This document was developed by a consensus conference initiated by Kristian Thygesen, MD, and Joseph S. Alpert, MD, after formal approval by Lars Ryden, MD, President of the European Society of Cardiology (ESC), and Arthur Garson, MD, President of the American College of Cardiology (ACC). All of the participants were selected for their expertise in the field they represented, with approximately one-half of the participants selected from each organization. Participants were instructed to review the scientific evidence in their area of expertise and to attend the consensus conference with prepared remarks. The first draft of the document was prepared during the consensus conference itself. Sources of funding appear in Appendix A. The recommendations made in this document represent the attitudes and opinions of the participants at the time of the conference, and these recommendations were revised subsequently. The conclusions reached will undoubtedly need to be revised as new scientific evidence becomes available. This document has been reviewed by members of the ESC Committee for Scientific and Clinical Initiatives and by members of the Board of the ESC who approved the document on April 15, 2000.

/pdf/myocardial-infarction-redefined-a-consensus-document-of-the-1purj3u22r.pdf

Myocardial infarction redefined - A consensus document of the Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction

Exosome secreted by MSC reduces myocardial ischemia/reperfusion injury.

Swynghedauw, Bernard. Molecular Mechanisms of Myocardial Remodeling. Physiol. Rev. 79: 215–262, 1999. — “Remodeling” implies changes that result in rearrangement of normally existing structures. Th...

Molecular Mechanisms of Myocardial Remodeling

Apoptosis is characterised by a series of typical morphological features, such as shrinkage of the cell, fragmentation into membrane-bound apoptotic bodies and rapid phagocytosis by neighbouring cells. This paper reviews the current knowledge on the molecular mechanisms of apoptosis as they relate to the morphologic hallmarks and their implications for the detection of apoptosis in cardiac tissue. Activation of cysteine proteases called caspases plays a major role in the execution of apoptosis. These proteases selectively cleave vital cellular substrates, which results in apoptotic morphology and internucleosomal fragmentation of DNA by selectively activated DNases. In response to several pro-apoptotic signals, mitochondria release caspase activating factors, that initiate an escalating caspase cascade and commit the cell to die. Members of the Bcl-2 oncoprotein family control mitochondrial events and are able to prevent, or induce, both apoptotic and non-apoptotic types of cell death. This suggests that different types of cell death share common mechanisms in the early phases, whereas activation of caspases determines the phenotype of cell death. Detection of apoptotic cells in tissue samples currently relies on the TUNEL assay. TUNEL-positive cardiomyocytes show morphological features of apoptosis and the typical ladder pattern in DNA electrophoresis. Thus, provided that the staining protocol is carefully standardised, this quantitative methodology provides reproducible results of the occurrence of cardiomyocyte apoptosis in cardiac samples. Recently, potentially more specific assays based on analysis of DNA fragmentation or demonstration of caspase activation have been developed. Applicability of these assays to demonstrate cardiomyocyte apoptosis should be tested.

Morphologic and biochemical hallmarks of apoptosis.

Cells can respond to stress in various ways ranging from the activation of survival pathways to the initiation of cell death that eventually eliminates damaged cells. Whether cells mount a protective or destructive stress response depends to a large extent on the nature and duration of the stress as well as the cell type. Also, there is often the interplay between these responses that ultimately determines the fate of the stressed cell. The mechanism by which a cell dies (i.e., apoptosis, necrosis, pyroptosis, or autophagic cell death) depends on various exogenous factors as well as the cell's ability to handle the stress to which it is exposed. The implications of cellular stress responses to human physiology and diseases are manifold and will be discussed in this review in the context of some major world health issues such as diabetes, Parkinson's disease, myocardial infarction, and cancer.

/pdf/cellular-stress-responses-cell-survival-and-cell-death-ucpcetstfo.pdf

Cellular Stress Responses: Cell Survival and Cell Death

Background After reopening of the infarct-related coronary artery, cardiomyocytes continue to die during reperfusion. The mechanisms of cell death have been subject to debate. We studied whether an apoptotic type of cell death occurs in human acute myocardial infarction (AMI). Methods and Results We studied myocardial samples of eight patients who died of AMI and had patent infarct-related arteries at autopsy. Six of the patients had received initially successful thrombolysis. Extensive formation of DNA strand breaks, the typical biochemical feature of apoptosis, was detected with the use of the in situ DNA end-labeling method. Apoptotic cardiomyocytes were observed particularly in the border zones of histologically infarcted myocardium, whereas very few apoptotic cells were present in the remote noninfarcted myocardium. Internucleosomal fragmentation was confirmed by agarose gel electrophoresis of DNA isolated from the representative myocardial areas. Conclusions This study provides evidence that in addi...

Apoptosis in Human Acute Myocardial Infarction

In the present study an in vitro model was developed and characterized for evaluation of the role of apoptosis in adult human testes. The samples came from adult men undergoing orchidectomy for prostate or testicular cancer. Segments of seminiferous tubules were isolated and incubated under serum-free conditions in the absence or presence of testosterone. Apoptosis was assessed by low mol wt DNA fragmentation (185-bp multiples) by use of 3′-end-labeled DNA, in situ end labeling, and morphological detection under light and electron microscopy. During the 4-h incubation, a 15-fold increase was seen in apoptotic DNA fragmentation. The extent of low mol wt DNA showed a time-dependent increase and reached a 20-fold intensity in 24 h of incubation compared to the level at 0 h. Apoptosis was significantly suppressed by testosterone concentrations of 10−7 and 10−6 mol/L during the first 4 h of incubation. Apoptotic cells were identified mainly as spermatocytes and occasionally as spermatids. We conclude that apop...

/pdf/testosterone-regulates-apoptosis-in-adult-human-seminiferous-32lm6i70uh.pdf

Testosterone regulates apoptosis in adult human seminiferous tubules in vitro.

The effects of 3 Gy local X-irradiation on the adult rat testis were studied together with exact determination of the radiation dose distribution in the testis. Seminiferous tubule segments were isolated 8-66 hours postirradiation (p.i.), squashed between a microscope slide and a coverslip, and the exact stage of the seminiferous epithelial cycle was identified under a phase-contrast microscope. The squash preparations were subjected to in situ end labeling (ISEL) for visualization and quantification of apoptotic cells. In controls, the highest numbers of apoptotic cells were scored in stages XII-XIV and I. In situ end-label staining of cells was observed in A 3 -A 4 spermatogonia, spermatocytes at zygotene, pachytene, and meiotic division phases, as well as in early spermatids. In irradiated testes, from 8 hours p.i. and onward, intermediate- and B-type spermatogonia were sensitive at stages II-VI. At 42 hours, in stage I, elevated numbers of degenerating spermatocytes were seen. Most of them had not undergone meiotic divisions at stage XIV and showed an apoptotic type of degeneration at stage I. At the time of irradiation, the cells were in stage XIII, suggesting that diakinetic spermatocytes are particularly sensitive to irradiation. Also, preleptotene-zygotene spermatocytes in stages VII-XII were sensitive to irradiation. Apoptotic-type of cell degeneration was confirmed by living cell squash preparations, electron microscopy, and DNA electrophoresis. In conclusion, irradiation may provide a useful model system for studying apoptosis, and its control in spermatogonia and meiotically dividing cells.

Kenth Henriksen

Papers

Apoptosis in Human Acute Myocardial Infarction

Testosterone regulates apoptosis in adult human seminiferous tubules in vitro.

Stage-specific apoptosis in the rat seminiferous epithelium : Quantification of irradiation effects