<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.1 20151215//EN" "https://jats.nlm.nih.gov/publishing/1.1/JATS-journalpublishing1.dtd">
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="research-article" dtd-version="1.0" specific-use="sps-1.6" xml:lang="en">
  <front>
    <journal-meta>
      <journal-id journal-id-type="nlm-ta">Arq Bras Cardiol</journal-id>
      <journal-id journal-id-type="publisher-id">abc</journal-id>
      <journal-title-group>
        <journal-title>Arquivos Brasileiros de Cardiologia</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Arq. Bras. Cardiol.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">0066-782X</issn>
      <issn pub-type="epub">1678-4170</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia - SBC</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v3">jCC7CPcS6vdnkdKDFrZhpRq</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v2">S0066-782X2017000700054</article-id>
      <article-id pub-id-type="doi">10.5935/abc.20170087</article-id>
      <article-id pub-id-type="publisher-id" specific-use="previous-pid">S0066-782X2017005011105</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Cardioprotective Effect of Crocin Combined with Voluntary Exercise in Rat: Role of Mir-126 and Mir-210 in Heart Angiogenesis</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Ghorbanzadeh</surname>
            <given-names>Vajihe</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Mohammadi</surname>
            <given-names>Mustafa</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Dariushnejad</surname>
            <given-names>Hassan</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Abhari</surname>
            <given-names>Alireza</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Chodari</surname>
            <given-names>Leila</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Mohaddes</surname>
            <given-names>Gisou</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
          <xref ref-type="corresp" rid="c1"/>
        </contrib>
        <aff id="aff1">
          <institution content-type="orgname">Tabriz University of Medical Sciences</institution>
          <institution content-type="orgdiv1">Drug Applied Research Center</institution>
          <addr-line>
            <named-content content-type="city">Tabriz</named-content>
          </addr-line>
          <country country="IR">Iran</country>
          <institution content-type="original">Drug Applied Research Center - Tabriz University of Medical Sciences, Tabriz - Iran</institution>
          <institution content-type="normalized">Tabriz University of Medical Sciences</institution>
        </aff>
      </contrib-group>
      <author-notes>
        <corresp id="c1"><bold>Mailing Address: Gisou Mohaddes</bold> Golgasht Ave. 5166614766. Meadle East. Tabriz - East Azarbaijan, Iran. E-mail: <email>gmohades@yahoo.com</email>
				</corresp>
        <fn fn-type="con">
          <p>
            <bold>Author contributions</bold>
          </p>
          <p>Conception and design of the research, Writing of the manuscript and Critical revision of the manuscript for intellectual content: Ghorbanzadeh V, Mohammadi M, Mohaddes G; Acquisition of data: Ghorbanzadeh V, Dariushnejad H, Abhari A, Chodari L; Analysis and interpretation of the data: Ghorbanzadeh V, Dariushnejad H, Abhari A; Statistical analysis:Ghorbanzadeh V, Dariushnejad H, Mohaddes G.</p>
        </fn>
        <fn fn-type="conflict">
          <p>
            <bold>Potential Conflict of Interest</bold>
          </p>
          <p>No potential conflict of interest relevant to this article was reported.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub">
        <day>29</day>
        <month>06</month>
        <year>2017</year>
      </pub-date>
      <pub-date pub-type="collection">
        <month>07</month>
        <year>2017</year>
      </pub-date>
      <volume>109</volume>
      <issue>01</issue>
      <fpage>54</fpage>
      <lpage>62</lpage>
      <history>
        <date date-type="received">
          <day>14</day>
          <month>07</month>
          <year>2016</year>
        </date>
        <date date-type="rev-recd">
          <day>20</day>
          <month>01</month>
          <year>2017</year>
        </date>
        <date date-type="accepted">
          <day>09</day>
          <month>03</month>
          <year>2017</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/" xml:lang="en">
          <license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
        </license>
      </permissions>
      <abstract>
        <title>Abstract</title>
        <sec>
          <title>Background:</title>
          <p>Crocin is reported to have a wide range of biological activities such as cardiovascular protection. Recent epidemiologic studies have shown that exercise reduces cardiovascular morbidity and mortality in the general population.</p>
        </sec>
        <sec>
          <title>Objective:</title>
          <p>The aim of this study was to evaluate the effect of crocin and voluntary exercise on miR-126 and miR-210 expression levels and angiogenesis in the heart tissue.</p>
        </sec>
        <sec>
          <title>Methods:</title>
          <p>Animals were divided into 4 groups: control, exercise, crocin, and exercise-crocin. Animals received oral administration of crocin (50 mg/kg) or performed voluntary exercise alone or together for 8 weeks. Akt, ERK1/2 protein levels, miR-126 and miR-210 expression were measured in the heart tissue. Immunohistochemical method was used to detect CD31 in the heart tissue.</p>
        </sec>
        <sec>
          <title>Results:</title>
          <p>Akt and ERK1/2 levels of the heart tissue were higher in crocin treated group and voluntary exercise trained group after 8 weeks. Combination of crocin and exercise also significantly enhanced Akt and ERK1/2 levels in the heart tissue. MiR-126, miR-210 expression and CD31 in the heart increased in both crocin and voluntary exercise groups compared with control group. In addition, combination of exercise and crocin amplified their effect on miR-126 and miR-210 expression, and angiogenesis.</p>
        </sec>
        <sec>
          <title>Conclusion:</title>
          <p>Crocin and voluntary exercise improve heart angiogenesis possibly through enhancement of miR-126 and miR-210 expression. Voluntary exercise and diet supplementation with crocin could have beneficial effects in prevention of cardiovascular disease.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="en">
        <title>Keywords:</title>
        <kwd>Rats</kwd>
        <kwd>Angiogenesis Modulating Agents</kwd>
        <kwd>Exercise</kwd>
        <kwd>Crocus Sativus</kwd>
        <kwd>Antioxidants</kwd>
        <kwd>miR-126</kwd>
        <kwd>miR-210</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec sec-type="intro">
      <title>Introduction</title>
      <p>Crocin is a bioactive constituent found in the fruits of gardenia and in the stigmas of saffron.<xref ref-type="bibr" rid="B1">1</xref> Crocin has long been used in traditional medicine and has been reported to have various pharmacological activities, such as antioxidant, anti-cancer, anti-inflammation, anti-atherosclerotic effects, and protection against cardiovascular diseases.<xref ref-type="bibr" rid="B2">2</xref> The cardioprotective effects of crocin has been reported in some studies that are related to modulation of endogenous antioxidant enzymatic activities and cardiac biomarkers.<xref ref-type="bibr" rid="B3">3</xref><sup>,</sup><xref ref-type="bibr" rid="B4">4</xref> Recent evidence has indicated the protective effect of crocin on hypoxic damage of myocardial cells by elevation of vascular endothelial growth factor (VEGF), as a proangiogenic factor.<xref ref-type="bibr" rid="B5">5</xref>
			</p>
      <p>Physical activity plays a critical role in metabolism, cardiovascular function, and immune function. In the last years it became evident that exercise training is a very powerful therapeutic strategy for prevention of development and progression of cardiovascular disease.<xref ref-type="bibr" rid="B6">6</xref> Nevertheless, exhaustive exercise may be problematic, as they are stressful through production of reactive oxygen species and can cause damage to muscle tissue and other organs.<xref ref-type="bibr" rid="B7">7</xref><sup>,</sup><xref ref-type="bibr" rid="B8">8</xref> It has been suggested that voluntary exercise may be a better model with more beneficial effects.<xref ref-type="bibr" rid="B9">9</xref> In the animal model of voluntary exercise, the animal has free access to a running wheel and uses the wheel according to its physiological threshold for physical activity. It has been discovered that physical activity triggers extension of the capillary network or angiogenesis. This process is known to be VEGF dependent.<xref ref-type="bibr" rid="B10">10</xref> However, the underlying mechanisms of exercise have yet to be fully elucidated.</p>
      <p>Micro-RNAs (miRs) are small non-coding 18-25 nucleotide RNAs that play a key role in regulating gene expression by inhibiting protein translation or enhancing messenger RNA degradation.<xref ref-type="bibr" rid="B11">11</xref><sup>,</sup><xref ref-type="bibr" rid="B12">12</xref> Their participation in cardiovascular disease has been recognized during recent years.<xref ref-type="bibr" rid="B11">11</xref><sup>-</sup><xref ref-type="bibr" rid="B13">13</xref> MiR-126 is one of the few miRNAs that is an endothelial cell-specific miRNA and plays an essential role in neoangiogenesis. MiRNA-126 is strongly expressed in the heart endothelium and targets Sprouty-related protein-1 (Spred-1), PIK3R2, a regulatory subunit of PI3K.<xref ref-type="bibr" rid="B14">14</xref><sup>,</sup><xref ref-type="bibr" rid="B15">15</xref> Downregulation of these targets activates survival kinases ERK and Akt and enhances the actions of vascular endothelial growth factor (VEGF).<xref ref-type="bibr" rid="B16">16</xref><sup>,</sup><xref ref-type="bibr" rid="B17">17</xref> VEGF exerts many of its effects on angiogenesis via the Akt and ERK1/2 pathways. During developmental vasculogenesis, the Akt pathway regulates venous specification, whereas the ERK pathway regulates arterial specification.<xref ref-type="bibr" rid="B18">18</xref><sup>,</sup><xref ref-type="bibr" rid="B19">19</xref> MiR-210 overexpression in normoxic endothelial cells stimulated the formation of capillary like structures as well as VEGF-driven cell migration.<xref ref-type="bibr" rid="B20">20</xref> MiR-210 induction is a virtually constant feature of the hypoxic response that is important in the pathogenesis of several human diseases, such as heart disease.<xref ref-type="bibr" rid="B21">21</xref>
			</p>
      <p>According to the advantage effects of crocin and voluntary exercise on diabetes that mentioned above, we hypothesized that, compared with crocin or voluntary exercise alone, 8 weeks of crocin combined with voluntary exercise in diabetic rats would produce a larger improvement in cardiovascular complications of type 2 diabetes. The present study was undertaken to clarify the effect of crocin and voluntary exercise on miR-126 and miR-210 expression in cardiac myocytes of diabetic rats.</p>
    </sec>
    <sec sec-type="methods">
      <title>Methods</title>
      <sec>
        <title>Animals</title>
        <p>Male Wistar rats (200-250g) were obtained from Tabriz medical faculty (Iran-Tabriz). Animals were housed in a room with a constant temperature of 24&#186;C, a relative humidity of 50%, and a 12h dark/light cycle with access to food and water ad libitum. Animals in the <italic>exercise group</italic> were placed in individual wheel-<italic>cage</italic> units while the sedentary <italic>group</italic>s were <italic>housed</italic> in normal plastic <italic>cages</italic>. This study was approved by the Animal Ethics Committee (document number 92197) in accordance with the instruction for the care and use of laboratory animals prepared by Tabriz University of Medical Sciences.</p>
      </sec>
      <sec>
        <title>Experimental design</title>
        <p>Forty animals were randomly divided into four groups. <italic>Ten animals were allocated</italic> to each experimental <italic>group a</italic>t the beginning of the study. Group 1: Rats received NaCl 0.9 % Solution as a control group (Con). Group 2: Rats received a single dose of crocin (50 mg/kg) for eight weeks (Cro). Group 3: Rats performed voluntary exercise for eight weeks (Exe). Group 4: Animals received crocin and simultaneously performed voluntary exercise for eight weeks (Cro-Exe).</p>
        <p>Crocin powder (Sigma, Germany) was diluted by normal saline (0.9%). Crocin was gavaged (50 mg/kg) 6 days a week for 8 weeks.<xref ref-type="bibr" rid="B22">22</xref> In addition, NaCl 0.9 % solution was gavaged in groups 1 and 3 during experiment.</p>
        <p>For the assessment of voluntary exercise, rats were housed individually in a cage containing a wheel (1.00 m circumference, TajhizGostar). Each exercising rat had a separate running wheel in its cage that allowed it to run voluntarily during 8 weeks of the study. This stainless-steel running wheel was equipped with a digital magnetic counter that was activated by wheel rotation and wheel revolutions were recorded daily. Then the running distance per day was calculated as the number of wheel revolutions each day. Rats with running distance lower than ~2000 m per day were eliminated before statistical analysis.<xref ref-type="bibr" rid="B23">23</xref> Considering the excluding criteria (exercise below standard protocols) statistical analysis was performed for 7 animals in each group.</p>
      </sec>
      <sec>
        <title>Quantification of Akt and ERK1/2 in heart by ELISA</title>
        <p>On the final day of experiment, rats were sacrificed under deep anesthesia with ketamine/xylazine (88/10 mg/kg, i.p.). Heart tissue immediately removed and washed with saline 0.9%. Tissue samples were weighted, homogenized in PBS (pH 7.2-7.4) and centrifuged for 20 min at the speed of 3000 rpm and 4&#186;C. Then supernatants were collected in new tube and Akt and ERK1/2 levels were measured using sandwich rat ELISA kits. The ELISA assay was performed according to the manufacturer's instructions. Akt protein activation by phosphorylation at serine residue 473 (P-Akt) and ERK1/2 phosphorylation (PT202/Y204) was assayed with ELISA (Akt: Cat. No. CK-E91385; Hangzhou Eastbiopharm Co., Ltd., Hangzhou, China. ERK1/2:Abcam Cambridge, UK) and normalized to the total protein concentration for each sample as determined by the Bradford assay.<xref ref-type="bibr" rid="B24">24</xref>
				</p>
      </sec>
      <sec>
        <title>Total RNA extraction, cDNA synthesis and real time PCR</title>
        <p>Expression of miR-126 and miR-210 was assessed by qRT-PCR. Triplicate assays were performed for each RNA sample. MicroRNA was extracted from the heart tissue using the miRCURYTM RNA Isolation Kit (Exiqon, Denmark) according to the manufacturer's protocol. The procedure was performed based on spin column using a proprietary resin as a separation matrix for RNA from other cell components. RNA content and purity were measured at a wavelength of 260-280 nm using Nanodrop 1000 spectrophotometer (Thermo scientific, Wilmington DE 19810 <italic>U</italic>SA).</p>
        <p>cDNA synthesis was done according to LNA universal RT miRNA PCR kit (Exiqon, Denmark). Briefly, total RNA containing microRNA was polyadenylated and cDNA was synthesized using a poly (T) primer with a 3' degenerate anchor and a 5' universal tag.</p>
        <p>Syber Green qPCR Mix purchased from Exiqon (denmark) and used for real time PCR. Real time PCR was done using Rotor-Gene 6000 Corbett. The 2<sup>-(&#916;&#916;Ct)</sup> method was used to determine relative quantitative levels of miR-126 and miR-210. The results were expressed as the fold-difference to the control group. Mir-1 was used as the endogenous control miRNA.</p>
      </sec>
      <sec>
        <title>Immunohistochemical assessments</title>
        <p>For the investigation of angiogenesis in the heart tissue, samples from left ventricle were immersed into 10% formalin after excision, embedded in paraffin, and cut into 4 &#181;m-thick slices. Sections were deparaffinized in xylene and dehydrated in a graded series of ethanol. Slides were incubated sequentially in proteinase K and treated by 0.3% hydrogen peroxide to block endogenous peroxidase activity. Sections were overlaid by primary antibody CD31 (Santa Cruz, USA) a marker of angiogenesis and incubated at +4&#186;C overnight. Sections were then washed and incubated with standard avidin-biotin complex (ABC; Santa Cruz) according to the manufacturer's instructions. Then, the slides were incubated in DAB (di-amino-benzidine, Santa Cruz), as the chromagen, and counterstained with Mayer's hematoxylin. Finally, sections were cleared in xylene, mounted with Entellan and assessed by light microscope (Olympus BX 40, Japan). Capillaries were visualized in the myocardium as a brown precipitate. Vascular structures positive for CD31 were counted for 5 to 6 slides per animal and 10 fields per slide.</p>
      </sec>
      <sec>
        <title>Statistical analysis</title>
        <p>Results are presented as mean &#177; SD. Statistical analysis was performed using SPSS version 21.0 statistical software for Windows. All parameters were tested for normality using the one-sample Kolmogorov-Smirnov test. Average daily running distances for rats in each exercise group were averaged for each week and were compared using repeated measures ANOVA. Physical activity between Exe and Cro-Exe groups was analyzed using independent t-test. For Akt, ERK, CD31, miR-126, and miR-210 parameters, data were analyzed using two-way ANOVA followed by Tukey's post hoc test. A <italic>p</italic>-value less than 0.05 was considered statistically significant.</p>
      </sec>
    </sec>
    <sec sec-type="results">
      <title>Results</title>
      <sec>
        <title>Voluntary exercise</title>
        <p>The <xref ref-type="fig" rid="f1">Figure 1</xref> illustrates the average running distance per week over the 8-week period of experiment. Animals ran voluntarily an average of 2.949 &#177; 178 m/week in the exercise group and an average of 3.090 &#177; 140 m/week in the crocin-exercise group. There was no significant difference in physical activity between Exe and Cro-Exe groups based on an independent t-test analysis.</p>
        <p>
          <fig id="f1">
            <label>Figure 1</label>
            <caption>
              <title>Running distance was averaged over each week of running wheel access (mean &#177; SD) for the 8-week duration of experiment, for both Exe and Cro-Exe groups (n = 7/group). There was no significant difference between groups. Animals in both Exe and Cro-Exe groups increased their average weekly running distance over the subsequent weeks. *p &lt; 0.05 indicates a significant difference between consecutive weeks in Exe group. #p &lt; 0.05 and ##p &lt; 0.01 indicate significant differences between consecutive weeks in Cro-Exe group.</title>
            </caption>
            <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf01.jpg"/></fig>
        </p>
        <p>Average running distance increased gradually in both Exe and Cro-Exe groups from first to eighth week. This increase in Exe group was significantly different from the prior week in fourth (p &lt; 0.05) and sixth (p &lt; 0.05) weeks. In Cro-Exe group, animals ran significantly more distance in second (p &lt; 0.01), third (p &lt; 0.01), fifth (p &lt; 0.05), and sixth (p &lt; 0.05) weeks than the prior week.</p>
      </sec>
      <sec>
        <title>Effects of crocin combined with voluntary exercise on Akt levels in the heart tissue</title>
        <p>After 8 weeks of administration of crocin or performing voluntary exercise, the level of p-Akt increased significantly in Exe (p &lt; 0.01), Cro (p &lt; 0.01) and Cro-Exe (p &lt; 0.001) groups in comparison with Con group (<xref ref-type="fig" rid="f2">Figure 2</xref>). A comparison between the Cro-Exe group with Exe and Cro groups exhibited significant difference among these groups (p &lt; 0.01 and p &lt; 0.001, respectively).</p>
        <p>
          <fig id="f2">
            <label>Figure 2</label>
            <caption>
              <title>Effect of crocin and voluntary exercise on p-Akt levels. Data are shown as mean &#177; SD for n = 7 animals. <sup>***</sup>p &lt; 0.001 and <sup>**</sup>p &lt; 0.01 indicate significant differences with control group,<sup>$$$</sup>p &lt; 0.001 indicates a significant difference with Cro group, and <sup>##</sup>p &lt; 0.01 indicates a significant difference with Exe group.</title>
            </caption>
            <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf02.jpg"/></fig>
        </p>
      </sec>
      <sec>
        <title>Effects of crocin combined with voluntary exercise on ERK1/2 levels in the heart tissue</title>
        <p>Two-way ANOVA showed that the p-ERK1/2 levels were significantly higher in rats treated with crocin or voluntary exercise than in control rats (Exe: p &lt; 0.01, Cro: p &lt; 0.05, and Cro-Exe: p &lt; 0.001). Administration of crocin combined with exercise significantly increased p-ERK1/2 levels of the heart tissue compared to Exe (p &lt; 0.01) and Cro (p &lt; 0.001) groups (<xref ref-type="fig" rid="f3">Figure 3</xref>). <xref ref-type="fig" rid="f2">Figure 2</xref> also indicates that crocin combined with voluntary exercise has a synergistic effect in p-ERK1/2 protein levels in heart tissue.</p>
        <p>
          <fig id="f3">
            <label>Figure 3</label>
            <caption>
              <title>Effect of crocin and voluntary exercise on p-ERK1/2 levels. Data are shown as mean &#177; SD for n = 7 animals.<sup>*</sup>p &lt; 0.05, <sup>**</sup>p &lt; 0.01, and <sup>***</sup>p &lt; 0.001 indicate significant differences with control group. <sup>$$$</sup>p &lt; 0.001 indicates a significant difference with Cro group and <sup>##</sup>p &lt; 0.01 indicates a significant difference with Exe group.</title>
            </caption>
            <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf03.jpg"/></fig>
        </p>
      </sec>
      <sec>
        <title>Effects of crocin combined with voluntary exercise on miR-126 expression in the heart tissue</title>
        <p>Two-way ANOVA showed that the miR-126 expression were significantly higher in rats treated with crocin (p &lt; 0.001), voluntary exercise (p &lt; 0.01) and crocin combination with exercise (p &lt; 0.001) than in control rats. In the rats that underwent voluntary exercise and simultaneously received crocin for 8 weeks, expression of heart miR-126 significantly increased compared with Exe (p &lt; 0.01), and Cro (p &lt; 0.001) groups (<xref ref-type="fig" rid="f4">Figure 4</xref>).</p>
        <p>
          <fig id="f4">
            <label>Figure 4</label>
            <caption>
              <title>Effect of crocin and voluntary exercise on miR-126 expression levels. Data are shown as mean &#177; SD for n = 7 animals. <sup>**</sup>p &lt; 0.01 and <sup>***</sup>p &lt; 0.001 indicate significant differences with control group. <sup>$$$</sup>p &lt; 0.001 indicates a significant difference with Cro group and <sup>##</sup>p &lt; 0.01 indicates a significant difference with Exe group.</title>
            </caption>
            <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf04.jpg"/></fig>
        </p>
      </sec>
      <sec>
        <title>Effects of crocin combined with voluntary exercise on miR-210 expression in the heart tissue</title>
        <p>As shown in <xref ref-type="fig" rid="f5">Figure 5</xref>, following crocin administration and exercise performing, the heart expression level of miR-210 was significantly upregulated in Cro and Exe groups when compared to control group (p &lt; 0.01 and p &lt; 0.001, respectively). On the other hand, the expression of miR-210 increased significantly in Cro-Exe group compared with control group (p &lt; 0.001). In addition, there is a significant difference between Cro-Exe and Cro groups (p &lt; 0.01).</p>
        <p>
          <fig id="f5">
            <label>Figure 5</label>
            <caption>
              <title>Effect of crocin and voluntary exercise on miR-210 expression levels. Data are shown as mean &#177; SD for n = 7 animals. <sup>**</sup>p &lt; 0.01 and <sup>***</sup>p &lt; 0.001 indicate significant differences with control group and <sup>$$$</sup>p &lt; 0.001 indicates a significant difference with Cro group.</title>
            </caption>
            <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf05.jpg"/></fig>
        </p>
      </sec>
      <sec>
        <title>Effects of crocin combined with voluntary exercise on CD31<sup>+</sup> cells in myocardial capillary network</title>
        <p>As demonstrated in <xref ref-type="fig" rid="f6">figure 6</xref>, number of CD31<sup>+</sup> cells were higher in animals that received crocin (p &lt; 0.05) or performed exercise (p &lt; 0.05) compared with control group (<xref ref-type="fig" rid="f6">Figures 6A</xref>, <xref ref-type="fig" rid="f6">B</xref>, <xref ref-type="fig" rid="f6">C</xref>). In addition, CD31<sup>+</sup> cells were significantly higher in sections from the heart of Cro-Exe group than Exe (p &lt; 0.01) and Cro (p &lt; 0.01) groups (<xref ref-type="fig" rid="f6">Figure 6D</xref>). Thus, crocin combination with voluntary exercise appears to enhance vasculogenic response.</p>
        <p>
          <fig id="f6">
            <label>Figure 6</label>
            <caption>
              <title>A) Representative images of CD31 staining (brown) in cardiac vessels of control, exercise, crocin and exercise-crocin groups (Magnification &#215;400). A: Con, B: Exe, C: Cro, D: Cro-Exe. B) Microvessel density was analyzed by immunohistochemistry for CD31. Microvessel density was quantified using 6 slides per animal and 10 fields per slide. Data are shown as mean &#177; SD for n = 7 animals. ***p &lt; 0.001 indicates a significant difference with control group. ###p &lt; 0.001 and $$$p &lt; 0.001 indicate significant differences with exercise group and crocin group, respectively.</title>
            </caption>
            <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf06.jpg"/></fig>
        </p>
      </sec>
    </sec>
    <sec sec-type="discussion">
      <title>Discussion</title>
      <p>In the present study, we demonstrated that miR-126 and miR-210 expression of rat cardiac tissue increased in crocin, voluntary exercise, and exercise-crocin groups. In addition, crocin and voluntary exercise stimulated Akt and ERK1/2 proteins and angiogenesis in the heart tissue. For the first time, our study demonstrated that heart miR-126 and its related pathways including Akt and ERK1/2 upregulated in response to crocin combined with voluntary exercise in rats. Furthermore, our findings showed that crocin administration and voluntary exercise performing increased the expression of heart miR-210.</p>
      <p>MiR-210, a hypoxia-specific miRNA, depends on HIF activation and upregulated after hypoxia.<xref ref-type="bibr" rid="B25">25</xref> When miR-210 is overexpressed in endothelial cells, the ability of these cells to form blood vessels becomes pronounced, more than that of cells with normal levels of expression. Confirming miR-210 proangiogenic role, up-regulation of miR-210 in CD34+ cells increased tissue perfusion and capillary density in a mouse model of hind limb ischemia.<xref ref-type="bibr" rid="B26">26</xref> Previous research has indicated that miR-210 may improve angiogenesis through the negative regulation of its target gene, ephrin A3, which is an important member of the ephrin angiogenesis regulatory gene family.<xref ref-type="bibr" rid="B27">27</xref> Heart tissue expresses a variety of miRNAs, but little is known about the cardiac angiogenic response to crocin and exercise.<xref ref-type="bibr" rid="B28">28</xref> Preclinical work demonstrated that intracardiac injections with a minicircle vector carrying miR-210 in a mouse model of myocardial infarction promoted significant improvement of left ventricular fractional shortening, decreased cellular apoptosis, and increased neovascularization.<xref ref-type="bibr" rid="B9">9</xref> In the current study, we observed that crocin and voluntary exercise increased miR-210 expression levels in heart tissue using quantitative real-time PCR analysis. The miR-210 upregulation seems to be dependent on the exercise performing because the group that performed voluntary exercise showed a stronger miR-210 expression than crocin group. A probable mechanism is that during exercise, local hypoxic conditions in the cardiac muscle can occur and hypoxic situation trigger a number of physiological responses such as angiogenesis through HIF-1&#945;-induced miR-210 expression.<xref ref-type="bibr" rid="B30">30</xref><sup>,</sup><xref ref-type="bibr" rid="B31">31</xref> These data are in line with the observations made by Anja Bye et al.<xref ref-type="bibr" rid="B32">32</xref> regarding significant increase in miR-210 expression in subjects with low Vo2max following the exercise activity.</p>
      <p>MiR-126 is a pro-angiogenic miR, which is strongly expressed in the heart endothelium and directly targets SPRED1 and PIK3R2 for repression and functions to promote VEGF signaling.<xref ref-type="bibr" rid="B14">14</xref><sup>,</sup><xref ref-type="bibr" rid="B15">15</xref> In fact, miR-126 activates survival kinases including ERK and Akt by downregulation of its targets and enhances the actions of VEGF.<xref ref-type="bibr" rid="B16">16</xref><sup>,</sup><xref ref-type="bibr" rid="B17">17</xref> In endothelial cells, VEGF promotes angiogenesis through the phosphorylation of ERK1 and Akt. ERK and Akt are well known kinases that activate and promote cell proliferation by stimulating growth factors.<xref ref-type="bibr" rid="B18">18</xref>
			</p>
      <p>In the present study, we showed that miR-126 regulates heart angiogenesis via Akt and ERK1/2 pathways in response to crocin and voluntary exercise. However, a few studies available say that exercise can increase miR expression in cardiac tissue. In line with our results, Uhlemann et al.<xref ref-type="bibr" rid="B33">33</xref> reported that miR-126 expression increased after acute endurance exercise. Major findings also emerge from Fernandes et al.<xref ref-type="bibr" rid="B34">34</xref> study indicating that exercise training restored the levels of peripheral miR-126 associated with revascularization in hypertension. Despite the observation that exercise affects endothelial function, the exact mechanism remains speculative. It is well established that exercise can increase VEGF levels, which is one of the major regulators of angiogenesis and cell survival.<xref ref-type="bibr" rid="B35">35</xref> VEGF binds to VEGFR2 and promotes endothelial survival and angiogenesis signals which are intermediated by PI3K and its downstream target of the Akt and ERK1/2. In addition, we showed that ERK1/2 and Akt levels increased under high expression of miR-126. Therefore, it seems that voluntary exercise relieves the repressive influence of Spred-1/PI3K on the Akt and ERK1/2 by miR-126 overexpression, which finally improves cardiac angiogenesis. This finding is in agreement with a previous study that showed that PI3KR2 mRNA expression in the heart decreased in the exercise groups and it was associated with increase in protein expression of PI3K and phosphorylated Akt.<xref ref-type="bibr" rid="B36">36</xref>
			</p>
      <p>In this study, we also showed that crocin regulates heart angiogenesis through miR-126 and its related Akt and ERK1/2 pathways. Crocin, a carotenoid pigment of saffron, has different pharmacological functions on the nervous,<xref ref-type="bibr" rid="B37">37</xref> cardiac,<xref ref-type="bibr" rid="B38">38</xref> and renal<xref ref-type="bibr" rid="B39">39</xref> systems. Cardioprotective effects of crocin have been reported in some studies that are related to improvement of antioxidant activities and cardiac biomarkers.<xref ref-type="bibr" rid="B3">3</xref><sup>,</sup><xref ref-type="bibr" rid="B40">40</xref> Although many researchers have explored the roles of crocin on different tissues, only a few studies have investigated the effects of crocin on angiogenesis in the heart tissue. Bie et al<xref ref-type="bibr" rid="B41">41</xref> demonstrated that saffron increased expression of VEGF-R2 and promoted angiogenesis following brain injury in rats. Furthermore, it has been reported that the PI3K/Akt pathways are activated by crocin in the ganglion cell layer after retinal IR injury.<xref ref-type="bibr" rid="B42">42</xref> Kang et al<xref ref-type="bibr" rid="B43">43</xref> also showed that saffron increased the phosphorylation of mitogen-activated protein kinases (MAPKs), as one member of ERK family, in the muscle cells. Also our previous study confirms that crocin increases VEGF-A levels in the heart tissue of diabetic and non-diabetic rats.<xref ref-type="bibr" rid="B40">40</xref>
			</p>
      <p>Based on the present results it could be concluded that crocin pretreatment improved cardiac angiogenesis, the effect which can be attributed to its ability of increasing Akt and ERK1/2 levels via enhancement of miR-126. Preservation of histoarchitecture of heart tissue by crocin pretreatment confirms these effects. Regarding the limitations of this study, we did not measure other factors involved in angiogenesis and we referred to previous studies. Further studies are needed to explore other possible mechanisms and pathways that might be directly or indirectly involved in its cardioprotective effects. Therefore, we suggest that crocin by increasing of miR-126 and enhancement of VEGF signaling pathways through Akt and ERK1/2 can induce cardiac capillary formation. In addition, we showed that crocin combination with voluntary exercise has synergistic effects on miR-126 expression and Akt, ERK1/2 levels in heart tissue, which was the first study in rat cardiac angiogenesis.</p>
    </sec>
    <sec sec-type="conclusions">
      <title>Conclusion</title>
      <p>This study shows that crocin in combination with voluntary exercise promotes cardiac angiogenesis and this may be related to expression of miRNA-126 and miR-210. Further studies about the mechanism of crocin and voluntary exercise on cardiac angiogenesis may provide a basis for the development of new therapeutic or preventive approaches to some overcome cardiovascular diseases.</p>
    </sec>
  </body>
  <back>
    <fn-group>
      <fn fn-type="supported-by">
        <p>
          <bold>Sources of Funding</bold>
        </p>
        <p>This study was funded by Drug Applied Research Center of Tabriz University of Medical Sciences.</p>
      </fn>
      <fn fn-type="other">
        <p>
          <bold>Study Association</bold>
        </p>
        <p>This article is part of the thesis of Doctoral submitted by Vajiheh Ghorbanzadeh from Tabriz University of Medical Sciences.</p>
      </fn>
    </fn-group>
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  <sub-article article-type="translation" id="s1" xml:lang="pt">
    <front-stub>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Artigos</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Efeito Cardioprotetor de Crocina Combinado com Exerc&#237;cio Volunt&#225;rio em Ratos: Papel do Mir-126 e Mir-210 na Angiog&#234;nese Card&#237;aca</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Ghorbanzadeh</surname>
            <given-names>Vajihe</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Mohammadi</surname>
            <given-names>Mustafa</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Dariushnejad</surname>
            <given-names>Hassan</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Abhari</surname>
            <given-names>Alireza</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Chodari</surname>
            <given-names>Leila</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Mohaddes</surname>
            <given-names>Gisou</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
          <xref ref-type="corresp" rid="c2"/>
        </contrib>
        <aff id="aff2">
          <institution content-type="original">Drug Applied Research Center - Tabriz University of Medical Sciences, Tabriz - Ir&#227;</institution>
        </aff>
      </contrib-group>
      <author-notes>
        <corresp id="c2"><bold>Correspond&#234;ncia: Gisou Mohaddes</bold> Golgasht Ave. 5166614766. Meadle East. Tabriz - East Azarbaijan - Ir&#227;. E-mail: <email>gmohades@yahoo.com</email>
				</corresp>
        <fn fn-type="con">
          <p>
            <bold>Contribui&#231;&#227;o dos autores</bold>
          </p>
          <p>Concep&#231;&#227;o e desenho da pesquisa, Reda&#231;&#227;o do manuscrito e Revis&#227;o cr&#237;tica do manuscrito quanto ao conte&#250;do intelectual importante: Ghorbanzadeh V, Mohammadi M, Mohaddes G; Obten&#231;&#227;o de dados: Ghorbanzadeh V, Dariushnejad H, Abhari A, Chodari L; An&#225;lise e interpreta&#231;&#227;o dos dados: Ghorbanzadeh V, Dariushnejad H, Abhari A; An&#225;lise estat&#237;stica: Ghorbanzadeh V, Dariushnejad H, Mohaddes G.</p>
        </fn>
        <fn fn-type="conflict">
          <p>
            <bold>Potencial conflito de interesses</bold>
          </p>
          <p>Declaro n&#227;o haver conflito de interesses pertinentes.</p>
        </fn>
      </author-notes>
      <abstract>
        <title>Resumo</title>
        <sec>
          <title>Fundamentos:</title>
          <p>A crocina tem uma vasta gama de atividades biol&#243;gicas, tais como a prote&#231;&#227;o cardiovascular. Estudos epidemiol&#243;gicos recentes demonstraram que o exerc&#237;cio reduz a morbidade e a mortalidade cardiovasculares na popula&#231;&#227;o em geral.</p>
        </sec>
        <sec>
          <title>Objetivo:</title>
          <p>O objetivo deste estudo foi avaliar o efeito da crocina e do exerc&#237;cio volunt&#225;rio nos n&#237;veis de express&#227;o miR-126 e miR-210 e na angiog&#234;nese no tecido card&#237;aco.</p>
        </sec>
        <sec>
          <title>M&#233;todos:</title>
          <p>Os animais foram divididos em 4 grupos: controle, exerc&#237;cio, crocina e exerc&#237;cio-crocina. Os animais receberam a administra&#231;&#227;o oral de crocina (50 mg/kg) ou realizaram exerc&#237;cio volunt&#225;rio sozinhos ou em conjunto durante 8 semanas. Os n&#237;veis de prote&#237;na Akt, ERK1/2, e a express&#227;o de miR-126 e miR-210 foram medidos no tecido card&#237;aco. O m&#233;todo imunohistoqu&#237;mico foi utilizado para detectar CD31 no tecido card&#237;aco.</p>
        </sec>
        <sec>
          <title>Resultados:</title>
          <p>Os n&#237;veis de Akt e ERK1/2 do tecido card&#237;aco foram maiores no grupo tratado com crocina e no grupo de exerc&#237;cio volunt&#225;rio ap&#243;s 8 semanas. A combina&#231;&#227;o de crocina e exerc&#237;cio tamb&#233;m aumentou significativamente os n&#237;veis de Akt e ERK1/2 no tecido card&#237;aco. A express&#227;o de MiR-126, miR-210 e CD31 no cora&#231;&#227;o aumentou tanto em no grupo de crocina como no grupo de exerc&#237;cio volunt&#225;rio em compara&#231;&#227;o com o grupo de controle. Al&#233;m disso, a combina&#231;&#227;o de exerc&#237;cio e crocina amplificou seu efeito na express&#227;o de miR-126 e miR-210 e angiog&#234;nese.</p>
        </sec>
        <sec>
          <title>Conclus&#227;o:</title>
          <p>A Crocina e o exerc&#237;cio volunt&#225;rio melhoram a angiog&#234;nese card&#237;aca possivelmente atrav&#233;s do aumento da express&#227;o de miR-126 e miR-210. O exerc&#237;cio volunt&#225;rio e a suplementa&#231;&#227;o diet&#233;tica com crocina podem ter efeitos ben&#233;ficos na preven&#231;&#227;o de doen&#231;as cardiovasculares.</p>
        </sec>
      </abstract>
      <kwd-group xml:lang="pt">
        <title>Palavras-chave:</title>
        <kwd>Ratos</kwd>
        <kwd>Moduladores da Angiog&#234;nese</kwd>
        <kwd>Exerc&#237;cio</kwd>
        <kwd>Crocus Sativus</kwd>
        <kwd>Antioxidantes</kwd>
        <kwd>miR-126, miR-210</kwd>
      </kwd-group>
    </front-stub>
    <body>
      <sec sec-type="intro">
        <title>Introdu&#231;&#227;o</title>
        <p>A crocina &#233; um componente bioativo encontrado nos frutos da gard&#234;nia e nos estigmas do a&#231;afr&#227;o.<xref ref-type="bibr" rid="B1">1</xref> A crocina tem sido usada h&#225; muito tempo na medicina tradicional e tem sido relatada como tendo v&#225;rias atividades farmacol&#243;gicas, como antioxidante, anticancer&#237;gena, anti-inflamat&#243;ria, efeitos ateroscler&#243;ticos e prote&#231;&#227;o contra doen&#231;as cardiovasculares.<xref ref-type="bibr" rid="B2">2</xref> Os efeitos cardioprotetores da crocina t&#234;m sido relatados em alguns estudos que est&#227;o relacionados &#224; modula&#231;&#227;o de atividades enzim&#225;ticas antioxidantes end&#243;genas e biomarcadores card&#237;acos.<xref ref-type="bibr" rid="B3">3</xref><sup>,</sup><xref ref-type="bibr" rid="B4">4</xref> Evid&#234;ncias recentes indicaram o efeito protetor da crocina na les&#227;o por hip&#243;xia das c&#233;lulas mioc&#225;rdicas devido &#224; eleva&#231;&#227;o do fator de crescimento endotelial vascular (VEGF), como fator proangiog&#234;nico.<xref ref-type="bibr" rid="B5">5</xref>
				</p>
        <p>A atividade f&#237;sica desempenha um papel cr&#237;tico no metabolismo, fun&#231;&#227;o cardiovascular e fun&#231;&#227;o imunol&#243;gica. Nos &#250;ltimos anos, tornou-se evidente que o treinamento f&#237;sico &#233; uma estrat&#233;gia terap&#234;utica muito poderosa para a preven&#231;&#227;o do desenvolvimento e progress&#227;o da doen&#231;a cardiovascular.<xref ref-type="bibr" rid="B6">6</xref> No entanto, exerc&#237;cios exaustivos podem ser problem&#225;ticos, pois s&#227;o estressantes pela produ&#231;&#227;o de esp&#233;cies reativas de oxig&#234;nio e podem causar danos no tecido muscular e outros &#243;rg&#227;os.<xref ref-type="bibr" rid="B7">7</xref><sup>,</sup><xref ref-type="bibr" rid="B8">8</xref> Sugeriu-se que o exerc&#237;cio volunt&#225;rio pode ser um modelo melhor com mias efeitos ben&#233;ficos.<xref ref-type="bibr" rid="B9">9</xref> No modelo animal de exerc&#237;cio volunt&#225;rio, o animal tem livre acesso a uma roda de corrida e eua a roda de acordo com seu limiar fisiol&#243;gico para a atividade f&#237;sica. Descobriu-se que a atividade f&#237;sica desencadeia a extens&#227;o da rede capilar ou angiog&#233;nese. Sabe-se que esse processo &#233; dependente do VEGF.<xref ref-type="bibr" rid="B10">10</xref> No entanto, os mecanismos subjacentes ao exerc&#237;cio ainda n&#227;o foram totalmente elucidados.</p>
        <p>Os micro-RNAs (miRs) s&#227;o pequenos RNAs de 18 a 25 nucle&#243;tidos n&#227;o codificantes que desempenham um papel chave na regula&#231;&#227;o da express&#227;o de genes, inibindo a tradu&#231;&#227;o de prote&#237;nas ou aumentando a degrada&#231;&#227;o do RNA mensageiro.<xref ref-type="bibr" rid="B11">11</xref><sup>,</sup><xref ref-type="bibr" rid="B12">12</xref> A sua participa&#231;&#227;o nas doen&#231;as cardiovasculares tem sido reconhecida nos &#250;ltimos anos.<xref ref-type="bibr" rid="B11">11</xref><sup>-</sup><xref ref-type="bibr" rid="B13">13</xref> O MiR-126 &#233; um dos poucos miRNAs que &#233; um miRNA espec&#237;fico de c&#233;lulas endoteliais e desempenha um papel essencial na neoangiog&#233;nese. O MiRNA-126 &#233; fortemente expresso no endot&#233;lio card&#237;aco e alvos Sprouty relacionados &#224; prote&#237;na-1 (Spred-1), PIK3R2, uma subunidade reguladora de PI3K.<xref ref-type="bibr" rid="B14">14</xref><sup>,</sup><xref ref-type="bibr" rid="B15">15</xref> A desregula&#231;&#227;o desses alvos ativa as quinases ERK e Akt e melhora a a&#231;&#227;o do fator de crescimento endotelial vascular (VEGF).<xref ref-type="bibr" rid="B16">16</xref><sup>,</sup><xref ref-type="bibr" rid="B17">17</xref> O VEGF exerce muitos dos seus efeitos na angiog&#233;nese atrav&#233;s das vias Akt e ERK1/2. Durante a vasculog&#234;nese do desenvolvimento, a via Akt regula a especifica&#231;&#227;o venosa, enquanto a via ERK regula a especifica&#231;&#227;o arterial.<xref ref-type="bibr" rid="B18">18</xref><sup>,</sup><xref ref-type="bibr" rid="B19">19</xref> O MiR-210 em c&#233;lulas endoteliais norm&#243;xicas estimulou a forma&#231;&#227;o de estruturas semelhantes a capilares, bem como a migra&#231;&#227;o celular impulsionada pelo VEGF.<xref ref-type="bibr" rid="B20">20</xref> A indu&#231;&#227;o de MiR-210 &#233; uma caracter&#237;stica praticamente constante da resposta hip&#243;xica que &#233; importante na patog&#234;nese de v&#225;rias doen&#231;as humanas como as card&#237;acas.<xref ref-type="bibr" rid="B21">21</xref>
				</p>
        <p>De acordo com os efeitos de vantagem da crocina e do exerc&#237;cio volunt&#225;rio sobre o diabetes mencionado acima, a hip&#243;tese &#233; que, em compara&#231;&#227;o com crocina ou exerc&#237;cio volunt&#225;rio sozinho, 8 semanas de crocina combinadas com exerc&#237;cio volunt&#225;rio em ratos diab&#233;ticos iria produzir uma maior melhoria nas complica&#231;&#245;es cardiovasculares do diabetes tipo 2. O presente estudo foi realizado para esclarecer o efeito da crocina e do exerc&#237;cio volunt&#225;rio na express&#227;o de miR-126 e miR-210 em mi&#243;citos card&#237;acos de ratos diab&#233;ticos.</p>
      </sec>
      <sec sec-type="methods">
        <title>M&#233;todos</title>
        <sec>
          <title>Animais</title>
          <p>Ratos Wistar machos (200-250g) foram obtidos da Faculdade de Medicina de Tabriz (Ir&#227;-Tabriz). Os animais foram alojados numa sala com uma temperatura constante de 24&#186;C, uma humidade relativa de 50% e um ciclo de 12h escurid&#227;o / luz com acesso a alimentos e &#225;gua &#224; vontade. Os animais do grupo de exerc&#237;cios foram colocados em unidades individuais de gaiolas de rodas, enquanto os grupos sedent&#225;rios foram alojados em gaiolas de pl&#225;stico normais. Este estudo foi aprovado pelo Comit&#234; de &#201;tica Animal (documento n&#250;mero 92197) de acordo com a instru&#231;&#227;o para o cuidado e uso de animais de laborat&#243;rio preparado pela Universidade de Ci&#234;ncias M&#233;dicas de Tabriz.</p>
        </sec>
        <sec>
          <title>Design experimental</title>
          <p>Quarenta animais foram divididos aleatoriamente em quatro grupos. Dez animais foram alocados para cada grupo experimental no in&#237;cio do estudo. Grupo 1: Ratos receberam solu&#231;&#227;o de NaCl a 0,9% como grupo de controle (Con). Grupo 2: Os ratos receberam uma dose &#250;nica de crocina (50 mg/kg) durante oito semanas (Cro). Grupo 3: Os ratos realizaram exerc&#237;cio volunt&#225;rio durante oito semanas (Exe). Grupo 4: Os animais receberam crocina e realizaram, simultaneamente, exerc&#237;cio volunt&#225;rio durante oito semanas (Cro-Exe). O p&#243; de crocina (Sigma, Alemanha) foi dilu&#237;do por solu&#231;&#227;o salina normal (0,9%). A crocina foi administrada por gavagem (50 mg/kg) 6 dias por semana durante 8 semanas.<xref ref-type="bibr" rid="B22">22</xref> Tamb&#233;m, a solu&#231;&#227;o de NaCl a 0,9% foi administrada por gavagem nos grupos 1 e 3 durante a experi&#234;ncia.</p>
          <p>Para a avalia&#231;&#227;o do exerc&#237;cio volunt&#225;rio, os ratos foram alojados individualmente numa gaiola contendo uma roda (circunfer&#234;ncia de 1,00 m, TajhizGostar). Cada rato de exerc&#237;cio tinha uma roda de funcionamento separada na sua gaiola que lhe permitiu correr voluntariamente durante as 8 semanas do estudo. Esta roda de a&#231;o inoxid&#225;vel foi equipada com um contador magn&#233;tico digital que foi ativado pela rota&#231;&#227;o da roda e as revolu&#231;&#245;es da roda foram registradas diariamente. Ent&#227;o a dist&#226;ncia de corrida por dia foi calculada como o n&#250;mero de rota&#231;&#245;es de roda por dia. Os ratos com uma dist&#226;ncia de corrida inferior a ~ 2000 m por dia foram eliminados antes da an&#225;lise estat&#237;stica.<xref ref-type="bibr" rid="B3">3</xref> Considerando os crit&#233;rios de exclus&#227;o (exerc&#237;cio abaixo dos protocolos padr&#227;o) foi realizada an&#225;lise estat&#237;stica para 7 animais em cada grupo.</p>
        </sec>
        <sec>
          <title>Quantifica&#231;&#227;o de Akt e ERK1/2 no cora&#231;&#227;o por ELISA</title>
          <p>No &#250;ltimo dia da experi&#234;ncia, os ratos foram sacrificados sob anestesia profunda com cetamina/xilazina (88/10 mg/kg, i.p.). O tecido card&#237;aco foi imediatamente removido e lavado com soro fisiol&#243;gico 0,9%. As amostras de tecido foram pesadas, homogeneizadas em PBS (pH 7,2-7,4) e centrifugadas durante 20 min &#224; velocidade de 3000 rpm e 4&#186;C. Em seguida, os sobrenadantes foram recolhidos em novo tubo e os n&#237;veis de Akt e ERK1/2 foram medidos utilizando kits sandu&#237;che ELISA de rato. O ensaio ELISA foi realizado de acordo com as instru&#231;&#245;es do fabricante. A ativa&#231;&#227;o da prote&#237;na Akt por fosforila&#231;&#227;o no res&#237;duo de serina 473 (P-Akt) e a fosforila&#231;&#227;o da ERK1/2 (PT202/Y204) foi analisada com ELISA (Akt: Cat. N&#186;. CK-E91385; Hangzhou Eastbiopharm Co., Ltd., Hangzhou, China. ERK1/2: Abcam Cambridge, UK) e normalizada para a concentra&#231;&#227;o de prote&#237;na total para cada amostra como determinado pelo ensaio de Bradford.<xref ref-type="bibr" rid="B24">24</xref>
					</p>
        </sec>
        <sec>
          <title>Extra&#231;&#227;o total de RNA, s&#237;ntese de cDNA e PCR em tempo real</title>
          <p>A express&#227;o de miR-126 e miR-210 foi avaliada por qRT-PCR. Foram realizados ensaios em triplicado para cada amostra de RNA. O MicroRNA foi extra&#237;do do tecido card&#237;aco utilizando o kit de isolamento de RNA miRCURYTM (Exiqon, Dinamarca) de acordo com o protocolo do fabricante. O procedimento foi realizado com base na coluna de spin utilizando uma resina patenteada como matriz de separa&#231;&#227;o de RNA de outros componentes celulares. O teor de RNA e a pureza foram medidos a um comprimento de onda de 260-280 nm utilizando o espectrofot&#243;metro Nanodrop 1000 (Thermo Scientific, Wilmington DE 19810 EUA).</p>
          <p>A s&#237;ntese de cDNA foi realizada de acordo com o kit de PCR de miRNA RT LNA universal (Exiqon, Dinamarca). Resumidamente, o RNA total contendo microRNA foi poliadenilado e o cDNA foi sintetizado utilizando um primer poli (T) com uma &#226;ncora degenerada 3' e uma etiqueta universal 5'.</p>
          <p>Syber Green qPCR Mix adquirido da Exiqon (Dinamarca) e utilizado para PCR em tempo real. O PCR em tempo real foi feito usando Rotor-Gene 6000 Corbett. O m&#233;todo 2- (<sup>&#916;&#916;Ct</sup>) foi utilizado para determinar n&#237;veis quantitativos relativos de miR-126 e miR-210. Os resultados foram expressos como o dobro do grupo de controle. Utilizou-se Mir-1 como o miARN de controle end&#243;geno.</p>
        </sec>
        <sec>
          <title>Avalia&#231;&#245;es imunohistoqu&#237;micas</title>
          <p>Para a investiga&#231;&#227;o da angiog&#234;nese no tecido card&#237;aco, as amostras do ventr&#237;culo esquerdo foram imersas em formol a 10% ap&#243;s excis&#227;o, embebidas em parafina e cortadas em fatias de 4 &#181;m de espessura. As sec&#231;&#245;es foram desparafinadas em xileno e desidratadas numa s&#233;rie graduada de etanol. As l&#226;minas foram incubadas sequencialmente em proteinase K e tratadas com per&#243;xido de hidrog&#233;nio a 0,3% para bloquear a atividade de peroxidase end&#243;gena. As fatias foram sobrepostas pelo anticorpo prim&#225;rio CD31 (Santa Cruz, EUA) um marcador de angiog&#234;nese e incubadas a + 4&#186;C toda a noite. As se&#231;&#245;es foram ent&#227;o lavadas e incubadas com complexo avidina-biotina padr&#227;o (ABC, Santa Cruz) de acordo com as instru&#231;&#245;es do fabricante. Em seguida, as l&#226;minas foram incubadas em DAB (di-amino-benzidina, Santa Cruz), como cromog&#234;nio e coradas por contraste com hematoxilina de Mayer. Finalmente, as se&#231;&#245;es foram clareadas em xileno, montadas com Entellan e avaliadas por microsc&#243;pio &#243;ptico (Olympus BX 40, Jap&#227;o). Os capilares foram visualizados no mioc&#225;rdio como um precipitado castanho. As estruturas vasculares positivas para CD31 foram contadas para 5 a 6 l&#226;minas por animal e 10 campos por l&#226;mina.</p>
        </sec>
        <sec>
          <title>An&#225;lise estat&#237;stica</title>
          <p>Os resultados s&#227;o apresentados como m&#233;dia &#177; DP. A an&#225;lise estat&#237;stica foi realizada usando o software estat&#237;stico SPSS vers&#227;o 21.0 para Windows. Todos os par&#226;metros foram testados quanto &#224; normalidade utilizando o teste Kolmogorov-Smirnov de uma amostra. As m&#233;dias das dist&#226;ncias di&#225;rias percorridas pelos ratos em cada grupo de exerc&#237;cio foram m&#233;dias para cada semana e foram comparadas utilizando ANOVA de medidas repetidas. A atividade f&#237;sica entre os grupos Exe e Cro-Exe foi analisada utilizando o teste t independente. Para os par&#226;metros de Akt, ERK, CD31, miR-126 e miR-210, os dados foram analisados utilizando ANOVA bidirecional seguida pelo teste post hoc de Tukey. Um valor p inferior a 0,05 foi considerado estatisticamente significativo.</p>
        </sec>
      </sec>
      <sec sec-type="results">
        <title>Resultados</title>
        <sec>
          <title>Exerc&#237;cio volunt&#225;rio</title>
          <p>A <xref ref-type="fig" rid="f7">Figura 1</xref> ilustra a m&#233;dia de dist&#226;ncia percorrida por semana durante o per&#237;odo de 8 semanas do experimento. Os animais realizaram voluntariamente uma m&#233;dia de 2,949 &#177; 178 m/semana no grupo de exerc&#237;cios e uma m&#233;dia de 3,090 &#177; 140 m/semana no grupo de crocina e exerc&#237;cios. N&#227;o houve diferen&#231;a significativa na atividade f&#237;sica entre os grupos Exe e Cro-Exe com base em uma an&#225;lise de teste t independente.</p>
          <p>
            <fig id="f7">
              <label>Figura 1</label>
              <caption>
                <title>A m&#233;dia de dist&#226;ncia percorrida foi calculada cada semana de acesso &#224; roda (m&#233;dia &#177; DP) durante a dura&#231;&#227;o de 8 semanas do experimento, para os grupos Exe e Cro-Exe (n = 7/grupo). N&#227;o houve diferen&#231;a significativa entre os grupos. Animais em ambos os grupos Exe e Cro-Exe aumentaram a sua dist&#226;ncia m&#233;dia semanal de corrida nas semanas subsequentes. * p &lt; 0,05 indica uma diferen&#231;a significativa entre as semanas consecutivas no grupo Exe. <italic>#</italic> p &lt; 0,05 e <italic>##</italic> p &lt; 0,01 indicam diferen&#231;as significativas entre semanas consecutivas no grupo Cro-Exe.</title>
              </caption>
              <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf01-pt.jpg"/></fig>
          </p>
          <p>A dist&#226;ncia m&#233;dia percorrida aumentou gradualmente nos grupos Exe e Cro-Exe da primeira para a oitava semana. Este aumento no grupo Exe foi significativamente diferente da semana anterior na quarta (p &lt; 0,05) e sexta (p &lt; 0,05) semanas. No grupo Cro-Exe, os animais correram uma dist&#226;ncia significativamente maior na segunda (p &lt;0,01), terceira (p &lt; 0,01), quinta (p &lt; 0,05) e sexta (p &lt; 0,05) do que na semana anterior.</p>
        </sec>
        <sec>
          <title>Efeitos da crocina combinada com o exerc&#237;cio volunt&#225;rio nos n&#237;veis de Akt no tecido card&#237;aco</title>
          <p>Ap&#243;s 8 semanas de administra&#231;&#227;o de crocina ou realiza&#231;&#227;o de exerc&#237;cio volunt&#225;rio, o n&#237;vel de p-Akt aumentou significativamente nos grupos Exe (p &lt; 0,01), Cro (p &lt; 0,01) e Cro-Exe (p &lt; 0,001) em compara&#231;&#227;o com o grupo Con (<xref ref-type="fig" rid="f8">Figura 2</xref>). Uma compara&#231;&#227;o entre o grupo Cro-Exe com os grupos Exe e Cro apresentou diferen&#231;a significativa entre esses grupos (p &lt; 0,01 e p &lt; 0,001, respectivamente).</p>
          <p>
            <fig id="f8">
              <label>Figura 2</label>
              <caption>
                <title>Efeito da crocina e exerc&#237;cio volunt&#225;rio sobre os n&#237;veis de p-Akt. Os dados s&#227;o apresentados como m&#233;dia &#177; DP para n = 7 animais. <italic>***</italic>p &lt; 0.001 e ** p &lt; 0,01 indicam diferen&#231;as significativas com o grupo controle, <italic>$$$</italic> p &lt; 0,001 indica uma diferen&#231;a significativa com o grupo Cro, e <italic>##</italic> p &lt; 0,01 indica uma diferen&#231;a significativa com o grupo Exe.</title>
              </caption>
              <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf02-pt.jpg"/></fig>
          </p>
        </sec>
        <sec>
          <title>Efeitos da crocina combinada com o exerc&#237;cio volunt&#225;rio nos n&#237;veis ERK1/2 no tecido card&#237;aco</title>
          <p>A ANOVA de duas vias mostrou que os n&#237;veis de p-ERK1/2 foram significativamente mais elevados em ratos tratados com crocina ou em exerc&#237;cios volunt&#225;rios do que nos ratos de controle (Exe: p &lt; 0,01, Cro: p &lt; 0,05 e Cro-Exe: p &lt; 0,001). A administra&#231;&#227;o de crocina combinada com exerc&#237;cio aumentou significativamente os n&#237;veis de p-ERK1/2 do tecido card&#237;aco em compara&#231;&#227;o com os grupos Exe (p &lt; 0,01) e Cro (p &lt; 0,001) (<xref ref-type="fig" rid="f9">Figura 3</xref>). A <xref ref-type="fig" rid="f8">Figura 2</xref> tamb&#233;m indica que a crocina combinada com o exerc&#237;cio volunt&#225;rio tem um efeito sin&#233;rgico nos n&#237;veis de prote&#237;na p-ERK1/2 no tecido card&#237;aco.</p>
          <p>
            <fig id="f9">
              <label>Figura 3</label>
              <caption>
                <title>Efeito da crocina e exerc&#237;cio volunt&#225;rio sobre os n&#237;veis de p-ERK1/2. Os dados s&#227;o apresentados como m&#233;dia &#177; DP para n = 7 animais. * p &lt; 0,05, ** p &lt; 0,01 e *** p &lt;0,001 indicam diferen&#231;as significativas com o grupo de controlo. $$$ p &lt; 0,001 indica uma diferen&#231;a significativa com o grupo Cro e ## p &lt; 0,01 indica uma diferen&#231;a significativa com o grupo Exe.</title>
              </caption>
              <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf03-pt.jpg"/></fig>
          </p>
        </sec>
        <sec>
          <title>Efeitos da crocina combinada com o exerc&#237;cio volunt&#225;rio na express&#227;o de miR-126 no tecido card&#237;aco</title>
          <p>A ANOVA bidirecional mostrou que a express&#227;o de miR-126 foi significativamente maior em ratos tratados com crocina (p &lt; 0,001), exerc&#237;cio volunt&#225;rio (p &lt; 0,01) e combina&#231;&#227;o de crocina com exerc&#237;cio (p &lt; 0,001) do que em ratos controle. Nos ratos submetidos a exerc&#237;cio volunt&#225;rio e que simultaneamente receberam crocina durante 8 semanas, a express&#227;o do miR-126 card&#237;aco aumentou significativamente em compara&#231;&#227;o com os grupos Exe (p &lt; 0,01) e Cro (p &lt; 0,001) (<xref ref-type="fig" rid="f10">Figura 4</xref>).</p>
          <p>
            <fig id="f10">
              <label>Figura 4</label>
              <caption>
                <title>Efeito da crocina e exerc&#237;cio volunt&#225;rio nos n&#237;veis de express&#227;o de miR-126. Os dados s&#227;o apresentados como m&#233;dia &#177; DP para n = 7 animais. ** p &lt; 0,01 e *** p &lt; 0,001 indicam diferen&#231;as significativas com o grupo de controle. <italic>$$$</italic> p &lt; 0,001 indica uma diferen&#231;a significativa com o grupo Cro e <italic>##</italic> p &lt;0,01 indica uma diferen&#231;a significativa com o grupo Exe.</title>
              </caption>
              <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf04-pt.jpg"/></fig>
          </p>
        </sec>
        <sec>
          <title>Efeitos da crocina combinada com o exerc&#237;cio volunt&#225;rio na express&#227;o de miR-210 no tecido card&#237;aco</title>
          <p>Conforme ilustrado na <xref ref-type="fig" rid="f11">Figura 5</xref>, ap&#243;s a administra&#231;&#227;o de crocina e a execu&#231;&#227;o de exerc&#237;cios, o n&#237;vel de express&#227;o card&#237;aca de miR-210 foi significativamente aumentado nos grupos Cro e Exe quando comparado com o grupo de controle (p &lt; 0,01 e p &lt; 0,001, respectivamente). Por outro lado, a express&#227;o de miR-210 aumentou significativamente no grupo Cro-Exe em compara&#231;&#227;o com o grupo controle (p &lt; 0,001). Al&#233;m disso, h&#225; uma diferen&#231;a significativa entre os grupos Cro-Exe e Cro (p &lt; 0,01).</p>
          <p>
            <fig id="f11">
              <label>Figura 5</label>
              <caption>
                <title>Efeito da crocina e exerc&#237;cio volunt&#225;rio sobre os n&#237;veis de express&#227;o de miR-210. Os dados s&#227;o apresentados como m&#233;dia &#177; DP para n = 7 animais. **p &lt; 0,01 e ***p &lt; 0,001 indicam diferen&#231;as significativas com o grupo de controle e <italic>$ $</italic>p &lt; 0,001 indica uma diferen&#231;a significativa com o grupo Cro.</title>
              </caption>
              <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf05-pt.jpg"/></fig>
          </p>
        </sec>
        <sec>
          <title>Efeitos da crocina combinada com o exerc&#237;cio volunt&#225;rio em c&#233;lulas CD31 + na rede capilar mioc&#225;rdica</title>
          <p>Conforme demonstrado na <xref ref-type="fig" rid="f12">Figura 6</xref>, o n&#250;mero de c&#233;lulas CD31 + foi maior nos animais que receberam crocina (p &lt; 0,05) ou realizaram exerc&#237;cios (p &lt; 0,05) em compara&#231;&#227;o com o grupo controle (<xref ref-type="fig" rid="f12">Figuras 6A</xref>, <xref ref-type="fig" rid="f6">B</xref>, <xref ref-type="fig" rid="f6">C</xref>). Al&#233;m disso, as c&#233;lulas CD31 + foram significativamente mais elevadas em se&#231;&#245;es do cora&#231;&#227;o do grupo Cro-Exe do que nos grupos Exe (p &lt; 0,01) e Cro (p &lt; 0,01) (<xref ref-type="fig" rid="f12">Figura 6D</xref>). Assim, a combina&#231;&#227;o de crocina com o exerc&#237;cio volunt&#225;rio parece aumentar a resposta vasculog&#234;nica.</p>
          <p>
            <fig id="f12">
              <label>Figura 6</label>
              <caption>
                <title>A) Imagens representativas da colora&#231;&#227;o CD31 (castanha) em vasos card&#237;acos de grupos de controle, exerc&#237;cio, crocina e exerc&#237;cio-crocina (Amplia&#231;&#227;o &#215; 400). A: Con, B: Exe, C: Cro, D: Cro-Exe. B) A densidade de microvasos foi analisada por imunohistoqu&#237;mica para CD31. A densidade de microvasos foi quantificada utilizando 6 l&#226;minas por animal e 10 campos por l&#226;mina. Os dados s&#227;o apresentados como m&#233;dia &#177; DP para n = 7 animais. *** p &lt; 0,001 indica uma diferen&#231;a significativa com o grupo de controle. <italic>###</italic>p &lt; 0,001 e <italic>$$$</italic>p &lt; 0,001 indicam diferen&#231;as significativas com o grupo de exerc&#237;cio e grupo de crocin, respectivamente.</title>
              </caption>
              <graphic xlink:href="1678-4170-abc-109-01-0054-70087-gf06-pt.jpg"/></fig>
          </p>
        </sec>
      </sec>
      <sec sec-type="discussion">
        <title>Discuss&#227;o</title>
        <p>No presente estudo, demonstramos que a express&#227;o de miR-126 e miR-210 do tecido card&#237;aco de ratos aumentou nos grupos de crocina, exerc&#237;cio volunt&#225;rio e exerc&#237;cio-crocina. Al&#233;m disso, a crocina e o exerc&#237;cio volunt&#225;rio estimularam as prote&#237;nas Akt e ERK1/2 e a angiog&#234;nese no tecido card&#237;aco. Pela primeira vez, nosso estudo demonstrou que o miR-126 card&#237;aco e suas vias relacionadas incluindo Akt e ERK1/2 aumentaram em resposta &#224; crocina combinada com o exerc&#237;cio volunt&#225;rio em ratos. Al&#233;m disso, nossos achados mostraram que a administra&#231;&#227;o de crocina e a realiza&#231;&#227;o de exerc&#237;cio volunt&#225;rio aumentaram a express&#227;o do miR-210 card&#237;aco.</p>
        <p>MiR-210, um miRNA espec&#237;fico da hip&#243;xia, depende da ativa&#231;&#227;o de HIF e aumentou ap&#243;s a hip&#243;xia.<xref ref-type="bibr" rid="B25">25</xref> Quando o miR-210 &#233; superexpressado em c&#233;lulas endoteliais, a capacidade dessas c&#233;lulas para formar vasos sangu&#237;neos torna-se mais pronunciada do que a das c&#233;lulas com n&#237;veis normais de express&#227;o. Confirmando o papel pr&#243;-angiog&#234;nico do miR-210, a regula&#231;&#227;o positiva do miR-210 em c&#233;lulas CD34 + aumentou a perfus&#227;o tecidual e a densidade capilar em um modelo de isquemia de membros posteriores em ratos.<xref ref-type="bibr" rid="B26">26</xref> Pesquisas pr&#233;vias indicaram que o miR-210 pode melhorar a angiog&#234;nese atrav&#233;s da regula&#231;&#227;o negativa de seu gene alvo, a efrina A3, que &#233; um membro importante da fam&#237;lia de efrinas de genes reguladores da angiog&#234;nese.<xref ref-type="bibr" rid="B27">27</xref> O tecido card&#237;aco expressa uma variedade de miRNAs, mas pouco se sabe sobre a resposta angiog&#234;nica card&#237;aca &#224; crocina e exerc&#237;cio.<xref ref-type="bibr" rid="B28">28</xref> O trabalho pr&#233;-cl&#237;nico demonstrou que as inje&#231;&#245;es intracard&#237;acas com um vetor minic&#237;rculo transportando miR-210 em um modelo murino de infarto do mioc&#225;rdio promoveu melhora significativa do encurtamento fracion&#225;rio ventricular esquerdo, diminui&#231;&#227;o da apoptose celular e aumento da neovasculariza&#231;&#227;o.<xref ref-type="bibr" rid="B29">29</xref> No presente estudo, observamos que a crocina e o exerc&#237;cio volunt&#225;rio aumentaram os n&#237;veis de express&#227;o de miR-210 no tecido card&#237;aco usando an&#225;lise quantitativa da PCS em tempo real. O aumento do miR-210 parece ser dependente do exerc&#237;cio realizado porque o grupo que realizou exerc&#237;cio volunt&#225;rio mostrou uma express&#227;o mais forte do miR-210 do que o grupo crocina. Um mecanismo prov&#225;vel &#233; que, durante o exerc&#237;cio, podem ocorrer condi&#231;&#245;es hip&#243;xicas locais no m&#250;sculo card&#237;aco e a situa&#231;&#227;o hip&#243;xica desencadear um n&#250;mero de respostas fisiol&#243;gicas como a angiog&#234;nese atrav&#233;s da express&#227;o de miR-210 induzida por HIF-1&#945;.<xref ref-type="bibr" rid="B30">30</xref><sup>,</sup><xref ref-type="bibr" rid="B31">31</xref> stes dados est&#227;o de acordo com as observa&#231;&#245;es feitas por Bye et al.<xref ref-type="bibr" rid="B32">32</xref> quanto ao aumento significativo da express&#227;o de miR-210 em indiv&#237;duos com baixa Vo2max ap&#243;s a atividade de exerc&#237;cio.</p>
        <p>MiR-126 &#233; um miR pr&#243;-angiog&#234;nico, que &#233; fortemente expresso no endot&#233;lio card&#237;aco e aponta diretamente para SPRED1 e PIK3R2 para repress&#227;o e fun&#231;&#245;es afim de promover a sinaliza&#231;&#227;o VEGF.<xref ref-type="bibr" rid="B14">14</xref><sub>,</sub><xref ref-type="bibr" rid="B15">15</xref> e fato, o miR-126 ativa quinases de sobreviv&#234;ncia incluindo ERK e Akt por regula&#231;&#227;o negativa dos seus alvos e aumenta as a&#231;&#245;es do VEGF.<xref ref-type="bibr" rid="B16">16</xref><sup>,</sup><xref ref-type="bibr" rid="B17">17</xref> as c&#233;lulas endoteliais, o VEGF promove a angiog&#233;nese atrav&#233;s da fosforila&#231;&#227;o de ERK1 e Akt. ERK e Akt s&#227;o quinases bem conhecidas que ativam e promovem a prolifera&#231;&#227;o celular estimulando fatores de crescimento.<xref ref-type="bibr" rid="B18">18</xref>
				</p>
        <p>No presente estudo, mostramos que o miR-126 regula a angiog&#234;nese card&#237;aca atrav&#233;s das vias Akt e ERK1/2 em resposta &#224; crocina e exerc&#237;cio volunt&#225;rio. No entanto, existem alguns estudos dispon&#237;veis que sinalizam que o exerc&#237;cio pode aumentar a express&#227;o miR no tecido card&#237;aco. Em linha com nossos resultados, Uhlemann et al.<xref ref-type="bibr" rid="B33">33</xref> relataram que a express&#227;o de miR-126 aumentou ap&#243;s exerc&#237;cio de resist&#234;ncia aguda. Importantes conclus&#245;es tamb&#233;m surgem de Fernandes et al.,<xref ref-type="bibr" rid="B34">34</xref> indicando que o exerc&#237;cio f&#237;sico restabeleceu os n&#237;veis de miR-126 perif&#233;rico associado &#224; revasculariza&#231;&#227;o na hipertens&#227;o. Apesar da observa&#231;&#227;o de que o exerc&#237;cio afeta a fun&#231;&#227;o endotelial, o mecanismo exato permanece especulativo. Est&#225; bem estabelecido que o exerc&#237;cio pode aumentar os n&#237;veis de VEGF, que &#233; um dos principais reguladores da angiog&#234;nese e da sobreviv&#234;ncia celular.<xref ref-type="bibr" rid="B35">35</xref> O VEGF liga-se ao VEGFR2 e promove os sinais de sobreviv&#234;ncia e angiog&#233;nese endoteliais que s&#227;o intermediados pela PI3K e o seu alvo a jusante do Akt e ERK1/2. Al&#233;m disso, mostraram que os n&#237;veis de ERK1/2 e Akt aumentaram sob alta express&#227;o de miR-126. Portanto, parece que o exerc&#237;cio volunt&#225;rio alivia a influ&#234;ncia repressiva de Spred-1/PI3K na superexpress&#227;o de Akt e ERK1/2 por miR-126, o que finalmente melhora a angiog&#234;nese card&#237;aca. Este achado est&#225; de acordo com um estudo pr&#233;vio que mostrou que a express&#227;o de ARNm de PI3KR2 no cora&#231;&#227;o diminuiu nos grupos de exerc&#237;cios e foi associada ao aumento na express&#227;o prot&#233;ica de PI3K e Akt fosforilado.<xref ref-type="bibr" rid="B36">36</xref>
				</p>
        <p>Neste estudo, tamb&#233;m mostramos que a crocina regula a angiog&#234;nese card&#237;aca atrav&#233;s do miR-126 e as vias relacionadas a Akt e ERK1/2. A crocina, um pigmento caroten&#243;ide do a&#231;afr&#227;o, tem diferentes fun&#231;&#245;es farmacol&#243;gicas nos sistemas nervoso,<xref ref-type="bibr" rid="B37">37</xref> card&#237;aco<xref ref-type="bibr" rid="B38">38</xref> e renal.<xref ref-type="bibr" rid="B39">39</xref> Efeitos cardioprotetores da crocina t&#234;m sido relatados em alguns estudos que est&#227;o relacionados &#224; melhoria das atividades antioxidantes e biomarcadores card&#237;acos.<xref ref-type="bibr" rid="B3">3</xref><sup>,</sup><xref ref-type="bibr" rid="B40">40</xref>
				</p>
        <p>Embora muitos pesquisadores tenham explorado os pap&#233;is da crocina em diferentes tecidos, apenas alguns estudos t&#234;m investigado os efeitos da crocina sobre a angiog&#234;nese no tecido card&#237;aco. Bie et al.,<xref ref-type="bibr" rid="B41">41</xref> demonstraram que o a&#231;afr&#227;o aumentou a express&#227;o de VEGF-R2 e promoveu angiog&#234;nese ap&#243;s les&#227;o cerebral em ratos. Al&#233;m disso, tem sido relatado que as vias PI3K/Akt s&#227;o activadas pela crocina na camada de c&#233;lulas ganglionares ap&#243;s les&#227;o de retina IR.<xref ref-type="bibr" rid="B42">42</xref> Kang et al.,<xref ref-type="bibr" rid="B43">43</xref> tamb&#233;m mostraram que o a&#231;afr&#227;o aumentou a fosforila&#231;&#227;o de prote&#237;nas-quinases ativadas por mit&#243;genos (MAPKs), como um membro da fam&#237;lia ERK, nas c&#233;lulas musculares. Tamb&#233;m o nosso estudo anterior confirma que a crocina aumenta os n&#237;veis de VEGF-A no tecido card&#237;aco de ratos diab&#233;ticos e n&#227;o diab&#233;ticos.<xref ref-type="bibr" rid="B40">40</xref>
				</p>
        <p>Com base nos presentes resultados, pode concluir-se que o pr&#233;-tratamento com crocina melhorou a angiog&#233;nese card&#237;aca, efeito que pode ser atribu&#237;do &#224; sua capacidade de aumentar os n&#237;veis de Akt e ERK1/2 atrav&#233;s do aumento de miR-126. A preserva&#231;&#227;o da histo-arquitectura do tecido card&#237;aco pelo pr&#233;-tratamento com crocina confirma estes efeitos. Em rela&#231;&#227;o &#224;s limita&#231;&#245;es deste estudo, n&#227;o se avaliaram outros fatores envolvidos na angiog&#234;nese e nos referimos a estudos pr&#233;vios. S&#227;o necess&#225;rios mais estudos para explorar outros poss&#237;veis mecanismos e vias que possam estar direta ou indiretamente envolvidos nos seus efeitos cardioprotectores. Por conseguinte, sugerimos que o incremento do miR-126 pela crocina e o aumento das vias de sinaliza&#231;&#227;o do VEGF atrav&#233;s de Akt e ERK1/2 pode induzir a forma&#231;&#227;o de capilares card&#237;acos. Al&#233;m disso, mostramos que a combina&#231;&#227;o de crocina com exerc&#237;cio volunt&#225;rio tem efeitos sin&#233;rgicos sobre a express&#227;o do miR-126 e os n&#237;veis de Akt, ERK1/2 no tecido card&#237;aco, o qual foi o primeiro estudo na angiog&#233;nese card&#237;aca de ratos.</p>
      </sec>
      <sec sec-type="conclusions">
        <title>Conclus&#227;o</title>
        <p>Este estudo mostra que a crocina combinada com o exerc&#237;cio volunt&#225;rio promove angiog&#234;nese card&#237;aca e isso pode estar relacionado &#224; express&#227;o do miRNA-126 e do miR-210. Novos estudos sobre o mecanismo da crocina e exerc&#237;cio volunt&#225;rio na angiog&#234;nese card&#237;aca podem fornecer uma base para o desenvolvimento de novas abordagens terap&#234;uticas ou preventivas para superar doen&#231;as cardiovasculares.</p>
      </sec>
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    <back>
      <fn-group>
        <fn fn-type="supported-by">
          <p>
            <bold>Fontes de financiamento</bold>
          </p>
          <p>O presente estudo foi financiado pelo Drug Applied Research Center of Tabriz University of Medical Sciences.</p>
        </fn>
        <fn fn-type="other">
          <p>
            <bold>Vincula&#231;&#227;o acad&#234;mica</bold>
          </p>
          <p>Este artigo &#233; parte de tese de Doutorado de Vajiheh Ghorbanzadeh pela <italic>Tabriz University of Medical Sciences</italic>.</p>
        </fn>
      </fn-group>
    </back>
  </sub-article>
</article>
