Sanguinarine inhibits angiotensin II-induced apoptosis in H9c2 cardiac cells via restoring reactive oxygen species-mediated decreases in the mitochondrial membrane potential.

Cell apoptosis induced by Angiotensin II (Ang II) has a critical role in the development of cardiovascular diseases. The aim of the present study was to investigate whether sanguinarine (SAN), a drug which was proved to have anti‑oxidant, anti‑proliferative and immune enhancing effects, can abolish cell apoptosis induced by Ang II. In the present study, H9c2 cardiac cells were stimulated with 10 µM Ang II with or without SAN. The level of intracellular reactive oxygen species (ROS) generation was assessed using dichlorodihydrofluorescein diacetate, and changes of the mitochondrial membrane potential (MMP) were assessed using JC‑1 staining. Furthermore, mRNA expression of NOX2 was determined by reverse transcription quantitative polymerase chain reaction, and apoptosis was detected by Annexin V/propidium iodide staining and flow cytometry. The expression of B‑cell lymphoma 2 (Bcl‑2), Bcl‑2‑associated X protein (Bax) as well as cleaved (c)‑caspase 3 and ‑9 were detected by western blot analysis, and the activity of caspase 3 and ‑9 was detected using an ELISA. The results of the present study showed that NOX2 expression and ROS generation induced by Ang II were inhibited by SAN, and the Ang 2‑induced MMP loss was also ameliorated. Furthermore, Ang II‑induced H9c2 cardiac cell apoptosis as well as c‑caspase 3 and ‑9 levels were significantly reduced by SAN. Investigation of the possible pathway involved in the anti‑apoptotic effect of SAN showed that the expression of Bcl‑2 was decreased, while that of Bax was increased following stimulation with Ang II, which was reversed following treatment with SAN. In addition, Ang II enhanced the activity of caspase 9 and cleaved downstream caspases such as caspase‑3, initiating the caspase cascade, while pre‑treatment of H9c2 cardiac cells with SAN blocked these effects. In conclusion, the findings of the present study indicated that SAN inhibits the apoptosis of H9c2 cardiac cells induced by Ang II, most likely via restoring ROS‑mediated decreases of the MMP.