A novel cardioprotective agent in cardiac transplantation: metformin activation of AMP-activated protein kinase decreases acute ischemia-reperfusion injury and chronic rejection

Yale J Biol Med. 2011 Dec;84(4):423-32.

Abstract

The main cause of mortality after the first year from cardiac transplantation is cardiac allograft vasculopathy (CAV), which leads to chronic rejection of the heart. To improve long-term outcomes in cardiac transplantation, treatments to prevent or diminish CAV are actively being researched. Ischemia-reperfusion (I-R) injury has been shown to be the strongest alloantigen-independent factor in the development of CAV. Here, we investigate the use of metformin in murine cardiac transplantation models as a novel cardioprotective agent to limit acute I-R injury and subsequent chronic rejection. We show that metformin treatment activates AMP-activated kinase (AMPK) in vitro and in vivo. In the acute transplantation model, metformin activation of AMPK resulted in significantly decreased apoptosis in cardiac allografts on postoperative day (POD) 1 and 8. In the chronic transplantation model, metformin pretreatment of allografts led to significantly improved graft function and significantly decreased CAV, as measured on POD 52. Taken together, our results in the acute and chronic rejection studies suggest a potential cardioprotective mechanism for metformin; we demonstrate a correlation between metformin-induced decrease in acute I-R injury and metformin-related decrease in chronic rejection. Thus, one of the ways by which metformin and AMPK activation may protect the transplanted heart from chronic rejection is by decreasing initial I-R injury inherent in donor organ preservation and implantation. Our findings suggest novel therapeutic strategies for minimizing chronic cardiac rejection via the use of metformin- and AMPK-mediated pathways to suppress acute I-R injury.

Keywords: AMPK; I-R injury; Metformin; acute rejection; apoptosis; cardiac transplantation; chronic rejection.

MeSH terms

  • AMP-Activated Protein Kinases / metabolism*
  • Aminoimidazole Carboxamide / analogs & derivatives
  • Aminoimidazole Carboxamide / pharmacology
  • Animals
  • Apoptosis / drug effects
  • Cardiotonic Agents / pharmacology
  • Cardiotonic Agents / therapeutic use*
  • Endothelial Cells / drug effects
  • Endothelial Cells / enzymology
  • Enzyme Activation / drug effects
  • Graft Rejection / drug therapy*
  • Graft Rejection / enzymology
  • Graft Rejection / pathology
  • Heart Transplantation*
  • Metformin / pharmacology
  • Metformin / therapeutic use*
  • Mice
  • Mice, Inbred C57BL
  • Reperfusion Injury / drug therapy*
  • Reperfusion Injury / enzymology*
  • Reperfusion Injury / pathology
  • Ribonucleotides / pharmacology
  • Signal Transduction / drug effects
  • Transplantation, Homologous

Substances

  • Cardiotonic Agents
  • Ribonucleotides
  • Aminoimidazole Carboxamide
  • Metformin
  • AMP-Activated Protein Kinases
  • AICA ribonucleotide