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Rongen GA, Wever KE. Cardiovascular pharmacotherapy: Innovation stuck in translation. Eur J Pharmacol 2015; 759:200-4. [PMID: 25814253 DOI: 10.1016/j.ejphar.2015.03.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/07/2015] [Accepted: 03/12/2015] [Indexed: 12/25/2022]
Abstract
Systematic reviews of animal studies have revealed serious limitations in internal and external validity strongly affecting the reliability of this research. In addition inter-species differences are likely to further limit the predictive value of animal research for the efficacy and tolerability of new drugs in humans. Important changes in the research process are needed to allow efficient translation of preclinical discoveries to the clinic, including improvements in the laboratory and publication practices involving animal research and early incorporation of human proof-of-concept studies to optimize the interpretation of animal data for its predictive value for humans and the design of clinical trials.
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Affiliation(s)
- Gerard A Rongen
- Department of Pharmacology-Toxicology and Internal Medicine, Radboud university medical center, P.O. box 9101, Internal post address: 137, 6500 HB Nijmegen, The Netherlands.
| | - Kimberley E Wever
- SYstematic Review Centre for Laboratory animal Experimentation, Radboud university medical center, Nijmegen, The Netherlands
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Impact of ischemic preconditioning on outcome in clinical liver surgery: a systematic review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:370451. [PMID: 25756045 PMCID: PMC4338382 DOI: 10.1155/2015/370451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/30/2015] [Accepted: 01/31/2015] [Indexed: 12/17/2022]
Abstract
Background. Ischemia-reperfusion injury is a major cause of post-liver-surgery complications. Ischemic preconditioning (IPC) has been demonstrated to protect against ischemia-reperfusion injury. Clinical studies have examined IPC in liver surgery but with conflicting results. This systematic review aimed to evaluate the effects of IPC on outcome in clinical liver surgery. Methods. An electronic search of OVID Medline and Embase databases was performed to identify studies that reported outcomes in patients undergoing liver surgery subjected to IPC. Basic descriptive statistics were used to summarise data from individual clinical studies. Results. 1093 articles were identified, of which 24 met the inclusion criteria. Seven topics were selected and analysed by subgroup. There were 10 studies in cadaveric liver transplantation, 2 in living-related liver transplantation, and 12 in liver resection. IPC decreases hepatocellular damage in liver surgery as determined by transaminases but does not translate to any significant clinical benefit in orthotopic liver transplant or liver resection. Conclusions. Available clinical evidence does not support routine use of IPC in liver surgery as it does not offer any apparent benefit in perioperative outcome. Further clinical studies will need to be carried out to determine the subset of patients that will benefit from IPC.
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Ge YZ, Wu R, Xin H, Liu H, Lu TZ, Zhao YC, Shen JW, Hu ZK, Yu P, Zhou LH, Xu LW, Xu Z, Wu JP, Li WC, Zhu JG, Jia RP. Effects of ischemic preconditioning on the systemic and renal hemodynamic changes in renal ischemia reperfusion injury. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:1128-1140. [PMID: 25972999 PMCID: PMC4396246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Ischemic preconditioning (IPC) could protect against subsequent renal ischemia reperfusion injury (IRI). However, the mechanisms underlying IPC remain far from complete. Hence, we explored the effects of IPC on the renal and systemic hemodynamic changes, renal function and morphology, as well the involvement of endothelial and inducible nitric oxide synthase (eNOS/iNOS), and nitric oxide (NO). METHODS Male Sprague-Dawley rats were randomly divided into five groups after right-side nephrectomy: Sham group (surgery without vascular clamping); IRI group (the left renal artery was clamped for 45 min); IPC group (pretreated with 15 min of ischemia and 10 min of reperfusion); IPC + vehicle group (administrated with 0.9% saline 5 min before IPC); and IPC + N(G)-nitro-L-arginine methylester (L-NAME) group (pretreated with L-NAME 5 min prior to IPC). The renal and systemic hemodynamic parameters, renal function and morphology, as well as eNOS, iNOS, and NO expression levels in the kidneys were measured at the indicated time points after reperfusion. RESULTS IPC rats exhibited significant improvements in renal function, morphology, and renal artery blood flow (RABF), without obvious influence on the systemic hemodynamics and renal vein blood flow. Increased eNOS, iNOS, and NO expression levels were detected in the kidneys of IPC rats 24 h after reperfusion. Furthermore, the beneficial effects were fully abolished by the administration of L-NAME. CONCLUSIONS The results suggest that IPC contributes to early restoration of RABF, probably through eNOS/iNOS-mediated NO production, thereby alleviating the renal dysfunction and histological damage caused by IRI.
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Affiliation(s)
- Yu-Zheng Ge
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Ran Wu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Hui Xin
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Hao Liu
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine88 Jiefang Road, Hangzhou 310009, China
| | - Tian-Ze Lu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - You-Cai Zhao
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Jiang-Wei Shen
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Department of Ultrasound and Radiology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Zhi-Kai Hu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Department of Ultrasound and Radiology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Peng Yu
- Department of Urology, The First Hospital of Nanchang, Nanchang University128 Xiangshan North Road, Nanchang 330008, China
| | - Liu-Hua Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Lu-Wei Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Zheng Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Jian-Ping Wu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Wen-Cheng Li
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Jia-Geng Zhu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
| | - Rui-Peng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
- Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University68 Changle Road, Nanjing 210006, China
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Papazova DA, Oosterhuis NR, Gremmels H, van Koppen A, Joles JA, Verhaar MC. Cell-based therapies for experimental chronic kidney disease: a systematic review and meta-analysis. Dis Model Mech 2015; 8:281-93. [PMID: 25633980 PMCID: PMC4348565 DOI: 10.1242/dmm.017699] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cell-based therapy is a promising strategy for treating chronic kidney disease (CKD) and is currently the focus of preclinical studies. We performed a systematic review and meta-analysis to evaluate the efficacy of cell-based therapy in preclinical (animal) studies of CKD, and determined factors affecting cell-based therapy efficacy in order to guide future clinical trials. In total, 71 articles met the inclusion criteria. Standardised mean differences (SMD) and 95% confidence intervals (CI) were calculated for outcome parameters including plasma urea, plasma creatinine, urinary protein, blood pressure, glomerular filtration rate, glomerulosclerosis and interstitial fibrosis. Sub-analysis for each outcome measure was performed for model-related factors (species, gender, model and timing of therapy) and cell-related factors (cell type, condition and origin, administration route and regime of therapy). Overall, meta-analysis showed that cell-based therapy reduced the development and progression of CKD. This was most prominent for urinary protein (SMD, 1.34; 95% CI, 1.00–1.68) and urea (1.09; 0.66–1.51), both P<0.001. Changes in plasma urea were associated with changes in both glomerulosclerosis and interstitial fibrosis. Sub-analysis showed that cell type (bone-marrow-derived progenitors and mesenchymal stromal cells being most effective) and administration route (intravenous or renal artery injection) were significant predictors of therapeutic efficacy. The timing of therapy in relation to clinical manifestation of disease, and cell origin and dose, were not associated with efficacy. Our meta-analysis confirms that cell-based therapies improve impaired renal function and morphology in preclinical models of CKD. Our analyses can be used to optimise experimental interventions and thus support both improved preclinical research and development of cell-based therapeutic interventions in a clinical setting.
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Affiliation(s)
- Diana A Papazova
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Nynke R Oosterhuis
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Arianne van Koppen
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
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Weekers L, de Tullio P, Bovy C, Poma L, Marée R, Bonvoisin C, Defraigne JO, Krzesinski JM, Jouret F. Activation of the calcium-sensing receptor before renal ischemia/reperfusion exacerbates kidney injury. Am J Transl Res 2015; 7:128-138. [PMID: 25755835 PMCID: PMC4346530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
Activation of the calcium-sensing receptor (CaSR) by ischemia/reperfusion (I/R) favours apoptosis in cardiomyocytes, hepatocytes and neurons. Its role in renal I/R is unknown. We investigated the impact of pharmacological preactivation of the CaSR on kidney structure and function in a murine model of bilateral renal 30-min ischemia and 48-hour reperfusion, and in a 6-year cohort of kidney transplant recipients (KTR). C57BL/6J mice were administered daily with CaSR agonist, R-568, or with vehicle for 48 hours. Evaluation of serum urea and creatinine levels, renal histology and urine metabolome by nuclear magnetic resonance showed that R-568 was not nephrotoxic per se. Following I/R, serum urea and creatinine levels increased higher in R-568-treated animals than in controls. Jablonski's score was significantly greater in R-568-treated kidneys, which showed a higher rate of cell proliferation and apoptosis in comparison to controls. Next, we retrospectively identified 36 patients (10.7% of our cohort) who were treated by CaSR agonist, cinacalcet, at the time of kidney transplantation (KTx). After matching these to 61 KTR upon type of donor, cold ischemic time, residual diuresis, and donor age, we observed that delayed graft function, i.e. need for dialysis in the first week after KTx, occurred in 42 and 23% of cinacalcet-treated and control groups, respectively (p≤0.05). These data suggest that pharmacological preactivation of the CaSR before renal I/R exacerbates kidney injury.
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Affiliation(s)
- Laurent Weekers
- Division of Nephrology, University of Liège Hospital (ULg CHU)Liège, Belgium
| | - Pascal de Tullio
- Centre for Interdisciplinary Research on Medicines (CIRM), University of LiègeLiège, Belgium
| | - Christophe Bovy
- Division of Nephrology, University of Liège Hospital (ULg CHU)Liège, Belgium
| | - Laurence Poma
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of LiègeLiège, Belgium
| | - Raphaël Marée
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Bioinformatics and Systems and Modeling, University of LiègeLiège, Belgium
| | - Catherine Bonvoisin
- Division of Nephrology, University of Liège Hospital (ULg CHU)Liège, Belgium
| | - Jean-Olivier Defraigne
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of LiègeLiège, Belgium
| | - Jean-Marie Krzesinski
- Division of Nephrology, University of Liège Hospital (ULg CHU)Liège, Belgium
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of LiègeLiège, Belgium
| | - François Jouret
- Division of Nephrology, University of Liège Hospital (ULg CHU)Liège, Belgium
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of LiègeLiège, Belgium
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Chu MJJ, Vather R, Hickey AJR, Phillips ARJ, Bartlett ASJR. Impact of ischaemic preconditioning on experimental steatotic livers following hepatic ischaemia-reperfusion injury: a systematic review. HPB (Oxford) 2015; 17:1-10. [PMID: 24712641 PMCID: PMC4266433 DOI: 10.1111/hpb.12258] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/14/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Steatotic livers are vulnerable to the deleterious effects of ischaemia-reperfusion injury (IRI) that occur after hepatic surgery. Ischaemic preconditioning (IPC) has been shown to abrogate the effects of IRI in patients undergoing hepatic surgery. Experimental studies have suggested that IPC may be beneficial in steatotic livers subjected to IRI. OBJECTIVE The aim of this systematic review was to evaluate the effects of IPC on steatotic livers following hepatic IRI in experimental models. METHODS An electronic search of the OVID Medline and EMBASE databases was performed to identify studies that reported clinically relevant outcomes in animal models of hepatic steatosis subjected to IPC and IRI. RESULTS A total of 1093 articles were identified, of which 18 met the inclusion criteria. There was considerable heterogeneity in the type of animal model, and duration and type of IRI. Increased macrovesicular steatosis (> 30%) was associated with a poor outcome following IRI. Ischaemic preconditioning was found to be beneficial in > 30% steatotic livers and provided for decreased histological damage, improved liver function findings and increased survival. CONCLUSIONS Experimental evidence supports the use of IPC in steatotic livers undergoing IRI. These findings may be applicable to patients undergoing liver surgery. However, clinical studies are required to validate the efficacy of IPC in this setting.
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Affiliation(s)
- Michael J J Chu
- Department of Surgery, University of AucklandAuckland, New Zealand,Correspondence, Michael J. J. Chu, Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Tel: + 64 2134 5320. Fax: + 64 9 377 9656. E-mail:
| | - Ryash Vather
- Department of Surgery, University of AucklandAuckland, New Zealand
| | - Anthony J R Hickey
- Maurice Wilkins Centre for Biodiscovery, University of AucklandAuckland, New Zealand,School of Biological Sciences, University of AucklandAuckland, New Zealand
| | - Anthony R J Phillips
- Department of Surgery, University of AucklandAuckland, New Zealand,Maurice Wilkins Centre for Biodiscovery, University of AucklandAuckland, New Zealand,School of Biological Sciences, University of AucklandAuckland, New Zealand,New Zealand Liver Transplant Unit, Auckland City HospitalAuckland, New Zealand
| | - Adam S J R Bartlett
- Department of Surgery, University of AucklandAuckland, New Zealand,School of Biological Sciences, University of AucklandAuckland, New Zealand,New Zealand Liver Transplant Unit, Auckland City HospitalAuckland, New Zealand
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Efeitos de dexmedetomidina em conjunto com o pré‐condicionamento isquêmico remoto em lesão de isquemia‐reperfusão renal em ratos. Braz J Anesthesiol 2014; 64:382-90. [DOI: 10.1016/j.bjan.2014.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022] Open
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Moradi H, Wang PH. Renoprotective mechanisms of ischemic postconditioning in ischemia-reperfusion injury: improved mitochondrial function and integrity. Nephrol Dial Transplant 2014; 28:2667-9. [PMID: 24169608 DOI: 10.1093/ndt/gft313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hamid Moradi
- Division of Nephrology and Hypertension, Department of Medicine, University of California, Irvine, USA
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Suokas AK, Sagar DR, Mapp PI, Chapman V, Walsh DA. Design, study quality and evidence of analgesic efficacy in studies of drugs in models of OA pain: a systematic review and a meta-analysis. Osteoarthritis Cartilage 2014; 22:1207-23. [PMID: 25008207 DOI: 10.1016/j.joca.2014.06.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/28/2014] [Accepted: 06/12/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies using animal models are important in drug development, but often poorly predict treatment results in man. We investigated factors that may impact on the magnitude of the analgesic treatment effect in animal models of osteoarthritis (OA) pain. DESIGN Systematic review of studies that measured behavioural pain outcomes in small animal models of OA, and tested drugs which reduce OA pain in man. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated using random effects meta-analysis for selected models and drugs. RESULTS Most studies used rat models (42/50) and chemical methods of OA induction (39/50). Analgesic treatment effect (SMD) was most commonly measured between drug- and vehicle treated rats with knee OA. Meta-analysis was carried out for 102 such comparisons from 26 studies. The pooled SMD was 1.36 (95% CI = 1.15-1.57). Non-steroidal anti-inflammatory drugs (NSAIDs) were associated with smaller SMDs than opioids (z = -3.25, P = 0.001). Grip strength gave larger SMDs than assessment of static weight bearing (z = -4.60, P < 0.001), mechanically-evoked pain (z = -3.83, P = 0.001) and movement-evoked pain (z = -5.23, P < 0.001), and SMDs for mechanically-evoked pain were larger than for movement-evoked pain (z = -2.78, P = 0.006). Studies that reported structural evaluation of OA phenotype were associated with smaller SMDs (z = -2.45, P = 0.014). Publication was significantly biased towards positive findings. CONCLUSION Attention to study-level moderators and publication bias may improve the ability of research using animal models to predict whether analgesic agents will reduce arthritis pain in man.
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Affiliation(s)
- A K Suokas
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham, UK.
| | - D R Sagar
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Life Sciences, University of Nottingham, Nottingham, UK
| | - P I Mapp
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham, UK
| | - V Chapman
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Life Sciences, University of Nottingham, Nottingham, UK
| | - D A Walsh
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham, UK
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Fishbein-Kaminietsky M, Gafni M, Sarne Y. Ultralow doses of cannabinoid drugs protect the mouse brain from inflammation-induced cognitive damage. J Neurosci Res 2014; 92:1669-77. [DOI: 10.1002/jnr.23452] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 01/05/2023]
Affiliation(s)
- Miriam Fishbein-Kaminietsky
- The Adelson Center for the Biology of Addictive Diseases and The Mauerberger Chair in Neuropharmacology; Sackler Faculty of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Mikhal Gafni
- The Adelson Center for the Biology of Addictive Diseases and The Mauerberger Chair in Neuropharmacology; Sackler Faculty of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Yosef Sarne
- The Adelson Center for the Biology of Addictive Diseases and The Mauerberger Chair in Neuropharmacology; Sackler Faculty of Medicine, Tel-Aviv University; Tel-Aviv Israel
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Twine CP, Ferguson S, Boyle JR. Benefits of remote ischaemic preconditioning in vascular surgery. Eur J Vasc Endovasc Surg 2014; 48:215-9. [PMID: 24951376 DOI: 10.1016/j.ejvs.2014.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/06/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Remote ischaemic preconditioning (RIPC) is a physiological mechanism to protect against ischaemia-reperfusion injury. It is a technique in which short pre-emptive periods of ischaemia and reperfusion are thought to protect against ischaemia-reperfusion injury during procedures requiring longer periods of ischaemia. Discovered in the 1980s, its clinical application has been investigated heavily since the first human study in 2006. The aim of this paper was to provide a review of this rapidly expanding subject. METHODS This study consists of a narrative review of the literature focusing on previous meta-analyses and randomised control trials. RESULTS Five small randomised trials have been published on the effects of RIPC in vascular surgery. Several randomised trials have been published in cardiac surgery and percutaneous coronary intervention. Meta-analysis shows a significant reduction in troponin levels and biomarkers of renal dysfunction in RIPC patients, but as yet no convincing clinical benefit. The largest powered randomised trial in cardiac surgery showed no benefit to RIPC. CONCLUSIONS Current trials and therefore meta-analyses are generally underpowered. The technique is physiologically sound but remains lacking in clear clinical benefit.
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Affiliation(s)
- C P Twine
- South East Wales Vascular Network, Royal Gwent Hospital, Newport, UK.
| | | | - J R Boyle
- Addenbrooke's Hospital, Cambridge, UK
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Abstract
Acute kidney injury (AKI) is a common clinical problem and is associated with high mortality rates. It is accepted that after AKI cellular regeneration of the proximal tubule occurs from intrinsic tubule cells. Recently, scattered tubular cells (STCs) were discovered as a novel subpopulation of tubule cells involved in regeneration. STCs have a distinct morphology, unique protein expression profile resembling that of parietal epithelial cells, proliferate more than the remaining proximal tubule cells, and are less susceptible to injuries. In response to AKI, STCs become more numerous, independent of the primary insult (ischemic, acute obstruction, and so forth). STCs can be detected with the highest sensitivity and manipulated by the parietal epithelial cell-specific, doxycycline inducible transgenic mouse line PEC-rtTA. In cell fate tracing experiments it was shown that STCs are not a fixed progenitor population. Rather, STCs arise from any surviving proximal tubule cell. Thus, the STC phenotype is a transient, graded, and specific transcriptional program facilitating tubular regeneration. Understanding this program my open new approaches to prevent and/or treat AKI.
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Affiliation(s)
- Katja Berger
- Division of Nephrology and Clinical Immunology, Rheinisch-Westfaelische Technische Hochschule (RWTH), Aachen, Germany
| | - Marcus J Moeller
- Division of Nephrology and Clinical Immunology, Rheinisch-Westfaelische Technische Hochschule (RWTH), Aachen, Germany.
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Thuret R, Saint Yves T, Tillou X, Chatauret N, Thuillier R, Barrou B, Billault C. Ischemic pre- and post-conditioning: current clinical applications. Prog Urol 2014; 24 Suppl 1:S56-61. [DOI: 10.1016/s1166-7087(14)70065-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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114
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Kim JH, Lee S, Lee MY, Shin HK. Therapeutic effect of Soshiho-tang, a traditional herbal formula, on liver fibrosis or cirrhosis in animal models: a systematic review and meta-analysis. JOURNAL OF ETHNOPHARMACOLOGY 2014; 154:1-16. [PMID: 24727191 DOI: 10.1016/j.jep.2014.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Liver fibrosis has been recognized as a major lesion of the liver that leads to liver cirrhosis at the end stage. Soshiho-tang (SST) has been used to improve liver fibrosis/cirrhosis by ameliorating fibrosis-specific markers. This study aimed to assess the efficacy of SST on liver fibrosis/cirrhosis through a systematic review of the literature and meta-analysis using animal models. MATERIALS AND METHODS Studies of SST treatment in liver fibrosis/cirrhosis-induced animal models were searched by electronic data bases. The quality of the studies included was assessed and the efficacy of SST was evaluated based on markers from liver tissues and serum. RESULTS Among the 838 studies identified in the literature search, 20 studies that met the inclusion criteria were included in the analysis. SST significantly reduced the elevated levels of fibrosis markers, such as the degree of fibrosis, hydroxyproline, hyaluronic acid, transforming growth factor-β1, and procollagen III in liver tissues, and aspartate aminotransferase, alanine aminotransferase, procollagen III, tissue inhibitor of metalloproteinase-1, and type IV collagen in the serum. CONCLUSIONS SST was effective in decreasing pathologically increased markers in animal models of liver fibrosis/cirrhosis. A larger-scale of animals, well-designed animal study is expected to improve the methodological quality, heterogeneity, and potential biases of the meta-analysis.
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Affiliation(s)
- Jung-Hoon Kim
- Herbal Medicine Formulation Research Group, Korea Institute of Oriental Medicine, Daejeon 305-811, Republic of Korea
| | - Seunghoon Lee
- Acupuncture, Moxibustion & Meridian Research Group, Korea Institute of Oriental Medicine, Daejeon 305-811, Republic of Korea
| | - Mee-Young Lee
- Herbal Medicine Formulation Research Group, Korea Institute of Oriental Medicine, Daejeon 305-811, Republic of Korea
| | - Hyeun-Kyoo Shin
- Herbal Medicine Formulation Research Group, Korea Institute of Oriental Medicine, Daejeon 305-811, Republic of Korea.
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115
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The cyclin-dependent kinase inhibitor p21 is essential for the beneficial effects of renal ischemic preconditioning on renal ischemia/reperfusion injury in mice. Kidney Int 2014; 85:871-9. [DOI: 10.1038/ki.2013.496] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 07/23/2013] [Accepted: 08/22/2013] [Indexed: 01/02/2023]
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116
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Guo KJ, Zhao FC, Guo Y, Li FL, Zhu L, Zheng W. The influence of age, gender and treatment with steroids on the incidence of osteonecrosis of the femoral head during the management of severe acute respiratory syndrome: a retrospective study. Bone Joint J 2014; 96-B:259-62. [PMID: 24493194 DOI: 10.1302/0301-620x.96b2.31935] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Corticosteroid use has been implicated in the development of osteonecrosis of the femoral head (ONFH). The exact mechanism and predisposing factors such as age, gender, dosage, type and combination of steroid treatment remain controversial. Between March and July 2003, a total of 539 patients with severe acute respiratory syndrome (SARS) were treated with five different types of steroid. There were 129 men (24%) and 410 women (76%) with a mean age of 33.7 years (21 to 59). Routine screening was undertaken with radiographs, MRI and/or CT to determine the incidence of ONFH. Of the 129 male patients with SARS, 51 (39.5%) were diagnosed as suffering from ONFH, compared with only 79 of 410 female patients (19.3%). The incidence of ONFH in the patients aged between 20 and 49 years was much higher than that of the group aged between 50 and 59 years (25.9% (127 of 491) versus 6.3% (3 of 48); p = 0.018). The incidence of ONFH in patients receiving one type of steroid was 12.5% (21 of 168), which was much lower than patients receiving two different types (28.6%; 96 of 336) or three different types of steroid (37.1%; 13 of 35).
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Affiliation(s)
- K J Guo
- Affiliated Hospital of Xuzhou Medical College, Department of Orthopedic Surgery, Xuzhou, Jiangsu 221002, China
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117
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Ritskes‐Hoitinga M, Leenaars M, Avey M, Rovers M, Scholten R. Systematic reviews of preclinical animal studies can make significant contributions to health care and more transparent translational medicine. Cochrane Database Syst Rev 2014; 2014:ED000078. [PMID: 24719910 PMCID: PMC10845857 DOI: 10.1002/14651858.ed000078] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | | | - Marc Avey
- Ottawa Hospital Research InstituteCanada
| | - Maroeska Rovers
- Radboud University Medical CenterDepartment for Health EvidenceNijmegenthe Netherlands
| | - Rob Scholten
- University Medical Center UtrechtDutch Cochrane Centrethe Netherlands
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118
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Hooijmans CR, Rovers MM, de Vries RBM, Leenaars M, Ritskes-Hoitinga M, Langendam MW. SYRCLE's risk of bias tool for animal studies. BMC Med Res Methodol 2014; 14:43. [PMID: 24667063 PMCID: PMC4230647 DOI: 10.1186/1471-2288-14-43] [Citation(s) in RCA: 2012] [Impact Index Per Article: 201.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Background Systematic Reviews (SRs) of experimental animal studies are not yet common practice, but awareness of the merits of conducting such SRs is steadily increasing. As animal intervention studies differ from randomized clinical trials (RCT) in many aspects, the methodology for SRs of clinical trials needs to be adapted and optimized for animal intervention studies. The Cochrane Collaboration developed a Risk of Bias (RoB) tool to establish consistency and avoid discrepancies in assessing the methodological quality of RCTs. A similar initiative is warranted in the field of animal experimentation. Methods We provide an RoB tool for animal intervention studies (SYRCLE’s RoB tool). This tool is based on the Cochrane RoB tool and has been adjusted for aspects of bias that play a specific role in animal intervention studies. To enhance transparency and applicability, we formulated signalling questions to facilitate judgment. Results The resulting RoB tool for animal studies contains 10 entries. These entries are related to selection bias, performance bias, detection bias, attrition bias, reporting bias and other biases. Half these items are in agreement with the items in the Cochrane RoB tool. Most of the variations between the two tools are due to differences in design between RCTs and animal studies. Shortcomings in, or unfamiliarity with, specific aspects of experimental design of animal studies compared to clinical studies also play a role. Conclusions SYRCLE’s RoB tool is an adapted version of the Cochrane RoB tool. Widespread adoption and implementation of this tool will facilitate and improve critical appraisal of evidence from animal studies. This may subsequently enhance the efficiency of translating animal research into clinical practice and increase awareness of the necessity of improving the methodological quality of animal studies.
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Affiliation(s)
- Carlijn R Hooijmans
- SYRCLE at Central Animal Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands.
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119
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van Luijk J, Cuijpers Y, van der Vaart L, de Roo TC, Leenaars M, Ritskes-Hoitinga M. Assessing the application of the 3Rs: a survey among animal welfare officers in The Netherlands. Lab Anim 2014; 47:210-9. [PMID: 23579322 PMCID: PMC3811125 DOI: 10.1177/0023677213483724] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Implementation of the 3Rs (Replacement, Refinement and Reduction) in animal studies is a legal requirement in many countries. In The Netherlands, animal welfare officers (AWOs) are appointed to monitor the welfare of laboratory animals. As part of this task, AWOs give advice to researchers and can therefore have an influential role in implementing 3R methods in research. A national survey was conducted to gain more insight into how Dutch AWOs obtain and apply 3R information in their daily work. Nearly half of the AWO population filled out the questionnaire (15/32; a response rate of 46.9%). Two-thirds of the respondents pointed out that finding 3R information is not an easy task and more than half of the respondents believed that information on possibilities to implement the 3Rs is regularly being missed. The respondents indicated that most 3R information is obtained directly from colleagues and other AWOs. Special online 3R databases are rarely used. All the responding AWOs feel that they contribute to Refinement (15/15), nearly one-third of the respondents feel they contribute to Reduction (4/15), and one AWO feels he/she contributes to Replacement (1/15). According to the respondents, better exchange of knowledge can contribute to more successful implementation of the 3Rs. How this knowledge exchange can best be established and facilitated needs further exploration. To this end, the authors make suggestions for a 3R-integrated evidence-based approach.
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Affiliation(s)
- Judith van Luijk
- 3R Research Centre/SYRCLE, Central Animal Laboratory, Radboud University Nijmegen Medical Centre, The Netherlands.
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120
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McCafferty K, Byrne C, Yaqoob MM. Ischaemic conditioning strategies for the nephrologist: a promise lost in translation? Nephrol Dial Transplant 2014; 29:1827-40. [PMID: 24589718 DOI: 10.1093/ndt/gfu034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Over the last quarter of a century, a huge effort has been made to develop interventions that can minimise ischaemia reperfusion injury. The most potent of these are the ischaemic conditioning strategies, which comprise ischaemic preconditioning, remote ischaemic preconditioning and ischaemic postconditioning. While much of the focus for these interventions has been on protecting the myocardium, other organs including the kidney can be similarly protected. However, translation of these beneficial effects from animal models into routine clinical practice has been less straightforward than expected. In this review, we examine the role of ischaemic conditioning strategies in reducing tissue injury from the 'bench to the bedside' and discuss the barriers to their greater translation.
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Affiliation(s)
- Kieran McCafferty
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Conor Byrne
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University London, London, UK
| | - Muhammad M Yaqoob
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University London, London, UK
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Kim SM, Kim SW, Jung YJ, Min SI, Min SK, Kim SJ, Ha J. Preconditioning with thyroid hormone (3,5,3-triiodothyronine) prevents renal ischemia-reperfusion injury in mice. Surgery 2014; 155:554-61. [DOI: 10.1016/j.surg.2013.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 10/07/2013] [Indexed: 11/16/2022]
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122
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Erpicum P, Detry O, Weekers L, Bonvoisin C, Lechanteur C, Briquet A, Beguin Y, Krzesinski JM, Jouret F. Mesenchymal stromal cell therapy in conditions of renal ischaemia/reperfusion. Nephrol Dial Transplant 2014; 29:1487-93. [PMID: 24516234 DOI: 10.1093/ndt/gft538] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury (AKI) represents a worldwide public health issue of increasing incidence, with a significant morbi-mortality. AKI treatment mostly relies on supportive manoeuvres in the absence of specific target-oriented therapy. The pathophysiology of AKI commonly involves ischaemia/reperfusion (I/R) events, which cause both immune and metabolic consequences in renal tissue. Similarly, at the time of kidney transplantation (KT), I/R is an unavoidable event which contributes to early graft dysfunction and enhanced graft immunogenicity. Mesenchymal stromal cells (MSCs) represent a heterogeneous population of adult, fibroblast-like multi-potent cells characterized by their ability to differentiate into tissues of mesodermal lineages. Because MSC have demonstrated immunomodulatory, anti-inflammatory and tissue repair properties, MSC administration at the time of I/R and/or at later times has been hypothesized to attenuate AKI severity and to accelerate the regeneration process. Furthermore, MSC in KT could help prevent both I/R injury and acute rejection, thereby increasing graft function and survival. In this review, summarizing the encouraging observations in animal models and in pilot clinical trials, we outline the benefit of MSC therapy in AKI and KT, and envisage their putative role in renal ischaemic conditioning.
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Affiliation(s)
- Pauline Erpicum
- Divisions of Nephrology and Transplantation, University of Liege CHU (ULg CHU), Liege, Belgium
| | - Olivier Detry
- Abdominal Surgery and Transplantation, University of Liege CHU (ULg CHU), Liege, Belgium Laboratories of Cardiovascular Sciences, University of Liege, Liege, Belgium
| | - Laurent Weekers
- Divisions of Nephrology and Transplantation, University of Liege CHU (ULg CHU), Liege, Belgium
| | - Catherine Bonvoisin
- Divisions of Nephrology and Transplantation, University of Liege CHU (ULg CHU), Liege, Belgium
| | - Chantal Lechanteur
- Laboratory of Cell and Gene Therapy, University of Liege CHU (ULg CHU), Liege, Belgium
| | - Alexandra Briquet
- Laboratory of Cell and Gene Therapy, University of Liege CHU (ULg CHU), Liege, Belgium Hematology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), University of Liege, Liege, Belgium
| | - Yves Beguin
- Laboratory of Cell and Gene Therapy, University of Liege CHU (ULg CHU), Liege, Belgium Hematology, Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), University of Liege, Liege, Belgium
| | - Jean-Marie Krzesinski
- Divisions of Nephrology and Transplantation, University of Liege CHU (ULg CHU), Liege, Belgium Laboratories of Cardiovascular Sciences, University of Liege, Liege, Belgium
| | - François Jouret
- Divisions of Nephrology and Transplantation, University of Liege CHU (ULg CHU), Liege, Belgium Laboratories of Cardiovascular Sciences, University of Liege, Liege, Belgium
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van den Akker EK, Hesselink DA, Manintveld OC, Lafranca JA, de Bruin RWF, Weimar W, IJzermans JNM, Dor FJMF. Ischemic postconditioning in human DCD kidney transplantation is feasible and appears safe. Transpl Int 2014; 27:226-234. [DOI: 10.1111/tri.12242] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Eline K. van den Akker
- Department of Surgery; division of Transplant Surgery; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Dennis A. Hesselink
- Department of Internal Medicine; division of Nephrology and Renal Transplantation; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Olivier C. Manintveld
- Department of Cardiology; Heart Transplant Unit; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jeffrey A. Lafranca
- Department of Surgery; division of Transplant Surgery; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Ron W. F. de Bruin
- Department of Surgery; division of Transplant Surgery; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine; division of Nephrology and Renal Transplantation; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery; division of Transplant Surgery; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery; division of Transplant Surgery; Erasmus MC; University Medical Center Rotterdam; Rotterdam The Netherlands
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124
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Erpicum P, Krzesinski JM, Jouret F. [Role of AMP-activated protein kinase in renal ischemic preconditioning]. Nephrol Ther 2013; 10:17-24. [PMID: 24387947 DOI: 10.1016/j.nephro.2013.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 08/06/2013] [Accepted: 10/15/2013] [Indexed: 12/29/2022]
Abstract
Kidney transplantation represents the best treatment of end-stage renal disease. In addition to the degree of human leukocyte antigen matching, long-term graft survival is influenced by the quality of the graft before its transplantation. Quality criteria include the level of ischemic damage caused by the transplantation per se. Renal ischemic preconditioning (IP) consists of different approaches to prevent ischemia/reperfusion (I/R) damage induced by the interruption and recovery of renal circulation, as observed during transplantation. Distinct animal models show promising results regarding the efficiency of PCI to preserve kidney structure and function in I/R conditions. Characterizing the cellular cascades involved in I/R led to the identification of putative targets of renal IP, including the adenosine monophosphate-activated protein kinase (AMPK). AMPK is a ubiquitous energy sensor, which has been implicated in the maintenance of epithelial cell polarization under energy deprivation. Among others, the anti-diabetic drug, metformin, is a potent activator of AMPK. Here, we summarize the in vitro and in vivo data about the role of AMPK in renal IP. Defining the pharmacological conditions of IP would help to improve the quality of the renal graft before its transplantation, thereby increasing its long-term survival.
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Affiliation(s)
- Pauline Erpicum
- Service de néphrologie, université de Liège CHU (ULg CHU), CHU de Liège, tour 1, 6(e) étage, avenue de l'Hôpital, 1 B-4000 Liège, Belgique
| | - Jean-Marie Krzesinski
- Service de néphrologie, université de Liège CHU (ULg CHU), CHU de Liège, tour 1, 6(e) étage, avenue de l'Hôpital, 1 B-4000 Liège, Belgique; GIGA Cardiovascular Sciences, université de Liège, tour 3, 5(e) étage, avenue de l'Hôpital, 1 B-4000 Liège, Belgique
| | - François Jouret
- Service de néphrologie, université de Liège CHU (ULg CHU), CHU de Liège, tour 1, 6(e) étage, avenue de l'Hôpital, 1 B-4000 Liège, Belgique; GIGA Cardiovascular Sciences, université de Liège, tour 3, 5(e) étage, avenue de l'Hôpital, 1 B-4000 Liège, Belgique.
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125
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Gassanov N, Nia AM, Caglayan E, Er F. Remote ischemic preconditioning and renoprotection: from myth to a novel therapeutic option? J Am Soc Nephrol 2013; 25:216-24. [PMID: 24309187 DOI: 10.1681/asn.2013070708] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is currently no effective prophylactic regimen available to prevent contrast-induced AKI (CI-AKI), a frequent and life-threatening complication after cardiac catheterization. Therefore, novel treatment strategies are required to decrease CI-AKI incidence and to improve clinical outcomes in these patients. Remote ischemic preconditioning (rIPC), defined as transient brief episodes of ischemia at a remote site before a subsequent prolonged ischemia/reperfusion injury of the target organ, is an adaptational response that protects against ischemic and reperfusion insult. Indeed, several studies demonstrated the tissue-protective effects of rIPC in various target organs, including the kidneys. In this regard, rIPC may offer a novel noninvasive and virtually cost-free treatment strategy for decreasing CI-AKI incidence. This review evaluates the current experimental and clinical evidence for rIPC as a potential renoprotective strategy, and discusses the underlying mechanisms and key areas for future research.
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Affiliation(s)
- Natig Gassanov
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
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127
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Muscari C, Giordano E, Bonafè F, Govoni M, Pasini A, Guarnieri C. Molecular mechanisms of ischemic preconditioning and postconditioning as putative therapeutic targets to reduce tumor survival and malignancy. Med Hypotheses 2013; 81:1141-5. [PMID: 24230458 DOI: 10.1016/j.mehy.2013.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 09/19/2013] [Accepted: 10/20/2013] [Indexed: 10/26/2022]
Abstract
In tumors intermittent hypoxia has been reported to be more representative than normoxia or continuous exposure to low oxygen concentrations. Intermittent hypoxia is thought to increase tumor resistance against both anti-cancer therapy and the sustained ischemia that randomly occurs because of the dynamic nature of tumor vasculature. Here, we hypothesize that the molecular mechanisms underlying intermittent hypoxia in tumor cells share some triggers, modulators, and end-effectors of the intermittent episodes of ischemia and reperfusion that characterize ischemic preconditioning and postconditioning. These are among the most effective maneuvers protecting cells from ischemia-reperfusion injury. If this hypothesis were confirmed, several well-investigated molecular mediators of pre/post-conditioning could be explored as therapeutic targets against tumor malignancy. For examples, drugs that completely block the cardioprotection induced by ischemic preconditioning, such as mitochondrial potassium ATP channel inhibitors or mitochondrial permeability transition pore openers, could be extraordinarily efficient in counteracting the adaptations of tumor cells and cancer stem cells to intermittent hypoxia. As a consequence, this strategy should be effective in blunting tumor capacity to progress toward malignancy and survive in ischemic conditions.
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Affiliation(s)
- Claudio Muscari
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; National Institute for Cardiovascular Research, Bologna, Italy; BioEngLab, Health Science and Technology-Interdepartmental Center for Industrial Research (HST-CIRI), University of Bologna, Ozzano Emilia (BO), Italy.
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Menting TP, Wever KE, Hendriks EJ, Van der Vliet DJA, Rovers MM, Warle MC. Ischaemic preconditioning for the reduction of renal ischaemia reperfusion injury. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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129
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Sedaghat Z, Kadkhodaee M, Seifi B, Salehi E, Najafi A, Dargahi L. Remote preconditioning reduces oxidative stress, downregulates cyclo-oxygenase-2 expression and attenuates ischaemia-reperfusion-induced acute kidney injury. Clin Exp Pharmacol Physiol 2013; 40:97-103. [PMID: 23240616 DOI: 10.1111/1440-1681.12044] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 12/12/2012] [Indexed: 11/29/2022]
Abstract
Remote preconditioning (rPeC) is a phenomenon by which short-time intermittent ischaemia-reperfusion (I/R) of a remote organ during ischaemia protects other organs from I/R injury (IRI). The aim of the present study was to investigate the protective effect of rPeC on renal IRI in rats. Rats were subjected to right nephrectomy and randomized as into a sham group (no additional intervention), an I/R group (subjected to 45 min left renal pedicle occlusion) and an rPeC group (subjected to four cycles of 5 min I/R of the left femoral artery administered at the beginning of renal ischaemia). After 24 h, blood, urine and tissue samples were collected. Compared with the sham group, I/R resulted in renal dysfunction, as evidenced by significantly lower creatinine clearance (CCr; 0.52 ± 0.06 vs 0.11 ± 0.02 mL/min, respectively) and higher fractional excretion of sodium (FE(Na) ; 0.80 ± 0.07% vs 2.46 ± 0.20%, respectively). This was accompanied by decreased superoxide dismutase (SOD; 6.9 ± 1.7 vs 26.7 ± 2.7 U/g tissue) and catalase (CAT; 20.2 ± 8.8 vs 32.2 ± 8.7 K/g tissue) activity in the I/R group, as well as decreased levels of reduced glutathione (GSH; 21.7 ± 8.1 vs 81.2 ± 20.2 μmol/g tissue) and increased malondialdehyde levels (MDA; 1.2 to 0.1 vs 0.5 ± 0.2 μmol/100 mg), cyclo-oxygenase (COX)-2 expression and histological damage. In the rPeC group, renal histology and function were significantly improved (CCr 0.32 ± 0.02 mL/min; FE(Na) 1.33 ± 0.12%) compared with the I/R group. Furthermore, compared with the I/R group, the rPeC group exhibited increases in SOD and CAT activity (22.8 ± 3.8 U/g tissue and 21.7 ± 8.6 K/g tissue, respectively), increased GSH levels (74.0 ± 4.9) and decreased MDA levels (1.1 ± 0.3 μmol/100 mg) and COX-2 expression. In conclusion, rPeC appears to exert protective effects against renal IRI. This protection may be a consequence of reductions in lipid peroxidation, intensification of anti-oxidant systems and downregulation of COX-2 expression. A simple approach, rPeC may be a promising strategy for protection against IRI in clinical practice.
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Affiliation(s)
- Zahra Sedaghat
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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130
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Reduction of myocardial infarct size with ischemic "conditioning": physiologic and technical considerations. Anesth Analg 2013; 117:891-901. [PMID: 23960036 DOI: 10.1213/ane.0b013e318294fc63] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A wealth of evidence has revealed that the heart can be "conditioned" and rendered less vulnerable to ischemia-reperfusion injury via the upregulation of endogenous protective signaling pathways. Three distinct conditioning strategies have been identified: (1) preconditioning, the phenomenon where brief episodes of myocardial ischemia (too brief to cause cardiomyocyte death) limit necrosis caused by a subsequent sustained ischemic insult; (2) postconditioning, the concept that relief of myocardial ischemia in a staged or stuttered manner attenuates lethal ischemia-reperfusion injury; and (3) remote conditioning, or upregulation of a cardioprotective phenotype initiated by ischemia in a remote organ or tissue and "transported" to the heart. Progress has been made in defining the technical requirements and limitations of each of the 3 ischemic conditioning models (including the timing and severity of the protective stimulus), as well as elucidating the molecular mechanisms (in particular, the receptor-mediated signaling pathways) responsible for conditioning-induced myocardial protection. Moreover, phase III clinical trials are in progress, seeking to capitalize on the protection that can be achieved by postconditioning and remote conditioning, and applying these strategies in patients undergoing cardiac surgery or angioplasty for the treatment of acute myocardial infarction. There is, however, a potentially important caveat to the clinical translation of myocardial conditioning: emerging data suggest that the efficacy of ischemic conditioning is compromised in aging, diabetic, and hypertensive cohorts, the specific populations in which myocardial protection is most relevant. Successful clinical application of myocardial conditioning will therefore require an understanding of the potential confounding consequences of these comorbidities on the "conditioned" phenotype.
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131
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Fan LH, He L, Cao ZQ, Xiang B, Liu L. Effect of ischemia preconditioning on renal ischemia/reperfusion injury in rats. Int Braz J Urol 2013; 38:842-54. [PMID: 23302405 DOI: 10.1590/1677-553820133806842] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To study the effect of ischemia preconditioning (IP) on renal ischemia/reperfusion (I/R)-associated functional injury and expression of renal adhesion molecules in rats. MATERIALS AND METHODS The ischemia preconditioning plan adopted in this experiment involved renal warm ischemia for 6 min. and blood flow for 4 min., repeated four times. The Wistar rat kidneys used for warm ischemia preconditioning were subjected to 60 min of renal warm ischemia followed by reperfusion. The rat kidneys with ischemia/reperfusion were compared with the ischemia preconditioning group to observe rat renal function and changes in the expression of renal adhesion molecules ICAM-1, P-Selectin, and E-Selectin. RESULTS The expression of rat renal adhesion molecules (ICAM-1, P-Selectin, and E-Selectin) with ischemia preconditioning was significantly lower than that of the ischemia/reperfusion group. Serum creatinine was significantly lower than that in the ischemia/reperfusion group after 48 hours. CONCLUSIONS Ischemia preconditioning has a protective effect on renal function. Reduced expression of renal adhesion molecules is likely a mechanism involved in the observed protection.
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Affiliation(s)
- Lian-hui Fan
- Department of Urology, The General Hospital of Shenyang Military Region, Shenyang, China
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132
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Candilio L, Malik A, Hausenloy DJ. Protection of organs other than the heart by remote ischemic conditioning. J Cardiovasc Med (Hagerstown) 2013; 14:193-205. [PMID: 23079610 DOI: 10.2459/jcm.0b013e328359dd7b] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Organ or tissue dysfunction due to acute ischemia-reperfusion injury (IRI) is the leading cause of death and disability worldwide. Acute IRI induces cell injury and death in a wide variety of organs and tissues in a large number of different clinical settings. One novel therapeutic noninvasive intervention, capable of conferring multiorgan protection against acute IRI, is 'remote ischemic conditioning' (RIC). This describes an endogenous protective response to acute IRI, which is triggered by the application of one or more brief cycles of nonlethal ischemia and reperfusion to one particular organ or tissue. Originally discovered as a therapeutic strategy for protecting the myocardium against acute IRI, it has been subsequently demonstrated that RIC may confer protection against acute IRI in a number of different noncardiac organs and tissues including the kidneys, lungs, liver, skin flaps, ovaries, intestine, stomach and pancreas. The discovery that RIC can be induced noninvasively by applying the RIC stimulus to the skeletal tissue of the upper or lower limb has facilitated its application to a number of clinical settings in which organs and tissues are at high risk of acute IRI. In this article, we review the experimental studies that have investigated RIC in organs and tissues other than the heart, and we explore the therapeutic potential of RIC in preventing organ and tissue dysfunction induced by acute IRI.
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Affiliation(s)
- Luciano Candilio
- Hatter Cardiovascular Institute, University College London, London, UK
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Evaluation of the potential sensitization of chlorogenic Acid: a meta-analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:208467. [PMID: 23762111 PMCID: PMC3670571 DOI: 10.1155/2013/208467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/02/2013] [Accepted: 04/02/2013] [Indexed: 12/05/2022]
Abstract
Chlorogenic acid (CGA) widely exists in many plants, which are used as medicinal substances in traditional Chinese medicine injectables (TCMIs) that have been widely applied in clinical treatments. However, it is still controversial whether CGA is responsible for TCMIs-related hypersensitivity. Several studies have been performed to evaluate its potential sensitization property, but the results were inconclusive. Therefore, the aim of this study was to evaluate its potential sensitization systematically using meta-analysis based on data extracted from literatures, searching databases of PubMed, EMBASE, ISI Web of Knowledge, CNKI, VIP, and CHINAINFO from January 1979 to October 2012, a total of 108 articles were retrieved by electronic search strategy, out of which 13 studies met the inclusion criteria. In ASA test, odds ratio of behavior changes was 4.33 (1.62, 11.60), showing significant changes after CGA treatment (P = 0.004). Serum IgG, serum histamine, PLN cellularity, and IgG1 AFCs were significantly enhanced after CGA treatment (P < 0.05). Totally, these results indicated that CGA could induce a positive reaction in potential sensitization, and intravenous administration of it might be a key factor for sensitization triggering, which could at least warrant more careful application of TCMIs containing CGA in clinical practices.
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134
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Acute kidney injury in ICU. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2012.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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135
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Huang J, Chen Y, Dong B, Kong W, Zhang J, Xue W, Liu D, Huang Y. Effect of remote ischaemic preconditioning on renal protection in patients undergoing laparoscopic partial nephrectomy: a 'blinded' randomised controlled trial. BJU Int 2013; 112:74-80. [PMID: 23452148 DOI: 10.1111/bju.12004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate whether remote ischaemic preconditioning (RIPC) reduces renal injury in patients undergoing laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS In all, 82 patients undergoing LPN were randomly assigned to either the RIPC or control group, with 40 and 38 patients, respectively completing 6-months follow-up. RIPC was conducted after induction of anaesthesia, which consisted of three 5-min cycles of right lower limb ischaemia and 5 min of reperfusion during each cycle. The primary outcome was the absolute change in glomerular filtration rate (GFR) of the affected kidney by renal scintigraphy from baseline to 6 months. The secondary outcomes included urinary retinol-binding protein (RBP) levels measured at 24 and 48 h, serum creatinine, and estimated GFR (eGFR) at 1 and 6 months, and changes in GFR by renal scintigraphy. RESULTS There were no differences in the change of GFR of the affected kidney at 6 months, while it was significantly decreased by 15.0% in the control group vs 8.8% in the RIPC group at 1 month (P = 0.034). The urinary RBP levels increased 8.4-fold at 24 h in the control group compared with a lower increase of 3.9-fold in the RIPC group (P < 0.001). There were no differences in the serum creatinine level or eGFR at 1 and 6 months between the two groups. CONCLUSIONS In patients undergoing LPN, RIPC using transient lower limb ischaemia may reduce renal impairment in the short term, but failed in the longer term despite a non-significant trend in favour of RIPC. These novel data support the need for a larger study of RIPC during LPN surgery.
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Affiliation(s)
- Jiwei Huang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Reply. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Menting TP, Wever KE, van der Vliet JAD, Warlé MC. Regarding "Remote and local ischemic preconditioning equivalently protects rat skeletal muscle mitochondrial function during experimental aortic cross-clamping". J Vasc Surg 2012; 56:896; author reply 896-7. [PMID: 22917049 DOI: 10.1016/j.jvs.2012.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 04/09/2012] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
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