Research indicates that SD elevates markers of myocardial injury and oxidative stress levels, thus becoming a risk factor for cardiovascular diseases (Jówko et al., 2018). SD also has a significant impact on the emergence of hypertension and morphological changes in the myocardium (Münzel et al., 2021). Contemporary epidemiological inquiries have shown that SD is strongly associated with the incidence of cardiovascular disease, accentuating the imperative for pharmacological interventions targeting SD-induced myocardial impairment. GAS can effectively inhibit various cardiovascular diseases, including myocardial ischemia/reperfusion injuries (Zhu et al., 2018). However, it is yet unclear how GAS contributes to myocardial damage brought on by SD. The study observed an aberrant rise in heart rates among the SD group. Meanwhile, the H&E staining results in the SD group also showed disturbed arrangement of cardiomyocytes in myocardial tissues, uneven cytoplasmic coloring, myocardial fibers were seen to be broken, and the nuclei of cardiomyocytes in the damaged area were solidified. After GAS treatment, the heart rate of the mice decreased and returned to normal. Correspondingly, myocardial injury in mice was improved after GAS treatment, especially in the GAS 25 mg/kg group, where the cardiomyocytes were neatly aligned, with clear boundaries, uniformly colored cytoplasm, and centered nuclei. The myocardial fibers were regular, and no fracture was observed.
LDH, an indicator of myocardial injury, abounds in myocardial tissues and is liberated into the bloodstream consequent to myocardial damage (Xia and Sun, 2023). CK is also a marker of myocardial infarction and its total activity is commonly used to assess the extent of myocardial injury (Zhou et al., 2024). SOD operates as an antioxidative enzyme, fortifying cells against oxidative harm. Increased MDA levels signify cellular membrane compromise resulting from oxidative stress, closely linked to cardiovascular disease progression (Amin et al., 2018). GSH is an intrinsic antioxidant that reduces oxidative stress damage during ferroptosis (Xia et al., 2024). The absorption, transportation, storage, and utilization of ferric ions all affect the susceptibility to ferroptosis. Extracellular Fe3+ enters the intracellular and is converted to Fe2+. Excessive intracellular Fe2+ will react to produce hydroxyl radicals thereby damaging the cell membrane and leading to the onset of cellular ferroptosis (Dixon and Olzmann, 2024). To substantiate the myocardial impairment engendered by SD, we assessed myocardial injury, oxidative stress markers, and Fe2+ levels. discovering anomalously heightened concentrations of CK, LDH, MDA, and Fe2+ in sleep deprivation mice, alongside markedly diminished SOD and GSH levels. Treatment with GAS significantly reversed the abnormal changes in the above molecular markers and attenuated the level of oxidative stress in myocardial injury. Additionally, the study demonstrated the ability of GAS to attenuate sleep deprivation-induced myocardial injury in mice. Similarly, we evaluated the aforementioned markers and Fe2+ levels in an Erastin-induced ferroptosis model of H9c2 cells, finding increased CK, LD, MDA, and Fe2+ levels with reduced SOD and GSH levels in Erastin-treated H9c2 cells, while GAS rectified these deviations. Thus, our findings confirm the efficacy of GAS in ameliorating myocardial tissue and Erastin-induced H9c2 cell injury.
The morphological characteristics of ferroptosis are primarily manifested by ultrastructural changes in mitochondria (Otasevic et al., 2021). Ferroptosis is primarily characterized by the Fenton reaction caused by increased Fe2+ and the accumulation of ROS damage due to reduced GPX4 (Henning et al., 2022). Ferroptosis leads to mitochondrial damage and an increase in ROS in H9c2 cells, whereas GAS ameliorates mitochondrial morphological damage and reduces ROS accumulation in H9c2 cells. P53, serving as a pivotal transcription factor, plays an instrumental role in the pathogenesis and therapeutic approaches of cardiac disorders, mediating through anti-angiogenic activities, apoptotic induction, autophagy modulation, and metabolic regulation (Wang et al., 2023). Elevated levels of P53 occur in heart failure, myocardial injury, and a variety of other diseases (Evans and Mann, 2013, Su et al., 2021). It has been observed that myocardial infarction and cardiomyopathy are linked to reduced GPX4 expression, with the in vitro inhibition of GPX4 leading to ferroptosis. SIRT6 deficiency in mice leads to the occurrence of myocardial fibrosis, accompanied by an increase in P53 expression (Zhang et al., 2022). It has been shown that P53 mediates the suppression of SLC7A11 expression, thus inhibiting cystine transport, which is fundamental for GSH biosynthesis (Zeng et al., 2022). Cystine is a raw material for the synthesis of GSH, and a decrease in SLC7A11 leads to a block in cystine uptake indirectly leading to a decrease in GPX4 (Zhang et al., 2024).
SIRT6 emerges as a quintessential member of the Sirtuin family, endowed with capabilities to attenuate oxidative stress, counter cellular autophagy, avert apoptosis, and forestall cellular aging and tumorigenesis (Liu et al., 2021). Increasing studies have revealed the connection between SIRT6 and cardiac protection, highlighting its pivotal role in cardiomyocyte preservation(Liu et al., 2024). The deficiency of SIRT6 in mice results in myocardial mitochondrial damage akin to that observed in aged mice (Divya et al., 2024). Moreover, the overexpression of SIRT6 mitigates oxidative stress-induced damage and cardiotoxicity in myocardial cells induced by doxorubicin (DOX) (Pillai et al., 2021). Deficiency of SIRT6 leads to cardiomyocyte injury and mitochondrial dysfunction, whereas its overexpression attenuates various cardiovascular diseases, suggesting that it plays an indispensable role in cardiomyocyte viability (Divya et al., 2024). A particular study showed that that inhibiting the expression of SIRT6 protein exacerbates iron death mediated by P53 in acute lung injury in mice, while inhibition of P53 attenuates the exacerbation of iron death injury by inhibiting SIRT6 expression (Cao et al., 2023b). To explore the relationship between sirt6 and ferroptosis, we measured the expression of ferroptosis-related proteins. Western blot assays showed a decline in SIRT6, SLC7A11 and GPX4 protein levels, concurrently with an elevation in P53 expression. GAS exerted an influence on the aberrations induced by SD in SIRT6, SLC7A11, and GPX4 protein expressions within the mice myocardium, enhancing SIRT6, SLC7A11, and GPX4 levels but reducing P53 expressions. The same expression was observed in Erastin-induced H9c2 cells, where Erastin-induced a significant downregulation of SIRT6, SLC7A11, GPX4, and an upregulation of P53. Remarkably, GAS reversed Erastin induced abnormal changes in the above proteins in H9c2 cells.
To further explore the relationship between SIRT6, P53, and ferroptosis, as well as the influence of GAS on them. This study added the SIRT6 inhibitor, OSS, to Erastin-induced H9c2 cells to block SIRT6 activity. It was found that the therapeutic effect of GAS on Erastin-induced H9c2 cells was inhibited by the addition of OSS, and the expression of SIRT6, P53, SLC7A11, and GPX4 were restored to the level of the Erastin group. The above results suggest that GAS may regulate the expressions of P53, SLC7A11, and GPX4 by activating SIRT6 and thus inhibiting ferroptosis in cardiomyocytes.