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Int J Med Sci 2023; 20(12):1570-1583. doi:10.7150/ijms.83207 This issue Cite

Research Paper

High-dose remifentanil exacerbates myocardial ischemia-reperfusion injury through activation of calcium-sensing receptor-mediated pyroptosis

Yejing Zhu^1,2*, Jinyu Chi^3*, Shunv Cai^1,2, Siqi Liu^1,2, Junbo Yuan¹, Hongliang Xu^1✉, Huidan Zhou^1✉

1. Department of Anesthesiology, Zhejiang Cancer Hospital. Hangzhou, Zhejiang Province, 310022, China.
2. Laboratory of Anesthesia and Perioperative Medicine, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310018, China.
3. Department of Cardiology, First Affiliated Hospital of Harbin Medical University, No. 199 Dazhi Street, Harbin, 150001, China.
*These authors contributed equally to this work.

✉ Corresponding authors: Huidan Zhou, Department of Anesthesiology, Zhejiang Cancer Hospital. Hangzhou, Zhejiang Province, 310022, China. (E-mail address: zhouhdorg.cn); Hongliang Xu, Department of Anesthesiology, Zhejiang Cancer Hospital. Hangzhou, Zhejiang Province, 310022, China. (E-mail: Xuhlorg.cn) More

Abstract

Background: The aim of this study was to investigate whether calcium-sensing receptor (CaSR) was involved in HRF-mediated exacerbation of MI/R injury through NLRP3 inflammasome activation and pyroptosis.

Methods: In vivo, a rat MI/R model was established by ligating the left coronary artery, and short-term HRF exposure was induced during reoxygenation. Then, TUNEL, H&E, Masson staining, immunohistochemical (IHC) and serum levels of lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK), as well as the expression levels of CaSR and pyroptosis-related proteins in heart tissues, were measured. H9c2 cells were cultured to create a hypoxia/reoxygenation (H/R) model and exposed to different concentrations of RF. After pretreatment with the CaSR activator gadolinium chloride (GdCl₃) and inhibitor NPS2143 in the H/R model and treatment with HRF, we compared cellular viability, TUNEL, cytosolic [Ca²⁺]_i, the levels of LDH and CK, pyroptosis-related proteins and CaSR in H9c2 cells. We further researched the mechanisms of CaSR-mediated pyroptosis in the H/R+HRF model by CaSR-shRNA, Ac-YVAD-CMK, MCC950 and NAC.

Results: We found that HRF significantly increased CaSR expression, rate of cell death, levels of CK and LDH, and exacerbated pyroptosis in MI/R model. In vitro, HRF increased CaSR expression, decreased viability, enhanced cytosolic [Ca²⁺]_i and exacerbated pyroptosis in H/R cells. Pretreated with GdCl₃ worsen these changes, and NPS2143, MCC950, Ac-YVAD-CMK, NAC and sh-CaSR can reversed these effects.

Conclusion: Exposure to HRF for a short time exacerbates MI/R-induced injury by targeting CaSR to increase cytosolic [Ca²⁺]_i and ROS levels, which mediate the NLRP3 inflammasome and pyroptosis.

Keywords: High-dose remifentanil, CaSR, Myocardial ischemia-reperfusion, Pyroptosis, Reactive oxygen species.

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