All these effects of ECSW were eliminated using inhibitors specific to PI3K (LY294002), Akt (MK-2206), and eNOS (L-NAME).Conclusion: ECSW exerted a strong repaired effect on EPCs suffering inhibited hypoxia injury by inhibiting cell apoptosis and promoting angiogenesis, mainly through activating the PI3K/Akt/eNOS signaling pathway, which provide new evidence for ECSW therapy in CHD.

Effects of Cavitation from Extracorporeal Shock Wave Combined with Sulfur Hexafluoride Microbubble on Myocardial Ultrastructure in Rats

“…The focal pressure can reach 3~75 MPa, the frequency of the SW is 0.1~0.2 MHz, and the energy flow density is 0.005~0.640 mJ/mm 2 , which is only 1/10 of the extracorporeal lithotripsy energy. 16 The sulfur hexafluoride MB consists of a sulfur hexafluoride gas core and an external phospholipid shell, with a diameter of about 2.5 μm. 17 Sulfur hexafluoride MB can display 2 states in the application process, stable cavitation, and inertial cavitation.…”

Principle and design of clinical efficacy observation of extracorporeal cardiac shock wave therapy for patients with myocardial ischemia-reperfusion injury: A prospective randomized controlled trial protocol

“…Our previous studies confirmed that the cardioprotective effects of Vitro cardiac shock therapy are primarily achieved by promoting the proliferation, mobilization, and activation of endothelial progenitor cells [26]. Subsequent studies further found that ECSW treatment (500 injections at 0.09 mJ/mm2) significantly improved cell viability, anti-apoptosis, migration, and tube formation of EPCs, which may be related to the promotion of downstream p-eNOS and anti-apoptotic protein Bcl-2 expression and inhibition of pro-apoptotic protein Bax and Cas-pase3 expression through PI3K/AKT and MEK/ERK signaling pathways [27,28].…”

Inhibition of Myocardial Cell Apoptosis Is Important Mechanism for Ginsenoside in the Limitation of Myocardial Ischemia/Reperfusion Injury

“…The PI3K/Akt signaling pathway is an important pathway by which ginsenosides improve apoptosis. The activation of this pathway promotes angiogenesis, alleviates tissue hypoxia, suppresses cell damage, and improves MC apoptosis ( Wang M. et al, 2021 ; Zhang J. et al, 2021 ; Cao et al, 2021 ). Evidence showed that ginsenoside Rb1, Rb3, Rb2/Rb3 combination, Rd, Rg1, Rg2, Rg3, Rh1, Rh2, Rk3 activated the PI3K/Akt-mediated signaling pathway ( Supplementary Table S1 ).…”