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      Cardioprotective effect of antioxidant combination therapy: A highlight on MitoQ plus alpha-lipoic acid beneficial impact on myocardial ischemia-reperfusion injury in aged rats

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          Abstract

          Objective

          (s): Considering the poor prognosis of ischemic heart disease and the diminished effectiveness of cardioprotective interventions in the elderly, it becomes necessary to investigate the interaction of aging with protection during myocardial ischemia/reperfusion injury (IRI). This study was conducted to assess the impact of mitoquinone (MitoQ) and alpha-lipoic acid (ALA) preconditioning on cardioprotection following IRI in aged rats.

          Methods

          Fifty aged male Wistar rats (22–24 months old) were divided into five groups including Sham, IR, and treatment groups receiving ALA and/or MitoQ. Treatment groups were received 100 mg/kg/day ALA by oral gavage and/or 10 mg/kg/day MitoQ by intraperitoneal injection for 14 consecutive days. An in vivo model of myocardial IRI was established through ligation of coronary artery for 30 min and it's reopening for 24 h. The left ventricles were removed at the end of reperfusion to assess oxidative stress indicators, mitochondrial function, and expression of mitochondrial dynamic genes. Myocardial infarct size (IS), hemodynamic parameters, and serum lactate dehydrogenase (LDH) level were also measured.

          Results

          Combination of MitoQ and ALA reduced oxidative stress, LDH level, and IS in aged hearts subjected to IRI. It also enhanced mitochondrial function and upregulated Mfn1, Mfn2, and Foxo1 and downregulated Drp1 and Fis1 gene expression. Co-administration of MitoQ and ALA partially restored IRI-induced hemodynamic changes to normal state. In all measured parameters, the effect of combined treatment was greater than monotherapies.

          Conclusion

          The combination therapy of MitoQ and ALA demonstrated considerable therapeutic potential in protecting the aging heart against IRI by improving oxidative stress, mitochondrial function, and dynamics in aged rats.

          Graphical abstract

          Highlights

          • Ischemia/reperfusion injury increased the infarct size and oxidative stress and reduced mitochondrial function in aged heart.

          • Combination of mitoquinone and alpha-lipoic acid was able to exert greater cardioprotective impacts.

          • Improvement of mitochondria-targeting antioxidants may play a role in the effect of combination therapy in aging.

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          Most cited references57

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          Animal and human studies with the mitochondria-targeted antioxidant MitoQ.

          As mitochondrial oxidative damage contributes to a wide range of human diseases, antioxidants designed to be accumulated by mitochondria in vivo have been developed. The most extensively studied of these mitochondria-targeted antioxidants is MitoQ, which contains the antioxidant quinone moiety covalently attached to a lipophilic triphenylphosphonium cation. MitoQ has now been used in a range of in vivo studies in rats and mice and in two phase II human trials. Here, we review what has been learned from these animal and human studies with MitoQ.
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            Lipoic acid metabolism and mitochondrial redox regulation

            Lipoic acid is an essential cofactor for mitochondrial metabolism and is synthesized de novo using intermediates from mitochondrial fatty-acid synthesis type II, S -adenosylmethionine and iron–sulfur clusters. This cofactor is required for catalysis by multiple mitochondrial 2-ketoacid dehydrogenase complexes, including pyruvate dehydrogenase, α-ketoglutarate dehydrogenase, and branched-chain ketoacid dehydrogenase. Lipoic acid also plays a critical role in stabilizing and regulating these multienzyme complexes. Many of these dehydrogenases are regulated by reactive oxygen species, mediated through the disulfide bond of the prosthetic lipoyl moiety. Collectively, its functions explain why lipoic acid is required for cell growth, mitochondrial activity, and coordination of fuel metabolism.
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              Chronic Supplementation With a Mitochondrial Antioxidant (MitoQ) Improves Vascular Function in Healthy Older Adults

              Excess reactive oxygen species production by mitochondria is a key mechanism of age-related vascular dysfunction. Our laboratory has shown that supplementation with the mitochondrial-targeted antioxidant MitoQ improves vascular endothelial function by reducing mitochondrial reactive oxygen species and ameliorates arterial stiffening in old mice, but the effects in humans are unknown. Here we sought to translate our preclinical findings to humans and determine the safety and efficacy of MitoQ. Twenty healthy older adults (60–79 years) with impaired endothelial function (brachial artery flow-mediated dilation <6%) underwent six weeks of oral supplementation with MitoQ (20 mg/day) or placebo in a randomized, placebo-controlled, double-blind, crossover design study. MitoQ was well tolerated and plasma MitoQ was higher after the treatment vs. placebo period (P<0.05). Brachial artery flow-mediated dilation was 42% higher after MitoQ vs. placebo (P<0.05); the improvement was associated with amelioration of mitochondrial reactive oxygen species-related suppression of endothelial function (assessed as the increase in flow-mediated dilation with acute, supra-therapeutic MitoQ [160 mg] administration, n=9, P<0.05). Aortic stiffness (carotid-femoral pulse wave velocity) was lower after MitoQ vs. placebo (P<0.05) in participants with elevated baseline levels (carotid-femoral pulse wave velocity >7.60 m/s, n=11). Plasma oxidized low-density lipoprotein, a marker of oxidative stress, also was lower after MitoQ vs. placebo (P<0.05). Participant characteristics, endothelium-independent dilation (sublingual nitroglycerin) and circulating markers of inflammation were not different (all P>0.1). These findings in humans extend earlier preclinical observations and suggest that MitoQ and other therapeutic strategies targeting mitochondrial reactive oxygen species may hold promise for treating age-related vascular dysfunction.
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                Author and article information

                Contributors
                Journal
                Heliyon
                Heliyon
                Heliyon
                Elsevier
                2405-8440
                14 March 2024
                30 March 2024
                14 March 2024
                : 10
                : 6
                : e28158
                Affiliations
                [a ]Drug Applied Research Center, Tabriz University of Medical Sciences, Iran
                [b ]Student Research Committee, Tabriz University of Medical Sciences, Iran
                [c ]Department of Physiology, Faculty of Medicine, Tabriz University of Medical Sciences, Iran
                [d ]Molecular Medicine Research Center, Tabriz University of Medical Sciences, Iran
                [e ]Physiology Research Center, Semnan University of Medical Sciences, Iran
                Author notes
                [* ]Corresponding author. Physiology, Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. badalzadeh.r@ 123456tbzmed.ac.ir reza.badalzadeh@ 123456gmail.com
                Article
                S2405-8440(24)04189-6 e28158
                10.1016/j.heliyon.2024.e28158
                10957437
                38524576
                c5d601ef-5e48-4d83-a0c1-62ad33fa4408
                © 2024 Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 12 November 2023
                : 12 March 2024
                : 13 March 2024
                Categories
                Research Article

                cardioprotection,ischemia,aging,mitochondria,oxidative stress,combination therapy

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