Objectives: The etiology of myocardial ischemia/reperfusion (I/R) injury is multifactorial, but activation of the innate immune system and the resulting inflammatory response are important components of I/R injury. The aim of this study was to investigate the protective effect of a hemoglobin-based oxygen carrier (HBOC) on cold I/R heart and to explore the underlying mechanisms. Methods: Isolated Sprague-Dawley rat hearts were perfused in the Langendorff mode. After 30 min of basal perfusion, rat hearts were arrested with histidine-tryptophan-ketoglutarate solution (HTKs) with or without an HBOC and hypothermically stored (4°C) for 9 or 14 h, followed by 2 h of reperfusion. Results: Compared with HTKs alone, the HBOC in HTKs greatly improved heart contraction and decreased infarct size, necrosis and apoptosis, which was related to the reduced expression of Toll-like receptor 2 (TLR 2), TLR 4, TNF-α, IL-1β and nuclear factor-ĸB (NF-ĸB) activation. Conclusions: Our results demonstrated that the HBOC protected isolated rat heart from cold I/R injury and this protection was associated with attenuation of the expression of the TLR 2 and TLR 4/NF-ĸB signaling pathway, which may down-regulate the inflammatory response.

1.
Yellon DM, Hausenloy DJ: Myocardial reperfusion injury. N Engl J Med 2007;357:1121–1135.
2.
Inserte J, Barrabes JA, Hernando V, Garcia Dorado D: Orphan targets for reperfusion injury. Cardiovasc Res 2009;83:169–178.
3.
Murphy E, Steenbergen C: Mechanisms underlying acute protection from cardiac ischemia-reperfusion injury. Physiol Rev 2008;88:581–609.
4.
Gustafsson AB, Gottlieb RA: Heart mitochondria: gates of life and death. Cardiovasc Res 2008;77:334–343.
5.
Saeed SA, Waqar MA, Zubairi AJ, et al: Myocardial ischaemia and reperfusion injury: reactive oxygen species and the role of neutrophil. J Coll Physicians Surg Pak 2005;15:507–514.
6.
Parish RC, Evans JD: Inflammation in chronic heart failure. Ann Pharmacother 2008;42:1002–1016.
7.
Miyake K: Innate immune sensing of pathogens and danger signals by cell surface Toll-like receptors. Semin Immunol 2007;19:3.
8.
Kaczorowski DJ, Mollen KP, Edmonds R, et al: Early events in the recognition of danger signals after tissue injury. J Leukoc Biol 2008;83:546.
9.
Mollen KP, Anand RJ, Tsung A, et al: Emerging paradigm: Toll-like receptor 4-sentinel for the detection of tissue damage. Shock 2006;26:430.
10.
Standl T, Freitag M, Burmeister MA, Horn EP, Wilhelm S, Am Esch JS: Hemoglobin-based oxygen carrier HBOC-201 provides higher and faster increase in oxygen tension in skeletal muscle of anemic dogs than do stored red blood cells. J Vasc Surg 2006;37:859–865.
11.
George I, Yi GH, Schulman, AR, Morrow BT, Cheng Y, Gu A, Zhang G, Oz MC, Burkhoff D, Wang JA: Polymerized bovine hemoglobin oxygen carrier preserves regional myocardial function and reduces infarct size after acute myocardial ischemia. Am J Physiol Heart Circ Physiol 2006;291:H1126–H1137.
12.
Li T, Li J, Liu J, Zhang P, Wu W, Zhou R, Li G, Zhang W, Yi M, Huang H: Polymerized placenta hemoglobin attenuates ischemia/reperfusion injury and restores the nitroso-redox balance in isolated rat heart. Free Radic Biol Med 2009;46:397–405.
13.
Li T, Liu J, Yang Q, Wu W, Zhang P, Yang J, Li J, Zhang W, Yang C: Polymerized placenta hemoglobin improves cardiac functional recovery and reduces infarction size of isolated rat heart. Artif Cells Blood Substit Immobil Biotechnol 2009;37:48–52.
14.
Yang J, Yang J, Ding JW, Chen LH, et al: Sequential expression of TLR4 and its effects on the myocardium of rats with myocardial ischemia-reperfusion injury. Inflammation 2008;31:304–312.
15.
Vandesompele J, De Preter K, Pattyn F, Poppe B, Van Roy N, De Paepe A: Accurate normalization of real-time quantitative RT-PCR data by geometric averaging of multiple internal control genes. Genome Biol 2006;3:RESEARCH0034.
16.
Caswell JE, Strange MB, Rimmer DM 3rd, Gibson MF, Cole P, Lefer DJA: Novel hemoglobin-based blood substitute protects against myocardial reperfusion injury. Am J Physiol Heart Circ Physiol 2005;288:H1796–H1801.
17.
Serruys P, Vranckx P, Slagboom T, Regar E, Meliga E, de Winter R, Heyndrickx G, Schuler G, van Remortel E, Dubé GP, Symons J: Haemodynamic effects, safety, and tolerability of haemoglobin-based oxygen carrier-201 in patients undergoing PCI for CAD. EuroIntervention 2008;3:600–609.
18.
Olofsson C, Nygards EB, Ponzer S, Fagrell B, Przybelski R, Keipert PE, Winslow N, Winslow RM: A randomized, single-blind, increasing dose safety trial of an oxygen-carrying plasma expander (Hemospan) administered to orthopaedic surgery patients with spinal anaesthesia. Transfus Med 2008;18:28–39.
19.
Yu B, Shahid M, Egorina EM, Sovershaev MA, et al: Endothelial dysfunction enhances vasoconstriction due to scavenging of nitric oxide by a hemoglobin-based oxygen carrier. Anesthesiology 2010;112:586–594.
20.
Li T, Yu R, Zhang HH, Wang H, Liang WG, Yang XM, Yang CM: A method for purification and viral inactivation of human placenta hemoglobin. Artif Cells Blood Substit Immobil Biotechnol 2006;34:175–188.
21.
Wu W, Yang Q, Li T, Zhang P, Zhou R, Yang C: Hemoglobin-based oxygen carriers combined with anticancer drugs may enhance sensitivity of radiotherapy and chemotherapy to solid tumors. Artif Cells Blood Substit Immobil Biotechnol 2009;37:163–165.
22.
You Z, Li T, Yang C, Wu H, Zeng Y: Comparison of the cardioprotective effect of deoxygenated hemoglobin-based oxygen carrier (HBOC) pretreatment and ischemia preconditioning. Artif Cells Blood Substit Immobil Biotechnol 2011;39:7–11.
23.
Asanuma H, Nakai K, Sanada S, Minamino T, Takashima S, et al: S-nitrosylated and pegylated hemoglobin, a newly developed artificial oxygen carrier, exerts cardioprotection against ischemic hearts. J Mol Cell Cardiol 2007;42:924–930.
24.
Burmeister MA, Rempf C, Standl TG, Rehberg S, Bartsch-Zwemke S, Krause T, Tuszynski S, Gottschalk A, Schulte am Esch J: Effects of prophylactic or therapeutic application of bovine haemoglobin HBOC-200 on ischaemia-reperfusion injury following acute coronary ligature in rats. Br J Anaesth 2005;95:737–745.
25.
O’Neill LAJ: How Toll-like receptors signal: what we know and what we don’t know. Curr Opin Immunol 2006;18:3–9.
26.
Oyama J, Blais C Jr, Liu X, et al: Reduced myocardial ischemia-reperfusion injury in Toll-like receptor 4-deficient mice. Circulation 2004;109:784.
27.
Sha Y, Zmijewski J, Xu Z, et al: HMGB1 develops enhanced proinflammatory activity by binding to cytokines. J Immunol 2008;180:2531.
28.
Liew FY, Xu D, Brint EK, O’Neill LAJ: Negative regulation of Toll-like receptor-mediated immune responses. Nat Rev Immunol 2005;5:446–458.
29.
Fialkow L, Wang Y, Downey GP: Reactive oxygen and nitrogen species as signaling molecules regulating neutrophil function. Free Radic Biol Med 2007;42:153–164.
30.
Kim JH, Na HJ, Kim CK, Kim JY, Ha KS, Lee H, et al: The nonprovitamin A carotenoid, lutein, inhibits NF-ĸB-dependent gene expression through redox-based regulation of the phosphatidylinositol 3-kinase/PTEN/Akt and NF-ĸB-inducing kinase pathways: role of H2O2 in NF-ĸB activation. Free Radic Biol Med 2008;45:885–896.
31.
Arslan F, De Kleijn DPV, Timmers L, Doevendans PA, Pasterkamp G: Bridging innate immunity and myocardial ischemia/reperfusion injury: the search for therapeutic targets. Curr Pharm Des 2008;14:1205–1216.
32.
Palm NW, Medzhitov R: Pattern recognition receptors and control of adaptive immunity. Immunol Rev 2009;227:221–233.
33.
Zahringer U, Lindner B, Inamura S, Heine H, Alexander C: TLR2 – promiscuous or specific? A critical re-evaluation of a receptor expressing apparent broad specificity. Immunobiology 2008;213:205–224.
34.
Aprahamian CJ, Lorenz RG, Harmon CM, Dimmit RA: Toll-like receptor 2 is protective of ischemia-reperfusion-mediated small-bowel injury in a murine model. Pediatr Crit Care Med 2008;9:105–109.
35.
Cavassani KA, Ishii M, Wen H, Schaller MA, Lincoln PM, Lukacs NW, et al: TLR3 is an endogenous sensor of tissue necrosis during acute inflammatory events. J Exp Med 2008;205:2609–2621.
36.
Khandoga AG, Khandoga A, Anders HJ, Krombach F: Postischemic vascular permeability requires both TLR-2 and TLR-4, but only TLR-2 mediates the transendothelial migration of leukocytes. Shock 2009;31:592–598.
37.
Ito I, Fukazawa J, Yoshida M: Post-translational methylation of high mobility group box 1 (HMGB1) causes its cytoplasmic localization in neutrophils. J Biol Chem 2007;282:16336–16344.
38.
Lambeth JD: NOX enzymes and the biology of reactive oxygen. Nat Rev Immunol 2004;4:181–189.
39.
Kazama H, Ricci JE, Herndon JM, Hoppe G, Green DR, Ferguson TA: Induction of immunological tolerance by apoptotic cells requires caspase-dependent oxidation of high-mobility group box-1 protein. Immunity 2008;29:21–32.
40.
Park HS, Jung HY, Park EY, Kim J, Lee WJ, Bae YS: Cutting edge: direct interaction of TLR4 with NAD(P)H oxidase 4 isozyme is essential for lipopolysaccharide-induced production of reactive oxygen species and activation of NF-kappa B. J Immunol 2004;173:3589–3593.
41.
Clarke SJ, Khaliulin I, Das M, Parker JE, Heesom KJ, Halestrap AP: Inhibition of mitochondrial permeability transition pore opening by ischemic preconditioning is probably mediated by reduction of oxidative stress rather than mitochondrial protein phosphorylation. Circ Res 2008;102:1082–1090.
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